Clinical Investigation of Acute Spontaneous Subdural Hematoma Cases

Background: Acute spontaneous subdural hematomas of arterial origin without any traumatic history or vascular anomaly are rarely reported. Here, we report our series of 6 patients with acute spontaneous subdural hematoma. Methods: All patients with acute spontaneous subdural hematoma were surgically treated at our hospital between January 1994 and December 2003. Each patient's constitution, medical history, clinical findings, intraoperative findings, complications, and outcomes were reviewed. Results: The patients were 5 men and 1 woman with a mean age of 53.0 years (range 32-82). Two of the 6 patients had histories of head injury with onset more than 10 years earlier. Other medical histories included hepatitis C, dementia, alcoholism, and hypertension in one patient each. Initial symptoms were rapidly progressive disturbance of consciousness in 5 patients. Surgical operation was performed in all patients, and the bleeding points were identified as ruptures of cortical arteries located near the sylvian fissure. One patient completely recovered, one had a moderate deficit, two had severe deficits, one fell into a vegetative state, and one died (mortality was 16.7%). Conclusion: In many cases, the patients suddenly fell into a serious disturbance of consciousness at the onset, and the outcomes were poor. We emphasize that a very early operation is required for a good outcome.