scholarly journals Early Decompressive Craniectomy in Subdural Hematoma and Good Outcome – Case Report

2021 ◽  
pp. 1-2
Author(s):  
Richam Faissal El Hossain Ellakkis ◽  
◽  
Beatriz Larentis de Souza ◽  
Keyword(s):  
Ct Scan ◽  
Decompressive Craniectomy ◽  
Subdural Hematoma ◽  
Brain Trauma ◽  
Neurological Deficits ◽  
Early Surgery ◽  
Midline Shift ◽  
Critical Feature ◽  
Good Outcome ◽  
Specific Paper

A 20-year-old man presented to our Hospital with severe brain trauma, hit by a car while he was riding a bike. On the arrival at the emergency room (ER) his Glasgow Coma Scale (GCS) was 4 (eyes 1; verbal 1 and motor 2) with fixed midriatic pupils and submitted to mechanical ventilation. A CT scan was performed and revealed a subdural hematoma, midline shift greater than 5mm and a swelling, Marshall V (surgically evacuated). The patient was submitted to a decompressive craniectomy and hematoma evacuation two hours after the accident and sent to ICU with ICP monitoring. About 48 hours after surgery a new CT scan was performed and revealed a good outcome with regression of the edema, no midline shift and then we suspended the sedation and 7 days after the trauma the patient woke up without neurological deficits. Some authors did not see benefits in early surgery although the average time of surgical approach was 5 hours after the accident and in many cases the worse patients that underwent to early surgery had a poor outcome. We did not find a specific paper describing the outcome in patients with a very poor GCS ( less than 5 ) and fixed pupils, although the pupils abnormalities remains a critical feature for surgical indication. We believe that even in patient with severe brain trauma, poor GCS and non-reactive pupils, early surgery especially if it is performed before 4 hours can probable improves the outcome, considering other clinical features such as blood pressure and oxygen saturation

scholarly journals Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

2014 ◽  
Vol 21 (1) ◽  
pp. 109-112
Author(s):  
P. Sasikala ◽  
Bindu Menon ◽  
Amit Agarwal
Keyword(s):  
Ct Scan ◽  
Movement Disorders ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Midline Shift ◽  
Rare Presentation ◽  
Surgical Evacuation ◽  
Significant Mass Effect ◽  
Significant Mass

Abstract Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

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 Correlation between Head Computed Tomography Scan, Pre-operative Blood Lactate, and Pre-operative Glucose Level in Acute Traumatic Subdural Hematoma

2021 ◽  
Vol 53 (2) ◽  
Author(s):  
Jefri Henky ◽  
◽  
Ahmad Faried
Keyword(s):  
Blood Glucose ◽  
Ct Scan ◽  
Blood Lactate ◽  
Subdural Hematoma ◽  
Midline Shift ◽  
Head Ct ◽  
Positive Correlation ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Weak Positive Correlation

Acute traumatic subdural hematoma (SDH) is a focal brain injury resulting in alteration of cerebral perfusion and glucose metabolism, which would also results in hyperglicemia-induced-hyperlactatemia. A cross-sectional study was performed to analyze acute traumatic SDH patients by head CT scan and observe the effect on pre-operative blood lactate and blood glucose levels in 40 acute traumatic SDH patients at Dr. Hasan Sadikin Hospital, Bandung, Indonesia during the period of July-September 2013. Somers' D correlation were used in the analysis with a p-value of ≤0.05 considered as significant with 95% confidence interval. The mean values of pre-operative blood lactate and blood glucose levels were 3.16±1.49 mmol/L and 155.85±32.95 mg/dl, respectively with a strong positive correlation between the hematoma thickness and the increase in blood lactate (r= 0.656; p= 0.021) and a moderate positive correlation with increased blood glucose (r= 0.556; p= 0.025). In addition, the compressed cistern also had a very weak positive correlation with increase in blood lactate (r =0.156; p=0.043) and very weak positive correlation with increase in blood glucose (r= 0.139; p=0.056) while the midline shift had a weak positive correlation with increased blood lactate (r=0.353; p= 0.041) and a weak positive correlation with increased blood glucose (r = 0.333; p= 0.046). In conclusion, increased hematoma thickness, compressed cistern, and midline shift seen on head CT scan correlate with increasing blood lactate and glucose levels in acute traumatic SDH. Head CT scan, blood lactate level, and blood glucose level can be considered as one of the routine examinations to determine acute traumatic SDH severity at the macroscopic and cellular level.

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.

scholarly journals A STUDY ON CORRELATION OF DEGREE OF MIDLINE SHIFT ON CT SCAN AND GLASGOW COMA SCALE IN PATIENTS OF ACUTE TRAUMATIC HEAD INJURY

2020 ◽  
Vol 4 (8) ◽  
Author(s):  
Sandeep Kumar ◽  
Narendra Kumar Kardam ◽  
Kushal babu Gahlot ◽  
Manphhol Singh Maharia
Keyword(s):  
Head Injury ◽  
Glasgow Coma Scale ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Midline Shift ◽  
Extradural Hematoma ◽  
Traumatic Head Injury ◽  
Coma Scale ◽  
Depressed Fracture ◽  
Traumatic Head

Background: The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Other variables such as Glasgow coma scale have been subsequently introduced to build more complex and accurate prognostic model. Methods: A study was conducted on patients with acute traumatic head injury. Most common and important complication of traumatic head injury is the development of an increased intracranial pressure resulting in midline shift. The larger the amount of the midline shift on CT scan the poorer will be the outcome of traumatic head injury. Results: External injury of scalpel is seen in 92% of cases, blackening of eye in 50% & vomiting in 50%. Cerebral contusion (50%) was the most common CT scan finding followed by depressed fracture (32%), subdural hematoma (22%) than extradural hematoma (6%). Hemorrhagic contusion was the most common CT scan finding irrespective of GCS score. In patients with GCS 3-5 other outcome findings are extradural hematoma, subdural hematoma, & depressed fracture. In patients with GCS 6-8 other common findings are extradural hematoma, depressed fracture & hemorrhagic contusion. In patients with GCS 9-12 other common findings were hemorrhagic contusion, depressed fracture & intra cerebral hematoma. In patients with GCS 13-15 other common findings were depressed fracture, hemorrhagic contusion. Conclusions: The increased degree of midline shift in patients with head injuries by CT scan was related to the severity of head injury (GCS= 3-12) and was significantly related to poor final clinical outcome. Keywords: CT scan, Glasgow coma scale, acute traumatic head injury.

scholarly journals The impaction of time from injury to surgery in functional recovery of traumatic acute subdural hematoma

2020 ◽  
Author(s):  
Shih-Han Chen ◽  
Jui-Ming Sun ◽  
Wen-Kuei Fang
Keyword(s):  
Ct Scan ◽  
Scale Score ◽  
Functional Recovery ◽  
Roc Curve ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
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 minutes, P-value=0.001). TIS was a significant factor for functional outcomes in the univariate and 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 an important factor l for the functional recovery of comatose TASDH patients who underwent surgery.

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.

scholarly journals Decompressive Craniectomy (DC) - Comparative Study of 30-Day Mortality in Surgeries of Severe Brain Trauma with Subdural Hematoma, with and without DC

2016 ◽  
Vol 36 (01) ◽  
pp. 21-25
Author(s):  
Lucas Bonadio ◽  
Luis Mello ◽  
Leandro Haas ◽  
Vitor Boer ◽  
Celso Bernardes ◽  
...  
Keyword(s):  
Comparative Study ◽  
Decompressive Craniectomy ◽  
Subdural Hematoma ◽  
Brain Lesion ◽  
Acute Subdural Hematoma ◽  
Midline Shift ◽  
Outcome Predictor ◽  
Brain Swelling ◽  
Group 2 ◽  
Group 1

Objective Compare 30 days mortality of patients harboring acute subdural hematomas in two series, one treated only by wide aspiration of hematoma and other with aspiration followed by decompressive craniectomy. Methods Comparing retrospectively two series of ASD with and without DC. Involved 81 TBI patients with acute subdural hematoma and GCS ≤ 8 (Jan 2000 to Nov 2014) arranged into two groups. Group 1 - 58 cases underwent to DC. Group 2 - 23 patients underwent only hematoma aspiration. Results Group 1 showed 44.8% mortality directly due to brain lesion within 30 days. The most frequent associated lesion were contusion in 37.2%. Group 2 the mortality within 30 days was 47.8%. The majority of deaths (82%) resulted from uncontrollable brain swelling, midline shift was present in 94.7% of patients. Conclusion High admission GCS and age less than 50 remain better outcome predictor in 30 days survival for patients undergoing surgery of traumatic ASDH.

scholarly journals Efficiency and Limitations of Decompressive Craniectomy in Patients after Traumatic Brain Injury – Preliminary Results

2017 ◽  
Vol 17 (3) ◽  
pp. 32-38
Author(s):  
M Hanko ◽  
R Richterova ◽  
B. Kolarovszki
Keyword(s):  
Traumatic Brain Injury ◽  
Prognostic Factors ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Full Potential ◽  
Midline Shift ◽  
Unfavourable Outcome ◽  
Good Outcome ◽  
Tier Ii ◽  
Intraventricular Bleeding

Abstract Introduction: Decompressive craniectomy (DC) has been recently proven effective tier II therapeutic procedure in the treatment of refractory posttraumatic intracranial hypertension. However, its full potential and effectivity is yet to be described and this surgery remains controversial. The goals of our study include analysis of efficiency of DC and description of risk factors associated with unfavourable outcome. Methods: 24 patients who underwent DC at the Clinic of Neurosurgery, JFM CU in Martin, during years 2015–2016 were prospectively observed. Selected demographic, clinical, and radiographic factors were analysed and compared with patient’s GOS (Glasgow Outcome Scale) at the time of their first ambulatory control (after 3.5 months in average). Results: We observed mortality of 29.17 %. Good outcome (GOS 4–5) was achieved by 29.17 % of the patients as well. Preoperative GCS ≤ 5 (p = 0.049), intraventricular bleeding (p = 0.0268), midline shift ≥ 15 mm (p = 0.0067), and the volume of intracranial lesion (R = −0.41, p = 0.046), especially its extracerebral component (R = −0.46, p = 0.02), were identified as statistically significant negative prognostic factors. Conclusion: DC is effective in the management of patients with traumatic brain injury. Good outcome is achieved by 29.17 % of the patients. Described negative prognostic factors (preoperative GCS ≤ 5, intraventricular bleeding, midline shift ≥ 15 mm, and increasing the volume of traumatic mass lesion) could help in targeting this surgery only to patients who are expected to benefit from it.

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