scholarly journals Delayed Treatment of Acute Subdural Hematomas: Retrospective Outcome Analysis of 215 Patients

2021 ◽  
Vol 9 (B) ◽  
pp. 779-785
Author(s):  
Kanat Akhmetov ◽  
Serik Akshulakov ◽  
Yerzhan Adilbekov ◽  
Altynshash Jaxybayeva ◽  
Mariya Dmitriyeva ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Basic Result ◽  
Treatment Method ◽  
Acute Subdural Hematoma ◽  
Outcome Analysis ◽  
Craniocerebral Injury ◽  
Delayed Treatment ◽  
Reduce Risk

BACKGROUND: The preferred treatment method for acute subdural hematoma (aSDH) is surgical intervention. AIM: We aimed to show that, regardless of the good results of surgical treatment, conventional delayed treatment might be very useful in some situations and might lead to chronicity of hematoma as well as reduction of surgical intervention scope and reduce risk of anesthesia. It might also give rise to spontaneous resorption of hematoma. METHODS: In the period March 1, 2013–March 1, 2020, we retrospectively examined 215 aSDH patients. The basic result of the outcome analysis was evaluated on the basis of the Glasgow Outcome Scale (GOS) at discharge after 3-month and 6-month follow-up. RESULTS: A total of 215 patients with aSDH and minor or moderate brain injury were examined, while applying conventional delayed treatment, the following results were obtained: large craniotomy was carried out in 123 patients (57.2%) on the 2nd–3rd day of observation, small craniotomy with drainage was applied in 29 patients (13.5%) and spontaneous resorption of subdural hematoma occurred in 63 patients (29.3%). The median score as per the Glasgow Coma Scale at admission to the hospital was 11.4. CONCLUSION: This study showed that conventional delayed treatment applied in patients with aSDH and minor or moderate craniocerebral injury might lead to chronicity and resorption of aSDH. The outcomes as per the GOS scale also showed good data three and 6 months after hospitalization.

scholarly journals Acute subdural hematoma as a complication of diagnostic lumbar puncture: case report

2016 ◽  
Vol 30 (4) ◽  
pp. 526-529
Author(s):  
Luis Rafael Moscote-Salazar ◽  
Andres M. Rubiano ◽  
Hernando Raphael Alvis-Miranda ◽  
Nasly Zabaleta-Churio ◽  
Willem Guillermo Calderón-Miranda ◽  
...  
Keyword(s):  
Case Report ◽  
Lumbar Puncture ◽  
Subdural Hematoma ◽  
Fluid Collection ◽  
Acute Subdural Hematoma ◽  
Acute Bacterial Meningitis ◽  
Red Flags ◽  
Diagnostic Lumbar Puncture ◽  
Head Computed Tomography

Abstract Background: Intracranial hemorrhagic complications are unusual after diagnostic lumbar puncture. Case report: A diagnostic lumbar puncture was performed in a 55 year-old male for acute bacterial meningitis workup. Immediately after the procedure he developed intense headache and a head Computed Tomography (CT) was done which identified an acute subdural fluid collection. No surgical management was offered and conservative medical follow-up was indicated. Conclusion: The occurrence of a headache with red flags after a lumbar puncture may suggest the possibility of an acute subdural hematoma.

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.

scholarly journals MON-298 IGF-1 in the Early Post-operative Assessment of Acromegaly

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Diane Donegan ◽  
Alicia Algeciras-Schimnich ◽  
Dana Z Erickson
Keyword(s):  
Cavernous Sinus ◽  
Surgical Intervention ◽  
Patient Anxiety ◽  
Cavernous Sinus Invasion ◽  
Delayed Treatment ◽  
First Line Therapy ◽  
Significant Difference ◽  
Suppression Test ◽  
Operative Assessment

Abstract Introduction: Transsphenoidal surgery is recommended as first line therapy in the vast majority of patients with acromegaly. Successful surgical intervention is determined by normalization of insulin like-growth factor (IGF) - 1 and adequate suppression of growth hormone (GH) during glucose GH suppression test or random GH levels <1.0 ng/mL. Given the long half-life of IGF-1, evolution of IGF-1 and GH assays and limitations of GH suppression test, clinicians remain reliant on IGF-1 results 3–6 months following surgery to assess disease remission following surgical intervention. This can lead to delayed treatment of patients with persistent disease and significantly increase patient anxiety. Aim: To determine if IGF-1 levels at 6 weeks were equally predictive of surgical outcomes when compared to IGF-1 levels at 3–6 months postoperative. Methods: Retrospective review of patients with newly diagnosed acromegaly who had surgery between 2010–2019 and had post-operative IGF-1 level measured at 6 weeks and 3–6 months. IGF-1 was measured using the Siemens Immulite assay until 2016 when it was replaced by a LC-MS/MS assay. IGF-1 measurements at 6 weeks are obtained based on clinician discretion. Results: 69 patients (mean age 49 ± 14.8, female 31/69, 44.9%) with acromegaly had surgery and IGF-1 follow-up measurements at 6 weeks and 3–6 months. Persistent acromegaly was noted in 45/69 at 3–6 months. The median IGF-1 pre-operative was 701 ng/ mL (289–1600), 6 weeks postoperative was 286 ng/ mL (109–1038) and at 3–6 months was 267 ng/ mL (77–996). The median pre-operative IGF-1 was significantly higher than the median IGF-1 level at 6 weeks and 3–6 months (P=<0.001). Although a statistically significant difference was seen between IGF-1 levels at 6 weeks and 3–6 months, the mean difference between these time points was small (20 ng/mL, P=<0.001). There was a greater percent reduction in IGF-1 at 6 weeks following surgery in those who had a normal IGF-1 at 3–6 months compared to those who did not (63% vs 35%, P=<0.01). Among patients who were deemed in remission at 3–6 months (24/69, 35%), 3/24 patients (all male with macroadenoma and no cavernous sinus invasion) had mildly elevated IGF-1 levels at 6 weeks (≤1.12 upper limit of normal) which subsequently normalized. In all of these patients, GH was <1 ng/mL post-op. In 1 male (macroadenoma and cavernous sinus invasion), IGF-1 levels increased from normal at 6 weeks to abnormal when measured at 3–6 months. Conclusion: In the vast majority of patients, 6 weeks post-operative IGF-1 can be used to assess response to surgery avoiding a delay in treatment. However, we would recommend repeating IGF-1 levels at 3–6 months in those who have marginally elevated IGF-1 above normal (≤ 1.12), without cavernous sinus invasion and a post-operative GH of <1 ng/mL prior to intervening if the IGF-1 is elevated 6 weeks as the IGF-1 may normalize.

scholarly journals DIagnostic Subdural EEG electrodes And Subdural hEmatoma (DISEASE): a study protocol for a prospective nonrandomized controlled trial

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Sae-Yeon Won ◽  
Thomas M. Freiman ◽  
Philipp S. Reif ◽  
Daniel Dubinski ◽  
Elke Hattingen ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Therapeutic Monitoring ◽  
Acute Subdural Hematoma ◽  
Secondary Outcome ◽  
Surgical Removal ◽  
Grid Electrode ◽  
Link Type ◽  
Epileptiform Discharges ◽  
Nonconvulsive Seizures

Abstract Background Epileptic seizures are common clinical features in patients with acute subdural hematoma (aSDH); however, diagnostic feasibility and therapeutic monitoring remain limited. Surface electroencephalography (EEG) is the major diagnostic tool for the detection of seizures but it might be not sensitive enough to detect all subclinical or nonconvulsive seizures or status epilepticus. Therefore, we have planned a clinical trial to evaluate a novel treatment modality by perioperatively implanting subdural EEG electrodes to diagnose seizures; we will then treat the seizures under therapeutic monitoring and analyze the clinical benefit. Methods In a prospective nonrandomized trial, we aim to include 110 patients with aSDH. Only patients undergoing surgical removal of aSDH will be included; one arm will be treated according to the guidelines of the Brain Trauma Foundation, while the other arm will additionally receive a subdural grid electrode. The study’s primary outcome is the comparison of incidence of seizures and time-to-seizure between the interventional and control arms. Invasive therapeutic monitoring will guide treatment with antiseizure drugs (ASDs). The secondary outcome will be the functional outcome for both groups as assessed via the Glasgow Outcome Scale and modified Rankin Scale both at discharge and during 6 months of follow-up. The tertiary outcome will be the evaluation of chronic epilepsy within 2–4 years of follow-up. Discussion The implantation of a subdural EEG grid electrode in patients with aSDH is expected to be effective in diagnosing seizures in a timely manner, facilitating treatment with ASDs and monitoring of treatment success. Moreover, the occurrence of epileptiform discharges prior to the manifestation of seizure patterns could be evaluated in order to identify high-risk patients who might benefit from prophylactic treatment with ASDs. Trial registration ClinicalTrials.gov identifier no. NCT04211233.

scholarly journals Acute Subdural Hematoma: Severity of Injury, Surgical Intervention, and Mortality

1993 ◽  
Vol 33 (1) ◽  
pp. 13-18 ◽  
Author(s):  
Shizuo HATASHITA ◽  
Nobunori KOGA ◽  
Yasuaki HOSAKA ◽  
Suguru TAKAGI
Keyword(s):  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Acute Subdural Hematoma ◽  
Severity Of Injury

scholarly journals Delayed Surgical Intervention in Acute Subdural Hematoma

Cureus ◽  
2020 ◽  
Author(s):  
Omar S Akbik ◽  
Robert Starling ◽  
Ross Green ◽  
Yiliang Zhu ◽  
Jeremy Lewis
Keyword(s):  
Subdural Hematoma ◽  
Surgical Intervention ◽  
Acute Subdural Hematoma

scholarly journals Significant increase in acute subdural hematoma in octo- and nonagenarians: surgical treatment, functional outcome, and predictors in this patient cohort

2017 ◽  
Vol 43 (5) ◽  
pp. E10 ◽  
Author(s):  
Sae-Yeon Won ◽  
Daniel Dubinski ◽  
Nina Brawanski ◽  
Adam Strzelczyk ◽  
Volker Seifert ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Functional Outcome ◽  
Subdural Hematoma ◽  
Clinical Status ◽  
The Elderly ◽  
Favorable Outcome ◽  
Acute Subdural Hematoma ◽  
Common Disease ◽  
Gcs Score

OBJECTIVEAcute subdural hematoma (aSDH) is a common disease increasing in prevalence given the demographic growth of the aging population. Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age ≥ 80 years) remain unclear. Therefore, the aims of this study were to evaluate the incidence of aSDH in patients 80 years or older, determine overall functional outcome, identify predictors of an unfavorable or favorable outcome, and establish specific risk factors for seizures.METHODSThe authors retrospectively analyzed patients 80 years and older who presented with isolated aSDH in the past 10 years at their institution. The following parameters were assessed: baseline characteristics, clinical status on admission and 24 hours after surgery, and clinical course. Functional outcome was assessed at discharge and the 3-month follow-up (FU).RESULTSIn the period from January 2007 to December 2016, 165 patients with aSDH were admitted to the authors’ institution. Sixty-eight patients (41.2%) were 80 years old or older, and the mean age overall was 85 years (range 80–96 years). The incidence of aSDH in the elderly had significantly increased over past decade, with more than 50% of patients admitted to our institution for aSDH now being 80 years or older. The overall mortality rate was 28% at discharge and 48% at the FU. Independent predictors of an unfavorable outcome at discharge were a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and pneumonia (p < 0.02). At the FU, a GCS score ≤ 8 at 24 hours after operation (p < 0.001) and cumulative comorbidities (≥ 5; p < 0.05) were significant independent predictors. All patients with more than 6 comorbidities had died by the FU. Surgical treatment in comatose compared to noncomatose patients had statistically significant, higher mortality rates at discharge and the FU. Still, 23% of the comatose patients and more than 50% of the noncomatose patients had a favorable outcome at the FU (p = 0.06).CONCLUSIONSThe number of octo- and nonagenarians with aSDH significantly increased over the last decade. These patients can achieve a favorable outcome, especially those with a noncomatose status and fewer than 5 comorbidities. Surgical and nonsurgical treatment of octo- and nonagenarians during and after discharge should be optimized to increase clinical improvement.

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

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.

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.

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

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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