title: Computerized tomography in the assessment of brain shifts in acute subdural hematoma.
abstract: Computed tomography (CT) was used to characterize brain shifts in 30 adult patients (mean age 51.9 years) with fatal supratentorial acute subdural hematomes (ASH) who were admitted within 3 hours of the head trauma. The Glasgow Coma Scale (GCS) score, hematoma width, and midline shift were tabulated. The width of the cistern surrounding the brainstem (CSBS) and the distance from the floor of the fourth ventricle to the posterior clinoid process (IVv-PC) were measured. Opening (+) or disappearance (-) of the suprasellar cistern (SC) was determined using axial CT. The data were compared with those in agematched controls (n = 26) using the Wilcoxon and Kruskal-Wallis tests. The hematomas in the SC(-) group (n = 22, mean GCS score: 3.8 +/- 1.0) were wider (p = 0.02) than those in the SC(+) group (n = 8, mean GCS score: 4.7 +/- 1.5). The CSBS in the SC(+) group was significantly smaller than that in the controls (p < 0.01). In the SC(-) group the CSBS was smaller and the IVv-PC was significantly larger than those in the controls (IVv-PC; p < 0.01) and the SC(+) group (IVv-PC; p < 0.05). In the evolution of brainstem shifts in ASH, when the SC is open the predominant vector is in the direction of the skull base, while when the SC is not observed, an axial vector shifts the brainstem.
authors.affiliation: Department of Neurosurgery, Nagoya University School of Medicine, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kuchiwaki
authors.forename: S
authors.initials: S
authors.lastname: Inao
authors.forename: M
authors.initials: M
authors.lastname: Furuse
authors.forename: N
authors.initials: N
authors.lastname: Hirai
authors.forename: N
authors.initials: N
authors.lastname: Misu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001925:Brain Damage, Chronic / Q000000981:diagnostic imaging / Q000473:pathology; D001930:Brain Injuries / Q000000981:diagnostic imaging* / Q000473:pathology; D001933:Brain Stem / Q000000981:diagnostic imaging* / Q000473:pathology; D002535:Cerebral Aqueduct / Q000000981:diagnostic imaging* / Q000473:pathology; D002946:Cisterna Magna / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007427:Intracranial Pressure / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D014057:Tomography, X-Ray Computed