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
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
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
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
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
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”.
Virchow R. Das hematoma der dura mater. Verh Phys-Med Ges
Gardner M. Traumatic subdural haematoma with particular
reference to the latent interval. Arch Neurol Psychiatr
Weir B. Oncotic pressure of subdural fluids. J Neurosurg
Weir B. The osmolality of subdural haematoma fluid. J
Sato S, Suzuki J. Ultrastructure observations of the capsule of
chronic subdural haematoma in various clinical stages. J
J Ayub Med Coll Abbottabad 2012;24(1)
Yamashima T, Kubota T, Yamamoto S. Eosinophil
degranulation in the capsule of chronic subdural haematomas. J
Yamashima T, Yamamoto S. How do vessels proliferate in the
capsule of a chronic subdural haematoma? Neurosurgery
Kawakami T, Chikama M, Tamiya T, Shimamura Y.
Coagulation and fibrinolysis in chronic subdural haematoma.
Hardman M. The pathology of traumatic brain injuries. Adv
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
Feliciano CE, Jesus OD. Conservative management outcomes of
traumatic acute subdural hematomas. PRHSJ September
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