Acute Subdural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 17-26
Author(s):  
Benjamin McGahan ◽  
Nathaniel Toop ◽  
Varun Shah ◽  
John McGregor
Keyword(s):  
Brain Injury ◽  
Arteriovenous Malformation ◽  
Conservative Management ◽  
Epidural Hematoma ◽  
Mass Effect ◽  
Acute Subdural Hematoma ◽  
Subdural Space ◽  
Cortical Injury ◽  
Subdural Hematomas ◽  
Hemorrhagic Lesion

Acute subdural hematomas are collections of acute blood in the subdural space. They usually present as a result of significant head trauma. They can occur spontaneously in relationship to an underlying hemorrhagic lesion such as tumor, arteriovenous malformation, or aneurysm. They are more likely to be associated with cortical injury than the epidural hematoma. Neurological symptoms on presentation are related to the underlying brain injury and/or mass effect. Acute subdural blood on CT scan is hyperdense, in a crescent shape, along the inner dural surface. Emergent surgical intervention via craniotomy is indicated in patients with at least 10 mm in thickness or at least 5 mm shift, or elevated ICP, or pupillary dilatations suggesting herniation, or progression of deficit based on the Glasgow Coma Score. Conservative management of small acute subdural hematomas may be done in select situations that include proper ICU monitoring for ICP elevations and neurological deteriorations.

scholarly journals P.082 Traumatic inter hemispheric subdural hematomas – clinical presentation, management and outcome

2016 ◽  
Vol 43 (S2) ◽  
pp. S39-S40
Author(s):  
R Bokari ◽  
S Schur ◽  
C Couturier ◽  
A Al-Azri ◽  
J Marcoux ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Conservative Management ◽  
Subdural Hematoma ◽  
Trauma Center ◽  
Complete Resolution ◽  
Clinical Presentation ◽  
Acute Subdural Hematoma ◽  
Detailed Review ◽  
Subdural Hematomas ◽  
Level I

Background: There is currently little data on the incidence, clinical outcome and management of traumatic interhemispheric subdural hematomas (IHSDHs). Methods: All patients admitted with an acute subdural hematoma (SDH) over a 5-year period at a Level I trauma center were included. A detailed review of all cases of large IHSDH (≥7 mm) was performed to document clinical presentation, management and outcomes. Results: Of 1182 patients with acute subdural hematomas (SDHs), 420 had IHSDHs (24%), and 50 were large IHSDHs. For patients with large IHSDH, the average age was 76 years (±11) and 44% were female. The average GCS was 12 on presentation (±4), and the average GOSE was 4 (±2). 66% of patients had associated cranial/ intracranial injuries (fracture, subarachnoid/epidural/SDH) and 26% required operations for acute convexity SDH. Three patients required operations for their IHSDH by inter hemispheric approach. By 10 weeks, 82% had a complete resolution of the IHSDHs. Conclusions: IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is often appropriate to manage even large IHSDHs, as most resolve spontaneously. This study will help document the occurrence of falx syndrome, as well as the management and outcomes of larger IHSDHs.

Acute subdural hematomas of arterial origin

1974 ◽  
Vol 41 (4) ◽  
pp. 435-439 ◽  
Author(s):  
Paul K. O'Brien ◽  
John W. Norris ◽  
Charles H. Tator
Keyword(s):  
Vessel Wall ◽  
Arterial Wall ◽  
Acute Subdural Hematoma ◽  
Subdural Space ◽  
Small Surface ◽  
Content Type ◽  
Subdural Hematomas ◽  
Arterial Bleeding ◽  
Fine Print

✓ Five cases of acute subdural hematoma associated with bleeding from cortical arteries are described. In the four cases in which the affected vessel was examined histologically, there was a defect in the arterial wall secondary to avulsion of a small surface twig, which had apparently been traversing the subdural space. The possible mechanisms for damage to the vessel wall and the role of this arterial bleeding in subdural hematomas are discussed.

Predicting Outcome and Conservative Treatment Failure in Patients with Skull Fracture after Traumatic Brain Injury: A Retrospective Cohort Study

2019 ◽  
Vol 80 (06) ◽  
pp. 460-469
Author(s):  
Ernest J. Bobeff ◽  
Bartłomiej J. Posmyk ◽  
Katarzyna Ł. Bobeff ◽  
Jan Fortuniak ◽  
Karol Wiśniewski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Conservative Treatment ◽  
Treatment Failure ◽  
Epidural Hematoma ◽  
Skull Fracture ◽  
Mass Effect ◽  
Independent Risk Factors ◽  
Neurosurgical Intervention

Abstract Objective Traumatic brain injury (TBI) remains a major cause of morbidity and mortality worldwide. The prognostic value of skull fracture (SF) remains to be clearly defined. To evaluate the need for neurosurgical intervention and determine the risk factors of conservative treatment failure (CTF), we retrieved from the hospital database the records of patients with SF after TBI. Methods We analyzed 146 consecutive patients (mean age: 49.8 ± 17.5 years) treated at the department of neurosurgery in a 5-year period. Clinical data, radiologic reports, and laboratory results were evaluated retrospectively. Results A total of 63% of patients were treated conservatively, 21.9% were operated on immediately, and 15.1% experienced CTF. Overall, 73.3% had a favorable outcome; the mortality rate was 13%. Intracranial bleeding occurred in 96.6% of cases, basilar SF in 61%, and cerebrospinal fluid (CSF) leak in 2.8%. The independent risk factors for outcome were Glasgow Coma Scale (GCS) score, age, and platelet count (PCT). The independent risk factors for CTF were epidural hematoma, subdural hematoma, mass effect, edema, international normalized ratio, PCT, mean platelet volume, and CSF leakage. The consensus decision tree algorithm used at the accident and emergency department indicated patients with no need for neurosurgical intervention with an accuracy of 91.7%, sensitivity of 88.9%, and featured the importance of mass effect, GCS, and epidural hematoma. Conclusions Tests included in the complete blood count appeared useful for predicting the course in patients with SF, although the most important factors were age and neurologic status, as well as radiologic findings. Our decision tree requires further validation before it can be used in everyday practice.

Chronic Subdural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 27-34
Author(s):  
Nathaniel Toop ◽  
Benjamin McGahan ◽  
Varun Shah ◽  
John McGregor
Keyword(s):  
Old Age ◽  
Conservative Management ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Neurological Dysfunction ◽  
Cortical Surface ◽  
Subdural Space ◽  
Presenting Symptoms ◽  
Subdural Drain ◽  
The Brain

Chronic subdural hematomas are collections of blood in the subdural space. They can present variably in size and age. They can present as a single hemorrhage event or with evidence of repeated hemorrhages. They tend to be more common in an aging population. The associated trauma can be surprisingly minimal. The brain atrophy associated with old age allows for more room for subdural blood to pool prior to causing significant neurological dysfunction. They may occur spontaneously, and the symptoms relate to mass effect and irritation of the cortical surface. Treatment varies depending on presenting symptoms, size, chronicity, and degree of septations. Care should be taken in surgical cases to avoid disruption of the cortical surface, assure hemostasis prior to closure, and consider placement of a subdural drain. Growing evidence suggests there is a roll for conservative management in select presentations.

Traumatic Epidural and Subdural Hematomas

2019 ◽  
pp. 614-620
Author(s):  
Patrick R. Maloney ◽  
Michelle J. Clarke
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
Cerebral Edema ◽  
Subdural Hematoma ◽  
Epidural Hematoma ◽  
Nonoperative Management ◽  
Mass Effect ◽  
Increased Intracranial Pressure ◽  
Cerebral Herniation

Traumatic brain injury is a broad topic and encompasses a spectrum of pathophysiologic disorders that result in increased intracranial pressure (ICP), cerebral edema, bleeding, mass effect, cerebral herniation, and death. Traumatic epidural hematoma (EDH) and subdural hematoma (SDH) are the focus of this chapter. EDH and SDH are intracranial blood collections that have mass effect within the intracranial vault (Figure 88.1) for which operative and nonoperative management criteria are established.

Hyperbaric oxygen therapy in the treatment of malign edema complication after arteriovenous malformation radiosurgery

2019 ◽  
pp. 713-717
Keyword(s):  
Arteriovenous Malformation ◽  
Hyperbaric Oxygen ◽  
Vasogenic Edema ◽  
Mass Effect ◽  
Radiological Examination ◽  
Temporal Region ◽  
Left Frontal Lobe ◽  
Steroid Resistant ◽  
Alternative Treatment Option ◽  
Martin Grade

A 16-year-old female patient with headache was admitted to our hospital. Radiological examination showed a Spetzler- Martin Grade III arteriovenous malformation (AVM) located at the left frontal lobe. Volume-staged stereotactic radiosurgery (SRS) treatment performed in two fractions at three-month intervals and post-procedural period were uneventful. Eight months later the patient was admitted to our hospital with headache, vomiting, right-sided facial palsy and right upper extremity paresthesia. Radiological examination demonstrated severe vasogenic edema in the left centrum semiovale and temporal region. Due to severe and steroid-resistant malign edema, hyperbaric oxygen (HBO2) therapy was performed as an alternative treatment option. Neurological symptoms resolved completely after HBO2. Radiological examination demonstrated serious improvement of brain edema and mass effect.

Acute subdural hematoma

1982 ◽  
Vol 57 (2) ◽  
pp. 254-257 ◽  
Author(s):  
Henry A. Shenkin
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Neurological Status ◽  
Neurological Dysfunction ◽  
Acute Subdural Hematoma ◽  
Consecutive Series ◽  
Content Type ◽  
Subdural Hematomas ◽  
Fine Print

✓ In a consecutive series of 39 cases of acute subdural hematoma (SDH), encountered since computerized tomography diagnosis became available, 61.5% were found to be the result of bleeding from a small cortical artery, 25.6% were of venous origin, 7.7% resulted from cerebral contusions, and 5% were acute bleeds into chronic subdural hematomas. Craniotomy was performed promptly on admission, but there was no difference in survival (overall 51.3%) between patients with arterial and venous bleeds. The only apparent factor affecting survival in this series was the preoperative neurological status: 67% of patients who were decerebrate and had fixed pupils prior to operation died. Of patients with less severe neurological dysfunction, only 20% failed to survive.

scholarly journals Clinical application of magnetic resonance in acute traumatic brain injury

2008 ◽  
Vol 66 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Dionei F. Morais ◽  
Antonio R. Spotti ◽  
Waldir A. Tognola ◽  
Felipe F.P. Gaia ◽  
Almir F. Andrade
Keyword(s):  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Magnetic Resonance ◽  
Subdural Hematoma ◽  
Diffuse Axonal Injury ◽  
Correlation Method ◽  
Acute Subdural Hematoma ◽  
Acute Traumatic Brain Injury ◽  
Magnetic Resonance Imaging Mri

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.

Development of a de novo arteriovenous malformation after severe traumatic brain injury

2014 ◽  
Vol 14 (4) ◽  
pp. 418-420 ◽  
Author(s):  
Brandon A. Miller ◽  
David I. Bass ◽  
Joshua J. Chern
Keyword(s):  
Traumatic Brain Injury ◽  
Cerebral Cortex ◽  
Brain Injury ◽  
Arteriovenous Malformation ◽  
Severe Traumatic Brain Injury ◽  
Arteriovenous Malformations ◽  
De Novo ◽  
First Report ◽  
Congenital Lesions

Arteriovenous malformations (AVMs) are typically considered congenital lesions, although there is growing evidence for de novo formation of these lesions as well. The authors present the case of an AVM in the same cerebral cortex that had been affected by a severe traumatic brain injury (TBI) more than 6 years earlier. To the best of the authors' knowledge, this is the first report attributing the formation of an AVM directly to TBI.

Sign in / Sign up

Export Citation Format

Share Document