Clinical Features of Interhemispheric Subdural Hematomas (original) (raw)
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Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques
ABSTRACT: Object: Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH. Methods: This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected. Results: Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred ...
Surgical management of traumatic interhemispheric subdural hematoma
Turkish neurosurgery, 2014
To review our experience in the surgical treatment of TISH, and to analyze prognostic factors. Clinical and imaging data, surgical modalities, and outcomes of 21 patients with TISH who were treated with microsurgery were analyzed retrospectively. Prognostic factors for outcome were analyzed by univariate analysis. Long-term follow up with outcome assessment according to the Glasgow Outcome Scale (GOS) showed good recovery in 16 cases, moderate disability in two cases, severe disability in one case, and death in two cases. During surgery the origin of bleeding could be identified in all 21 cases. A rupture of the distal anterior cerebral artery or veins in the interhemispheric fissure was seen more frequently in patients with whole interhemispheric fissure hematoma, while hemorrhage from brain tissue laceration was seen more frequently in patients with more localized hematomas. The outcome in patients with an identified rupture of a vessel was better than in those with cortical lacer...
Acute-on-Chronic Subdural Hematoma: Not Uncommon Events
Journal of Korean Neurosurgical Society, 2011
We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan. We could find 9 patients (8% of chronic SDH) with acute-onchronic SDH. We collected the medical records of these patients. We examined these medical records to obtain clinical features regarding the symptoms, history, preoperative mental status, and operative findings. We reviewed the radiological features of the CT scans. We measured the maximum thickness of the hematoma, degree of the midline shift around the third ventricle, and the highest density of the hematoma in Hounsfield units. RESULTS Clinical features There was only one female patient. The age ranged from 48 to 83 years old (Table 1). The most common cause of trauma was a slip in drunken state. All had a history of alcoholism with multiple episodes of trauma. The most recent trauma was occurred within two weeks, usually 3 to 5 days. The most common symptom was hemiparesis.
Clinical Neurology and Neurosurgery, 1997
Subdural interhemispheric hematomas (ISH), though not really rare, are quite an uncommon complication of head traumas. This condition is more frequent in childhood, where it is generally considered as a part of a more complex syndrome, called 'Shaken Children Syndrome', usually pointing out child abuse. Although a head injury is very often considered the cause (in about 80-90X of the cases), possible predisposing factors such as coagulopathies, alcohol abuse or anticoagulant therapy can also be considered. Furthermore, as the rupture of an intracranial aneurysm has also occasionally pinpointed as a possible cause, this event should be kept in mind in order to be able to address exactly both the diagnostic and therapeutical procedures. A new conservatively managed case is thereby described. A review of the literature with particular attention drawn to the diagnosis and the different therapeutical possibilities is also elaborated. 0 1997 Elsevier Science B.V.
Epidemiology and Prognostic Factors in Patients with Subdural Hematoma
Facta Universitatis, Series: Medicine and Biology, 2021
SDH was first described in 1658 and in 1914 trauma was recognized as one of the causes. Acute SDH is more common in younger population while chronic is common in the elderly with the peak of incidence of 7.35/100000 per year in the age group 70-79 years. Trauma is one of the main causes of SDH although in 30-50% of patients direct trauma to the head can be omitted. Other predisposing factors include: anticoagulant therapy, epilepsy, and hypertension. The aim of the study was to determine risk factors and prognostic factors for the occurrence of SDH, also to show what age group is most at risk for developing chronic and acute SDH. Identify the diagnostic steps in proving SDH and the best method of treatment. The study includes 267 patients treated in the period from 1.1.2019 to 31.12.2019 at the Clinic for Neurosurgery CCS. SDH was diagnosed by neurological examination and brain CT in all patients and all were treated conservatively or surgically. The analytical statistics were used...
Acute Subdural Hematomas; management, complications and outcome -a tertiary center experience AUTHOR
Background: acute subdural hematoma is the most common traumatic intracranial hematoma which carries highest mortality. It's a type of hemorrhage that occurs beneath the dura and is usually associated with other brain injuries. These a number of variables include like age, mechanism of injury, neurological condition on admission, postoperative intracranial pressure (ICP), and time of injury to surgical evacuation contribute to mortality and morbidity in acute SDH. In the present study the management, complications and outcome of acute SDH will be studied. Methods: The study was prospective in nature conducted on all patients of acute subdural hematoma admitted in the Department of neurosurgery, Sher-I-Kashmir Institute of Medical Sciences (SKIMS) Srinagar for a period of two years between June 2015-August 2017. 150 patients diagnosed with acute subdural hematoma were recruited into the study. Results: In this study acute subdural hematoma was most common in the age group of 21-30 year which was 22% followed by age group of 31-40 years which was about 21.3% with male predominance in all age groups. Most common mode of head injury was road traffic accidents which was found in 67 patients (44.7%) followed by fall from height which was found in 59 patients (39.3%). Most common symptom in acute SDH was Loss of consciousness in 50(33.3 %) patients followed by Vomiting in 43 (28.66%). Glasgow coma scale (GCS) <8 at presentation was found in 73(48.66%) patients followed by GCS of 9-12 in 39(26%) patients. Unilateral dilated pupil which was found in majority of patients. Most patients had thicker SDH>10 mm (50.66%) with significant midline shift and associated contusion (35.33%). Most common location of acute subdural hematoma was in fronto-temporo-parietal region which was found in 44.7% of patients followed by temporal region which was found in 30.7% of patients. Only a minority of patients (20%) were managed conservatively. Most common postoperative complication during hospital stay in our study was chest infection in 30% of patients followed by sepsis in 19.33% of patients. With age there is increase in mortality. Mortality is highest in age group of 60-65 which is 86.20% and lowest in 1-20 age group which is 26.08%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality of Acute subdural hematoma with associated SAH is 55.55% followed by patients associated with Contusion which is 49.05%. Mortality rate increased with delay in surgery with delay of >12 hours the mortality is 58.82%. Most of the patients presented with GCS< 8 at the time of presentation to hospital and had a mortality of 78.08%, which indicates very bad prognosis. Conclusion: Traumatic acute SDH is a fatal condition despite all developments in neurosurgical interventions. GCS score, hematoma size, midline shift and associated brain injury are important parameters influencing mortality and morbidity. Early intubation, hyperventilation, prevention and treatment of shock, and surgical decompression and management of increased intracranial pressure are basic requisites for meaningful recovery in patients with severe head injury and acute subdural hematoma.