A new study by researchers from the NYU Langone Medical Center in New York, NY, estimates that chronic bleeding on the brain – known as chronic subdural hematoma – will become the most common adult brain condition requiring neurosurgery in the US over the next 15 years. As a result, the researchers say the medical community may need to dedicate more resources to the prevention and management of the condition.
Subdural hematoma (SDH), also referred to as subdural hemorrhage, is bleeding that occurs on the surface of the brain.
Acute SDH can occur as a result of a serious head trauma. The brain can fill with blood very quickly and the brain tissue becomes compressed. This is the most severe form of the condition, often leading to brain injury and death.
SDH caused by minor head trauma is referred to as “chronic,” and this is the most common form of the condition among elderly individuals. This is primarily because older adults have greater brain atrophy, meaning the veins between the brain’s surface and the protective covering are thinner and more susceptible to damage from the slightest trauma.
Repeated falls and recurrent head injuries – which frequently occur among military veterans – can also raise the risk of chronic SDH.
The NYU Langone researchers note that while doctors know which populations are at highest risk for chronic SDH, how many people in the US are affected by the condition is unclear. With their study – recently published in the Journal of Neurosurgery – they aimed to find out.
Study leader Dr. Uzma Samadani, assistant professor in the Departments of Neurosurgery, Psychiatry, Neuroscience and Physiology at NYU Langone, and colleagues analyzed data from the US Department of Veteran Affairs detailing all veteran hospital visits between 2000 and 2012 involving a diagnosis of chronic SDH.
The team also gathered incidence data of chronic SDH among the civilian population of Finland and Japan, where accurate records of all diagnoses of the condition are kept. All data was used to create a mathematical model to predict chronic SDH incidence in the US between 2012 and 2040.
Between 2000 and 2012, the researchers identified 695 new cases of chronic SDH among veterans during hospital visits. Of these, 29% needed to be treated with surgery – specifically, a surgical drainage procedure. The team says this figure indicates that 79.4 cases of chronic SDH are currently diagnosed per 100,000 veterans.
What is more, the team found that over 70% of chronic SDH diagnoses occurred in patients aged 65 years and older.
Using these figures, Dr. Samadani and colleagues estimate that by 2030 – at a point when more than a quarter of the US population will be 65 or older – chronic SDH will affect 121.4 veterans per 100,000, while the condition will affect 17.6 people in every 100,000 of the general population.
In total, the researchers predict chronic SDH will affect around 60,000 Americans a year by 2030.
These findings, Dr. Samadani says, indicate that the medical community – especially those caring for veterans – will need to pour more resources into the prevention and management of chronic SDH. She adds:
“In 15 years, drainage for SDH will likely be the most common type of adult brain surgery performed, surpassing the number of operations required for brain tumors.
If we can identify patients at risk and prevent brain atrophy from occurring as Americans age, we may be able to slow this trend. If not, we are going to need increased neurosurgical and rehabilitation capacity to manage these patients.”
The researchers note that patients being treated for chronic SDH are also likely to require longer hospital stays than those being treated for brain tumors; they often need more comprehensive physical therapy and rehabilitation.
Earlier this month, MNT reported on a study suggesting physical activity could protect older adults against age-related brain damage.