The authors summarize experience with 100 cases in which surgery demonstrated subdural hematoma as the cause of the patient's symptoms. Spinal puncture, performed in 80 of these cases, yielded cerebrospinal fluid that was xanthochromic in 33, under increased pressure in 45, and abnormally high in protein content in 13. Spinal puncture was therefore not of great value in diagnosing this condition. Carotid and brachial angiography, on the other hand, has helped immeasurably in the diagnosis. Angiograms were taken in 63 patients, and clots located by angiography were invariably found later at surgery. Five cases in which the findings were unusual or paradoxical are described. The authors believe that the use of cerebral angiography has done away with diagnostic and frequently negative bur-hole trephinations.THIS REPORT concerns experiences in the diagnosis and management of 100 cases of sub¬ dural hematoma treated during the past 2 years on the neurosurgical ward of the Cook County Hospital and in several private hospitals in Chi¬ cago. All cases were verified surgically, and the patients were operated upon by the authors or members of the neurosurgical resident staff at the Cook County Hospital. Cases of subdural hema¬ toma in infancy present a different clinical prob¬ lem and are not discussed in this paper. The cases of subdural hematoma are classified as "acute" if operation is performed within 3 days of injury, as "subacute" if operation is performed within 3 weeks of injury, and as "chronic" if operation is per¬ formed more than 3 weeks after injury.The formation of a subdural hematoma is gen¬ erally accepted as resulting from hemorrhage into the subdural space after a tear in a bridging vein draining into a durai sinus. Subsequent organiza¬ tion of the clot occurs and the sequestered large protein molecules cause water to pass osmotically across the hematoma membranes from the subarachnoid space and brain. Gardnerl originally verified this mechanism by implanting cellophane chambers containing blood in dog peritoneal and subdural spaces and demonstrated a gain in weight of these chambers due to increased water content.Dandy2 disputed this concept and felt that the hematoma increases in size because of secondary bleeding from the organizing outer membrane ad¬ jacent to the dura. Lichtenstein3 feels that a sub¬ dural hematoma may develop from hemorrhage into the dura itself, separating its layers to form a split hematoma membrane. In an attempt to dem¬ onstrate the mechanism of subdural clot growth within the primate skull, one of the authors4 im¬ planted sealed dialyzing bags of viscose casing containing blood under the dura of monkeys. In¬ crease in size of some of the bags occurred but others did not change, suggesting that there may be other unappreciated factors operating in sub¬ dural hematoma growth.The profound disparity between the survival rates in acute and chronic cases of subdural hematoma have led us to conclude that the acute subdural hematoma and the chronic subdural hematoma are not merely diff...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.