Bilateral Acute Subdural Hematoma Following Evacuation of Chronic Subdural Hematoma

2007 ◽  
Vol 41 (4) ◽  
pp. 267 ◽  
Author(s):  
Seok Won Kim ◽  
Seung Myung Lee ◽  
Ho Shin
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Acute Subdural Hematoma

Frequency of and Risk Factors for Chronification in Traumatic Acute Subdural Hematoma following Conservative Therapy

2019 ◽  
Vol 80 (05) ◽  
pp. 359-364 ◽  
Author(s):  
Stefanie Kaestner ◽  
Marina van den Boom ◽  
Wolfgang Deinsberger
Keyword(s):  
Risk Factors ◽  
Subdural Hematoma ◽  
Head Injuries ◽  
Chronic Subdural Hematoma ◽  
Length Of Hospital Stay ◽  
The Elderly ◽  
Coagulation System ◽  
Acute Subdural Hematoma ◽  
Neurosurgical Department ◽  
Anticoagulant Medication

Background In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. Methods We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. Results A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10–98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). Conclusion Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.

Chronic subdural hematoma in infancy

1990 ◽  
Vol 73 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Treatment Protocol ◽  
Chronic Subdural Hematoma ◽  
Neurological Deficits ◽  
Acute Subdural Hematoma ◽  
Hemorrhagic Diathesis ◽  
Content Type ◽  
Fine Print ◽  
Subdural Tapping

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

Factors Favoring the Development of Chronic Subdural Hematoma After Traumatic Acute Subdural Hematoma in the Elderly

2021 ◽  
pp. 000313482110562
Author(s):  
Tarik Wasfie ◽  
Nicholas Fitzpatrick ◽  
Mursal Niasan ◽  
Jennifer L. Hille ◽  
Raquel Yapchai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Anticoagulant Therapy ◽  
Subdural Hematoma ◽  
Significant Risk ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Acute Subdural Hematoma ◽  
Mortality Data ◽  
Group A

Introduction Traumatic acute subdural hematoma (TASDH) is by far the most common traumatic brain injury in elderly patients presented to the emergency department, and a number of those treated conservatively will develop chronic subdural hematoma (CSDH). The factors contributing to chronicity were not well studied in the elderly; therefore, we retrospectively analyzed our elderly patients with acute subdural hematomas to identify the risk factors which might contribute to the development of subsequent CSDH. Methods A retrospective analysis of 254 patients with TASDH admitted between 2012 and 2016 to our level 2 trauma department in a community hospital was collected. Data include age, sex, comorbid conditions, CT findings, anticoagulant therapy, surgical interventions, disposition after discharge, and mortality. Data on those readmitted within the first 2 months with the diagnosis of CSDH were also studied (group A), and compared to those not readmitted (group B). Multiple logistic regression was used to determine the risk factors associated with readmission at P ≤ .05. Institutional review board approval was obtained for this study. Results There were 254 patients who were admitted with TASDH, 144 male (56.7%) and 110 female (43.3%), with the mean age of 71.4 (SD ± 19.38) years. Only 37 patients (14.6%) went for surgery in their initial admission. A total of 14 patients (5.6%) were readmitted subsequently with the diagnosis of CSDH within two months of initial discharge (group A). Only four patients (28.5%) were on anticoagulant therapy and these patients went for emergency craniotomy for evacuation of hematoma. All 14 patients had a history of coronary artery disease and hypertension and only 5 (35.7%) were diabetic. Review of head CT on initial admission of those patients revealed 4 patients (28.5%) had multiple lesions and 4 (28.5%) had tentorial/falax bleeding and 4 (28.5%) had a shift. The initial size and thickness of the bleeding was 1.4-5 mm. The adjusted model identified diabetes, race, and initial disposition as significant risk factors ( P < .05). Conclusion Risk associated with the transformation of TASDH to CSDH is difficult to assess in those group of elderly patients because of the small number; however, diabetes, race, and initial disposition to home pointed toward a risk for future development of CSDH and those patients should be followed clinically and radiographically over the next few months after discharge, particularly those on anticoagulant therapy.

scholarly journals Acute Subdural Hematoma after Irrigation of the Contralateral Chronic Subdural Hematoma in a Hemodialyzed Patient

1986 ◽  
Vol 26 (6) ◽  
pp. 510-513
Author(s):  
Kazuya NAGATA ◽  
Takafumi IDE ◽  
Norihiko BASUGI ◽  
Yoshinori SEZAI
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Hemodialyzed Patient

Surgical Procedure in the Treatment of Organized Chronic Subdural Hematoma: A Single-Center Experience

2021 ◽  
Author(s):  
Keng Chen ◽  
Kun Wang ◽  
Danzhi Chen ◽  
Huanjiang Niu ◽  
Shuxu Yang ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Surgical Procedure ◽  
Clinical Symptoms ◽  
Chronic Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Imaging Data ◽  
Single Center ◽  
Single Center Experience ◽  
Significant Difference ◽  
Better Than

Abstract Background Organized chronic subdural hematoma (CSDH) is a special type of CSDH. However, the optimal surgical procedure has not been established. We present our experience here to discuss the surgical procedure in treatment of organized CSDH. Methods Thirty-three patients with organized CSDH were admitted between January 1, 2008 and January 1, 2018. Age, gender, clinical symptoms, imaging data, type of surgical procedure, Barthel index (BI), and postoperative complications were collected and retrospectively analyzed. The BI was assessed both pre and postoperatively (1 week and 1 month after surgery). Results Overall, 14 patients underwent large craniotomy and 19 patients underwent small craniotomy. No significant differences in gender, age, initial clinical symptoms, and preoperative BI were found between the groups (p > 0.05). Among the 14 patients who underwent large craniotomy, 2 patients developed epilepsy after the operation, while 1 patient had postoperative aphasia. None of the patients had recurrence in 6 months postoperatively. Among the 19 patients who underwent small craniotomy, 1 patient developed an acute subdural hematoma and 1 patient developed aphasia. No obvious complications were found in the remaining 18 patients and none of the 19 patients had recurrence in 6 months postoperatively. BI scores of the small craniotomy group were significantly better than those of the large craniotomy group at 1 week postoperatively (p < 0.05). However, there was no significant difference in the 1-month results (p > 0.05). Conclusion According to our single-center experience, a small craniotomy for treating organized CSDH can be considered as an alternative to a larger craniotomy.

scholarly journals Contralateral Development of Acute Subdural Hematoma Following Surgery for Chronic Subdural Hematoma —Case Report—

1992 ◽  
Vol 32 (13) ◽  
pp. 969-971 ◽  
Author(s):  
Katsuhiko HARADA ◽  
Katsuyasu OHTSURU ◽  
Kenji NAKAYAMA ◽  
Shigeyuki TAKAGI ◽  
Minoru SHIGEMORI ◽  
...  
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Acute Subdural Hematoma
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