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The Rabbit Blood-shunt Model for the Study of Acute and Late Sequelae of Subarachnoid Hemorrhage: Technical Aspects
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Acute-to-chronic subdural hematoma: radiographic and clinical progression from acute subdural hematoma

Adrian Liebert1, Emily Hirschmann2, Thomas Eibl2

  • 1Department of Neurosurgery, Paracelsus Medical University, Breslauer Straße 201, 90471, Nuremberg, Bavaria, Germany. adrian.liebert@stud.pmu.ac.at.

Neurosurgical Review
|May 29, 2024
PubMed

Insights

Acute subdural hematoma (ASDH) can transform into chronic subdural hematoma (CSDH), requiring early intervention. Close monitoring is vital as these cases often present with disturbance of consciousness and rapid deterioration.

Area of Science:

  • Neurosurgery
  • Trauma Surgery
  • Neurology

Background:

  • The exact pathogenesis of chronic subdural hematoma (CSDH) remains unclear.
  • One proposed pathway involves the transformation of acute subdural hematoma (ASDH) into CSDH.
  • This transformation can lead to space-occupying subdural fluid collections.

Purpose of the Study:

  • To investigate the clinical and radiographic differences between CSDH evolving from ASDH and conventional CSDH.
  • To analyze the progression of parameters in patients where ASDH transforms into CSDH.
  • To correlate parameters between these two groups before surgical intervention.

Main Methods:

  • Retrospective analysis of unilateral CSDH patients undergoing burr hole trephination (2018-2023).
  • Patients divided into an acute-to-chronic group (Group A, n=41) and a conventional group (Group B, n=282).
  • Comparison of clinical and radiographic parameters within Group A and between Group A and Group B.

Main Results:

  • In Group A, hematoma volume and midline shift significantly increased during progression from acute to chronic.
  • Clinical performance (mRS, GCS) significantly declined in Group A.
  • Patients treated within 12 days of trauma had larger ASDH volumes; Group A showed more disturbance of consciousness but fewer new motor deficits pre-operatively compared to Group B.

Conclusions:

  • Transformation of ASDH to CSDH necessitates early treatment due to significant volume increase and midline shift.
  • Close patient monitoring is crucial for CSDH evolving from ASDH, as disturbance of consciousness and rapid deterioration are common.
  • Understanding this progression aids in timely surgical intervention for improved patient outcomes.
Abstract

Keywords:
Acute subdural hematomaChronic subdural hematomaClinical deteriorationDisturbance of consciousnessVolume increase

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