Acute Traumatic Subdural Hematoma: Series of Thirty Cases

  • Muhammad Asif Sahiwal Medical College/DHQ Hospital, Sahiwal – Pakistan
  • Waqar Aziz Rehman Sahiwal Medical College/DHQ Hospital, Sahiwal – Pakistan
  • Sumaira Sarwar Sahiwal Medical College/DHQ Hospital, Sahiwal – Pakistan
  • Hamza Younas Sahiwal Medical College/DHQ Hospital, Sahiwal – Pakistan
  • Aatika Younas Sahiwal Medical College/DHQ Hospital, Sahiwal – Pakistan
Keywords: Acute Traumatic Subdural Hematoma, Road Traffic Accident

Abstract

Objectives: Acute Traumatic Subdural Hematoma (ASDH) is one of the most dangerous and challenging neurosurgical problems faced by neurosurgeons. Road traffic accidents (RTAs) and falls are the most common causes of ASDH. This study focused to evaluate the incidence, mode, and severity of the injury, treatment options, and determine outcomes in patients with ASDH.

Material & Methods:  Thirty patients with ASDH were studied over a period of three years. Detailed history, general and neurological examination including GCS were noted, CT scans were done and patients managed according to said protocol.

Results:  Twenty-three (76.66%) were male and Seven (23.33%) were female. The common mode of injury were road traffic accidents (66.66%) and falls (26.66%). Out of 30 patients, 53.33% had GCS 3-5. Overall, the mortality rate was 60%. 23.33% of patients survived with severe disability and 10% of patients showed moderate disability and good recovery. The mortality rate was higher in patients above 50 years of age.

Conclusion:  Acute traumatic subdural hematoma is still very fatal and has a high mortality. Early CT scanning emergency, surgery and good postoperative ICU care can play a role in improving the outcome in patients with ASDH.

References

1. Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, Servadei F, Walters BC, Wilberger J. Surgical management of traumatic brain injury. Neurosurgery, 2006; 58 (3): 16-24.
2. Ersahin Y, Mutluer S. Posterior fossa extradural hematomas in children. Pediatric Neurosurgery, 1993; 19 (1): 31-3.
3. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. New England Journal of Medicine, 1981; 304 (25): 1511-8.
4. Servadei F, Nasi MT, Cremonini AM, Giuliani G, Cenni P, Nanni A. Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. Journal of Trauma and Acute Care Surgery, 1998; 44 (5): 868-73.
5. Wilberger JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. Journal of Neurosurgery, 1991; 74 (2): 212-8.
6. Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and twenty-seven cases of acute subdural haematoma operated on. Actaneurochirurgica. 1996; 138 (2): 185-91.
7. Servadei, MT Nasi, G. Giuliani, A. Maria Cremonini, P. Cenni, D. Zappi, GS Taylor F. CT prognostic factors in acute subdural haematomas: the value of the 'worst' CT scan. British Journal of Neurosurgery, 2000; 14 (2): 110-6.
8. Dent DL, Croce MA, Menke PG, Young BH, Hinson MS, Kudsk KA, Minard G, Pritchard FE, Robertson JT, Fabian TC. Prognostic factors after acute subdural hematoma. Journal of Trauma and Acute Care Surgery, 1995; 39 (1): 36-43.
9. Gabl M, Mohsenipour I, Benedetto K. Acute post-traumatic subdural hematoma in advanced age. Unfallchirurgie. 1989; 15 (6): 273-8.
10. Koc RK, Akdemir H, Öktem IS, Meral M, Menkü A. Acute subdural hematoma: outcome and outcome prediction. Neurosurgical Review, 1997; 20 (4): 239-44.
11. Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and twenty-seven cases of acute subdural haematoma operated on. Actaneurochirurgica. 1996; 138 (2): 185-91.
12. Howard MA, Gross AS, Dacey RG, Winn HR. Acute subdural hematomas: an age-dependent clinical entity. Journal of Neurosurgery, 1989; 71 (6): 858-63.
13. Kotwica Z, Brzeziński J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Actaneurochirurgica. 1993; 121 (3): 95-9.
14. Cordobés F, Lobato RD, Rivas JJ, Muñoz MJ, Chillón D, Portillo JM, Lamas E. Observations on 82 patients with extradural hematoma: comparison of results before and after the advent of computerized tomography. Journal of Neurosurgery, 1981;54 (2): 179-86.
15. Van den Brink WA, Zwienenberg M, Zandee SM, Van der Meer L, Maas AI, Avezaat CJ. The prognostic importance of the volume of traumatic epidural and subdural haematomas revisited. Actaneurochirurgica. 1999; 141 (5): 509-14.
16. Hatashita S, Koga N, Hosaka Y, Takagi S. Acute subdural hematoma: severity of injury, surgical intervention, and mortality. Neurologia Medico-
Chirurgica. 1993; 33 (1): 13-8.
17. Haselsberger K, Pucher R, Auer LM. Prognosis after acute subdural or epidural haemorrhage. Actaneurochirurgica. 1988; 90 (3): 111-6.
18. Howard MA, Gross AS, Dacey RG, Winn HR. Acute subdural hematomas: an age-dependent clinical entity. Journal of Neurosurgery, 1989; 71 (6): 858-63.
19. Jamieson KG, Yelland JD. Surgically treated traumatic subdural hematomas. Journal of Neurosurgery, 1972; 37 (2): 137-49.
20. Richards T, Hoff J. Factors affecting survival from acute subdural hematoma. Surgery, 1974; 75 (2): 253-8.
21. Wilberger JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. Journal of Neurosurgery, 1991; 74 (2): 212-8.
22. Seelig JM, Becker DP, Miller JD, Greenberg RP, Ward JD, Choi SC. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. New England Journal of Medicine, 1981; 304 (25): 1511-8.
23. Stone JL, Lowe RJ, Jonasson OL, Baker RJ, Barrett JO, Oldershaw JB, Crowell RM, Stein RJ. Acute subdural hematoma: direct admission to a trauma center yields improved results. The Journal of Trauma, 1986; 26 (5): 445-50.
24. Alagoz F, Yildirim AE, Sahinoglu M, Korkmaz M, Secer M, Celik H, Yel C, Guvenc Y, Uckun OM, Narin F, Daglioglu E. Traumatic acute subdural hematomas: analysis of outcomes and predictive factors at a single center. Turk Neurosurg. 2017; 27 (2): 187-91.
25. Li LM, Kolias AG, Guilfoyle MR, Timofeev I, Corteen EA, Pickard JD, Menon DK, Kirkpatrick PJ, Hutchinson PJ. Outcome following evacuation of acute subdural haematomas: a comparison of craniotomy with decompressive craniectomy. Actaneurochirurgica. 2012; 154 (9): 1555-61.
26. Ryan CG, Thompson RE, Temkin NR, Crane PK, Ellenbogen RG, Elmore JG. Acute traumatic subdural hematoma: current mortality and functional outcomes in adult patients at a Level I trauma center. The Journal of Trauma and Acute Care Surgery, 2012; 73 (5): 1348.
27. Subdural NR, Delik HO. Results of single burr hole drainage for acute subdural hematoma with non-reactive pupil. Turkish Neurosurgery, 2012; 22 (2): 196-9.
28. Wilberger JE, Harris M, Diamond DL. Acute subdural hematoma: morbidity, mortality, and operative timing. Journal of Neurosurgery, 1991; 74 (2): 212-8.
29. Kaptanoğlu E, Solaroğlu I, Uçar MD, Okutan MO, Beşkonakli E, Taşkin Y. Acute subdural hematomas: surgical treatment. Retrospective analysis of 73 cases. Ulusaltravmadergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES. 2001; 7 (4): 246-9.
30. Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, Rusnak M. Outcome after severe brain trauma due to acute subdural hematoma. Journal of Neurosurgery, 2012; 117 (2): 324-33.
31. Meyer S, Gibb T, Jurkovich GJ. Evaluation and significance of the pupillary light reflex in trauma patients. Annals of Emergency Medicine, 1993; 22 (6): 1052-7.
32. Gennarelli TA, Spielman GM, Langfitt TW, Gildenberg PL, Harrington T, Jane JA, Marshall LF, Miller JD, Pitts LH. Influence of the type of intracranial lesion on outcome from severe head injury: a multicenter study using a new classification system. Journal of Neurosurgery, 1982; 56 (1): 26-32.
33. Shen J, Pan JW, Fan ZX, Zhou YQ, Chen Z, Zhan RY. Surgery for contralateral acute epidural hematoma following acute subdural hematoma evacuation: five new cases and a short literature review. Actaneurochirurgica. 2013; 155 (2): 335-41.
34. Berger MS, Pitts LH, Lovely M, Edwards MS, Bartkowski HM. Outcome from severe head injury in children and adolescents. Journal of Neurosurgery, 1985; 62 (2): 194-9.
35. Braakman R, Habbema JD, Gelpke GJ. Prognosis and prediction of outcome in comatose head injured patients. Modern Concepts in Neurotraumatology, 1986: 112-7.
36. Jennett BO, Teasdale G, Braakman R, Minderhoud J, Knill-Jones R. Predicting outcome in individual patients after severe head injury. The Lancet. 1976; 307 (7968): 1031-4.
Published
2021-06-14
Section
Original Articles