Korean J Neurotrauma.  2018 Oct;14(2):61-67. 10.13004/kjnt.2018.14.2.61.

Causes and Trauma Apportionment Score of Chronic Subdural Hematoma

Affiliations
  • 1Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea. ksleens@sch.ac.kr

Abstract


OBJECTIVE
The pathophysiology of chronic subdural hematoma (CSH) is not yet clear. Trauma alone is not sufficient to result in CSH in young individuals, while a trivial injury can result in CSH in older adults. Although the causality and apportionment of trauma are important issues in CSH, especially in terms of insurance, it is too obscure to solve all struggles.
METHODS
There are three key factors for producing CSH. First, CSH necessitates a potential subdural reservoir. Other important precipitating factors are trauma and coagulopathy. However, these factors are not sufficient to cause CSH development. The trauma apportionment score (TAS) can be used to compare the relative importance of these three factors. Here, we applied the TAS to 239 consecutive cases of CSH. We retrospectively obtained the patients' history and laboratory results from their medical records.
RESULTS
The TAS ranged from −5 to 5. The most common score was 0. If we defined the cause of CSH as being combined when the TAS was 0, then the cause was combined in 30 cases (12.6%). If we extended the criteria for a combined cause from 0 to −1 to 1, the cause was combined in 107 cases (44.8%). Regardless of the criteria used, traumatic CSHs were more common than were spontaneous CSHs. Spontaneous CSHs were more common in older than in younger patients (p < 0.01, Fisher's exact test).
CONCLUSION
The TAS is a useful tool for differentiating the causality of CSH.

Keyword

Aging; Causality; Craniocerebral trauma; Hematoma, subdural, chronic; Insurance; Intracranial pressure

MeSH Terms

Adult
Aging
Craniocerebral Trauma
Hematoma, Subdural, Chronic*
Humans
Insurance
Intracranial Pressure
Medical Records
Precipitating Factors
Retrospective Studies

Figure

  • FIGURE 1 Distribution of the estimated causes of 239 cases of chronic subdural hematomas. When the trauma apportionment score is −1 to 1, the cause is regarded as combined. This extended criteria may be suitable for a legal judgment or an economical estimation.

  • FIGURE 2 Distribution of the estimated causes of 239 cases of chronic subdural hematomas. When the trauma apportionment score is 0, the cause is regarded as combined. This narrow criteria may be a useful tool for medical or academical study.

  • FIGURE 3 Computed tomography scans of Case 1 to 3. A chronic subdural hematoma (A) was developed on the opposite side of the acute subdural hematoma (B) after trauma in Case 1. Bilateral hematomas (C, D) were found in Case 2. Isodense chronic subdural hematoma on the left side (E) was resolved after a burr-hole drainage (F) in Case 3.

  • FIGURE 4 Computed tomography scans and magnetic resonance imaging of Case 4. Chronic subdural hematoma with calcification was evacuated by a burr-hole on October 2014 (D), however it remained over almost 10 years.

  • FIGURE 5 Computed tomography scans of Case 5 and 6. An arachnoid cyst on the left temporal pole (B) was noticed after burr-hole drainage of the chronic subdural hematoma on the same side (A) in Case 5. An isodense chronic subdural hematoma (C) were drained by a burr-hole (D) in Case 6. However, it recurred on the same side (E). The hematoma was resolved after a burr-hole drainage (F).


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