Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm |
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| Institution: | 1. Department of Neurological Surgery, Vall d’Hebron University Hospital, Paseo Vall D’Hebron, 119-129, Barcelona 08035, Spain;2. Neurotraumatology and Neurosurgery Research Unit, Vall d’Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain;1. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;2. Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, USA;1. Department of Neurology, New York University School of Medicine, 240 East 38th Street, 20th Floor, New York, NY 10016, USA;2. Department of Population Health, New York University School of Medicine, New York, NY, USA;3. Department of Ophthalmology, New York University School of Medicine, New York, NY, USA;1. Department of Neurosurgery, The Johns Hopkins University School of Medicine, 600 North Wolfe Street, Meyer 5-185, Baltimore, MD 21287, USA;2. Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA;1. Department of Neurosurgery, Rush University Medical Center, 1725 W. Harrison St., Suite 855, Chicago, IL 60612, USA;2. Department of Pathology, Rush University Medical Center, Chicago, IL, USA |
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| Abstract: | Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10 mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. |
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| Keywords: | Acute subdural hematoma Coma Outcome Prognosis Ruptured intracranial aneurysm Subarachnoid hemorrhage |
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