Delayed Onset of Posttraumatic Acute Subdural Hematoma After Mild Head Injury With Normal Computed Tomography: A Case Report and Brief Review

Abstract A case is presented in which a patient sustained a closed head injury with subsequent acute subdural hematoma and delayed posterior dislocation of the atlas without fracture of the odontoid process and with an intact C-1 arch. The subdural hematoma was treated operatively. The atlas dislocation was managed with closed reduction without manipulation and subsequent posterior fusion of C-1, C-2, and C-3. The patient was intact neurologically on admission and remained so throughout his hospitalization.

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Correlation of Initial Computed Tomography Findings with Outcomes of Patients with Acute Subdural Hematoma: A Prospective Study

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713721 ◽

2020 ◽

Author(s):

Ajay Choudhary ◽

Kaviraj Kaushik ◽

Surya Narayanan Bhaskar ◽

Laxmi Narayan Gupta ◽

Rajesh Sharma ◽

...

Keyword(s):

Computed Tomography ◽

Head Injury ◽

Ct Scan ◽

Subdural Hematoma ◽

Emergency Services ◽

Skull Fracture ◽

Contralateral Side ◽

Acute Subdural Hematoma ◽

Outcome Analysis ◽

Midline Shift

AbstractIn modern emergency service systems, patients are often treated with sedation, intubation, and ventilation at the accident site. But neurosurgical assessment before all these emergency services is important. Thus, this study was designed to investigate the relationships between various parameters of initial CT scan findings and the outcomes of the patients. Methodology A total of 56 adult patients of traumatic acute subdural hematoma (SDH) whose computed tomography (CT) scan was performed within 8 hours of injury were recruited. The patients with prolonged hypotension, open head injury or depressed skull fracture, bilateral side acute SDH, or contusions/hematoma/extradural hematoma on the contralateral side were excluded. Six separate CT findings were analyzed and recorded, including hematoma, midline shift, subarachnoid hemorrhage (SAH), presence of basal cistern obliteration (BCO), intraparenchymal hematoma/contusion in the same hemisphere, and presence of effacement of the sulcal spaces, and were followed up for three months for outcome analysis. Results The overall mortality and functional recovery rate were 27 and 50%, respectively. The patients with obliterated basal cisterns and the presence of underlying SAH in patients with acute SDH had statistically significant poorer outcomes as compared with others. However, the extent of midline shift, SDH thickness, and the presence of underlying contusions and sulcal effacement on initial CT scan showed no statistically significant correlation with patients’ outcomes. Conclusions BCO and presence of subarchnoid hemorrhage underlying acute SDH on the earliest scan in head injury patients signify the severity of brain parenchymal injury. Along with the initial Glasgow Coma Scale score after resuscitation, these two factors should be considered as the most significant ones for predicting the outcomes in traumatic acute SDH patients.

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A Prospective Study on Acute Subdural Hematoma in Mild Head Injury Patients: Outcome with Initial Nonoperative Management

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1677636 ◽

2018 ◽

Vol 15 (02/03) ◽

pp. 082-086

Author(s):

R. K Barooah ◽

Hriday Haloi ◽

B. K. Baishya ◽

Kishore Sarma

Keyword(s):

Head Injury ◽

Prospective Study ◽

Decompressive Craniectomy ◽

Conservative Management ◽

Subdural Hematoma ◽

Nonoperative Management ◽

Acute Subdural Hematoma ◽

Mild Head Injury ◽

A Prospective Study

Abstract Introduction Incidence of acute subdural hematoma (SDH) is 21% in head injury patients. Decompressive craniectomy done for acute SDH itself carries a very high morbidity and mortality. The skull bone defect, prolonged hospital stay, the need of a second surgery (cranioplasty), and bone flap infection are other problems associated with decompressive craniectomy. Hence, this study looks into the outcome of conservative management in acute SDH in patients with mild head injury. Aims and Objectives The main objective of this article is to study the patients included in the study with regard to outcome, morbidity, duration of hospital stay, and hospital cost. This article also studies the efficacy and outcome of lesser aggressive management (burr-hole evacuation) after initial nonoperative management of the patients included in the study. Materials and Methods This is a prospective study performed in the Department of Neurosurgery, Gauhati Medical College and Hospital. A total of 30 patients arriving in the emergency department during a 6-month period from December 1, 2017 to May 31, 2018 with a diagnosis of acute SDH and with Glasgow coma scale (GCS) 13 to 15 were evaluated. Evaluation was done by history, clinical examination, GCS, computed tomography (CT) (plain) scan brain, and Glasgow outcome score at 6 months follow-up. Results and Observations Twenty patients showed complete resolution of the clot, and eight patients had liquefaction of clot which was evacuated by burr-hole. One mortality was recorded and one had to undergo decompressive craniectomy. About 93.33% of patients managed by initial nonoperative management showed functionally independent outcome at 6 months follow-up. Conclusion Conservative management in patients with acute SDH can be a viable alternative in certain cases. Those patients with GCS of 13 and above with CT scan showing midline shift of even ≥5 mm or thickness of 10 mm and more can also be managed conservatively by close monitoring.

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