Risk factors for moderate disturbance of consciousness in patients with unilateral chronic subdural hematoma

Abstract

Objective

Chronic subdural hematoma (CSDH) patients usually present with mild symptoms; however, a subset of patients presents with disturbance of consciousness (DOC). We analyzed clinical and radiographic factors, which could influence the level of consciousness in CSDH patients before surgery.

Methods

We retrospectively analyzed consecutive unilateral CSDH patients, who were surgically treated in our department from 2018 to 2023. We compared a group of patients with moderate DOC (group 1), defined as a Glasgow Coma Scale (GCS) 9–13, with a control group of awake but symptomatic patients (GCS > 13, group 2). Clinical and radiographic parameters were analyzed in bivariate and multivariate analyses.

Results

41 (12.9 %) patients presented with GCS 9–13 and 276 patients with GCS > 13. In bivariate analysis, radiographic parameters, like greater mean midline shift (p < 0.001), homogenous hypodense type (p = 0.017), additional temporal (p < 0.001) and occipital (p < 0.001) location, “acute-to-chronic” (p = 0.002) and “acute-on-chronic” (p = 0.049) forms were more frequent in group 1. The trabecular hematoma subtype was less common in group 1 (p = 0.002). INR (p = 0.004) and CRP values (p = 0.003) in the preoperative blood sample were significantly higher in group 1. History of ischemic stroke and intake of statins were more common in group 1 (p = 0.033, p = 0.04; resp.). In the multivariate analysis, midline shift (p = 0.033), occipital location (p = 0.005) and history of ischemic stroke (p = 0.046) remained significant.

Conclusion

We could identify factors which contribute to DOC in CSDH patients. Among those are greater midline shift, occipital location and history of ischemic stroke as independent risk factors.