Spontaneous Acute Subdural Hematomas. A Clinical Comparison with Traumatic Acute Subdural Hematomas.

Missori, Paolo; Fenga, Livio; Maraglino, C; Rocchi, G; Nardacci, Barbara; Calderaro, G.; Salvati, Maurizio; Delfini, Roberto

doi:10.1007/s007010070115

Cited by 28 publications

(16 citation statements)

References 29 publications

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“…1 In addition, the distinction between a traumatic and a nontraumatic SDH based on ICD-9 coding appears dubious, as truly nontraumatic SDH is a rare condition. 15 The selection of codes may reflect the presence of an identifiable, recent trauma in the history rather than the actual underlying cause of bleeding.…”

Section: Mortality Ratementioning

confidence: 99%

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Lukasiewicz

Grant

Basques

et al. 2016

JNS

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Subdural hematoma (SDH) is a common condition confronting neurosurgeons, resulting in more than 90,000 hospitalizations annually. 6 Morbidity, mortality, and length of stay (LOS) in patients treated with surgical evacuation of SDH are not well described, and the patient characteristics associated with adverse outcomes are not clearly established.Positive outcomes following surgery for SDH have been demonstrated, particularly in young patients and in patients treated within 4 hours of injury. 9,18,19 However, this population has a known significant risk of death. Historically, death after surgical evacuation of SDH has been reported in the range of 30%-60%. 5,12,20,22 More recently, 3 groups have investigated the mortality risk of SDH using abbreviatioNs ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CHF = congestive heart failure; CPT = Current Procedural Terminology; DVT = deep venous thrombosis; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; MI = myocardial infarction; NIS = National Inpatient Sample; NSQIP = National Surgical Quality Improvement Project; OR = operating room; PE = pulmonary embolism; RR = relative risk; SDH = subdural hematoma. results A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk coNclusioNs Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery.[http://thejns.org/doi/abs/10.3171/2015.2.JNS142721

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Section: Mortality Ratementioning

confidence: 99%

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Lukasiewicz

Grant

Basques

et al. 2016

JNS

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“…20) Advanced age, hypertension, coagulopathy, and alcohol abuse are the reported risk factors. 2,3,6,9,11,12,14,20,21) In the present case of an elderly woman with hypertension, the encapsulated ASDH, considered to have the same bleeding source from the cortical artery as the initial bleeding, satisfied the criteria of ASSDH of arterial origin.…”

Section: Discussionmentioning

confidence: 99%

Encapsulated Acute Subdural Hematoma Mimicking Acute Epidural Hematoma on Computed Tomography

Miki

Fujita

Katayama

et al. 2012

Neurol. Med. Chir.(Tokyo)

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An 87-year-old woman presented with an atypical case of acute subdural hematoma (ASDH) manifesting as disturbance of consciousness and left hemiparesis. Computed tomography revealed a high density lentiform lesion in the right convexity, which was thought to be acute epidural hematoma preoperatively. Emergent decompressive craniotomy revealed an encapsulated solid fresh clot in the subdural space and a bleeding small cortical artery under the clot. The arachnoid membrane and the brain parenchyma were intact, and no other abnormal feature such as aneurysm or arteriovenous malformation was observed. The encapsulated ASDH was removed en bloc and the patient fully recovered. Histological examination confirmed that both the outer thicker and the inner membrane were fibrinous single structures without vasculature. The red blood cells constituting the clot in the capsule maintained their cell structure. The reported pathological mechanisms of lentiform ASDH are adhesion of the arachnoid membrane and the dura mater or intracapsular bleeding from sinusoidal vessels in the outer membrane of the chronic subdural hematoma. However, in our case, the arachnoid membrane had not adhered to the dura mater and the capsule was a fibrinous single structural membrane without vasculature, which probably resulted from a previous hematoma due to initial bleeding from the cortical artery. The possible mechanism in our case was that the re-bleeding dissected and flowed into the fibrinous single structural membrane, resulting in formation of the lentiform ASDH.

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“…Other favorable variables include a high glasgow coma score score upon admission, appropriate pupillary reactivity, and young age. [20] …”

Section: Discussionmentioning

confidence: 99%

“…[11] We report a patient of MM having low platelet count who presented with spontaneous acute SDH. The case is important as the condition reported is very rare and, to our knowledge, is nowhere mentioned in literature.…”

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confidence: 99%

Spontaneous acute subdural hematoma in a patient with multiple myeloma

Wani¹,

Kumar²,

Ramzan³

et al. 2012

IJNS

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A b S T R A c TAcute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy. Bleeding diathesis is commonly seen in this disease and it has been estimated that as many as onethird of the patients with plasma cell myeloma may have this complication. [12,13] The common abnormalities contributing to bleeding diathesis include thrombocytopenia, platelet dysfunction related to uremia, hyperviscosity with bleeding tendency, disorders of coagulation factors, etc. The possible mechanisms by which coagulopathy could develop in patients with dysproteinemias in MM include: paraprotein interference with the normal function of coagulation factor(s) (i.e. by complexing with specific clotting factors), enhancement of the clearance of coagulation factor(s) by the reticuloendothelial system, anticoagulant activity of paraproteins, impaired normal platelet function, excessive fibrinolysis, and hyperviscosity. [2][3][4][5]12] Patients on bortezomib chemotherapy also often develop low platelet counts, but these usually recover rapidly.[14] During melphalan, prednisolone, and thalidomide chemotherapy, periodic blood tests are needed to ensure that an individual has adequate levels of white blood cells and platelets. The dose of melphalan must be adjusted based on these findings. Paul et al. reported one death due to SDH in the dexamethasone group in a study comparing bortezomib and high-dose dexamethasone for relapsed MM.[15] Thrombocytopenia does not usually result in any symptoms, but if the platelet count is very low there is an increased risk of bleeding. Transfusion of platelets may be required temporarily. Keith et al., in their review of 23 cases of MM, described one patient with unilateral large subdural collection looking like acute SDH on imageology, but subsequently it turned out to be a malignant effusion. [16] Spontaneous acute SDH is a rare but serious condition. This term is based simply on the absence of a traumatic history. [8,17,18] Mortality rate has been reported to be between 60 and 76.5%. [19] Early surgical intervention is often imperative for hematomas with significant mass effect. The survival rate for surgery within 4 h of acute onset compared to surgery after 4 h is 50 to 0%, respectively. Other favorable variables include a high glasgow coma score score upon admission, appropriate pupillary reactivity, and young age. CONCLUSIONAlthough coagulopathy-associated spontaneous acute SDH has been well documented, spontaneous acute SDH related to coagulopathy, particularly in MM, has never been recognized.

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Spontaneous Acute Subdural Hematomas. A Clinical Comparison with Traumatic Acute Subdural Hematomas.

Cited by 28 publications

References 29 publications

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Encapsulated Acute Subdural Hematoma Mimicking Acute Epidural Hematoma on Computed Tomography

Spontaneous acute subdural hematoma in a patient with multiple myeloma

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