Meta analysis of clinical efficacy of craniotomy and decompressive craniectomy for acute subdural hematoma / 中国医师杂志

Objective To systematically evaluate the efficacy and safety of craniotomy and decompressive craniectomy in the treatment of acute subdural hematoma.Methods A systematic search was performed in PubMed,EMbase,the Cochrane Library,Web of science,China National Knowledge Infrastructure (CNKI),WanFang Data,and CBM databases up to June 2018 for the studies that provided comparisons between craniotomy hematoma evacuation and decompressive craniectomy for acute subdural hematoma.For the two categorical variables,the Odds Ratio (OR) and its 95％ Confidence Interval (95％ CI) are used.Two researchers independently screened the literature,extracted the data,and evaluated the risk of bias of the included studies.The meta analysis was performed using Stata/SE 12.0 software.Results A total of 8 studies were included in the meta analysis,of which 828 patients underwent craniotomy,and 663 patients underwent decompressive craniectomy.Meta analysis results showed that patients receiving decompressive craniectomy had a significantly lower Glasgow Coma Scale (GCS) when they first had symptoms.The residual rate of acute subdural hematoma in the decompressive craniectomy group was significantly lower than that in the craniotomy group (P =0.015),but there was no significant difference in the rate of reoperation.The incidence of poor outcome at following was lower in the craniotomy group compared with decompressive craniectomy group (50.1％ vs 60.1％;P =0.003).Similarly,the mortality of the craniotomy group was lower than that of the decompressive craniectomy group (P =0.002).Conclusions Decompressive craniectomy may be the first choice for acute subdural hematoma,but the study is influenced by many factors and is not sufficient to provide definitive evidence.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma / 中华创伤杂志

Objective@#To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution.@*Methods@#A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness≥5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018. There were 37 males and 23 females, aged 18-80 years [(47.0±16.9)years]. There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group. Coagulation function [prothrombin time (PT) and international normalized ratio (INR)] on admission, hospital stay, Glasgow outcome scale (GOS), and brain CT results were compared between the two groups.@*Results@#The PT and INR values in the rapid resolution group were (11.9±2.1)s and 1.1±0.2 respectively, while those in the non-rapid resolution group were (10.8±1.0)s and 1.0±0.1 respectively, with significant differences (P<0.05). There was no significant difference in hospital stay and GOS between the two groups (P>0.05). The thickness of subdural hematoma of the two groups in the first CT scanning was (8.2±2.3)mm and (7.3±1.8)mm, respectively, with no statistically significant difference (P>0.05). In the second CT scanning, the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs. (6.6±2.1)mm] (P<0.01). The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group (93% vs. 36%) (P<0.01). The incidence of subarachnoid hemorrhage(SAH) increase was significantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan (74% vs. 15%) (P<0.01). The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4% in the rapid resolution group, which was significantly lower than 18% in the non rapid resolution group (P<0.05).@*Conclusions@#The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma. The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma, suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients.

Analysis on clinical characteristics of rapid and non-rapid resolution of traumatic acute subdural hematoma / 中华创伤杂志

Objective To compare the clinical and imaging characteristics of traumatic acute subdural hematoma acute subdural hematoma with rapid resolution and those without rapid resolution.Methods A retrospective case-control analysis was conducted on the clinical data of 60 traumatic acute subdural hematoma patients with hematoma thickness ≥ 5 mm admitted to Second Affiliated Hospital of Shantou University Medical College from January 2011 to May 2018.There were 37 males and 23 females,aged 18-80 years [(47.0±16.9)years].There were 27 patients in the rapid resolution group and 33 patients in the non-rapid resolution group.Coagulation function [prothrombin time(PT)and international normalized ratio(INR)] on admission,hospital stay,Glasgow outcome scale(GOS),and brain CT results were compared between the two groups.Results The PT and INR values in the rapid resolution group were(11.9±2.1)s and 1.1±0.2 respectively,while those in the non-rapid resolution group were(10.8±1.0)s and 1.0±0.1 respectively,with significant differences(P＜0.05).There was no significant difference in hospital stay and GOS between the two groups(P＞0.05).The thickness of subdural hematoma of the two groups in the first CT scanning was(8.2±2.3)mm and(7.3±1.8)mm,respectively,with no statistically significant difference(P＞0.05).In the second CT scanning,the hematoma thickness in the rapid resolution group was significantly lower than that in the non-rapid resolution group [(2.7±1.9)mm vs.(6.6±2.1)mm](P＜0.01).The incidence of low density zone between the hematoma and intracranial plate was statistically higher in rapid resolution group than that in non-rapid resolution group(93％vs.36％)(P＜0.01).The incidence of subarachnoid hemorrhage(SAH)increase wassignificantly higher in rapid resolution group than that in non-rapid resolution group in the second CT scan(74％vs.15％)(P＜0.01).The conversion rate of acute subdural hematoma to subacute or chronic subdural hematoma was 4％in the rapid resolution group,which was significantly lower than 18％in the non rapid resolution group(P＜0.05).Conclusions The abnormal coagulation function and low density zone indicated by CT are two important indicators of rapid resolution in patients with traumatic acute subdural hematoma.The risk of conversion from acute into subacute or chronic subdural hematoma is lower in rapid resolution of traumatic acute subdural hematoma,suggesting that rapid resolution may be one of the prognostic indicators of ASDH patients.

Effect of bone flap reduction on unilateral acute subdural hematoma under intracranial pressure monitoring / 中华创伤杂志

Objective To investigate the effect of bone flap reduction on unilateral acute subdural hematoma (ASDH) under intracranial pressure monitoring.Methods A retrospective case control study was conducted to analyze the clinical data of 139 patients with unilateral ASDH admitted to the First Affiliated Hospital of Xinjiang Medical University from July 2014 to December 2017.There were 84 males and 55 females,aged 19-87 years (mean,53 years).At the time of admission,the Glasgow Coma Score (GCS) was 3-5 points in 63 patients and 6-8 points in 76.There were 40 patients with unilateral cavity dilation and 16 cases with bilateral pupil dilation.According to the different surgical methods,the patients were divided into study group (n =61) and control group (n =78).The study group removed the cranial hematoma under cranial pressure monitoring and determined whether to perform bone flap reduction according to the actual intracranial pressure.The control group was treated with craniotomy hematoma removal and standard large bone decompressed craniectomy (DC).The success rate of bone flap reduction in the study group was recorded.The complications at postoperative 3 months and the Glasgow Outcome Score (GOS) at postoperative 6 months were compared.Results All patients were followed up for 1-6 months,average 5.5 months.In the study group,23 patients underwent bone flap reduction,and the bone flap reduction rate was 38％.At postoperative 3 months,the study group showed better efficacy in subdural effusion (9:25),hydrocephalus (7 ∶19),and brain swelling in the skull defect area(5 ∶ 18) than the control group (P ＜0.05).Based on the GOS at 6 months after operation,in the study group,25 patients were with good results,nine with moderate disability,10 with heavy disability,seven with plant survival,and 10 died;in the control group,six patients were with good results,21 with moderate disability,15 with heavy disability,10 with plant survival,and 26 died.The number of patients with good prognosis (good and moderate disability) and the number of deaths in the study group were statistically different from those in the control group (P ＜ 0.05).Conclsion In the treatment of unilateral ASDH,bone flap reduction under intracranial pressure monitoring can reduce the incidence of complications and improve the life quality of patients.

Value of minimally invasive puncturation via hard tunnel in decompression before craniotomy for acute subdural hematoma combined with cerebral hernia / 中华创伤杂志

Objective To explore the value of minimally invasive puncturation via the hard tunnel in decompression before craniotomy for acute subdural hematoma combined with cerebral hernia.Methods A retrospective method was adopted to analyze the clinical data of 303 patients with traumatic acute subdural hematoma combined with cerebral hernia treated from January 2004 to October 2016.There were 206 males and 97 females,with age range of 12-77 years [(43.6 ± 20.1) years].The Glasgow coma scale (GCS) was 3-5 points in 187 patients and 6-8 points in 116.The patients were divided into study group (n =199) and control group (n =104) according to the different surgical procedures.For study group,the patients were treated with disposable ventricular needle to suck out and drain the intracranial hematoma,and the skull was opened through the large craniotomy to remove the subdural hematoma.For control group,the skull was opened through the large craniotomy which was used to directly remove the subdural hematoma according to the traditional instruction.The differences between two groups were compared with regard to time from confirming the cerebral hernia to the first decompression,time of regaining consciousness after surgery,hospitalization duration and cranial cavity infection after surgery.Glasgow outcome scale (GOS) was used to evaluate the prognosis.Results The time to first decompression was 10-15 minutes [(12.5 ± 1.7)minutes] in study group and 50-75 minutes [(133.0 ± 7.9) minutes] in control group (P ＜ 0.05).Regaining consciousness within 3 days after surgery was found in 62 patients of study group and 18 of control group.Regaining consciousness at days 4-7 after surgery was found in 76 patients of study group and 22 of control group.Regaining consciousness at days 8-15 days after surgery was found in 26 patients of study group and 29 of control group.Regaining consciousness over 15 days after surgery was found in 10 patients of study group and 12 of control group.Postoperative unconsciousness including death was found in 25 patients of study group and 23 of control group (P ＜ 0.05).The hospitalization duration was (19.5 ± 1.1) days in study group and (22.8 ± 2.8) days in control group (P ＜ 0.05).No cranial cavity infection was found in study group,while cranial cavity infection occurred in one patient in control group.According to the GOS,the outcome in study group was good in 133 patients,moderate to severe disability in 41,vegetative state in 7 and death in 18,while the outcome in control group was good in 34 patients,moderate to severe disability in 47,vegetative state in 9 and death in 14 (P ＜ 0.05).Conclusion The minimally invasive puncturation via the hard tunnel to remove the hematoma is capable of reducing the intracranial pressure before craniotomy for acute subdural hematoma combined with cerebral hernia,can decrease the disability rate and hence is prioritized to clinical application.

Predictable Values of Decompressive Craniectomy in Patients with Acute Subdural Hematoma: Comparison between Decompressive Craniectomy after Craniotomy Group and Craniotomy Only Group / 대한신경손상학회지

OBJECTIVE: Patients with traumatic acute subdural hematoma (ASDH) often require surgical treatment. Among patients who primarily underwent craniotomy for the removal of hematoma, some consequently developed aggressive intracranial hypertension and brain edema, and required secondary decompressive craniectomy (DC). To avoid reoperation, we investigated factors which predict the requirement of DC by comparing groups of ASDH patients who did and did not require DC after craniotomy. METHODS: The 129 patients with ASDH who underwent craniotomy from September 2007 to September 2017 were reviewed. Among these patients, 19 patients who needed additional DC (group A) and 105 patients who underwent primary craniotomy only without reoperation (group B) were evaluated. A total of 17 preoperative and intraoperative factors were analyzed and compared statistically. Univariate and multivariate analyses were used to compare these factors. RESULTS: Five factors showed significant differences between the two groups. They were the length of midline shifting to maximal subdural hematoma thickness ratio (magnetization transfer [MT] ratio) greater than 1 (p 1, IVH, and TICH on preoperative brain computed tomography images, intraoperative signs of intracranial hypertension, brain edema, and bleeding tendency were identified as factors indicating that DC would be required. The necessity for preemptive DC must be carefully considered in patients with such risk factors.

Clinical Features and Outcomes of Bilateral Decompression Surgery for Immediate Contralateral Hematoma after Craniectomy Following Acute Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Immediate contralateral epidural hematoma (EDH) and traumatic intracerebral hematoma (T-ICH) after craniectomy for traumatic subdural hematoma (SDH) are rare but devastating post-operative complications. Their clinical features and outcomes are not well studied. In this report, we present the clinical features and outcomes of immediate contralateral acute hematoma cases requiring a second operation. METHODS: This study includes 10 cases of immediate contralateral EDH and T-ICH following bilateral craniectomy for the evacuation of traumatic SDH and contralateral hematoma between 2004 and 2015. Their medical records and radiographic findings were reviewed and analyzed retrospectively. RESULTS: Ten of the 528 patients (1.89%) who underwent craniectomy for the evacuation of traumatic SDH developed post-operative EDH (n=5), T-ICH (n=5). The trauma was caused by a fall in 5 patients and by a traffic accident in 5 patients. The patients who suffered trauma due to pedestrian accidents died. Seven patients had a low admission Glasgow Coma Scale (GCS; GCS≤8) score in the preoperative state (average admission GCS, 7.7; average discharge GCS, 3.4; and average discharge Glasgow Outcome Scale, 2.0). Severe intra-operative brain swelling was noted in all patients, while skull fracture was observed in 8. Multiple associated injuries and medication for heart disease were characteristic of patients who died. CONCLUSION: The prognosis of delayed contralateral hematoma was very poor. Multiple associated injuries, past medical history and traffic accidents, especially pedestrians were seemed to be associated with higher mortality rates. Finally, contralateral skull fractures can indicate high risk of delayed contralateral acute intracranial hematoma.

A Review of Sport-Related Head Injuries / 대한신경손상학회지

We review current topics in sport-related head injuries including acute subdural hematoma (ASDH), traumatic cerebrovascular disease, cerebral concussion, and chronic traumatic encephalopathy (CTE). Sports-related ASDH is a leading cause of death and severe morbidity in popular contact sports like American football and Japanese judo. Rotational acceleration can cause either cerebral concussion or ASDH due to rupture of a parasagittal bridging vein. Although rare, approximately 80% of patients with cerebral infarction due to sport participation are diagnosed with ischemia or infarction due to arterial dissection. Computed tomography angiography, magnetic resonance angiography, and ultrasound are useful for diagnosing arterial dissection; ultrasound is particularly useful for detecting dissection of the common and internal carotid arteries. Repeated sports head injuries increase the risks of future concussion, cerebral swelling, ASDH, and CTE. To avoid fatal consequences of CTE, it is essential to understand the criteria for safe post-concussion sports participation. Once diagnosed with a concussion, an athlete should not be allowed to return to play on the same day and should not resume sports before the concussion symptoms have completely resolved. Information about the risks and management of head injuries in different sports should be widely disseminated in educational institutions and by sport organization public relations campaigns.

Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome / 대한신경손상학회지

OBJECTIVE: Craniotomy (CO) and decompressive craniectomy (DC) are two main surgical options for acute subdural hematomas (ASDH). However, optimal selection of surgical modality is unclear and decision may vary with surgeon's experience. To clarify this point, we analyzed preoperative findings and surgical outcome of patients with ASDH treated with CO or DC. METHODS: From January 2010 to December 2014, data for 46 patients with ASDH who underwent CO or DC were retrospectively reviewed. The demographic, clinical, imaging and clinical outcomes were analyzed and statistically compared. RESULTS: Twenty (43%) patients underwent CO and 26 (57%) patients received DC. In DC group, preoperative Glascow Coma Scale was lower (p=0.034), and more patient had non-reactive pupil (p=0.004). Computed tomography findings of DC group showed more frequent subarachnoid hemorrhage (p=0.003). Six month modified Rankin Scale showed favorable outcome in 60% of CO group and 23% of DC group (p=0.004). DC was done in patient with more unfavorable preoperative features (p=0.017). Patients with few unfavorable preoperative features (<6) had good outcome with CO (p<0.001). CONCLUSION: In selective cases of few unfavorable clinical findings, CO may also be an effective surgical option for ASDH. Although DC remains to be standard of surgical modality for patients with poor clinical status, CO can be an alternative considering the possible complications of DC.

Risk Factors of Chronic Subdural Hematoma Progression after Conservative Management of Cases with Initially Acute Subdural Hematoma / 대한신경손상학회지

OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH. METHODS: We divided 177 patients, presenting with ASDH (managed conservatively initially) between January 2008 to December 2013, into two groups; 'CSDH progression group' (n=16) and 'non-CSDH progression group' (n=161). Patient's data including age, sex, past medical history, medication were collected and brain computed tomography was used for radiologic analysis. RESULTS: Our data demonstrated that no significant intergroup difference with respect to age, sex ratio, co-morbid conditions, medication history, ischemic heart disease, liver disease and end-stage renal disease was found. However, Hounsfield unit (hematoma density) and mixed density was higher in the 'ASDH progression group' (67.50+/-7.63) than in the 'non-CSDH progression group' (61.53+/-10.69) (p=0.031). Midline shifting and hematoma depth in the 'CSDH progression group' were significantly greater than the 'non-CSDH progression group' (p=0.067, p=0.005). CONCLUSION: Based on the results of this study, the risk factors that are related to progression of initially non-operated ASDH to CSDH are higher Hounsfield unit and hematoma depth. Therefore, we suggest that ASDH patients, who have bigger hematoma depth and higher Hounsfield unit, should be monitored and managed carefully during the follow-up period.

Rapid Spontaneous Resolution of Acute Subdural Hematoma in a Patient with Liver Cirrhosis / 대한신경손상학회지

Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.

Encapsulated Unresolved Subdural Hematoma Mimicking Acute Epidural Hematoma: A Case Report / 대한신경손상학회지

Encapsulated acute subdural hematoma (ASDH) has been uncommonly reported. To our knowledge, a few cases of lentiform ASDH have been reported. The mechanism of encapsulated ASDH has been studied but not completely clarified. Encapsulated lentiform ASDH on a computed tomography (CT) scan mimics acute epidural hematoma (AEDH). Misinterpretation of biconvex-shaped ASDH on CT scan as AEDH often occurs and is usually identified by neurosurgical intervention. We report a case of an 85-year-old man presenting with a 2-day history of mental deterioration and right-sided weakness. CT scan revealed a biconvex-shaped hyperdense mass mixed with various densities of blood along the left temporoparietal cerebral convexity, which was misinterpreted as AEDH preoperatively. Emergency craniectomy was performed, but no AEDH was found beneath the skull. In the subdural space, encapsulated ASDH was located. En block resection of encapsulated ASDH was done. Emergency craniectomy confirmed that the preoperatively diagnosed AEDH was an encapsulated ASDH postoperatively. Radiologic studies of AEDH-like SDH allow us to establish an easy differential diagnosis between AEDH and ASDH by distinct features. More histological studies will provide us information on the mechanism underlying encapsulated ASDH.

Study on severity and prognosis of acute subdural hematoma in patients by magnetic resonance spectroscopy and S-100B pro-tein / 中国医师杂志

Objective To investigate the evaluation value of magnetic resonance spectroscopy (MRS) combined with S-100B protein in the severity and prognosis in patients with acute subdural hematoma ( ASDH).Methods Eighty cases of ASDH patients and 20 cases of healthy check-up were selected.MRS was used to test NAA/Cr, Cho/Cr, NAA/Cho, and Glx /Cr in thalamus and corpus callosum.The blood S-100B protein was detected in 72 h after injury.The relationships of those MRS detection indices with glasgow coma scale ( GCS) and glasgow prognostic score ( GOS) for 2 months after injury were analyzed .Results MRS detection in-dex and the S100B protein in ASDH were compared between each group relative to normal control group , all difference had statistical significance ( P <0.05).As aggravating the severity of traumatic brain injury , Cho/Cr, Glx/Cr ratio, and S-100B protein concentra-tion were elevated , and NAA/Cho and NAA/Cr were reduced .All differences were statistically significant among poor recovery , good recovery, and normal control groups ( P <0.05).For patients with traumatic brain injury, there were worse prognosis, the higher ra-tios of Cho/Cr and Glx/Cr, higher concentration of S-100B protein, and lower ratios of NAA/Cho and of NAA/Cr.GCS score and GOS scores were negatively correlated with Cho/Cr and Glx/Cr ratios of corpus callosum , and were positively correlated with NAA/Cho, NAA/Cr ratios of corpus callosum .S-100B protein was positively correlated with Cho/Cr and Glx/Cr, and was negatively correlated with NAA/Cho and NAA/Cr.MRS combined S-100B can improve the prognosis of patients with up to the accuracy of 81%.Conclu-sions MRS detection in the early stage after injury of ASDH patients has important value in assessment of the severity of the injury and its prognosis , the accuracy of assessment of prognosis is improved with a combination of MRS detection and blood S -100 B protein meas-urement.

Clinical analysis of standard large trauma craniotomy in treatment of acute subdural hematoma / 中国基层医药

Objective To explore the surgical techniques and clinical outcome of standard large trauma craniotomy in the treatment of acute subdural hematoma.Methods The clinical data of 51 cases with acute subdural hematoma,who underwent standard large trauma craniotomy in recent 5 years in our department,were retrospectively analyzed.Results All the patients were followed up for 3 ～ 6 months.10 cases were dead,4 persistent vegetative status,severe disability in 6 cases,midrange disability occurred in 11 cases and 20 cases were good.Postoperative complications included tardive haematoma in 4 cases,traumatic cerebral infarction in 2 cases,subdural collection of fluid in 4 cases,cerebromalacia in depressor area in 2 cases,hydrocephalus in 2 cases,and traumatic epilepsy in 3 cases.Conclusion Standard large trauma craniotomy is an effective approach in the treatment of acute subdural hematoma,due to its advantages such as satisfactory exposure for haemostasis,rapid removal of haematoma and relief of acute intracranial hypertension.

key-hole drainage for acute traumatic subdural hematoma / 中华创伤杂志

ObjectiveTo investigate the effects of minimally invasive key-hole drainage for treating acute subdural hematoma.MethodsThirty-five patients with acute subdural hematoma treated by key-hole drainage were retrospectively analyzed.CT-oriented key-hole drainage was performed to aspirate,liquefy and drain hematoma.The transfixion pin was removed after hematoma was basically cleared within 1 to 3 days.ResultsHematoma volume decrease was greater than 80％ by follow-up CT 24 hours postoperatively.Headache and vomiting in the preoperative conscious patients were significantly relieved after key-hole drainage.Glasgow Outcome Score (GOS) was 5 points in 16 patients,4 points in 15 and 3 points in four six months postoperatively.One patient was complicated with hydrocephalus and two with epilepsy.ConclusionsKey-hole drainage with disposable transfixion pin selective employed for patients with acute subdural hematoma is effective and has few complications.The treatment notably improves prognosis of the patients.

Analysis on prognostic influence factors of acute subdural hematoma / 中国基层医药

Objective.To explore the prognostic influence factors of acute subdural hematoma.Methods The clinical data of 114 patients of acute subdural hematoma were analyzed retrospectively,they were divided into good prognosis group(62 patients) and poor prognosis group(52 patients) according to prognosis,analyzed the related factors for the prognosis were gualyzed in two groups.Results The prognosis of acute subdural hematoma with sex,weight was no significant correlation(all P＞0.05),but related with age,GCS score,pupillary changes,brain shift and hematoma volume(all P＜0.05).Conclusion Patient's age,GCS score,pupillary changes,brain shift and hematoma volume were the prognostic influence factors of acute subdural hematoma.

Spontaneous Rapid Reduction of a Large Acute Subdural Hematoma

The majority of acute post-traumatic subdural hematomas (ASDH) require urgent surgical evacuation. Spontaneous resolution of ASDH has been reported in some cases. We report here on a case of a patient with a large amount of ASDH that was rapidly reduced. A 61-yr-old man was found unconscious following a high speed motor vehicle accident. On initial examination, his Glasgow Coma Score scale was 4/15. His pupils were fully dilated and non-reactive to bright light. Brain computed tomography (CT) showed a massive right-sided ASDH. The decision was made to treat him conservatively because of his poor clinical condition. Another brain CT approximately 14 hr after the initial scan demonstrated a remarkable reduction of the previous ASDH and there was the new appearance of high density in the subdural space adjacent to the falx and the tentorium. Thirty days after his admission, brain CT revealed chronic SDH and the patient underwent surgery. The patient is currently able to obey simple commands. In conclusion, spontaneous rapid resolution/reduction of ASDH may occur in some patients. The mechanisms are most likely the result of dilution by cerebrospinal fluid and the redistribution of hematoma especially in patients with brain atrophy.