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Background: Acute subdural hematoma (ASDH) is a critical and often fatal condition, particularly in elderly patients receiving anticoagulant therapy. With a growing global aging population, the incidence of traumatic brain injuries, including ASDH, is projected to rise, presenting significant challenges in clinical management. This study evaluates the outcomes of surgically treated ASDH in patients aged 65 years and older, comparing those who received anticoagulant therapy with those who did not. It also aims to identify the main risk factors for poor outcomes and explore preventive strategies in this vulnerable population., Methods: A retrospective analysis was conducted on 90 patients aged 65 years and older who underwent surgery for ASDH at our institution between 2018 and 2023. Patients were categorized into two groups based on anticoagulant therapy use. Demographic data, mechanisms of injury, clinical presentations, and outcomes, including mortality and reoperation rates, were analyzed. Radiological assessments included hematoma thickness, midline shift, and the presence of residual hematoma., Results: No significant differences were observed in hematoma thickness, midline shift, or mortality between patients receiving anticoagulant therapy and those not on anticoagulants. However, a significant association was found between anticoagulant use and the mechanism of injury; patients on anticoagulants were more likely to sustain ASDH from low-energy trauma, such as a fall from the same level (p=0.005). Despite the high mortality rates associated with ASDH in elderly patients, the multidisciplinary approach employed, including the prompt reversal of coagulopathy, likely contributed to the observed outcomes., Conclusion: Acute subdural hematoma in elderly patients, particularly those receiving anticoagulant therapy, remains a challenging problem with a high rate of poor outcomes. This study highlights the urgent need for preventive measures to mitigate the risks associated with even minor trauma, especially in patients on anticoagulants. Our findings underscore the importance of appropriate management protocols, including the timely reversal of coagulopathy, in improving survival rates within this high-risk population. Further research is needed to develop and validate comprehensive preventive strategies and to investigate long-term outcomes in these patients.

Background: Subdural hematoma (SDH) is usually an emergent clinical condition in neurosurgery. The relationship between the SDH and epilepsy is not well established. Therefore, the use of anti-convulsive treatment in patients with SDH is controversial. The aim of this study is to analyze the presence of seizures in patients who underwent surgery for SDH., Methods: Patients who were operated on for SDH in our department between 2016 and 2021 were reviewed retrospectively. Demographic features, Glasgow Coma Scale (GCS) score at admission, type of SDH, location, etiology, type of surgical intervention, presence of seizures, and re-operation were evaluated., Results: There were 175 patients with SDH. There is a statistically significant difference between the frequency of seizures and the type of SDH. More seizures were observed in acute SDH than in the others. There is also a statistically significant difference between the GCS score and the frequency of seizures. Patients with a GCS score <12 at admission had more frequent seizures than patients with a score of 12 or higher. No statistically significant difference was found between factors such as etiology, re-operation, hematoma location, and the development of seizures., Conclusion: Anti-convulsive treatment may be recommended in patients with acute SDH and a low GCS score at admission. Further studies with larger series should be performed to determine the most appropriate anti-convulsive agent for patients with SDH.