Published: 2017-02-20

Clinical study of acute subdural haematoma – a level I trauma care centre experience

P. Prahaladu, K. Satyavara prasad, B. Rajasekhar, K. Satyanarayana Reddy


Background: Acute subdural hematoma is the most common type of traumatic intra cranial hematoma accounting for 24% cases of severe head injuries and caries highest mortality. The aim of this study is to analyse the clinical spectrum, and to evaluate the postoperative outcome.

Methods: This is a prospective observational Study which included 150 patients  admitted  in King George hospital, Andhra Medical College, Visakhapatnam, India over the past two years (01st August 2013 to 30th August 2015) with head injury, diagnosed to have Traumatic subdural Hemorrhage. A detailed clinical history, physical examination, CT scan was performed in all patients. Patients who were subjected to surgery, post-operative out-come were compared.

Results: The maximum patients suffering from SDH are in the age group of 20-40 years (63%) with male predominance (73%). The most common mode of injury is RTA (73.33%). 40% of cases presented to hospital with gcs <8. Pupillary reaction, hypotension, CT scan findings i.e. thickness of hematoma >10mm and midline shift of >5mm, Basal cisterns obliteration, post traumatic seizure and delay in interval between the surgery had greatly affected on outcome of patients. Out of 150 cases, surgical approach was considered in 120 patients while remaining 30 patients were managed conservatively.

Conclusions: Interval between injury to surgery with interval <4 hours having favourable outcome. Basal cistern obliteration, which is an indicator of increased intra cranial pressure is the single most important factor for unfavourable outcome. Hypotension and post traumatic seizures influence high mortality.


Glasgow coma scale, Glasgow outcome, Scale subdural hematoma

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Ramamurthi B. Acute subdural haematoma. In : Handbook of clinical neurology : Injuries of the brain and skull. Vinken PJ, Bruyn GM (eds). North Holland Publishing Company Amsterdam. 1976;275.

Bagchi A. An introduction of head injuries; Oxford University Press, Calcutta. 1980;58-9.

Jamieson KG, Yelland JD. surgically treated traumatic subdural hematomas J Neurosurg. 1972;37:137.

Kalyana Raman S, Ramamurthi B subdural hematoma. Neurol. 1970;18:18.

Abernethy J. surgical observations on injuries of head Dobson. 1811;2.

Burrows G. Lond Med Gaz. 1835;16:710.

Jacobson HH. Inter hemispherically situated hematoma. Case report. Acta radiol. 1995;43:23.

Kristiansen K, Tandon PN. Diagnosis and surgical treatment of severe cranio cerebral injuries. J Oslo City Hosp (Supl.). 1960;10:107-213.

Miller SD, Statham PF. Surgical management of traumatic intracranial haematomas. In: Operative Neurosurgical Techniques. Schmidek HH, Sweet WH (eds.) W.B. Saunders Company, Philadelphia. 1995;73-80.

Pospiech J, Kalff R, Herwegen H. Prognostic factors in acute traumatic epi - and subdural haematoma. Aktuelle Traumatol. 1993;23:1-6.

Gutam MB, Moulton RJ, Sullivan I. Risk factors predicting operable intracranial haematomas in head injury. J Neurosurg. 1992;77:9-14.

Rao D, Subramaniam MV, Reddy MVR. Mortality in head injuries. Neurol. 1967;15:1.

Kristianson K, Tandon PN. Diagnosis and treatment of severe oedema. 2001.

Tandon PN. Management of head injury: Fads, fashions and facts. Neurol India. 1986;34:1-30.

Seelig J, Becker DP, Miller JD. Traumatic acute sub dural hematoma. N Engl J. Med. 1981;304:1511-8.

Marshall. The outcome of severe closed head injury. J.neurosurg,75,s.J. Neurosurg. 1991;75,s28-36.

Willberger J, Harris E. Acute subdural hematoma J Neurosurgery. 1991;74:212-8.

Gennereli T. A Influence of type of lesion on outcome from severe head injury.J.Neurosurg. 1982;56:26-32.

Stone JL. Acute subdural hematoma :progress in definition, clinical pathology and therapy Surg Neurol. 1983;19:216-31.

Vigouroux RP, Guillermain P. Post-traumatic hemisphere contusion and laceration. In: Progress in neurological surgery. Krayenbuhl H, Maspco PE, Sweet WH (eds). 1981;10:49-163.

Hasselberger K. Prognosis after acute sub dural and extra dural hemorrhage. Acta neurochir. 1988;90:111-6.