Reversible Dementia in victims of Chronic Subdural Hematomas

  • Ashraf Mehmood Department of Neurosurgery, SIMS, Services Hospital, Lahore
  • Sohaib Hassan Department of Neurology, SIMS, Services Hospital, Lahore
  • WAQAS . Department of Neurosurgery, SIMS, Services Hospital, Lahore
Keywords: Reversible dementia, chronic subdural hematomas


Objective: The objective of this joint study was to offer the prompt surgical treatment to all diagnosed victims of Reversible dementia with chronic subdural hematomas in our population. Evaluation was based upon comparison of their Pre and Postoperative MMS scoring and HDS-R grading.
Materials and Methods: This study started in June 2013 and is currently ongoing at the Services Institute of Medical Sciences with its allied Services Hospital, Lahore as a joint venture principally between the departments of Neurosurgery and Neurology. We included 30 cases in this study.
Results: Out of 30 cases there were 25 (83.3%) males and 05 (16.66%) females patients. Twenty five out of 30 victims (83.3%) were suffering from dementia pre operatively. Twenty out of these patients (80%) recovered fully and three patients (10%) partially. 02 patients (6.6%) neither improved nor deteriorated. Twenty eight out of 30 victims underwent surgical evacuation by burr holes with closed drainage system under general anesthesia (91.1%) and 2 under went under local anesthesia (6.6%) due to their co-morbid conditions.
Complications: There was no noticeable mortality. One patient complained of post operative pyrexia with convulsions (%) and was managed satisfactorily by conservative treatment. Another patient complained of head-ache for 3 days which was also managed conservatively pie diagram – II. There was no intracranial wound infection in our study.
Conclusion: It was concluded that there was marked post operative improvement in patient’s memory, behavior and neurological status. This was established by proper recording, documentation and comparison of their pre and post operative MMS scoring and HDS-R grading system. It is recommended that the victims of chronic subdural hematomas should be offered prompt evacuation to improve their neurological status.


1. Mashour GA, Schwamm LH, Leffert L. Intracranial subdural hematoma and cerebral herniation after labourepidural analgesia with no evidence of dural puncture. Anesthesiology Mar. 2006; 104 (3): 610-2.
2. Vanden Doel EM. Balzacs Pierette. An early descript-ion of chronic subdural hematoma. Arch Neurol. Dec. 1986; 43 (12): 1291-2.
3. (Guideline) Bullock MR, Cheselnut R, Ghajae J, Gor-don D, Hartl R, Newwell DW, et al. Surgical manage-ment of acute subdural hematomas. Neurosurgery. Mar. 2006; 58 (3Suppl): 516-24; Discussion Si-iv.
4. Herbert H Engelhard, Grant P Sinson, George Timothy Reiter et al. Updated Feb. 4, 2014.
5. Emich S, Richling B, McCoy MR et al. The efficacy of dexamethasone in the reoperation rate of chronic sub-dural hematoma, the DRESH study: straightforward study protocol for randomized controlled trial.
6. J Kor Neurotramatol Soc 2008, 4:66 – 69.
7. Ishikawa E, Yana Ka, Sugimoto K, Ayuzawa S, Nose T. Reversible Dementia in patients with chronic sub-dural hematomas, J Neurosurg 96; 680 – 683, 2002.
8. Evans DA, Funkenstein HH, Albert MS, Scherr PA, Cook NR, Chown MJ etal. Prevalance of Alzheimer‟s disease ina community population of older persons. Higher than previously reported. JAMA, 1989; 262: 2551 – 2556,.
9. Nobuhiko A. Chronic Subdural hematoma in infancy clinical analysis of 30 cases in CT – Era. J. Neurosurg. 1990; 73: 201 – 205.
10. Folstein MF, Folstein SE, MC Hugh PR. “Minimal Mental state”. A practical method for grading the cog-nitive state of patients for the clinicians. J Syckiotr Res 1975; 12: 189 – 198.
11. Foelhem R, Wallimo O. Epidemiology of chronic sub-dural hematoma. Acta Neuro Chir, 1975; 32: 247 – 250.
12. Mark RI, Richard HS. Chronic subdural hematoma in adults and early patients. Neurosurg Clin N Am. 2000; 11: 447 – 454.
13. Fogelholm R, Heiskanen O, Waltimo O. Chronic Sub-dural hematoma in adults. Influence on patients age on symptoms, signs and thickness of hematoma. J. Neuro-surg. 1975; 42: 43 – 46.
14. Mayeux R, Foster NL, Rosser M, White House PG. The clinical evaluation of patients with dementia in H White House PG (ed) „Dementia Philadephia; FA Davis, PP 1993; 92: 92 – 129.
Original Articles