Selected Topics: Neurological Emergencies

, Abstract—Background: Patients with subdural hematomas (SDH) are frequently transferred to tertiary care centers. Although many prognostic factors, treatment strategies, and outcomes for convexity SDH have been reported, little is known about falcine and tentorial SDH. Objectives: To describe features and outcomes of isolated falcine and tentorial SDH. Methods: We reviewed clinical/radiographic findings, treatment, length of stay (LOS), and outcome of adult patients transferred to a tertiary care center for acute SDH. Characteristics of patients with isolated falcine/tentorial SDH and outcomes (favorable [discharge to home/ acute rehabilitation] vs. unfavorable [death/hospice/skilled nursing facility/long term care]) were assessed with univariate analyses. Results: Of 210 patients with SDH, mean age was 69.5 years; 117 were male; 98 (47%) underwent surgical SDH evacuation. Twenty-seven patients had isolated falcine or tentorial SDH, with known traumatic etiology in 23. None of the falcine/tentorial SDH patients required surgery or intubation. Compared with convexity SDH, patients with falcine/tentorial SDH were younger (59.7 vs. 70.9 years, p = 0.01), had higher admission Glasgow Coma Scale scores at the referring (p = 0.01) and receiving facility (p = 0.004), and shorter median intensive care unit LOS (1 vs. 3, p < 0.0001). All patients (100%) with falcine/tentorial SDH had favorable outcome vs. 68% with convexity SDH (p = 0.0005). Conclusion: Isolated tentorial/falcine SDH without associated neurological deficits represent a benign entity among acute SDH, with no need for surgical intervention, short LOS, and favorable outcome. Our data indicate that for these patients, in the absence of complicating factors, transfer to a tertiary care center may not be routinely indicated. 2015 Elsevier Inc.

[1]  O. Samuels,et al.  Interhospital Transfer of Neurosurgical Patients to a High-Volume Tertiary Care Center: Opportunities for Improvement. , 2015, Neurosurgery.

[2]  A. Levy,et al.  Outcomes of a nontransfer protocol for mild traumatic brain injury with abnormal head computed tomography in a rural hospital setting. , 2014, World neurosurgery.

[3]  A. Maas,et al.  Surgical management of traumatic interhemispheric subdural hematoma. , 2014, Turkish neurosurgery.

[4]  S. Prabhakaran,et al.  Predictors of mortality in nontraumatic subdural hematoma. , 2013, Journal of neurosurgery.

[5]  Katharina M. Busl,et al.  Treatment of Acute Subdural Hematoma , 2013, Current Treatment Options in Neurology.

[6]  H. Nawashiro,et al.  Traumatic peritentorial subdural hematomas: a study of 32 cases. , 2012, Turkish neurosurgery.

[7]  A. Carlson,et al.  Low rate of delayed deterioration requiring surgical treatment in patients transferred to a tertiary care center for mild traumatic brain injury. , 2010, Neurosurgical focus.

[8]  K. Slavin,et al.  NEUROSURGICAL EMERGENCY TRANSFERS TO ACADEMIC CENTERS IN COOK COUNTY: A PROSPECTIVE MULTICENTER STUDY , 2008, Neurosurgery.

[9]  Sujata Subramanian,et al.  Advanced age and preinjury warfarin anticoagulation increase the risk of mortality after head trauma. , 2006, The Journal of trauma.

[10]  Jamshid Ghajar,et al.  Surgical management of acute subdural hematomas. , 2006, Neurosurgery.

[11]  T. Masaryk,et al.  Bilateral tentorial subdural hematoma without subarachnoid hemorrhage secondary to anterior communicating artery aneurysm rupture: a case report and review of the literature. , 2004, AJNR. American journal of neuroradiology.

[12]  W. Verhagen,et al.  Interhemispheric subdural hematoma in adults: case reports and a review of the literature. , 1995, Neurosurgery.

[13]  M. Baldini,et al.  Typical interhemispheric subdural haematomas and falx syndrome: four cases and a review of the literature. , 1995, Zentralblatt fur Neurochirurgie.