Predictors of subacute hematoma expansion requiring surgical evacuation after initial conservative treatment in patients with acute subdural hematoma

Kayahara, Tomomichi; Kikkawa, Yuichiro; Komine, Hiroyuki; Kamide, Tomoya; Suzuki, Kaima; Shibata, Aoto; Ikeda, Shoko; Ikeda, Toshiki; Kurita, Hiroki

doi:10.1007/s00701-019-04187-7

Cited by 12 publications

(12 citation statements)

References 14 publications

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“…According to a previous study, 6.5% to 23.2% of initially conservatively treated ASDH patients eventually experience worsening that required surgery in their clinical course 1,16) . A more recent study described that 9% of ASDH patients experienced worsening in the subacute phase 9) . Our study focused on elderly ASDH patients; 14.6% of initially non-surgically managed patients presented with deterioration on ≤ 20 days from trauma onset.…”

Section: Discussionmentioning

confidence: 99%

“…A total of 82 patients who initially exhibited good neurological status with not much ASDH and were thus determined to be managed conservatively were reviewed. We divided the phases based on the time from trauma onset, less than 4 days as the acute phase, 4 to 20 days as the subacute phase, and more than 21 days as the chronic phase, referring to a previous study 9) . Deterioration was defined as a decrease of ≥ 2 points on the Glasgow Coma Scale (GCS) scores, focal neurological deficits and medical treatment-re-sistant seizure.…”

Section: Patient Selection and Data Collectionmentioning

confidence: 99%

“…CMI was recorded as the ratio of the greatest distance between both temporal bone outer tables at the cella-media level to the maximum length between lateral surfaces of both lateral ventricles on the same slice 5,14) . We modified the SFR measurement by referring to previous studies 9,16) . The ratio of the total maximal length of both Sylvian fissures to the maximal distance between the outer tables of temporal bones was recorded as SFR.…”

Section: Radiological Evaluationmentioning

confidence: 99%

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Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Lee

Kim

Shin

et al. 2020

J Neurointensive Care

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We investigated the features and possible predictors of deterioration in the acute or subacute phase of acute subdural hematoma (ASDH) patients aged > 65 years who initially received conservative treatment. MethodsBetween January 2016 and December 2019, 184 patients with ASDH were treated in a single institution. Eighty-two patients aged ≥ 65 years who had initially presented with preserved neurological status and conservatively treated were included in this study. We classified patients into deterioration and non-deterioration groups according to whether deterioration occurred in the acute and subacute phases. Medical records and computed tomography scans were reviewed, retrospectively. ResultsTwelve out of 82 patients (14.6%) exhibited deterioration in the acute or subacute phase; the remaining 70 patients had not deteriorated in the acute and subacute phases. Clinical outcome at discharge was significantly worse in the deterioration group (p<0.001) than in the non-deterioration group. The proportion of patients taking antithrombotics was significantly higher in the deteriorated patients (p=0.003). In the deterioration group, the midline shift was more severe (p<0.001), the hematoma was thicker (p=0.001), and the proportion of mixed-density hematomas was higher (p<0.001). ConclusionEven when elderly ASDH patients present with an initially good neurological status, acute or subacute deterioration is not uncommon. Maximum care should be paid to elderly patients under initial conservative management, especially those taking antithrombotics.

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Section: Discussionmentioning

confidence: 99%

Section: Patient Selection and Data Collectionmentioning

confidence: 99%

Section: Radiological Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Lee

Kim

Shin

et al. 2020

J Neurointensive Care

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“…12) Therefore, patients with a large hematoma without neurological deficits are sometimes treated conservatively, and some of them require subacute surgery due to enlarged SASDH. 2,[14][15][16][17][18] However, the true mechanism of the SASDH development is unknown, and little is also known about hemodynamic changes, the optimum treatment strategies, and perioperative complications.…”

Section: Subacute Subdural Hematomamentioning

confidence: 99%

Endoscopically Treated Subacute Subdural Hematoma Presenting Postoperative Cerebral Hyperperfusion Syndrome: Chronological Changes of Cerebral Blood Flow on Arterial Spin Labeling and Subcortical Low Intensity on Fluid-attenuated Inversion Recovery Images

Katsuki

Narita

Watanabe

et al. 2021

NMC Case Report Journal

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Subacute subdural hematoma (SASDH) is a neurotraumatic entity. There are few reports of chronological changes of cerebral blood flow (CBF) on arterial spin labeling (ASL) and subcortical low intensity (SCLI) on fluid-attenuated inversion recovery (FLAIR) images of magnetic resonance imaging (MRI) observations from the injury onset, deterioration, to post-surgery. We reported a SASDH patient presenting postoperative cerebral hyperperfusion (CHP) syndrome with chronological changes of those findings. An 85-year-old woman fell and presented right ASDH. She was treated conservatively due to no neurological deficits. On day 3, ASL image revealed increased CBF against brain compression. On day 7, the CBF was normalized on ASL image, but SCLI was confirmed. On day 14, SCLI was strengthened. Then she developed left hemiparesis due to brain compression by SASDH. Considering age and comorbidities, we performed endoscopic hematoma removal under local anesthesia, and her neurological deficits improved after the surgery. On postoperative day 1, she newly presented left upper limb paresis. MRI revealed increased CBF and enhanced SCLI. We diagnosed CHP syndrome, and antihypertensive treatment improved the symptoms gradually. However, SCLI had been consistently observed, and CBF easily changed depending on the blood pressure, suggesting dysfunction of the CBF autoregulation. We showed the endoscopically treated SASDH patient with CBF's chronological changes on ASL images and SCLI on FLAIR images. Long-time brain compression would lead to dysfunction of the CBF autoregulation, and we should be careful about CHP syndrome after the endoscopic surgery for SASDH.

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“…As many specialists will attest, there is rarely an adequate algorithmic approach, despite guidance from the literature. [4][5][6][7][8][9][10] A unified departmental protocol for such decision making can help in times of uncertainty.…”

Section: Triage Of Cases and Patient Managementmentioning

confidence: 99%

Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System

et al. 2020

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The COVID-19 pandemic has stretched health care resources to a point of crisis throughout the world. To answer the call for care, health care workers in a diverse range of specialties are being retasked to care for patients with COVID-19. Consequently, specialty services have had to adapt to decreased staff available for coverage coupled with a need to remain available for specialty-specific emergencies, which now require a dynamic definition. In this Invited Commentary, the authors describe their experiences and share lessons learned regarding triage of patients, staff safety, workforce management, and the psychological impact as they have adapted to a new reality in the Department of Neurosurgery at Montefiore Medical Center, a COVID-19 hot spot in New York City.

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Predictors of subacute hematoma expansion requiring surgical evacuation after initial conservative treatment in patients with acute subdural hematoma

Cited by 12 publications

References 14 publications

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Acute and Subacute Deterioration in Elderly Acute Subdural Hematoma Patients Who Were Initially Managed with Non-Surgical Treatment

Endoscopically Treated Subacute Subdural Hematoma Presenting Postoperative Cerebral Hyperperfusion Syndrome: Chronological Changes of Cerebral Blood Flow on Arterial Spin Labeling and Subcortical Low Intensity on Fluid-attenuated Inversion Recovery Images

Managing a Specialty Service During the COVID-19 Crisis: Lessons From a New York City Health System

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