[Acute subdural hematomas, prognostic factors].

Abstract

Subdural hematomas are considered to be acute when diagnosed within 24 hours of trauma. The high mortality rate associated with them demonstrates the need to improve their outcome, especially by study of prognostic variables. The authors have studied 35 patients with acute subdural hematoma (ASDH) treated surgically. The diagnosis of ASDH was documented by clinical examination and computerized axial tomography scan (CAT-scan). Follow-up of the patients shows that age, sex, and pre-operative neurological examination, including depth of coma and pupillary changes, are significant prognostic variables. Post-operative intracranial pressure (ICP) is an important factor in determining the outcome, since all the patients with an ICP over 50 mm Hg died. Furthermore, the patients treated surgically by craniotomy have a better outcome and a rate of good recovery much higher than those treated by burr holes only. Thus, the prognosis of ASDH may be improved by careful and systematic monitoring of the ICP with adequate treatment when it reaches critical levels, and by large decompressive craniotomy for evacuation of the clot.