Clinical characteristics and problems of traumatic brain injury in the elderly

In recent years, instances of traumatic brain injury (TBI) in the elderly has been increased. This article addresses the clinical characteristics and problems of TBI in the elderly. Either falls to the ground from standing or from heights are the most frequent causes of elderly TBI, since both motor and physiological functions are degraded in the elderly. Acute subdural hematomas (ASDH) are the most frequently encountered acute traumatic intracranial lesions. Their high frequency has been proposed to be associated with the increased volume of the subdural space resulting from atrophy of the brain often found in the elderly. The delayed aggravation of intracranial hematomas has also been explained by such anatomical and physiological changes present in the elderly. Delayed hyperemia/hyperperfusion may also be a characteristic of 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 of TBI in the elderly difficult. Establishing preventions and treatments for elderly TBI is an urgent issue since its outcome has remained poor for more than 40 years.