Dating subdural hemorrhage

There were no complaints of nausea or vomiting. His medical history only included glaucoma for which he used Latanoprost eye drops Xalatan. Two months earlier our patient fell on the back of his head after tripping over a lose tile. There were no neurologic symptoms at that time. A CT-scan of his skull and brain excluded an intracranial bleed or skull fracture and the patient was safely discharged home. His recovery was uneventfull until 10 days ago. Neurologic examination in our ED revealed a wide based gait, a tendency to fall to the left, an inadequate coordination response and a dysdiadochokinesia of the right hand.

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His Glascow Coma Scale was maximal and further neurologic and general examination were unremarkable. The CT-scan of skull and brain Figure 1 revealed a relatively large bilateral subdural hematoma with possibly an small active haemorrhage in the rightsided frontolateral area. There was no midline shift because of the symmetry and there was no reduced patency of the basal cisterns.

Subdural hematoma without midline shift and with active bleed in right frontoparietal area. Because of the slow onset of symptoms and the overall clinical appearence, the neurosurgeon opted for semi-elective surgery and admitted the patient for close observation with Dexamethasone 4 mg twice daily. During surgery the next day a bilateral burr hole was made, the dura mater was incised and access to both hematomas was achieved. Two partially liquified, dark redcoloured hematomas were evacuated.

Information on the findings during surgery were not available to us.

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The neurosurgeon irrigated untill clear liquids returned and thereby excluded an active bleed on the right side. The wounds were closed with passive drains in situ, which did not return serosanguinolent liquids up till their removal the next morning. The patient recovered uneventfully without any persisting neurologic deficit and was discharged home after two days. In patients with underlying low hemoglobin and platelets conditions such as sickle cell anemia , acute subdural hemorrhage may be hypodense even in the acute phase As the clot ages and protein degradation occurs, the density starts to drop.

The key to identification is visualizing a number of indirect signs, including:. Rarely, the periphery of the SDH may calcify, see calcified chronic subdural hematoma for an in-depth discussion regarding the CT appearance of this entity. Acute on chronic subdural hematomas refers to a second episode of acute hemorrhage into a pre-existing chronic subdural hematoma.

It typically appears as a hypodense collection with a hematocrit level located posteriorly. A similar appearance can be seen in patients with clotting disorders or on anticoagulants 4. The appearance of a hematoma varies with the biochemical state of hemoglobin which varies with the age of the hematoma. It may appear biconvex-shaped on the coronal plane rather than crescent-shaped which is a typical appearance on the axial plane.

Treatment depends primarily on the amount of mass-effect and neurological impairment caused by the collection, and thus correlates with the size of the subdural hemorrhage. Small collections — so-called 'smear subdurals' — especially those which are chronic and are not causing symptoms can be observed with serial CT scans. Symptomatic collections need to be surgically evacuated. In the acute setting, this should be performed rapidly within 4 hours 3 and usually requires a craniotomy as the clot is not easily evacuated via burr holes.

The compressed brain can take some time to re-expand, and subdural collections may re-accumulate.

Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study

To quiz yourself on this article, log in to see multiple choice questions. You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Unable to process the form. Check for errors and try again. Thank you for updating your details. Log in Sign up. Articles Cases Courses Quiz. About Blog Go ad-free. Though single slice CT scanners are not used in state of the art head scans [ 29 ], the constraints on the availability of advanced scanners in a developing country like India, has compelled us to use the resources at hand. Considering a few recent studies being done on the postmortem use of the radiological technologies in the interpretation of the cranio-cerebral traumatic injuries [ 23 , 24 ] one can with some confidence say that these methods hold a lot of stake for the future of radiological autopsy or may indeed replace few of the routinely conducted forensic autopsies of the present times.

The present study has adopted one of the most objective and scientific methods in determining the attenuation of the subdural haematomas in contrast to the other previous studies where none has been applied or has not been mentioned. Though this study has been limited to the early post-traumatic intervals, it could still grasp some significant findings in the form of variations in the attenuation of the subdural haemorrhage with relation to time of the injury. The attenuation of the acute subdural haemorrhage decreased with increase in the post-traumatic interval.

On further classification of these HU numbers about post-traumatic intervals, information was obtained on the range of attenuation for a particular post-traumatic interval. The variations in the hospital care and treatment, the mode of injuries high velocity , have considerably changed over the years and hence could have contributed to the observed variations despite proper study design. These are also in part due to the dynamic character of such injuries and the various manner in which trauma victims react to an injury.

Subdural Hematoma

National Center for Biotechnology Information , U. J Clin Diagn Res. Published online Apr 1. Find articles by Murali Gundu Rao. Find articles by Dalbir Singh.

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Find articles by Niranjan Khandelwal. Find articles by Suresh Kumar Sharma. Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Introduction Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes.

Materials and Methods The study included a total of cases of closed head injury with subdural haemorrhage. Results Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. Conclusion The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past.

Attenuation coefficient, Computed tomography, Post-traumatic interval, Subdural haemorrhage, Volume. Introduction Subdural Haemorrhage SDH is a form of brain haemorrhage in which there is a collection of blood between the dura and the arachnoid layers of the meninges. Radiological Procedure Non-contrast computed tomography of the head was done using single slice hi-speed GE machine scanner with a tube current of mA, tube voltage of kVp and a slice thickness of 10 mm Window Width HU, Window centre HU. Results A total of cases in the age group of years were studied.

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  • Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study.
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Open in a separate window. Frequency distribution of cases according to the post-traumatic interval. Kolmogorov Smirnov test for testing normality of data.

Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

Time Observer 1 1 st reading Observer 1 2 nd reading Observer 1 3 rd reading Observer 2 1 st reading Observer 2 2 nd reading Observer 2 3 rd reading Kolmogorov Smirnov- Z 1. The cut value is. Variables in the Equation B S.

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  • Dare to date: age estimation of subdural hematomas, literature, and case analysis..
  • Dating of Acute and Subacute Subdural Haemorrhage: A Histo-Pathological Study?

Exp B Odds Ratio Variable s entered on step 1: Discussion The timing of a traumatic event by post-mortem findings carries immense significance for the forensic experts. Limitations of The Study The study was limited by the small sample of materials investigated. Future Prospects A long-term study involving more number of cases helps in the better understanding of the attenuation variations of the SDH with relation to time. Further this study could be extended to cases below 18 years of age that hold a lot of medico-legal significances. More innovative research can be done by the application of HU measurements on different organs in determining the time since death.

Conclusion The present study has adopted one of the most objective and scientific methods in determining the attenuation of the subdural haematomas in contrast to the other previous studies where none has been applied or has not been mentioned. Forensic Neuropathology and associated neurology. Berlin Heidelberg New York: Fundamentals of Diagnostic Radiology. CT-number variability in thoracic geometry.

Surgical management of acute subdural haematomas. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: Bedside twist drill craniostomy for chronic subdural haematoma: Preliminary results of a prospective randomized study. Overview, Computed Tomography [Internet]. MRI of the central nervous system.

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