Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma

Abstract

ABSTRACT:Object:Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH.Methods:This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected.Results:Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient.Conclusion:IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.

Evaluation of Traumatic Subdural Hematoma Volume by Using Image Segmentation Assessment Based on Deep Learning

“…It is still one of the main causes of traumatic brain injury death [ 21 ]. With the increase of traffic accidents and falling accidents, the incidence of this disease is increasing year by year [ 1 ]. The brain function of patients with TSDH is seriously damaged, and there are many kinds of dysfunction, which is a serious threat to patients' health and life safety [ 22 ].…”

“…Traumatic subdural hematoma (TSDH) is a common disease in neurosurgery [ 1 ]. The pathogenesis of this disease is mainly that the patient's head is violently hit, which causes the dura mater of his brain tissue to shift.…”

A case of traumatic acute interhemispheric subdural hematoma due to injured dural branch of anterior cerebral artery

“…Elderly people with enlarged subdural space due to cerebral atrophy, excessive alcohol consumption, anticoagulant medication, and coagulopathy were reported to be risk factors for AISDH. [1,4] Léveillé et al [5] reported that AISDH was found in 420 (35.5%) of 1182 cases of traumatic acute subdural hematoma. However, most of the cases consisted of only a small subdural hematoma in the interhemispheric fissure, which arose secondarily from other traumatic injuries such as acute subdural hematoma in the convexity, subarachnoid hemorrhage, and cerebral contusion, and needed no surgery.…”

“…However, most of the cases consisted of only a small subdural hematoma in the interhemispheric fissure, which arose secondarily from other traumatic injuries such as acute subdural hematoma in the convexity, subarachnoid hemorrhage, and cerebral contusion, and needed no surgery. [5] Wang et al [9] also reported that surgery was infrequently required for AISDH and that surgical cases of AISDH were identified in only 21 (0.3%) out of 6840 cases of traumatic brain injury. In the present operative case of AISDH, subdural hematoma was found not only in the interhemispheric fissure but also in the convexity.…”

“…Traumatic acute interhemispheric subdural hematoma (AISDH) rarely causes neurological deficits, requiring surgery. [ 1 , 3 , 4 , 5 , 7 , 8 , 9 ] A rupture of the bridging vein, anterior cerebral artery (ACA), its branches, and cerebral contusion have been reported as a possible cause of AISDH. [ 9 ] However, the precise causes of the hematoma formation are often unknown: the sources of bleeding cannot be directly confirmed during surgery in most cases.…”