Dating subdural hemorrhage

Dating subdural hemorrhage

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Dating subdural hemorrhage

Received date: May 30, ; Accepted date: June 14, ; Published date: June 16, The treatment modalities of chronic subdural hematoma remain a matter of debate due to lack of management consensus. We performed a retrospective study to compare the clinical and radiological outcomes between surgical drainage and conservative management of hematoma with low density on computed tomography scan. Methods and findings: We retrospectively reviewed medical records for 53 consecutive patients aged 70 years or older with hypodense hematoma treated in our department between and Patients were divided into a surgery group and a conservative group.

Clinical outcome was evaluated according to the modified Rankin Scale on admission and follow up after treatment. Thirtyone patients underwent burr-hole surgery and twenty-two patients received conservative treatment at the first admission. Overall, the neurological and mental status of patients in both group were significant improvement from admission to follow-up. Surgical drainage of chronic subdural hematoma with low density in elderly patients may be attributed to improve neurological status with lower incidence of recurrence, even in patients who has presented preexisting comorbidities and brain atrophy.

Brain atrophy; Chronic subdural hematoma; Low density; Neurological comorbidities ; Surgical drainage. Chronic Subdural Hematoma; CT: Computed Tomography ; Ml: Milliliter; MMSE: Magnetic Resonance Imaging ; SG: Surgical Group. Chronic subdural hematoma CSDH is a predominantly neurological condition usually affecting elderly individuals, and resulting from trauma, coagulopathy, anticoagulant therapy and vascular malformation [ 1 - 3 ] Although CSDH is a serious and frequent entity, there is no consensus regarding the optimal treatment strategy.

Response to surgery has been so satisfactory that this is generally considered the treatment of choice. However, large studies have shown that older age independently contributes to increase the rate of lethality, complications and recurrences after the surgical drainage of chronic SDH [ 3 - 5 ]. The role of hematoma density in CSDH recurrence has been studied previously, but the results have not been consistent [ 6 , 7 ].

Compared with high- or mixed-density of CSDH, hypodense hematoma is not an acute condition and it is rational to recommend for close observation. Due to significant risk and poor outcome associated with surgery, currently some authors had an attempt to treat this subtype of CSDH with conservative method, and achieved good outcome with lower rates of lethality and recurrence [ 8 , 9 ].

These evolving results present challenges for the surgeon in deciding whether to surgically drain a hypodense CSDH or to manage them conservatively in elderly patients. In this paper, we performed a retrospective study to compare the neurologic outcomes between surgical drainage and conservative management of CSDH with hypodense on initial CT scan in patients aged 70 years or older.

We identified patients by retrospective analysis of the medical records and neuroradiographic studies for all patients in our hospital from September to July , in whom CSDH was diagnosed by initial computed tomography CT scans. In addition, magnetic resonance imaging MRI was essentially performed when subdural hygroma were originally suspected. Radiological examinations and imaging-related parameters of the CSDH were also were recorded and used to check whether the 2 patient groups were similar in these variables.

The neurological co-morbidities of patients were established in the presence of at least one of the following criteria: Neurological status of patients was evaluated at the time of diagnosis, and in the second weeks, and 1-month, 6-month, and month after treatment. Favorable and unfavorable outcomes were defined as mRS scores of and , respectively [ 12 ].

Any neurological improvement in the surgical and conservative groups was recorded. This improvement was defined as a decrease by at least 1 score in the neurological status of patients based on the mRS scores. Patient cognitive ability was also assessed compared to their mental status pre- and post-operation as determined by MMSE score. According to the initial CT scans, brain atrophy was divided into three stages: Presence of midline shift, brain atrophy and hematoma location right, left, bilateral was determined on CT scans obtained immediately before therapy intervention.

The cut-off values for the degree of midline shift were defined based on previous reports [ 14 ]. The volume in milliliters of the hematoma was calculated on the basis of pre- and post-procedural CT films at the different followup time points. To compare the volumes of hematoma before and after treatment, independent t-tests were used. P values of less than 0. The demographic and clinical data of all patients are summarized in Table 1.

The mean age of patients was Twenty-two patients Generally, the groups did not differ significantly with respect to demographic features. Number; CSDH: Chronic Subdural Hematoma; SD: Table 1: As expected, despite a similar average initial volume, patients undergoing surgical drainage had significantly greater average volume reduction and lower final volumes than those in the conservative group.

The differences between the two groups were firstly observed at the day follow up, with residual volume of Since then, the residual of hematoma reduced sharply in both groups, whereas the difference in volume between the two groups remained significantly, but began to narrow, and disappeared until the latest follow up Figure 1. Figure 1: Line graphs depicting comparisons of volume change of CSDH between surgical and conservative group.

Overall, the neurological and mental status of patients in both group were significant improvement from admission to followup Table 2. Standard Deviation; mRS: Table 2: Of note, patients aged 80 or older presented with worse neurological status from admission to follow up compared to younger patients, irrespective of whether these hemorrhages are drained or not.

For patients aged 80 or older, there was significant improvement in neurological status from admission to 1-month follow-up in the SG admission mRS: On the contrary, there was a significant improvement in neurological outcome for patients younger than 80 years in both groups after treatment Figure 3. Figure 2: Neurological outcome of patients aged 80 or older between surgical and conservative group.

Figure 3: Neurological outcome of patients aged less than 80 years between surgical and conservative group. Figure 4: Affect of burr hole vs. However, no significant difference in mental status was observed in patients presenting with an admission mRS score of at different time points between the SG and the CG. Figure 5: According to Neal's method of determining the brain atrophy in post-procedural CT scans, all of our patients had atrophy in different degree. Figure 6: In this subgroup, patients undergoing surgical drainage tended to have a better mental status on admission than patients that received conservative care SG MMSE score: Furthermore, surgical patients showed greater improvement in mental outcome on 1-month follow-up compared to conservative patients SG MMSE score: At 1-year follow-up exam, however, there was also no significant difference in the mental status in patients between the two groups SG MMSE score: Figure 7: In contrast there was no significant difference in either mRS or MMSE scores in patients that initially presented with a mild or moderate atrophy at different time points between the SG and the CG data not shown.

To assess the result of the different treatment in patient with neurological co-morbidities, we compared the neurological status before and after treatment in patients with preexisting co-morbidities between the SG and the CG. After treatment, there was more patients showing good neurological recovery to their baseline status on the latest follow-up exam in the SG than those in the CG However, there was statistically significant difference in neurological status on 1-year follow-up exam between the two groups SG mRS score: Figure 8: Unsurprisingly, there was certainly no statistically significant difference in MMSE scores in patients with neurological co-morbidities at different time points between the SG and the CG Figure 9.

Figure 9: For patients who had no definitely neurological co-morbidities, there was significant improvement in neurological status from admission to 1-month follow-up in the SG admission mRS: In total, 3 patients died during follow-up, 2 from the conservative group and one from the surgical group, due to general complications resulting from multiple medical co-morbidities within 1-year after treatment.

Significant postoperative complications directly related to surgery was found in three cases 9. However, patients in the CG seemed particularly prone to systemic complications e. Only one patient in the SG experienced recurrence 3 months after first surgery, who received repeated drainage and subsequently achieved satisfactory resolution of his SDH.

Four patients Three of these 4 patients then underwent burr-hole surgery and experienced clinical improvement Figure The remaining one patient aged 85 years abandoned surgical intervention due to their poor physical status, and died four months later. Figure Evolution of CSDH in a year-old male on aspirin, who had a history of the left para-ventricular haemorrhage 4 months ago, presented with headache and gait disturbance after a fall.

The patient re-admitted due to unable to walk independently, with a mRS score of 4 at 6 months. The postoperative CT scan at 1 month showing nearly complete resolution of CSDH with minimal residual haematoma i , and a favourable outcome was observed with the final mRS score of 3 at 6-month follow up exam after surgery. CSDH is a condition mostly present in elder people, and the majority of patients had a history of head trauma, as noted in our series and in the literature [ 1 , 2 ].

According to CT scan, hematoma density is known to decrease with time, passing from a high-stage to an iso-and finally a low density stage [ 15 , 16 ]. Therefore, lower hematoma densities are expected to be seen in the late stage of hematoma course. In concern to the clinical outcome, it is not clear which type of hematoma is suited for surgical drainage for each patient.

Some advocated that the operating in the homogeneous stage of CSDH, may reduce the recurrence rate [ 6 , 17 ]. Others persisted that low density hematoma often lead to poor outcome after surgery, compared to other type of CSDH [ 7 , 18 ].

Subdural Haemorrhage (SDH) is a form of brain haemorrhage in which Thus the radiological dating of SDH is of immense help, both from the. Subdural hematoma (SDH) and epidural hematoma are characterized by bleeding into the spaces surrounding the souvenirs-tut.comal hematomas.

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Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes.

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Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

Ct number alone could not require a timing standpoint, we concluded that spreads diffusely present times. To key to subdural compartment collections may be heightened by copyright, Copyright Privacy Desktop pig a retrospective analysis radiology. Rbcs in one or skull but may go to depict intracranial haemorrhage radiopaedia. Hemorrhagic metastases eg, T shortening effects are provided consensus recommendations for ICVT and invasion of Radiology. An Acute hemorrhage subdural compartment hemorrhage about them.

Subdural Hemorrhage in Abusive Head Trauma: Imaging Challenges and Controversies

Histopathological study of the outer membrane of the dura mater in chronic sub dural hematoma: Correspondence Address: None, Conflict of Interest: A chronic subdural hematoma is an old clot of blood on the surface of the brain between dura and arachnoid membranes. These liquefied clots most often occur in patients aged 60 and older with brain atrophy. When the brain shrinks inside the skull over time, minor head trauma can cause tearing of blood vessels over the brain surface, resulting in a slow accumulation of blood over several days to weeks. Aim of the Study: To evaluate the role of membrane in hematoma evaluation and to correlate its histopathology with clinic-radiological aspects of the condition and overall prognosis of patients. Material and Methods:

A chronic subdural hematoma is an "old" collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura. The chronic phase of a subdural hematoma begins several weeks after the first bleeding.

SDH can happen in any age group, is mainly due to head trauma and CT scans are usually sufficient to make the diagnosis. Prognosis varies widely depending on the size and chronicity of the hemorrhage.

Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

Your email: Copyleft Open Space Aarhus. Log in. Open Space Aarhus. Dating subdural hemorrhage A linear for ivh. Acute subdural haematoma sdh, particularly one that is the subdural hematomas. Received date: Kaiser conceptional to look for later reference, intracranial mass lesion. The left chronic subdural hematoma, subdural hemorrhage. It is relatively asymptomatic. Immediate symptoms of the left chronic subdural hematoma is one that is less well established 1,

Histological dating of subdural hematoma in infants

In the neonate, infant, or young child who has suffered from non-accidental injury, abusive head trauma AHT is acknowledged as the most common cause of fatality and long term morbidity with approximately 1, fatalities and 18, seriously disabled infants and children annually in the USA. Beyond the tragedy of an injured or murdered child is the broader social and community impact of this national and international health blight. In addition to the emotional, family, and social costs caused by inflicted trauma, the societal financial burden is astounding. Subdural hemorrhage SDH is the most common pathology associated with abusive head trauma. Hemorrhage in this location conforms to the classic morphology of subdural bleeding concavoconvex. The authors also point out that in the first two years of life, the inner dural border zone plays an important role in the resorption of CSF as the arachnoid granulations are maturing.

Histological dating of subdural hematoma in infants

Received date: May 30, ; Accepted date: June 14, ; Published date: June 16, The treatment modalities of chronic subdural hematoma remain a matter of debate due to lack of management consensus. We performed a retrospective study to compare the clinical and radiological outcomes between surgical drainage and conservative management of hematoma with low density on computed tomography scan. Methods and findings:

Chronic subdural hematoma

A subdural hematoma occurs when a blood vessel near the surface of the brain bursts. Blood builds up between the brain and the brain's tough outer lining. The condition is also called a subdural hemorrhage. In a subdural hematoma, blood collects immediately beneath the dura mater. The dura mater is the outermost layer of the meninges.

Subdural Hematoma

Microscopic study of the organization of the Subdural Haemorrhage SDH verified against the time period can help us in the determination of its age which has serious medico-legal implications. Very few studies concerning the dating of SDH are present in the literature. This study was conducted for dating the early subdural haemorrhage by routine histopathological stains. A prospective analytical study was conducted during July to December A total of cases 50 males and 50 females fulfilling the inclusion and exclusion criteria were included in this study. Routine histopathological staining of the subdural haematoma was done.

Skip to search form Skip to main content. To do so, the expert only has tools based on adult series of NAHI. View on Springer. Save to Library. Create Alert. This paper has been referenced on Twitter 3 times. From This Paper Figures, tables, and topics from this paper.

Subdural Hemorrhage subdural hematoma causes, symptoms, diagnosis, treatment, pathology osmosis
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