Neurosurgical Treatment Variation of Traumatic Brain Injury: Evaluation of Acute Subdural Hematoma Management in Belgium and The Netherlands

PURPOSE: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. METHOD: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. RESULTS: Statistical significant differences (McNemar test): ocurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. CONCLUSION: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI.

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The Synergistic Effect of Acute Subdural Hematoma Combined with Diffuse Traumatic Brain Injury on Brain Edema

Brain Edema XI ◽

10.1007/978-3-7091-6346-7_43 ◽

2000 ◽

pp. 213-216

Author(s):

Y. Tomita ◽

S. Sawauchi ◽

A. Beaumont ◽

Anthony Marmarou

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Synergistic Effect ◽

Brain Edema ◽

Subdural Hematoma ◽

Acute Subdural Hematoma

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HYPEREMIA BENEATH EVACUATED ACUTE SUBDURAL HEMATOMA IS FREQUENT AND PROLONGED IN PATIENTS WITH AN UNFAVORABLE OUTCOME

Neurosurgery ◽

10.1227/01.neu.0000341872.17024.44 ◽

2009 ◽

Vol 64 (4) ◽

pp. 705-718 ◽

Cited By ~ 13

Author(s):

Arturo Chieregato ◽

Alberto Noto ◽

Alessandra Tanfani ◽

Giovanni Bini ◽

Costanza Martino ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Severe Traumatic Brain Injury ◽

Subdural Hematoma ◽

Time Course ◽

Unfavorable Outcome ◽

Acute Subdural Hematoma ◽

Control Group ◽

Computed Tomographic ◽

The Mean

Abstract OBJECTIVE To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome. METHODS rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months. RESULTS Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes. CONCLUSION On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.

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Acute Subdural Hematoma after Isolated Traumatic Brain Injury: Risk Factors and Prediction of Mortality

Sveikatos mokslai ◽

10.5200/sm-hs.2015.028 ◽

2015 ◽

Vol 25 (2) ◽

pp. 36-40

Author(s):

Dalia Adukauskienė ◽

Asta Mačiulienė ◽

Aušra Čiginskienė ◽

Agnė Adukauskaitė ◽

Justina Čyžiūtė

Keyword(s):

Risk Factors ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Blood Cell ◽

Cell Count ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Blood Cell Count ◽

Lethal Outcome ◽

Pupil Reaction

The aim of this study was to determine mortality and it‘s risk factors also prediction of lethal outcome in case of acute subdural hematoma after isolated traumatic brain injury (ITBI). Methods. A retrospective study of 162 patients after ITBI was carried out in Neurosurgical Intensive Care Unit (NITS) of Lithuanian University of Health Sciences Hospital (LUHSH) Kaunas Clinics (KC). Demographic (gender, age), clinical (pupil reaction to light, Glasgow Coma Scale (GCS) score, APACHE II scale score) and laboratory (white blood cell count, glycemia) data analysis on the first day after the injury was made. Conclusions. The mortality rate of acute subdural hematoma after isolated traumatic brain injury was 41 pct. Risk factors of mortality were estimated to be patient age ≥ 65 yrs, absence of pupil reaction to light, GCS 3-8, APACHE II score ≥ 16 points, white blood cell count ≥10,1 x 109/l and glycemia ≥5,6mmol/l. It was estimated the evident relation between predicted lethal outcome and real mortality when the risk of lethal outcome was higher than 25 pct.

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Prognostic Factors after Acute Subdural Hematoma

10.53350/pjmhs2115112979 ◽

2021 ◽

Vol 15 (11) ◽

pp. 2979-2981

Author(s):

Ali Akbar ◽

Safdar Hussain Arain ◽

Mumtaz Ali Narejo ◽

Najmus Saqib Ansari

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Midline Shift ◽

College Hospital ◽

Medical College ◽

Significant Difference ◽

The Mean ◽

Computed Topography

Background: Acute subdural hematoma is a lesion caused by traumatic brain injury. Computed topography, hematoma thickness and midline shift analysis are important factors in evaluating its prognosis. Aim: To evaluate the factors involved in prognosis of acute subdural hematoma. Study design: Retrospective study Place and duration of study: Department of Neurosurgery, Chandka Medical College Hospital, Larkana from 1st October 2020 to 30the June 2021. Methodology: One hundred patients from both genders and between age 18-55 years were enrolled. Clinical examination and radiological complete examination was done in each patient. Zumkeller Index (ZI) was calculated and Glasgow scoring was performed. Results: The mean age were 44.1±15.8 years with 87% males having major reasoning of head injury as a motor cycle accident. Traumatic brain injury was recorded as >3mm ZI in 10 cases. The mean midline shift was 12.4±6.06 mm with a significant difference between three categories. Conclusion: Midline shift and hematoma thickness are useful predictors of prognosis related to acute subdural hematoma. Keywords: Prognostic factor, Acute subdural hematoma, Computed tomography (CT)

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EFFECTIVENESS OF TREATMENT OF ELDERLY PATIENTS WITH TRAUMATIC BRAIN INJURY COMPLICATED BY SUBDURAL HEMATOMA

Успехи геронтологии ◽

10.34922/ae.2021.34.3.017 ◽

2021 ◽

pp. 461-465

Author(s):

А.А. Баландин ◽

И.А. Баландина ◽

М.К. Панкратов

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Elderly Patients ◽

Subdural Hematoma ◽

Young Patients ◽

Acute Subdural Hematoma ◽

Severe Condition ◽

Neurosurgical Patients ◽

Personalized Approach ◽

Outpatient Practice

Работа основана на результатах ретроспективного анализа медицинской документации 56 пациентов с черепно-мозговой травмой, осложненной острой субдуральной гематомой объемом 60-100 см3. Пациенты были разделены на две группы по возрасту: 1-я 29 пациентов 22-29 лет; 2-я 27 пациентов 61-69 лет. Степень нарушения сознания у пострадавших при поступлении в клинику оценивали по шкале Глазго, эффективность проводимого лечения при выписке пациентов из стационара проводили по шкале Рэнкина, оценивая степень независимости и инвалидизации. У пациентов пожилого возраста выявлено более тяжелое состояние при поступлении в клинику. При выписке из стационара оценка степени независимости и инвалидизации по шкале Рэнкина выявила статистически значимое преобладание баллов в группе пациентов пожилого возраста (p<0,01), что говорит о менее эффективном их лечении в сравнении с пострадавшими молодого возраста. Результаты данного исследования могут послужить основой для разработки дополнительных рекомендаций в амбулаторной практике для ухода и попечения пациентов старшей возрастной группы и персонифицированному подходу к пострадавшим нейрохирургического профиля с учетом их возраста. The work is based on the results of a retrospective analysis of the medical records of 56 patients with traumatic brain injury complicated by acute subdural hematoma with a volume of 60-100 cm3. The patients were divided into 2 groups according to their age: the 1st group included 29 patients aged 22-29 years, the 2nd group consisted of 27 patients aged 61-69 years. The degree of impaired consciousness in the victims at admission to the clinic was evaluated on the Glasgow scale, the effectiveness of the treatment at discharge from the hospital was performed on the Rankin scale, assessing the degree of independence and disability. Elderly patients were found to have a more severe condition upon admission to the clinic. Upon discharge from the hospital, the assessment of the degree of independence and disability on the Rankin scale revealed a statistically significant predominance of scores in the group of elderly patients ( p <0,01), which indicates less effective treatment in comparison with young patients. The results of this study can serve as a basis for the development of additional recommendations in outpatient practice for the care and care of patients in the older age group and a personalized approach to neurosurgical patients taking into account their age.

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Insomniac disorders in patients with traumatic brain injury complicated with subdural hematoma

Курский научно-практический вестник «Человек и его здоровье» ◽

10.21626/vestnik/2021-1/06 ◽

2021 ◽

Vol 24 (1) ◽

pp. 47-53

Author(s):

Anatoliy A. Balandin ◽

Irina A. Balandina ◽

Mikhail K. Pankratov

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subdural Hematoma ◽

Sleep Disturbances ◽

Medical Center ◽

Acute Subdural Hematoma ◽

Temporal Region ◽

Occipital Region ◽

Group I ◽

Number Of Patients

The objective: to determine the frequency of insomniac disorders in patients with traumatic brain injury (TBI) complicated with subdural hematoma, for early detection and prevention of sleep disorders in recovery periods. Materials and methods. A survey was conducted in 102 patients with TBI complicated with acute subdural hematoma who were operated on in the Neurosurgical Department of the M.A. Tverye State medical center in Perm in the period from 2018 to 2019. The study included patients with the most frequent localization of subdural hematoma. Group I consisted of 31 patients (30%) with a hematoma localized in the frontotemporal region, group II - 28 patients (27%) with a hematoma localized in the parietal - temporal region, group III - 18 patients (18%) with a hematoma localized in the frontotemporal - occipital region, group IV - 25 patients (25%) with a hematoma localized in the parietal-occipital region. On day 13-14 after surgical intervention to remove the subdural hematoma, the patients were interviewed using the ISI scale to determine the presence and severity of insomnia. Results. The severity of condition on admission was assessed as 13-12 points on the Glasgow scale in the largest number of patients. The most severe general condition on admission was noted in patients with subdural hematoma localized in the frontal-parietal-occipital area. Out of 102 patients, only one patient was found to have moderate sleep disturbances when assessing the insomnia severity index and 13 patients were found to have mild sleep disturbances. The most common complaints of the patients when interviewed were a feeling of heaviness in the head after sleep, intermittent, shallow sleep. Conclusion. Interrupted sleep and heaviness in the head afterwards, as well as the need for daytime sleep, are the most frequent complaints about the sleep process in patients with a traumatic brain injury complicated with a subdural hematoma on the 13th-14th day after injury.

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Effectiveness of managing patients with subdural hematoma with a volume of 60-100 cm3 of various localization

Курский научно-практический вестник «Человек и его здоровье» ◽

10.21626/vestnik/2020-2/01 ◽

2020 ◽

pp. 4-9

Author(s):

Irina A. Balandina ◽

Anatoliy A. Balandin ◽

Mikhail K. Pankratov

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Subdural Hematoma ◽

Treatment Effectiveness ◽

Medical Documentation ◽

Acute Subdural Hematoma ◽

Temporal Region ◽

Occipital Region ◽

Group Iii ◽

Group I

The aim of the study was to determine the relationship between the effectiveness of treatment of patients with traumatic brain injury complicated by subdural hematoma and the localization of the hematoma. Materials and methods. The medical documentation of 52 patients with traumatic brain injury (TBI) complicated by acute subdural hematoma with a volume of 60-100 cm3 was retrospectively analyzed. Patients were divided into 3 groups depending on the location of the hematoma: group I consisted of 21 patients (40%) with hematoma localization in the frontotemporal region, group II - 18 patients (35%) with hematoma localization in the parietal - temporal region, group III - 13 patients (25%) with hematoma localization in the frontotemporal - occipital region. When patients are discharged from the hospital, their condition indicators are calculated according to the Rankin scale. Results. More often subdural hematomas were localized in the frontotemporal and parietal-temporal regions, less often in the frontotemporal-occipital region. The severity of the victims' condition, estimated at less than 10 points according to the Glasgow scale, prevailed in patients with TBI complicated by subdural hematoma localized in the frontal-parietal-occipital region. The volume of hematoma localized in the frontal-parietal-occipital region prevailed in comparison with the frontal-temporal and parietal-temporal regions (p<0.01). After completing treatment in a specialized department, the degree of independence and disability, less than 2 points according to the Rankin scale, was established in 31 (60%) of the 52 victims; of these, in 18 (35%) patients, the hematoma was localized in the frontotemporal region. Conclusion. The results of surgical treatment of patients with TBI complicated by subdural hematoma with a volume of 60-100 cm3 are interrelated with its localization. The best indicators of treatment effectiveness were found in patients with subdural hematoma localized in the frontotemporal region. The least effective treatment was observed when the hematoma was localized in the frontal-parietal-occipital region.

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