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Background Trauma is the most frequent cause of young adult (under 45 years of age) fatalities worldwide, and traumatic brain injury accounts for up to 50% of these deaths. The incidence of traumatic brain injuries is increasing globally, largely due to an increase in motor vehicle use in low-income and middle-income countries. Purpose The aim of study was to investigate the factors that modulate the prognosis of patients with traumatic acute subdural hematoma. Patients and methods This study was conducted on 30 patients with acute traumatic subdural hematoma managed in the Department of Neurosurgery, ER, and Surgical ICU, Al-Azhar University Hospitals. All the data collected were statistically analyzed and the results were compared with the international results. Our recommendations were based on that comparison. Results Mortality rate was 53.3% (16 patients) in our study. The mean and SD of age in our study was 46.3±20.6 years. The range of age was 64 years (21–85 years). There was no statistical difference between sexes as regards age (P=0.393). The entire study population was subjected to logistic regression analysis, severity of injury, presence of a secondary injury especially hypoxia or both hypoxia and hypotension. Polytrauma, status of conscious level at admission, anemia, thickness of hematoma, and necessity for endotracheal intubation were enrolled. The hypoxia and lower Glasgow coma scale at admission were found to be significant predictors of mortality. Conclusion Traumatic acute subdural hematoma still has a high mortality rate despite all developments in neurosurgical interventions. Initially low Glasgow coma scale and hypoxia are important parameters that correlate with the mortality rate.

Background An injury to the brain or intracranial hemorrhage may cause it to swell. The pressure within the skull then increases as the brain has no room to expand; this excess pressure, known as intracranial hypertension, can cause further brain injury. High intracranial pressure (ICP) is the most frequent cause of death and disability in brain-injured patients. If high ICP cannot be controlled using general or first-line therapeutic measures such as adjusting body temperature or carbon dioxide levels in the blood and sedation, second-line treatments are initiated. One of these is a procedure called decompressive craniectomy (DC). DC involves the removal of a section of skull so that the brain has room to expand and the pressure decreases. Patients and methods We studied 20 patients who presented to the Neuroemergency Unit in AL-Azhar University Hospitals in Cairo and Damanhur Medical National Institute in Damanhur from January 2017 to December 2017 with severe traumatic brain injury with clinical and radiological evidence of increased ICP and indicated for DC. All patients were followed up postoperatively in ICU with serial follow-up computed tomography. Consciousness level was evaluated using the Glasgow Coma Scale and Glasgow outcome score. Results The overall mortality was five (25%) cases, four severely disabled (20%), and 11 (55%) patients had favorable outcome. Conclusion In 20 cases with severely raised ICP resistant to conservative management, DC allowed 55% of cases to be discharged from hospitals with mild degree of disability for rehabilitation.

Background and Purpose: Decompressive craniectomy is a surgery used to remove a large bone flap and opening the dura to allow edematous brain tissue to bulge extracranially. However, the efficacy of decompressive surgery to reduce the mortality and improve the outcome in patients with refractory intracranial pressure is still unclear. We investigated whether decompressive craniectomy is associated with improved conscious state and survival in patients with severely raised intracranial pressure and resistant to conservative management. Methods: We studied 20 patients with clinical and radiological evidence of increased intracranial pressure & indicated for decompressive craniectomy. All patients were followed postoperatively in ICU with serial follow up (CT). Consciousness level was evaluated using the Glasgow Coma Scale and Glasgow outcome score. Results: The overall mortality was 11 cases (55%), two cases remain in a vegetative state (10%), one case (5%) was severely disabled and six cases (30%) discharged with mild disability. Conclusion: In 20 cases with severely raised intracranial pressure resistant to conservative management Decompressive Craniectomy allowed (30 %) of cases to be discharged from hospitals with mild degree of disability for rehabilitation.

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