Sixty patients with acute subdural hematoma were treated at Tokyo Metropolitan Hiroo Hospital between 1981 and 1989. The overall mortality was 55% and the functional recovery rate 30%. Thirteen (93%) of 14 patients with a Glasgow Coma Scale (GCS) score of 3 died, while all eight patients with a GCS score of 7 or more achieved functional recovery. The mortality of patients with GCS scores of 4-6 ranged from 45 to 67%. Patients with GCS scores of 4-6 over 65 years old had a mortality of 82%, compared to 50% mortality for those aged 19-40 years. The mortality for patients with GCS scores of 4-6 operated on within 4 hours of injury was 62% in contrast to 33% for those operated on from 4 to 10 hours. Patients with GCS scores of 4-6 who underwent craniotomy with evacuation of the hematoma achieved significantly better recovery than those treated by burr holes. Four patients with GCS scores of 4-6 died in spite of decompressive craniectomy or craniotomy with duroplasty. The mortality is only influenced by age and type of surgical intervention among patients with GCS scores of 4-6. Shorter time from injury to surgical evacuation does not affect mortality within 10 hours of injury.
S U M M A R YIn 18 autopsies from patients with primary pontine hemorrhage we studied the sites of bleeding, the volumes and development of hematomas and clinicopathological correlations. A modular optical electronic planimeter was introduced to measure the size of hematomas. The series of patients can be divided into 2 groups from the viewpoint of bleeding sites, their development and clinical symptomatology. These are 1) the tegmentobasiiar type and 2) the tegmentai type. The precise location of the orgin of hemorrhage, and the approximate volume of hematomas can now be determined with the help of computerized tomography. This information will be of help in understanding clinical symptoms. Two different typical patient reports, selected from the collection, are presented.
A case of ruptured intracranial mycotic aneurysm associated with acute subdural hematoma is presented. A 26-year-old woman with cardiac valve disease who had been intermittently febrile for 2 weeks suddenly became comatose. There had been no head injury. At the time of admission, a cardiac murmur was audible and petechiae were noted on the conjunctivae and fingers, suggesting a diagnosis of bacterial endocarditis. The blood culture yielded Streptococcus faecalis. The computed tomo graphic scan revealed an intracerebral hematoma and acute subdural hematoma. Angiography dis closed an aneurysm at the distal middle cerebral artery. Such a combination of intracranial mycotic aneurysm and acute subdural hematoma is very rare.
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.