Article
Treatment and prognosis of poor grade acute subdural hematoma of aneurysmatic origin
Therapie und Prognose komatöser Patienten mit akutem aneurysmatischem Subduralhämatom
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Published: | May 8, 2006 |
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Outline
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Objective: Spontaneous subdural hematoma can be caused by aneurysm rupture. Patients may present in a disastrous clinical state, deeply comatose with signs of uncal herniation or decerebration. For the clinician the question arises how and whether at all the patient should be treated in order to reach the best possible outcome and prevent vegetative survival due to extensive brain damage.
Methods: We present 7 cases with acute subdural hematoma and subarachnoid hemorrhage due to aneurysm rupture. All patients were graded WFNS 5. Four presented with anisocoria, two with bilaterally fixed and dilated pupils, one developed anisocoria in the course of treatment.
Results: One patient was not treated due to extensive brain damage and severe hypoxia. The remaining six patients were transferred to rehabilitation units after maximum therapy. Six months after the insult four had no or only minor neurological deficits (GOS 4 or 5), two had major neurological deficits but were able to communicate and returned to home (GOS 3).
Conclusions: In spite of disastrous clinical presentation on admission, acute subdural hematoma due to aneurysm rupture can be survived without clinical or radiological signs of brain damage under maximum surgical and medical therapy if no other complications arise throughout the course of therapy. Midline shift and uncal herniation may mimic a clinical condition which is far worse than the accompanying subarachnoid hemorrhage can be accounted for.