A Study of the Progression from Acute Subdural Hematoma to Chronic Stage Requiring Surgical Treatment / 대한신경손상학회지

ABSTRACT

OBJECTIVE: The conscious patients with a small amount of acute subdural hematoma had no neurological deterioration are managed conservatively. Most of them are resolved spontaneously in several weeks without surgery. In our experience, however, some progressed to chronic stage requiring surgical treatment in a few days, unlike chronic subdural hematoma derived from acute hematoma following several weeks or months after head trauma. We aimed to analyse this phenomenon and associated the risk factor comparing with the chronic subdural hematomas. METHODS: Retrospective analysis of 175 alert patients with unilateral acute subdural hematoma identified among 661 patients diagnosed the acute subdural hematoma from October 2009 to September 2012 was performed. Univariate and multivariate analyses were performed to describe the relationships between progression to chronic stage requiring surgery from small amount of acute subdural hematoma and clinical characteristics and radiologic features. RESULTS: Eighteen patients (10.3%) showed neurological deterioration due to progression to chronic stage of acute subdural hematoma and underwent a surgical treatment. The mean time interval between the head trauma and development of neurological symptoms was 12.7 days. Univariate and multivariate analyses found that depth of hematoma and degree of brain swelling were a risk factor for progression to chronic stage requiring surgery from the acute subdural hematoma. CONCLUSION: In spite of the conscious patients with acute subdural hematoma not requiring surgical decompression, the more amount of hematoma and the severer brain swelling, there is higher probability of neurological deterioration caused by the progression to chronic stage in a few days.