The Surgical Treatment of Three Young Chronic Subdural Hematoma Patients with Different Causes

Chronic subdural hematoma (CSDH), which rarely happens in the young, is thought to be a disease of the elderly. Whereas unspecific symptoms and insidious onset in juveniles and young adults, as a result of its relative low morbidity, CSDH is usually neglected even undertreated in the young. Through the three cases and review of the current literature on this subject, we tried to illustrate the clinical and etiopathological characteristics of this entity and find out the most appropriate treatment strategy. We report three young CSDH patients with different but similar symptoms. The present histories, tests and examinations revealed different predisposing factors accounting for the genesis of CSDH. Their preoperative symptoms were all resolved with burr hole and drainage operation. Juveniles and young adults suffering from CSDH differ from that of their elderly counterparts in their clinical and etiopathological characteristics. Although trauma is the most important risk factor in young and old CSDH patients, some other predisposing factors may exist. Burr hole and drainage surgery could resolve the problem most of the time. But further tests and examinations even specific management should be made in some cases.

The abnormalities of nailfold capillaries in scleroderma as assessed by video image analysis and photomicroscopy.

Scleroderma is a systemic connective tissue disease in which the diagnosis in supported by morphological changes in nailfold capillary size and density. These changes are open to observer bias. In this paper we describe 2 objective methods that allow quantitative definition of capillary changes, video image analysis (VIA) and photomicroscopy. VIA was used to assess 15 healthy control subjects and 22 patients with scleroderma. Scleroderma patients had a significantly larger capillary diameter (43 microns versus 20 microns, p = 0.0001) and capillary density was reduced by a mean factor of 0.5. Image stored on computer will facilitate serial assessments of nailfold capillary changes and possibly provide information on disease progression.