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