Traumatic Subacute Subdural Hematomas : Possible Mechanisms that Cause their Development

Karasawa, Hideharu; Naito, Hiromichi; Sugiyama, Ken; Ueno, Junji; Kin, Hiroshi; Oketa, Riki

doi:10.7887/jcns.4.121

Cited by 8 publications

(10 citation statements)

References 11 publications

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“…9) Subdural hematoma in the subacute stage includes so-called traumatic subacute subdural hematoma 5,10,11) and chronic subdural hematoma-like hematoma. 12) However, the diagnostic criteria, pathophysiology, and therapeutic procedures of these traumatic subdural hematomas are still not established.…”

Section: Discussionmentioning

confidence: 99%

“…5,10) The operative exploration of Cases 1-3 revealed that the subdural hematomas consisted of hemorrhagic outer membrane, dark-brown solid or jelly clot, and yellowish fluid. The yellowish fluid was located under the solid clot as if the fluid was enclosed between the solid clot and the arachnoid membrane.…”

Section: Discussionmentioning

confidence: 99%

“…The operative findings supported the origin of subdural effusion from the torn arachnoid membrane as the solid subdural hematoma resolved. 5,10) The ADC values of the low intensity areas on the diffusionweighted imaging reflected the mixture of CSF and extracellular methemoglobin derived from the solid clot.…”

Section: Discussionmentioning

confidence: 99%

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Diffusion-Weighted Imaging of Traumatic Subdural Hematoma in the Subacute Stage-Five Case Reports-

Kuwahara¹,

Fukuoka²,

Koan³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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Five cases of traumatic subdural hematomas in the subacute stage (from 7 to 20 days after head injury) were treated in one male and four females, aged from 63 to 82 years, with evacuation via craniotomy in three and aspiration via burr hole surgery in two. All hematomas were evaluated by T 1 -, T 2 -, and diffusion-weighted magnetic resonance imaging, and measurement of the apparent diffusion coefficient (ADC). Diffusion-weighted imaging showed the hematoma as a crescent high intensity area with a low intensity rim close to the brain surface (two-layered structure) in four cases and as high intensity with low intensity components in one case. The high intensity areas under the dura mater on diffusion-weighted imaging appeared as homogeneous high intensity on T 1 -and T 2 -weighted imaging in four cases, and inhomogeneous high intensity on T 1 -and isointensity on T 2 -weighted imaging in one case. The mean ADC value of the high intensity areas was 0.58 ± 0.23 (mean ± standard deviation) × 10 -3 mm 2 /sec. The operative findings revealed the high intensity areas as solid clots. The low intensity areas on diffusion-weighted imaging appeared as homogeneous high intensity in four cases and inhomogeneous isointensity with high intensity components in one case on T 1 -and T 2 -weighted imaging. The mean ADC value of the low intensity areas was 2.03 ± 0.27 × 10 -3 mm 2 /sec. The operative findings revealed the low intensity areas as mixtures of resolved clot and cerebrospinal fluid. Diffusion-weighted imaging showed the characteristic two-layered structure in traumatic subdural hematomas in the subacute stage, and analysis of the ADC values was useful for differentiating solid from liquid hematoma and for selection of the surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diffusion-Weighted Imaging of Traumatic Subdural Hematoma in the Subacute Stage-Five Case Reports-

Kuwahara¹,

Fukuoka²,

Koan³

et al. 2005

Neurol. Med. Chir.(Tokyo)

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“…7) Recently, subdural hematomas that show reduction in the acute stage but enlarge comparatively rapidly in the subacute stage in conservatively treated patients with ASDH have been referred to as SASDH. 3,9) In addition, along with the aging of the Japanese population, the number of aged patients with ASDH caused by mild head trauma has also been increasing, 2) as has the number of those patients being treated conservatively 1) in view of their mild clinical conditions and bleeding tendency induced by antiplatelet and/or anticoagulant use. 5,12) Therefore, the majority of reported clinical studies of SASDH have been conducted in Japan.…”

Section: Discussionmentioning

confidence: 99%

“…14) However, in the subacute stage, clinical deterioration occasionally occurs associated with comparatively rapid enlargement of the hematoma, necessitating surgery, and this has recently been referred to as subacute subdural hematoma (SASDH). 1,3,6,9,10,[13][14][15] Our aim in the present study was to clarify the clinical characteristics and pathophysiology of patients with ASDH who ultimately required surgery in the subacute or chronic stage, and devise an appropriate form of management for them.…”

Section: Introductionmentioning

confidence: 99%

Acute Subdural Hematoma Requiring Surgery in the Subacute or Chronic Stage

Izumihara

Yamashita

Murakami

2013

Neurol. Med. Chir.(Tokyo)

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The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate form of management for them. A total of 50 patients with ASDH were admitted to our institution during a 5-year period. Hematoma removal in the subacute or chronic stage was performed in 8 patients. The ASDH had been caused by a fall in 5 patients. Five patients had been treated with antiplatelet agents. Fluid-attenuated inversion recovery magnetic resonance (MR) imaging demonstrated an irregularly shaped hematoma with gyrus patterns in 4 of 5 patients. Diffusion-weighted MR imaging demonstrated a two-layered hematoma structure in 3 of 4 patients. The hematoma was removed via a craniotomy, a small craniotomy, and a burr hole in 1, 1, and 6 patients, respectively. At surgery in the craniotomy case, a solid clot was located beneath the dura, and a liquid hematoma was located close to the brain. After hematoma removal, no inner membrane was observed on the brain surface. One patient had typical chronic subdural hematoma in the subacute stage, and 2 patients had so-called subacute subdural hematoma (SASDH) in the chronic stage. Although the majority of such cases can be treated by burr-hole surgery, a small craniotomy or craniotomy ought to be considered as a further surgical option if SASDH is diagnosed on the basis of clinical and radiological data, especially diffusion-weighted MR imaging.

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Subacute Subdural Hematoma

Takeuchi

Takasato

Otani

et al. 2013

Acta Neurochirurgica Supplement

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Subacute subdural hematoma (SASDH) is a rare entity. We retrospectively reviewed 8 patients with SASDH. Four patients were male and 4 were female, with an age range of 45-87 years (mean, 67.8 years). The minimal level of deterioration ranged from 8 to 14 (mean, 10.5). The deterioration of neurological symptoms was confirmed 4-20 days after injury (mean, 12.9). The hematoma volume was increased in 6 patients. Seven patients underwent surgeries (burr-hole irrigation in 6, craniotomy in 1). The Glasgow Outcome Scale indicated a good recovery in 4 patients and moderate disability in 4 patients. Increased cerebral blood flow was observed just below the SDH in 1 patient. We consider that the hypoperfused tissue in the acute phase might become hyperperfused during the subacute phase owing to impaired autoregulation, and the hyperperfusion may be responsible for the development of the SASDH, leading to deterioration. Further investigations in a larger series are needed to elucidate the mechanism underlying the development of SASDH.

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Traumatic Subacute Subdural Hematomas : Possible Mechanisms that Cause their Development

Cited by 8 publications

References 11 publications

Diffusion-Weighted Imaging of Traumatic Subdural Hematoma in the Subacute Stage-Five Case Reports-

Diffusion-Weighted Imaging of Traumatic Subdural Hematoma in the Subacute Stage-Five Case Reports-

Acute Subdural Hematoma Requiring Surgery in the Subacute or Chronic Stage

Subacute Subdural Hematoma

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