Outcomes of Conservative Management of Acute Subdural Hematoma at GCS 15/15 in Post-Traumatic Patients
Keywords:Acute subdural hematoma
Objectives: We observed the results of conservative care of acute subdural hematoma at GCS 15/15 in patients with a head injury from a car accident (RTA).
Material and Methods: It is a comparative observational study of 15 patients with presented to NS -2 Punjab Institute of Neurosciences (PINS), Lahore. Presenting complaints of patients were loss of consciousness, vomiting, headache, ENT bleeding, etc.
Results: The age range was 10 – 70 years. The mean age was 40 years. Conservative management was given to all patients for 10 days except 2 patients. All patients were advised to take complete bed rest for 3 weeks. We advised head ends elevation of all patients up to 15 – 30 degrees to lessen intracranial pressure. Anti-epileptic, mannitol, antibiotics, and acetazolamide were the medication that was given. Our 4 (26%) were hypertensive. Their blood pressures were monitored regularly and kept in the range of 140 – 160 mmHg so that the hematoma may not expand. Our 2 (13%) patients had DM and their BSR levels were monitored and consultation was also done from the diabetes clinic. Our 2 (13%) patients had a headache, and vomiting and which did not resolve so we had to operate on the patients. Midline shift in CT brain was ? 5 mm.
Conclusion: Acute subdural hematoma at GCS 15/15, midline shift was less than 5 mm, and thickness on plain CT brain was greater than 1 cm is best treated by medical management except in 13% of cases.
Merck Manual. Intracranial Hematomas. Available from: https://www.merckmanuals.com/home/injuries-and-poisoning/head-injuries/intracranial-hematomas#v740124. Accessed 11/18/2021.
Pierre L, Kondamudi NP. Subdural Hematoma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532970/) In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Dec 1. Accessed 11/18/2021.
Kucera KL, Yau RK, Register-Mihalik J, Marshall SW, Thomas LC, Wolf S, Cantu RC, Mueller FO, Guskiewicz KM. Traumatic brain and spinal cord fatalities among high school and college football players—the United States, 2005–2014. Morbidity and Mortality Weekly Report. 2017 Jan 6; 65 (52): 1465-9.
American Academy of Family Physicians. Head Injuries. (https://familydoctor.org/condition/head-injuries/) Accessed 11/18/2021.
Vega RA, Valadka AB. Natural history of acute subdural hematoma. Neurosurgery Clinics, 2017; 28 (2): 247-55.
d’Avella D, Servadei F, Scerrati M, Tomei G, Brambilla G, Massaro F, Stefini R, Cristofori L, Conti A, Cardali S, Tomasello F. Traumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients. Acta
neurochirurgica. 2003; 145: 1037-44.
Ahmed E, Aurangzeb A, Khan SA, Maqbool S, Ali A, Zadran KK, Nawaz A. Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma. Journal of Ayub Medical College Abbottabad, 2012; 24 (1): 71-4.
Hanif S, Abodunde O, Ali Z, Pidgeon C. Age related outcome in acute subdural haematoma following traumatic head injury. Irish medical journal, 2009; 102 (8): 255-7.
Llamas L, Ramos-Zúñiga R, Sandoval L. Acute interhemispheric subdural hematoma: two case reports and analysis of the literature. min-Minimally Invasive Neurosurgery, 2002; 45 (01): 55-8.
Feliciano CE, De Jesús O. Conservative management outcomes of traumatic acute subdural hematomas. Puerto Rico health sciences journal, 2008; 27 (3).
Lee JJ, Won Y, Yang T, Kim S, Choi CS, Yang J. Risk
factors of chronic subdural hematoma progression after conservative management of cases with initially acute subdural hematoma. Korean Journal of Neurotrauma. 2015; 11 (2): 52.
Wong CW. Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta neurochirurgica. 1995; 135: 38-43.
Kaestner S, van den Boom M, Deinsberger W. Frequency of and risk factors for chronification in traumatic acute subdural hematoma following conservative therapy. Journal of Neurological Surgery Part A: Central European Neurosurgery, 2019; 80 (05): 359-64.
Kayahara T, Kikkawa Y, Komine H, Kamide T, Suzuki K, Shibata A, Ikeda S, Ikeda T, Kurita H. Predictors of subacute hematoma expansion requiring surgical evacuation after initial conservative treatment in patients with acute subdural hematoma. Acta Neurochirurgica. 2020; 162: 357-63.
Copyright (c) 2023 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The work published by PJNS is licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). Copyrights on any open access article published by Pakistan Journal of Neurological Surgery are retained by the author(s).