Thin Acute Subdural Hematoma: Part 1 : Clinical Significance

A retrospective study on 107 cases of acute(within 24 hours) subdural hematoma(ASDH) with special reference to the size is presented. The thin ASDH is defined as the hematoma of which thickness is less than 3 mm in the printed CT film(true thickness about 10 mm). 45 cases are the thin ASDH and 62 cases are the not-thin ASDH. Age, Glasgow coma score, pupil, CT finding, operation finding, operation method, interval from injury to CT and operation, and outcome at 1 month are compared and analysed with chi square tests. The most significant difference is the high surgical mortality (92.6%) in the thin ASDH despite of the fact that there are no significant bad prognostic factors. This difference might be due to the fact that diffuse brain injury is more commonly associated with the thin ASDH and suggested that the thin ASDH should be managed differently from the not-thin ASDH.

Thin Acute Subdural Hematoma: Part 2 : Role of Surgery

A retrospective study on 78 cases of surgically treated acute(within 24 hours) subdural hematoma(ASDH) with special reference to the size is presented. The thin ASDH is defined as the hematoma of which thickness is less than 3 mm in the printed CT film(true thickness about 10 mm). 27 cases are the thin ASDH and 51 cases are the not-thin ASDH. Pre-operative Glasgow coma score(GCS1), Postoperative Glasgow coma score(GCS2) and difference between GCS2 and GCS1(GCS2-GCS1) are compared in two groups by student t-tests. The mean GCS2 is worse than the mean GCS1 in the thin ASDH. In the not-thin ASDH, the mean GCS2 is better than the mean GCS1. Futhermore, in the thin ASDH, the mean difference between GCS2 and GCS1 is -1.04("-" means deteriorated after operation). In the not-thin ASDH, it was 0.77. In the thin ASDH, 44.4% is deteriorated(GCS2-GCS1 or = 2). In the not-thin ASDH, 31.4% is improved and 17.6% is deteriorated. Comparisons between the improved cases and the deteriorated cases with various factors are made by chi square tests. Four statistically significant differences are found. The size of hematoma and midline shift are rather smaller in the deteriorated cases, but brain swelling or contused underlying cortex is more commonly observed during operation in the deteriorated cases and craniectomy with or without excision of the contused cortex is more frequently performed. One possible explanation of these results is that surgical decompression on the thin ASDH may cause or exercerbate brain swelling, hemorrhagic contusion or intracerebral hematoma-justlike "popping", thus replacement of the bone flap is difficult. Therefore, the thin ASDH should not be operated immediately, but closely observed in the ICU. If deteriorated, seek for the causing lesion by such as repeated CT scanning, then, treat the causing lesion, often it is not the ASDH itself.

Isolated Traumatic Ganglionic Hemorrhage

The authors present a series of 6 patients with isolated traumatic ganglionic hemorrhage. Although the patient population is small, some characteristic features of this rare type of traumatic lesion can be drawn. Isolated traumatic ganglionic hemorrhage differs from traumatic intracerebral hemorrhage or diffuse white matter injury, but also shares some features of both types of lesion. Some characteristic CT findings of isolated traumatic ganglionic hemorrhage are discussed. The prognosis of this lesion can be predicted by the degree of motor deficit and pupillary change with high accuracy.

Primary Intracranial Subdural Empyema: Case Report

Two cases of primary intracranial subdural empyema are reported. One is 15 yr-old male and the other is 14 yr-old female. Clinical presentation was high fever, severe headache, impaired consciousness, marked neck stiffness and periorbital swelling in both cases. Since CT brain scan with contract enhancement clearly demonstrated the lesion, angiography was not performed. In one case, craniotomy was done with drainage of pus and thorough irrigation. He died on the 9th postoperative day after generalized covulsive seizure. In the other case, craniectomy was taken. She received additional two craniectomies due to reaccumulation of pus and osteomyelitis, and discharged without major disability on the 64th hospital day. Related reports were briefly reviewed.