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

Korean J Neurotrauma. 2013 Oct;9(2):74-80. Korean.
Published online October 31, 2013.  https://doi.org/10.13004/kjnt.2013.9.2.74
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: gnuhpis@gnu.ac.kr
Received July 01, 2013; Revised September 07, 2013; Accepted September 07, 2013.

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.

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

Figures


FIGURE 1
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

Tables


TABLE 1
Grade of Cerebral swelling
Click for larger image


TABLE 2
Factors related to progressed to chronic stage requiring surgical treatment: univariate analysis
Click for larger image


TABLE 3
Multivairate logistic regression analysis of factors related to progressed to chronic stage requiring surgical treatment
Click for larger image

Notes

The authors have no financial conflicts of interest.

References
1. Adams JH, Graham DI, Scott G, Parker LS, Doyle D. Brain damage in fatal non-missile head injury. J Clin Pathol 1980;33:1132–1145.
2. Andrews PJ, Citerio G. Intracranial pressure. Part one: historical overview and basic concepts. Intensive Care Med 2004;30:1730–1733.
3. Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: results of a large single-center cohort study. Neurosurg Rev 2004;27:263–266.
4. Bullock R, Teasdale GM. Head injuries-surgical management: traumatic intracranial haematomas. In: Braakman R, editor. Vinken and Bruyn's Handbook of clinical neurology, head injury. Vol 24. Amsterdam: Elsevier Science Publishers; 1991. pp. 249-298.
5. Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 2000;11:399–406.
6. Creasy JL. In: The general appearance of edema and hemorrhage on ct, mr and us (including a general introduction to ct, mr and us scanning): Dating neurological injury. Nashville, USA: Springer; 2011. pp. 43-58.
7. Croce MA, Dent DL, Menke PG, Robertson JT, Hinson MS, Young BH, et al. Acute subdural hematoma: nonsurgical management of selected patients. J Trauma 1994;36:820–826.
discussion 826-827.
8. Cuatico W, Yamamoto R, Howeiler B, Smith R. Spontaneous resolution of subdural hematomas. J Neurosurg Sci 1991;35:139–145.
9. Forster MT, Mathé AK, Senft C, Scharrer I, Seifert V, Gerlach R. The influence of preoperative anticoagulation on outcome and quality of life after surgical treatment of chronic subdural hematoma. J Clin Neurosci 2010;17:975–979.
10. Inamasu J, Nakamura Y, Saito R, Kuroshima Y, Mayanagi K, Ohba S, et al. Rapid resolution of traumatic acute subdural hematoma by redistribution. Am J Emerg Med 2002;20:376–377.
11. Ito H, Yamamoto S, Saito K, Ikeda K, Hisada K. Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method. J Neurosurg 1987;66:862–864.
12. Kang HJ, Lee YS, Suh SJ, Lee JH, Ryu KY, Kang DG. Clinical outcomes of patients with good neurological scores in spite of significant amounts of acute subdural hematoma. Korean J Neurotrauma 2013;9:12–16.
13. Labadie EL, Glover D. Local alterations of hemostatic-fibrinolytic mechanisms in reforming subdural hematomas. Neurology 1975;25:669–675.
14. Lee CH, Kang DH, Hwang SH, Park IS, Jung JM, Han JW. Spontaneous rapid reduction of a large acute subdural hematoma. J Korean Med Sci 2009;24:1224–1226.
15. Lee KS, Bae HG, Yun IG. Small-sized acute subdural hematoma: operate or not. J Korean Med Sci 1992;7:52–57.
16. Lee KS, Bae WK, Doh JW, Bae HG, Yun IG. Origin of chronic subdural haematoma and relation to traumatic subdural lesions. Brain Inj 1998;12:901–910.
17. Lee YB. Risk factors related to prognosis in patients with isolated traumatic subdural hematoma. J Korean Neurotraumatol Soc 2011;7:12–18.
18. Lindvall P, Koskinen LO. Anticoagulants and antiplatelet agents and the risk of development and recurrence of chronic subdural haematomas. J Clin Neurosci 2009;16:1287–1290.
19. Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien) 1993;121:100–108.
20. Maurice-Williams RS. Chronic subdural haematoma: an everyday problem for the neurosurgeon. Br J Neurosurg 1999;13:547–549.
21. Mckissock W, Richardson A, Bloom WH. Subdural haematoma: A review of 389 cases. Lancet 1960;275:1365–1369.
22. Munro D, Merritt HH. Surgical pathology of subdural hematoma based on a study of one hundred and five cases. Arch Neurol Psychiatry 1936;35:64–79.
23. Park JK, Lee KS, Bae KG, Yun IG, Lee IS. Thin acute subdural hematoma: part 3: result of conservative treatment. J Korean Neurosurg Soc 1990;19:937–944.
24. Putnam T, Cushing H. Chronic subdural hematomaits pathology, its relation to pachymeningitis hemorrhagica and its surgical treatment. Arch Surg 1925;11:329–393.
25. Sato M, Nakano M, Sasanuma J, Asari J, Watanabe K. Rapid resolution of traumatic acute subdural haematoma in the elderly. Br J Neurosurg 2005;19:58–61.
26. Tokmak M, Iplikcioglu AC, Bek S, Gökduman CA, Erdal M. The role of exudation in chronic subdural hematomas. J Neurosurg 2007;107:290–295.
27. Winn HR, Youmans JR. In: Youmans neurological surgery. ed 6. Vol 2. Philadelphia, PA: Saunders; 2011. pp. 424.
28. Wintzen AR. The clinical course of subdural haematoma. A retrospective study of aetiological, chronological and pathological features in 212 patients and a proposed classification. Brain 1980;103:855–867.
29. Yamamoto T, Katayama Y, Tsubokawa T, Sasaki J, Kumagara H, Sugitani M. Features of chronic subdural haematoma developed from definitely identified acute subdural haematoma. Brain Inj 1990;4:135–146.
30. Yamashima T, Yamamoto S. Clinicopathological study of acute subdural haematoma in the chronic healing stage. Clinical, histological and ultrastructural comparisons with chronic subdural haematoma. Neurochirurgia (Stuttg) 1984;27:98–105.
31. Yamashima T, Yamamoto S. How do vessels proliferate in the capsule of a chronic subdural hematoma? Neurosurgery 1984;15:672–678.
TOOLS
Similar articles

Treatment of Chronic Subdural Hematoma with Arachnoid Cyst

"Contralateral" Acute Subdural and Intracerebral Hemorrhage Occurring Simultaneously after Evacuation of Huge Chronic Subdural Hematoma

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

Death by Subdural Hematoma with Metastatic Carcinoma of Unknown Origin: An Autopsy Case Report

Multi -Layer Chronic Subdural Hematoma Requiring Craniotomy