Two cases of chronic subdural haematoma following a snowboard head injury are reported. Chronic subdural hematoma presents a distinct clinical problem from acute trauma to the brain. Subdural haemorrhage intracranial haemorrhage geeky medics. Acute subdural hematomas cause symptoms right away.
Methods sixty patients with csdh underwent 5 weeks of treatment with an additional 7week followup. Chronic subdural haematoma csdh is one of the most common clinical entities in daily neurosurgical practice. 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. But these rather nonspecific symptoms may lead to misdiagnosis such as dementia and false treatment. Aggressive reversal of coagulopathy should be accomplished in most patients with a subdural haematoma. It was thought that its development was continuous from acute to subacute and then to chronic subdural hematoma. Material and we report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. Nonsurgical treatment of chronic subdural hematoma with. The chronic phase of a subdural hematoma begins several weeks after the first bleeding. Management of chronic subdural haematoma authors reply. The recurrence rate in the patients with csdh is 3. May 30, 2019 a subdural hematoma occurs when a blood vessel near the surface of the brain bursts. Assessing and managing patients with chronic subdural. The common manifestations are altered mental state and focal neurological deficit.
Previously, csdh was seen simply as the chronic form of acute subdural hematoma. Acute subdural hematoma usually occurs after severe, highimpact injuries and is often associated with contusions of the adjacent areas of the brain. 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. It starts with a headache but can have a much more sinister nature.
Although such cases are rare in sport, the risk in snowboarders is higher than expected. 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. 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. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Pdf chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Surgical treatment is the treatment of choice and burr hole trephination bht is widely performed. However, people with chronic subdural hematomas may have no symptoms at all. With the chronic subdural hematoma, the onset of the symptoms is remote in time from the original trauma, which is usually trivial. There is lack of uniformity about the treatment strategies, such as the role of burr hole, twist drill, craniotomy, etc. In this country the interest in chronic subdural hemorrhage was aroused by the report of putnam and cushing 1 in 1925. There is lack of uniformity in the treatment of csdh amongst. Cerebral collapse associated with chronic subdural haematoma in adults.
However, to the best of the authors knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma. 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. Embolization of the middle meningeal artery in patients with. Chronic subdural haematoma in the elderly postgraduate. A chronic subdural hematoma sdh is a collection of blood on the brains surface, under the outer covering of the brain dura. Review chronic subdural haematoma in the elderly v adhiyaman, m asghar, k n ganeshram, b k bhowmick postgrad med j2002. Subdural hematomas are divided into acute, subacute, and chronic, depending on the speed of their onset. 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. Due to the fact that the population continues to get old, it is expected that in 2030, its incidence will double 14. Wed like to understand how you use our websites in order to improve them. Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. Chronic subdural hematoma csdh is one of the most common neurosurgical conditions. This is the space between two of the meninges, which form the protective lining that covers the brain. Chronic subdural hematoma csdh is expected to double by 2030.
Chronic subdural hematomas may take weeks to months to appear. Putnam and cushing 2 in 1925 discussed the neurosurgical aspects, and gardner. Abstract we present a rare case report of a patient with chronic subdural haematoma presenting with sudden onset blindness secondary to severe acute bilateral. 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. These are more commonly seen in the elderly population where brain shrinkage. In the elderly, chronic subdural hematoma csdh has impairment of cognitive function such as memory and language. Diagnosis and management overview in primary care setting amy s. A subdural haematoma is a serious condition where blood collects between the skull and the surface of the brain. In a subdural hematoma, blood collects immediately beneath the dura mater. Medical and surgical management of chronic subdural. Subdural haematoma symptoms, diagnosis and treatment bmj. It is a serious condition and emergency treatment may be needed.
As the volume of the haematoma increases, brain parenchyma is compressed and displaced, and the intracranial pressure may rise and cause herniation. 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. Subdural hematoma is defined as a collection of blood outside the brain below the dura mater. Subdural hematomas may be classified as acute one to two days, subacute 314 days or chronic 15 days. 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. The management and outcome for patients with chronic subdural. Review chronic subdural hematoma an uptodate concept.
Treatment of chronic subdural hematoma with atorvastatin. Chronic subdural haematoma after snowboard head injury. Pdf chronic subdural hematoma csdh is one of the most common neurosurgical conditions. The chronic subdural hematoma is defined as a clearly encapsulated accumulation of fluid between the dura and arachnoid membrane 11, generally.
Feb 02, 2019 chronic subdural hematoma is a form of intracranial bleeding that starts to present weeks after the original injury. Moreover, the prevalence of chronic subdural haematoma is of 69% vs. 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. Acute subdural haematomas generally occur in younger adults, after a major trauma, often associated with structural brain injury, and present. A history of direct trauma to the head is absent in up to half the cases. Sudden onset blindness as a presenting feature of chronic subdural haematoma. Chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Lurking danger behind headache chronic subdural hematoma. Spontaneous recurrent chronic subdural hematoma in a young. 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. Chronic subdural hematoma may have presentation similar to what. Sometimes you may not remember hitting your head at all. Subdural haematoma symptoms, diagnosis and treatment.
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. 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. Current diagnosis and treatment of chronic subdural haematomas. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. Since the difference in 30day mortality between the drain and. Increasing incidence of chronic subdural haematoma in the. Subdural hematoma is the result of bleeding over the surface of the brain, beneath the dura. Gordon deen, in neurology and clinical neuroscience, 2007.
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. It is visible as a crescentshaped lesion on the ct scan. Subdural haematoma causes, tests and treatment patient. A steady increase in the incidence of csdh has been observed in developing countries due to the rise in life expectancy. Jacobs is trans ferred to the local trauma center for definitive management of her head bleed. Chronic subdural haematoma is predominantly a disease of the elderly. 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.
Csdh is usually diagnosed by contrastenhanced computed tomography scan. 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. Subdural hematoma is a blood collection between the dura mater and the arachnoid that may be present in 10% of head traumas. A subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed. Pdf management of chronic subdural haematoma mohammad. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. Chronic subdural hematoma has been well described in the literature. Chronic subdural hematoma is a form of intracranial bleeding that starts to present weeks after the original injury. Neurological state at the time of diagnosis is the most important prognostic factor. Sdh can happen in any age group, is mainly due to head trauma and ct scans are usually sufficient to make the diagnosis. Sep 24, 2017 a subdural haematoma is a collection of clotting blood that forms in the subdural space. Introduction with increase in the aging population, many diseases have become more prevalent. In sdh, blood accumulates in the space between the dural and arachnoid membranes surrounding the brain.
There is lack of uniformity in the treatment of csdh amongst surgeons in terms of various treatment strategies. The preferred surgical method continues to attract debate. 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. Chronic subdural haematomas respond strikingly to surgical drainage. Chronic subdural hematoma cleveland clinic journal of. This study investigated the risk factors associated with. Chronic subdural hematoma in the aged, trauma or degeneration. The dura mater is the outermost layer of the meninges.
Presentations seen is dependent on the level of bleeding but general include siezures, apathy, weakness, lethargy, nausea, dizziness, behaviorual changes, confusion and severe headache. 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. Middle meningeal artery embolization for chronic subdural. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. 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. Dexamethasone treatment in chronic subdural haematoma.
Chronic subdural hematoma csdh is a common neurosurgical pathology associated with prior traumatic brain injury tbi and older age that. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital. The condition is also called a subdural hemorrhage. Chronic subdural hematoma csdh is defined as a cystic unclotted hematoma with the outer and inner membranes 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 an encapsulated collection of blood and fluid on the surface of the brain. Even though 1% to 6% of patients with untreated acute subdural hematoma experience. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. Evolving management of symptomatic chronic subdural hematoma. Management of chronic subdural haematoma the lancet. Subdural hematoma sdh a guide for patients and families. Surgical management surgical evacuation of the subdural hematoma under ga 18. In contrast, epidural hematomas are usually caused by tears in arteries, resulting in a buildup of blood between the dura mater and the. There in a high variance in the treatment in literature.
Objective symptomatic chronic subdural hematoma csdh will become an increasingly common presentation in neurosurgical practice as. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia. Subdural hematoma a subdural hematoma sdh is a form of traumatic brain injury in which blood gathers between the dura and the arachnoid. Chronic subdural hematomas cshs are generally regarded to be a traumatic lesion. Dec 09, 2017 a subdural hematoma occurs when a vein located beneath the skull ruptures and starts to bleed.
Acute subdural hematomas are often lifethreatening. The authors sought to test the hypothesis that adding dexamethasone dxm to atorvastatin ato potentiates the effects of ato on chronic subdural hematoma csdh. A chronic subdural hematoma sdh is an old clot of blood on the surface of the brain beneath its outer covering. Clinical presentation may vary from no symptoms to unconsciousness. Chronic subdural hematoma csdh remains a neurosurgical condition with high recurrence rate after surgical treatment. The primary pathological mechanism is considered to be repeated microbleedings from fragile neovessels within the outer hematoma membrane. 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. Sep 16, 2014 chronic subdural haematoma csdh is one of the most common neurological disorders, and is especially prevalent among elderly individuals. Which ct findings indicate chronic subdural hematomas sdhs.
Feb 25, 2015 the medium age of patients with chronic subdural haematoma is of 63 years old. It usually begins forming several days or weeks after bleeding initially starts. 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. It can be lifethreatening and requires immediate attention. Subdural hematoma an overview sciencedirect topics. Chronic subdural hematoma csdh is one of the most common types of intracranial hemorrhages usually associated with trauma. Chronic subdural hematoma csdh is a common condition after head trauma. Cognitive impairment in the elderly with chronic subdural. A subdural hematoma develops when bridging veins tear and leak blood. Clinical analysis of risk factors for recurrence in. Head injury or other aetiological factors are commonly. Chronic subdural hematoma is seen in the right side with a hematocrit level. Spontaneous chronic subdural hematoma csh is rare and is mostly seen in elderly persons. Multiple t2wflair high signal intensity lesions in the periventricular white matter represent chronic small vessel changes.
A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Hutchinson1 abstract chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. To compare the rates of recurrence of chronic subdural hematoma following surgical evacuation by one of two methods, namely, using. 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. Chronic subdural hematoma international journal of medical. It usually begins forming several days or weeks after bleeding. Chronic subdural hematomas csdhs are encapsulated collections of blood breakdown products and fluid between the dura mater and the arachnoid. The neovessels are supplied from peripheral branches of the middle meningeal artery, and embolization of mma emma has been performed. About chronic subdural hematomas general information. Pathogenesis and pathophysiology of chronic subdural haematoma. 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. Pathogenetic factors in chronic subdural haematoma and causes of recurrence after drainage. Chronic subdural hematomas have a better prognosis if properly managed. Blood builds up between the brain and the brains tough outer lining.
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. Surgical evacuation is the mainstay of management for. Chronic subdural haematoma csdh is a condition predominantly affecting the elderly. 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.