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)

HYPEREMIA BENEATH EVACUATED ACUTE SUBDURAL HEMATOMA IS FREQUENT AND PROLONGED IN PATIENTS WITH AN UNFAVORABLE OUTCOME

Neurosurgery ◽  
2009 ◽  
Vol 64 (4) ◽  
pp. 705-718 ◽  
Author(s):  
Arturo Chieregato ◽  
Alberto Noto ◽  
Alessandra Tanfani ◽  
Giovanni Bini ◽  
Costanza Martino ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Severe Traumatic Brain Injury ◽  
Subdural Hematoma ◽  
Time Course ◽  
Unfavorable Outcome ◽  
Acute Subdural Hematoma ◽  
Control Group ◽  
Computed Tomographic ◽  
The Mean

Abstract OBJECTIVE To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome. METHODS rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months. RESULTS Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes. CONCLUSION On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.

scholarly journals Intracranial Pressure during External Ventricular Drainage Weaning Is an Outcome Predictor of Traumatic Brain Injury

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Jia-cheng Gu ◽  
Hong Wu ◽  
Xing-zhao Chen ◽  
Jun-feng Feng ◽  
Guo-yi Gao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Intracranial Pressure ◽  
External Ventricular Drainage ◽  
Unfavorable Outcome ◽  
Ventricular Drainage ◽  
Outcome Group ◽  
Significant Difference ◽  
The Mean ◽  
The Relationship

External ventricular drainage (EVD) is widely used in patients with a traumatic brain injury (TBI). However, the EVD weaning trial protocol varies and insufficient studies focus on the intracranial pressure (ICP) during the weaning trial. We aimed to establish the relationship between ICP during an EVD weaning trial and the outcomes of TBI. We enrolled 37 patients with a TBI with an EVD from July 2018 to September 2019. Among them, 26 were allocated to the favorable outcome group and 11 to the unfavorable outcome group (death, post-traumatic hydrocephalus, persistent vegetative state, and severe disability). Groups were well matched for sex, pupil reactivity, admission Glasgow Coma Scale score, Marshall computed tomography score, modified Fisher score, intraventricular hemorrhage, EVD days, cerebrospinal fluid output before the weaning trial, and the complications. Before and during the weaning trial, we recorded the ICP at 1-hour intervals to calculate the mean ICP, delta ICP, and ICP burden, which was defined as the area under the ICP curve. There were significant between-group differences in the age, surgery types, and intensive care unit days (p=0.045, p=0.028, and p=0.004, respectively). During the weaning trial, 28 (75.7%) patients had an increased ICP. Although there was no significant difference in the mean ICP before and during the weaning trial, the delta ICP was higher in the unfavorable outcome group (p=0.001). Moreover, patients who experienced death and hydrocephalus had a higher ICP burden, which was above 20 mmHg (p=0.016). Receiver operating characteristic analyses demonstrated the predictive ability of these variables (area under the curve AUC=0.818 [p=0.002] for delta ICP and AUC=0.758 [p=0.038] for ICP burden>20 mmHg). ICP elevation is common during EVD weaning trials in patients with TBI. ICP-related parameters, including delta ICP and ICP burden, are significant outcome predictors. There is a need for larger prospective studies to further explore the relationship between ICP during EVD weaning trials and TBI outcomes.

scholarly journals Clinical application of magnetic resonance in acute traumatic brain injury

2008 ◽  
Vol 66 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Dionei F. Morais ◽  
Antonio R. Spotti ◽  
Waldir A. Tognola ◽  
Felipe F.P. Gaia ◽  
Almir F. Andrade
Keyword(s):  
Traumatic Brain Injury ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Magnetic Resonance ◽  
Subdural Hematoma ◽  
Diffuse Axonal Injury ◽  
Correlation Method ◽  
Acute Subdural Hematoma ◽  
Acute Traumatic Brain Injury ◽  
Magnetic Resonance Imaging Mri

PURPOSE: To evaluate the clinical applications of magnetic resonance imaging (MRI) in patients with acute traumatic brain injury (TBI): to identify the type, quantity, severity; and improvement clinical-radiological correlation. METHOD: Assessment of 55 patients who were imaged using CT and MRI, 34 (61.8%) males and 21 (38.2%) females, with acute (0 to 5 days) and closed TBI. RESULTS: Statistical significant differences (McNemar test): ocurred fractures were detected by CT in 29.1% and by MRI in 3.6% of the patients; subdural hematoma by CT in 10.9% and MRI in 36.4 %; diffuse axonal injury (DAI) by CT in 1.8% and MRI in 50.9%; cortical contusions by CT in 9.1% and MRI in 41.8%; subarachnoid hemorrhage by CT in 18.2% and MRI in 41.8%. CONCLUSION: MRI was superior to the CT in the identification of DAI, subarachnoid hemorrhage, cortical contusions, and acute subdural hematoma; however it was inferior in diagnosing fractures. The detection of DAI was associated with the severity of acute TBI.

scholarly journals Acute Subdural Hematoma after Isolated Traumatic Brain Injury: Risk Factors and Prediction of Mortality

2015 ◽  
Vol 25 (2) ◽  
pp. 36-40
Author(s):  
Dalia Adukauskienė ◽  
Asta Mačiulienė ◽  
Aušra Čiginskienė ◽  
Agnė Adukauskaitė ◽  
Justina Čyžiūtė
Keyword(s):  
Risk Factors ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Blood Cell ◽  
Cell Count ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Blood Cell Count ◽  
Lethal Outcome ◽  
Pupil Reaction

The aim of this study was to determine mortality and it‘s risk factors also prediction of lethal outcome in case of acute subdural hematoma after isolated traumatic brain injury (ITBI). Methods. A retrospective study of 162 patients after ITBI was carried out in Neurosurgical Intensive Care Unit (NITS) of Lithuanian University of Health Sciences Hospital (LUHSH) Kaunas Clinics (KC). Demographic (gender, age), clinical (pupil reaction to light, Glasgow Coma Scale (GCS) score, APACHE II scale score) and laboratory (white blood cell count, glycemia) data analysis on the first day after the injury was made. Conclusions. The mortality rate of acute subdural hematoma after isolated traumatic brain injury was 41 pct. Risk factors of mortality were estimated to be patient age ≥ 65 yrs, absence of pupil reaction to light, GCS 3-8, APACHE II score ≥ 16 points, white blood cell count ≥10,1 x 109/l and glycemia ≥5,6mmol/l. It was estimated the evident relation between predicted lethal outcome and real mortality when the risk of lethal outcome was higher than 25 pct.

scholarly journals S100B Serum Level as a Mortality Predictor for Traumatic Brain Injury: A Meta-Analysis

2018 ◽  
Vol 6 (11) ◽  
pp. 2239-2244 ◽  
Author(s):  
Nyoman Golden ◽  
Tjokorda Gde Bagus Mahadewa ◽  
Citra Aryanti ◽  
I Putu Eka Widyadharma
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Meta Analysis ◽  
Head Injuries ◽  
Case Series ◽  
Mortality Data ◽  
Serum S100b ◽  
Significant Difference ◽  
The Mean

  BACKGROUND: The pathogenesis of inflammatory neuronal cell damage will continue after traumatic brain injury in which contributed to subsequent mortality. Serum S100B levels were shown to be an early predictor of mortality due to traumatic brain injury. AIM: This Meta-Analysis will analyse the mean and diagnostic strength of serum S100B levels between survived and died subjects with head injuries based on the various follow-up times of nine studies. METHODS: We conducted a meta-anelysis in accordance with PRISMA guidelines and adhering to Cochrane Handbook for Systematic Review of Interventions. Literature search was conducted on March 16, 2018 from Medline and Scopus in the past 10 years, using various keywords related to S100, brain injury, and outcome. Duplicate journals were sorted out via EndNote. Included articles were as follows: original data from the group, clinical trials, case series, patients undergoing serum S100B levels with both short- and long-term follow-up mortality. Data were collected for mortality, serum S100B levels, and its diagnostic strength. All data were analyzed using Review Manager 5.3 (Cochrane, Denmark). RESULTS: The results of the meta-analysis showed a significant difference in S100B levels between survived and died subjects with head injuries on overall follow-up timeline (0.91, 95.9% CI 0.7-1.12, I2 = 98%, p < 0.001), during treatment (1.43, 95% CI 0.97 to 1.89, I2 = 98%, p < 0.001), or 6 months (0.19; 95%CI 0.1-0.29, I2 = 76%, p < 0.001) with an average threshold value that varies according to the study method used. The mean diagnostic strength was also promising to predict early mortality (sensitivity of 77.18% and 92.33%, specificity of 78.35% and 50.6%, respectively). CONCLUSION: S100B serum levels in the future will be potential biomarkers, and it is expected that there will be standardised guidelines for their application.

EFFECTIVENESS OF TREATMENT OF ELDERLY PATIENTS WITH TRAUMATIC BRAIN INJURY COMPLICATED BY SUBDURAL HEMATOMA

2021 ◽  
pp. 461-465
Author(s):  
А.А. Баландин ◽  
И.А. Баландина ◽  
М.К. Панкратов
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Elderly Patients ◽  
Subdural Hematoma ◽  
Young Patients ◽  
Acute Subdural Hematoma ◽  
Severe Condition ◽  
Neurosurgical Patients ◽  
Personalized Approach ◽  
Outpatient Practice

Работа основана на результатах ретроспективного анализа медицинской документации 56 пациентов с черепно-мозговой травмой, осложненной острой субдуральной гематомой объемом 60-100 см3. Пациенты были разделены на две группы по возрасту: 1-я 29 пациентов 22-29 лет; 2-я 27 пациентов 61-69 лет. Степень нарушения сознания у пострадавших при поступлении в клинику оценивали по шкале Глазго, эффективность проводимого лечения при выписке пациентов из стационара проводили по шкале Рэнкина, оценивая степень независимости и инвалидизации. У пациентов пожилого возраста выявлено более тяжелое состояние при поступлении в клинику. При выписке из стационара оценка степени независимости и инвалидизации по шкале Рэнкина выявила статистически значимое преобладание баллов в группе пациентов пожилого возраста (p<0,01), что говорит о менее эффективном их лечении в сравнении с пострадавшими молодого возраста. Результаты данного исследования могут послужить основой для разработки дополнительных рекомендаций в амбулаторной практике для ухода и попечения пациентов старшей возрастной группы и персонифицированному подходу к пострадавшим нейрохирургического профиля с учетом их возраста. The work is based on the results of a retrospective analysis of the medical records of 56 patients with traumatic brain injury complicated by acute subdural hematoma with a volume of 60-100 cm3. The patients were divided into 2 groups according to their age: the 1st group included 29 patients aged 22-29 years, the 2nd group consisted of 27 patients aged 61-69 years. The degree of impaired consciousness in the victims at admission to the clinic was evaluated on the Glasgow scale, the effectiveness of the treatment at discharge from the hospital was performed on the Rankin scale, assessing the degree of independence and disability. Elderly patients were found to have a more severe condition upon admission to the clinic. Upon discharge from the hospital, the assessment of the degree of independence and disability on the Rankin scale revealed a statistically significant predominance of scores in the group of elderly patients ( p <0,01), which indicates less effective treatment in comparison with young patients. The results of this study can serve as a basis for the development of additional recommendations in outpatient practice for the care and care of patients in the older age group and a personalized approach to neurosurgical patients taking into account their age.

scholarly journals Decompressive craniectomy in severe traumatic brain injury - a study of 20 cases

2014 ◽  
Vol 43 (2) ◽  
pp. 100-102
Author(s):  
Sukriti Das ◽  
Md Jahangir Alam ◽  
KM Tarikul Islam ◽  
Fazle Elahi ◽  
Ehsan Mahmud
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Decompressive Craniectomy ◽  
Severe Traumatic Brain Injury ◽  
Operative Management ◽  
College Hospital ◽  
Cross Sectional ◽  
Medical College ◽  
Included Patient ◽  
Gcs Score

Severe traumatic brain injury is common in all developing countries like Bangladesh. These patients are commonly managed conservatively in the most of the hospitals of our country where immediate surgical intervention and perioperative ICU facilities are not available.This cross sectional interventional study was aimed at evaluating and comparing the post operative surgical outcome of decompressive craniectomy in patients with severe traumatic brain injury (TBI) with conservatively treated patients.This study was done in Dhaka Medical College Hospital from January 2010 to December 2012. Twenty clinically suspected patients who sustained severe head injury with a GCS of 3-8 with neurological deterioration and evidence of brain contusion, laceration or evidence of brain swelling on CT Scan were included. Patient with primary fatal brain stem injury, an initial and persisting GCS score of 3, or bilaterally dilated and fixed pupil are not candidate for operative management. Outcome was assessed by Glasgow outcome scale (GOS). Follow up was given for a period of six to twelve months. DOI: http://dx.doi.org/10.3329/bmj.v43i2.21392 Bangladesh Med J. 2014 May; 43 (2): 100-102

Long-term outcome in traumatic brain injury patients with midline shift: a secondary analysis of the Phase 3 COBRIT clinical trial

2019 ◽  
Vol 131 (2) ◽  
pp. 596-603 ◽  
Author(s):  
Ross C. Puffer ◽  
John K. Yue ◽  
Matthew Mesley ◽  
Julia B. Billigen ◽  
Jane Sharpless ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Outcome Measures ◽  
Secondary Analysis ◽  
Unfavorable Outcome ◽  
Favorable Outcome ◽  
Midline Shift ◽  
Phase 3 ◽  
The Mean ◽  
Recovery Trajectory

OBJECTIVEFollowing traumatic brain injury (TBI), midline shift of the brain at the level of the septum pellucidum is often caused by unilateral space-occupying lesions and is associated with increased intracranial pressure and worsened morbidity and mortality. While outcome has been studied in this population, the recovery trajectory has not been reported in a large cohort of patients with TBI. The authors sought to utilize the Citicoline Brain Injury Treatment (COBRIT) trial to analyze patient recovery over time depending on degree of midline shift at presentation.METHODSPatient data from the COBRIT trial were stratified into 4 groups of midline shift, and outcome measures were analyzed at 30, 90, and 180 days postinjury. A recovery trajectory analysis was performed identifying patients with outcome measures at all 3 time points to analyze the degree of recovery based on midline shift at presentation.RESULTSThere were 892, 1169, and 895 patients with adequate outcome data at 30, 90, and 180 days, respectively. Rates of favorable outcome (Glasgow Outcome Scale–Extended [GOS-E] scores 4–8) at 6 months postinjury were 87% for patients with no midline shift, 79% for patients with 1–5 mm of shift, 64% for patients with 6–10 mm of shift, and 47% for patients with > 10 mm of shift. The mean improvement from unfavorable outcome (GOS-E scores 2 and 3) to favorable outcome (GOS-E scores 4–8) from 1 month to 6 months in all groups was 20% (range 4%–29%). The mean GOS-E score for patients in the 6- to 10-mm group crossed from unfavorable outcome (GOS-E scores 2 and 3) into favorable outcome (GOS-E scores 4–8) at 90 days, and the mean GOS-E of patients in the > 10-mm group nearly reached the threshold of favorable outcome by 180 days postinjury.CONCLUSIONSIn this secondary analysis of the Phase 3 COBRIT trial, TBI patients with less than 10 mm of midline shift on admission head CT had significantly improved functional outcomes through 180 days after injury compared with those with greater than 10 mm of midline shift. Of note, nearly 50% of patients with > 10 mm of midline shift achieved a favorable outcome (GOS-E score 4–8) by 6 months postinjury.

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