Clinical Outcome of Borderline Subdural Hematoma with 5-9 mm Thickness and/or Midline Shift 2-5 mm
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2017, Vol 5, Issue 3
Abstract
Introduction: Patients with a subdural hematoma (SDH) and midline shift (MLS) of <10 mm on the computed tomography scans and with a Glasgow coma scale (GCS) score of 15 initially might be treated conservatively under close observation, reserving urgent craniotomy, and evacuation of the SDH for those with deteriorating neurological conditions. Aim: The aim is to study the clinical outcome in management of borderline acute subdural hematoma with 5-9 mm thickness and/or MLS 2-5 mm. Materials and Methods: Patients with head injury and acute SDH were screened. SDH thickness 5-9 mm, MLS 2-5 mm, GCS score >8, time since injury within 6 h of trauma, volume of contusion <20 ml, and loss of consciousness <1 h duration were included in the study. Results: SDH thickness and outcome, it was observed that out of 17 cases with SDH thickness <5 mm, 15 were alive and 2 cases expired with a survival rate of 88%. In 83 patients with SDH thickness > 5 mm, survival rate was 76% with 63 survivors and 20 deaths. In the group with MLS 2-5 mm and SDH thickness <5 mm, there was only one death among 17 patients with 16 survivors. In the group with MLS 2-5 mm and SDH thickness 5-9 mm, there were 19 deaths with 9 survivors. The survival rate was 47%. Conclusion: The mortality rate among those taken up for surgery after initial conservative management was significantly higher and thus emphasizing the need for close monitoring of conservatively managed patients and also to take up for primary surgery at the slightest degree of suspicion regarding conservative management in patients with associated contusion or subarachnoid hemorrhage.
Authors and Affiliations
Raja S Vignesh, R R Ramkumar, Heber Anandan
Keywords
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