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.

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 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

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 Delayed brain reexpansion in schizophrenic patient affected by trabecular type chronic subdural hematoma

2021 ◽  
Vol 12 ◽  
pp. 442
Author(s):  
Salvatore Marrone ◽  
Roberta Costanzo ◽  
Gianluca Scalia ◽  
Giuseppe Emmanuele Umana ◽  
Carmelo Riolo ◽  
...  
Keyword(s):  
Schizophrenic Patient ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Management ◽  
Maximum Diameter ◽  
High Morbidity ◽  
Normal Brain ◽  
Factors Affecting ◽  
Brain Ct ◽  
Gcs Score

Background: Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy. Case Description: A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift. Conclusion: According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management.

scholarly journals A nomogram for estimating intracranial pressure using acute subdural hematoma thickness and midline shift

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Chun-Chih Liao ◽  
Heng-Chun Liao ◽  
Feipei Lai ◽  
Furen Xiao
Keyword(s):  
Intracranial Pressure ◽  
Subdural Hematoma ◽  
Element Model ◽  
Brain Parenchyma ◽  
Lookup Table ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
Numerical Convergence ◽  
Additional Information ◽  
Estimation Formula

AbstractAlthough criteria for surgical treatment of acute subdural hematoma (SDH) have been proposed, interaction exists between SDH, midline shift (MLS), and intracranial pressure (ICP). Based on our half sphere finite-element model (FEM) of the supratentorial brain parenchyma, tools for ICP estimation using SDH thickness (SDHx) and MLS were developed. We performed 60 single load step, structural static analyses, simulating a left-sided SDH compressing the cerebral hemispheres. The Young's modulus was taken as 10,000 Pa. The ICP loads ranged from 10 to 80 mmHg with Poisson's ratios between 0.25 and 0.49. The SDHx and the MLS results were stored in a lookup table. An ICP estimation equation was derived from these data and then was converted into a nomogram. Numerical convergence was achieved in 49 model analyses. Their SDHx ranged from 0.79 to 28.3 mm, and the MLS ranged from 1.5 to 16.9 mm. The estimation formula was log(ICP) = 0.614–0.520 log(SDHx) + 1.584 log(MLS). Good correlations were observed between invasive ICP measurements and those estimated from preoperative SDHx and MLS data on images using our model. These tools can be used to estimate ICP noninvasively, providing additional information for selecting the treatment strategy in patients with SDH.

Prognostic Factors after Acute Subdural Hematoma

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)

scholarly journals Rapid spontaneous resolution of traumatic acute subdural hematoma

2019 ◽  
pp. 464-469
Author(s):  
Gautam Sachidanand ◽  
Shringi Prashant
Keyword(s):  
Subdural Hematoma ◽  
Prognostic Score ◽  
Head Injuries ◽  
Critical Role ◽  
Case Series ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Acute Subdural Hematoma ◽  
High Morbidity ◽  
Rapid Reduction

Introduction: Acute subdural hematoma (ASDH) is the most common type of traumatic intra -cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The mortality rates are seen to be ranging from 40% to 90%, diagnosed on computed tomography (CT) as extra axial, hyperdense, crescent lesion between the Dura and brain parenchyma1. Acute SDH is an acute space occupying lesion to increase intracranial pressure (ICP), and is often complicated by co-existing intracranial lesions, including a variety of diffuse injuries, contusional hematomas, and edema. Acute subdural post-traumatic hematoma’s (SDH) continue to have a distressingly high morbidity and mortality.2 Clinical factors like presenting GCS, Pupils, time to operative interval, Hemodynamics and co-morbidities, plays a critical role in overall outcome from acute subdural hematoma.3Careful monitoring of the neurological status is mandatory even for selected acute SDH patients with intact consciousness and no brain shift because of the possibility of the unexpected worsening. Spontaneous resolution of an acute SDH has been reported in rare cases. We report a case series of spontaneous rapid reduction of acute SDH, also we discuss the prognosis of each patient according to a Clinicoradiological Prognostic Score developed by Gautam and Sharma3 as well as mechanisms related to the rapid resolution of acute SDH.

scholarly journals Acute subdural hematoma in the elderly: outcome analysis in a retrospective multicentric series of 213 patients

2020 ◽  
Vol 49 (4) ◽  
pp. E21 ◽  
Author(s):  
Gianluca Trevisi ◽  
Carmelo Lucio Sturiale ◽  
Alba Scerrati ◽  
Oriela Rustemi ◽  
Luca Ricciardi ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
The Elderly ◽  
Acute Subdural Hematoma ◽  
Outcome Predictors ◽  
Midline Shift ◽  
Radiological Findings ◽  
Entire Study ◽  
Good Outcome ◽  
Poor Outcome ◽  
Gcs Score

OBJECTIVEThe objective of this study was to analyze the risk factors associated with the outcome of acute subdural hematoma (ASDH) in elderly patients treated either surgically or nonsurgically.METHODSThe authors performed a retrospective multicentric analysis of clinical and radiological data on patients aged ≥ 70 years who had been consecutively admitted to the neurosurgical department of 5 Italian hospitals for the management of posttraumatic ASDH in a 3-year period. Outcome was measured according to the Glasgow Outcome Scale (GOS) at discharge and at 6 months’ follow-up. A GOS score of 1–3 was defined as a poor outcome and a GOS score of 4–5 as a good outcome. Univariate and multivariate statistics were used to determine outcome predictors in the entire study population and in the surgical group.RESULTSOverall, 213 patients were admitted during the 3-year study period. Outcome was poor in 135 (63%) patients, as 65 (31%) died during their admission, 33 (15%) were in a vegetative state, and 37 (17%) had severe disability at discharge. Surgical patients had worse clinical and radiological findings on arrival or during their admission than the patients undergoing conservative treatment. Surgery was performed in 147 (69%) patients, and 114 (78%) of them had a poor outcome. In stratifying patients by their Glasgow Coma Scale (GCS) score, the authors found that surgery reduced mortality but not the frequency of a poor outcome in the patients with a moderate to severe GCS score. The GCS score and midline shift were the most significant predictors of outcome. Antiplatelet drugs were associated with better outcomes; however, patients taking such medications had a better GCS score and better radiological findings, which could have influenced the former finding. Patients with fixed pupils never had a good outcome. Age and Charlson Comorbidity Index were not associated with outcome.CONCLUSIONSTraumatic ASDH in the elderly is a severe condition, with the GCS score and midline shift the stronger outcome predictors, while age per se and comorbidities were not associated with outcome. Antithrombotic drugs do not seem to negatively influence pretreatment status or posttreatment outcome. Surgery was performed in patients with a worse clinical and radiological status, reducing the rate of death but not the frequency of a poor outcome.

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