The risk factors for the occurrence of acute brain swelling in acute subdural hematoma

Abstract

There are many cases of acute subdural hematoma (ASDH) in which acute brain swelling (ABS) occurs intra- or post-operative period and the control of intracranial pressure becomes impossible, resulting in death. Consequently, we investigated the risk factors for ABS in ASDH. Thirteen cases were used for this study. The average age was 53.8 years, and all the subjects were males whose Glasgow Coma Scale (GCS) was an average of 4.8 when hospitalized. We examined the relationship of blood gas values (pH, PaO2, PaCO2, HCOj, and base excess) when hospitalized, mean arterial blood pressure (MAP) before surgery, and the presence of hypotension during the surgery with ABS. There were no cases, which showed evidence of hypoxia or hypotension when hospitalized or before the surgery. No statistical differences in blood gas values when hospitalized were observed between the 7 cases with ABS and the 6 cases without ABS. However, all of 7 cases with ABS showed MAP 2 140 mmHg, and 6 cases demonstrated intraoperative hypotension (systolic pressure < 90 mmHg). Conspicuous hypertension before the surgery was shown to be a possible risk factor for ABS. Therefore; MAP ≥ 140 mmHg may be a warning sign for the occurrence of ABS. © Springer-Verlag 2003.