Contralateral subdural hematoma development following unilateral acute subdural hematoma evacuation

The development of a contralateral subdural hematoma (SDH) following unilateral acute SDH evacuation represents a devastating complication that requires urgent treatment in traumatic brain injury. However, few studies have attempted to analyze the risk factors for this phenomenon. The goal of this study was to determine the incidence, mortality and predictive risk factors of delayed SDH contralateral to the side of surgery. In this retrospective study, 210 patients who underwent unilateral supratentorial acute SDH evacuation at a single hospital were included. Of these, 58 patients with remote hematomas other than SDH and 17 patients on warfarin or antiplatelet therapy were excluded. Patients with postoperative SDH development (n = 8) were compared with the control group (n = 127) to identify the risk factors of developing delayed contralateral SDH. We examined the patient demographics, coagulation test results (D-dimer, FDP, fibrinogen, PT and APTT), and radiological features (presence of skull fractures, presence of contusional hematomas, width of hematoma, and midline shift). The incidence and mortality for contralateral SDH were 4.1% and 75%, respectively. A significant association between fibrinogen (mg/dl) and delayed SDH were found (odds ratio, 0.98; 95% confidence interval, 0.97 to 0.99, p = 0.02). Contralateral SDH development after acute SDH is infrequent and results in high mortality. Cautious observation and a low threshold for radiological evaluation are mandatory for improved patient outcome in patients with low fibrinogen.