gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Treatment and prognosis of poor grade acute subdural hematoma of aneurysmatic origin

Therapie und Prognose komatöser Patienten mit akutem aneurysmatischem Subduralhämatom

Meeting Abstract

  • corresponding author T. Westermaier - Neurochirurgische Klinik, Universität Würzburg
  • E. Kunze - Neurochirurgische Klinik, Universität Würzburg
  • J. Eriskat - Neurochirurgische Klinik, Universität Würzburg
  • K. Roosen - Neurochirurgische Klinik, Universität Würzburg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocP 09.122

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Westermaier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.