Acute epidural hematoma: an analysis of factors influencing the outcome of patients undergoing surgery in coma (original) (raw)
Related papers
Epidural Hematoma: A Prospective Analysis of Morbidity and Mortality in 173 Patients
Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery, 2015
Objectives A few recent studies have focused on epidural hematomas (EDHs) that are routine in emergency rooms. The study was to evaluate the latest situation of affected patients by encephalic trauma associated with EDH in our service. Methods Prospective study between September 1, 2003 and May 30, 2009. Data were computed regarding age, sex, trauma mechanism, qualification by Glasgow coma scale admission, presence of anisocoria, and evaluation by the recovery of Glasgow scale high, with all patients by computed tomography (CT) scan. Results Among the 173 analyzed patients, mortality reached 20 patients (11.5%). Mortality was higher in the subgroup of 76 patients (44%) admitted with Glasgow coma scale (GCS 8) with 17 deceased, corresponding to 85% of total deaths. Prevalence of male subjects (140 cases, 81%) with bruises located in the temporal, frontal and parietal regions; 147 (85%) patients underwent neurosurgical treatment by craniotomy. The worst prognosis was in patients with hematomas of higher-volume (50 mL), midline structures deviations greater than 1.5 mm and basal cisterns CSF closed. Conclusion The authors emphasize the correct indication of neurosurgery and the postoperative intensive care unit (ICU) as key factors for success in the treatment of patients with EDHs.
Traumatic Epidural Hematoma: Patient Characteristics and Management
The American Surgeon, 2017
Brief Reports should be submitted online to www.editorialmanager.com/ amsurg. (See details online under ''Instructions for Authors''.) They should be no more than 4 double-spaced pages with no Abstract or sub-headings, with a maximum of four (4) references. If figures are included, they should be limited to two (2). The cost of printing color figures is the responsibility of the author.
Outcome of Surgically Treated Acute Traumatic Epidural Hematomas Based on the Glasgow Coma Scale
Open Journal of Modern Neurosurgery, 2018
This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).
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.
Surgical Management of Acute Epidural Hematomas
Neurosurgery, 2006
(see Methodology) Indications for Surgery • An acute subdural hematoma (SDH) with a thickness greater than 10 mm or a midline shift greater than 5 mm on computed tomographic (CT) scan should be surgically evacuated, regardless of the patient's Glasgow Coma Scale (GCS) score. • All patients with acute SDH in coma (GCS score less than 9) should undergo intracranial pressure (ICP) monitoring. • A comatose patient (GCS score less than 9) with an SDH less than 10-mm thick and a midline shift less than 5 mm should undergo surgical evacuation of the lesion if the GCS score decreased between the time of injury and hospital admission by 2 or more points on the GCS and/or the patient presents with asymmetric or fixed and dilated pupils and/or the ICP exceeds 20 mm Hg. Timing • In patients with acute SDH and indications for surgery, surgical evacuation should be performed as soon as possible.
Clinical Analysis of Delayed Surgical Epidural Hematoma
Korean Journal of Neurotrauma, 2015
Objective: A small epidural hematoma (EDH) that has been diagnosed to be nonsurgical by initial brain computed tomography (CT) can increase in size and need surgical removal, resulting in a poor prognosis. However, there have been few studies, which focused delayed operated EDH. Therefore, we analyzed the clinical factors to determine the predicting factors of delayed operated EDH. Methods: Between January 2011 and January 2014, 90 patients, who were admitted due to EDH, were enrolled in this study. None of the patients were indicated for operation initially. Based on the presence of surgery, we classified the patients into a delayed-surgery group (DG) and a non-surgical group (NG). Additionally, we analyzed them according to the following: time interval between the trauma and the initial CT, gender, age, medical history, drinking, change of mean arterial pressure (MAP), volume of EDH and other traumatic brain lesion. Results: Among the 90 patients, the DG was 19 patients. Compared with NG, the DG revealed increased MAP, less presence of drinking, and a short time interval (DG vs. NG: +9.684 mm Hg vs.-0.428 mm Hg, 5.26% vs. 29.58%, 1.802 hours vs. 5.707 hours, respectively, p<0.05). Analyzing the time interval with receiver operating characteristic, there was 88.2% sensitivity and 68.3% specificity at the 2.05-hour cutoff value (area under the curve=0.854). Conclusion: According to our results, the time interval between the trauma and the initial CT along with blood pressure change are potential predicting factors in the cases of delayed operation of EDH.
Delayed post-traumatic epidural hematoma. A review
Neurosurgical Review, 1995
Post-traumatic acute epidural hematoma (EDH) is generally visible on the CT scan done immediately after admission: occasionally, it only comes to light at a later scan and is then termed delayed (DEDH). Since the introduction of CT, the frequency of this occurrence has gone up from 6–13% to 30%. The mechanisms responsible for the delayed appearance of the epidural hematoma a “tamponade” effect are usually increased endocranial pressure and post-traumatic arterial hypotension as well as, in a limited number of cases, coagulopathy, CSF drainage, and arterio-venous shunt. The authors report 5 of their own cases and 45 published cases and discuss the characteristics of this particular form of hematoma and its outcome.
Epidural hematoma: postoperative complication
International Surgery Journal, 2017
A 22-year-old male patient was admitted to the clinic with headache and a decline in the level of consciousness. We detected a left parietal astrocytoma and hydrocephalus (Figure 1 a-b). We first planned and performed right median pressure ventriculoperitoneal shunt surgery and left ventricular drainage in emergency ABSTRACT Epidural hematoma is an indication for emergency neurosurgical intervention. This condition is an extremely rare postoperative complication of ventriculoperitoneal shunt and contralateral decompressive craniectomy. A 22-year-old male patient was admitted to our clinic with headache and a decline in the level of consciousness. We detected a left thalamic astrocytoma and hydrocephalus, which we treated via ventriculoperitoneal shunt surgery and ventricular drainage in emergency conditions. The patient experienced dysphasia on the first postoperative day and we found a right frontoparietal epidural hematoma. We evacuated the hematoma and exchanged the medium pressure valve for a high-pressure valve. The second patient was a 19-year-old male who had been assaulted. His pupils were fixed and dilated and had no reaction to painful stimulus. We detected bilateral frontotemporal skull fractures and right frontotemporoparietal subdural and epidural hematomas. We performed a right decompressive craniectomy and subdural/epidural hematoma evacuation followed by recovery under sedation in the intensive care unit. We performed cranial computed tomography six hours after surgery and found a left temporoparietal epidural hematoma. We performed a left temporoparietal craniotomy and epidural hematoma evacuation. The patient exhibited a higher level of consciousness and increased movement of his extremities. Epidural hematoma is a life-threatening complication encountered in neurosurgery practice. Neurosurgeons should be aware of the possibility of epidural hematoma following ventriculoperitoneal shunt or traumatic brain injury surgery.
Epidural Hematoma Treated Conservatively: When to Expect the Worst
Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques, 2015
ABSTRACTBackground: The Brain Trauma Foundation’s 2006 surgical guidelines have objectively defined the epidural hematoma (EDH) patients who can be treated conservatively. Since then, the literature has not provided adequate clues to identify patients who are at higher risk for EDH progression (EDHP) and conversion to surgical therapy. The goal of our study was to identify those patients. Methods: We carried a retrospective review over a 5-year period of all EDH who were initially triaged for conservative management. Demographic data, injury severity and history, neurological status, use of anticoagulants or anti-platelets, radiological parameters, conversion to surgery and its timing, and Glasgow Outcome Scale were analyzed. Bivariate association and further logistic regression were used to point out the significant predictors of EDHP and conversion to surgery. Results: 125 patients (75% of all EDH) were included. The mean age was 39.1 years. The brain injury was mild in 62.4% of o...
Radiology, 2014
Purpose To assess the use of a dual-phase multidetector computed tomography (CT)-based grading system alone and in combination with assessment of clinical parameters at triage of patients with blunt splenic injury for determination of appropriate treatment (observation, splenic artery embolization [SAE], or splenic surgery). Materials and Methods This HIPAA-compliant retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between January 2009 and July 2011, 171 hemodynamically stable patients with blunt splenic injury underwent multidetector CT at admission to the hospital. Images were reviewed by applying a multidetector CT-based grading system, and the amount of hemoperitoneum was quantified. Demographic data, vital signs, laboratory values, injury severity score, abbreviated injury severity, final treatment decision, and success of nonsurgical treatment were reviewed. Receiver operating characteristic curves and ste...