Subacute Subdural Hematoma
Subacute subdural hematoma (SASDH) is a rare entity. We retrospectively reviewed 8 patients with SASDH. Four patients were male and 4 were female, with an age range of 45–87 years (mean, 67.8 years). The minimal level of deterioration ranged from 8 to 14
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Abstract Subacute subdural hematoma (SASDH) is a rare entity. We retrospectively reviewed 8 patients with SASDH. Four patients were male and 4 were female, with an age range of 45–87 years (mean, 67.8 years). The minimal level of deterioration ranged from 8 to 14 (mean, 10.5). The deterioration of neurological symptoms was confirmed 4–20 days after injury (mean, 12.9). The hematoma volume was increased in 6 patients. Seven patients underwent surgeries (burr-hole irrigation in 6, craniotomy in 1). The Glasgow Outcome Scale indicated a good recovery in 4 patients and moderate disability in 4 patients. Increased cerebral blood flow was observed just below the SDH in 1 patient. We consider that the hypoperfused tissue in the acute phase might become hyperperfused during the subacute phase owing to impaired autoregulation, and the hyperperfusion may be responsible for the development of the SASDH, leading to deterioration. Further investigations in a larger series are needed to elucidate the mechanism underlying the development of SASDH. Keywords Head trauma • Subacute • Subdural hematoma • Surgery
S. Takeuchi (*) and N. Otani Department of Neurosurgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan e-mail: [email protected] Y. Takasato, H. Masaoka, T. Hayakawa, H. Yatsushige, and K. Shigeta Department of Neurosurgery, National Hospital Organization Disaster Medical Center, 3256 Midori-cho, Tachikawa, Tokyo 190-0014, Japan H. Miyawaki Department of Traumatology and Critical Care Medicine, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan
Introduction Subacute subdural hematoma (SASDH) is a rare clinical entity, and has been the focus of only limited investigations because the attention of neurosurgeons has been directed toward acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) [2, 3, 7, 8, 10, 11]. Because of their rarity, the features and underlying mechanisms of SASDH have not been established. We have treated eight patients with SASDHs, and retrospectively investigated their features. We herein report these results, and also discuss the potential mechanisms responsible for the development of SASDH from the viewpoint of the cerebral blood flow (CBF).
Materials and Methods During a period of 12 years, 1,310 patients with a subdural hematoma (SDH) were hospitalized at our hospital. We gathered information from the patients’ electronic medical records, and focused on eight patients (0.6 % of all SDHs) with SASDH. We retrospectively reviewed the patients’ clinical and radiological findings, management, and outcomes. We applied the following inclusion criteria for SASDH: 1. ASDH with deteriorating neurological symptoms, such as loss of consciousness, headache during the subacute period (4–20 days after injury) despite the fact that conservative therapy was performed because of a slight neurological deficit on admission. 2. Radiological findings showed no contusion or epidural hematoma. 3. There was no pathological disorder, such
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