Clinical, arteriographic, and cisternographic observations after removal of acute subdural hematoma

1975 ◽  
Vol 43 (1) ◽  
pp. 27-31
Author(s):  
Julian Hoff ◽  
John Grollmus ◽  
Barbara Barnes ◽  
M. Theodore Margolis
Keyword(s):  
Subdural Hematoma ◽  
Head Injuries ◽  
Acute Subdural Hematoma ◽  
Content Type ◽  
Closed Head Injuries ◽  
Postoperative Changes ◽  
Closed Head ◽  
Diagnostic Usefulness ◽  
Burr Holes

✓ The authors review 47 patients with closed-head injuries requiring treatment for acute subdural hematoma and report that 21 (45%) survived for 5 days or more. Follow-up study of these 21 survivors led to the following observations: that clinical evaluation of these patients is the most reliable index of their postoperative progress; that the diagnostic usefulness of postoperative cerebral arteriograms is limited because immediate postoperative changes tend to persist; that craniotomy is preferable to burr holes for removal of an acute hematoma; and that the value of cisternography, unless done serially, is limited since posttraumatic hydrocephalus develops rapidly and may persist indefinitely.

Long-term follow-up review of patients with acute and subacute subdural hematomas

1978 ◽  
Vol 48 (3) ◽  
pp. 345-349 ◽  
Author(s):  
Jarl Rosenørn ◽  
Flemming Gjerris
Keyword(s):  
Survival Rate ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Content Type ◽  
Subdural Hematomas ◽  
Long Term Follow Up ◽  
Fine Print ◽  
Back To Work

✓ The authors present 149 patients suffering from acute (112) and subacute (37) subdural hematomas admitted during the 10-year period 1965 to 1974, with a follow-up period of 2 to 12 years. During the time of observation, 104 patients died and 45 survived; 73% of the patients with acute and 27% with subacute subdural hematomas died. Of the patients with an acute subdural hematoma, 11% went back to work, as against 32% of those with subacute subdural hematomas. The 5-year survival rate was 28% in patients with acute and 76% in patients with subacute subdural hematomas.

Traumatic intracerebellar hematomas

1982 ◽  
Vol 56 (5) ◽  
pp. 691-694 ◽  
Author(s):  
Eugenio Pozzati ◽  
Claudio Grossi ◽  
Roberto Padovani
Keyword(s):  
Clinical Course ◽  
Head Injuries ◽  
Medical Complications ◽  
Content Type ◽  
Limited Size ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Study Support ◽  
Results Of Surgery ◽  
Fine Print

✓ Seven patients with “isolated” traumatic intracerebellar hematomas due to closed head injuries are presented. Computerized tomography parameters useful in the correct management of these hematomas include: location (hemisphere or midline), size, and appearance of the posterior fossa cisterns (intact or obliterated). Three patients with hemispheric hematomas were treated conservatively and recovered. One patient with a midline hematoma was managed conservatively and died. Three hematomas (one hemispheric and two midline) were operated on. The immediate results of surgery were good, but two patients died later due to medical complications. The results of this study support the concept that large hematomas (3 cm or greater) generally need surgery and that hemispheric hematomas of limited size (less than 3 cm) may be treated conservatively. The clinical course and prognosis of midline hematomas is grave, and evacuation of accessible hematomas should be considered early in the course of the disease.

The oval pupil: clinical significance and relationship to intracranial hypertension

1983 ◽  
Vol 58 (4) ◽  
pp. 566-568 ◽  
Author(s):  
Lawrence F. Marshall ◽  
David Barba ◽  
Belinda M. Toole ◽  
Sharon A. Bowers
Keyword(s):  
Intracranial Hypertension ◽  
Head Injuries ◽  
Transitional Stage ◽  
Content Type ◽  
Closed Head Injuries ◽  
Transtentorial Herniation ◽  
Neurosurgical Patients ◽  
Closed Head ◽  
Third Nerve ◽  
Fine Print

✓ The oval pupil, or what has also been termed the “oblong” or “football” pupil, has been observed in 15 neurosurgical patients over a 2-year period. In 14 of the 15 patients, the intracranial pressure (ICP) was elevated, ranging from 18 to 38 mm Hg. While the oval pupil was primarily seen in patients suffering closed head injuries (11 cases), it was also observed in two patients with elevated ICP following hemorrhage from an arteriovenous malformation. In nine of the 14 patients in whom the pupillary abnormality was associated with intracranial hypertension, the oval pupil disappeared when the ICP was reduced to below 20 mm Hg. In four cases, the ICP could not be controlled and the pupil became progressively larger, and finally fixed and unreactive. The oval pupil represents a transitional stage indicating transtentorial herniation with third nerve compression. Although it may be seen in the absence of intracranial hypertension (one case in this series), this appears to be relatively uncommon. The presence of such a pupil on examination in a patient suffering an intracranial catastrophe, be it head injury, subarachnoid hemorrhage, or intracerebral hemorrhage, suggests impending transtentorial herniation with brain-stem compression.

Acute subdural hematoma: morbidity, mortality, and operative timing

1991 ◽  
Vol 74 (2) ◽  
pp. 212-218 ◽  
Author(s):  
Jack E. Wilberger ◽  
Mark Harris ◽  
Danial L. Diamond
Keyword(s):  
Subdural Hematoma ◽  
Head Injuries ◽  
Survival Rates ◽  
Treatment Protocol ◽  
Critical Factor ◽  
Operative Intervention ◽  
Acute Subdural Hematoma ◽  
Content Type ◽  
Postoperative Control ◽  
Gcs Score

✓ Traumatic acute subdural hematoma remains one of the most lethal of all head injuries. Since 1981, it has been strongly held that the critical factor in overall outcome from acute subdural hematoma is timing of operative intervention for clot removal; those operated on within 4 hours of injury may have mortality rates as low as 30% with functional survival rates as high as 65%. Data were reviewed for 1150 severely head-injured patients (Glasgow Coma Scale (GCS) scores 3 to 7) treated at a Level 1 trauma center between 1982 and 1987; 101 of these patients had acute subdural hematoma. Standard treatment protocol included aggressive prehospital resuscitation measures, rapid operative intervention, and aggressive postoperative control of intracranial pressure (ICP). The overall mortality rate was 66%, and 19% had functional recovery. The following variables statistically correlated (p < 0.05) with outcome: motorcycle accident as a mechanism of injury, age over 65 years, admission GCS score of 3 or 4, and postoperative ICP greater than 45 mm Hg. The time from injury to operative evacuation of the acute subdural hematoma in regard to outcome morbidity and mortality was not statistically significant even when examined at hourly intervals although there were trends indicating that earlier surgery improved outcome. The findings of this study support the pathophysiological evidence that, in acute subdural hematoma, the extent of primary underlying brain injury is more important than the subdural clot itself in dictating outcome; therefore, the ability to control ICP is more critical to outcome than the absolute timing of subdural blood removal.

Early diagnosis of delayed posttraumatic intracerebral hematomas

1979 ◽  
Vol 50 (2) ◽  
pp. 217-223 ◽  
Author(s):  
Fernando G. Diaz ◽  
Douglas H. Yock ◽  
David Larson ◽  
Gaylan L. Rockswold
Keyword(s):  
Medical Center ◽  
Head Injuries ◽  
Ct Scans ◽  
Intracerebral Hematoma ◽  
Pertinent Literature ◽  
Content Type ◽  
Closed Head Injuries ◽  
Hennepin County ◽  
Closed Head ◽  
Cranial Injury

✓ Nine cases of delayed posttraumatic intracerebral hematomas (DTICH) were found retrospectively among 656 patients with closed head injuries admitted to the Hennepin County Medical Center in a 12-month period. All cases had severe head injuries sustained with the head in motion. The interval from cranial injury to diagnosis of DTICH by computerized tomography (CT) varied from 8 hours to 13 days. Eight patients were comatose on admission, three had focal seizures, and three had focal findings. The diagnosis was made on repeat CT scans obtained because of the development of focal findings in four cases, lack of improvement in four cases, and general neurological deterioration in one case. Four patients had initially negative CT scans. Four demonstrated only extracerebral hematomas on initial CT scan. One patient showed intracerebral hematoma on the initial scan followed by new hematomas on repeat study. The cases presented are discussed in light of pertinent literature.

Follow-up of Adolescent Trauma Victims: A New Model of Care

PEDIATRICS ◽  
1986 ◽  
Vol 77 (2) ◽  
pp. 236-241
Author(s):  
Marc S. Jacobson ◽  
Elaine M. Rubenstein ◽  
Wayne E. Bohannon ◽  
Diane L. Sondheimer ◽  
Regina Cicci ◽  
...  
Keyword(s):  
Short Term Memory ◽  
Developmental Stages ◽  
Head Injuries ◽  
Memory Loss ◽  
Recovery Process ◽  
Adolescent Trauma ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Time Required

A comprehensive model of service delivery for the rehabilitative care of adolescents with closed head injuries is presented. Our data show that the Glasgow Coma Scale score on hospital admission correlates with the length of time required for follow-up. Adolescents with mild closed head injuries require more follow-up than adults with comparable injuries because of adolescent developmental stages that complicate the recovery process. Anticipatory guidance has helped the patient and family cope with stresses. Finally, we have identified a typical pattern of difficulties during the recovery process including: impaired judgment, reduced attention span, irritability, short-term memory loss, and ongoing memory deficits.

Delayed traumatic intracerebral hematomas

1978 ◽  
Vol 48 (6) ◽  
pp. 1019-1022 ◽  
Author(s):  
Frederick D. Brown ◽  
Sean Mullan ◽  
Eugene E. Duda
Keyword(s):  
Head Injuries ◽  
Content Type ◽  
Closed Head Injuries ◽  
Closed Head ◽  
Fine Print

✓ Three patients are reported who developed delayed intracerebral hematomas following closed head injuries. Two patients showed hematomas within 24 hours after a normal computerized tomogram. All three were treated surgically, and two had good results.

Electroencephalographic Findings in MZ Twin Pairs, Discordant for Closed Head Injury

1968 ◽  
Vol 17 (2) ◽  
pp. 389-401 ◽  
Author(s):  
Ilmar A. Sulg ◽  
Sven J. Dencker
Keyword(s):  
Normal Population ◽  
Head Injuries ◽  
Closed Head Injury ◽  
Closed Head Injuries ◽  
Eeg Abnormalities ◽  
Head Injured ◽  
Closed Head ◽  
High Concordance ◽  
Eeg Pattern

SummaryA follow-up EEG study in 28 cases with closed head injuries, using MZ co-twins as controls, is described. A new concept in EEG analysis is introduced. A combined EEG code and point scale are more effective in discriminating subtle differences between two EEG records. A high concordance was found whether the EEG showed normal or abnormal patterns. Not only the head-injured twins but also the controls showed more abnormalities than in the normal population. Without this check by co-twins the EEG abnormalities could have been taken for persisting signs of the proband injury. It was found, however, in late follow-up that proband twins showed more EEG aberrations and abnormalities than co-twins, but the probands differed already in pre-traumatic mental make-up from their genetically identical controls. Neither differences in mental make-up nor in EEG characteristics showed any statistically significant correlation with the severity of the proband injury. These observations limit the significance of EEG abnormalities in late concussional states.This study also indicates that there are individually specific EEG patterns, which in health retain their characteristics throughout life. The EEG pattern is therefore concordant in identical twins. Thus, when a twin is influenced by a brain disease or lesion, the co-twin may serve as a biological control in both acute and follow-up studies.

Closed Head Injuries in Athletes

1990 ◽  
Vol 9 (2) ◽  
pp. 247-261 ◽  
Author(s):  
Lawrence B. Lehman ◽  
Steven J. Ravich
Keyword(s):  
Head Injuries ◽  
Closed Head Injuries ◽  
Closed Head
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