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[Chronic bilateral subdural hematomas]

G Penchet1, H Loiseau, J P Castel

  • 1Clinique Universitaire de Neurochirurgie, Hôpital Pellegrin, Bordeaux.

Neuro-Chirurgie
|December 29, 1998
PubMed
Summary
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Bilateral chronic subdural hematomas show slightly longer diagnostic delays and higher recurrence rates than unilateral forms. However, both conditions have comparable overall prognoses and can be safely treated with a standard burr hole procedure.

Area of Science:

  • Neurosurgery
  • Neurology
  • Radiology

Context:

  • Chronic subdural hematomas (CSH) are collections of blood between the dura mater and arachnoid mater.
  • Distinguishing between unilateral and bilateral CSH is crucial for understanding diagnostic and therapeutic nuances.
  • Previous studies have not extensively compared bilateral CSH to unilateral CSH regarding clinical presentation and outcomes.

Purpose:

  • To compare chronic bilateral subdural hematomas (CSH) with unilateral CSH.
  • To analyze differences in diagnostic delay, clinical presentation, post-operative recovery, and recurrence rates.
  • To evaluate the management outcomes and long-term prognosis of bilateral CSH.

Summary:

  • A retrospective analysis of 236 CSH cases (41 bilateral) revealed significant differences in prediagnostic period duration and recurrence rates (12% for bilateral).

Related Experiment Videos

  • Bilateral CSH exhibited longer diagnostic delays, potentially linked to poorer cerebral reexpansion and increased recurrence risk.
  • Despite these differences, both unilateral and bilateral CSH demonstrated good outcomes (97.5%) and low morbidity (14.6%), with comparable overall prognoses.

    • Impact:

    • Findings suggest that while bilateral CSH may have a slightly prolonged prediagnostic phase and higher recurrence rate, their overall prognosis is similar to unilateral CSH.
    • A standard burr hole procedure with closed drainage is effective and safe for both unilateral and bilateral CSH, including recurrent cases.
    • Routine use of antiepileptic drugs and routine antibiotherapy are not necessary for CSH management; a single delayed postoperative clinical follow-up is sufficient.