Acute subdural hematoma

• First Case Report of the Use of Postmortem Wide-Angle Fundus Photography in Abusive Head Trauma
• Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas - a multicenter experience
• How Volume of Neurosurgical Interventions Impacts Patient Outcomes: An Analysis of 30,000 Craniectomies and Craniotomies
• Effectiveness of subdural evacuating port system (SEPS) and middle meningeal artery embolization (MMAE) for chronic subdural hematomas
• Survival of a patient with an acute traumatic subdural hematoma and high-grade liver injury with associated IVC injury without surgical intervention
• Multimodal Imaging Reveals Labbe Vein Thrombosis Mimicking Subdural Hematoma: A Diagnostic Pitfall in Emergency Neuroimaging
• Rare Presentation of Moyamoya Disease with an Acute Subdural Hemorrhage from a Rare Location of Aneurysm-Related Moyamoya Disease
• Endovascular Thrombectomy in a Young Female Patient With Atrial Septal Defect: A Case Report

An acute subdural hematoma (SDH) is a rapidly clotting blood collection below the inner layer of the dura but external to the brain and arachnoid membrane.

Subdural hematomas may be mixed in nature, such as when acute bleeding has occurred into a chronic subdural hematoma.

Intracranial acute traumatic subdural hematoma.

Intracranial acute spontaneous subdural hematoma.

Acute-on-chronic subdural hematoma

Acute subdural hematoma after chronic subdural hematoma surgery.

ABC/2 volume formula

SHE Score

The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as a mortality predictor in patients older than 65 years with nontraumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome.

Methods: Patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5-12, 2 points for GCS 3-4), and SDH volume (1 point for volume 50 mL). The sum of points determines the SHE score. Multivariate logistic regression analysis was performed to identify additional independent risk factors associated with 30-day mortality.

Results: We evaluated 131 patients with aSDH who were treated at our institution between 2008 and 2020. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100 percent regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3, and 2 for SHE 4. The logistic regression showed the surgical evacuation to be the only significant risk factor for developing the seizure. All patients who developed SE underwent surgery (p = 0.0065). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment.

Conclusions: SHE score is a reliable mortality predictor for minor trauma acute subdural hematoma in elderly patients. In addition, we identified status epilepticus as a strong life-expectancy-limiting factor in patients undergoing surgical evacuation ¹⁾.

Clinically evident or subclinical seizures are common manifestation in acute subdural hematoma (aSDH); however, there is a paucity of research investigating the relationship between seizures and aSDH.

see Acute subdural hematoma diagnosis.

Hyperdense enhancing subdural effusion due to contrast extravasation has been recently described as a potential mimicker of acute subdural hematoma following a percutaneous coronary procedure.

Zamora and Lin report on 2 patients who presented with subarachnoid hemorrhage from ruptured cerebral aneurysms and who developed enhancing subdural effusions mimicking acute subdural hematomas after angiography and endovascular coil placement. In 1 case, the subdural effusions completely cleared but recurred after a second angiography. CT attenuation values higher than expected for blood, as well as the evolution of the effusions and density over time, allowed for differentiation of enhancing subdural effusions from acute subdural hematomas ²⁾.

see Acute subdural hematoma treatment.

Acute subdural hematoma outcome.

see Acute subdural hematoma case series.

A 22-year-old woman jumped from the 4th floor of her apartment in an attempt to commit suicide. Whole-body computed tomography showed multiple injuries, including right acute subdural hematoma, left hemopneumothorax, several fractures, intraperitoneal hemorrhage, and spleen injury. Her consciousness deteriorated rapidly, and her right pupil was dilated. Furthermore, she had unstable vital signs including blood pressure of approximately 70/40 mmHg, pulse about 150/minute, respiratory rate 25/minute, and percutaneous oxygen saturation of 90% on 10 L oxygen. Intratracheal intubation and insertion of a thoracostomy tube were performed in the emergency room. Due to concomitant brain herniation and hemorrhagic shock, simultaneous decompressive craniectomy for acute subdural hematoma and transarterial embolization of intraperitoneal injured arteries were performed in our hybrid operating room. Despite rapid blood transfusions, the blood pressure did not increase. After starting embolization of the injured arteries of the spleen, the blood pressure increased, thereby making it possible to remove the acute subdural hematoma, and hemostasis was then achieved. Four hours later, the acute subdural hematoma and intracranial pressure increased again, and re-operation was performed in the normal operating room. Cranioplasty and clavicular fracture reduction were performed 14 days later. She recovered enough to talk and walk, and her consciousness stabilized. Interviews with her and her family by a psychiatrist determined that abnormal behaviors had first appeared 2 months earlier. She was diagnosed with acute and transient psychotic disorders, and treatment was started. The patient was discharged home 1 month later with mild disability of her higher-order brain function ³⁾.

A 24-year-old female was admitted because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging.

Headbanging has the hazardous potential to cause a subdural hematoma ⁴⁾.

Extensive bilateral intraparenchymal hemorrhages are observed in the form of hyperdense, patchy, confluent foci in both temporooccipital regions, with moderate peripheral vasogenic edema. On the right side, they have a combined transverse diameter of 5.8 x 2.7 cm, and on the left side, 4.4 x 2.5 cm.

There is an extensive left hemispheric subdural hematoma, with fronto-temporo-parietal distribution, reaching a maximum thickness of approximately 1 cm in its frontal extension. It causes a significant mass effect with subfalcine herniation and a midline deviation of approximately 1.4 cm. Signs of left uncal herniation are also present.

A subdural hemorrhage component is observed, laminar, covering both sides of the cerebellar tentorium. A small component of subarachnoid hemorrhage is noted in the right frontal and left temporal sulci.

Extensive subgaleal soft tissue hematomas are present, predominantly distributed in the right frontal and upper parietal regions.

Decompressive Craniectomy

Percutaneous Tracheostomy. Development of Ventilator-Associated Pneumonia (VAP) caused by Serratia marcescens Turbulent clinical evolution with fever and respiratory deterioration in previous days.

Stable hemodynamically with a tendency towards arterial hypertension (HTA). Undergoing treatment with oral antihypertensive medications. Adequate diuresis with a negative fluid balance of -900cc the previous day. Analytical parameters within acceptable ranges (Hb 9.8, K 4.3, Na 138, Ca 1.19, Cl 101, Lac 0.3). New febrile peak, pending cultures from 02/01. Ongoing antibiotic therapy with Tazocel + Amikacin, awaiting culture results. Suppuration in the craniectomy incision in previous days, cranial CT on 31/12 suggests probable overinfection of contused hematomas.

Tolerating enteral nutrition adequately, blood glucose levels within range without insulin therapy.

Reduce sedation and attempt to progress with ventilator weaning. Continue antibiotic therapy (Tazocel + Amikacin) until culture results are obtained. Maintain treatment with oral antihypertensive medications. Assessment and dressing of the craniectomy incision by Neurosurgery today, without the need for surgical revision at the moment.