Depreitere B, Van Calenbergh F, van Loon J
Department of Neurosurgery, University Hospital Gasthuisberg, Herestraat 49, B-3000 Leuven, Belgium.
Acta Neurochir (Wien). 2003 Jul;145(7):541-6; discussion 546. doi: 10.1007/s00701-003-0020-7.
Non-traumatic acute subdural haematomas enable study of the morbidity and mortality due to the haematoma without the effect of trauma. Whereas it is known that coagulation disorders worsen the outcome of spontaneous intracerebral haematomas, this has not been studied in non-traumatic acute subdural haematomas.
In a series of 13 non-traumatic acute subdural haematomas admitted to our department between January 1995 and March 2002, we had 9 coagulopathy associated haematomas and 3 haematomas corresponding to the syndrome of 'spontaneous acute subdural haematoma of arterial origin'. Both groups were compared.
Age and gender distribution were comparable. The bleeding source was a cortical artery in 2 of the 2 non-coagulopathy related haematomas operated on, but also in 2 of the 4 coagulopathy associated haematomas that underwent surgery. The average haematoma thickness was higher in the coagulopathy related haematomas. The mean Glasgow Coma Score on admission was 7.7 and the mortality rate was 55.6% in the coagulopathy related group. In the non-coagulopathy related haematomas the mean Glasgow Coma Score was 12.0 and the mortality rate 33.3%. The latter mortality rate corresponds well to that of a historical group of 'spontaneous acute subdural haematomas of arterial origin' collected from the literature.
The outcome was worse in the non-traumatic acute subdural haematomas that were associated with a coagulation deficiency. While in all non-traumatic acute subdural haematomas the interval to surgery should be minimized, early recognition and urgent correction of coagulation deficiencies is certainly indicated.
非创伤性急性硬膜下血肿有助于在无创伤影响的情况下研究血肿所致的发病率和死亡率。虽然已知凝血功能障碍会使自发性脑内血肿的预后恶化，但在非创伤性急性硬膜下血肿中尚未对此进行研究。
在1995年1月至2002年3月期间收入我科的一系列13例非创伤性急性硬膜下血肿中，有9例与凝血病相关的血肿和3例符合“动脉源性自发性急性硬膜下血肿”综合征的血肿。对两组进行了比较。
年龄和性别分布具有可比性。在接受手术的2例与非凝血病相关的血肿中，有2例的出血源为皮质动脉，但在接受手术的4例与凝血病相关的血肿中也有2例如此。与凝血病相关的血肿的平均血肿厚度更高。凝血病相关组入院时的格拉斯哥昏迷评分平均为7.7，死亡率为55.6%。在与非凝血病相关的血肿中，格拉斯哥昏迷评分平均为12.0，死亡率为33.3%。后一死亡率与从文献中收集的一组“动脉源性自发性急性硬膜下血肿”的历史数据相符。
与凝血功能缺陷相关的非创伤性急性硬膜下血肿的预后更差。虽然在所有非创伤性急性硬膜下血肿中都应尽量缩短至手术的间隔时间，但肯定需要尽早识别并紧急纠正凝血功能缺陷。
