Clinical Relevance of Seizure in Pediatric Patients with Isolated Acute Subdural Hematoma without Parenchymal Brain Injury

2019 ◽  
Vol 80 (04) ◽  
pp. 233-239 ◽  
Author(s):  
Sae-Yeon Won ◽  
Daniel Dubinski ◽  
Bedjan Behmanesh ◽  
Adam Strzelczyk ◽  
Volker Seifert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Pediatric Patients ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Injury Score ◽  
Antiepileptic Treatment ◽  
Baseline Characteristics

Purpose Isolated acute subdural hematoma (aSDH) in pediatric patients is rare, but it has a major impact on outcome. The purpose of this study was to determine incidence, seizure risk factors, and the outcome of pediatric patients with aSDH. Methods Within a 10-year period (2007–2016), 10 children with aSDH were identified. Baseline characteristics and these parameters were analyzed: pediatric Glasgow Coma Scale (pGCS) score at admission and 24 hours after the operation, hematoma volume/side, and midline shift. Functional outcome was assessed at 3-month follow-up using the King's Outcome Scale for Childhood Head Injury score. Results Three subgroups were identified depending on age and etiology: birth-associated, nontraumatic, and traumatic aSDH. The overall incidence of seizures was 60%, and an even higher rate (75%) was observed in children < 1 month of age. Of those patients, two (67%) developed late seizures. Significant predictors for seizures were low pGCS score at admission (p = 0.03) and 24 hours after surgery (p = 0.03) as well as increased midline shift (p = 0.02). Patients with seizures tended to have an unfavorable outcome. Conclusion Pediatric patients with aSDH are at high risk for seizures, particularly if the pGCS score is low at admission/24 hours after the operation and midline shows a shift. Determining seizure-prone pediatric patients may facilitate early antiepileptic treatment and promote better clinical outcomes.

scholarly journals Clinical Predictors of outcome in Isolated Traumatic Acute Subdural Hematoma

2018 ◽  
Vol 15 (3) ◽  
pp. 8-13
Author(s):  
Maya Bhattachan ◽  
Ali Niyaf ◽  
Ram K. Shrestha ◽  
Amit Pradhananga ◽  
Gopal Sedain ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Adult Population ◽  
Radiological Finding ◽  
Acute Subdural Hematoma ◽  
Study Patient ◽  
High Morbidity ◽  
Midline Shift ◽  
Clinical Predictors ◽  
Hematoma Volume ◽  
Factors Affecting

Head injury is the major cause of death in young adult population worldwide with associated high morbidity. The objective of this study is to find out the outcome and factors affecting the outcome in isolated traumatic acute subdural hematoma. All patients with isolated acute subdural hematoma presenting within 24 hours of trauma and admitted over a period of 1 year were included in this study. Patient was classified according to Glasgow Coma Scale(GCS) after resuscitation in the emergency department. The outcome of the patient was recorded according to the Glasgow Outcome Scale at the time of discharge and at 3 months after the trauma in follow-up. Statistical analysis was performed to find the correlation between GCS, papillary changes and radiological finding in the form of midline shift and hematoma volume to dichotomized outcome. Out of 38 patients enrolled in the study, 33 patients had favorable outcome. Surgery was performed in 12 patients out of whom 4 patients had unfavorable outcome. GCS score, papillary changes, midline shift and hematoma volume were found to have significant association with the outcome in isolated traumatic acute subdural hematoma. Clinical parameters and radiological parameters can gauge the outcome in isolated traumatic brain injury.

scholarly journals Risk Factors Contributing to Higher Mortality Rates in Elderly Patients with Acute Traumatic Subdural Hematoma Sustained in a Fall: A Cross-Sectional Analysis Using Registered Trauma Data

2018 ◽  
Vol 15 (11) ◽  
pp. 2426 ◽  
Author(s):  
Ching-Hua Hsieh ◽  
Cheng-Shyuan Rau ◽  
Shao-Chun Wu ◽  
Hang-Tsung Liu ◽  
Chun-Ying Huang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Young Adults ◽  
Elderly Patients ◽  
Subdural Hematoma ◽  
Odds Ratio ◽  
The Elderly ◽  
Mortality Rates ◽  
Acute Subdural Hematoma ◽  
Hematoma Volume ◽  
Independent Risk Factors

Background: We aimed to explore the risk factors that contribute to the mortality of elderly trauma patients with acute subdural hematoma (SDH) resulting from a fall. Mortality rates of the elderly were compared to those of young adults. Methods: A total of 444 patients with acute traumatic subdural hematoma resulting from a fall, admitted to a level I trauma center from 1 January 2009 to 31 December 2016 were enrolled in this study. Patients were categorized into two groups: elderly patients (n = 279) and young adults (n = 165). The primary outcome of this study was patient mortality in hospital. The adjusted odds ratio (AOR) with 95% confidence interval (CI) for mortality was calculated according to gender and pre-existing comorbidities. Univariate and multivariate logistic regression analyses were performed to identify factors related to mortality in the elderly. Results: The odds ratio for mortality caused by falls in the elderly patients was four-fold higher than in the young adults, after adjusting for gender and pre-existing comorbidities. In addition, the presence of pre-existing coronary artery disease (OR 3.2, 95% CI 1.09–9.69, p = 0.035), end-stage renal disease (OR 4.6, 95% CI 1.48–14.13, p = 0.008), hematoma volume (OR 1.2, 95% CI 1.11–1.36, p < 0.001), injury severity score (OR 1.3, 95% CI 1.23–1.46, p < 0.001), and coagulopathy (OR 4.0, 95% CI 1.47–11.05, p = 0.007) were significant independent risk factors for mortality in patients with acute traumatic SDH resulting from a fall. Conclusions: In this study, we identified that pre-existing CAD, ESRD, hematoma volume, ISS, and coagulopathy were significant independent risk factors for mortality in patients with acute traumatic SDH. These results suggest that death following acute SDH is influenced both by the extent of neurological damage and the overall health of the patient at the time of injury.

scholarly journals Midline shift in relation to thickness of traumatic acute subdural hematoma predicts mortality

BMC Neurology ◽  
2015 ◽  
Vol 15 (1) ◽  
Author(s):  
Ronald HMA Bartels ◽  
Frederick JA Meijer ◽  
Hans van der Hoeven ◽  
Michael Edwards ◽  
Mathias Prokop
Keyword(s):  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Midline Shift

P4151Changes in incidence and risk factors for heart failure over a 21-year follow-up period in two cohorts of middle aged men born 30 years apart

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C Ergatoudes ◽  
P.-O Hansson ◽  
K Svardsudd ◽  
A Rosengren ◽  
E Thunstrom ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Antihypertensive Medication ◽  
Piecewise Linear ◽  
Risk Profile ◽  
Middle Aged ◽  
Glucose Levels ◽  
Increased Risk ◽  
Baseline Characteristics

Abstract Background Several characteristics or conditions are associated with increased risk for heart failure (HF). In recent years we have witnessed gradually improved cardiovascular prevention and treatment. However, how the risk profile of HF has changed during the last decades remains inadequately studied. Purpose To compare risk factors for heart failure in two generations of middle-aged men from the general population born 30 years apart. Methods Two cohorts of randomly selected men born in 1913 (n=855) and in 1943 (n=798) and resident in Gothenburg, Sweden were first examined at 50 years of age in 1963 and 1993, respectively, and followed longitudinally over 21 years until age 71. Data about medical history, concomitant diseases and general health were collected by questionnaires, repeated medical examinations and review of individual medical records. The outcome was defined as hospitalization with HF as a discharge diagnosis or HF reported on the death certificate. Cox-regression analysis was used to examine the impact of baseline characteristics and time-updated atrial fibrillation (AF), ischemic heart disease (IHD) and diabetes mellitus (DM) on the outcome. Furthermore the incidence of HF overall between the two cohorts was also compared. Significance was defined as p<0.05 for all two-sided tests, except for interaction terms where p<0.10 was applied. Results During a 21-year follow up, 80 men born in 1913 (9.4%) and 36 men born in 1943 (4.6%) developed HF. Men born in 1943 had a 52% lower risk for HF (adjusted HR 0.48 95% CI 0.29–0.77 p=0.003) compared to men born in 1913. Baseline characteristics associated with higher HF risk in both cohorts were higher body mass index (BMI) and the use of antihypertensive medication. Higher heart rate was associated with an increased risk only in men born 1913 whereas higher systolic blood pressure (SBP), smoking, higher glucose levels and higher total cholesterol levels were associated with higher risk in men born 1943. Onset of AF, IHD or DM was associated with higher HF risk in both cohorts. Multivariable models using stepwise regression showed that AF, IHD, higher BMI (continuous variable), use of antihypertensive medication and higher heart rate (piecewise linear) were independent predictors for HF in men born in 1913 whereas AF, higher glucose levels, IHD and higher SBP (piecewise linear) in men born in 1943. Finally, interaction analyses showed that in comparison with those born in 1913, the relative importance as risk factors for HF among those born in 1943 has decreased for AF whereas it has increased for systolic blood pressure and cholesterol. Of note, impact of IHD as risk factor decreased numerically, and that of physical activity increased, but for both without reaching statistical significance. Cox proportional hazard analysis Conclusions The incidence of HF in middle aged men living in Gothenburg has decreased during the last decades, and in the meantime risk profile for incident HF has also changed.

Frequency of and Risk Factors for Chronification in Traumatic Acute Subdural Hematoma following Conservative Therapy

2019 ◽  
Vol 80 (05) ◽  
pp. 359-364 ◽  
Author(s):  
Stefanie Kaestner ◽  
Marina van den Boom ◽  
Wolfgang Deinsberger
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Head Injuries ◽  
Chronic Subdural Hematoma ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Coagulation System ◽  
Acute Subdural Hematoma ◽  
Neurosurgical Department ◽  
Anticoagulant Medication

Background In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. Methods We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. Results A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10–98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). Conclusion Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.

Syndrome of the trephined

2009 ◽  
Vol 111 (4) ◽  
pp. 650-652 ◽  
Author(s):  
Vivek Joseph ◽  
Peter Reilly
Keyword(s):  
Subdural Hematoma ◽  
Skin Flap ◽  
Neurological Status ◽  
Bone Flap ◽  
Acute Subdural Hematoma ◽  
Skull Bone ◽  
Midline Shift ◽  
Scalp Flap ◽  
Dependent Position ◽  
Syndrome Of The Trephined

“Syndrome of the trephined” or “sinking skin flap syndrome” is an unusual syndrome in which neurological deterioration occurs following removal of a large skull bone flap. The neurological status of the patient can occasionally be strongly related to posture. A 77-year-old male patient with an acute subdural hematoma was treated using a hemicraniectomy and evacuation of the hematoma. On the 9th postoperative day there was deterioration in sensorium associated with a sunken scalp flap and worsening midline shift on CT. A significant improvement in sensorium and a filling up of the scalp flap occurred after maintaining the patient's head in a dependent position. The patient subsequently made an excellent recovery following replacement of the bone flap. The pathophysiology of “syndrome of the trephined” or “sinking skin flap syndrome” is reviewed.

scholarly journals Significance of time from injury to surgery in the functional recovery of individuals with traumatic acute subdural hematoma

2019 ◽  
Author(s):  
Shih-Han Chen ◽  
Jui-Ming Sun ◽  
Wen-Kuei Fang
Keyword(s):  
Ct Scan ◽  
Scale Score ◽  
Functional Recovery ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
Coma Scale ◽  
Poor Recovery ◽  
Recovery Group ◽  
Time From Injury

Abstract Background: The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). However, only few studies have confirmed such notion.Methods: The data of TASDH patients who were surgically treated in Chia-Yi Christian Hospital between January 2008 and December 2015 were collected. The significance of variables, including age, sex, traumatic mechanism, coma scale, midline shift on brain computed tomography (CT) scan, and TIS, in functional recovery was assessed using the student’s t -test, chi-square test, univariate and multivariate models, and receiver operating characteristic (ROC) curve.Results: A total of 37 patients achieved functional recovery (outcome scale score of 4 or 5) and 33 patients had poor recovery (outcome scale score of 1–3) after at least 1 year of follow-up. No significant difference was observed in terms of age, sex, coma scale score, traumatic mechanism, or midline shift on brain CT scan between the functional and poor recovery groups. TIS was found to be significantly shorter in the functional recovery group than in the poor recovery group (145.5±27.0 vs. 181.9±54.5, P-value=0.001). TIS and midline shift ≥10 mm were significant factors for functional outcomes in the multivariate regression models. The analysis of TIS with the ROC curve between these two groups showed that the threshold time for functional recovery in comatose patients and those with TASDH who were surgically treated was 2 hours and 57.5 minutes.Conclusions: TIS is crucial for the functional recovery of TASDH patients who underwent surgery.

scholarly journals Acute subdural hematoma as a complication of diagnostic lumbar puncture: case report

2016 ◽  
Vol 30 (4) ◽  
pp. 526-529
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Andres M. Rubiano ◽  
Hernando Raphael Alvis-Miranda ◽  
Nasly Zabaleta-Churio ◽  
Willem Guillermo Calderón-Miranda ◽  
...  
Keyword(s):  
Case Report ◽  
Lumbar Puncture ◽  
Subdural Hematoma ◽  
Fluid Collection ◽  
Acute Subdural Hematoma ◽  
Acute Bacterial Meningitis ◽  
Red Flags ◽  
Diagnostic Lumbar Puncture ◽  
Head Computed Tomography

Abstract Background: Intracranial hemorrhagic complications are unusual after diagnostic lumbar puncture. Case report: A diagnostic lumbar puncture was performed in a 55 year-old male for acute bacterial meningitis workup. Immediately after the procedure he developed intense headache and a head Computed Tomography (CT) was done which identified an acute subdural fluid collection. No surgical management was offered and conservative medical follow-up was indicated. Conclusion: The occurrence of a headache with red flags after a lumbar puncture may suggest the possibility of an acute subdural hematoma.

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