Gerıatrıc Traumatıc Acute Subdural Haematomas: A Retrospectıve Study

Abstract

Objective:Acute subdural hematomas (ASDH) are severe traumatic brain injuries. Older patients have a higher mortality rate.We retrospectively reviewed 19 geriatric patients with ASDH to demonstrate the outcome of the management of ASDH and to find out which parameters are significant in predicting the outcome. Methods:Computer records and patient files of 19 geriatric patients with traumatic ASDH who underwent surgical intervention in OndokuzMayıs University School of Medicine at Department of Neurosurgery between January 2006-December 2009 were reviewed.The diagnosis was based on computerized tomography (CT) findings.Examined criteria were age, sex , mechanism of the trauma, Glasgow Coma Score (GCS )on admission , presence of a midline shift and contusio cerebri , thickness of the haematoma , accompanying chronic diseases , anticoagulant therapy , type of surgery and neurological examination on discharge.ASDH of the posterior fossa , subacute-chronic subdural haematomas , patients with serious extracranial injuries and aged below 65 were excluded. Results:A GCS of ≤ 8 on initial presentation,pupillary non reactivity,presence of a midline shift and contusio cerebri was found to be significantly associated with increased mortality and a poor patient outcome.Effect of sex,anticoagulant therapy and type of surgery couldn’t have been found to be determinant on prognosis.

Keywords

• Acute Subdural Haematoma
• Geriatric Age
• Glasgow Coma Score
• Traumatic
• Computerized Tomography
• Brain Injury

References

1. Alessandri, B., Nishioka, T., Heimann, A., 2006. Caspase-dependent cell death involved in brain damage after acute subdural hematoma in rats. Brain Res. 1111, 196-202
2. Bullock, M. R., Chesnut, R., Ghajar, J., 2006. Surgical Management of Traumatic Brain Injury Author Group. Surgical management of acute subdural hematomas. Neurosurg. 58, 16 – 24
3. Dennis, G., Vollmer, James C., 1991. Torner, Howard M.Eisenberg et. al., Age and outcome following traumatic coma: why do older patients fare worse? J. Neurosurg. 75, 37−48.
4. Dent, D. L., Croce, M. A., Menke, P. G., 1995. Prognostic factors after acute subdural hematoma. J. Trauma. 39, 36– 42
5. Hanif, S., Abodunde, O., Ali, Z., Pidgeon, C., 2009. Age related outcome in acute subdural haematoma following traumatic head injury. Ir. Med. J. 102,255-257.
6. Koç, R. K., Akdemir, H., Oktem, I. S., Meral, M., Menkü, A., 1997. Acute subdural hematoma: outcome and outcome prediction. Neurosurg. Rev. 20, 239-244.
7. Marshall, L.F., Gautille, T., Klauber, M.R., 1991. The outcome of severe closed head injury. J. Neurosurg. 75, 28–36.
8. Mendelow, A.D., 2006. The effect of age on outcome following severe head injury for patients in coma from the outset: A mitochondrial DNA degradation phenomenon? Indian J. Neurotrauma. 3, 95−98.

9. Miller, J.D., Bullock, R., Graham, D.I., 1990. Ischemic brain damage in a model of acute subdural hematoma. Neurosurgery. 27, 433–439
10. Mosenthal, A.C., Lavery, R. F., 2002. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J. Trauma. 52, 907−911.
11. Sawauchi, S., Marmarou, A., Beaumont, A., 2003. A new rat model of diff use brain injury associated with acute subdural hematoma: assessment of varying hematoma volume, insult severity, and the presence of hypoxemia. J. Neurotrauma. 20, 613–622.
12. Seelig, J.M., Becker, D.P., Miller, J.D., 1981. Traumatic acute subdural hematoma: major mortality reduction in comatose patients treated within four hours. N. Engl. J. Med. 304, 1511–1518.
13. Ushewokunze, S., Nannapaneni, R., Gregson, B.A., Stobbart, L., Chambers, I.R., Mendelow, A.D., 2004. Elderly patients with severe head injury in coma from the outset−has anything changed? British J. Neurosurgery.18, 604−607.
14. Zumkeller, M., Behrmann, R., Heissler, H. E., 1996. Computed tomographic criteria and survival rate for patients with acute subdural hematoma. Neurosurg. 39, 708–713.