Prognosis and Clinical Relevance of Anisocoria-Craniotomy Latency for Epidural Hematoma in Comatose Patients

Cohen, José E.; Montero, Antonio; Israel, Zvi

doi:10.1097/00005373-199607000-00019

Cited by 110 publications

(57 citation statements)

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“…With delay to decompression, patients who suffered from brain herniation syndromes have increased rates of permanent disability and death (5). Some authors also reported that the critical time is not the time from injury, but the time from the onset of symptomatic brain compression (8,12,22,26). Haselsberger et al (12) reported that mortality rose from 17% to 65% and good recovery dropped from 67% to 13% when the time from the onset of coma to operation was more than 2 hours.…”

Section: █ Conclusionmentioning

confidence: 99%

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The surgical outcome of traumatic extraaxial hematomas causing brain herniation

Gürer¹,

Kertmen²,

Yı́lmaz³

et al. 2015

Turkish Neurosurgery

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ABSTRACTcommon clinical entities encountered by any neurosurgical service.Brain herniation due to posttraumatic hematoma remains one of the most difficult situation faced by neurosurgeons, and causes significant mortality and morbidity. To our knowledge there were only few past studies focused especially into the herniated subgroup of traumatic extraaxial hematomas (31,37,43,44).The aim of this retrospective study was to assess the surgical outcome and the prognostic importance of clinical and █ INTRODUCTION A ccident is the leading cause of death among individuals younger than 45 years. Traumatic brain injury (TBI) accounts for approximately 70% of these traumatic deaths and most of the unfavorable outcomes (2). The most important complication of TBI is the development of intracranial hematomas. It is estimated that intracranial hematomas occur in 25-45% of severe TBI, 3-12% of moderate cases and approximately 1 in 500 patients with mild TBI (40). As a result, acute traumatic extraaxial hematomas (epidural hematoma (EDH) and subdural hematoma (SDH)), are among the most AIm: The aim of this study was to assess the surgical outcome and the prognostic importance of clinical and radiological data of patients operated emergently for an extraaxial hematoma causing brain herniation. mATERIAl and mEThODS:This retrospective study comprised 108 adult patients who were operated due to herniated traumatic extraaxial hematomas from January 2000 to January 2013. RESUlTS:Of 108 patients, 63 patients (58.3%) were diagnosed as subdural hematoma (SDH), and 45 patients (41.7%) as epidural hematoma (EDH). An unfavorable outcome was significantly increased for patients who were diagnosed as SDH (90.4%) compared with EDH patients (33.3%). Mortality rate for herniated SDH patients was 65.1%, and 26.6% for herniated EDH patients. High mortality and unfavorable outcome ratios were associated with Glasgow Coma Scale scores at admission, mean postoperative intracranial pressure (ICP) values, type of the brain herniation, interval from the time of trauma to the time of hematoma decompression, the duration of the brain herniation, intraoperative acute brain swelling, hematoma volume and thickness, degree of the midline shift and the obliteration of the basal cisterns. CONClUSION:Our data showed that, postoperative ICP values were one most important predictor of the mortality. We recommended postoperative ICP monitoring for all patients presenting with the brain herniation due to traumatic extraaxial hematoma.

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Section: █ Conclusionmentioning

confidence: 99%

“…Pupils that are bilaterally unresponsive to light are associated with a high mortality (4,8,9,25,30,45). Patients with bilateral fixed and dilated pupils at surgery had 0-13% favorable outcome and 64-93% mortality rate (13,29,31,38,46).…”

mentioning

confidence: 99%

The surgical outcome of traumatic extraaxial hematomas causing brain herniation

Gürer¹,

Kertmen²,

Yı́lmaz³

et al. 2015

Turkish Neurosurgery

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“…More than 70% of the extradural haematomas are associated with a skull fracture in adults but the figure is notably low in children 3 . Mortality ranges from 5-43% in various jurisdictions 4,5 . A high mortality rate is noted in the extremes of age, fewer than five years and those over 55 years of age 5 .…”

Section: Introductionmentioning

confidence: 99%

“…Mortality ranges from 5-43% in various jurisdictions 4,5 . A high mortality rate is noted in the extremes of age, fewer than five years and those over 55 years of age 5 . Patients who present with a GCS of 3 with dilated and fixed pupils have specifically been reported to have a very high mortality rate 6 .…”

Section: Introductionmentioning

confidence: 99%

“…Patients who present with a GCS of 3 with dilated and fixed pupils have specifically been reported to have a very high mortality rate 6 . Survival has been reported to depend on: the age of the patient, the speed of haematoma formation, the size and location of the clot, the pre operative GCS and the presence of intra cerebral lesions and finally the interval between the onset of pupillary changes and surgery 5,6,7,8,9 . This study aims to highlight the presentation, incidence, the functional outcome as measured by the Glasgow outcome scale 10 at discharge of patients with extradural haematomas as seen at the Nakuru level five hospital.…”

Section: Introductionmentioning

confidence: 99%

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Patient Profile and Outcomes of Traumatic Extradural Haematomas as Seen at The Nakuru Level Five Hospital in Kenya

Nasio¹

2017

East. Cent. Afr. J. Surg.

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Background: An extradural haematoma (EDH) also referred to as epidural haematoma is a collection of blood between the skull and the dura. Extradural haematomas are present in 1-2% of all head injury patients. In those who present in coma, extradural haematomas are present in 10% of them. Mortality rates have been reported to range from 5-43% in different regions of the world. Mortality is reportedly nil in patients who present without coma and 20% for those who present comatosed. Methods: A prospective cross sectional descriptive study of patients diagnosed with extradural haematoma by CT scan conducted at the Nakuru level five hospital between 1 st January 2015 and 30 th November 2015. Descriptive patient demographic data, clinical presentation data, investigations, surgical treatments offered, length of hospital stay and outcomes were captured using a questionnaire. Results: A total of 32 patients with extradural haematoma were recruited into the study. There was a male preponderance that accounted for 96.8% of patients. Their ages ranged from 5 to 64 years with a mean age of 30.75 years (+ 13.6) and. The commonest cause of injury was assault at 31.3% of all head injury patients followed by motorcycle related accidents at 28.1%. There were 34.4% mildly injured patients, 43.8% moderate and 21.9% of patients severely head injured. There were 8 deaths (25%) of the patients and 59.4% of the patients had good recovery. Low GCS, rhinorhoea, otorhoea, presence of an intracerebral haematoma, admission to the ICU, convulsions and loss of consciousness were associated with poor outcome.( p=0.00, 0.001, 0.022, 0.002, 0.009, 0.000, and 0.044 respectively). Conclusion: The extradural haematoma patient is mostly a young male. The commonest cause of extradural haematoma is assault/violence related followed by motorcycle accidents. There is an important co relationship between Glasgow coma score and outcome. Likewise Convulsions, loss of consciousness at any time after injury, otorhoea , rhinorhoea and presence of associated injuries worsened outcomes in this subset of extradural haematoma patients.

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