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Objective: Evaluation of the clinical findings and computed tomography results of patients with ASDH (acute subdural hematoma) retrospectively. Methods: In this study, 106 patients admitted to our clinic with acute subdural hematoma between January 2013- March 2017, were examined retrospectively. Each case was evaluated according to age, sex, etiology of subdural hematoma and computed tomography results. Computed tomography (CT) sections of the cases were examined by calculating in terms of midline shift, hematoma volume and densities. The results were evaluated statistically. Results: Meanage of 106 acute SDH cases in neurosurgery care services were 37.93±27.16 (1-89), [80 (75.5%) men, 26 (24.5%) women]. Twenty three of patients (21.7%) were operated. 65 (61.3%) of the cases, had resorbed spontaneously. However, 12 (11.3%) men and 6 (5.6%) women patients died during our follow-up, who had contusion, edema, or other systemic findings in addition to the midline shift in cranial CT images. Most common reasons for application were traffic accident in 48 cases (45%), falling in 23 cases (22%), assault in 14 cases (13%), gun fire injury in 11 cases (10%) with, and 10 cases (10%) with spontaneous bleeding. There was no statistical significance in comparison between men and women in terms of hematoma volume-density and midline shift. Mean volume of hematoma was 22.54±2.45cm3 (4-120), mean density of subdural hematoma was 52.35±15.12 HU (Hounsfield Units) (18-76), midline shift was 2.34±2,99mm (0-17.25) in cases on brain tomography. There was a positive correlation between age and subdural hematoma volume statistical evaluation (p<0.001, r=0.425). There was a negative correlation between the age and the assessment of hematoma density (p<0.05, r=-0.21). Conclusions: In our study, we evaluate patients applied to our clinic with ASDH, in terms of etiology, clinical and radiologically. Cranial CT is an important diagnostic tool for these patients. In cranial CT, additional findings in ASDH significantly increase mortality. In patients with ASDH, as age increased, hematoma volume increased and densities decreased. In elderly patients, ASDH may develop after minor trauma and symptoms may appear late. [ABSTRACT FROM AUTHOR]

Akut posterior fossa subdural hematom nadir olarak gözlenir ve çoğu travmaya bağlıdır. Travmatik olmayanlar ise anti-koagulan tedavi görmüş yada idiopatik trombositopenik purpura hastalarında rapor edilmiştir. Çalışmamızda ani ve ciddi oksipital baş ağrısı ile birlikte halsizlik, tekrarlayan kusmalar, dengesiz duruş ve yürüyüşü olan iranlı 57 yaşındaki bir erkek rapor edilmiştir. Bu kişi hipertansiyon veya diabet hastası değildir. Başında travma geçmişi bulunmamaktadır ve kişi uyuşturucu yada alkol kullanmadığını söylemektedir. Akut intra serebral hemoraji için ön bir tanı yapıldı. CT beyin taraması, posterior fossa bölgesinde sağ taraflı, ekstra aksiyal hilal şeklinde yoğunlaşmış bir alan olduğunu gösterdi. Rutin kan testleri, kanama zamanı, koagülasyon durumu ve trombosit sayımı normaldi. Hastada spontan gelişen akut infratentoryal subdural hematom vardı. Hasta tedavi edildi ve 5 gün sonra iyi bir şekilde taburcu edildi. O zamandan beri hasta klinik olarak veya radyolojik olarak takip edilemedi, çünkü hasta irana geri döndü. Hastanın durumu, klinik seyiri ve görüntüleri konservatif bir yönetim gerektirmiştir. Dolayısıyla genel anlamda hastanın durumu nispeten iyi olsada, CT beyin taramasını iyi yorumlanmadıkça ve olası teşhis konusunda önceden fikir sahibi olunmadıkca hastalık kolayca gözden kaçabilir.

Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.