Shivani Bindal , William Walker Wroe , William Dow , Ryan Kitagawa
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引用次数: 0
Abstract
Background
Incidences of catastrophic, life-threatening expansion of acute traumatic subdural hematomas (SDH) greater than 72-hours after injury are rare and limited to single case reports in the literature. Here we report the largest series of this rare subset of patients and evaluate the incidence and associated clinical factors.
Methods
We retrospectively reviewed all asymptomatic acute traumatic SDH admissions that were managed conservatively to a single large academic tertiary trauma center over a 5-year period. Inclusion criteria were diagnosis of non-operative acute SDH, Glasgow coma score (GCS) ≥14, and severe symptomatic expansion greater than 72 h after injury.
Results
Nine patients met criteria for severe, symptomatic delayed expansion of asymptomatic acute SDH. The median age was 80.1 years. In all cases, the mechanism of injury was a low velocity, ground-level fall. The SDH size on initial imaging ranged from 3 mm to 16 mm at maximum diameter. All patients were admitted for observation with repeat imaging demonstrating stability of hemorrhage within 12 h. The median time to SDH expansion was 4.5 days. Repeat imaging demonstrated large, acute, operative SDHs, measuring 20.8 mm on average. Five patients underwent immediate surgical intervention, of which 4 were eventually discharged with GCS ≥14. The remaining 4 patients were transitioned to comfort measures without surgical intervention.
Conclusion
The risk of neurologic devastation and catastrophic event from SDH expansion >72 h from injury is exceedingly low, and head imaging should be performed at the first sign of symptoms despite length of time from injury.
背景:急性外伤性硬膜下血肿(SDH)在损伤后超过72小时发生灾难性的、危及生命的扩张的发生率非常罕见,并且仅限于文献中的单个病例报道。在这里,我们报告了这一罕见患者的最大系列,并评估了发病率和相关的临床因素。方法:我们回顾性地回顾了在一个大型三级创伤中心保守治疗的5年内所有无症状急性外伤性SDH入院病例。纳入标准为诊断为非手术性急性SDH、格拉斯哥昏迷评分(GCS)≥14、伤后72 h以上严重症状扩张。结果9例患者符合无症状急性SDH严重、有症状的迟发性扩张标准。中位年龄为80.1岁。在所有病例中,损伤机制都是低速地面坠落。初始成像时,SDH的最大直径为3mm至16mm。所有患者入院观察,重复成像显示出血在12小时内稳定。SDH扩张的中位时间为4.5天。重复成像显示大的、急性的、可手术的sdh,平均20.8 mm。5例患者立即接受手术治疗,其中4例最终出院,GCS≥14。其余4例患者在没有手术干预的情况下过渡到舒适措施。结论损伤后72 h SDH扩张导致神经系统破坏和灾难性事件的风险极低,无论损伤时间长短,在出现症状时均应进行头部影像学检查。
期刊介绍:
This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology.
The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.