Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma
Affiliation(s)
Department of Neurosurgery, Jingzhou No. 1 People’s Hospital, Clinical Medical College, Yangtze University, Jingzhou, China.
Department of Neurosurgery, Jingzhou No. 1 People’s Hospital, Clinical Medical College, Yangtze University, Jingzhou, China.
ABSTRACT
Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.
Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.
KEYWORDS
Traumatic Subdural Effusion (TSDE), Chronic Subdural Hematoma (CSDH), Co-Morbid Conditions, Postoperative Recurrence (PR)
Traumatic Subdural Effusion (TSDE), Chronic Subdural Hematoma (CSDH), Co-Morbid Conditions, Postoperative Recurrence (PR)
Cite this paper
Richard, S. , Wu, M. and Lin, D. (2015) Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma. Open Journal of Modern Neurosurgery, 5, 12-22. doi: 10.4236/ojmn.2015.51003.
Richard, S. , Wu, M. and Lin, D. (2015) Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma. Open Journal of Modern Neurosurgery, 5, 12-22. doi: 10.4236/ojmn.2015.51003.
References
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http://dx.doi.org/10.1136/jnnp.50.12.1694 [3] Cenic, A., Bhandari, M. and Reddy, K. (2005) Management of Chronic Subdural Hematoma: A National Survey and Literature Review. Canadian Journal of Neurological Sciences, 32, 501-506. [4] Li, Y.G., Gong, J., Li, F., Wang, H.W., Zhu, S.G. and Wu, C.Y. (2009) Traumatic Subdural Hydroma: Clinical Characteristics and Classification. Injury-International Journal of the Care of the Injured, 40, 968-972.
http://dx.doi.org/10.1016/j.injury.2009.01.006 [5] Yamada, H., Kageyama, N., Nakajima, M. and Nakamura, S. (1979) Acute Posttraumatic Subdural Hematoma in Infancy: Special Reference to the Mechanism of Collection of Subdural Fluid. No Shinkei Geka, 7, 55-62. [6] Takahashi, Y., Sato, H., Inoue, Y., Takeda, S. and Ohkawara, S. (1981) CT Findings and the Evaluation of Chronic Subdural Hematoma. Neurologia Medico-Chirurgica, 21, 485-490.
http://dx.doi.org/10.2176/nmc.21.485 [7] Takahashi, Y., Mikami, J., Sato, H., Takeda, S., Matsuoka, T., Ito, K., Ueda, M. and Ohkawara, S. (1982) Analysis of Chronic Subdural Hematoma Based on CT (Part 2)—Symptoms and CT Findings. Neurologia Medico-Chirurgica, 22, 395-401.
http://dx.doi.org/10.2176/nmc.22.395 [8] Yamada, H., Watanabe, T., Murata, S., Shibui, S., Nihei, H., Kohno, T. and Itoh, T. (1980) Developmental Process of Chronic Subdural Collections of Fluid Based on CT Scan Findings. Surgical Neurology, 13, 441-448. [9] Stone, J.L., Lang, R.G.R., Sugar, O., Moody, R.A. (1981) Traumatic Subdural Hygroma. Neurosurgery, 8, 542-550.
http://dx.doi.org/10.1227/00006123-198105000-00005 [10] Grossman, R.I. and Yousem, D.M. (2010) The Requisites Neuroradiology. 3rd Edition, Mosby, New York, 176-177. [11] French, B.N. and Dublin, A.B. (1977) The Value of Computerized Tomography in the Management of 1000 Consecutive Head Injuries. Surgical Neurology, 7, 171-183. [12] Keiji, M. (1993) Chronic Subdural Hematoma May Be Preceded by Persistent Traumatic Subdural Effusion. Neurologia Medico-Chirurgica, 33, 691-696.
http://dx.doi.org/10.2176/nmc.33.691 [13] Lankan, W., Meese, W. and Kazner, E. (1976) CT Findings in Closed Head Injuries with Special Reference to Contusion. In: Lanksch, W. and Kazner, E., Eds., Cranial Computerized Tomography, Springer-Verlag, New York, 318-320. [14] Lee, K.S. (1998) The Pathogenesis and Clinical Significance of Traumatic Subdural Hygroma. Brain Injury, 12, 595- 603.
http://dx.doi.org/10.1080/026990598122359 [15] Seong-Hyun, P., Sun-Ho, L., Jaechan, P., Jeong-Hyun, H., Sung-Kyoo, H. and In-Suk, H. (2008) Chronic Subdural Hematoma Preceded by Traumatic Subdural Hygroma. Journal of Clinical Neuroscience, 15, 868-872.
http://dx.doi.org/10.1016/j.jocn.2007.08.003 [16] Markwalder, T.M., Steinsiepe, K.F., Rohner, M., Rohner, M., Reichenbach, W. and Markwalder, H. (1981) The Course of Chronic Subdural Haematomas after Burr-Hole Craniostomy and Closed-System Drainage. Journal of Neurosurgery, 55, 390-396.
http://dx.doi.org/10.3171/jns.1981.55.3.0390 [17] Liu, Y., Zhu, T. and Jiang, Y. (2002) Chronic Traumatic Subdural Hematoma Fluid Evolution. Chinese Journal of Trauma, 40, 360-362. [18] Apfelbaum, R.I., Guthkelch, A.N. and Shulman, K. (1974) Experimental Production of Subdural Hematomas. Journal of Neurosurgery, 40, 336-346.
http://dx.doi.org/10.3171/jns.1974.40.3.0336 [19] Ito, H., Komai, T. and Yamamoto, S. (1978) Fibrinolytic Enzyme in the Lining Walls of Chronic Subdural Hematoma. Journal of Neurosurgery, 48, 197-200.
http://dx.doi.org/10.3171/jns.1978.48.2.0197 [20] Ito, H., Saito, K., Yamamoto, S. and Hasegawa, T. (1988) Tissue-Type Plasminogen Activator in the Chronic Subdural Hematoma. Surgical Neurology, 30, 175-179.
http://dx.doi.org/10.1016/0090-3019(88)90269-8 [21] Watanabe, S., Shimada, H. and Ishii, S. (1972) Production of Clinical Form of Chronic Subdural Hematoma in Experimental Animals. Journal of Neurosurgery, 37, 552-561.
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http://dx.doi.org/10.3171/jns.2001.95.2.0256 [26] Schachenmayr, W. and Friede, R.L. (1978) The Origin of Subdural Neomembranes. I. Fine Structure of the Dura- Arachnoid Interface in Man. American Journal of Pathology, 92, 53-68. [27] Hasegawa, M., Yamashima, T., Yamashita, J., Suzuki, M. and Shimada, S. (1992) Traumatic Subdural Hygroma: Pathology and Meningeal Enhancement on Magnetic Resonance Imaging. Neurosurgery, 31, 580-585.
http://dx.doi.org/10.1227/00006123-199209000-00024 [28] Nomura, S., Kashiwagi, S., Fujisawa, H., Ito, H. and Nakamura, K. (1994) Characterization of Local Hyperfibrinolysis in Chronic Subdural Hematomas by SDS-PAGE and Immunoblot. Journal of Neurosurgery, 81, 910-913.
http://dx.doi.org/10.3171/jns.1994.81.6.0910 [29] Weir, B. and Gordon, P. (1983) Factors Affecting Coagulation: Fibrinolysis in Chronic Subdural Fluid Collections. Journal of Neurosurgery, 58, 242-245.
http://dx.doi.org/10.3171/jns.1983.58.2.0242 [30] Elms, M.J., Bunce, I.H., Bundesen, P.G., Masci, P.P., Rylatt, D.B., Whitaker, A.N. and Webber, A.J. (1986) Rapid Detection of Crosslinked Fibrin Degradation Products in Plasma Using Monoclonal Antibody-Coated Latex Particles. American Journal of Clinical Pathology, 85, 360-364. [31] Mernit, H.H. (1973) Textbook of Neurology. 5th Edition, Lea & Febiger, Philadelphia. [32] Goksu, E., Akyuz, M., Ucar, T. and Kazan, S. (2009) Spontaneous Resolution of a Large Chronic Subdural Hematoma: A Case Report and Review of the Literature. Turkish Journal of Trauma & Emergency Surgery, 15, 95-98. [33] Parlato, C., Guarracino, A. and Moraci, A. (2000) Spontaneous Resolution of Chronic Subdural Hematoma. Surgical Neurology, 53, 312-317.
http://dx.doi.org/10.1016/S0090-3019(00)00200-7 [34] Weigel, R., Schmiedek, P. and Krauss, J.K. (2003) Outcome of Contemporary Surgery for Chronic Subdural Haematoma: Evidence Based Review. Journal of Neurology, Neurosurgery & Psychiatry, 74, 937-943.
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[1] Virchow, R. (1857) Das Hamatom der Dura Mater. Verhandlungen der Physische-Medizinische Gesellschaft Wiirzburg, 7, 134-142. [2] Ohno, K., Suzuki, R., Masaoka, H., Matsushima, Y., Inaba, Y. and Monma, S. (1987) Chronic Subdural Hematoma Preceded by Persistent Traumatic Subdural Fluid Collection. Journal of Neurology Neurosurgery and Psychiatry, 50, 1694-1697.
http://dx.doi.org/10.1136/jnnp.50.12.1694 [3] Cenic, A., Bhandari, M. and Reddy, K. (2005) Management of Chronic Subdural Hematoma: A National Survey and Literature Review. Canadian Journal of Neurological Sciences, 32, 501-506. [4] Li, Y.G., Gong, J., Li, F., Wang, H.W., Zhu, S.G. and Wu, C.Y. (2009) Traumatic Subdural Hydroma: Clinical Characteristics and Classification. Injury-International Journal of the Care of the Injured, 40, 968-972.
http://dx.doi.org/10.1016/j.injury.2009.01.006 [5] Yamada, H., Kageyama, N., Nakajima, M. and Nakamura, S. (1979) Acute Posttraumatic Subdural Hematoma in Infancy: Special Reference to the Mechanism of Collection of Subdural Fluid. No Shinkei Geka, 7, 55-62. [6] Takahashi, Y., Sato, H., Inoue, Y., Takeda, S. and Ohkawara, S. (1981) CT Findings and the Evaluation of Chronic Subdural Hematoma. Neurologia Medico-Chirurgica, 21, 485-490.
http://dx.doi.org/10.2176/nmc.21.485 [7] Takahashi, Y., Mikami, J., Sato, H., Takeda, S., Matsuoka, T., Ito, K., Ueda, M. and Ohkawara, S. (1982) Analysis of Chronic Subdural Hematoma Based on CT (Part 2)—Symptoms and CT Findings. Neurologia Medico-Chirurgica, 22, 395-401.
http://dx.doi.org/10.2176/nmc.22.395 [8] Yamada, H., Watanabe, T., Murata, S., Shibui, S., Nihei, H., Kohno, T. and Itoh, T. (1980) Developmental Process of Chronic Subdural Collections of Fluid Based on CT Scan Findings. Surgical Neurology, 13, 441-448. [9] Stone, J.L., Lang, R.G.R., Sugar, O., Moody, R.A. (1981) Traumatic Subdural Hygroma. Neurosurgery, 8, 542-550.
http://dx.doi.org/10.1227/00006123-198105000-00005 [10] Grossman, R.I. and Yousem, D.M. (2010) The Requisites Neuroradiology. 3rd Edition, Mosby, New York, 176-177. [11] French, B.N. and Dublin, A.B. (1977) The Value of Computerized Tomography in the Management of 1000 Consecutive Head Injuries. Surgical Neurology, 7, 171-183. [12] Keiji, M. (1993) Chronic Subdural Hematoma May Be Preceded by Persistent Traumatic Subdural Effusion. Neurologia Medico-Chirurgica, 33, 691-696.
http://dx.doi.org/10.2176/nmc.33.691 [13] Lankan, W., Meese, W. and Kazner, E. (1976) CT Findings in Closed Head Injuries with Special Reference to Contusion. In: Lanksch, W. and Kazner, E., Eds., Cranial Computerized Tomography, Springer-Verlag, New York, 318-320. [14] Lee, K.S. (1998) The Pathogenesis and Clinical Significance of Traumatic Subdural Hygroma. Brain Injury, 12, 595- 603.
http://dx.doi.org/10.1080/026990598122359 [15] Seong-Hyun, P., Sun-Ho, L., Jaechan, P., Jeong-Hyun, H., Sung-Kyoo, H. and In-Suk, H. (2008) Chronic Subdural Hematoma Preceded by Traumatic Subdural Hygroma. Journal of Clinical Neuroscience, 15, 868-872.
http://dx.doi.org/10.1016/j.jocn.2007.08.003 [16] Markwalder, T.M., Steinsiepe, K.F., Rohner, M., Rohner, M., Reichenbach, W. and Markwalder, H. (1981) The Course of Chronic Subdural Haematomas after Burr-Hole Craniostomy and Closed-System Drainage. Journal of Neurosurgery, 55, 390-396.
http://dx.doi.org/10.3171/jns.1981.55.3.0390 [17] Liu, Y., Zhu, T. and Jiang, Y. (2002) Chronic Traumatic Subdural Hematoma Fluid Evolution. Chinese Journal of Trauma, 40, 360-362. [18] Apfelbaum, R.I., Guthkelch, A.N. and Shulman, K. (1974) Experimental Production of Subdural Hematomas. Journal of Neurosurgery, 40, 336-346.
http://dx.doi.org/10.3171/jns.1974.40.3.0336 [19] Ito, H., Komai, T. and Yamamoto, S. (1978) Fibrinolytic Enzyme in the Lining Walls of Chronic Subdural Hematoma. Journal of Neurosurgery, 48, 197-200.
http://dx.doi.org/10.3171/jns.1978.48.2.0197 [20] Ito, H., Saito, K., Yamamoto, S. and Hasegawa, T. (1988) Tissue-Type Plasminogen Activator in the Chronic Subdural Hematoma. Surgical Neurology, 30, 175-179.
http://dx.doi.org/10.1016/0090-3019(88)90269-8 [21] Watanabe, S., Shimada, H. and Ishii, S. (1972) Production of Clinical Form of Chronic Subdural Hematoma in Experimental Animals. Journal of Neurosurgery, 37, 552-561.
http://dx.doi.org/10.3171/jns.1972.37.5.0552 [22] Wakefield, T.W., Greenfield, L.J., Rolfe, M.W., DeLucia, A., Strieter, R.M., Abrams, G.D., Kunkel, S.L., Esmon, C.T., Wrobleski, S.K. and Kadell, A.M. (1993) Inflammatory and Procoagulant Mediator Interactions in an Experimental Baboon Model of Venous Thrombosis. Thrombosis and Haemostasis, 69, 164-172. [23] Friede, R.L. and Schachenmayer, W. (1978) The Origin of Subdural Neomembranes. II. Fine Structures of Neomembranes. American Journal of Pathology, 92, 69-84. [24] Kawano, N., Endo, M., Saito, M. and Yada, K. (1988) Origin of the Capsule of Chronic Subdural Hematoma—An Electron Microscopic Study. No Shinkei Geka, 16, 747-752. [25] Nakaguchi, H., Tanishima, T. and Yoshimasu, N. (2001) Factors in the Natural History of Chronic Subdural Hematomas That Influence Their Postoperative Recurrence. Journal of Neurosurgery, 95, 256-262.
http://dx.doi.org/10.3171/jns.2001.95.2.0256 [26] Schachenmayr, W. and Friede, R.L. (1978) The Origin of Subdural Neomembranes. I. Fine Structure of the Dura- Arachnoid Interface in Man. American Journal of Pathology, 92, 53-68. [27] Hasegawa, M., Yamashima, T., Yamashita, J., Suzuki, M. and Shimada, S. (1992) Traumatic Subdural Hygroma: Pathology and Meningeal Enhancement on Magnetic Resonance Imaging. Neurosurgery, 31, 580-585.
http://dx.doi.org/10.1227/00006123-199209000-00024 [28] Nomura, S., Kashiwagi, S., Fujisawa, H., Ito, H. and Nakamura, K. (1994) Characterization of Local Hyperfibrinolysis in Chronic Subdural Hematomas by SDS-PAGE and Immunoblot. Journal of Neurosurgery, 81, 910-913.
http://dx.doi.org/10.3171/jns.1994.81.6.0910 [29] Weir, B. and Gordon, P. (1983) Factors Affecting Coagulation: Fibrinolysis in Chronic Subdural Fluid Collections. Journal of Neurosurgery, 58, 242-245.
http://dx.doi.org/10.3171/jns.1983.58.2.0242 [30] Elms, M.J., Bunce, I.H., Bundesen, P.G., Masci, P.P., Rylatt, D.B., Whitaker, A.N. and Webber, A.J. (1986) Rapid Detection of Crosslinked Fibrin Degradation Products in Plasma Using Monoclonal Antibody-Coated Latex Particles. American Journal of Clinical Pathology, 85, 360-364. [31] Mernit, H.H. (1973) Textbook of Neurology. 5th Edition, Lea & Febiger, Philadelphia. [32] Goksu, E., Akyuz, M., Ucar, T. and Kazan, S. (2009) Spontaneous Resolution of a Large Chronic Subdural Hematoma: A Case Report and Review of the Literature. Turkish Journal of Trauma & Emergency Surgery, 15, 95-98. [33] Parlato, C., Guarracino, A. and Moraci, A. (2000) Spontaneous Resolution of Chronic Subdural Hematoma. Surgical Neurology, 53, 312-317.
http://dx.doi.org/10.1016/S0090-3019(00)00200-7 [34] Weigel, R., Schmiedek, P. and Krauss, J.K. (2003) Outcome of Contemporary Surgery for Chronic Subdural Haematoma: Evidence Based Review. Journal of Neurology, Neurosurgery & Psychiatry, 74, 937-943.
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