ArticleNeurosurgical review2018
Clinical investigation of chronic subdural hematoma with impending brain herniation on arrival.
Article in Neurosurgical review, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Warfarin-associated Chronic Subdural Hematomas May Exhibit a Shorter Post-traumatic Interval: An Observational Study.Neurologia medico-chirurgica · 2026Observational
- Preliminary efficacy analysis of middle meningeal artery embolization using Glubran 2 for chronic subdural hematoma.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Article
- Prognostic significance of systemic inflammation response index, systemic immune-inflammation index and neutrophil-to-lymphocyte ratio in patients with chronic subdural hematoma after burr hole drainage.Frontiers in neurology · 2025Article
- Risk factors of prognosis in older patients with severe brain injury after surgical intervention.European journal of medical research · 2023Article
- Efficacy evaluation of neuroendoscopyWorld journal of clinical cases · 2022Article
- Chronic Subdural Hematoma (CSH) is Still an Important Clinical Problem. Analysis of 700 Consecutive Patients.Translational neuroscience · 2019Article
- Identity of growing pulsatile mass lesion of the scalp after blunt head injury: Case reports and literature review.Trauma case reports · 2018Article
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Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Chronic subdural hematoma (CSDH) with brain herniation signs is rarely seen in the emergent department. As such, there are few cumulative data to analyze such cases. In this study, we evaluated the clinical features, risk factors, and rates of completion with impending brain herniation on arrival in a cohort study. We analyzed 492 consecutive patients with CSDH between January 2010 and October 2015. First, we analyzed the clinical factors and compared them between patients with or without brain herniation signs on admission. Second, we compared clinical factors between patients with or without completion of brain herniation after operation among patients who had brain herniation signs on arrival. Eleven (2.2%) patients showed brain herniation signs on arrival, and six patients (1.2%) progressed to complete brain herniation. Patients with brain herniation signs on arrival were significantly older (P = 0.03) and more frequently hospitalized with a concomitant illness (P < 0.0001). Niveau formation (P = 0.0005) and acute-on CSDH (P = 0.0001) on computed tomography were also more frequently seen in patients with brain herniation signs. Multivariate logistic regression analysis showed that age older than 75 years (OR 2.16, P < 0.0001), niveau formation (OR 3.09, P < 0.0001), acute-on CSDH (OR 14, P < 0.0001), and admitted to another hospital (OR 52.6, P < 0.0001) were independent risk factors for having had brain herniation signs on arrival. On the other hand, having a history of head injury (P = 0.02) and disappearance of the ambient cistern (P = 0.0009) were significantly associated with completion of brain herniation. The prognosis was generally poor if the patient had presented with brain herniation signs on admission. Our results demonstrate that the diagnosis is often made late, despite hospitalization for a concomitant illness. When the elderly show mild disturbance of consciousness, physicians except neurosurgeons need to consider the possibility of CSDH regardless of a recent history of head injury.
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