The Danish Chronic Subdural Hematoma Study-comparison of hematoma age to the radiological appearance at time of diagnosis

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  • Thorbjørn Søren Rønn Jensen, University of Copenhagen
  • ,
  • Nina Andersen-Ranberg, University of Copenhagen
  • ,
  • Frantz Rom Poulsen, Odense University Hospital
  • ,
  • Bo Bergholt
  • Torben Hundsholt, Alborg University Hospital, Aalborg, Denmark.
  • ,
  • Kåre Fugleholm, University of Copenhagen

INTRODUCTION: Chronic subdural hematomas (CSDH) show different radiological characteristics on CT scans at the time of diagnosis. The reason for this is largely unknown. We hypothesize that the imaging characteristics reflect a time-linked pathophysiological evolution. We therefore conducted a retrospective study to examine a possible relation between the hematoma age and the radiological subtype of a CSDH.

METHODS: Demographic data on patients with CSDH were retrieved from a Danish national cohort from 2010 to 2012. CT scans obtained on admission to a neurosurgical department were categorized as homogenous, separated, mixed, or membranous hematoma subtypes. The time from a known date of head injury to time of diagnostic CT was defined as hematoma age. The hematoma age was correlated to radiological hematoma subtype at the time of diagnosis by analysis of variance testing.

RESULTS: In total, 543 patients were analyzed for hematoma age and classified in the following hematoma subtypes: 231 homogenous, 44 separated, 119 mixed, and 149 membranous. Patients with homogenous, separated, mixed, and membranous hematoma subtypes had a median interval of 37, 36, 40, and 60 days from head injury to diagnostic CT. We found that membranous hematoma is significantly older than other subtypes. Comparison between the other radiological subtypes showed no statistical hematoma age difference. The distribution of radiological subtypes in 590 patients without a known head injury was similar to that of patients with a known head injury. Additionally, we found that hematoma age was significantly younger for patients on antiplatelet medication.

CONCLUSION: In this large national cohort, patients with membranous CSDH had a significantly longer interval between head injury and diagnosis compared to other radiological subtypes. This indicates that the radiological appearance of CSDH evolves over time, causing an alteration from different early radiological subtypes to a radiological subtype with membranes.

CLINICAL TRIAL REGISTRATION NUMBER: The study was approved by the Danish Data Protection Agency (journal no.30-1145).

Original languageEnglish
JournalActa Neurochirurgica
Volume162
Issue9
Pages (from-to)2007-2013
Number of pages7
ISSN0001-6268
DOIs
Publication statusPublished - Sep 2020

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