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KMID : 0365819760160010021
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Journal of Pusan Medical College
1976 Volume.16 No. 1 p.21 ~ p.29
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Acute Intracranial Subdural Hemorrhage
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Abstract
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The general development in the civilization, and the steady inerease in all varieties of trauma, make the problems of head injury including subdural hematoma (hemorrhage) progressively more important.
The acute subdural hematoma repesents one of the most lethal neurosurgical problem. And the prognosis is related to the degree of traumatic brain injury and to the timing of operation, and operation to save life must usually be done before the appearance of coma.
It is common practice to classify subdural collection of blood into acute,, subacute and chronic on an arbitrary basis according to the interval between injury and the emergency of symptoms attributable to the hematoma. Traumatic subdural hematoma is a definite clinical entity that has been given considerable attention in the medical literature since Virchow´s classic description of "hematomas of the dura mater" in 1857.
The incidence of subdural hematoma following injury to the head is variously estimated at I to 10 percent depending upon the severity of the injury. In the 1940´s, the mortality from this injury was reported as ranging from 82 percent to 90 percent. In past 14- years, despite the introduction of carotid angiography, cortioosteroids, and dehydrating agents, the mortality figures reported for large series of cases have remained at 45 percent to 87 percent.
Hence it seemed valuable to review the clinical presentation, the surgical management, and in particular the prognostic features, of these lesions. Accordingly I have reviewed 50 cases of proven aute subdural hematoma admitted under author´s care to Busan National University Hospital for recent years.
The results were the follows:
1) Age incidence of acute subdural hematoma was high in the 2nd decade to 5th decade which is in vigorous social activity, and the male was predominantly high in incidence of 11 to 1.
2) The most common mode of acute subdural hematoma was the traffic accident in 46 percent of 50 cases. But the mortality of the trauma except the traffic accident and falling down from high place was higher.
3) The level of consciousness was various -from clear consciousness to coma. Only 2 percent of these cases had clear consciousness. The fatal cases had more severely deteriorated consciousness.
4) The pupil was dilated unilaterally or bilaterally in many cases.
5) Mainly CSF was blood stained.
6) 40 percent of these cases had subdural hematoma alone in ipsilateral site of bead injury, 22 percent in contralateral site, and 16 percent in bilateral sites, and 22 percent had subdural and epidural hematomas. and,22 percent had the injury_ in other parts of head.
7) The hematamas were?predominantly appeared in parietotemporal and frorntotetpporal areas.
8) The amount of hematoma was 50cc to 100ec in many races and it did not correlate with the mor tality.
9) Interval from injury to operation did not correlate with the mortality.
10) Types of operation were trephination, unilateral craniectomy or craniotomy and contralateral trephination, bilateral decompressive craniectomy, and bifrontal deoompressive craniectomy. The bilateral decompressive craniectomy and bifrontal deoompressive craniectomy for the management of posttaumatic cerebral edema seemed to show a signiticant decrease in the expected mortality. No correlation could directly be found, between the qualityy of survival and the neurological or operative findings.
11) The relationship between the patient´s age and his chance of survival was not so significant.
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