Guidelines for the management of severe traumatic brain injury, fourth edition. Chronic subdural hematoma a comparison of two different treatment modalities. Location and size of the sdh and presence of midline shift can rapidly be determined by computed tomography of the head. An acute subdural hemorrhage requires immediate medical attention. It is the consequence of a venous hemorrhage in the subdural space, most often. Santarius t, kirkpatrick pj, kolias ag, hutchinson pj 2010 working toward rational and evidencebased treatment of chronic subdural hematoma. However, to the best of our knowledge, for nonemergency cases not requiring surgery, no. While the presence of subdural hematoma can be inferred by neurologic decline and mechanism of traumatic injury, the diagnosis is typically made radiographically computed tomography or magnetic resonance imaging. Subdural hematoma symptoms, diagnosis and treatment. A subdural hemorrhage or hematoma is a type of bleeding that often occurs outside the brain as a result of a severe head injury. Chronic subdural haematoma in the elderly postgraduate. A craniotomy is performed to remove a large subdural hematoma.
What is the initial treatment of subdural hematoma sdh. The common manifestations are altered mental state and focal neurological deficit. A case report and technical tip of chronic subdural. A history of direct trauma to the head is absent in up to half the cases. A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Subdural haematoma causes, tests and treatment patient. Causes, clinical presentation, management, and outcomes of. Epidural hematomas arise in the potential space between the dura and the skull. Headache is usually severe in the case of acute subdural hematoma. Chronic subdural hematoma csdh is a common pathology in neurosurgery. Jul 26, 2018 a subdural hematoma sdh is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane see the images below. Immediate laboratory work up must include pt, ptt, inr, and platelet count.
Symptoms of a subdural hematoma may appear immediately following trauma to the head, or they may develop over time even weeks to months. Pdf nonsurgical treatment of chronic subdural hematoma with. Subdural hematomas form between the dura and the arachnoid membranes. It can be lifethreatening and requires immediate attention. Surgeons preferred one and two burrhole craniostomy to craniotomy or twistdrill craniostomy as the procedure of choice for initial treatment of subdural hematoma 35. Outcome of contemporary surgery for chronic subdural haematoma. Dexamethasone treatment in chronic subdural haematoma. If you sustain a major brain injury, this area can fill with blood and. Its management is often equated clinically to that of the chronic subdural hematoma csdh. In recurring chronic collections, subdural peritoneal omy is now generally reserved for those instances shunts have been used as a mode of treatment.
Pdf current diagnosis and treatment of chronic subdural. Hypotension and post traumatic seizures influence high mortality. A clinical study of the intraneuroendoscopic technique for the treatment of subacutechronic and chronic septal subdural hematoma bo du, jianzhong xu, jintao hu, xianliang zhong, jian liang, pengfei lei, hao wang, weichun li, yuping peng, aijun shan, yujuan zhang. Jul, 2017 a subdural hematoma occurs when a vein ruptures between your skull and your brains surface. Acute subdural hematoma and subarachnoid hemorrhage caused by ruptured cortical artery aneurysm. Other small subdural hematomas can be managed by inserting a temporary small catheter through a hole drilled through the skull and sucking out the hematoma. In contrast, only some chronic subdural hemorrhages require emergency surgery. Consider the diagnosis of chronic subdural haematoma as cause or consequence of new onset falls or increased fall frequency 74% in one series2. Nursing concept map subdural hematoma pathophysiology rt subdural hematoma is caused by high speed impulse to the skull, likely from traumahard hit to the head. The prognosis and management of sdh will be discussed here. One or two burrhole craniostomies with subgaleal or subdural drainage system and irrigation are the most common methods for surgical treatment of csdh. However, most subdural hematomas are thought to result from torn bridging veins, as judged by surgery or autopsy. Subdural hematoma is the most common type of traumatic intracranial mass lesion.
Glasgow coma scale, glasgow outcome, scale subdural hematoma. Pdf comparison of subgaleal and subdural closed drainage. Subdural hematoma sdh a guide for patients and families. An acute subdural hematoma can only be treated in a hospital, as the brain can swell at any time. Extradural haematoma edh neurosurgery geeky medics. Pdf dexamethasone treatment in chronic subdural haematoma. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. Seventy patients were treated by burrhole subdural drainage or subgaleal drainage system. Safety and efficacy of atorvastatin for chronic subdural. Subdural hemorrhage sdh also commonly called a subdural hematoma is a collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater of the meninges around the brain. It is a type of intracranial hemorrhage that occurs beneath the dura essentially, a collection of blood over the surface of the brain and may be associated with other brain injuries see the images below. A subdural haematoma sdh is a collection of clotting blood that forms in the subdural space.
Feb 01, 2017 analysis of the subdural evacuating port system for the treatment of subacute and chronic subdural hematomas j. Treatment of acute subdural hematoma curr treat options neurol. Pdf nonsurgical treatment of chronic subdural hematoma. Treating subdural hematoma symptoms university of utah health.
Neurological state at the time of diagnosis is the most important prognostic factor. A case report and technical tip of chronic subdural hematoma. Acute subdural hematoma is an emergency and requires prompt diagnosis. As the volume of the hematoma increases, brain parenchyma is compressed and displaced, and the intracranial pressure may rise and cause herniation. The aim of this study is to compare the advantages or disadvantages of these techniques used for csdh. Aruga t, onuma t, shigemori m, members of the japanese guidelines committee on the. This procedure can often be performed at the patients bedside rather than the operating room. Sdh can happen in any age group, is mainly due to head trauma and ct scans are usually sufficient to make the diagnosis.
Middle meningeal artery embolization for chronic subdural. Subdural hematomas are a frequent and highly heterogeneous traumatic disorder, with significant clinical and socioeconomic consequences. Some small subdural hematomas can be managed by careful monitoring until the body heals itself. Because seizures are a wellknown complication of sdh, associated with substantial morbidity and mortality, we aimed to analyze the incidence of acute symptomatic seizures asz, including status epilepticus, and determine the functional outcomes in this.
However, to the best of our knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing. If there is a small, acute subdural haematoma that is not producing any symptoms or the symptoms are not severe, it can sometimes be treated just by careful monitoring and observation. Subdural hematomas sdh represent common neurosurgical problem associated with significant morbidity, mortality, and high recurrence rates. However, most subdural hematomas are thought to result from torn. Sep 24, 2017 the treatment will depend on whether the haematoma is sudden acute or longstanding chronic, the size of the haematoma, and the symptoms that you have.
Furthermore, up to 25% recurrence rate is reported. Between 12% and 29% of patients admitted with a severe traumatic brain injury tbi have an acute sdh. Repeated head scans will likely be needed to monitor hematoma size and trends. Pathophysiology and nonsurgical treatment of chronic. Craniotomy and two burrholes were preferred for recurrent subdural hematomas 43. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. Subdural hematoma sdh and epidural hematoma are characterized by bleeding into the spaces surrounding the brain. When combining all patients with tbi, 11% present with an sdh. Seventy patients were treated by burrhole subdural drainage or subgaleal drainage system with irrigation. Trotter,1 in 1914, first emphasized the traumatic etiology of virchows pachymeningitis hemorrhagica interna. It is often successfully treated surgically by inserting a bur hole and draining the liquefied hematoma.
It usually results from tears in bridging veins that cross the subdural space subdural hematomas may cause an increase in the pressure inside the. The role of craniectomy in the treatment of chronic subdural hematomas. Mri in diagnosis of subdural hematoma, treatment of subdural hematoma. Glucocorticoids in the treatment of chronic subdural hematoma. Primary outcome was treatment failure defined as a composite of incomplete hematoma reso lution remaining or reaccumulated hematoma with thick ness. May 30, 2017 chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Surgical management of traumatic acute subdural hematoma in. A subdural hematoma is a collection of blood between the dural and arachnoid coverings of the brain. Variable disease course, depending on size of hematoma, age of the. Chronic subdural hematomas csdhs and its management comprise a. Despite the excellent outcomes obtained by surgery, complications may occur, some of which may be potentially severe or fatal.
A standardized classification for subdural hematomas jose luis alves, md, joao goncalo santiago, md, guerreiro costa, md, and anabela mota pinto, md, phd abstract. This swelling causes increased internal pressure in the skull, which must be treated with special drill holes in the skull. It takes place when blood vessels burst between the brain and the leatherlike membrane that wraps around the brain the dura mater. It is a tear in a blood vessel which then causes to blood leaks into the subdural space below the dura. Fifty three consecutive adult patients treated for chronic subdural hematoma with the. Chronic subdural hematoma csdh is a common condition after head trauma. A standardized classification for subdural hematomas. Clinical study of acute subdural haematoma a level i trauma care. Patients with chronic subdural hematomas that produce symptoms are effectively and safely treated by drilling a hole in the skull and draining the blood mass through a catheter.
A developed society is usually also characterized by an elderly population. It is a type of bleed that occurs inside of the head but outside of the brain in the subdural area. Dec 09, 2017 a subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed. Subacute subdural hematoma sasdh is an entity which is yet to gain popular foothold among treating neurosurgeons.
Chronic subdural hematoma csdh is increasingly common because of the aging population. Object chronic subdural hematoma csdh is a common condition after head trauma. Medication this may help resolve the subdural hematoma. However, to the best of the authors knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma enlargement or resolving it completely. Presence of a coagulopathy or bleeding diathesis requires. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Aug 01, 2018 pathophysiology and nonsurgical treatment of chronic subdural hematoma. There are three types of surgery used for removing hematomas.
Chronic subdural haematoma is predominantly a disease of the elderly. Others can be treated by inserting a small catheter through a hole drilled through the skull and sucking out the hematoma. In most cases, emergency surgery must be done to drain the hematoma and to control bleeding. Subdural hematoma medical specialties clinical medicine. Larger hematomas that produce increased pressure or brain shifting need urgent surgery for removal. A subacute sdh this phase begins 37 days after the initial injury. Safety and efficacy of atorvastatin for chronic subdural hematoma. Dec 21, 20 clinical presentation, neurologic condition, and imaging findings are the key components in establishing a treatment plan for acute sdh. Other common features are behavioural or cognitive disturbances present in 3455% of patients1 5 10 22 and transient 121% of patients, persistent or progressive focal neurological deficits 24% to 88% of patients. An acute subdural hematoma sdh with a thickness greater than 10 mm or a midline shift greater than 5 mm on computed tomographic ct scan should be. Treatment and outcome of chronic subdural hematoma in sub. From past to present to future author links open overlay panel dana c.
Twentytwo patients on dexamethasone ultimately required surgical drain 21. Chronic subdural hematoma can sometimes become an intractable and difficult prob drainage of the liquefied hematoma 9,17. Subacute subdural hematoma sasdh is an entity which is yet to capture the popular imagination among the neurosurgeons. Subdural hematoma symptoms, diagnosis and treatment bmj. Sep 28, 2020 acuteonchronic subdural hematoma acsdh describes acute bleeding into a chronic subdural hematoma sdh, after surgery or second trauma. Subdural hematomas have even been reported to be caused by intracranial tumors. Middle meningeal artery embolization for the management of. Small subdural hematomas with mild symptoms may require no treatment beyond observation. May 27, 2020 a subdural hematoma sdh is a common neurosurgical disorder that often requires surgical intervention. Pathophysiology and nonsurgical treatment of chronic subdural. It has been asserted that the primary brain injury associated with subdural hematoma plays a major role in mortality.
T raumatic subdural hematomas sdhs are a common pathological entity in neurosurgical practice. Treating subdural hematoma symptoms university of utah. Some small subdural hematomas can be managed by careful monitoring as the blood clot is eventually resorbed naturally. Nonsurgical treatment options for chronic subdural hematoma. Treatment of a subdural hematoma depends on its size and rate of growth. Brain surgery craniotomy this is a surgical procedure that opens the skull to remove the subdural hematoma. Chronic subdural hematoma csdh is one of the most common neurosurgical diagnoses in adults. Treatment options for chronic nonacute subdural hematomas include the following. Cooper po, rovit rl, ransohoff j 1976 hemicraniectomy in the treatment of acute subdural hematoma. A subdural hematoma occurs when a vein ruptures between your skull and your brains surface. The disease is fundamentally a disorder of the meningeal blood vessels, and options exist for the minimally invasive neuroendovascular management. A subdural hematoma forms because of an accumulation of blood under the dura mater, one of the protective layers to the brain tissue under. Most physicians will recommend surgery for larger hemorrhages and those that cause neurological symptoms.
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