Rathore Lavlesh, Sahana Debabrata, Kumar Sanjeev, Sahu Rajiv K, Jain Amit K, Tawari Manish, Borde Pravin R
Department of Neurosurgery, DKS-Postgraduate Institute and Research Center, DKS Bhawan, Raipur, Chhattisgarh, India.
Asian J Neurosurg. 2021 Feb 23;16(1):33-43. doi: 10.4103/ajns.AJNS_380_20. eCollection 2021 Jan-Mar.
Traumatic acute subdural hematoma (ASDH) is an oft encountered entity in neurosurgery. While resolution of such thick SDHs usually takes time, certain cases of rapid spontaneous resolution have also been reported. This article attempts to review the pathophysiology, clinical and radiological features of such cases, as well as provide an insight into decision making for their management.
Electronic literature search was done to look for similar cases of spontaneous rapid resolution of ASDH. Five of authors cases have been described. Their clinical and radiological features along with those of cases from literature search were tabulated and analyzed.
A total of 44 relevant cases were included for analyses. Of these, 39 cases were from 33 articles found in existing literature and 5 cases were from author's collection. The M:F ratio was 25:19 with a mean age was 41.84(SD-4.094) years. Twenty -six patients showed "Rapid" neurological improvement (</= 24 hours) while "gradual" neurological improvement (>24 hours) occurred in 10 patients. The mean hematoma resolution time on CT scan was 13.78 hours (SD 16.46) ranging from 1- 72 hours. Twenty-nine patients showed redistribution of hematoma, most commonly to tentorium and falx cerebelli. CT scan findings were classified into 5 types as per the nature of hypodensity around hematoma. The geometric mean time to resolution of hematoma was least for type 2 (7.27 hours) and type 1(7.52 hours) patients.
Selected patients of ASDH with rapid neurological improvement and specific CT findings may show spontaneous resolution of ASDH. Multicentric studies with larger study population may provide better insight into the nature and outcomes of such entities.
创伤性急性硬膜下血肿（ASDH）是神经外科中经常遇到的病症。虽然这种厚硬膜下血肿的消散通常需要时间，但也有一些快速自发消散的病例报道。本文试图回顾此类病例的病理生理学、临床和放射学特征，并深入探讨其治疗决策。
通过电子文献检索寻找ASDH自发快速消散的类似病例。描述了作者的5例病例。将他们的临床和放射学特征以及文献检索中的病例特征制成表格并进行分析。
共纳入44例相关病例进行分析。其中，39例来自现有文献中找到的33篇文章，5例来自作者的病例集。男女比例为25:19，平均年龄为41.84（标准差-4.094）岁。26例患者显示“快速”神经功能改善（≤24小时），而10例患者出现“渐进性”神经功能改善（>24小时）。CT扫描上血肿的平均消散时间为13.78小时（标准差16.46），范围为1至72小时。29例患者显示血肿重新分布，最常见于小脑幕和小脑镰。根据血肿周围低密度的性质，CT扫描结果分为5种类型。血肿消散的几何平均时间在2型（7.27小时）和1型（7.52小时）患者中最短。
具有快速神经功能改善和特定CT表现的ASDH特定患者可能会出现ASDH的自发消散。对更大研究人群的多中心研究可能会更好地洞察此类病症的性质和结果。
