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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.
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FIGURE 1.
Brain CT image of case 2. A: Initial CT scan on admission revealed a subdural hematoma with a maximal thickness of approxima-tely 11 mm in the left fronto-temporo-parietal con-vexity with a complete effacement of sulci and the decrease the ventricle in size. B: Eight days later, she was drowsy mental status with right hemiple-gia, CT scan disclosed a increase of the subdural hematoma of mixed density, accompanied by a severe midline shift.
TABLE 1.
Grade of Cerebral swelling
The cerebral swelling is to cause the involved gyri to expand and the intervening sulci to decrease in size. As the brain continues to swell, not only do the sulci decrease, but all of the CSF spaces of the hemispheres decrease as well. The more brain swelling progress, it is to cause the ventricles to decreased in size. As the brain tissues swell, in order for the total intracranial volume to remain constant, the ventricles and extraaxial CSF spaces must decrease in total volume (6)
TABLE 2.
Factors related to progressed to chronic stage requiring surgical treatment: univariate analysis
| Factor | No. of patients (%) | p value | |
|---|---|---|---|
| Case | Control | ||
| Age (years) | 61.1±13.9∗ | 59.5±20.3∗ | 0.737 |
| Max depth of ASDH | 0.000 | ||
| ≥7 mm | 15 (83.3%) | 40 (25.5%) | |
| ＜7 mm | 3 (16.7%) | 117 (74.5%) | |
| Brain swelling | 0.001 | ||
| Grade 1 | 2 (11.1%) | 59 (37.6%) | |
| Grade 2 | 4 (22.2%) | 63 (40.1%) | |
| Grade 3 | 8 (44.4%) | 27 (17.2%) | |
| Grade 4 | 4 (22.2%) | 8 (5.1%) | |
| Hypertension | 6 (33.3%) | 33 (21.0%) | 0.240 |
| Diabetes mellitus | 4 (22.2%) | 30 (19.1%) | 0.478 |
| Cerebravascular disease | 3 (16.7%) | 9 (5.7%) | 0.111 |
| Cardiac disease | 4 (22.2%) | 7 (4.5%) | 0.017 |
| Liver disease | 1 (5.6%) | 8 (5.1%) | 0.633 |
| Kidney disease | 1 (5.6%) | 3 (1.9%) | 0.355 |
| Antiplatelet drug | 4 (22.2%) | 21 (13.4%) | 0.296 |
| Alcohol (bottle per month) | 7.89±14.8∗ | 6.22±14.6∗ | 0.426 |
| Smoking (PYS) | 6.11± 9.3∗ | 7.06±13.9∗ | 0.935 |
TABLE 3.
Multivairate logistic regression analysis of factors related to progressed to chronic stage requiring surgical treatment
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