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Acute Subdural Hematoma

Acute Subdural Haematoma


Presentation

  • Routine CTA should be performed in all patients presenting with an aSDH associated with SAH and no clear history of trauma.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The present data confirm that patients with aneurysm-related SAH and acute SDH, even when presenting in poor clinical condition, might achieve favorable outcome.[ncbi.nlm.nih.gov]
  • We describe a case of a delayed subdural hemorrhage presenting in a young adult not on any antiplatelet or anticoagulation therapy. A 19-year-old male presented to the emergency department after being involved in a motor vehicle accident.[ncbi.nlm.nih.gov]
  • Clinical presentation is due to rupture and bleeding. In only 1.3% of cases it results in subdural hematoma, which is associated with direct interaction of the aneurysm with the basal arachnoid membrane.[ncbi.nlm.nih.gov]
  • This 25-year-old man presented to the hospital with an acute left-sided SDH after a head-on motor vehicle collision. At the time of presentation, the patient had an acute SDH with 11 mm of midline shift.[ncbi.nlm.nih.gov]
Fever
  • Case 1: A 54-year-old man presented with a 10-day history of headache, fever. At admission neurologic examination and Brain-CT were normal. Blood cultures showed Streptococcus bovis.[ncbi.nlm.nih.gov]
  • A 58-year-old man, a shepherd, was admitted to Centre Hospitalier National (Nouakchott, Mauritania) on July 2, 2012, with fever and epistaxis. One week earlier, he had fever, nausea, and vomiting.[wwwnc.cdc.gov]
  • An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure.[ncbi.nlm.nih.gov]
Developmental Delay
  • Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion.[ncbi.nlm.nih.gov]
Hypersomnia
  • An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure.[ncbi.nlm.nih.gov]
Hunting
  • Favorable outcome was achieved in 68% of patients with good-grade clinical presentation on admission (Hunt and Hess Grades I-III) versus 23% of the patients with poor-grade presentation (Hunt and Hess Grades IV and V, p 0.0001).[ncbi.nlm.nih.gov]
Hypertension
  • Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion.[ncbi.nlm.nih.gov]
  • The differences in functional status, postoperative control of intracranial hypertension, and number of cranial reoperations were analyzed. A subgroup analysis compared decompressive craniectomy with riding flap craniotomy alone.[ncbi.nlm.nih.gov]
  • Treprostinil is a synthetic analog of prostacyclin, which is used for treatment of pulmonary arterial hypertension (PAH).[ncbi.nlm.nih.gov]
  • Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years.[ncbi.nlm.nih.gov]
  • At any time during this clinical sequence, the patient may demonstrate the Cushing reflex—systemic arterial hypertension and bradycardia—which is also a secondary sign of severe intracranial hypertension.[alpfmedical.info]
Headache
  • A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission.[ncbi.nlm.nih.gov]
  • We assessed sex, age, smoking, hypertension, history of SAH, sentinel headache, location of the ruptured aneurysm, and intracerebral hemorrhage (ICH) as risk factors for an aSDH.[ncbi.nlm.nih.gov]
  • Neurosurgeons should be aware that SIH patients do not always present with orthostatic headache.[ncbi.nlm.nih.gov]
  • A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal.[ncbi.nlm.nih.gov]
  • Ten months later, she was referred to our center with headache after a minor head trauma. Her medical history revealed that she had not received fresh frozen plasma for the last 2 months.[ncbi.nlm.nih.gov]
Seizure
  • Ninety percent of patients with preoperative seizures were seizure free after operation for 3 months. Independent predictors of seizures were GCS CONCLUSION: Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH.[ncbi.nlm.nih.gov]
  • A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match.[ncbi.nlm.nih.gov]
  • There was no history of trauma or seizure. The CT scans showed an acute subdural hematoma in the right temporoparietooccipital region with midline shift and a coincidental right cerebellar arachnoid cyst.[ncbi.nlm.nih.gov]
  • Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion.[ncbi.nlm.nih.gov]
  • The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field.[ncbi.nlm.nih.gov]
Confusion
  • METHODS (CASE PRESENTATIONS): Identical twin brothers presented 1 year and 10 days apart to an academic medical center after incurring confusion, decreased mental functioning, and a subsequent comatose state.[ncbi.nlm.nih.gov]
  • The patient may have loss of memory and confusion. Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures.[sportsinjuryclinic.net]
  • The patient was discharged with mild confusion 40 days after the admission.[jmedicalcasereports.biomedcentral.com]
  • Deterioration in consciousness, including increasing confusion, sleepiness, and a deep coma, can quickly follow.[merckmanuals.com]
Lethargy
  • Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure.[ncbi.nlm.nih.gov]
  • Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures. Causes Chronic subdural intracranial hematomas usually occur in those over the age of 60.[sportsinjuryclinic.net]
  • Symptoms of subdural hematomas include confusion, headache , movement difficulties, loss of sensation, visual changes, speech difficulties, seizures, lethargy, vomiting , and loss of consciousness.[healthgrades.com]
  • Symptoms often include headache, hemiparesis or alteration of consciousness like agitation, lethargy, or coma. If the acute subdural is small, it can be managed non-surgically. Antiplatelet drugs are stopped, and coagulation is corrected.[neurosurgerybasics.com]
Altered Mental Status
  • We report a case of plasmacytoma that presented as altered mental status after head trauma, located in the subdural area. We also describe its differential diagnosis and treatment by total removal and adjuvant radiotherapy.[ncbi.nlm.nih.gov]
  • Three days after discharge, she unexpectedly returned with worsening headache and altered mental status. Brain computed tomography (CT) showed increased SDH volume.[ncbi.nlm.nih.gov]
  • Altered mental status may be from an SDH, not ethanol. Consult a neurosurgeon as soon as the diagnosis is suspected and initiate transfer if a another facility is required for diagnosis or management. Media file 1: Acute subdural hematoma.[oncare.blogspot.com]
  • Gastrointestinal or Nutrition Issues Nutritional status must be closely monitored in SDH patients, especially those with altered mental status or coma. Supplemental nutrition may be required.[clinicaladvisor.com]

Workup

  • She was admitted for workup. The next day, she neurologically deteriorated to a GCS score of 6. CT of the head was reobtained and showed acute, left-sided subdural hematoma with shift and herniation.[ncbi.nlm.nih.gov]
  • Intubation and imaging Consider endotracheal intubation when Glasgow Coma Score (GCS; see the Glasgow Coma Scale calculator) score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup.[emedicine.medscape.com]
  • TREATMENT Emergency Department Care Consider endotracheal intubation when GCS score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup.[oncare.blogspot.com]
Epileptiform Activity
  • Twenty-four patients who underwent evacuation for acute or acute-on-chronic SDH and with epileptiform activity on EEG were identified retrospectively.[ncbi.nlm.nih.gov]
Periodic Lateralized Epileptiform Discharges
  • Twenty-one patients (87%) had epileptiform discharges on EEG; 13 of them (62%) had midline epileptiform discharges and 9 of them (43%) had periodic lateralized epileptiform discharges (PLEDs).[ncbi.nlm.nih.gov]
Multifocal Discharges
  • Poor early outcomes were associated with the presence of bilateral (P 0.03), midline (P 0.04), and bilateral independent multifocal discharges (P 0.09) on EEG. The EEG findings in this group of patients were complex.[ncbi.nlm.nih.gov]
Staphylococcus Aureus
  • A methicillin-sensitive staphylococcus aureus left-sided IE was diagnosed. Pre- and post-contrast Brain-CT were normal. He presented 15 days later a secondarily generalized status epilepticus.[ncbi.nlm.nih.gov]
Streptococcus Pneumoniae
  • Streptococcus pneumoniae was identified from bacterial cultures. Despite improvement in postoperative CT findings, she fell into septic shock and died 3 days after the drainage.[ncbi.nlm.nih.gov]
Streptococcus Bovis
  • Blood cultures showed Streptococcus bovis. MRI 5 days later revealed ischemic spots and minime ASDH over the right convexity.[ncbi.nlm.nih.gov]

Treatment

  • KEYWORDS: ASDH; TBI; treatment variation[ncbi.nlm.nih.gov]
  • CONCLUSIONS: The safety and efficacy of craniotomy versus decompressive craniectomy in treatment of acute SDH remain controversial.[ncbi.nlm.nih.gov]
  • Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age 80 years) remain unclear.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Hematoma removal alone may result in hematoma recurrence and require a second treatment comprising shunt management to effectively control hematoma.[ncbi.nlm.nih.gov]
  • Early detection and diagnosis are crucial to ensure management and treatment success.[ncbi.nlm.nih.gov]

Prognosis

  • Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma.[ncbi.nlm.nih.gov]
  • The patient was reoperated and eventually had a poor prognosis. We highlight that super-early intervention of contralateral hematoma is important to improve the prognosis of these patients.[ncbi.nlm.nih.gov]
  • Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.[ncbi.nlm.nih.gov]
  • These results suggest that the presence of microbleeds and CH on MR images may indicate poor prognosis in patients with acute SDH.[ncbi.nlm.nih.gov]
  • Although good recovery tended to be observed less frequently in the bleeding tendency group than in the control group, the mean age of the bleeding tendency group was significantly higher than that of the control group, so the prognosis might be affected[ncbi.nlm.nih.gov]

Etiology

  • Keywords: Meningioma; Intracranial; Subdural hematoma; Surgery; Etiology Introduction Meningioma usually manifests as a gradual onset of symptoms.[austinpublishinggroup.com]
  • (Etiology) Acute Subdural Hematoma generally occurs due to a severe blow or injury to the head Research has demonstrated Acute Subdural Hematoma to be rated as one of the most serious conditions in comparison to the other head trauma associated conditions[dovemed.com]
  • The etiological possibilities of spontaneous subdural hematoma are discussed. Patients and methods We analyzed 8 cases of acute spontaneous subdural hematoma among a total number of 321 patients with subdural hematoma is presented.[revistaneurocirugia.com]

Epidemiology

  • In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described.[ncbi.nlm.nih.gov]
  • Coma/diagnosis* Coma/epidemiology Coma/surgery Female Follow-Up Studies Hematoma, Subdural, Acute/diagnosis* Hematoma, Subdural, Acute/epidemiology Hematoma, Subdural, Acute/surgery Humans Intracranial Aneurysm/diagnosis* Intracranial Aneurysm/epidemiology[ncbi.nlm.nih.gov]
  • Tallon JM, Ackroyd-Stolarz S, Karim SA, et al ; The epidemiology of surgically treated acute subdural and epidural hematomas in Can J Surg. 2008 Oct51(5):339-45.[patient.info]
  • Traumatic Brain Injury (TBI) - Definition, Epidemiology, Pathophysiology at eMedicine "Acute Subdural Hematomas - UCLA Neurosurgery, Los Angeles, CA". neurosurgery.ucla.edu. Retrieved 2019-02-19.[en.wikipedia.org]
Sex distribution
Age distribution

Pathophysiology

  • In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed.[ncbi.nlm.nih.gov]
  • The pathophysiological mechanism of this rare complication was discussed, and the relevant literature was also reviewed.[ncbi.nlm.nih.gov]
  • Abstract The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate[ncbi.nlm.nih.gov]
  • The findings of this study support the pathophysiological evidence that, in acute subdural hematoma, the extent of primary underlying brain injury is more important than the subdural clot itself in dictating outcome; therefore, the ability to control[ncbi.nlm.nih.gov]
  • The pathophysiology of severe head trauma and its complications are still unclear.[smjonline.org]

Prevention

  • Decompression with a burr-hole craniotomy promptly followed by a decompressive craniectomy was performed to prevent contralateral ASDH.[ncbi.nlm.nih.gov]
  • Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.[ncbi.nlm.nih.gov]
  • We propose a prevention strategy for this event, which has not been previously described. We also discuss possible mechanisms involved in this unexpected complication.[ncbi.nlm.nih.gov]
  • Abstract This study investigated biomechanical mechanisms of acute subdural hematoma caused by judo and sought preventive measures to reduce injury.[ncbi.nlm.nih.gov]
  • We performed a left extraintracranial bypass to prevent recurrent hemorrhage. With intensive rehabilitation, the patient accordingly achieved stroke-free survival with a modified Rankin Scale score of 3 for 1 year.[ncbi.nlm.nih.gov]

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