Cerebral perfusion changes in acute subdural hematoma

Abstract

Introduction Acute subdural hematoma (aSDH) is one of the main causes of high mortality and morbidity in traumatic brain injury. Prognosis is poor due to the rapid volume shift and mass effect. Cerebral perfusion is likely affected in this condition. This study quantifies perfusion changes in aSDH using early ER polytrauma CT with perfusion imaging (CTP). Methods Data of 54 patients with traumatic aSDH were retrospectively collected. Glasgow Coma scale (GCS), perfusion parameters, therapeutic decisions and imaging data including hematoma thickness, midline shift, and hematoma localization were analyzed. The cortical perfusion parameters of each hemisphere, the area anterior to the hematoma (AAH), area below the hematoma (ABH), area posterior to the hematoma (PAH), and corresponding mirrored contralateral regions were determined. Results We found a significant difference in Tmax in affected and unaffected whole-hemisphere data (mean 4.0 s vs. 3.3 s, p < 0.05) and a significantly different mean for Tmax in ABH and for the corresponding mirrored area (mABH) (mean 3.8 s vs. 3.1 s, p < 0.05). No significant perfusion changes in cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) were found. Conclusion There was a significant elevation of time to maximum (Tmax) values in the underlying cortical area of aSDH. Possible pathophysiological explanations, the influence on immediate surgical decision-making and further therapeutic consequences have to be evaluated.

Acute Computer Tomography Findings in Pediatric Accidental Head Trauma-Review

“… 28 Since the volume can increase a lot in a short period of time, SDH can have mass effect on the underlying brain parenchyma and thus entails high risk for herniation. 13 , 29 The only thing that differentiates the age of SDH is the density - subacute ones are isodense to the brain, and the chronic ones are hypodense. The SDH is an entity associated with a high mortality and morbidity, 29 and in children under five years is the most common sign of non-accidental trauma.…”

“…13,29 The only thing that differentiates the age of SDH is the density -subacute ones are isodense to the brain, and the chronic ones are hypodense. The SDH is an entity associated with a high mortality and morbidity, 29 and in children under five years is the most common sign of non-accidental trauma. [30][31][32] The typical triad found in abusive head trauma is represented by subdural haematomas, retinal haemorrhages, and encephalopathy.…”