• Subdural hematomas were found at operation in 300 patients out of 30,000 hospitalized for recent head injuries. Diagnosis was difficult, since abnormal neurological signs were frequently not of localizing value. Marked dilation of the pupil on one side was associated with ipsilateral lesions in 35 cases, contralateral in 9, and bilateral in 12.
The prognosis was related to the degree of traumatic brain injury and to the timing of operation. Operation to save life must usually be done before the appearance of coma.
Patients in whom operation became necessary during the first seven days were classified as having acute subdural hematomas; of the 93 patients in this group, 67 died. There was a subacute group in which operation was done on the 7th to 22nd day; of 132 patients in this group, 31 died. Of 75 patients in the chronic group, in whom operation was done later than 21 days after the trauma, 19 died.
Progressive, often fluctuating, stupor, developing gradually after a lucid interval, is characteristic of hematoma. Operation relieves the symptoms of the hematoma but not those caused by irreversible damage to the brain itself. It is important to recognize the existence of the subacute group, since patients in this group required surgery to save life on the 7th to 21st day after injury.
Echlin FA, Sordillo SVR, Garvey TQ. ACUTE, SUBACUTE, AND CHRONIC SUBDURAL HEMATOMA. JAMA. 1956;161(14):1345–1350. doi:10.1001/jama.1956.02970140001001
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