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