1
|
Kwon HC, Hwang YS, Shin HS. Rapid Spontaneous Resolution of Large Acute Subdural Hematoma. Korean J Neurotrauma 2021; 17:162-167. [PMID: 34760828 PMCID: PMC8558017 DOI: 10.13004/kjnt.2021.17.e16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/06/2021] [Indexed: 11/15/2022] Open
Abstract
Usually, acute subdural hematomas (ASDHs) result from head trauma and require urgent surgical treatment. However, there have been many reports of rapid spontaneous resolution of ASDHs since 1986. Recently, we experienced a case of a massive ASDH that resolved spontaneously within 1.5 days. A 76-year-old man was admitted to a local hospital after a head injury. According to his clinical records, his initial neurologic status was good (Glasgow Coma Scale score of 14). However, his head computer tomography (CT) scan demonstrated a massive ASDH to the right, with a significant midline shift. Based on his neurological status and general condition, surgery was not considered, and the patient was closely monitored in the intensive care unit. The next day, the patient was transferred to our hospital as requested by his family, after which his neurological state stabilized, and the customary follow-up brain CT was performed. It was about 32 hours after the patient's head injury, and it revealed an unexpected finding, near-total resolution of the ASDH. Herein, we review previously reported similar cases and relevant mechanisms of rapid resolution of the ASDH. We believe that neurosurgeons should comprehensively assess the patient's condition and CT findings and provide appropriate treatment, especially when surgical intervention is unnecessary.
Collapse
Affiliation(s)
- Hee Chang Kwon
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Yong Soon Hwang
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea
| | - Hyung Shik Shin
- Department of Neurosurgery, Sanggye Paik Hospital, Inje University, Seoul, Korea
| |
Collapse
|
2
|
Rathore L, Sahana D, Kumar S, Sahu RK, Jain AK, Tawari M, Borde PR. Rapid Spontaneous Resolution of the Acute Subdural Hematoma: Case Series and Review of Literature. Asian J Neurosurg 2021; 16:33-43. [PMID: 34211864 PMCID: PMC8202355 DOI: 10.4103/ajns.ajns_380_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/15/2020] [Indexed: 11/04/2022] Open
Abstract
Background: Traumatic acute subdural hematoma (ASDH) is an oft encountered entity in neurosurgery. While resolution of such thick SDHs usually takes time, certain cases of rapid spontaneous resolution have also been reported. This article attempts to review the pathophysiology, clinical and radiological features of such cases, as well as provide an insight into decision making for their management. Methods: Electronic literature search was done to look for similar cases of spontaneous rapid resolution of ASDH. Five of authors cases have been described. Their clinical and radiological features along with those of cases from literature search were tabulated and analyzed. Results: A total of 44 relevant cases were included for analyses. Of these, 39 cases were from 33 articles found in existing literature and 5 cases were from author's collection. The M:F ratio was 25:19 with a mean age was 41.84(SD-4.094) years. Twenty -six patients showed “Rapid” neurological improvement (</= 24 hours) while “gradual” neurological improvement (>24 hours) occurred in 10 patients. The mean hematoma resolution time on CT scan was 13.78 hours (SD 16.46) ranging from 1- 72 hours. Twenty-nine patients showed redistribution of hematoma, most commonly to tentorium and falx cerebelli. CT scan findings were classified into 5 types as per the nature of hypodensity around hematoma. The geometric mean time to resolution of hematoma was least for type 2 (7.27 hours) and type 1(7.52 hours) patients. Conclusion: Selected patients of ASDH with rapid neurological improvement and specific CT findings may show spontaneous resolution of ASDH. Multicentric studies with larger study population may provide better insight into the nature and outcomes of such entities.
Collapse
Affiliation(s)
- Lavlesh Rathore
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Debabrata Sahana
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Sanjeev Kumar
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Rajiv K Sahu
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Amit K Jain
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Manish Tawari
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| | - Pravin R Borde
- Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India
| |
Collapse
|
3
|
Kayahara T, Kikkawa Y, Komine H, Kamide T, Suzuki K, Shibata A, Ikeda S, Ikeda T, Kurita H. Predictors of subacute hematoma expansion requiring surgical evacuation after initial conservative treatment in patients with acute subdural hematoma. Acta Neurochir (Wien) 2020; 162:357-363. [PMID: 31879816 DOI: 10.1007/s00701-019-04187-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/16/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to clarify the factors associated with requiring subacute surgery in patients with acute subdural hematoma (ASDH) treated conservatively at admission. METHODS Among the patients with ASDH admitted to our hospital from 2007 to 2018, we retrospectively reviewed data for 200 patients initially treated conservatively. We compared patients' characteristics, medical history, radiological findings, and clinical outcomes and differences between patients undergoing subacute surgery or no surgery. RESULTS Of the 200 patients treated conservatively, 17 (8.5%) patients underwent subacute surgery due to deterioration of their clinical and/or computed tomography (CT) findings, while 183 (91.5%) patients did not undergo subacute surgery. There were significant differences in the presence of focal neurological deficits, modified Rankin Scale scores, degree of midline shift, hematoma thickness, hematoma volume, cella media index, Sylvian fissure ratio, and hematoma density between the two groups. CONCLUSIONS Large hematoma, brain atrophy, and hematoma density may be useful predictors for the need for subacute surgery in patients with ASDH treated conservatively at admission. Intensive investigation of clinical findings or CT images is warranted in patients with adverse prognostic factors, even if their initial symptoms are mild.
Collapse
Affiliation(s)
- Tomomichi Kayahara
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Yuichiro Kikkawa
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan.
- Department of Neurosurgery, Saitama Prefecture Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan.
| | - Hiroyuki Komine
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
- Department of Neurosurgery, Saitama Prefecture Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Tomoya Kamide
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Kaima Suzuki
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Aoto Shibata
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
- Department of Neurosurgery, Saitama Prefecture Cardiovascular and Respiratory Center, 1696 Itai, Kumagaya, Saitama, 360-0105, Japan
| | - Shunsuke Ikeda
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Toshiki Ikeda
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| | - Hiroki Kurita
- Department of Cerebrovascular Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, 350-1298, Japan
| |
Collapse
|
4
|
Özevren H, Hattapoğlu S. Akut Subdural Hematomlu 106 Olgunun Retrospektif Değerlendirilmesi. DICLE MEDICAL JOURNAL 2018. [DOI: 10.5798/dicletip.410849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
5
|
Gelsomino M, Awad AJ, Gerndt C, Nguyen HS, Doan N, Mueller W. Mechanism for the Rapid Spontaneous Resolution of an Acute Subdural Hematoma and Transformation into a Subdural Hygroma. World Neurosurg 2018; 115:282-284. [PMID: 29660550 DOI: 10.1016/j.wneu.2018.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Spontaneous resolution of acute subdural hematomas (SDHs), occurring as the result of a traumatic injury, is well reported in the literature and rapidly resolving SDHs have been reported as well. Although the mechanism behind the rapid resolution of a SDH has not been well understood, there are postulated mechanisms for this phenomenon. The aim of this report is to present a patient who experienced the rapid resolution of a traumatic SDH, which was replaced by a subdural hygroma. CASE DESCRIPTION This 25-year-old man presented to the hospital with an acute left-sided SDH after a head-on motor vehicle collision. At the time of presentation, the patient had an acute SDH with 11 mm of midline shift. The hematoma resolved spontaneously within 48 hours and was replaced by a thin subdural hygroma. CONCLUSIONS Rapidly resolving SDHs represent a phenomenon that has been well described, although is not entirely understood. The imaging findings of this patient suggest that cerebrospinal fluid washout is a mechanism that promotes acute SDH resolution.
Collapse
Affiliation(s)
- Michael Gelsomino
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Ahmed J Awad
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA; Faculty of Medicine and Health Sciences, An-Najah National University, Palestine
| | - Clayton Gerndt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ha S Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| |
Collapse
|
6
|
Abstract
Introduction: This study reports a rare patient of a rapid spontaneously resolving acute subdural hematoma. In addition, an analysis of potential clues for the phenomenon is presented with a review of the literature. Patient Presentation: A 1-year-and-2-month-old boy fell from a height of approximately 2 m. The patient was in a superficial coma with a Glasgow Coma Scale of 8 when he was transferred to the authors’ hospital. Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. His guardians refused invasive interventions and chose conservative treatment. Repeat imaging after 15 hours showed the evident resolution of the hematoma and midline reversion. Progressive magnetic resonance imaging demonstrated the complete resolution of the hematoma, without redistribution to a remote site. Conclusions: Even though this phenomenon has a low incidence, the probability of a rapid spontaneously resolving acute subdural hematoma should be considered when patients present with the following characteristics: children or elderly individuals suffering from mild to moderate head trauma; stable or rapidly recovered consciousness; and simple acute subdural hematoma with a moderate thickness and a particularly low-density band in computed tomography scans.
Collapse
|
7
|
Vital RB, Hamamoto Filho PT, Oliveira VAD, Romero FR, Zanini MA. Spontaneous resolution of traumatic acute subdural haematomas: A systematic review. Neurocirugia (Astur) 2016; 27:129-35. [DOI: 10.1016/j.neucir.2015.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 05/06/2015] [Accepted: 05/10/2015] [Indexed: 12/09/2022]
|
8
|
Spontaneous rapid resolution of acute subdural hematoma in children. Childs Nerv Syst 2015; 31:2239-43. [PMID: 26391785 DOI: 10.1007/s00381-015-2910-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 09/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Spontaneous rapid resolution of acute subdural hematoma developing secondary to trauma has been reported in the literature, yet it is very rare in pediatric population. The aim of the present review is to analyze mechanisms, characteristics, and outcomes of pediatric acute subdural hematoma cases with spontaneous rapid resolution in conjunction with an exemplary case of ours. CASE DESCRIPTION A 3-year-old boy was admitted to our emergency department following mild head trauma secondary to a fall from 2 m. He was alert and has a GCS of 15. He had no motor or sensorial deficit on neurological examination. On the emergent brain computed tomography image, an acute subdural hematoma over left frontoparietal lobe was observed. There was a midline shift of 8.3 mm and the width of the hematoma at the thickest portion was 11.2 mm. Surgery was postponed with a close neurological follow-up of the patient in pediatric intensive care unit, due to his well neurological status without any increased ICP findings. On the fourth hour follow-up head CT image, amount of midline shift and hematoma thickness were observed to have regressed dramatically. At the second week, the hematoma resorbed totally with only conservative approach, and he was discharged to home in well status. DISCUSSION AND CONCLUSION Analysis of 12 pediatric patients revealed a mean and median ages of 6.87 and 3.9 years, respectively (range = 8 months-18 years). Causes for ASH development were fall, traffic accident, struggle, and child abuse. Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. Close follow-up with conservative treatment should be mode of approach in pediatric patients with ASH, if neurological and radiological findings are favorable. However, if patients' neurological status deteriorates after admission to hospital, surgery should be conveyed with no further delay.
Collapse
|
9
|
Jiang R, Wang D, Poon WS, Lu YC, Li XG, Zhao SG, Wang RZ, You C, Yuan XR, Zhang JM, Feng H, Fei Z, Yu XG, Zhao YL, Hu J, Kang DZ, Yu RT, Gao GD, Zhu XD, Sun T, Hao JH, Liu XZ, Su N, Yue SY, Zhang JN. Effect of ATorvastatin On Chronic subdural Hematoma (ATOCH): a study protocol for a randomized controlled trial. Trials 2015; 16:528. [PMID: 26581842 PMCID: PMC4652431 DOI: 10.1186/s13063-015-1045-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/04/2015] [Indexed: 02/05/2023] Open
Abstract
Background Chronic subdural hematoma (CSDH) is a common disease that is more prevalent in older people. Surgical intervention is a safe treatment of choice. However, the recurrence rate is relatively high and the outcome is not always satisfactory among surgically treated patients. It is believed that aberrant angiogenesis and intracapsular inflammation contribute to the development of CSDH. Atorvastatin is reported to promote angiogenesis and suppress inflammation. We have recently shown that atorvastatin is effective to non-surgically reduce and eliminate CSDH with minimal side effects. Here, we report a clinical research trial protocol that is designed to evaluate the therapeutic effects of atorvastatin on CSDH. Methods/Design We have designed a multi-center, randomized, placebo-controlled, double blind clinical trial for evaluating the efficacy of oral atorvastatin in reducing CSDH. We have so far recruited 96 patients with CT-confirmed or MRI-confirmed CSDHs from 16 medical centers in China. These patients were originally recruited for the Oriental Neurosurgical Evidence-based Study Team (ONET) study. After informed consent is provided, patients are randomized to receive either atorvastatin (oral 20 mg/night for 8 weeks) or placebo (dextrin for 8 weeks); and followed for 16 weeks after the treatment. The primary outcome is the change in hematoma volume at the end of 8-week treatment. Secondary outcomes include: changes in 1) the hematoma volume at the 4th, 12th, and 24th weeks; 2) Markwalder’s Grading Scale and Glasgow Coma Scale (MGS-GCS); 3) Glasgow Outcome Score (GOS) and 4) Activities of Daily Life – the Barthel Index scale (ADL-BI). Safety will be assessed during the study by monitoring adverse events, laboratory tests, electrocardiography (ECG), measurements of vital signs (temperature, pulse, and blood pressure) and body weight. Discussion Results of this trial will provide critical information regarding whether atorvastatin is an effective and safe alternative to surgical treatment of CSDH. Trial registration ClinicalTrials.gov Identifier – NCT02024373 The date of trial registration: 7 August 2013 Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1045-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Neurological Institute, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Oriental Neurosurgical Evidence-based Study Team (ONET) of People's Republic of China, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Dong Wang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Neurological Institute, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Oriental Neurosurgical Evidence-based Study Team (ONET) of People's Republic of China, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Wai Sang Poon
- Division of Neurosurgery, Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories East, Hong Kong.
| | - Yi Cheng Lu
- Department of Neurosurgery, Shanghai Changzheng Hospital, 415 Fengyang Street, Shanghai, 200003, People's Republic of China.
| | - Xin Gang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, 107 Wenhuaxi Street, Jinan, Shandong Province, 250012, People's Republic of China.
| | - Shi Guang Zhao
- Department of Neurosurgery, The First Affiliated hospital of Harbin Medical University, 23 Youzheng Street, Nangang district, Harbin, Heilongjiang Province, 150001, People's Republic of China.
| | - Ren Zhi Wang
- Department of Neurosurgery, Peking Union Medical College Hospital, 41 Damucang Street, Xicheng district, Beijing, 100032, People's Republic of China.
| | - Chao You
- Department of Neurosurgery, West China Hospital Sichuan University, 37 Guoxuegang Street, Wuhou district, Chengdu, Sichuan Province, 610041, People's Republic of China.
| | - Xian Rui Yuan
- Department of Neurosurgery, Xiangya Hospital Central South University, 87 Xiangya Street, Changsha, Hunan Province, 410008, People's Republic of China.
| | - Jian Min Zhang
- Department of Neurosurgery, The Second Affiliated Hospital Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang Province, 310009, People's Republic of China.
| | - Hua Feng
- Department of Neurosurgery, Southwest Hospital, 30 Gaotanyanzheng Road, Shapingba district, Chongqing, Sichuan Province, 400038, People's Republic of China.
| | - Zhou Fei
- Department of Neurosurgery, Xijing Hospital, 15 Changlexi Road, Xian, Shanxi Province, 710032, People's Republic of China.
| | - Xin Guang Yu
- Department of Neurosurgery, The General Hospital of Chinese People's Liberation Army, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Yuan Li Zhao
- Department of Neurosurgery, Beijing Tian Tan Hospital, Capital Medical University, 6 Tiantan Xili, Dongcheng district, Beijing, 100050, People's Republic of China.
| | - Jin Hu
- Department of Neurosurgery, Huashan Hospital Fudan University, 12 Wulumuqizhong Street, Shanghai, 200040, People's Republic of China.
| | - De Zhi Kang
- Department of Neurosurgery, First Affiliated Hospital of Fujian Medical University, 20 Chazhong Road, Fuzhou, Fujian Province, 350005, People's Republic of China.
| | - Ru Tong Yu
- Department of Neurosurgery, The Affiliated Hospital of Xuzhou Medical College, 99 Huaihaixi Road, Xuzhou, Huhehot, Jiangsu Province, 221006, People's Republic of China.
| | - Guo Dong Gao
- Department of Neurosurgery, Tangdu Hospital, The Second Affiliated hospital of the Fourth Military Medical University, 1 Xinsi Road, Xian, Shanxi Province, 710038, People's Republic of China.
| | - Xi De Zhu
- Department of Neurosurgery, Linyi People's Hospital, 27 Jiefang Road, Linyi, Shandong Province, 276003, People's Republic of China.
| | - Tao Sun
- Department of Neurosurgery, General Hospital of Ningxia Medical University, 804 Shenglinan Road, Xingqing district, Yinchuan, Ningxia Province, 750004, People's Republic of China.
| | - Jie He Hao
- Department of Neurosurgery, First Affiliated Hospital of Shanxi Medical University, 85 Jiefangnan Road, Taiyuan, Shanxi Province, 030001, People's Republic of China.
| | - Xian Zhi Liu
- Department of Neurosurgery, The First Affiliated Hospital of Zhengzhou University, 1 Jianshedong Road, Zhengzhou, Henan Province, 450052, People's Republic of China.
| | - Ning Su
- Department of Neurosurgery, Inner Mongolia people's Hospital, 26 Zhaowuda Road, Saihan district, Huhehot, Inner Mongolia Province, 010017, People's Republic of China.
| | - Shu Yuan Yue
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Neurological Institute, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Oriental Neurosurgical Evidence-based Study Team (ONET) of People's Republic of China, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| | - Jian Ning Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Key Laboratory of Post-trauma Neuro-repair and Regeneration in Central Nervous System, Ministry of Education, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Key Laboratory of Injuries, Variations and Regeneration of Nervous System, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Tianjin Neurological Institute, 154 Anshan Road, Tianjin, 300052, People's Republic of China. .,Oriental Neurosurgical Evidence-based Study Team (ONET) of People's Republic of China, 154 Anshan Road, Tianjin, 300052, People's Republic of China.
| |
Collapse
|
10
|
Köksal V, Özdemir B. A calvarial acute subdural hematoma migrating into the spinal canal in a young male. Am J Emerg Med 2015; 33:1537.e1-4. [PMID: 26314217 DOI: 10.1016/j.ajem.2015.07.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
It is not common for an acute subdural hematoma (SDH) in the supratentorial region to show rapid resolution or migration during the clinical course. In this report, we present a rare case where the SDH in the supratentorial region was observed to rapidly migrate into the lumbar spinal canal, leading to severe radiculopathy. A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal. He had vomited 3 times after the onset of pain. No stiff neck was found, and the computed tomography showed an ASDH over the outer layer of the right hemisphere, causing a 7- to 8-mm shift. During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. Acute SDH associated with a minor head trauma may migrate from the supratentorial compartment into the spinal canal by the help of elastic cerebral tissues in young adults and children.
Collapse
MESH Headings
- Angiography
- Craniocerebral Trauma/complications
- Craniocerebral Trauma/diagnosis
- Glasgow Coma Scale
- Hematoma, Subdural, Intracranial/diagnosis
- Hematoma, Subdural, Intracranial/etiology
- Hematoma, Subdural, Intracranial/pathology
- Hematoma, Subdural, Spinal/diagnosis
- Hematoma, Subdural, Spinal/etiology
- Hematoma, Subdural, Spinal/pathology
- Humans
- Magnetic Resonance Imaging
- Male
- Subdural Effusion/diagnosis
- Subdural Effusion/etiology
- Subdural Effusion/pathology
- Tomography, X-Ray Computed
- Young Adult
Collapse
Affiliation(s)
- Vaner Köksal
- Department of Neurosurgery, Recep Tayip Erdoğan University, Medical School, Rize, Turkey.
| | - Bülent Özdemir
- Department of Neurosurgery, Recep Tayip Erdoğan University, Medical School, Rize, Turkey
| |
Collapse
|
11
|
Fujimoto K, Otsuka T, Yoshizato K, Kuratsu JI. Predictors of rapid spontaneous resolution of acute subdural hematoma. Clin Neurol Neurosurg 2014; 118:94-7. [DOI: 10.1016/j.clineuro.2013.11.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/08/2013] [Accepted: 11/29/2013] [Indexed: 10/25/2022]
|
12
|
Lee CH. Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis. Korean J Crit Care Med 2014. [DOI: 10.4266/kjccm.2014.29.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Chul-Hee Lee
- Department of Neurosurgery, Gyeongsang National University School of Medicine, Jinju, Korea
| |
Collapse
|
13
|
Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK. Natural course of initially non-operated cases of acute subdural hematoma : the risk factors of hematoma progression. J Korean Neurosurg Soc 2013; 54:211-9. [PMID: 24278650 PMCID: PMC3836928 DOI: 10.3340/jkns.2013.54.3.211] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 02/03/2013] [Accepted: 08/19/2013] [Indexed: 11/27/2022] Open
Abstract
Objective The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. Methods Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. Results No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. Conclusion A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging.
Collapse
Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gachon University, Gil Medical Center, Incheon, Korea
| | | | | | | | | | | |
Collapse
|
14
|
Liu B, Zhuang Z, Luo J. Fluctuation of intra-parenchymal cerebral pressure may drive the rapid spontaneous resolution of acute subdural hematoma. Med Hypotheses 2013; 81:159-62. [PMID: 23769000 DOI: 10.1016/j.mehy.2013.05.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/19/2013] [Indexed: 02/05/2023]
Abstract
Acute subdural hematoma (ASDH) is a severe insult with a high mortality rate, and emergent surgical evacuation is recommended in the vast majority of such cases. Generally, resolution of the hemorrhage requires weeks and months in patients treated conservatively. However, numerous cases of rapid spontaneous resolution of ASDH, occurring within 72h after the trauma, have been reported to date in the literature. Several possible hypotheses have been suggested, primarily involving redistribution and dilution, or washing out the ASDH. In this study, we present the relevant images of such a case, review the mechanisms of the rapid spontaneous resolution in the literature, and also propose a new hypothesis to explain the occurrence of the rapid spontaneous resolution of ASDH. We indicate that the fluctuation of intra-parenchymal cerebral pressure that drives the rapid spontaneous resolution of ASDH.
Collapse
Affiliation(s)
- Bin Liu
- Department of Neurosurgery, Second Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong 515041, China.
| | | | | |
Collapse
|
15
|
Park JY, Moon KS, Lee JK, Jeung KW. Rapid resolution of acute subdural hematoma in child with severe head injury: a case report. J Med Case Rep 2013; 7:67. [PMID: 23497374 PMCID: PMC3607936 DOI: 10.1186/1752-1947-7-67] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 01/30/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Rapid spontaneous resolution of traumatic acute subdural hematoma is an infrequent phenomenon and mainly develops in a case of simple acute subdural hematoma without parenchymal contusion. However, it has been rarely reported in a pediatric case with severe initial head injury. CASE PRESENTATION A 7-year-old Asian girl with traumatic acute subdural hematoma was transferred to our hospital for an emergency operation based on the results of an initial computed tomography scan and neurological examination. However, a repeat computed tomography scan two hours after trauma disclosed considerable reduction of the hematoma and midline shift with neurological improvements. Serial follow-up imaging studies demonstrated apparent redistribution of the hematoma over the cerebellar tentorium, posterior interhemispheric fissure and subarachnoid space. The patient was discharged with mild confusion 40 days after the admission. CONCLUSION A follow-up computed tomography scan is strongly recommended before surgery when a child with a severe head injury presents with any sign of neurological improvement, especially with a mixed density hematoma on the initial computed tomography scan.
Collapse
Affiliation(s)
- Jae-Young Park
- Department of Neurosurgery, Chonnam National University Hwasun Hospital, Hwasun-gun, Jeollanamdo 519-763, South Korea.
| | | | | | | |
Collapse
|
16
|
A Study of the Progression from Acute Subdural Hematoma to Chronic Stage Requiring Surgical Treatment. Korean J Neurotrauma 2013. [DOI: 10.13004/kjnt.2013.9.2.74] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
17
|
Han SH, Lee HK, Moon JG, Kim CH, Cho TG. Rapid spontaneous reduction of a huge intracerebral hematoma. J Cerebrovasc Endovasc Neurosurg 2012; 14:104-7. [PMID: 23210037 PMCID: PMC3471261 DOI: 10.7461/jcen.2012.14.2.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/13/2012] [Accepted: 05/14/2012] [Indexed: 11/23/2022] Open
Abstract
Rapid reduction of a large acute subdural hematoma has been frequently reported. In my knowledge, however, it was rarely reported that rapid spontaneous reduction occurred in large volume of spontaneous intracerebral hematoma (sICH). We describe a patient with a rapid spontaneous decrease in the volume of a large hematoma. A 73-year-old man presented semi-comatose mentality. Initial brain computed tomography (CT) revealed the huge sICH. An emergency operation was planned, but was not performed due to the refusal of patient's family. Therefore, we decided to treat with conservative therapy. However, follow-up brain CT 16 hours after initial scan showed a remarkable reduction of previous sICH. The mechanism involving the spontaneous rapid decrease of the hematoma is presumed to occur through redistribution in brain atrophy, compression effect from the increased intracranial pressure and dilution through a wash out by the cerebrospinal fluid.
Collapse
Affiliation(s)
- Sung Hoon Han
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, College of Medicine, Hallym University, Seoul, Korea
| | | | | | | | | |
Collapse
|
18
|
Hadjigeorgiou G, Chamilos C, Petsanas A, Vranos G, Foteas P, Spiridakis F. Rapid spontaneous resolution of acute subdural haematoma in a patient with chronic alcoholism. Br J Neurosurg 2011; 26:415-6. [PMID: 22111954 DOI: 10.3109/02688697.2011.631619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Acute subdural haematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery. There are only several reports that show the rapid disappearance of ASDH without surgical intervention. We report a case of a 64-year-old alcoholic man who had a traumatic subdural haematoma after a fall from a height of about eight meters on level ground. The computed tomography (CT) of the brain on admission demonstrated a left parietooccipital ASDH. A follow-up CT scan after 8 hours showed resolution of the hematoma. The patient was discharged 9 days later with no neurological deficit. We discuss the possible mechanisms of the rapid resolution of the ASDH.
Collapse
|