Clinical Characteristics and Outcome in Elderly Patients with Traumatic Brain Injury: For Establishment of Management Strategy

• Published in: Neurologia medico-chirurgica Vol. 57; no. 8; pp. 418 - 425
• Main Authors: KARIBE, Hiroshi, HAYASHI, Toshiaki, NARISAWA, Ayumi, KAMEYAMA, Motonobu, NAKAGAWA, Atsuhiro, TOMINAGA, Teiji
• Format: Journal Article
• Language: English
• Published: Japan The Japan Neurosurgical Society 2017; Japan Science and Technology Agency
• Subjects: Accidental Falls - statistics & numerical data; Age Factors; Aged; Aged, 80 and over; anticoagulant; Anticoagulants - adverse effects; antiplatelet; Atrophy; Brain - pathology; Brain - physiopathology; Brain Damage, Chronic - epidemiology; Brain Damage, Chronic - etiology; Brain Damage, Chronic - prevention & control; Brain Edema - etiology; Brain Edema - physiopathology; Brain Injuries, Traumatic - complications; Brain Injuries, Traumatic - epidemiology; Brain Injuries, Traumatic - physiopathology; Brain Injuries, Traumatic - therapy; Comorbidity; delayed deterioration; Disease Management; Disease Progression; elderly; Geriatrics; Hematoma; Humans; Hyperemia; Hyperemia - physiopathology; Intracranial Hemorrhage, Traumatic - etiology; Intracranial Hemorrhage, Traumatic - physiopathology; Management; Physiology; Platelet Aggregation Inhibitors - adverse effects; Practice Guidelines as Topic; Special Topic; Subdural Space - pathology; Traumatic brain injury; traumatic brain injury (TBI); Treatment Outcome; traumatic brain injury (TBI); anticoagulant; antiplatelet; elderly; delayed deterioration
• ISSN: 0470-8105; 1349-8029
• DOI: 10.2176/nmc.st.2017-0058

In recent years, instances of neurotrauma in the elderly have been increasing. This article addresses the clinical characteristics, management strategy, and outcome in elderly patients with traumatic brain injury (TBI). Falls to the ground either from standing or from heights are the most common causes of TBI in the elderly, since both motor and physiological functions are degraded in the elderly. Subdural, contusional and intracerebral hematomas are more common in the elderly than the young as the acute traumatic intracranial lesion. High frequency of those lesions has been proposed to be associated with increased volume of the subdural space resulting from the atrophy of the brain in the elderly. The delayed aggravation of intracranial hematomas has been also explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of the elderly TBI, although its mechanisms are not fully understood. In addition, widely used pre-injury anticoagulant and antiplatelet therapies may be associated with delayed aggravation, making the management difficult for elderly TBI. It is an urgent issue to establish preventions and treatments for elderly TBI, since its outcome has been remained poor for more than 40 years.