Mixed density chronic subdural hematoma
Computed Tomography for chronic subdural hematoma frequently appears to be mixed density.
Septated chronic subdural hematoma.
Mixed density chronic subdural hematoma
Acute trauma on the patients with chronic subdural hematoma may develop acute bleeding over the cSDH, which would produce mixed density
Repeated episodes of acute bleeding may result mixed densities of SDH. In other words, mixed density suggests multiple episodes of trauma 1).
Theoretically, the mixed density results from three hypotheses. The first situation is in hyper-acute bleeding; the difference between solid clot and liquid blood may produce the mixed density 2).
The second situation is in subacute subdural hematoma; resolving hematoma may appear peripheral hypodensity with central hyperdensity during transitional period 3).
Extra-axial hematoma in the right convexity, up to 1.5 cm thick and with mixed density (hypodense in its anterior aspect and with hyperdense foci in its interior) of probable acute chronology (it was not present in a CT scan of 4 months ago and no other TBI has been reported since then) without being able to rule out rebleeding of chronic hematoma.
The hematoma conditions a mass effect on the surrounding parenchyma, with partial compression of the right lateral ventricle and a midline shift of 4 mm
Outcome
If mixed computed tomography (CT) density is found, burr hole hematoma evacuation is prone to recurrence. Endoscopic examination of the hematoma cavity provides a novel strategy 4).
Case series
The clinical and radiologic data of 240 patients with inhomogeneous CSH who underwent surgery between January 2005 and January 2021 were retrieved. A total of 111 patients were included in this study. Clinical and radiological outcomes were compared between the groups undergoing different surgery types.
Results: A total of 102 (91.8%) patients showed clinical improvement after surgery; 81 (93.1%) and 21 (87.5%) patients showed improvements in clinical symptoms in the single burr hole and mini craniotomy groups, respectively. A total of 102 (91.9%) patients showed favorable radiological findings after the surgery, including inhomogeneous CSH disappearance in 64 (73.6%) burr hole and 13 (54.2%) mini craniotomy patients, and inhomogeneous CSH improvement in 17 (19.5%) burr hole and 8 (33.3%) mini craniotomy patients. There were no significant differences in the patient characteristics or surgical outcomes between the groups.
Conclusion: Single burr hole drainage showed a slightly better improvement in clinical and radiologic findings and lower recurrence and complication rates than mini craniotomy. There were no statistically significant differences between the two groups 5)