[Course dynamics and early prognosis in traumatic intracranial hemorrhage. II. Subdural hematoma].

181 subdural haematomas were subjected to surgery within a period of 3 years. Basing on the dynamics of their course and on their prognosis, we can differentiate between acute (50.8%, interval up to 24 hours), sub-acute (10.5%, interval 2 to 10 days) and chronic types (38.7%, interval 11 days to 6 months). Acute subdural haematomas are due to severe traumas, mostly combined with skull fractures; in most cases, there is no free interval, and they are associated with severe disturbances of consciousness. Their prognosis is poor (mortality 7.2%) and less due to a space-occupying growth, namely the haematoma, than to the primarily traumatic cerebral lesion. Sub-acute subdural haematomas are often characterized by a free interval; the disturbances of consciousness are less severe, and their prognosis is much more favourable (mortality 26.3%). Chronic subdural haematomas are the sequels of milder traumas, but it is clinically impossible to distinguish them from pachymeningiosis haemorrhagica interna. They become manifest by mental changes, headache and neurological focal symptoms. If treated in time, their prognosis is favourable, the mortality being 10%. All types of subdural haematoma present a characteristic clinical pattern. Atypical courses are much rare than with the epidural haematomas. Preoperative classification with assessment of prognosis can be achieved via findings obtained by computed tomography and angiography of the carotid artery.