Cardiac abnormalities in patients with acute subdural hemorrhage

Although cardiac abnormalities are well described among patients with acute brain injury, they have not been investigated systematically for acute subdural hemorrhage (SDH). We sought to investigate the prevalence and characteristics of cardiac abnormalities in patients with SDH.

Consecutive adult patients admitted to Rush University Neurosciences Intensive Care Unit with a diagnosis of SDH were analyzed. Electrocardiograms (ECGs), obtained within 48 h of admission were reviewed. Myocardial injury, defined as troponin I elevation (>0.09 ng/ml) on admission was identified.

One hundred and fourteen patients admitted with SDH between 1 January 2010 and 31 December 2011 were included. Mean age was 67.9 years (SD 16.6 years), 60% were male. Comorbidities included hypertension (74%), diabetes mellitus (31%), cardiovascular disease (35%), and cerebrovascular disease (25%). The SDH was right-sided in 47%, and the most common location was frontoparietal (43%). SDH size was 14.4 ± 7.9 mm, with 4.6 ± 5.5 mm midline shift. One or more ECG abnormalities were found in 75% of patients. Troponin was elevated in nine patients. Cardiac abnormalities were not associated with SDH characteristics. Classic neurogenic ECG findings were not encountered.

Although we found ECG abnormalities to be common in patients with SDH, they were not associated with SDH characteristics, and classic neurogenic findings were not observed. Myocardial injury was infrequent and not associated with SDH characteristics. While cardiac abnormalities in acute intracerebral injury often are attributed to neurocardiogenic causes, these are unlikely prominent mechanisms in SDH. Other medical causes need to be considered, as this will have important implications for management.