title: Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.
abstract: Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH.
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain; Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain. Electronic address: ratorne@vhebron.net.
authors.forename: Ramon
authors.initials: R
authors.lastname: Torné
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Hernández
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain.
authors.forename: Fabián
authors.initials: F
authors.lastname: Romero-Chala
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain; Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Fuat
authors.initials: F
authors.lastname: Arikan
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain; Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Vilalta
authors.affiliation: Department of Neurological Surgery, Vall d'Hebron University Hospital, Paseo Vall D'Hebron, 119-129, Barcelona 08035, Spain; Neurotraumatology and Neurosurgery Research Unit, Vall d'Hebron Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sahuquillo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D003128:Coma / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D020199:Hematoma, Subdural, Acute / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
keywords: Acute subdural hematoma; Coma; Outcome; Prognosis; Ruptured intracranial aneurysm; Subarachnoid hemorrhage