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[The outcome of acute subdural hematoma]
Insights
Computed tomography (CT) scans can predict acute subdural hematoma (ASDH) prognosis. Severe CT findings like midline shift and cistern effacement indicate poor outcomes, while less severe findings correlate with good recovery after surgery.
Area of Science:
- Neurosurgery
- Neuroradiology
- Trauma Surgery
Background:
- Acute subdural hematoma (ASDH) is a severe traumatic brain injury.
- Prognosis in ASDH patients is highly variable.
- Identifying factors influencing ASDH outcomes is crucial for patient management.
Purpose of the Study:
- To investigate the influence of computed tomography (CT) findings and time to surgical intervention on ASDH prognosis.
- To correlate specific CT imaging features with patient outcomes.
Main Methods:
- Retrospective review of 35 acute subdural hematoma cases.
- Division of patients into poor outcome (Group A) and good outcome (Group B) groups.
- Analysis of CT scan findings (midline shift, subdural hematoma thickness, ventricle collapse, ambient cistern visibility) and time to surgery.
Main Results:
- Group A (poor outcome) showed significant midline shift (>15 mm), thick subdural hematomas (>15 mm), and absent ambient cisterns on CT.
- Group B (good outcome) had less severe CT findings, including smaller midline shifts (<7.5 mm), thinner hematomas (<7.5 mm), and visible ambient cisterns.
- Surgical intervention in Group B led to good recovery, while Group A had high mortality and severe disability.
Conclusions:
- CT scan findings, particularly midline shift, subdural hematoma thickness, and ambient cistern status, are strong predictors of ASDH prognosis.
- Early surgical intervention combined with favorable CT findings is associated with better patient outcomes.
Abstract:
Thirty-five cases of acute subdural hematoma (ASDH) were reviewed and divided into two groups of A and B according to the outcome. The findings of computed tomography (CT) and the time interval between head trauma and surgical intervention were investigated to know the factors that influence the prognosis in ASDH. Group A, 18 patients, had a poor outcome. Fifteen patients out of 18 had the removal of hematoma and decompression craniectomy with 10 deaths, 4 vegetative states and 1 severe disability. Three patients died without surgery. Group B, 17 patients, were treated surgically in the same way as in group A and all patients had a good recovery with 14 making a full recovery and 3 with a moderate disability. Surgical mortality was 31.3% and overall mortality was 37.1%. The features of the CT findings in 18 patients of group A were as follows. Eleven patients had midline shift of more than 15 mm, 9 had subdural high density area of more than 15 mm and 12 patients had bilateral collapse of the lateral ventricles. The characteristic finding of CT recognized in all patients of group A was disappearance of the ambient cistern. On the contrary, in 17 patients of group B the displacement of the intracranial structure was not so severe as in group A. The midline shift of 14 patients was less than 7.5 mm, the width of subdural high density area of 15 patients was less than 7.5 mm and the ambient cistern was recognized in 12 patients.(ABSTRACT TRUNCATED AT 250 WORDS)