Chronic subdural hematoma international journal of medical. These liquefied clots most often occur in patients age 60 and older who have brain atrophy, a shrinking or wasting away of brain tissue due to age or disease. Chronic subdural hematoma may have presentation similar to what. Chronic subdural hematoma csdh represents one of the most frequent types of intracranial disorder which carries a most favorable prognosis when diagnosed accurately and treated adequately. There is lack of uniformity in the treatment of csdh amongst surgeons in terms of various treatment strategies. A chronic subdural hematoma sdh is an old clot of blood on the surface of the brain beneath its outer covering. Chronic subdural hematoma presents a distinct clinical problem from acute trauma to the brain. Since the difference in 30day mortality between the drain and.
Subdural hematoma an overview sciencedirect topics. Subdural haematoma symptoms, diagnosis and treatment bmj. Chronic subdural hematoma csdh is a common neurosurgical pathology associated with prior traumatic brain injury tbi and older age that. Management of chronic subdural haematoma authors reply. Sep 24, 2017 a subdural haematoma is a collection of clotting blood that forms in the subdural space. A subdural haematoma is a collection of blood between the dural and arachnoid coverings of the brain. Chronic subdural haematoma csdh is one of the most common clinical entities in daily neurosurgical practice. Chronic subdural hematoma cleveland clinic journal of. Clinical presentation may vary from no symptoms to unconsciousness. Since the difference in 30day mortality between the drain and nondrain groups was nonsignificant, the cause of death at 6 months might be unrelated to the recurrence of chronic subdural haematoma. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. Clinical presentation patients with chronic subdural haematomas can present in a variety of ways, and symptom onset and progression may range from days to weeks. Embolization of the middle meningeal artery in patients with.
The main conclusion of thomas santarius and colleagues well done study sept 26, p 10671that morbidity from chronic subdural haematoma is lower if a drain is placed postoperativelywill probably change the management of this condition around the world. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. Subdural hematoma sdh a guide for patients and families. In this country the interest in chronic subdural hemorrhage was aroused by the report of putnam and cushing 1 in 1925. Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache. Middle meningeal artery embolization for chronic subdural.
Subdural hematoma a subdural hematoma sdh is a form of traumatic brain injury in which blood gathers between the dura and the arachnoid. Csdh is usually diagnosed by contrastenhanced computed tomography scan. Feb 25, 2015 the medium age of patients with chronic subdural haematoma is of 63 years old. Wed like to understand how you use our websites in order to improve them. Acute subdural hematomas are often lifethreatening. Salesllopis neurosurgery department, university general hospital of alicante, foundation for the promotion of health and biomedical research in the valencian region fisabio, alicante, spain chronic subdural hematoma csdh is an encapsulated collection of old. Curiously enough, at that time these authors could report but six cases from the peter bent brigham hospital records, although a very large amount of neurosurgical material passed through this clinic. Multiple t2wflair high signal intensity lesions in the periventricular white matter represent chronic small vessel changes. It usually begins forming several days or weeks after bleeding. A subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed.
The condition is also called a subdural hemorrhage. Subdural hemorrhage sdh also commonly called a subdural hematoma is a collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater of the meninges around the brain. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Chronic subdural haematoma in the elderly postgraduate.
Subdural hematoma is a blood collection between the dura mater and the arachnoid that may be present in 10% of head traumas. Objective symptomatic chronic subdural hematoma csdh will become an increasingly common presentation in neurosurgical practice as. Chronic subdural hematoma csdh is a common condition after head trauma. Subdural hematomas may be classified as acute one to two days, subacute 314 days or chronic 15 days. The objectives of the study were to evaluate the glasgow outcome scores and recurrence in wide dural window and incision of inner membrane in chronic.
Current diagnosis and treatment of chronic subdural haematomas. There is lack of uniformity in the treatment of csdh amongst. Chronic subdural hematoma has been well described in the literature. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. Even though 1% to 6% of patients with untreated acute subdural hematoma experience. Abstract we present a rare case report of a patient with chronic subdural haematoma presenting with sudden onset blindness secondary to severe acute bilateral. Acute subdural hematoma usually occurs after severe, highimpact injuries and is often associated with contusions of the adjacent areas of the brain. The common manifestations are altered mental state and focal neurological deficit. This study investigated the risk factors associated with. Chronic subdural hematoma csdh is defined as a cystic unclotted hematoma with the outer and inner membranes in the subdural space. In the elderly, chronic subdural hematoma csdh has impairment of cognitive function such as memory and language. Assessing and managing patients with chronic subdural. Chronic subdural haematoma csdh is an encapsulated collection of fluid, blood and blood degradation products layered between the arachnoid and dura mater coverings on the brains surface fig. It is visible as a crescentshaped lesion on the ct scan.
Subdural haematoma causes, tests and treatment patient. Feb 02, 2019 chronic subdural hematoma is a form of intracranial bleeding that starts to present weeks after the original injury. However, people with chronic subdural hematomas may have no symptoms at all. It starts with a headache but can have a much more sinister nature. Chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Jacobs is trans ferred to the local trauma center for definitive management of her head bleed. An early theory about the formation of csdh was of a traumatic injury causing tearing of the bridging veins traversing from the brain to the draining duralvenous sinuses 1, 2. About chronic subdural hematomas general information.
Pdf chronic subdural hematoma csdh is one of the most common neurosurgical conditions. Head injury or other aetiological factors are commonly. Subdural hematomas are divided into acute, subacute, and chronic, depending on the speed of their onset. Medical and surgical management of chronic subdural. Material and we report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients.
In patients who have no significant mass effect on imaging studies and no neurologic symptoms or signs except mild headache, chronic subdural hematomas have been observed with serial scans and have been seen to remain stable or to resolve. The recurrence rate in the patients with csdh is 3. Subdural hematoma is the result of bleeding over the surface of the brain, beneath the dura. A steady increase in the incidence of csdh has been observed in developing countries due to the rise in life expectancy. Review chronic subdural hematoma an uptodate concept. These are more commonly seen in the elderly population where brain shrinkage. Chronic subdural haematoma after snowboard head injury. Cognitive impairment in the elderly with chronic subdural.
A subdural hematoma sdh is a type of bleeding in which a collection of bloodusually associated with a traumatic brain injurygathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Diagnosis and management overview in primary care setting amy s. Management of chronic subdural haematoma the main conclusion of thomas santarius and colleagues well done study sept 26, p 10671that morbidity from chronic subdural haematoma is lower if a drain is placed postoperativelywill probably change the management of this condition around the world. Chronic subdural haematomas respond strikingly to surgical drainage. This is the space between two of the meninges, which form the protective lining that covers the brain. Aggressive reversal of coagulopathy should be accomplished in most patients with a subdural haematoma. Putnam and cushing 2 in 1925 discussed the neurosurgical aspects, and gardner. Sep 16, 2014 chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. It was thought that its development was continuous from acute to subacute and then to chronic subdural hematoma. Chronic subdural hematomas cshs are generally regarded to be a traumatic lesion. Surgical treatment is the treatment of choice and burr hole trephination bht is widely performed. In contrast, epidural hematomas are usually caused by tears in arteries, resulting in a buildup of blood between the dura mater and the.
Subdural haemorrhage intracranial haemorrhage geeky medics. Treatment of chronic subdural hematoma with atorvastatin. Chronic subdural hematoma in the aged, trauma or degeneration. Acute subdural hematomas cause symptoms right away. Subdural haematoma symptoms, diagnosis and treatment. A history of direct trauma to the head is absent in up to half the cases. The symptoms of a subdural haematoma can develop soon after a severe head injury, or gradually over days or weeks after a more minor head injury. Chronic subdural hematoma csdh is one of the most common types of intracranial hemorrhages usually associated with trauma. Review chronic subdural haematoma in the elderly v adhiyaman, m asghar, k n ganeshram, b k bhowmick postgrad med j2002.
Pdf chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. As the volume of the haematoma increases, brain parenchyma is compressed and displaced, and the intracranial pressure may rise and cause herniation. In sdh, blood accumulates in the space between the dural and arachnoid membranes surrounding the brain. Sdh can happen in any age group, is mainly due to head trauma and ct scans are usually sufficient to make the diagnosis. In chronic subdural hematoma, blood in liquid state accumulates in the subdural space and causes altered mental status such as drowsiness and confusion, headache, paralysis, and other symptoms it is most commonly seen in elderly adults, generally in men. Dec 09, 2017 a subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed. Moreover, the prevalence of chronic subdural haematoma is of 69% vs. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century.
A chronic subdural hematoma sdh is a collection of blood on the brains surface, under the outer covering of the brain dura. Chronic subdural hematomas may take weeks to months to appear. Spontaneous chronic subdural hematoma csh is rare and is mostly seen in elderly persons. Management of chronic subdural haematoma the lancet. Chronic subdural hematoma is seen in the right side with a hematocrit level. Blood builds up between the brain and the brains tough outer lining. The preferred surgical method continues to attract debate. In a subdural hematoma, blood collects immediately beneath the dura mater. Acute subdural haematomas generally occur in younger adults, after a major trauma, often associated with structural brain injury, and present. Initial descriptions were published several centuries before 1857, when virchows paper, 1 now considered a classic, first presented a clear account of the histopathologic nature of the lesion and suggested an explanation of its origin. The management and outcome for patients with chronic subdural.
Pdf management of chronic subdural haematoma mohammad. Chronic subdural hematomas csdhs are encapsulated collections of blood breakdown products and fluid between the dura mater and the arachnoid. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. But these rather nonspecific symptoms may lead to misdiagnosis such as dementia and false treatment. May 30, 2019 a subdural hematoma occurs when a blood vessel near the surface of the brain bursts. A subdural hematoma develops when bridging veins tear and leak blood. Chronic subdural hematoma is fundamentally a disorder of the meningeal blood vessels embolization of the middle meningeal artery mma has recently been proposed as a curative treatment for chronic subdural hematoma csdh, but evidence for the indication and timing is not definitive. There is lack of uniformity about the treatment strategies, such as the role of burr hole, twist drill, craniotomy, etc. Increasing incidence of chronic subdural haematoma in the.
Chronic subdural hematoma csdh remains a neurosurgical condition with high recurrence rate after surgical treatment. However, to the best of the authors knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma. Cerebral collapse associated with chronic subdural haematoma in adults. It can be lifethreatening and requires immediate attention. Sometimes you may not remember hitting your head at all.
Chronic subdural hematoma csdh is expected to double by 2030. Although such cases are rare in sport, the risk in snowboarders is higher than expected. Introduction with increase in the aging population, many diseases have become more prevalent. Clinical analysis of risk factors for recurrence in. Surgical management surgical evacuation of the subdural hematoma under ga 18. The neovessels are supplied from peripheral branches of the middle meningeal artery, and embolization of mma emma has been performed. Evaluation of a snowboarder with a history of head injury, albeit mild, who complains of headaches should include computed tomography or magnetic resonance imaging to allow rapid identification of any intracranial. The dura mater is the outermost layer of the meninges. Nonsurgical treatment of chronic subdural hematoma with. Pathogenesis and pathophysiology of chronic subdural haematoma. With the chronic subdural hematoma, the onset of the symptoms is remote in time from the original trauma, which is usually trivial. Chronic subdural hematomas have a better prognosis if properly managed. Due to the fact that the population continues to get old, it is expected that in 2030, its incidence will double 14.
Which ct findings indicate chronic subdural hematomas sdhs. Previously, csdh was seen simply as the chronic form of acute subdural hematoma. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. A chronic subdural hematoma is an old collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura. It is a serious condition and emergency treatment may be needed. Spontaneous recurrent chronic subdural hematoma in a young. It usually begins forming several days or weeks after bleeding initially starts. Chronic subdural hematoma is a form of intracranial bleeding that starts to present weeks after the original injury. The chronic subdural hematoma is defined as a clearly encapsulated accumulation of fluid between the dura and arachnoid membrane 11, generally. Surgical evacuation is the mainstay of management for. The symptoms can develop soon after a severe head injury acute subdural haematoma, or very occasionally a few days or weeks after a more minor head injury subacute or chronic subdural haematoma.
There in a high variance in the treatment in literature. Chronic subdural haematoma csdh is a condition predominantly affecting the elderly. To compare the rates of recurrence of chronic subdural hematoma following surgical evacuation by one of two methods, namely, using. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Methods sixty patients with csdh underwent 5 weeks of treatment with an additional 7week followup.
The chronic phase of a subdural hematoma begins several weeks after the first bleeding. Since recent studies have demonstrated a higher incidence, we repeated our study to estimate the current incidence of csdh amongst people above the age of 65 in north wales. To evaluate the clinical features, computed tomography findings, surgical results, and complications our series was statistically analysed to elucidate the factors affecting the postoperative outcome. Hutchinson1 abstract chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Subdural hematoma is defined as a collection of blood outside the brain below the dura mater. The primary pathological mechanism is considered to be repeated microbleedings from fragile neovessels within the outer hematoma membrane. The combination of raised intracranial pressure headache, fluctuating drowsiness and mild hemiparesis, although highly suggestive of subdural haematoma, is not always encountered, and epilepsy, aphasia, hemianopia and dense hemiplegia can all occur contrary to text book descriptions. Lurking danger behind headache chronic subdural hematoma. Sudden onset blindness as a presenting feature of chronic subdural haematoma. The authors sought to test the hypothesis that adding dexamethasone dxm to atorvastatin ato potentiates the effects of ato on chronic subdural hematoma csdh. Chronic subdural haematoma is predominantly a disease of the elderly. Acute subdural hematomas that are due to trauma are the most lethal of all head injuries and have a high mortality rate if they are not rapidly treated with surgical decompression acute bleeds often develop after high speed acceleration or deceleration injuries and are increasingly severe. Dexamethasone treatment in chronic subdural haematoma.
Neurological state at the time of diagnosis is the most important prognostic factor. Two cases of chronic subdural haematoma following a snowboard head injury are reported. Evolving management of symptomatic chronic subdural hematoma. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia.
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