Case Of Acute Subdural Hematoma Research Articles

Features of chronic subdural haematoma developed from definitely identified acute subdural haematoma

Follow-up results for 13 cases of acute subdural haematoma, which were identified by CT scan within two days of head injury and treated conservatively, were classified into two groups: In the first group of seven cases the acute subdural haematoma disappeared spontaneously within two weeks; in the second group the other six cases revealed clinical signs and CT scan findings which were identical to chronic subdural haematoma and underwent surgery within three weeks after the head injury. This group showed low ICP signs, such as the chronic stage of cerebral thrombosis, atrophic brain or subdural fluid collection with acute subdural haematoma at the initial CT scan, and most of these cases had only minor head injury. Common features of the operative findings in this second group, in which chronic subdural haematoma developed, included the identification of an external haematoma capsule based on the fibrin layer and granulation tissue beneath the dura. Also, fluid type haematoma was present under these structures, but no inner membrane of the haematoma could be identified other than the non-transparent white arachnoid membrane. Our results indicate the importance of a low ICP in determining whether or not acute subdural haematoma progresses to chronic subdural haematoma.

Prognostic Factors in Acute Subdural Hematoma and the Significance of Serum FDP Measurement

Sixty-two cases of acute subdural hematoma were clinically analyzed with special reference to such prognostic factors as age, Glasgow Coma Scale (GCS) score on admission, pupillary signs, decerebration, and initial computed tomography (CT) findings. Intraparenchymal lesions demonstrated by CT were evaluated according to Yamaura's classification. In 19 cases, serum fibrin and fibrinogen degradation products (FDP) were measured at the time of admission. Emergency surgery was performed in 46 cases, and the remaining 16 patients were treated conservatively. The final outcome was judged according to the Glasgow Outcome Scale, and patients were divided into a "good outcome" group (good recovery or moderate disability) and a "poor outcome" group (severe disability, vegetative state, or death). In general, the outcomes proved to be unsatisfactory. Forty-four patients (71%) had a poor outcome, with 32/62 (52%) mortality, and only 18 (29%) had a good outcome. The clinical factors associated with a poor outcome were age over 64 years, a GCS score on admission of less than 7, decerebration, and absence of pupillary reaction to light. Initial CT scans showed brain damage in 46 patients (74%), 39 (85%) of whom had a poor outcome. This indicates that the outcome was significantly related to brain injury complicating the acute subdural hematoma. A high serum FDP level was similarly related to a poor outcome, which suggests that the serum FDP level reflects the degree of both primary and secondary brain injury. Thus, measurement of serum FDP may be valuable both in assessing clinical status and in evaluating the extent of brain injury in acute subdural hematoma.

Rapid Resolution of Acute Subdural Hematoma

We report four cases of acute subdural hematoma (ASDH) in which the hematoma rapidly resolved. Three of the four hematomas were traumatic. The outcome was good in three cases and fair in one. Spontaneous resolution of ASDH is rare.

Acute Subdural Hematoma in Judo Practitioners

Four cases of acute subdural hematoma in judo players are presented. Three were teenagers and one a young adult. Three sustained very severe injuries involving rupture of the bridging vein draining into the superior sagittal sinus without primary cortical laceration. These four cases are described and the incidence and nature of judo-related head injuries are discussed.

Acute Spontaneous Subdural Hematoma from Arterial Rupture

Three cases of acute subdural hematoma without head injury but attributable to surgically verified bleeding from a cortical artery are presented. Case 1: A 46-year-old male complained of a headache. Neurological examination revealed no abnormality. A subdural hematoma was found on computed tomography. Case 2: A 49-year-old male developed a consciousness disturbance. Removal of a hematoma was performed leaving mild confusion. Case 3: A 68-year-old female was admitted because of acute onset of confusion. An emergency operation was performed but profound hypotension occurred. Confusion persisted and the patient died from a complication. The previous reports on acute subdural hematoma caused by rupture of a cortical artery consisted of 17 cases with preceding trivial head trauma and 34 without. In most of the cases without head injury, the initial symptom was a headache mimicking that of subarachnoid hemorrhage which was followed by consciousness disturbance. Tearing of a cortical artery adhering to the dura mater by a trivial trauma or rapid head movement is proposed as a causative mechanism of the hematoma. In chronic subdural hematomas, only a negligible or no preceding head injury is often demonstrated. It is suggested, therefore, that a hemorrhage of the artery may cause an acute subdural hematoma if massive, and may also cause chronic subdural hematoma when it is minimal and subsequent bleeding from the hematoma membrane in the organizing process takes place.

Acute subdural haematomas: aetiology, pathology and outcome.

The aetiology, mechanisms of haemorrhage and results of treatment of a series of 63 consecutive cases of acute subdural haematoma are presented. Forty-six cases were due to trauma (46% mortality) and 17 cases were non-traumatic (41% mortality). Only 15 patients overall (24%) made a good recovery. The various mechanisms of venous and arterial bleeding leading to subdural haematoma are reviewed and the importance of brain swelling as a determinant of fatal outcome is stressed.

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

A case of acute subdural hematoma immediately after surgical intervention for the contralateral chronic subdural hematoma in a regularly hemodialyzed patient is reported. A 59-year-old male was admitted because of progressive right hemiparesis after six years of regular hemodialysis. A computed tomography (CT) scan revealed typical left chronic subdural hematoma. Irrigation and drainage of the hematoma through a single burr hole was performed. The right hemiparesis was improved after surgery and a CT scan two hours after surgery revealed a marked reduction of the hematoma cavity. However, the patient suddenly became comatose eight hours after surgery, and another CT scan showed a contralateral acute subdural hematoma. The patient expired the following morning. Postmortem pathologic examination showed an old left subdural hematoma membrane and a massive subdural hematoma without any membrane in the right fronto-temporal area. Subdural hematoma has a higher mortality rate among hemodialysis patients than in the normal population, and many authors have reported disappointing results of surgical intervention in such cases. This case suggests that the high frequency of subdural hematoma can be attributed to the accompanying coagulopathy and the acute decrease of intracranial pressure. The authors emphasize careful management including peritoneal dialysis before and after the surgical intervention.

Acute subdural hematoma. Review of 39 consecutive cases with high incidence of cortical artery rupture.

In a consecutive series of 39 cases of acute subdural hematoma (SDH), encountered since computerized tomography diagnosis became available, 61.5% were found to be the result of bleeding from a small cortical artery, 25.6% were of venous origin, 7.7% resulted from cerebral contusions, and 5% were acute bleeds into chronic subdural hematomas. Craniotomy was performed promptly on admission, but there was no difference in survival (overall 51.3%) between patients with arterial and venous bleeds. The only apparent factor affecting survival in this series was the preoperative neurological status: 67% of patients who were decerebrate and had fixed pupils prior to operation died. Of patients with less severe neurological dysfunction, only 20% failed to survive.

Subdural hematomas in neonates. Surgical treatment.

7 cases of acute subdural hematomas diagnosed and surgically treated during the first week of life are presented. 5 of them are alive and well at 6 and 7 months and 3, 4 and 6 years of follow-up. Free interval, raised intracranial pressure, lateralizing signs, fall of hematocrit and presence of blood in CSF were constant. Subdural puncture was negative in 6 cases, including a hemophilic patient (hemophilia B). Clinical diagnosis was ratified by means of neuroradiological procedures. The authors conclude that craniectomy is the treatment of choice and subdural tapping a useless procedure.

皮質動脈破綻による急性硬膜下血腫の2症例

皮質動脈破綻による急性硬膜下血腫の2症例

A study on the indication of external decompressive hemicraniectomy for acute subdural hematomas.

Fourteen cases of surgically treated acute subdural hematomas were studied. The indication of external decompressive hemicraniectomy for these cases of acute subdural hematomas was studied in detail according to postoperative intracranial pressure (pICP) changes in combination with their preoperative neurological, cardiorespiratory and angiographic findings.The pICP changes were classified into three groups according to the maximum values of intracranial pressures and the patterns of the pressure changes.Group one: pICP increased rapidly and progressively immediately after the operation, and then it reached the level of mean arterial blood pressure. This rapid increase of pICP in this group seemed to be the result of cerebral vasomotor paralysis. There was no effective treatment for these cases.Group two: pICP remained in the range of 40 to 70mmHg. Preoperative neurological examinations of these cases showed semicoma or coma not having the signs of brain stem dysfunction. Preoperative angiograms revealed the delay of circulation time and fairly good filling of small arteries in an early arterial phase. Operative findings in these cases showed that extensive cerebral contusion affected more than two lobes without any definitive brain swelling. Postoperative intracranial pressure might have continued to increase as shown in Group one, if external decompressive hemicraniectomy had not been performed for these cases. It was considered that external decompressive hemicraniectomy should be restricted to this group.Group three: pICP remained 10 to 30mmHg. Indication of external decompressive hemicraniectomy was not suggested for cases in this group.

Acute subdural hematomas of arterial origin.

✓ Five cases of acute subdural hematoma associated with bleeding from cortical arteries are described. In the four cases in which the affected vessel was examined histologically, there was a defect in the arterial wall secondary to avulsion of a small surface twig, which had apparently been traversing the subdural space. The possible mechanisms for damage to the vessel wall and the role of this arterial bleeding in subdural hematomas are discussed.