TY - JOUR
T1 - Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension
AU - Chen, Ying Chu
AU - Wang, Yen Feng
AU - Li, Jie Yuan
AU - Chen, Shih Pin
AU - Lirng, Jiing Feng
AU - Hseu, Shu Shya
AU - Tung, Hsin
AU - Chen, Po Lin
AU - Wang, Shuu Jiun
AU - Fuh, Jong Ling
N1 - Publisher Copyright:
© International Headache Society 2015.
PY - 2016/3/1
Y1 - 2016/3/1
N2 - Objective The objective of this article is to elucidate the outcome, prognostic predictors and timing of surgical intervention for subdural hematoma (SDH) in patients with spontaneous intracranial hypotension (SIH). Methods Patients with SDH were identified retrospectively from 227 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, and treatment of SDH, which was later divided into conservative treatment, epidural blood patches (EBP), and surgical intervention. Poor outcome was defined as severe neurological sequelae or death. Results Forty-five patients (20%) with SDH (mean maximal thickness 11.9 ± 6.2 mm) were recruited. All 15 patients with SDH <10 mm achieved good outcomes by either conservative treatment or EBP. Of 30 patients with SDH ≥10 mm, patients with uncal herniation (n = 3) had poor outcomes, even after emergent surgical evacuation (n = 2), compared to those without (n = 27) (100% vs. 0%, p < 0.001). Fourteen patients underwent surgical evacuation, resulting in good outcomes in all 12 who received early intervention and poor outcomes in the remaining two who received delayed intervention after Glasgow Coma Scale (GCS) score ≤8 (100% vs. 0%, p = 0.01). Conclusions Uncal herniation results in poor outcomes in patients with SIH complicated with SDH. In individuals with SDH ≥10 mm and decreased GCS scores, early surgical evacuation might prevent uncal herniation.
AB - Objective The objective of this article is to elucidate the outcome, prognostic predictors and timing of surgical intervention for subdural hematoma (SDH) in patients with spontaneous intracranial hypotension (SIH). Methods Patients with SDH were identified retrospectively from 227 consecutive SIH patients. Data were collected on demographics, clinical courses, neuroimaging findings, and treatment of SDH, which was later divided into conservative treatment, epidural blood patches (EBP), and surgical intervention. Poor outcome was defined as severe neurological sequelae or death. Results Forty-five patients (20%) with SDH (mean maximal thickness 11.9 ± 6.2 mm) were recruited. All 15 patients with SDH <10 mm achieved good outcomes by either conservative treatment or EBP. Of 30 patients with SDH ≥10 mm, patients with uncal herniation (n = 3) had poor outcomes, even after emergent surgical evacuation (n = 2), compared to those without (n = 27) (100% vs. 0%, p < 0.001). Fourteen patients underwent surgical evacuation, resulting in good outcomes in all 12 who received early intervention and poor outcomes in the remaining two who received delayed intervention after Glasgow Coma Scale (GCS) score ≤8 (100% vs. 0%, p = 0.01). Conclusions Uncal herniation results in poor outcomes in patients with SIH complicated with SDH. In individuals with SDH ≥10 mm and decreased GCS scores, early surgical evacuation might prevent uncal herniation.
KW - Spontaneous intracranial hypotension
KW - epidural blood patch
KW - increased intracranial pressure
KW - subdural hematoma
KW - uncal herniation
UR - http://www.scopus.com/inward/record.url?scp=84959314602&partnerID=8YFLogxK
U2 - 10.1177/0333102415585095
DO - 10.1177/0333102415585095
M3 - Article
C2 - 25944817
AN - SCOPUS:84959314602
SN - 0333-1024
VL - 36
SP - 225
EP - 231
JO - Cephalalgia
JF - Cephalalgia
IS - 3
ER -