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2 Table I Age & sex distribution: 21 elderly patients with chronic subdural hematoma. Table II Previous history & diagnosis before admission Table IV Initial symptoms and signs (21 patsents) Table III Table V Time interval before final diagnosis (From head injury to admission) case time

3 Table VI Findings on admission in the 21 patients Table VIII Clinical findings on admission (Examination) Table VII Pattern of onset (21 patients)

4 Table IX Diagnostic procedures and findings Table X Treatment and Result (18 patients)

5 A: Pre-operation image of hematoma hemisphere. The rcbf in this region was found to be decreased. B: Post- operation (3M) image of hematoma hemisphere. The rcbf in this hemisphere increased. was found to be

6

7 12) Kreminsky, J., Uber die Pachymeningitis interna heamorrhagica bei Menschen und Hun- den. Arch. f. Path. Anat., 42: , , ) Lalonde, A.A. and Gardner, W.J.: Chronic subdural hematoma. Expansion of compressed cerebral hemisphere and relief of hypotension by soinal injection of physiologic saline solu- New England J. Med., 239: , tion ) Lassen, N.A and Ingvar, D.H.,: Radioisotopic assessment of regional cerebral blood flow, Progr. Nucl. Med., 1: , ) Laudig, G.H., B.owder, E.J and Watson, R. A.: Subdural hematoma; Study of 143 caces encoutered during five-year period., Ann. Surg., 3) Bedford, P.D.: Discussion; Intracranial haemorrhage-diagnosis 113: , and Treatment-. Proc. Roy. 16) Lavy, S and Herishianu, Y.,: Chronic subdu- Soc. Med. 51: , ral hematoma in the aged. J. Am. Geriatrics 4) Bouzarth, W.F. and Bhatti, T.H.: Subdural Soc. 17: , heamatoma in the elderly. J.A.M.A., 23: , ) Dressier, W.: Klinische Betrachtungen Zur Pathogenese des Subdurales Hematoms. Acta. Neurochir. 5: 46-67, ) Gjerris, F and Schmidt, K.: Chronic subdural hematoma. Surgery or mannitol treatment. J. Neurosurg. 40: , ) Page, F.: Intracranial hypotension. Lancet, 264: 1-5, ) Perlmutter, I.: Subdural hematoma in older patients. J.A.M.A., 214: , ) Putnam, T and Cushing, H.: Chronic subdural

8 hematoma. Its pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch. Surg, 11: , ) Raskind. R., Glover, M.B and Weiss, S.R.: Chronic subdural hematoma challenge in the elderly.; a in diagnosis and treatment. J. Am. Geriatrics Soc, 20: , ) Raskind, R., Metcalf, J.S., Weiss, S.R and Doria, A.: elderly: Chronic subdural hematoma in the a curable lesion. J. Am. Geriatrics Soc, 16: , ) Scott, M.: Spontaneus subdural hematoma. J. A.M.A., 141: , ) Stuteville, P and Welch, K.: Subdural hematoma in the eldery person. J.A.M.A., 168: , Verhandl. d. Phys. med. Gesellsch, in Wurburg. 7: , ) Trotter, W.: Chronic subdural hemorrhage of traumatic origin and its relation to pachymeningitis hemorrhagica interna. Brit. J. Surg, 2: , ) Toyama, H., Iio, M., Iisaka, J., Chiba, K., Yamada, K., Hoshi, Y and Fuse, M.: Color functional images of the cerebral blood flow. J. Nucl. Med. 17: , ) Virchow, W.: Das Hamatom der Dura mater.

9 During the last 4 years, we have investigated clinical features and prognosis of 21 cases of chronic subdural hematoma who were all of ages over 65 years old. average ages was 77.1 years old and sex distribution The was not observed. In this group of 21 patients, a history of trauma was noted in 95%, history of hypertension in 52%, diabetes mellitus in 19% and chronic alchoholism in 14%. Among initial symptoms or signs given by the family at admission to the hospital, the most remarkable findings was gait disturbance in 43% (weakness of under ext., hemiparesis, hemiplegia.), mental or personality changes in 24%, incontinentia in 28%, headache in 24%, dementai in 24%, altered consciousness in 24% and others symptoms such as seizure and vertigo in 5%. Diagnosis before admission were cerebral infarction in 43%, cerebral artherosclerosis in 14%, intracerebral hemorrhage in 14%, senile dementia in 10% and other several diseases as head injury, brain tumor, meningitis in 5%. As 1) Department of Surgery, Division of Neurosurgery, Tokyo Metropolitan Geriatric hospital (Yoikuin), Tokyo, Japan 2)Department of Nuclear Medicine and Radiological Science, Tokyo Metropolitan Geriatric Hospital (Yoikuin), Tpkyo, Japan 3) Department of Neurology, Tokyo Metropolitan hospital (Yoikuin), Tokyo, Japan 4) Department of Neurosurgery, Tokyo Medical and Dental University, School of Medicine, Tokyo, Japan it was predicted by various different diagnosis before admission, differential diagnosis of chronic subdural hematoma in the elderly is difficult covered by senile dementia, cerebral vascular disease, concomitant other vascular disease and etc. The chief complaint on admission was disturbance of consciousness in 43%, mental disoder in 38%, symptoms of hemiparesis or hemiplegia in 71%, incontinentia in 28%, headache in 24%, speech disturbance in 24% and aphasia in 10%. Anisocoria and papilledema was noted only in 3%. By the lumbar puncture, it was shown that cerebrospinal fluid pressure was increased (over 180mmH2O) in 7 cases (33%) and decreased (under 120mmH2O) in 8 cases (38%). 50mg/dl The CSF protein level was elevated over in 5 cases (24%) in such cases with old apoplexia and cerebral infarction. Angiographic examination demonstrated conculusivelly the presence of a subdural space occupying lesion in almost all cases of a subdural space occupying lesion in almost all cases of our 17 patients. Improvement was recognized in findings of clinical featurs and results of CBF. cases of good prognosis CBF recovered excellently after 3 months of operation. When compared with younger patients with chronic subural hematoma in the aged caused lesser compression upon cerebral tissue since their brain suffered atrophy, previous cerebral vascural disturbance space was dilated. In accompanying and intracranial

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