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Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma

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Abstract

Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.

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Conflict of interest

The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Neurosurgery Unit, Sylvanus Olympio University Hospital, 08 BP: 8615, Lomé, Togo

    E. Kpelao, K. A. Beketi, A. K. Moumouni & A. Doleagbenou

  2. Radiology Unit, Kara University Hospital, Kara, Togo

    B. Ntimon

  3. Intensive Care Unit, Sylvanus Olympio University Hospital, Lomé, Togo

    P. Egbohou, T. Mouzou, K. Tomta & D. H. Sama

  4. Trauma-Orthopaedics Unit, Sylvanus Olympio University Hospital, Lomé, Togo

    A. Abalo, A. Walla & A. Dossim

Authors
  1. E. Kpelao
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  2. K. A. Beketi
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  3. A. K. Moumouni
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  4. A. Doleagbenou
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  5. B. Ntimon
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  6. P. Egbohou
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  7. T. Mouzou
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  8. K. Tomta
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  9. D. H. Sama
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  10. A. Abalo
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  11. A. Walla
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  12. A. Dossim
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Corresponding author

Correspondence to E. Kpelao.

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Comments

Ulrich Sure, Essen, Germany

Dr. Kpelao and colleagues describe a rare sub-entity of subdural hematomas. In their retrospective study, the authors identified a distinct subgroup of patients suffering from an isodense hemorrhage with a short recent history of trauma and a tendency for a rapid neurological deterioration. Obviously, the paper from Togo is afflicted with the usual drawbacks of retrospective studies. The conclusion of the authors that patients suffering from subdural hematomas with a rapid clinical deterioration should be subjected to a fast surgical evacuation points out a rare but an important condition in clinical practice. Furthermore, the manuscript represents a noteworthy attempt to initiate an academic culture in African neurosurgery that so far is only rarely visible within the international neurosurgical literature. For this reason, I wish to congratulate our colleagues from Togo for their efforts in publishing scientific clinical articles and wish them success for the future.

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Kpelao, E., Beketi, K.A., Moumouni, A.K. et al. Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma. Neurosurg Rev 39, 237–240 (2016). https://doi.org/10.1007/s10143-015-0669-4

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  • DOI: https://doi.org/10.1007/s10143-015-0669-4

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