CT findings linked to dangerous subdural hematoma expansion
New CT imaging data could enable providers to more accurately predict the expansion of subdural hematomas (SDH), potentially guiding more effective management strategies.
Published in Emergency Radiology, the data include both clinical and imaging features that could be indicative of SDH expansion. If left untreated, SDH expansion puts added pressure on the brain, which can lead to damage, impaired neurological function and even death. The risks of experiencing an SDH increase with age and individuals over 65 are considered among the most vulnerable to the associated complications.
There are numerous characteristics, however, that could help providers determine the likelihood a patient’s SDH will expand.
“The incidence of subdural hematomas is increasing due to the aging population, frequent use of anticoagulants/antiplatelets, and fall-related trauma. While some acute SDHs remain stable and require no intervention, others expand, necessitating neurosurgical management,” David Yousem, MD, with the Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institution, and colleagues explained. “Our study objective was to better identify predictors of acute SDH enlargement to guide clinical management.”
The team retrospectively analyzed over 32,000 noncontrast head CT scans completed over 6 years, homing in on 262 patients with acute SDH. Each patient’s demographic, clinical and radiologic factors were assessed to determine whether any particular detail was associated with hematoma enlargement and the need for surgical intervention.
Around 25% of the patients showed SDH growth on follow-up imaging. Factors found to be linked with enlargement included larger hematomas at baseline, concurrent subarachnoid hemorrhage and a history of hypertension. Furthermore, convexity location, and midline shift on imaging were also associated with expansion. The team suggested a size threshold of 8.5 mm was an accurate indicator of the need for surgery. None of the SDHs smaller than 3 mm required surgery, though some did expand slightly.
The researchers suggested their findings offer valuable insights that can be used to guide providers in treatment decisions. However, they acknowledged additional prospective studies are still needed, especially regarding SDHs smaller than 3mm in size on initial imaging.
Read more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.