Indian Journal of Neurotrauma 2004; 01(02): 37-44
DOI: 10.1016/S0973-0508(04)80008-X
Original Article
Thieme Medical and Scientific Publishers Private Ltd.

Predictors of Outcome in Acute Subdural Hematoma with severe head injury- A Prospective Study

Subodh Raju
,
Deepak Kumar Gupta
,
VS Mehta
,
A.K. Mahapatra

Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

Abstract

Acute subdural hematoma(SDH) is an uncommon condition, however, SDH associated with cerebral contusion or laceration is more frequent. Acute SDH still carry a high mortality and morbidity. This paper is a prospective analysis of 61 acute SDH patients admitted over 1 year period. Glasgow Coma Score of all the patients was 8 or less. Thickness of SDH, midline shift, associated pathology along with clinical parameters were correlated with outcome. While all the patients were ventilated, patients with significant mass lesion and midline shift were subjected to surgery. Forty percent patients were under 40 years of age and 85% patients were involved in vehicular accidents. Nine patients were M1 (motor response), 30 patients had bilateral fixed dilated pupils and 8 patients had unilateral dilated pupils. Overall survival was recorded in 21 patients (34.6%) and16.6% patients with bilateral dilated pupils survived. Young age, bilaterally reacting pupils, normal cold caloric response and midline shift less than 5 mm were good prognostic factors. Only 2 out of 21 patients with diffuse cerebral swelling survived. None of our patients with shock survived. Our study brings out the factors, which influence the outcome in patients with acute SDH.

 
  • References

  • 1 Seelig MJ, Becker BP, Miller JD, Greenberg PR, Ward JD, Choi SC. Traumatic acute subdural hematoma. Major mortality reduction in comatose patients treated within four hours. New Engl J Med 304 1981; 1511-1517
  • 2 Sahuguillo-Barris T, Lamercia-Cicero J. Villata-Cisten. Acute subdural hematoma and diffuse axonal injury after severe head trauma. J Neurosurg 68 1988; 894-900
  • 3 Kristiansen K, Tandon PN. Diagnosis and surgical treatment of severe craniocerebral injuries. J Oslo City Hosp (Suppl) 10 1960; 107-213
  • 4 Hasselberger K, Pulhar R, Amer LM. Prognosis after acute subdural or epidural hematoma. Acta Neurochir 90 1988; 111-116
  • 5 Levin HS, Aldrich FE, Sydjari C. et al Severe head injury in children: experience of the Traumatic Coma Data bank. Neurosurgery 31 1992; 435-443
  • 6 Mathew AH, Gross Alan S, Ralph BS, Richard HW. Acute subdural hematoma: an age dependent clinical entity. J Neurosurg 71 1989; 858-863
  • 7 Nakorchi P, Choomuang M, Ratanalert S. Outcome and outcome prediction in acute subdural hematoma. Surg Neurol 40 1993; 22-25
  • 8 Loh JK, Lin CL, Kwan AL, Howang SL. Acute subdural hematoma in infancy. Surg Neurol 58 2002; 218-224
  • 9 Willberger JE, Harris M, Diamond DI. Acute subdural hematoma: morbidity, mortality and operative timing. J Neurosurg 74 1991; 212-218
  • 10 David A Fell, Fitzgerald S, Moiel RH, Carain P. Acute subdural hematoma. Review of 144 cases. J Neurosurg; 42 1975; 37-42
  • 11 Henring A Shankin. Acute subdural hematoma. Review of 39 consecutive cases with high incidence of cortical artery rupture. J Neurosurg 57 1982; 25-27
  • 12 Massaro F, Lanotte M, Faccani G, Triola C. 127 cases of acute subdural hematoma operation. Correlation between CT scans findings and outcome. Acta Neurochir 138 1996; 185-191
  • 13 Servadei F. Prognostic factors in severely head injured adult patients with acute subdural hematomas. Acta Neurochir 169 1997; 274-285
  • 14 Braakman R, Glepke GJ, Habbema JDF. Systemic selection of prognosis features in-patients with severe head injury. Neurosurgery 06 1980; 362-370
  • 15 Tandon PN. Management of head injury: Fads, fashion, and facts. Neurol Ind 34 1998; 1-30
  • 16 Servadei F, Nasi MT, Giuliani G, Cremonine AM, Cenni P, Zappi D, Taylor GS. CT prognostic factors in acute subdural hematomas: the value of the ‘worst’ CT scan. Br J Neurosurg 14 2000; 1101-1116
  • 17 Becker D, Miller JD, Ward JD. The outcome from severe head injury with early diagnosis and management. J Neurosurg 47 1977; 491-502
  • 18 Jennett B, Teasdale G, Galraith S. Prognosis of patients with severe head injury. Neurosurgery 04 1979; 283-289
  • 19 Levati A, Fornia ML, Vechhi G. Prognosis of severe head injury. J Neurosurg 57 1982; 779-783
  • 20 Bowers SA, Marshall LF. Outcome in 200 consecutive cases of severe head injury treated in San Diego county: A prospective analysis. Neurosurgery 06 1980; 237-242
  • 21 Yanaka K, Kamezaki T, Yamada T. Acute subdural hematoma: prediction of outcome with linear discriminant function. Neurol Med Chir 33 1993; 552-558
  • 22 Kotwica Z, Bizezenski J. Acute subdural hematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir 121 1993; 96-99
  • 23 Wang JQ, Yf Li, Bian LG, Shen JK, Li N. Relationship of survival, hematoma thickness and midline shift in patients of acute subdural hematoma. Zhonghu Wai Ke Za Zhi 41 2003; 52-54
  • 24 Zumkeller M, Behrmann R, Heisslar HE, Dietz H. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery 39 1996; 708-713
  • 25 Domenicucci M, Strzelecki WJ, Delpini R. Acute posttraumatic subdural hematomas: ‘Intradural’ computed tomographic appearance as a favorable prognostic factor. Neurosurgery 42 1998; 51-55
  • 26 Mathew P, Oluoch-Olunya BR, Condon. Bullock R. Acute subdural hematoma in the conscious patients: outcome with initial non-operative management. Acta Neurochir 121 1993; 100-108
  • 27 Stone JL, Lowe RT, Jonossori O. et al Acute subdural hematoma: direct admission to a trauma centre yields improved results. J Trauma 26 1986; 445-450
  • 28 Tandon PN. Acute subdural hematoma: a reappraisal. Neurol Ind 49 2001; 3-12
  • 29 Tokutami T, Shigemori M, Kikridre N. Treatment of acute subdural hematoma. In: Nakamura N, Hashimoto T, Yasue M. (Eds). Recent advances in neurotraumatology. 1992. Springer; Berlin.Heidelberg, New york Tokyo: 367-370
  • 30 Marshall LF, Gautitle T, Klauba MR. et al The outcome of severe closed head injury. J Neurosurg 75 1991; 526-536
  • 31 Huang Q, Dai WM, Wu TH. et al Comparison of standard large trauma craniotomy with routine craniotomy in treatment of acute subdural hematoma. Clin J Traumatol 06 2003; 305-308