Hyperemia beneath evacuated acute subdural hematoma is frequent and prolonged in patients with an unfavorable outcome: a xe-computed tomographic study.
OBJECTIVE
To verify the values and the time course of regional cerebral blood flow (rCBF) in the cortex located beneath an evacuated acute subdural hematoma (SDH) and their relationship with neurological outcome.


METHODS
rCBF levels were measured in multiple regions of interest, by means of a Xe-computed tomographic technique, in the cortex underlying an evacuated SDH and contralaterally in 20 patients with moderate or severe traumatic brain injury and an evacuated acute SDH. Twenty-three patients with moderate or severe traumatic brain injury and an evacuated extradural hematoma or diffuse injury served as the control group. Outcome was evaluated by means of the Glasgow Outcome Scale at 12 months.


RESULTS
Values for the maximum (rCBFmax) and the mean of all rCBF levels in the cortex beneath the evacuated SDH were more frequently consistent with hyperemia. The side-to-side differences in the mean of all rCBF and rCBFmax levels between lesioned and nonlesioned hemispheres were greater in patients with evacuated SDH than in controls (P = 0.0013 and P = 0.0018, respectively). The side-to-side difference in the maximum rCBF value was higher in SDH patients with unfavorable outcomes than in controls at 24 to 96 hours and at 4 to 7 days and higher than in patients with favorable outcomes at 4 to 7 days. The widest side-to-side difference in rCBFmax value was more elevated in patients with an evacuated SDH with unfavorable outcome than in patients with a favorable outcome (P = 0.047), whereas no differences were found in controls. The SDH thickness and the associated midline shift were greater in patients with unfavorable outcomes than in those with favorable outcomes.


CONCLUSIONS
On average, hyperemic long-lasting rCBF values frequently occur in the cortex located beneath an evacuated SDH and seem to be associated with unfavorable outcome.
Neurosurgical and Trauma Intensive Care Unit, Maurizio Bufalini Hospital, Cesena, Italy. achiere@ausl-cesena.emr.it
Arturo
A
Chieregato
Alberto
A
Noto
Alessandra
A
Tanfani
Giovanni
G
Bini
Costanza
C
Martino
Enrico
E
Fainardi
D000328:Adult; D001930:Brain Injuries / Q000503:physiopathology; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D023261:Glasgow Outcome Scale; D020199:Hematoma, Subdural, Acute / Q000150:complications* / Q000473:pathology*; D006801:Humans; D006940:Hyperemia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed