title: Acute subdural hematoma because of boxing.
abstract: BACKGROUND
  To identify factors determining the clinical characteristics and prognosis of acute subdural hematoma (ASDH) arising from boxing injuries by comparing with ASDH due to any nonboxing cause.
  
  
  METHODS
  Two groups were selected for this study: 10 patients with ASDH because of boxing injuries and 26 patients with nonboxer ASDH. All of the patients underwent neurologic examination by neurosurgeons. Primary resuscitation and stabilization as well as operative therapy were performed to all patients according to the European Brain Injury Consortium Guidelines. Two groups were compared in terms of age, the Glasgow Coma Scale at admission, neurologic findings, craniogram and brain computed tomography scan findings, operative findings, and prognosis. As potential prognostic indicators for boxers, the time interval until surgery, the Glasgow Outcome Scale, hematoma thickness, midline shift, and the site of bleeding were analyzed.
  
  
  RESULTS
  The characteristics of patients because of boxing injuries are that patients were younger, had lucid interval, and had no cerebral contusion or contralateral brain injury. There was no significant difference in initial Glasgow Coma Scale, hematoma thickness, midline shift, and their prognosis. The most peculiar clinical presentation of boxers' ASDH was that all bleedings were limited from "bridging veins" or "cortical veins." The prognosis of boxers was most closely correlated with the site of bleeding (r2 = 0.81; p = 0.0001) and the midline shift (r2 = 0.67; p = 0.007).
  
  
  CONCLUSIONS
  Our study shows that ASDH because of boxing is characterized by bleeding from bridging or cortical veins, and that the site of bleeding is a significant determinant of their prognosis.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Itabashi-ku, Tokyo, Japan. hkushi@med.nihon-u.ac.jp
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kushi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Sakagami
authors.forename: Jyoji
authors.initials: J
authors.lastname: Ohtsuki
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Tanjoh
mesh_terms: D000293:Adolescent; D000328:Adult; D001914:Boxing / Q000293:injuries*; D016022:Case-Control Studies; D015600:Glasgow Coma Scale; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D011379:Prognosis; D012307:Risk Factors; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome