Mixed-density extradural hematomas on computed tomography—prognostic significance

• Published in: Surgical neurology Vol. 71; no. 2; pp. 202 - 206
• Main Authors: Pruthi, Nupur, MCh, Balasubramaniam, Anandh, MS, MCh, Chandramouli, Bangalore A., MCh, Somanna, Sampath, MCh, Devi, Bhagavatula Indira, MS, MCh, Vasudevan, Pillai Shibu, MCh, Subbakrishna, Doddaballapur K., PhD, Vasudev, Mandapati K., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2009; Elsevier
• Subjects: Adult; Biological and medical sciences; Cohort Studies; Computed tomography; Extradural hematoma; Female; Glasgow Coma Scale; Hematoma volume; Hematoma, Epidural, Cranial - diagnostic imaging; Hematoma, Epidural, Cranial - mortality; Hematoma, Epidural, Cranial - surgery; Humans; Hypodensity; Male; Medical sciences; Mixed density; Neurology; Neurosurgery; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Tomography, X-Ray Computed; Treatment Outcome; computed tomography; Glasgow coma score; Prognosis; Mixed density; EDH; Hematoma volume; Hypodensity; CT; subdural hematoma; intracranial pressure; GCS; SDH; CSF; cerebrospinal fluid; ICP; extradural hematoma; Computed tomography; Extradural hematoma; Vascular disease; Nervous system diseases; Surgery; Cardiovascular disease; Computerized axial tomography
• ISSN: 0090-3019; 1879-3339
• DOI: 10.1016/j.surneu.2007.10.032

Abstract Background It has been variably reported that patients who acutely present with low- or mixed-density blood on CT scan are associated with poor clinical outcome. The aim of the study was to correlate the presence or absence of mixed density within EDHs on CT scanning with the clinical outcome. Methods This is a retrospective study of a total of 109 patients with EDHs who were operated on from August 2001 to August 2002. The CT scans were reviewed and classified into 2 categories—predominantly hyperdense and mixed density. This was correlated with clinical details and outcome. Results In all, 43.2% (16/37) of patients in the mixed-density category presented with GCS of no more than 8 as compared with 23.6% (17/72) of patients in the hyperdense group ( P < .05). Mean hematoma volume in the mixed-density group was 72 cm3 as compared with 42 cm3 in the hyperdense group ( P < .05). Mortality rate was significantly higher in the mixed-density category (21.6% vs 4.2%, P < .05). Conclusion The study portends mixed density in EDH as a potent poor prognostic indicator. The mixed density of the clot probably indicates that the clot is rapidly increasing in size and requires even earlier and more aggressive treatment.