FREQUENCY OF CONSERVATIVELY MANAGED TRAUMATIC ACUTE SUBDURAL HAEMATOMA CHANGING INTO CHRONIC SUBDURAL HAEMATOMA

Authors

  • Ehtisham Ahmed
  • Ahsan Aurangzeb
  • Shahbaz Ali Khan
  • Saadia Maqbool
  • Asghar Ali
  • Khalid Khan Zadran
  • Amir Nawaz

Abstract

Background: Traumatic brain injury represents a significant cause of mortality and permanentdisability in the adult population. Acute subdural haematoma is one of the conditions most stronglyassociated with severe brain injury. Knowledge on the natural history of the illness and the outcomeof patients conservatively managed may help the neurosurgeon in the decision-making process.Methods: We prospectively analysed 27 patients with age ranges 15–90 years, in whom a CT scandiagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was notinitially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad (2008–2011). Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, anyother associated intracranial abnormalities, such as cerebral contusions, as shown on CT, wereexcluded from this study. All patients were followed by serial CT scans, and a neurologicalassessment was done. Results: There were 18 male and 9 female patients, Cerebral atrophy waspresent in over half of the sample. In 22 of our patients, the acute subdural haematoma resolvedspontaneously, without evidence of damage to the underlying brain, as shown by CT or neurologicalfindings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. Ineach of these patients, haematoma thickness was greater than 10 mm. The mean delay betweeninjury and operation in this group was 15–21 days. Among these patients 1 patient requiredcraniotomy for haematoma removal due to neurological deterioration. Conclusion: Certainconscious patients with small acute subdural haematomas, without mass effect on CT, may be safelymanaged conservatively, but due to high risk of these acute subdural haematoma changing intochronic subdural haematoma these patients should be reinvestigated in case of neurologicaldeterioration.Keywords: Acute subdural haematoma, conservative treatment, traumatic brain injury

References

Bullock MR, Chesnut R, Ghajar J, Gorgon D, Harti R, Newell

DW, et al. Surgical management of acute subdural hematomas.

Neurosurgery 2006;58(Suppl 2):16–24.

Dent DL, Croce MA, Menke PG, Menke PG, Young BH,

Hinson MS, et al. Prognostic factors after acute subdural

hematoma. J Trauma 1995;39:36–42.

Koc RK, Akdemir H, Oktem IS, Meral M, Menku A. Acute

subdural hematoma: Outcome and outcome prediction.

Neurosurg Rev 1977;20:239–44.

Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and

twenty-seven cases of acute subdural haematomas operated on.

Correlation between CT scan findings and outcome. Acta

Neurochir 1996;138:185–91.

Jennett B, Bond M. Assessment of outcome after severe brain

damage. A practical scale. Lancet 1975;1(7905):480–8.

Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet 1974;2(7872):81–3.

Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute

subdural haematoma in the conscious patient: Outcome with

initial non-operative management. Acta Neurochir

;121:100–8.

Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD,

Chori SC. Traumatic acute subdural haematoma. Major mortality

reduction in comatose patients treated within four hours. N Engl J

Med 1981;304:1511–8.

Zumkeller M, Behrmann R, Heissler HE, Hermann D. Computed

tomographic criteria and survival rate for patients with acute

subdural hematoma. Neurosurgery 1996;39:708–13.

Kawamata T, Takeshita M, Kubo O, Izawa M, Kaqwa M,

Takaura K. Management of intracranial hemorrhage associated

with anticoagulant therapy. Surg Neurol 1995;44:438–42.

Howard MA, Gross AS, Dacey RG Jr, Winn HR. Acute subdural

hematomas: An age-dependent clinical entity. J Neurosurg

;71:858–63.

Croce MA, Dent DL, Menke PG, Robertson JT, Hinson MS,

Young BH, et al. Acute subdural hematoma: nonsurgical

management of selected patients. J Trauma 1994;36(6):820–6.

Rockswold GL, Leonard PR, Nagib MG. Analysis in thirty-three

closed head injury patients who “talked and deteriorated”.

Neurosurgery 1987;21:51–5.

Virchow R. Das hematoma der dura mater. Verh Phys-Med Ges

Wurzburg 1957;7:134–42.

Gardner M. Traumatic subdural haematoma with particular

reference to the latent interval. Arch Neurol Psychiatr

;27:847–58.

Weir B. Oncotic pressure of subdural fluids. J Neurosurg

;53:512–5.

Weir B. The osmolality of subdural haematoma fluid. J

Neurosurg 1971;34:528–33.

Sato S, Suzuki J. Ultrastructure observations of the capsule of

chronic subdural haematoma in various clinical stages. J

Neurosurg 1975;43:569–78.

J Ayub Med Coll Abbottabad 2012;24(1)

http://www.ayubmed.edu.pk/JAMC/24-1/Ehtisham.pdf

Yamashima T, Kubota T, Yamamoto S. Eosinophil

degranulation in the capsule of chronic subdural haematomas. J

Neurosurg 1985;62:257–60.

Yamashima T, Yamamoto S. How do vessels proliferate in the

capsule of a chronic subdural haematoma? Neurosurgery

;15:672–8.

Kawakami T, Chikama M, Tamiya T, Shimamura Y.

Coagulation and fibrinolysis in chronic subdural haematoma.

Neurosurgery 1989;25:25–9.

Hardman M. The pathology of traumatic brain injuries. Adv

Neurol 1979:22:15–50.

Kaufman HH, Singer GM, Sadhu VK. Isodense acute subdural

hematoma. J Comput Assist Tomogr 1979;45:217–24.

Messina AV, Chernick NL. Computed tomography: the

“resolving” intracerebral haemorrhage. Radiology

;118:609–13.

Feliciano CE, Jesus OD. Conservative management outcomes of

traumatic acute subdural hematomas. PRHSJ September

;27(3):220–3.

Downloads

Published

2012-03-01

Most read articles by the same author(s)

1 2 3 4 5 > >>