S Sawauchi1, T Abe. 1. Department of Neurosurgery, Jikei University School of Medicine, Tokyo, Japan. ssawauchi@jcom.home.ne.jp
Abstract
OBJECTIVE: The high mortality of acute subdural haematoma (ASDH) is largely explained by its frequent association with primary brain damage consisting of contusion and brain swelling. However, the nature and causes of brain swelling after traumatic brain injury are multifactorial and poorly understood. The purpose of this study was to investigate the pathophysiology of brain swelling associated with ASDH in traumatic brain injury. METHODS: We examined whether the thickness of the haematoma, parenchymal injury, or presence of a secondary insult had an effect on traumatic brain swelling. The variables that might affect the pathophysiology of ASDH were examined, including: (1) age and mechanism of injury, (2) neurological findings, (3) secondary insult and extracranial injuries, (4) pre-operative computed tomography (CT) scan results, and (5) outcome. RESULTS: A total of 212 patients were included in this study. On CT scan, 159 patients (75.0%) did not have brain swelling, 29 (13.7%) had hemispheric brain swelling, and 24 (11.3%) had diffuse brain swelling. Brain swelling associated with ASDH is caused by secondary insult in addition to parenchymal injury. In the present study, the outcome of ASDH associated with brain swelling was poor, even when treated with early surgical evacuation; the mortality rate of such patients was over 75%. CONCLUSIONS: Given our findings, it is possible that the poor outcome of ASDH patients depends not only on the characteristics of the haematoma itself, but also on the presence of additional cerebral parenchymal injury and secondary insult.
OBJECTIVE: The high mortality of acute subdural haematoma (ASDH) is largely explained by its frequent association with primary brain damage consisting of contusion and brain swelling. However, the nature and causes of brain swelling after traumatic brain injury are multifactorial and poorly understood. The purpose of this study was to investigate the pathophysiology of brain swelling associated with ASDH in traumatic brain injury. METHODS: We examined whether the thickness of the haematoma, parenchymal injury, or presence of a secondary insult had an effect on traumatic brain swelling. The variables that might affect the pathophysiology of ASDH were examined, including: (1) age and mechanism of injury, (2) neurological findings, (3) secondary insult and extracranial injuries, (4) pre-operative computed tomography (CT) scan results, and (5) outcome. RESULTS: A total of 212 patients were included in this study. On CT scan, 159 patients (75.0%) did not have brain swelling, 29 (13.7%) had hemispheric brain swelling, and 24 (11.3%) had diffuse brain swelling. Brain swelling associated with ASDH is caused by secondary insult in addition to parenchymal injury. In the present study, the outcome of ASDH associated with brain swelling was poor, even when treated with early surgical evacuation; the mortality rate of such patients was over 75%. CONCLUSIONS: Given our findings, it is possible that the poor outcome of ASDH patients depends not only on the characteristics of the haematoma itself, but also on the presence of additional cerebral parenchymal injury and secondary insult.
Authors: Peter J Hutchinson; Angelos G Kolias; Tamara Tajsic; Amos Adeleye; Abenezer Tirsit Aklilu; Tedy Apriawan; Abdul Hafid Bajamal; Ernest J Barthélemy; B Indira Devi; Dhananjaya Bhat; Diederik Bulters; Randall Chesnut; Giuseppe Citerio; D Jamie Cooper; Marek Czosnyka; Idara Edem; Nasser M F El-Ghandour; Anthony Figaji; Kostas N Fountas; Clare Gallagher; Gregory W J Hawryluk; Corrado Iaccarino; Mathew Joseph; Tariq Khan; Tsegazeab Laeke; Oleg Levchenko; Baiyun Liu; Weiming Liu; Andrew Maas; Geoffrey T Manley; Paul Manson; Anna T Mazzeo; David K Menon; Daniel B Michael; Susanne Muehlschlegel; David O Okonkwo; Kee B Park; Jeffrey V Rosenfeld; Gail Rosseau; Andres M Rubiano; Hamisi K Shabani; Nino Stocchetti; Shelly D Timmons; Ivan Timofeev; Chris Uff; Jamie S Ullman; Alex Valadka; Vicknes Waran; Adam Wells; Mark H Wilson; Franco Servadei Journal: Acta Neurochir (Wien) Date: 2019-05-28 Impact factor: 2.216