Analysis of surgically treated our own 5 cases of subacute subdural hematoma

Sakakibara Yohtaro, Taguchi Yoshio, Nakamura Homare, Onodera Hidetaka, Uchida Masashi, Kawaguchi Kimiyuki

doi:10.32187/neurotraumatology.39.2_118

Objective: We retrospectively analyzed our own cases of subacute subdural hematoma (SSH) to investigate the clinical characteristics of SSH.Materials & Methods: From January 2011 to October 2015 we experienced 5 cases with SSH at our institution. Frequency, age, gender, clinical course, radiological findings, operative findings and outcomes were reviewed.Results: During the same period we treated 85 patients with acute subdural hematoma, thus frequency of SSH accounted for 5.9％. The patient’s ages ranged from 45 to 89 years with a mean age of 72 years. There were 2 men and 3 women. The cause of injury was fall on the same level in 4 patients, fall in 1. Glasgow coma scale score on admission was 15 in 4 patients, 14 in 1. Initial computerized tomography (CT) scans revealed mixed density subdural hematoma in 2 patients, homogenously high density in 3. The mean maximal thickness of hematoma was 10 mm. Time intervals to worsening were 5 to 13 posttraumatic days with a mean time interval of 9.6 days. Symptomatologically all patients developed contralateral hemiparesis. CT scans on worsening revealed mixed density in 2 patients, iso in 2, low in 1. The mean maximal thickness of hematoma was 13 mm and revealed mass sign and mild midline shift. Magnetic resonance imaging was obtained only in case 3 and demonstrated high signal intensity on T1 weighted images, low signal intensity on T2 weighted images, high signal intensity with the low intensity rim close to the brain surface on diffusion weighted images. All patients underwent craniotomy to evacuate hematoma. Postoperatively 4 patients recovered fully and 1 patient died of pulmonary failure.Conclusions: Even though subdural hematoma is treated conservatively at acute stage, it should be kept in mind that it may develop at subacute stage and cause neurological deterioration.

Analysis of surgically treated our own 5 cases of subacute subdural hematoma

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