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Management of Acute Subdural Hematomas from Aneurysmal Rupture

Published online by Cambridge University Press:  18 September 2015

Bryce Weir ,
Terence Myles ,
Moe Kahn ,
Falah Maroun ,
David Malloy ,
Brien Benoit ,
Michael McDermott ,
Douglas Cochrane ,
Gerard Mohr  and
Gary Ferguson
...Show all authors
Bryce Weir*
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Terence Myles
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Moe Kahn
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Falah Maroun
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
David Malloy
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Brien Benoit
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Michael McDermott
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Douglas Cochrane
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Gerard Mohr
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Gary Ferguson
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
Felix Durity
Affiliation:
University Hospital, Edmonton; Foothills Hospital, Calgary; University Hospital, Saskatoon; Health Sciences Complex, St. John’s, Newfoundland; Victoria General Hospital, Halifax; Ottawa Civic Hospital, Ottawa; St. Michael’s Hospital, Toronto; Calgary General Hospital, Calgary; Hôpital Notre Dame, Montreal; University Hospital, London; Vancouver General Hospital, Vancouver
*
Division of Neurosurgery, 11–102 Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6G 2G3
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Abstract:

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Subdural hematomas (SDH) from ruptured aneurysm (RA) are much less common than intracerebral (ICH) hematomas or subarachnoid (SAH) or intraventricular hemorrhage (IVH). With computerized tomography, preoperative diagnosis is now made more often. The authors have collected 18 such cases from a review of 897 cases of RA admitted to eleven medical centers in 1980 and 1981. Nine (50%) of these patients died prior to discharge from hospital. Four (22%) had surgery and died postoperatively and 9 (50%) were operated upon and survived. Thirteen (72%) of the patients showed anisocoria, decreased consciousness and unilateral weakness prior to surgery. Eight (89%) of the fatalities had shown preoperative herniation as opposed to only 5 (56%) of the survivors. The overall incidence of delayed ischemia due to vasospasm was 11% (2 cases). Those who died had greater midline shift and larger SDH on the admission CT scan. Sixteen (89%) of these patients were female. Thirteen (72%) had ruptured aneurysms on the internal carotid artery. All of these hematomas were unilateral and uniformly hyperdense, and the convexity hematomas were crescentic in shape. Seventeen (94%) had evidence of blood in locations other than the subdural space. If the patient is potentially salvageable and has a midline shift, the SDH should probably be evacuated immediately and the aneurysm clipped at the same operation since the development of a tentorial herniation has such an adverse effect on outcome.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 11 , Issue 3 , August 1984 , pp. 371 - 376
Copyright
Copyright © Canadian Neurological Sciences Federation 1984

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