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Journal of Korean Neurosurgical Society 1975;4(1): 37-42.
The Clinical Consideration for the Acute Subdural Hematoma.
Young Soo Lim, Jong Hyo Cho, Myoung Sun Moon
Department of Neurosurgery, Seoul Rad Cross Hospital, Seoul, Korea.
Acute subdural hematoma is commonly occurred by severe or minor head injury, which is encountered to neurosurgeons and needed the emergency operation. But the mortality rate of the acute subdural hematoma is still very high(60-90%) in spite of the recently advanced neuroradiology. Neurosurgery and anesthesiology the authors had managed 50 cases of acute subdural hematomas, confirmed surgically, during 24 months from march 1971 to march 1973 and observed clinically. Followings are the results. 1. The male sex was predominantly high in incidence, 6 to 1. the age incidence was high in the 3 rd decade to 5 th decade which is in vigorous social activity. 2. The most common mode of the head injury was the traffic accident in 35 of 50 cases. 15 cases were from other injuries. 3. The level of consciousness of the acute subdural hematoma was various from drowsy consciousness to coma. The lucid interval was developed in 18% of those. 44 cases showed papillary change. 39(88.6%) of these were ipsilateral mydriasis. In 23 of 50 cases had motor disturbance and 78.2% of 23 cases showed contralateral hemiplegia or hemiparesis. The papillary change and hemiplegia were valuable to know the side of hematoma. 4. One of the best diagnostic procedure for the acute subdural hematoma was the angiography. The authors performed the carotid angiography before surgery in all cases. The avascular zone of the angiographic finding was crescentic form in 71.4% of all and the most common site was the parietotemporal region, but rare in the posterior fossa in one case. 5. The mortality rate was 46%. the high mortality was observed in the condition of the old age, persistant coma after surgery, bilateral mydriatic fixed pupil, concomitant profound brain damage and brain swelling. 3 cases of non survival which were in the persistant coma after surgery were died of the complication of severe decubital ulcer, septicemia, pneumonia and cachexia. 6. In 27 survival cases, the hemiplegia, oculomotor palsy, organic dementia and epilepsy were observed as sequelae, which were progressively recovered. 9 of 27 cases were completely recovered to normal social life. But the epilepsy and organic dementia were falt to be the worst sequelae remaining the problem.
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