Treatment and prognosis of subdural hematoma in patients with spontaneous intracranial hypotension

Ying Chu Chen, Yen Feng Wang, Jie Yuan Li, Shih Pin Chen, Jiing Feng Lirng, Shu Shya Hseu, Hsin Tung, Po Lin Chen, Shuu Jiun Wang, Jong Ling Fuh*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)225-231
Number of pages7
JournalCephalalgia
Volume36
Issue number3
DOIs
StatePublished - 1 Mar 2016

Keywords

  • Spontaneous intracranial hypotension
  • epidural blood patch
  • increased intracranial pressure
  • subdural hematoma
  • uncal herniation

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