Abstract
T hE divergent clinical paths pursued by patients harboring subdural hematomata suggest that there are factors, other than the magnitude of the original violence, capable of altering the degree, direction and quality of this clinical response. The present study was undertaken to assess the influence of a few simple parameters, such as volume of subdural extravasation and age, upon the resultant clinical behavior and prognosis. The 80 cases of substantiated subdural hematomata (volume of 15 cc. or more) constituting this report were derived from the autopsy records of the neuropathology laboratory, Kings County Hospital Center, and represent all cases of subdural bleeding in patients over ~5 years of age during the period 1954-196s (Table 1). The interval of time between injury and death, or commencement of symptoms and death, was very variable, ranging from days to 6 months. Cases in which coexistent cerebral contusion, laceration or intracerebral hematoma of an appreciable extent occurred were not considered because it was felt not possible to divorce the effects of extracerebral from the intracerebral bleeding. Instances of subdural bleeding associated with blood dyscrasias or local neoplasia also were excluded. The existence of subdural hemorrhage compressing the cerebral hemisphere often provokes certain immediate and delayed responses within the subjacent tissues. One
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