Journal List > Korean J Neurotrauma > v.9(2) > 1058934

Korean J Neurotrauma. 2013 Oct;9(2):74-80. Korean.
Published online October 31, 2013.
Copyright © 2013 Korean Neurotraumatology Society
A Study of the Progression from Acute Subdural Hematoma to Chronic Stage Requiring Surgical Treatment
Jong-Won Yoon, MD,1 In Sung Park, MD,1,2 Hyun Park, MD,1 Dong-Ho Kang, MD,1 Kyung-Bum Park, MD,1 Chul-Hee Lee, MD,1 Soo-Hyun Hwang, MD,1 Jin-Myung Jung, MD,1 and Jong-Woo Han, MD1
1Department of Neurosurgery, School of Medicine, Gyeongsang National University, Jinju, Korea.
2Gyeongsang Institute of Health Science, Jinju, Korea.

Address for correspondence: In Sung Park, MD. Department of Neurosurgery, Gyeongsang National University Hospital, Gyeong Sang Institute of Health Science, 79 Gangnam-ro, Jinju 660-702, Korea. Tel: +82-55-750-8108, Fax: +82-55-759-0817, Email:
Received July 01, 2013; Revised September 07, 2013; Accepted September 07, 2013.



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.


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.


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.


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.

Keywords: Acute subdural hematoma; Brain edema; Risk factors; Chronic subdural hematoma


Brain CT image of case 2. A: Initial CT scan on admission revealed a subdural hematoma with a maximal thickness of approximately 11 mm in the left fronto-temporo-parietal convexity with a complete effacement of sulci and the decrease the ventricle in size. B: Eight days later, she was drowsy mental status with right hemiplegia, CT scan disclosed a increase of the subdural hematoma of mixed density, accompanied by a severe midline shift.
Click for larger image


Grade of Cerebral swelling
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Factors related to progressed to chronic stage requiring surgical treatment: univariate analysis
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Multivairate logistic regression analysis of factors related to progressed to chronic stage requiring surgical treatment
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The authors have no financial conflicts of interest.

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