Download PDF
CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2021; 18(01): 19-25
DOI: 10.1055/s-0040-1713721
Original Article

Correlation of Initial Computed Tomography Findings with Outcomes of Patients with Acute Subdural Hematoma: A Prospective Study

Ajay Choudhary
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
,
Kaviraj Kaushik
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
,
Surya Narayanan Bhaskar
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
,
Laxmi Narayan Gupta
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
,
Rajesh Sharma
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
,
Rahul Varshney
1   Department of Neurosurgery, Atal Bihari Vajpayee Institute of Medical Sciences, Ram Manohar Lohia Hospital, New Delhi, India
› Author Affiliations Funding None.
› Further Information
   Permissions and Reprints

Abstract

Introduction In modern emergency service systems, patients are often treated with sedation, intubation, and ventilation at the accident site. But neurosurgical assessment before all these emergency services is important. Thus, this study was designed to investigate the relationships between various parameters of initial CT scan findings and the outcomes of the patients.

Methodology A total of 56 adult patients of traumatic acute subdural hematoma (SDH) whose computed tomography (CT) scan was performed within 8 hours of injury were recruited. The patients with prolonged hypotension, open head injury or depressed skull fracture, bilateral side acute SDH, or contusions/hematoma/extradural hematoma on the contralateral side were excluded. Six separate CT findings were analyzed and recorded, including hematoma, midline shift, subarachnoid hemorrhage (SAH), presence of basal cistern obliteration (BCO), intraparenchymal hematoma/contusion in the same hemisphere, and presence of effacement of the sulcal spaces, and were followed up for three months for outcome analysis.

Results The overall mortality and functional recovery rate were 27 and 50%, respectively. The patients with obliterated basal cisterns and the presence of underlying SAH in patients with acute SDH had statistically significant poorer outcomes as compared with others. However, the extent of midline shift, SDH thickness, and the presence of underlying contusions and sulcal effacement on initial CT scan showed no statistically significant correlation with patients’ outcomes.

Conclusions BCO and presence of subarchnoid hemorrhage underlying acute SDH on the earliest scan in head injury patients signify the severity of brain parenchymal injury. Along with the initial Glasgow Coma Scale score after resuscitation, these two factors should be considered as the most significant ones for predicting the outcomes in traumatic acute SDH patients.

Keywords

traumatic brain injury - subarachnoid hemorrhage - SDH - CT findings - basal cistern obliteration


Publication History

Article published online:
09 September 2020

© 2020. Neurotrauma Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Alberico AM, Ward JD, Choi SC, Marmarou A, Young HF. Outcome after severe head injury. Relationship to mass lesions, diffuse injury, and ICP course in pediatric and adult patients. J Neurosurg 1987; 67 (05) 648-656
    CrossrefPubMedGoogle Scholar
  • 2 Maas AI. Traumatic brain injury in India: a big problem in need of data. Neurol India 2017; 65 (02) 257-258
    CrossrefPubMedGoogle Scholar
  • 3 Kaptanoglu E, Solaroglu I, Ucar MD. et al. Acute subdural hematomas: analysis of 73 cases. Ulus Travma Derg 2001; 7 (04) 246-249
    PubMedGoogle Scholar
  • 4 Klun B, Fettich M. Factors influencing the outcome in acute subdural haematoma. A review of 330 cases. Acta Neurochir (Wien) 1993; 121: 95-99
    CrossrefPubMedGoogle Scholar
  • 5 Kotwica Z, Brzeziński J. Acute subdural haematoma in adults: an analysis of outcome in comatose patients. Acta Neurochir (Wien) 1993; 121 (3-4) 95-99
    CrossrefPubMedGoogle Scholar
  • 6 Massaro F, Lanotte M, Faccani G, Triolo C. One hundred and twenty-seven cases of acute subdural haematoma operated on. Correlation between CT scan findings and outcome. Acta Neurochir (Wien) 1996; 138 (02) 185-191
    CrossrefPubMedGoogle Scholar
  • 7 Domenicucci M, Strzelecki JW, Delfini R. Acute posttraumatic subdural hematomas: “intradural” computed tomographic appearance as a favorable prognostic factor. Neurosurgery 1998; 42 (01) 51-55
    CrossrefPubMedGoogle Scholar
  • 8 Eisenberg HM, Gary HE Jr, Aldrich EF. et al. Initial CT findings in 753 patients with severe head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg 1990; 73 (05) 688-698
    CrossrefPubMedGoogle Scholar
  • 9 Zimmerman RA, Bilaniuk LT, Gennarelli T, Bruce D, Dolinskas C, Uzzell B. Cranial computed tomography in diagnosis and management of acute head trauma. AJR Am J Roentgenol 1978; 131 (01) 27-34
    CrossrefPubMedGoogle Scholar
  • 10 Zumkeller M, Behrmann R, Heissler HE, Dietz H. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurgery 1996; 39 (04) 708-712, discussion 712–713
    CrossrefPubMedGoogle Scholar
  • 11 Phuenpathom N, Choomuang M, Ratanalert S. Outcome and outcome prediction in acute subdural hematoma. Surg Neurol 1993; 40 (01) 22-25
    CrossrefPubMedGoogle Scholar
  • 12 Servadei F. Prognostic factors in severely head injured adult patients with acute subdural haematoma’s. Acta Neurochir (Wien) 1997; 139 (04) 279-285
    CrossrefPubMedGoogle Scholar
  • 13 Son S, Yoo CJ, Lee SG, Kim EY, Park CW, Kim WK. Natural course of initially non-operated cases of acute subdural hematoma: the risk factors of hematoma progression. J Korean Neurosurg Soc 2013; 54 (03) 211-219
    CrossrefPubMedGoogle Scholar
  • 14 Teasdale E, Cardoso E, Galbraith S, Teasdale G. CT scan in severe diffuse head injury: physiological and clinical correlations. J Neurol Neurosurg Psychiatry 1984; 47 (06) 600-603
    CrossrefPubMedGoogle Scholar
  • 15 Overgaard J, Tweed WA. cerebral blood flow and its regulation after closed head injury with emphasis on clinical correclations. J Neurosurg 1974; 41: 531-541
    CrossrefPubMedGoogle Scholar
  • 16 Graham DI, Adams JH, Doyle D. Ischaemic brain damage in fatal non-missile head injuries. J Neurol Sci 1978; 39 (2-3) 213-234
    CrossrefPubMedGoogle Scholar
  • 17 Muizelaar JP, Wei EP, Kontos HA, Becker DP. Mannitol causes compensatory cerebral vasoconstriction and vasodilation in response to blood viscosity changes. J Neurosurg 1983; 59 (05) 822-828
    CrossrefPubMedGoogle Scholar
  • 18 Servadei F, Murray GD, Teasdale GM. et al. Traumatic subarachnoid hemorrhage: demographic and clinical study of 750 patients from the European brain injury consortium survey of head injuries. Neurosurgery 2002; 50 (02) 261-267, discussion 267–269
    PubMedGoogle Scholar
  • 19 Lee TT, Aldana PR, Kirton OC, Green BA. Follow-up computerized tomography (CT) scans in moderate and severe head injuries: correlation with Glasgow Coma Scores (GCS), and complication rate. Acta Neurochir (Wien) 1997; 139 (11) 1042-1047, discussion 1047–1048
    CrossrefPubMedGoogle Scholar
  • 20 Servadei F, Nanni A, Nasi MT. et al. Evolving brain lesions in the first 12 hours after head injury: analysis of 37 comatose patients. Neurosurgery 1995; 37 (05) 899-906, discussion 906–907
    CrossrefPubMedGoogle Scholar
  • 21 Figg RE, Burry TS, Vander Kolk WE. Clinical efficacy of serial computed tomographic scanning in severe closed head injury patients. J Trauma 2003; 55 (06) 1061-1064
    CrossrefPubMedGoogle Scholar
  • 22 Wang MC, Linnau KF, Tirschwell DL, Hollingworth W. Utility of repeat head computed tomography after blunt head trauma: a systematic review. J Trauma 2006; 61 (01) 226-233
    CrossrefPubMedGoogle Scholar
  • 23 Oertel M, Kelly DF, McArthur D. et al. Progressive hemorrhage after head trauma: predictors and consequences of the evolving injury. J Neurosurg 2002; 96 (01) 109-116
    Google Scholar
  • 24 Cooper PR, Maravilla K, Moody S, Clark WK. Serial computerized tomographic scanning and the prognosis of severe head injury. Neurosurgery 1979; 5 (05) 566-569
    CrossrefPubMedGoogle Scholar
  • 25 Givner A, Gurney J, O’Connor D, Kassarjian A, Lamorte WW, Moulton S. Reimaging in pediatric neurotrauma: factors associated with progression of intracranial injury. J Pediatr Surg 2002; 37 (03) 381-385
    CrossrefPubMedGoogle Scholar
  • 26 Kaups KL, Davis JW, Parks SN. Routinely repeated computed tomography after blunt head trauma: does it benefit patients?. J Trauma 2004; 56 (03) 475-480, discussion 480–481
    CrossrefPubMedGoogle Scholar
  • 27 Sakai H, Takagi H, Ohtaka H, Tanabe T, Ohwada T, Yada K. Serial changes in acute extradural hematoma size and associated changes in level of consciousness and intracranial pressure. J Neurosurg 1988; 68 (04) 566-570
    CrossrefPubMedGoogle Scholar
  • 28 Soloniuk D, Pitts LH, Lovely M, Bartkowski H. Traumatic intracerebral hematomas: timing of appearance and indications for operative removal. J Trauma 1986; 26 (09) 787-794
    CrossrefPubMedGoogle Scholar
  • 29 Yadav YR, Basoor A, Jain G, Nelson A. Expanding traumatic intracerebral contusion/hematoma. Neurol India 2006; 54 (04) 377-381
    CrossrefPubMedGoogle Scholar
  • 30 Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group. J Neurosurg 1996; 85 (01) 82-89
    CrossrefPubMedGoogle Scholar
  • 31 Solaroglu I, Kaptanoglu E, Okutan O. et al. Prognostic value of initial computed tomography findings in patients with traumatic acute subdural hematoma. Turk Neurosurg 2002; 12: 89-94
    PubMedGoogle Scholar
  • 32 Langfitt TW, Tannanbaum HM, Kassell NF. The etiology of acute brain swelling following experimental head injury. J Neurosurg 1966; 24 (01) 47-56
    CrossrefPubMedGoogle Scholar