Hemispheric differences in the surgical outcomes of patients with traumatic acute subdural hematoma

Abstract

BackgroundOur assumption that prognosis of patients with traumatic acute subdural hematoma (ASDH) does not differ significantly according to the hemispheric laterality has never been verified.MethodsA review of the charts/radiographic images of 61 adult traumatic ASDH patients (33 left/28 right) was conducted. Intergroup comparison was made on the demographics, autonomic/laboratory data, and outcomes (90-day mortality rate). Based on the presence of concomitant brain contusion, patients were further quadrichotomized as: left ASDH with contusion (n = 14), right ASDH with contusion (n = 16), left ASDH without contusion (n = 19), and right ASDH without contusion (n = 12). Comparisons were made on demographic and outcome variables between the left ASDH with contusion and right ASDH with contusion, and between the left ASDH without contusion and right ASDH without contusion. Multivariate regression analysis was conducted to identify clinical variables correlated with fatality.ResultsThere were no significant differences in the demographic, autonomic, and laboratory data between the left and right ASDH patients. However, 90-day mortality rate was significantly higher in the left ASDH patients when concomitant contusion was present (79% vs. 25%, p = 0.009). However, there were no significant hemispheric differences in the mortality rate among those without contusion (32% vs. 33%, p = 0.77). Multivariate regression analysis showed that left ASDH was correlated with fatality among those with contusion (OR: 6.620; 95% CI: 1.219-46.249).ConclusionsThis study is probably the first to report that the left ASDH patients fared substantially worse than the right-sided counterparts. Future trials on traumatic ASDHs may benefit from considering hemispheric differences in the outcomes.

A multicentre retrospective cohort study on health-related quality of life after traumatic acute subdural haematoma: does cranial laterality affect long-term recovery?

“…The only previous study on hemispheric outcome difference in ASDH found a higher frequency of intractable brain swelling and mortality rate in patients with a left-sided ASDH. This difference was only significant if patients presented with a concomitant contusion [11], similar to our findings. Other studies found significant asymmetry of the autoregulatory index between the injured and intact hemisphere in TBI patients.…”

“…Laterality of the haematoma does not play a major role in the decision for surgery, as is reflected in the absence of consideration in TBI guidelines [10]. Furthermore, only a limited amount of research regarding this laterality is available [11][12][13][14]. This contrasts with stroke laterality where numerous studies have shown an association of worse outcome in dominant hemispheric infarction [15][16][17].…”

Cerebrospinal fluid leakage at the lumbar spine: A unique cause of delayed neurologic deterioration in a traumatic acute subdural hematoma patient

“…Conservative management is appropriate for patients with traumatic acute SDH without neurological deficits and radiographical evidence of brain compression because acute SDH is absorbed or sequestered, and disappears eventually in most cases. [ 1 2 3 4 ] However, delayed neurological deterioration due to hematoma increase during transition from acute to subacute stage has been reported in the literature,[ 5 6 7 8 ] with varying degree of frequency: while Bajsarowicz reported that only 6.5% of acute SDH patients who received initial conservative management sustained delayed hematoma increase requiring hematoma evacuation,[ 6 ] the frequency was as high as 35% in a cohort reported by Kim et al . [ 7 ] The mechanism of hematoma increase during transition from acute to subacute stage has been attributed to invasion of CSF into hematoma driven by osmotic gradient generated by the fibrinolytic products in the hematoma.…”

“…Prognosis of traumatic acute subdural hematoma (SDH) patients is determined mostly by hematoma volume, concomitant brain parenchymal damage, and patient age. [ 1 2 3 4 ] For patients who are neurologically intact and have only a small hematoma volume on imaging studies, conservative management is justified: acute SDH is absorbed gradually in such circumstances. [ 4 ] However, caution is required in cases which exhibit conversion of SDH from acute to subacute stage because delayed hematoma increase and neurological deterioration may occur.…”

“…[ 1 2 3 4 ] For patients who are neurologically intact and have only a small hematoma volume on imaging studies, conservative management is justified: acute SDH is absorbed gradually in such circumstances. [ 4 ] However, caution is required in cases which exhibit conversion of SDH from acute to subacute stage because delayed hematoma increase and neurological deterioration may occur. [ 5 6 7 8 ] Such deterioration can be managed with timely surgical intervention, that is, hematoma evacuation, and patient outcomes are mostly favorable.…”