Traumatic Brain Hemorrhage Clinical Trial
Official title:
Traumatic Acute Subdural Haematoma: Management and Outcome
Traumatic acute subdural haematomas (ASDHs) are common pathological entity in neurosurgical practice . The frequency of (ASDHs) has been proposed as approximately 10-20% of patients admitted with traumatic brain injury(TBI) .Approximately two -thirds of patient with TBI undergoing emergency cranial surgery have an acute subdural haematoma evacuated . Two common causes of traumatic ASDH: accumulation of blood around parenchymal laceration , usually frontal and temporal lobes and there is usually severe underlying brain injury .The second cause is surface or bridging vessel torn from cerebral acceleration - deceleration during violent head motion .
Traumatic acute subdural haematomas (ASDHs) are common pathological entity in neurosurgical
practice . The frequency of (ASDHs) has been proposed as approximately 10-20% of patients
admitted with traumatic brain injury(TBI) .Approximately two -thirds of patient with TBI
undergoing emergency cranial surgery have an acute subdural haematoma evacuated . Two common
causes of traumatic ASDH: accumulation of blood around parenchymal laceration , usually
frontal and temporal lobes and there is usually severe underlying brain injury .The second
cause is surface or bridging vessel torn from cerebral acceleration - deceleration during
violent head motion . These haematomas have been historically associated with high mortality
rate (between 40-60%)(1).This high mortality rate has been attributed to the characteristic
of haematoma itself , due to the primary insults to the brain like brain parenchymal injury ,
and to the secondary insults like hypoxia and hypotension in severe head injury patients .
Theoretically ,intracranial hypertension due to ASDH may lead to transtentorial cerebral
herniation and secondary ischemic injury of the brain.CT scan is main and most informative
investigatory aid in diagnosis of traumatic ASDH. The criteria used to select patients for
non - operative management are clinical stability or improvement during the time from injury
to evaluation at hospital , haematoma thickness less than 10 mm and mid line shift less than
5 mm in the initial CT. Surgery is indicated if on CT 1- ASDH with thickness > 10mm. or 2-
Mid line shift >5mm.on CT 3- ASDH with thickness <10 mm and midline shift <5mm on CT should
undergo surgical evaluation if (a) GCS drop by >_ 2 point from injury to admission .(b) and
or pupils are asymmetric or fixed and dilated (7). Time of surgery for ASDH is matter of
controversy. As general principle ,when surgery for ASDH is indicated it should be done as
soon as possible . Regarding evacuation of acute subdural haematoma, procedures vary from
single burrhole evacuation to craniotomies and decompressive procedures .Some advocated ASDH
evacuations by decompressive craniectomy with dural - slits .
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