kjn Korean Journal of Nutrition Korean J Nutr 0367-6463 2005-7121 The Korean Nutrition Society 10.13004/kjnt.2013.9.2.125 kjn-9-125 Clinical Article The Clinical Course of Subdural Hygroma with Head Injury ChaKyung HanMD KimChang HyunMD, PhD LeeHo KookMD, PhD MoonJae GonMD, PhD ChoTack GeunMD Department of Neurosurgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul, Korea Address for correspondence: Chang Hyun Kim, MD Department of Neurosurgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 150-950, Korea Tel: +82-2-829-5175, Fax: +82-2-833-0219 E-mail: nskch@hallym.or.kr 10 2013 20 10 2013 9 2 125 130 02092013 07102013 07102013 Copyright © 2013 The Korean Nutrition Society 2013 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Objective

Traumatic subdural hygroma (T-SDG) has been generally treated using conservative management rather than surgical methods. This study was performed to evaluate the clinical course of T-SDG with radiologic studies.

 Methods

A retrospective study was conducted among patients diagnosed with T-SDG from January 2011 to December 2011. The patients were categorized into two groups. Group A has the widest width of T-SDG below 8 mm, Group B more than 8 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) were carried out in both groups.

 Results

Seventy-four patients were confirmed with T-SDG and were grouped as follows: 44 patients in Group A and 30 patients in Group B. There was no significant difference in age and sex ratio between group A and B. It took more time to resolve T-SDG in Group B (95.2±86.4 days) than Group A (14.4±6.7)(p＜0.001). However, no significant difference was observed in the Glasgow Coma Scale (GCS) between the groups. In 10 patients of Group B, T-SDG developed into chronic subdural hematoma and one of these patients underwent surgery.

 Conclusion

Most T-SDGs were resolved after some period in this study. Surgery does not seem to be necessary in resolving T-SDG.

 Head injury Traumatic subdural hygroma Chronic subdural hematoma References Borzone M Capuzzo T Perria C Rivano C Tercero E Traumatic subdural hygromas: a report of 70 surgically treated cases J Neurosurg Sci 27 161165 1983 French BN Cobb CA 3rd Corkill G Youmans JR Delayed evolution of posttraumatic subdural hygroma Surg Neurol 9 145148 1978 Friede RL Schachenmayr W The origin ofsubdural neomembran-es. II. Fine structural of neomembranes Am J Pathol 92 6984 1978 Hasegawa M Yamashima T Yamashita J Suzuki M Shimada S Traumatic subdural hygroma: pathology and meningeal enhancement on magnetic resonance imaging Neurosurgery 31 580585 1992 HillL NC Goldstein NP McKenzie BF McGuckin WF Svien HJ Cerebrospinal-fluid proteins, glycoproteins, and lipoproteins in obstructive lesions of the central nervous system Brain 82 581593 1959 Hoff J Bates E Barnes B Glickman M Margolis T Traumatic subdural hygroma J Trauma 13 870876 1973 Ju CI Kim SW Lee SM Shin H The surgical results of traumatic subdural hygroma treated with subduroperitoneal shunt J Korean Neurosurg Soc 37 436442 2005 Koizumi H Fukamachi A Wakao T Tasaki T Nagaseki Y Yanai Y [Traumatic subdural hygromas in adults–on the possibility of development of chronic subdural hematoma (author's transl)] Neurol Med Chir (Tokyo) 21 397406 1981 Lee KS Bae WK Bae HG Yun IG The fate of traumatic subdural hygroma in serial computed tomographic scans J Korean Med Sci 15 560568 2000 Lee KS Bae WK Park YT Yun IG The pathogenesis and fate of traumatic subdural hygroma Br J Neurosurg 8 551558 1994 Lee KS Doh JW Bae HG Yun IG Relations among traumatic subdural lesions J Korean Med Sci 11 5563 1996 Litofsky NS Raffel C McComb JG Management of symptomat-ic chronic extra-axial fluid collections in pediatric patients Neurosurgery 31 445450 1992 McCluney KW Yeakley JW Fenstermacher MJ Baird SH Bon-mati CM Subdural hygroma versus atrophy on MR brain scans: “the cortical vein sign” AJNR Am J Neuroradiol 13 13351339 1992 McConnell AA Traumatic subdural effusions J Neurol Psychiatry 4 237256 1941 Naffziger HC Subdural fluid accumulations following head injury JAMA 82 17511752 1924 St John JN Dila C Traumatic subdural hygroma in adults Neurosurgery 9 621626 1981 Stone JL Lang RG Sugar O Moody RA Traumatic subdural hygroma Neurosurgery 8 542550 1981 Wetterling T Demierre B Rama B Spoerri O The clinical course of surgically treated posttraumatic subdural hygromas Acta Neurochir (Wien) 83 99104 1986 Figures and Tables

CT findings of representative cases. In a group A patient (A and B) the maximum width of T-SDG is below 8 mm whereas it is more than 8 mm in group B (C and D). T-SDG: traumatic subdural hematoma.

The patient of T-SDG who changed to chronic subdural hematoma and was treated by surgical management. He had undergone surgical removal of epidural hematoma (EDH) in second hospital day. A: Post-operative day (POD) 1. B: POD 10. C: POD 27. D: POD 38. E: POD 47. F: POD 90. G: POD 118.

Age distribution of patients with T-SDG

Age distribution Number of patients (%)
Group A Group B Total
0–9 0 (0) 0 (0) 0 (0)
10–19 2 (2.7) 0 (0) 2 (2.7)
20–29 2 (2.7) 3 (4.1) 5 (6.8)
30–39 8 (10.8) 2 (2.7) 10 (13.5)
40–49 5 (6.8) 1 (1.4) 6 (8.1)
50–59 8 (10.8) 7 (9.5) 15 (20.3)
60–69 10 (13.5) 6 (8.1) 16 (21.6)
70–79 5 (6.8) 7 (9.5) 12 (16.2)
80–89 4 (5.4) 4 (5.4) 8 (10.8)

T-SDG: traumatic subdural hygroma

Main diagnosis of patients with T-SDG

  Number of patients (%)
Group A Group B Total
T-SDH 9 (12.2) 14 (18.9) 23 (31.1)
Diffuse cerebral or cerebellar contusion 16 (21.6) 5 (6.8) 21 (28.4)
EDH 13 (17.6) 6 (8.1) 19 (25.7)
Other intracranial or head injury 3 (4.1) 1 (1.4) 4 (5.4)
T-SAH 1 (1.4) 2 (2.7) 3 (4.1)
Skull and facial bone fracture 1 (1.4) 1 (1.4) 2 (2.7)
Concussion 1 (1.4) 1 (1.4) 2 (2.7)

T-SDG: traumatic subdural hygroma, T-SDH: traumatic subdrural hematoma, EDH: epidural hematoma, T-SAH: traumatic subarachnoid hemorrhage

Cause of trauma in patients with T-SDG

  Number of patients (%)
Group A Group B Total
Traffic accident 14 (18.9) 11 (14.9) 25 (33.8)
Slip down 6 (8.1) 9 (12.2) 15 (20.3)
Rolling down at stairs 10 (13.5) 4 (5.4) 14 (18.9)
Unknown of origin 9 (12.2) 2 (2.7) 11 (14.9)
Fall down 3 (4.1) 3 (4.1) 6 (8.1)
Assault 1 (1.4) 1 (1.4) 2 (2.7)
Be hit 1 (1.4) 0 (0) 1 (1.4)

T-SDG: traumatic subdural hygroma

Sex, age, the time for the resolving T-SDG and GCS at admission between Group A and B

  Group A Group B p-value
Total patients 44 30 NC
Male/Female 33/11 25/5 0.393
Mean age 54.0±18.1 62.1±18.6 0.067
Mean days for the resolving T-SDG 14.4± 6.7 95.2±86.4 ＜0.001
GCS score at admission 13.3± 3.0 13.4± 3.2 0.803
GCS score at discharge 14.1± 2.5 14.1± 2.4 0.988
The development of T-SDG after intracranial operation (%) 7 (15.9) 5 (16.7) 0.931
Change to the CSDH (%) 0 (0) 10 (33.3) ＜0.001
Change to the CSDH/total T-SDG (%) T-SDG: traumatic subdural hygroma, Group A: slight observati 10/74 (13.5) ion group, Group B: close observation gr NC oup, GCS: Glasgow

T-SDG: traumatic subdural hygroma, Group A: slight observation group, Group B: close observation group, GCS: Glasgow Coma Scale, CSDH: chronic subdural hematoma, NC: not checked