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Management of Patients Presenting with Acute Subdural Hematoma due to Ruptured Intracranial Aneurysm.

Marbacher S, Tomasi O, Fandino J - Int J Vasc Med (2012)

Bottom Line: Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury.Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma.Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland.

ABSTRACT
Acute subdural hematoma is a rare presentation of ruptured aneurysms. The rarity of the disease makes it difficult to establish reliable clinical guidelines. Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury. Fast decision-making is required to treat this life-threatening condition. Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma. This paper reviews initial clinical and radiological findings, diagnostic approaches, treatment modalities, and outcome of patients presenting with aneurysmal subarachnoid hemorrhage complicated by acute subdural hematoma. Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.

No MeSH data available.


Related in: MedlinePlus

Illustrative schematic diagram of the protocol (management algorithm) for diagnosis and treatment of aneurysmal acute subdural hematoma. CT = computed tomography. CTA = CT angiography. DSA = digital subtraction angiography. * = if available.
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fig3: Illustrative schematic diagram of the protocol (management algorithm) for diagnosis and treatment of aneurysmal acute subdural hematoma. CT = computed tomography. CTA = CT angiography. DSA = digital subtraction angiography. * = if available.

Mentions: In patients who are in good neurological condition at the time of admission, management may proceed in a standard manner (Figure 3, left side of the flowchart). After initial CT and CTA examination, DSA is the diagnostic modality of choice to verify the angioarchitecture of the aneurysm. If the aneurysm is suitable for endovascular obliteration and the aSDH remains clinically insignificant, the aneurysm can be occluded during the same procedure [4]. If a decision is made to occlude the aneurysm surgically, DSA provides relevant anatomical information and guidance in determining a clipping strategy and surgical approach.


Management of Patients Presenting with Acute Subdural Hematoma due to Ruptured Intracranial Aneurysm.

Marbacher S, Tomasi O, Fandino J - Int J Vasc Med (2012)

Illustrative schematic diagram of the protocol (management algorithm) for diagnosis and treatment of aneurysmal acute subdural hematoma. CT = computed tomography. CTA = CT angiography. DSA = digital subtraction angiography. * = if available.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3303750&req=5

fig3: Illustrative schematic diagram of the protocol (management algorithm) for diagnosis and treatment of aneurysmal acute subdural hematoma. CT = computed tomography. CTA = CT angiography. DSA = digital subtraction angiography. * = if available.
Mentions: In patients who are in good neurological condition at the time of admission, management may proceed in a standard manner (Figure 3, left side of the flowchart). After initial CT and CTA examination, DSA is the diagnostic modality of choice to verify the angioarchitecture of the aneurysm. If the aneurysm is suitable for endovascular obliteration and the aSDH remains clinically insignificant, the aneurysm can be occluded during the same procedure [4]. If a decision is made to occlude the aneurysm surgically, DSA provides relevant anatomical information and guidance in determining a clipping strategy and surgical approach.

Bottom Line: Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury.Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma.Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Kantonsspital Aarau, 5001 Aarau, Switzerland.

ABSTRACT
Acute subdural hematoma is a rare presentation of ruptured aneurysms. The rarity of the disease makes it difficult to establish reliable clinical guidelines. Many patients present comatose and differential diagnosis is complicated due to aneurysm rupture results in or mimics traumatic brain injury. Fast decision-making is required to treat this life-threatening condition. Determining initial diagnostic studies, as well as making treatment decisions, can be complicated by rapid deterioration of the patient, and the mixture of symptoms due to the subarachnoid hemorrhage or mass effect of the hematoma. This paper reviews initial clinical and radiological findings, diagnostic approaches, treatment modalities, and outcome of patients presenting with aneurysmal subarachnoid hemorrhage complicated by acute subdural hematoma. Clinical strategies used by several authors over the past 20 years are discussed and summarized in a proposed treatment flowchart.

No MeSH data available.


Related in: MedlinePlus