Subdural hematoma classification: Difference between revisions
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Classification
Subdural hematomas are divided into acute, subacute, and chronic, depending on their speed of onset. Acute subdural hematomas that are due to trauma are the most lethal of all head injuries and have a high mortality rate if they are not rapidly treated with surgical decompression.
Acute bleeds develop after high speed acceleration or deceleration injuries and are increasingly severe with larger hematomas. They are most severe if associated with cerebral contusions. Though much faster than chronic subdural bleeds, acute subdural bleeding is usually venous and therefore slower than the usually arterial bleeding of an epidural hemorrhage. Acute subdural bleeds have a high mortality rate, higher even than epidural hematomas and diffuse brain injuries, because the velocities necessary to cause them cause other severe injuries as well.[1] The mortality rate associated with acute subdural hematoma is around 60 to 80% [2]
Chronic subdural bleeds develop over the period of days to weeks, often after minor head trauma, though such a cause is not identifiable in 50% of patients.[3] They may not be discovered until they present clinically months or years after a head injury.[4] The bleeding from a chronic bleed is slow, probably from repeated minor bleeds, and usually stops by itself. [5] Since these bleeds progress slowly, they present the chance to be stopped before they cause significant damage. Small subdural hematomas, those less than a centimeter wide, have much better outcomes than acute subdural bleeds: in one study, only 22% of patients with chronic subdural bleeds had outcomes worse than "good" or "complete recovery". Chronic subdural hematomas are common in the elderly.
References
- ↑ Vinas F.C. and Pilitsis J. 2006. Penetrating Head Trauma. Emedicine.com.
- ↑ Dawodu S. 2004. "Traumatic brain injury: Definition, epidemiology, pathophysiology" Emedicine.com. Retrieved on August 7, 2007.
- ↑ Downie A. 2001. "Tutorial: CT in head trauma". Retrieved on August 7, 2007.
- ↑ Kushner D (1998). "Mild Traumatic Brain Injury: Toward Understanding Manifestations and Treatment". Archives of Internal Medicine. 158 (15): 1617–1624. PMID 9701095.
- ↑ Graham DI and Gennareli TA. Chapter 5, "Pathology of brain damage after head injury" Cooper P and Golfinos G. 2000. Head Injury, 4th Ed. Morgan Hill, New York.