The subdural hematoma sdh is a potentially devastating. Chronic subdural hematoma in the aged, trauma or degeneration. It usually results from tears in bridging veins that cross the subdural space subdural hematomas may cause an increase in the pressure inside the. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. These are more commonly seen in the elderly population where brain shrinkage. Subacute subdural hematoma in a patient with bilateral dbs.
This type of subdural hematoma is often seen in older adults. An sdh is classified as acute, chronic, or subacute based on the timing of occurrence and brain imaging. Since the papers of trotter, 1 putnam, and cushing 2 on chronic subdural hematoma were published, neurologists and neurosurgeons have been well aware of this entity. Subdural hematomas sdh in patients with implanted deep brain stimulating dbs electrodes are rare. Middle meningeal artery embolization for chronic subdural. The most commonly accepted pathophysiological explanation of csh is that mild head trauma leads to tearing of bridging veins with subsequent bleeding, thus creating the hematoma 7. Moreover, the high incidence of these lesions in the neurocritical care settings behooves practitioners to have a firm grasp on their diagnosis and management. Surgical intervention is a safe treatment of choice.
Morbidity and mortality associated with an sdh increases with age and exposure to anticoagulant and antiplatelet therapy. The prognosis and management of sdh will be discussed here. Revisiting neuroimaging of abusive head trauma in infants. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of. The surgical management of chronic subdural hematoma vol.
Current diagnosis and treatment of chronic subdural haematomas. Core outcomes and common data elements in chronic subdural. This abrupt flexionextension movement of the head to rock music extremely rarely causes a subdural hematoma. A total of 448 csdh patients were enrolled in the study. In a study of patients with traumatic acute subdural hematoma, a midline shift exceeding the thickness of the hematoma by 3 mm or more at the initial ct predicted mortality in all cases. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Subdural hematoma in adults prognosis and management up to. Acute subdural hematoma is a common disease in neurosurgery. To study the effect of early cooling in acute subdural hematoma patients hopes the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Pathophysiology of chronic subdural hematoma longdom.
Subdural hematomas sdhs, though frequently grouped together, can result from a variety of different etiologies, and therefore many different subtypes exist. The brain trauma foundation has published guidelines on the surgical management of traumatic subdural hematoma sdh. The aim of this study was to determine the populationbased epidemiology of chronic subdural hematoma csdh over a 26year period. Chronic subdural hematoma may have presentation similar to what. Headbanging is the slang term used to denote violent shaking of ones head in time with the music. Morinaga k, matsumoto y, hayashi s, omiya n, mikami j, sato h.
If you sustain a major brain injury, this area can fill with blood and. It was first described by virchow, in 1857, as an internal hemorrhagic pachymeningitis. To investigate predictors of postoperative acute intracranial hemorrhage aih and recurrence of chronic subdural hematoma csdh after burr hole drainage. A 24yearold female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral. A subdural hematoma occurs when a vein ruptures between your skull and your brains surface. However, a history of trauma is absent in about 3050% of the cases, especially. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or. A ct scan will usually detect significant subdural hematomas. History of chronic subdural hematoma korean journal of. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under the calvarium. A subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed.
Understanding subdural collections in pediatric abusive. Effect of atorvastatin on chronic subdural hematoma atoch. It is believed that aberrant angiogenesis and intracapsular inflammation contribute to the development of csdh. Subdural hematoma is defined as a collection of blood outside the brain below the dura mater. Subdural hematomas form between the dura and the arachnoid membranes epidural hematomas arise in the potential space between the dura and the skull. Early diagnosis and rapidly executed treatment for acute subdural hematomas strikingly improve outcome. Subdural hematomas may be classified as acute one to two days, subacute 314 days or chronic 15 days. Listing a study does not mean it has been evaluated by the u. Acute subdural hematoma the manifestations appear during the first 3 days subacute subdural hematoma clinically manifests between 4 and 21 days chronic subdural hematoma the clinical manifestations appear after 21 days. This network of neurons and neuronal connective tissue is prone to. Its protean manifestations make its inclusion in the differential diagnosis of encephalopathy practically mandatory, especially when there is a history of trauma. Subdural hematoma, sdh, neurosurgery intensive care unit, neuro icu.
Variable disease course, depending on size of hematoma, age of the patient, presenting neurologic signssymptoms, presence of underlying coagulopathy or neoplasm, and associated injuries. However, a history of trauma is absent in about 3050% of the cases, especially after the age of 65. However, the recurrence rate is relatively high and the outcome is not always satisfactory among surgically treated patients. The amount of bleeding is smaller and occurs more slowly.
Chronic subdural hematoma international journal of medical. The more important prerequisite is sufficient potential subdural space, degeneration of the. The plethora of studies in chronic subdural hematoma csdh has not resulted in the development of an evidencebased treatment strategy, largely due to heterogeneous outcome measures that preclude crossstudy comparisons and guideline development. In the context of aht, subdural hematoma sdh is described as the most common intracranial pathology in infants and toddlers. A multicenter retrospective study of patients who underwent burr hole drainage for csdh between january 20 and march 2019. Subacute subdural hematoma in a 45yearold woman with no significant past medical history after a roller coaster ride. Chronic subdural hematomas may take weeks to months to appear. Only a handful of cases have been reported in the literature. Pdf chronic subdural hematoma csdh is one of the most common neurosurgical conditions.
It is visible as a crescentshaped lesion on the ct scan. A ct scan of his head revealed a subdural hematoma. The brain is the central repository of delicate neural tissue. Predictors of acute intracranial hemorrhage and recurrence. Ducruet and others published the surgical management of chronic subdural hematoma vol 35, pg 155, 2015 find, read and cite all the research you need on. Recurrent subdural hematoma secondary to headbanging. Management of a patient with subdural hematoma includes resuscitation followed by control of the bleeding. Management of apixabanassociated subdural hematoma.
The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain. In contrast, epidural hematoma, scalp swelling, and isolated skull fracture were. After a confirmatory cranial ct scan revealed a worsening subdural hematoma with midline shift, a. Description subdural hematomas most often affect people who are. For example, in a 2015 study of people with a subdural hematoma, the authors noted that the majority received conservative treatment. Methods a retrospective study was conducted of all adult patients. It was a prospective study on patients with chronic subdural hematoma managed in our centers from 2009 to 2015. Subdural hematoma is a blood collection between the dura mater and the arachnoid that may be present in 10% of head traumas. His home medications include asa, clopidogrel, and amlodipine. The incidence of chronic subdural hematomas from 1990 to. To study the effect of early cooling in acute subdural. Therefore, early diagnosis is the best way to prevent future problems. We describe a 68yearold female with bilateral dbs electrodes, who presented with acute, severe hemiparesis due to a large.
Acute subdural hematoma usually occurs after severe, highimpact injuries and is often associated with contusions of the adjacent areas of the brain. Delayed hypertensive process in subacute subdural hematoma. With any subdural hematoma, tiny veins between the surface of the brain and. In this country the interest in chronic subdural hemorrhage was aroused by the report of putnam and cushing1 in 1925. Subdural hematoma sdh and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. Traumatic acute subdural hematoma has a high mortality despite intensive treatment. Acute subdural hematoma asdh is a common occurrence following severe head injury. Chronic subdural hematoma csdh is a common disease that is more prevalent in older people. Subdural hematoma an overview sciencedirect topics. Dalam bentuk akut yang hebat,baik darah maupun cairan serebrospinal memasuki ruang tersebut sebagai akibat dari laserasi otak atau robeknya arachnoid, sehingga menambah. Samadani and colleagues reported last month in the journal of neurosurgery.
A 76yearold man presented to an outside facility with a chief complaint of headache and pain behind his right eye. By 2030, when a fifth to a quarter of the american population will be older than 65, chronic subdural hematoma, or sdh, is expected to afflict 60,000 americans a year, which would make it the most common reason for brain surgery, surpassing brain tumors and metastases, dr. It is most often caused by torn, bleeding veins on the inside of the dura as a result of a blow to the head. The patient was transferred to our facility with worsening clinical status. A simple tool to identify elderly patients with a surgically important acute subdural haematoma. However, no data exist on the proportion of patients with sdh that can be selected for conservative management and what is the outcome of these patients. Subdural hematoma definition a subdural hematoma is a collection of blood in the space between the outer layer dura and middle layers of the covering of the brain the meninges. Traumatic encephalopathy vs possible subdural hematoma. Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache. Subdural hematomas can also occur after a minor head injury. Subdural hematoma sdh a guide for patients and families. There in a high variance in the treatment in literature.
Pendahuluan hematoma subdural adalah penimbunan darah di dalam rongga subdural. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. Extensive investigation should be performed when the etiology of subdural hemorrhage is not clear. It is a misconception that an operation is rarely necessary in head injury. No clear management guidelines exist regarding the management of the hematoma and the existing electrodes.
Curiously enough, at that time these authors could report but six cases from the peter bent brigham hospital records, although. Subacute subdural hematoma clinically manifests between 4 and 21 days. Subdural hematoma is the result of bleeding over the surface of the brain, beneath the dura. Development of delayed acute subdural hematoma after mild traumatic brain injury. Subdural hematoma is a common injury in both military active duty and their dependents, including children subject to nonaccidental trauma.
A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Subdural hematoma uf health, university of florida health. It can be lifethreatening and requires immediate attention. Gordon deen, in neurology and clinical neuroscience, 2007. Pdf subdural hematoma is extracerebral accumulation of blood between the dura matter and the.
The neurocritical and neurosurgical care of subdural. Subdural hematoma definition of subdural hematoma by. Sakellaridis and dafniotidis, brain disord ther 2015, 4. A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on t2gradient recalledecho or susceptibilityweighted sequences such as swi and susceptibilityweighted angiography, which is not necessarily true. Chronic subdural hematoma presenting with symptoms of transient ischemic attack tia. Chronic subdural hematomas cshs are generally regarded to be consequences of head trauma 14,51.
The emergency management and follow up of this condition. Acute subdural hematomas if you sustain a major brain injury, this. Chronic sdh should be categorized as a degenerative lesion instead of a traumatic lesion. To characterize patients with chronic subdural hematoma undergoing surgery and to.
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