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Results of various modalities of treatment for acute subdural

hematomas in the department of neurosurgery, Abbasi Shaheed


Hospital, one year review study.

Authors: Maroof Hashmi, Zafar Iqbal, Akmal Jameel, Shahid Ahmed

Correspondence to Dr Maroof Hashmi: Department of Neurosurgery Abbasi Shaheed hospital, Nazimabad,


Karachi, Pakistan.
Phone: +92-21-9260400-9 Cell: +92-300-2850833 E-mail: maroof_hashmi@hotmail.com

Abstract

Background and purpose:


Acute subdural hematoma (ASDH) is associated with high mortality. The treatment of
ASDH varies according to the size, clinical condition and age, throughout the world. This
study analyses the outcome of patients with ASDH who were treated surgically or
conservatively.
Methods:
The outcome of the conservative and surgically treated patients was studied
retrospectively with 2 months follow up from the day of injury.
93 patients were admitted and treated in the department of neurosurgery, Abbasi Shaheed
hospital, from January 2008 to December 2008. 58 patients were treated conservatively
and 35 patients were selected for surgical intervention. All the patients were categorized
according to level of consciousness, size of hematoma, presence or absence of anisocoria,
hemi paresis or seizures, progress of the clinical as well as size of hematomas, associated
intracranial findings like subarachnoid hemorrhage & contusions and conservative and
operative treatments etc. The results in each category are evaluated and compared with
standard institutions. The outcome among various subgroups according to timings of
surgery and procedures are also compared.
Results:
The mortality was 57% among 35 patients who underwent craniotomy and it was 5%
among 58 patients who were treated conservatively. Functional recovery was observed in
66.6% of all the patients (91.3% in conservative group while 25.7% in operated
group).84.6% of patients with Glasgow Coma Scale (GCS) score (9–15) and 57.14% of
patients with GCS score (6–8) fully recovered. All of 15 patients with a GCS score 5 and
below expired. The mortality was 80% of patients over 50 years old, in comparison with
40% mortality for those aged below 50 years. 100% of patients with bilateral non-
reactive pupils and 42.8 % of patients with unilateral non-reactive pupil expired. Among
the patients with associated intracranial injuries mortality rates were 95% in contusions &
intracerebral hematoma, and 75% in subarachnid hemorrhage.
3 patients (5%) among conservative group died, all were above 50 years.
Among them one patient had COPD, and another was a known case of ischemic heart
disease.
Conclusions:
Level of consciousness and pupillary reaction were the most significant factors for
predicting recovery. Age and associated intracranial injuries were correlated to result.

Key words: acute subdural hematoma, surgical treatment, conservative treatment,


craniotomy