Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating (original) (raw)
Related papers
Prevalence of Subdural and Epidural Hematoma in Head Trauma Patients: A Cross-sectional Study
Disease and diagnosis, 2023
Background: Epidural hematoma (EDH) and subdural hematoma (SDH) are common complications after traumatic brain injury. Intracranial hematomas can be without complications or associated with life-threatening conditions, including midline shift, cerebral edema, intracerebral ischemia, and increased intracranial pressure. This study aimed to investigate the prevalence of EDH and SDH in patients with head trauma attending the emergency department. Materials and Methods: This descriptive cross-sectional study included 146 patients with head trauma referred to the Emergency Department of Shahid Mohammadi Hospital, Bandar Abbas, in 2021. Patients’ data, including age, gender, Glasgow Coma Scale (GCS) on admission, mechanism of trauma, type of hematoma, length of intensive care unit (ICU) stay, outcome (recovery/death), and neurosurgery requirements were extracted from their medical files. Results: The mean age of the participants was 20.97±15.05 years, of whom 114 (78.1%) were male. EDH and SDH were observed in 7.5% and 11% of patients, respectively. The most common mechanism of trauma was traffic accidents (39%), followed by falls (28.1%) and assaults (13%). Moreover, 11% of the patients needed neurosurgical intervention. Most patients recovered (95.9%), and 4.1% died. The mean GCS on admission was 13.47±2.34. Furthermore, SDH was significantly higher in the patients who died (P=0.001) and those aged≥18 years (P=0.028). Conclusion: The results of the current study showed a higher prevalence of SDH compared to that of EDH. Both hematoma types appeared to correlate with the mechanism of trauma, ICU admission, GCS on admission, and neurosurgery requirement, while SDH was associated with age and death.
The Professional Medical Journal
Objectives: To determine the frequency, clinical presentation and outcome ofextradural hematoma in patients with head injury. Study Design: Cross sectional descriptivest study. Setting: Neurosurgery department of Hayatabad Medical Complex, Peshawar. Period: 1st January 2011 to 1 July 2012. Patients and methods: All patients of head injury, from all ages andboth genders were included. Patients in whom EDH caused by bleeding disorders or vascularmalformations of the dura mater and post surgical EDHs were excluded from the study. CT scanbrain was done for all patients to confirm their diagnosis. The information regarding patientdemographical details, clinical presentation and site and size of hematoma was documented inpatient's Performa. The data was analyzed by SPSS version 16. Results: A total of 331 patientswith head injuries were included in the study. Out of 331 patients, there were 221(66.76%) malesand 110(33.23%) females. Majority of patients 90(27.2%) were in the age range ...
Indian Journal of Neurosurgery, 2016
Delayed development of traumatic acute subdural hematoma in patients having a coagulation disorder with or without taking anticoagulants have been well reported in literature. But delayed development of acute subdural hematoma (ASDH) in patients with head injury without any coagulation disorder is rare as per our knowledge. In this case report, we are reporting a 28-year-old male patient, who developed delayed posttraumatic life-threatening ASDH after 48 hours of trauma. The patient had no coagulation disorder. He was not an alcoholic and all his examinations, including coagulation profile, liver function tests, and peripheral smear examination were within the normal limits. We want to highlight that mere absence of a lesion on computed tomography and negative clinical, with radiological finding, at an emergency department, does not always hold the eligibility to discharge a head injury patient. Observation for at least 24 hours with subsequent minimum one short interval followup is necessary for the safety of the patient.
Canadian journal of surgery. Journal canadien de chirurgie, 2008
The purpose of this paper is to review the population-based epidemiology of surgically treated post-traumatic epidural hematomas (EDHs) and/or subdural hematomas (SDHs) among patients who presented to the single neurosurgical centre in Nova Scotia. We included all patients aged 16 years or older who presented to the tertiary care hospital with acute post-traumatic EDHs and/or SDHs between May 23, 1996, and May 22, 2005, and who were surgically treated. We generated an initial cohort from the provincial trauma registry and reviewed a total of 152 charts for possible inclusion; 70 (46%) patients met the study criteria. We performed a blinded, explicit chart review using a standardized data collection form, and we generated descriptive statistics. Of the patients who had surgery, 34 (49%) presented with SDHs, 23 (33%) presented with EDHs and 13 (19%) presented with both conditions. The median age was 45 years, and 80% of the cohort was male. The major mechanisms of injury were falls (5...
Subdural hematoma as a major determinant of short-term outcomes in traumatic brain injury
Journal of neurosurgery, 2017
OBJECTIVE Early radiographic findings in patients with traumatic brain injury (TBI) have been studied in hopes of better predicting injury severity and outcome. However, prior attempts have generally not considered the various types of intracranial hemorrhage in isolation and have typically not excluded patients with potentially confounding extracranial injuries. Therefore, the authors examined the associations of various radiographic findings with short-term outcome to assess the potential utility of these findings in future prognostic models. METHODS The authors retrospectively identified 1716 patients who had experienced TBI without major extracranial injuries, and categorized them into the following TBI subtypes: subdural hematoma (SDH), traumatic subarachnoid hemorrhage, intraparenchymal hemorrhage (which included intraventricular hemorrhage), and epidural hematoma. They specifically considered isolated forms of hemorrhage, in which only 1 subtype was present. RESULTS In genera...
Epidemiological Analysis of Surgically Treated Acute Traumatic Epidural Hematoma
Open Journal of Modern Neurosurgery, 2016
This study is a retrospective analysis of demographic, clinical, radiological and outcome data of surgically treated acute traumatic epidural hematomas. Forty-six consecutive cases of epidural hematomas were operated at the University Hospital Center of Yaoundé, Cameroon, between February 2006 and December 2013. The mean age was 29.56 years and63.04% of patients were between 21 and 30 years. Almost 94% of patients were males. Thirty-five percent of patients were motorcycle riders. Road traffic accident was the cause in 70% of cases. Mean time between head trauma and surgical evacuation was 78 hours. Head trauma was moderate in 52.17%. Initial loss of consciousness was found in 78.26% and lucid interval in 65.23%. Seventy-four percent of patients had signs of intracranial hypertension on admission, 35% had at least one neurologic focal sign and 50% had a scalp wound. Eight patients (17.39%) presented with unilateral or bilateral mydriasis. On computed tomography, the hematoma was on the left side in 60.86% of patients and frontal-parietal location was the most frequent. Computed tomography showed mass effect in 97.82% of patients. The most frequent surgical procedure was craniotomy. Six (13.04%) patients died, but 82.60% recovered fully (GOS 5). In Cameroon, traumatic acute epidural hematoma affects primarily healthy young men in their twenties and thirties. Road traffic accidents are the main etiology. Most patients had moderate head trauma and presented with intracranial hypertension. Early surgery is rarely done. Nevertheless, even with delayed surgery, most patients have good outcome.
Analyses of clinical prognostic factors in operated traumatic acute subdural hematomas
Ulus Travma Acil …, 2010
Travmaya bağlı akut subdural kanamalar kafa travma tanıları arasında en ölümcül olanıdır. GEREÇ VE YÖNTEM Bu çalışmada 1998 ile 2006 yılları arasında travma sonrası akut subdural kanama tanısı ile ameliyat edilen 113 hasta geriye yönelik olarak incelendi. Başvuru sırasındaki Glasgow Koma Skalası (GKS) Skoru, hasta yaşı, travma ile ameliyat arasında geçen süre ve pupilla reaksiyonundaki anormalliklerin mortalite ve morbidite üzerindeki etkilerini saptamak amacıyla istatistiksel analiz yapıldı. BULGULAR Elde edilen sonuçlar güncel literatürle karşılaştırılarak tartışıldı. Yüz on üç hastadaki toplam mortalite %56,6 olarak bulundu. SONUÇ Başvuru sırasındaki GKS skoru, hasta yaşı, travma ile ameliyat arasında geçen süre ve pupilla reaksiyonundaki anormalliklerin prognozun belirlenmesinde önemli olduğu sonucuna varılmıştır. Anahtar Sözcükler: Akut subdural kanama; prognoz; prognoztik faktörler; travma. BACKGROUND Traumatic acute subdural hematoma is the most lethal of all head injuries. METHODS In this study, 113 patients with the diagnosis of posttraumatic acute subdural hematoma, who were operated between 1998 and 2006, were reviewed retrospectively. Statistical analysis was performed to detect any effects of the variables of age, Glasgow Coma Scale (GCS) score on admission, time interval between the trauma and operation, and abnormality in the pupil reaction on the disease mortality and morbidity. RESULTS Results obtained in the study are discussed and compared with the related current literature. The overall mortality in 113 patients was 56.6%. CONCLUSION According to the results, the most important determinants of the prognosis are GCS score of the patient on admission, abnormality in pupil reaction, timing of the operation, and the patient's age.
Turkish Neurosurgery, 2015
ASDH might be classified into traumatic or non-traumatic and acute or chronic. It usually develops as a result of rupture of the bridging veins between the dura and cerebral cortex (17). It might also be associated with rupture of dural sinuses or superior cortical arteries. Traumatic ASDH is encountered in one third of severe head traumas and the mortality rate increases up to as high as 60% (2). Traumatic ASDH is seen usually in younger individuals compared to the non-traumatic variety █ INTRODUCTION A cute subdural hematoma (ASDH) is a clinical entity with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is obviously necessary for an optimum clinical outcome (5,24). Its mortality rate has begun to decline with the developments in medicine and is currently around 14% (16). AIm: In the present study, we evaluated the association of the Glasgow Coma Scale (GCS) score and amount of blood loss with mortality in patients presenting with traumatic acute subdural hematoma (ASDH). mATERIAl and mEThODS: This retrospective study was performed on 99 patients who were operated for traumatic acute subdural hematoma (ASDH) without any systemic association at a single center. Epidural hematoma was reported to be the most common additional pathology. Age, sex, mechanism of trauma, time interval between onset of trauma and admission to the emergency ward, associated problems, thickness of hematoma and Glasgow Coma Scale (GCS) score at the time of admission and on discharge were all studied. RESUlTS: The GCS score was inversely proportional to the thickness of hematoma and interval between onset of trauma and surgery (p<0.05). Although the mortality rate was reported to be high in traffic accidents, the rate was low in patients with head trauma only (p<0.05). The mortality rate was high in patients with associated pathologies (p<0.05). Lost patients were reported to be older patients with more extensive ASDH or those who presented earlier with a low GCS (p<0.05). CONClUSION: ASDH is associated with high mortality. GCS score and the thickness of the ASDH are important predictors of mortality. Age, additional trauma, and interval between trauma and hospital admission are major predictive factors for mortality.
Progressive epidural hematoma (PEDH) after head injury is often observed on serial computerized tomography (CT) scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS) score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR) 0.38, 95% confidence interval (CI) 0.17-0.84), time interval of the first CT scanning (OR 0.42, 95% CI 0.19-0.83), coagulopathy (OR 0.36, 95% CI 0.15-0.85), or decompressive craniectomy (DC) (OR 0.46, 95% CI 0.21-0.97) was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ 2 = 0.07, P = 0.86). In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.
POST-TRAUMATIC ACUTE-ON-CHRONIC SUBDURAL HAEMATOMA
Acute Subdural Haematomas (ASDH) have great forensic significance, because a wide spectrum of forces (usually head trauma) can cause them. Chronic subdural haematoma (CSDH) is also an important condition, which does not necessarily imply a recent trauma. The authors report the case of a 73 year-old man, with repeated craniocerebral trauma, hospitalized with right ASDH and left CSDH, who died within 12 hours after admission. The autopsy revealed, at external examination, a lacerated wound in the right parietal region and multiple abrasions and bruises; on internal examination, right ASDH and left CSDH with recent bleeding and left midline shifting. Sometimes, in cases of repeated assault it is possible to discover acute-on-chronic subdural haematoma (ACSDH), explained by recent bleeding, usually near the anterior part of the haematoma. Such cases require the attention of the forensic pathologist who should search for signs of recent brain trauma which aggravated an underlying condition or caused death; also, histological sampling can provide important forensic information.