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Microbleeds as a prognostic factor for acute subdural hematoma
Tadashi Yamaguchi1, Hiroki Takai, Satoshi Hirai
1Department of Neurosurgery, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Abstract:
This study investigated the frequency of poor outcome at discharge of acute subdural hematoma (SDH) patients with and without microbleeds. We retrospectively examined the records of 37 patients with acute SDH who were surgically treated with hematoma removal and received magnetic resonance (MR) imaging within 2 weeks of head injury onset. MR images were used to determine the presence or absence of microbleeds and contusional hemorrhage (CH). Patient outcome was categorized as good (moderate disability or good recovery) or poor (severely disability, vegetative state, or dead) according to the Glasgow Outcome Scale at discharge. Microbleeds were found in 23 patients (62%) and CH was found in 26 patients (70%). Fifteen patients (41%) had both microbleeds and CH. Poor outcome at discharge was more common in SDH patients with both microbleeds and CH than in SDH patients with neither microbleeds nor CH (14/15, 93% vs. 14/22, 64%; p = 0.04). Poor outcome at discharge was more common in SDH patients under 60 years of age with microbleeds (6/8, 75%) than patients under 60 years of age without microbleeds (0/4, 0%; p = 0.03). The location of the microbleed was not related to the outcome at discharge. These results suggest that the presence of microbleeds and CH on MR images may indicate poor prognosis in patients with acute SDH.
Insights
Microbleeds and contusional hemorrhage in acute subdural hematoma patients indicate a higher likelihood of poor outcomes. These findings on MRI may signal a worse prognosis for patients with acute subdural hematoma.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neurology
Background:
- Acute subdural hematoma (SDH) is a severe traumatic brain injury.
- Predicting outcomes in SDH patients is crucial for clinical management.
- The role of microbleeds in SDH prognosis requires further investigation.
Purpose of the Study:
- To investigate the frequency of poor outcomes at discharge in acute subdural hematoma patients.
- To determine the association between microbleeds, contusional hemorrhage (CH), and patient outcomes.
- To assess the prognostic value of microbleeds in acute subdural hematoma.
Main Methods:
- Retrospective analysis of 37 surgically treated acute subdural hematoma patients.
- Magnetic resonance (MR) imaging within 2 weeks of head injury to identify microbleeds and CH.
- Glasgow Outcome Scale used to categorize patient outcomes (good vs. poor) at discharge.
Main Results:
- Microbleeds were present in 62% of patients, and CH in 70%.
- Poor outcome was significantly more common in patients with both microbleeds and CH (93%) compared to those without (64%).
- Younger patients (<60 years) with microbleeds had a higher rate of poor outcomes (75%) than those without (0%).
Conclusions:
- The presence of microbleeds and CH on MR imaging may indicate a poor prognosis in acute subdural hematoma patients.
- Microbleeds appear to be a significant negative prognostic factor, especially in younger patients.
- Further research is warranted to explore the underlying mechanisms and clinical implications of microbleeds in SDH.
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