The document discusses chronic subdural hematoma in the elderly. It notes that while trauma is present in about 30-50% of cases in those over 65, other risk factors include alcohol abuse, seizures, CSF shunts, and coagulopathies. The etiology can be trauma, coagulopathy, a sufficient subdural space from cerebral atrophy or other causes like arachnoid cysts or hydrocephalus, or a combination of factors. The pathophysiology is that cerebral atrophy creates negative pressure that stretches bridging veins, leading to bleeding in the subdural space.

1. Chronic Subdural Hematoma in the Elderly
Ade Wijaya, MD – June 2019

2. Introduction
• Chronic Subdural Hematoma in the Elderly  Trauma ?
• A history of trauma is absent in about 30–50% of the cases, especially
after the age of 65 years
• Risk factors: alcohol abuse, seizures, cerebrospinal fluid shunts, and
coagulopathies including therapeutic anticoagulant
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

3. Etiology
• Trauma
• Coagulopathy
• Sufficient subdural space
• Others
• Combined
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

4. Trauma
• Head-banging
• Dancing
• Any tears in the arachnoid membrane following contusion of the brain
or slight bleeding from a bridging vein
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

5. Coagulopathy
• Factor X deficiency
• Factor XIII deficiency
• von Willebrand's disease
• Afibrinogenemia
• Anticoagulant therapy
• End stage renal disease
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

6. Sufficient Subdural Space
• Arachnoid cyst
• Cerebrospinal fluid leak
• Lumbar drainage
• Spinal anesthesia
• Intracranial hypotension
• Hydrocephalus
• Cerebral atrophy
• Old age
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

7. Others
• Dural metastasis
• Lymphoma
• Infection
• Antiviral therapy
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

8. Pathophysiology
Lee KS, Bae WK, Park YT, Yun IG. The pathogenesis and fate of traumatic subdural hygroma. Br J Neurosurg. 1994;8:551–558.

9. Pathophysiology
• Cerebral atrophy produce negative pressure within the cranium 
creating sufficient subdural space  bridging vein stretched
Lee KS. Chronic subdural hematoma in the aged, trauma or degeneration?. Journal of Korean Neurosurgical Society. 2016 Jan;59(1):1.

10. Summary
• Chronic subdural hematoma  multiple etiology
• In elderly  sufficient subdural space due to cerebral atrophy
• It would be reasonable that in the aged persons, degeneration of brain
might play the most important role in development of chronic subdural
hematoma