Background and Purpose: To evaluate the role of
preadmission conditions, dehydration specifically, in the development of
subdural hematoma in the elderly. Methods: Retrospective chart review. Results:
The most prevalent pre-admission medical condition was hypertension, followed
by atrial fibrillation, CAD, hyperlipidemia, diabetes, and cancer. Out of 95 patients,
69 (73%) had features of dehydration, 27% were on diuretics and 28% were on
antiplatelet agents and anticoagulation. Conclusions: Elderly population is
prone to dehydration. Overzealous use of diuretics especially in combination
with anticoagulation or antiplatelet therapy can contribute to the development
of subdural hematomas, both spontaneous and traumatic.
Cite this paper
Wirkowski, E. , DeMuro, J. , Hanna, A. , Yasen, J. , Narain, R. and Elcin, S. (2014) Spontaneous and iatrogenic dehydration in the elderly alone or in combination with antiplatelet/anticoagulation agents and risk of subdural hematoma. World Journal of Cardiovascular Diseases
, 1-4. doi: 10.4236/wjcd.2014.41001
 Fiki, M.E. (2012) Acute traumatic SDH outcome in patients older than 65 years. World Neurosurgery, 78, 228-230. http://dx.doi.org/10.1016/j.wneu.2012.02.049
 Chen, W. and Grafe, M. (1992) Unsuspected meningioma presenting as a subdural hematoma. Journal of Neurology, Neurosurgery & Psychiatry, 55, 167-168.http://dx.doi.org/10.1136/jnnp.55.2.167-a
 Markwalder, T. (1981) Chronic subdural hematomas: A review. Journal of Neurosurgery, 54, 637-645. http://dx.doi.org/10.3171/jns.1981.54.5.0637
 Cooper, D.J., Rosenfeld, J.V., Murray, L., Arabi, Y.M., Davies, A.R., D'Urso, P., et al. (2011) The DECRA trial decompressive craniectomy in diffuse traumatic brain injury. NEJM, 364, 1493-1502.
 Ramachdran, R. and Hegde, T. (2007) Chronic subdural hematomas-causes of morbidity and mortality. Surgical Neurology, 67, 367-372.http://dx.doi.org/10.1016/j.surneu.2006.07.022
 Reymond, M. and Marbet, G. (1992) Aspirin as a risk factor for hemorrhage in patients with head injuries. Neurosurgical Review, 15, 21-25. http://dx.doi.org/10.1007/BF02352062
 Dickson, J. and Weavers, H. (2005) The effects of dehydration on brain volume-preliminary results. International Sports Medicine, 26, 481-485. http://dx.doi.org/10.1055/s-2004-821318
 Marshall, S. and Hinman, F. (1962) Subdural hematoma following administration of urea for diagnosis of hypertension. JAMA, 182, 813-814. http://dx.doi.org/10.1001/jama.1962.03050460105017
 Akioka, N., Fukuda, O., Takaba, M., Kameda, H., Saito, T. and Endo, S. (2007) Clinical investigation of acute spontaneous SDH cases. Journal of Stroke and Cerebrovascular Disease, 16, 109-113.http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2006.11.007
 Nielsen, S., Nagelhus, E.A., Amiry-Moghaddam, M., Borque, C., Agre, P. and Ottersen, O.P. (1997) Specialized membrane domains for water transport in glial cells: High-resolution immunogold cytochemistry of aquaporin 4 in rat brain. Journal of Neuroscience, 17, 171-180.
 de Groot, B.L. and Grumbmuller, H. (2001) Water permeation across biological membranes: Mechanism and dynamics of aquaporin 1. Science, 294, 2353-2354.http://dx.doi.org/10.1126/science.1062459
 Murakami, H. and Hirose, Y. (2002) Why do chronic SDH continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. Journal of Neurosurgery, 96, 877-884. http://dx.doi.org/10.3171/jns.2002.96.5.0877
 Basaldella, L., Perin, A., Orvieto, E., Marton, E., Itskevich, D., Dei Tos, A.P., et al. (2010) A preliminary study of aquaporin 1 immunolocalization in chronic subdural hematoma membranes. Journal of Clinical Neuroscience, 17, 905-907. http://dx.doi.org/10.1016/j.jocn.2009.11.010
 Manley, G.T. and Fujimura, M. (2000) Aquaporin-4 deletion in mice reduces brain edema after acute water intoxication and ischemic stroke. Journal of Natural Medicines, 6, 159-163.
 Miglati, E., Meurice, N., DuBois, P., Fang, J.S., Somasekharan, S., Beckett, E., et al. (2009) Inhibition of AQP-1 and AQP-4 water permeability by derivative of the loop diuretic bumetamide acting at an internal pore occluding binding site. Molecular Pharmacology, 76, 105-112.
 Miranda, L. and Braxton, E. (2011) Chronic subdural hematoma in the elderly: Not a benign disease. Journal of Neurosurgery, 114, 72-76.http://dx.doi.org/10.3171/2010.8.JNS10298