Clinical Neurology and Neurosurgery 102 (2000) 199 – 202 Chronic subdural haematomas in patients aged under 50 P. Missori *, C. Maraglino, R. Tarantino, M. Salvati, G. Calderaro, A. Santoro, R. Delfini Department of Neurosciences, Neurotraumatology and Neurosurgery I, Uniersity of Rome, La Sapienza, iale del Policlinico 155, 00161 Rome, Italy Received 16 May 2000; received in revised form 14 August 2000; accepted 14 August 2000 Abstract The clinical findings in 31 patients with chronic subdural haematoma (CSH), aged between 20 and 50, are described. Aetiopathogenetic factors responsible for the formation of CSH match those of patients aged over 50 with CSH. A history of cranial trauma was present in 77% of the cases. In the remaining patients, a defect of haemostatic mechanisms was responsible for the subdural blood collection. On the computed tomography (CT) the haematoma generally appears as a thin subdural layer. The reliability of magnetic resonance imaging for detection of CSH makes it the most desirable investigation in such patients. Prognosis is influenced by preoperative clinical status and by the disease responsible for the formation of CSH. © 2000 Elsevier Science B.V. All rights reserved. Keywords: Chronic subdural haematoma; Magnetic resonance imaging; Surgery www.elsevier.com/locate/clineuro 1. Introduction The age-specific incidence of chronic subdural haematomas (CSHs) is only 0.13/100 000 per year for those in the third decade of life versus 7.4/100 000 per year for those in the seventh decade of life [1]. On the other hand, the 20–50 year age group accounted for between 28% [2], 50% [3] and 55% [4] in the various series. These high incidences are probably related to lower middle age population values. In the most recent published series, patients are grouped together without any age distinction. Since CSH is most common in elderly patients, our clinical study focused on a group of 31 patients with CSH whose ages ranged from 20 to 50, in order to identify any features differentiating them from more elderly patients. 2. Materials and methods The data regarding 344 patients operated on for chronic subdural haematoma from 1988 to 1998 in our Department of Neurosurgery was retrospectively evalu- ated. Thirty-one patients (9%) were aged between 20 and 50; 24 of these were males with a M:F ratio of 3.4:1. Total average age was 38 years (range 20–50) (Table 1). Twenty-four patients (77%) had a history of recent head injury. In another seven patients there was an alteration of the haemostatic mechanism secondary to a cyrrhotic hepatopathy due to either alcoholism [2], viral diseases [4] or haematocromatosis [1]. In one patient the CSH was due to the syphon effect of a large thoracic meningocele. In 29 patients, presenting symp- toms were characterised by a syndrome of intracranial hypertension with headache and vomiting. Two other patients were in coma on admission with a Glasgow coma scale (GCS) score of 5 and 7, respectively. In all cases computed tomography (CT) scan demonstrated a subdural blood layer, bilateral in four of them. In the majority of patients the subdural layer was not very thick and ventricular shift was moderate (Figs. 1 and 3a). One patient, HIV and HCV positive with marked brain atrophy had a large CSH on the CT scan (Fig. 2). * Corresponding author. Tel.: +390-6-4940941. E-mail address: missorp@yahoo.com (P. Missori). 0303-8467/00/$ - see front matter © 2000 Elsevier Science B.V. All rights reserved. PII:S0303-8467(00)00102-5