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Acute-on-Chronic Subdural Hematoma: Not Uncommon Events
Kyeong-Seok Lee1, Jae-Jun Shim, Seok-Mann Yoon
1Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Journal of Korean Neurosurgical Society
|February 11, 2012
Summary
Acute-on-chronic subdural hematoma (SDH) occurs in 8% of chronic SDH cases, often due to slips in intoxicated individuals. Repeated trauma can cause acute bleeding over chronic SDH, necessitating understanding of this mechanism.
Area of Science:
- Neurosurgery
- Radiology
- Trauma Surgery
Background:
- Asymptomatic chronic subdural hematoma (SDH) patients are susceptible to falls.
- Acute trauma can precipitate acute subdural bleeding over pre-existing chronic SDH.
- Acute-on-chronic SDH represents a distinct clinical and radiological entity.
Purpose of the Study:
- To describe the clinical and radiological features of acute-on-chronic SDH.
- To investigate the incidence and potential causes of acute-on-chronic SDH.
- To highlight the significance of repeated trauma in SDH progression.
Main Methods:
- Retrospective review of computed tomographic (CT) scans from 107 consecutive chronic SDH patients.
- Inclusion criteria: diagnosis of chronic SDH via CT (with or without MRI).
- Data collected: clinical presentation, trauma history, and radiological findings.
Main Results:
- Acute-on-chronic SDH identified in 8% of chronic SDH cases.
- Common trauma mechanism: slips, particularly in individuals with alcoholism and recurrent trauma history.
- Radiological appearance: hyperdense clot layer with irregular margins within liquefied hematoma.
- Surgical management: typically effective with single or two burr holes.
Conclusions:
- Repeated trauma is a significant factor in the development of acute bleeding over chronic SDH.
- Understanding the role of repeated trauma is crucial for managing hematoma enlargement.
- Prompt recognition and treatment of acute-on-chronic SDH are important for patient outcomes.
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