In the context of aht, subdural hematoma sdh is described as the most common intracranial pathology in infants and toddlers. Since recent studies have demonstrated a higher incidence, we repeated our study to estimate the current incidence of csdh amongst people above the age of 65 in north wales. Chronic subdural hematoma csdh is one of the most common clinical entities in daily neurosurgical practice. Characterization of chronic subdural hematoma fluid proteome. A subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed. A subdural hematoma is a collection of blood between the covering of the brain dura and the surface of the brain. However, most subdural hematomas are thought to result from torn bridging veins, as judged by surgery or autopsy. Incidence of csdh has been increasing in younger patients as a result of several clinical trends that increase bleeding risk including increased use of anticoagulant therapy and, hemodialysis, and longer survival with systemic. Crimeancongo hemorrhagic fever with acute subdural. A subdural hematoma is most often the result of a severe head injury. This network of neurons and neuronal connective tissue is prone to. The bleeding fills the brain area very rapidly, compressing brain tissue. She underwent burr hole evacuation, her weakness resolved, and she was discharged to home after 4 days. 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.
However, it persisted without postural component at. Chronic subdural hematomas cshs are generally regarded to be consequences of head trauma 14,51. A hematoma is benign and is initially in liquid form spread among the tissues including in sacs between tissues where it may coagulate and solidify before blood is reabsorbed into blood. We present two cases with calcified subdural hematoma. A subdural hematoma sdh, is a type of hematoma, usually associated with traumatic brain injury. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Association between subdural hematoma and preadmission antithrombotic drug use stratified by severity of head trauma in cases, funen area. The presentation of csdh could vary from no symptoms to. With the purpose of increasing awareness of such complications and a speedy diagnosis, we report two cases of. Increasing incidence of chronic subdural haematoma in the. Chronic subdural hematomas may take weeks to months to appear.
Nurses should develop their own standards of care in reducing postoperative complications. An 81yearold righthanded woman with hypertension developed mild left hemiparesis over 1 week. Subdural hematoma sdh a guide for patients and families. Subdural hematoma an overview sciencedirect topics. C complete resorption of the subdural hematoma with residual edema, 1 month later. Subdural hematoma published on jul 2012 by american association of neurological surgeons. Bilateral subdural intracranial hematoma after accidental.
Variable disease course, depending on size of hematoma, age of the patient, presenting neurologic signssymptoms, presence of underlying coagulopathy or neoplasm, and associated injuries. Evolution of chronic subdural hematoma based on brain ct. Intraparenchymal hemorrhage iph is defined as bleeding within the brain. Development of delayed acute subdural hematoma after mild traumatic brain injury. Standard surgical treatment has recurrence rates reported between 4 and 26%. Glucocorticoids in the treatment of chronic subdural hematoma. The headache improved with hydration, bed rest, and analgesics. Acute subdural hematoma, conservative treatment, traumatic brain injury.
This type of subdural hematoma is among the deadliest of all head injuries. Chronic subdural haematoma csdh is a condition predominantly affecting the elderly. Chronic subdural hematoma csdh, a common neurosurgical illness with a selflimited course, is a disease of the elderly. Chronic subdural hematoma csdh and subacute subdural hematoma sasdh are the two most common neurosurgical diseases.
Infantile subdural haematoma and its relationship to. A ct scan will usually detect significant subdural hematomas. Postoperative brain ct scans were obtained within 3 days following surgery. The authors report 2 patients with subacute subdural hematoma sasdh. Chronic subdural haematoma is a common but retractable neurological disease in the elderly with a high rate of recurrence.
Anticoagulant and antiplatelet use in seniors with chronic. A subdural hematoma sdh is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane see. Subdural hematoma treatment algorithm bmj best practice. Of this population, 125 patients with unilateral hematoma and measurable initial hematoma pressure were included in this study. Those patients younger than 65 years old, with small acute subdural hematomas and glasgow coma scale scores greater than 8, will have the best functional outcomes. Evacuation of chronic and subacute subdural hematoma via. Evolution of chronic subdural hematoma based on brain ct findings and appropriate treatment methods. Outcome after severe brain trauma due to acute subdural. Acute subdural hematoma is an emergency and requires prompt diagnosis using ct most of the. The bridging cortical veins rupture because of traumainduced rotational movement of the brain, which shears the. Calcification of hematoma is seen rarely although chronic subdural hematoma csh is a wellknown. Schonberger tja 2012 a bilateral subdural hematoma, case report.
The optimal followup for operated patients remains controversial. Ich subtypes are further defined by the anatomic site of the bleeding fig. Diagnosis and management william david freeman, mda,b, maria i. Critical depressed brain volume influences the recurrence of. Aguilar, mdc intracranial hemorrhage ich is defined as bleeding within the intracranial vault. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. An acute subdural hematoma is shown in this intraoperative photograph. There in a high variance in the treatment in literature. Conservative management outcomes of traumatic acute. Methods between february 2002 and april 2010, 17 austrian centers prospectively enrolled 863 patients with moderate and severe tbi into observational studies. Usually resulting from tears in bridging veins which cross the subdural space, subdural hemorrhages may cause an increase in intracranial pressure icp, which can cause compression of and damage to delicate brain. The brain is the central repository of delicate neural tissue. Contralateral acute subdural hematoma occurring after evacuation.
Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. Fiftythree consecutive adult patients treated for chronic subdural hematoma with the addition of glucocorticoids in their man. Pmc free article hendrick eb, harwoodhash dc, hudson ar. Chronic subdural hematoma in the aged, trauma or degeneration. Cerebral subdural hematoma following spinal anesthesia. It usually results from tears in bridging veins that cross the subdural space subdural hematomas may cause an increase in the pressure inside the. Dalam bentuk akut yang hebat,baik darah maupun cairan serebrospinal memasuki ruang tersebut sebagai akibat dari laserasi otak atau robeknya arachnoid, sehingga menambah. Due to the known high rate of a second hematoma at the same place usually within weeks, one strategy is to perform serial computer tomography scans in. Closedsystem drainage of the subdural hematoma cavity using soft silicon drain was performed in all cases for 1 to 5 days. The state of the art treatment of a symptomatic chronic subdural hematoma is to remove the hematoma by burr hole trepanation. A 29yrold healthy parturient developed positional frontoparietal headache after accidental dural puncture during attempted placement of an epidural catheter. Postsubdural hematoma transient ischemic attacks stroke.
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. Recurrence of chronic subdural hematoma csdh frequently occurs after surgical evacuation. In this study, we evaluated the independent risk factors of recurrence. Head injury, peritentorial, subdural hematoma, outcome. Computed tomography of the head showed a right acute on chronic subdural hematoma sdh. Subdural hematoma was evacuated and washed out by irrigation with warm physiological saline solution. To address whether to restart older patients on anticoagulants or antiplatelet agents in the setting of a chronic subdural hematoma csdh. Chronic subdural hematoma csh is a wellknown disease entity. These are more commonly seen in the elderly population where brain shrinkage. The understanding of subdural hematoma relies on the knowledge of neuroanatomical sheets covering the brain. A subdural hematoma results from the stretching and tearing of bridging cortical veins in the subdural space, a potential space between the pia arachnoid and the dura figs 22.
Morbidity and mortality associated with an sdh increases with age and exposure to anticoagulant and antiplatelet therapy. Understanding subdural collections in pediatric abusive. A bilateral subdural hematoma, case report longdom publishing. Computed tomography scan image of the brain of a 58yearold man with crimeancongo hemorrhagic fever, mauritania, 2012. Dexamethasone dx either as monotherapy or adjuvant therapy has been applied clinically, but its effectiveness and feasibility remain controversial. Subacute subdural hematoma in a 45yearold woman with no significant past medical history after a roller coaster ride. A subdural hematoma forms because of an accumulation of blood under. Pathophysiology and nonsurgical treatment of 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. An inflammatory process is known to be involved in the development of traumatic subdural effusion tse evolving into chronic.
It has been reported to be 15 cases per 10,000 of american people per year. Association between subdural hematoma type and preadmission antithrombotic drug use, funen area, 20002012. Independent predictors for recurrence of chronic subdural. Subdural hematomas are seen in 1020% of patients with head trauma young and destian, 2002. Pdf patogenesis y fisiopatologia del hematoma subdural. Traumatic peritentorial subdural hematomas turkish neurosurgery. The role of corticosteroids in the management of chronic subdural hematoma csdh remains a matter of debate. A hematoma, also spelled haematoma, is a localized bleeding outside of blood vessels, due to either disease or trauma including injury or surgery and may involve blood continuing to seep from broken capillaries. It can be lifethreatening and requires immediate attention.
Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. The dural border cell layer is weaker than the adjacent layers, and therefore even mild head injury may cleave open the layer resulting eventually in the formation of chronic subdural hematoma csdh. Outcome after severe brain trauma due to acute subdural hematoma. Blood gathers between the inner layer of the dura mater and the arachnoid mater. Chronic subdural hematoma csdh is a common neurosurgical pathology. Antithrombotic drug use and risk of subdural hematoma, funen area, 20002012. An sdh is classified as acute, chronic, or subacute based on the timing of occurrence and brain imaging. We report on a 59yearold man who had sudden onset of left. The mortality following subdural hematoma can be as high as 32%, and recurrence rates can reach 33%. However, a history of trauma is absent in about 3050% of the cases, especially. Subdural hematoma is bilateral in 20% of patients with chronic subdural hematoma. Association of antithrombotic drug use with subdural.
Chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Case report calcified chronic subdural hematoma ccsh. It has been asserted that the primary brain injury associated with subdural hematoma plays a major role in mortality. Pendahuluan hematoma subdural adalah penimbunan darah di dalam rongga subdural. In this paper, the authors goal was to identify factors contributing to outcomes after severe traumatic brain injury tbi due to acute subdural hematoma sdh. Subdural hematomas have even been reported to be caused by intracranial tumors. Factors affecting postoperative recurrence of chronic.