Acute Subdural Hematoma Regarding Glial Cystic Changes– A Case Report and Literature Review

Acute Subdural Hematoma Regarding Glial Cystic Changes– A Case Report and Literature Review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Acute Subdural Hematoma Regarding Glial Cystic Changes– A Case Report and Literature Review Daniel Encarnación-Santos, Dmitriy Rubenovich-Chikava, Murat Pachev, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3967434/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This report attempts to examine a controversial case of trauma-associated acute subdural hematoma (ASH). In that case, surgical intervention indicates an intraoperative craniectomy with trephine evacuation or, if the patient is eligible, a Decompressive Craniectomy. Clinical Case Description A 51-year-old male was referred to our emergency room due to severe dysarthria and left hemiparesis precipitated by a traumatic event to the right frontoparietal region. demonstrated an (ASH) associated with areas of cystic-glial transformation. Confirmed by CT and follow-up. Conclusion A case that illustrates and favors surgical intervention for evacuation with priority and recovery by osteoplastic craniotomy as a treatment and approaches to subdural hematoma, hematoma, and postoperative compliance after said procedure. Neurosurgery Acute subdural hematoma cystic-glial changes Trauma Osteoplastic craniotomy Figures Figure 1 Figure 2 Background Acute subdural hematomas (ASH) are related to trauma from a fall but a spontaneous subdural hematoma from blood pressure. The crucial factor and decision to proceed with surgery to remove the clot should be made four hours after the injury. This, in contrast to the actual mortality and recovery rates of 65% and 19% respectively, would reduce the mortality rate to 30% and the survival rate to 65%, even with a p-value equal to 0.05 and a strict control over intracranial pressure (ICP) [ 1 ]. However, research suggests that, depending on the severity of the traumatic brain injury (TBI), immediate surgical evacuation of an ASH can aggravate it by 11%. Depending on its etiology, trauma with underlying epidural hematoma (EDH) may cause or accompany ASH. In this case, only 80% of patients are susceptible to hospitalization, and 20–30% if not are declared ambulatory postoperatively given their limited evacuation time. [ 2 ]. Surgical intervention is the main consideration after MRI imaging evidence followed by computed tomography (CT) justifies respecting an ASH of > 10 mm and a midline thickness > 5 mm. [ 3 ]. CASE PRESENTATION A 51-year-old male was referred to our emergency room due to severe dysarthria and left hemiparesis precipitated by a traumatic event to the right frontoparietal region. Past medical history comprised stage II arterial hypertension and risk stage III; continued ahead imaging via CT demonstrated an ASH associated with areas of cystic-glial transformation. 2.1. Clinical examination and findings. The GCS score at the time of the clinical evaluation was 7, declining when a thorough physical assessment exhibited the patient to appear not completely lucid. 2.2. Imaging and initial diagnosis. On CT head imaging, an AcSH was observed with areas of cystic-glial transformation alongside solitary gas bubbles measuring a volume of 20 cm3, and a density of 35 HU was preserved in the right frontoparietal region. (Fig. 1 ). 2.3 Diagnosis Basic Clinic : Acute Subdural hematomas of the Right Frontotemporal–Parietal region causing compression of the brain surmounting a total volume of 120 cm3 within the ventricles. Fracture of the right parietal cranium impacting the left occipital and temporal bones extended to the lambdoid suture. Figure 2 . 2.4 Clinical complications of the underlying: Hemiparesis, dysarthria, and endobronchitis after aspiration. 2.5 Follow-up and Outcomes: D etailed postoperative diagnosis: compression of the brain caused by a 60ml epidural empyema in the right frontotemporal-parietal region. –––Overall, positive dynamics when compared to an earlier CT head scan were shown. The decision to discharge the patient was made because of his quick and steady recovery. Discussion Numerous factors may lead to TBI, such as socioeconomic discrepancies alongside simple or multifaceted falls caused by intoxication. Because of the severity of the issue, we might refer to it as a ‘silent pandemic’, most attributable to road traffic accidents remaining the most likely cause of mortality in young, adult, and elderly populations. Therefore, it is known that in Europe, 200–300:100,000 individuals sustain TBI, where we attribute severe skull trauma to the so-called extraaxial hemorrhagic lesions, including ASH, and EDH [ 4 ]. The recurrence of chronic bilateral subdural hematoma is higher than that of unilateral subdural hematoma, which indicates that there is a higher chance of recurrence because of a cerebral re-expansion. This may cause the artery to tear and the brain parenchyma to shift, resulting in a postoperative pneumocephalus and an accumulation of cerebrospinal fluid in the same hematoma chamber, both of which will increase the likelihood of recurrences. [ 5 , 11 ]. ASH would most likely require an emergency craniotomy or a decompressive craniectomy. This may be dependent on the age, sex, and neurological examination of the patient, where younger male individuals with unremarkable clinical assessments may undergo surgical evacuation via decompressive craniectomy. Even when coupled, decompressive craniectomy is usually associated with greater mortality [ 6 , 12 ]. ASH, whose brain injury is severe in most cases, with rapid onset and bleeding of up to 85% for the bridged veins, or can be present epidural hematoma where the median meningeal artery is the most probable cause, is occasionally managed conservatively. However, hematoma expansion may reach 5–65% and the management of ASH consists of surgical evacuation, either via medicated trepanation or craniotomy. Few postoperative studies reveal persistent subdural hematomas ranging from 0.35–23%, all of which may be managed by meningeal artery embolization. Solid materials, polyvinyl alcohol particles, gelatin spirals and sponges, liquids (i.e., n-butyl 2-cyanoacrylate), or any combination of these, may be employed in embolization. [ 7 , 13 ]. Replacement therapy comprising vitamin K, fresh frozen plasma, or Factor VIII, which aids in releasing or evacuating clots without causing further hemorrhage, may be warranted for reversal or termination of anticoagulants such as Warfarin which will raise the risk of thromboembolism. Pre-operative Warfarin and patient prothrombin time may also be indicative of peri- and postoperative mortality in the elderly. Because of this, the main recommendation is the implementation of GCS, which considers both increases and decreases in ICP. Pupil inspection and CT data are also included. It should be mentioned that patients whose initial GCS was less than 15 had a 5 mm displacement in the cerebral midline on CT due to the absence of surgical management [ 8 ]. A study comparable to this case report was conducted between 2014 and 2017 at a trauma center. Of the patients registered, 1407 (31%) sustained TBI. These patients presented with AcSH, for which surgical evacuation was performed in 336 (24%) and 245 (73%) received craniotomies. Ninety-one patients underwent decompressive craniectomies, 11% received both, and conservative management was completed in 982. As a result, the percentage of patients who underwent obstructive surgery ranged from 5–51% with a p < 0.0001 [ 9 ]. [ 10 , 15 ]. Conclusion This case of a patient with spontaneous acute subdural hematoma confirmed by MRI the formation of cystic glial changes so an emergency surgical intervention was recommended due to his clinical condition, there was no time for good conservative treatment so the success of said intervention It was suggested within the first 24 hours after injury for ideal recovery.We recommend osteoplastic craniotomy, which was initially performed for a positive postoperative cosmetic result in the patient. Therefore, the patient had an excellent motor response and psychomotor development in just a few days, so it was decided to discharge him. Abbreviations ASH Acute subdural hematoma ICP intracranial pressure CD Craniectomy decompressive CO craniotomy CT Computer tomography MRI Magnetic resonance imaging Declarations All authors have read and agreed to the published version of the manuscript. Funding Funding was not obtained for this research. Ethics approval and consent to participate The study was carried out according to the last revision of the Helsinki Declaration regarding medical research on human subjects. The CARE checklist has been followed. Concept for publication A written, informed consent from the patient was obtained Data Availability Statement This study does not generate or analyze any new data. Acknowledgments no Conflicts of Interest There is no conflict of interest disclosed by the authors Author Contributions Conceptualization, DES; methodology, D.E.S..; software, D.E.S., and G.S.; validation, I.B., and B.C; formal analysis, G.S., and G.F.; investigation, D.E.S. resources, M.B; and E.S. data curation, G.E.U. and G.S.; writing—original draft preparation, D.A.E.S., writing—review and editing, D.A.E.S., visualization, D.R, and M.B., supervision, G.S., and B.C. References Wilberger J, Harris M, Diamond D. et al. Acute subdural hematoma. 1991 Feb;74(2):212-8. doi: 10.3171/jns.1991.74.2.0212. Al-Mufti F, Maye SA. et al. Neurocritical Care of Acute Subdural Hemorrhage. 2017 Apr;28(2):267-278. doi: 10.1016/j.nec.2016.11.009. Manivannan S, Spencer R, Marei O, Mayo I, Elalfy O, Martin J, Zaben M. et al. Acute subdural hematoma in the elderly. PMID: 34862284 2021 Dec 3. doi: 10.1136/bmjopen-2021-050786 Kulesza B, Mazurek M, Nogalski A, Rol R.et al. Factors with the strongest prognostic value associated with in-hospital mortality rate. 2021 Oct. PMCID: PMC8476473 doi: 10.1007/s00068-020-01460-8. Chen FM, Wang K, Xu KL, Wang L, Zhan TX, Cheng F, Wang H, Zuo-Bing C, Gao L, Feng X. et al. Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma. 2020 Mar. PMID: 32169039 doi: 10.1186/s12883-020-01669-5 Ran KR, Vattipally VN, Giwa VA, Myneni S, Ra D. et al. Craniotomy versus craniectomy for traumatic acute subdural hematoma. 2024 Jan. doi: 10.1016/j.jocn.2023.11.021. Fan G, Wang H, Ding J, Xu C, Liu Y, Wang C, Li Z. et al. Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage. 2020 Aug. PMID: 32903661 doi: 10.3389/fneur.2020.00824 KARIBE H, HAYASHI T, HIRANO T, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. et al. Surgical Management of Traumatic Acute Subdural Hematoma in Adults. 2014 Oct. PMID: 25367584 doi: 10.2176/nmc.ra.2014-0204 Essen TAV, Lingsma HF, Pisică D, Singh RD, Volovici V. et al. Surgery versus conservative treatment for traumatic acute subdural haematoma. PMID: 35526554 2022 Jul. doi: 10.1016/S1474-4422(22)00166-1. Yang Y, Chen W, Mo H, Liang J, Li G, Zhong X, Chen Q, Chen M, Tang W. et al. Acute epidural-like subdural hematoma. 2022 Jan. PMID: 33529691 doi: 10.1016/j.neuchi.2021.01.015. Leitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, Rusnak M. et al. Outcome after severe brain trauma due to acute subdural hematoma. August 2012 https://doi.org/10.3171/2012.4.JNS111448 Martins WA, Teixeira AB, Frigeri TM, Paglioli E. et al. Spontaneous subdural hematoma associated to Duret h. march 2015 https://doi.org/10.1016/j.inat.2014.11.003 Herath HM, Matthias AT, Kulatunga A. et al. Acute on chronic bilateral subdural hematoma. Nov. 2017 DOI 10.1186/s13104-017-2969-y Chong-Chia MY. Et al. Development of a delayed chronic subdural hematoma. July 2020. https://doi.org/10.1002/emp2.12198 Ciochon UM, Steuble-Brandt EG, Stavngaard T. et al. Acute Tentorial Subdural Hematoma Caused by Rupture of the Posterior Cerebral Artery. February 2020. https://doi.org/10.3390/diagnostics10030175 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3967434","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":273528511,"identity":"247fceb3-cded-4b05-bd00-6fd5a08b17ea","order_by":0,"name":"Daniel Encarnación-Santos","email":"data:image/png;base64,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","orcid":"https://orcid.org/0000-0001-6484-6775","institution":"Rudn University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Daniel","middleName":"","lastName":"Encarnación-Santos","suffix":""},{"id":273529788,"identity":"62cac310-5cc7-4928-8ed8-62cc3b6dc6ac","order_by":1,"name":"Dmitriy Rubenovich-Chikava","email":"","orcid":"https://orcid.org/0000-0003-0430-790X","institution":"City Clinical Hospital №68 Gbuz Gkb Im. V.P. Demikhova","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Dmitriy","middleName":"","lastName":"Rubenovich-Chikava","suffix":""},{"id":273530180,"identity":"0e8a9925-e509-48b4-984b-ae7a644e1a83","order_by":2,"name":"Murat Pachev","email":"","orcid":"https://orcid.org/0000-0002-2446-3224","institution":"City Clinical Hospital №68 Gbuz Gkb Im. V.P.","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Murat","middleName":"","lastName":"Pachev","suffix":""},{"id":273530459,"identity":"bd2cbefd-d00e-4d47-a909-488d1fc10a89","order_by":3,"name":"ismail Bozkurt","email":"","orcid":"https://orcid.org/0000-0003-1033-4322","institution":"Medical Park Ankara","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"ismail","middleName":"","lastName":"Bozkurt","suffix":""},{"id":273530725,"identity":"934c2da9-6d4d-4559-9beb-14e3c7b3d94a","order_by":4,"name":"Gennady Chmutin","email":"","orcid":"https://orcid.org/0000-0002-3323-508X","institution":"RUDN University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gennady","middleName":"","lastName":"Chmutin","suffix":""},{"id":273530825,"identity":"ce0326e4-4b7a-465c-9b9b-4d8a8f722244","order_by":5,"name":"Bipin Chaurasia","email":"","orcid":"https://orcid.org/0000-0002-8392-2072","institution":"Bhawani Hospital and Research Center, Birgunj","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bipin","middleName":"","lastName":"Chaurasia","suffix":""}],"badges":[],"createdAt":"2024-02-18 16:16:53","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-3967434/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3967434/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":51390739,"identity":"322793d0-823e-4894-8fa4-bb008dc61958","added_by":"auto","created_at":"2024-02-20 18:22:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":148743,"visible":true,"origin":"","legend":"\u003cp\u003eCT head scan demonstrating evidence of a dislocated midline structure on the left and a late subacute subdural hematoma in the right frontoparietal region. Cystic-gliotic changes were observed in the left temporal and frontal lobes.\u003c/p\u003e","description":"","filename":"20240206204453Document42Word.png","url":"https://assets-eu.researchsquare.com/files/rs-3967434/v1/ef4f5d48eb396ef1828156ca.png"},{"id":51390747,"identity":"9693e7c2-35ae-41ec-b175-4d6a810fb76c","added_by":"auto","created_at":"2024-02-20 18:22:20","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":122626,"visible":true,"origin":"","legend":"\u003cp\u003eCT head imaging displaying right frontotemporoparietal region accumulation and removal of intracerebral, subdural, and epidural hematomas. Lesion of the middle cerebral artery (MCA) was observed.\u003c/p\u003e","description":"","filename":"20240207001334Document43Word.png","url":"https://assets-eu.researchsquare.com/files/rs-3967434/v1/c47e82b55ab0c218830e14f5.png"},{"id":51391853,"identity":"b47fdab0-fec1-420d-81c4-432ffccca4e3","added_by":"auto","created_at":"2024-02-20 18:30:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":506061,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3967434/v1/7f09dec0-7342-4361-a604-182eecf03493.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eAcute Subdural Hematoma Regarding Glial Cystic Changes– A Case Report and Literature Review\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eAcute subdural hematomas (ASH) are related to trauma from a fall but a spontaneous subdural hematoma from blood pressure. The crucial factor and decision to proceed with surgery to remove the clot should be made four hours after the injury. This, in contrast to the actual mortality and recovery rates of 65% and 19% respectively, would reduce the mortality rate to 30% and the survival rate to 65%, even with a p-value equal to 0.05 and a strict control over intracranial pressure (ICP) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, research suggests that, depending on the severity of the traumatic brain injury (TBI), immediate surgical evacuation of an ASH can aggravate it by 11%. Depending on its etiology, trauma with underlying epidural hematoma (EDH) may cause or accompany ASH. In this case, only 80% of patients are susceptible to hospitalization, and 20\u0026ndash;30% if not are declared ambulatory postoperatively given their limited evacuation time. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Surgical intervention is the main consideration after MRI imaging evidence followed by computed tomography (CT) justifies respecting an ASH of \u0026gt;\u0026thinsp;10 mm and a midline thickness\u0026thinsp;\u0026gt;\u0026thinsp;5 mm. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e"},{"header":"CASE PRESENTATION","content":"\u003cp\u003eA 51-year-old male was referred to our emergency room due to severe dysarthria and left hemiparesis precipitated by a traumatic event to the right frontoparietal region. Past medical history comprised stage II arterial hypertension and risk stage III; continued ahead imaging via CT demonstrated an ASH associated with areas of cystic-glial transformation. 2.1. Clinical examination and findings. The GCS score at the time of the clinical evaluation was 7, declining when a thorough physical assessment exhibited the patient to appear not completely lucid. 2.2. Imaging and initial diagnosis. On CT head imaging, an AcSH was observed with areas of cystic-glial transformation alongside solitary gas bubbles measuring a volume of 20 cm3, and a density of 35 HU was preserved in the right frontoparietal region. (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). \u003cem\u003e2.3 Diagnosis Basic Clinic\u003c/em\u003e: Acute Subdural hematomas of the Right Frontotemporal\u0026ndash;Parietal region causing compression of the brain surmounting a total volume of 120 cm3 within the ventricles. Fracture of the right parietal cranium impacting the left occipital and temporal bones extended to the lambdoid suture. Figure\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. \u003cem\u003e2.4 Clinical complications of the underlying: Hemiparesis, dysarthria, and endobronchitis\u003c/em\u003e after aspiration. \u003cem\u003e2.5 Follow-up and Outcomes: D\u003c/em\u003eetailed postoperative diagnosis: compression of the brain caused by a 60ml epidural empyema in the right frontotemporal-parietal region. \u0026ndash;\u0026ndash;\u0026ndash;Overall, positive dynamics when compared to an earlier CT head scan were shown. The decision to discharge the patient was made because of his quick and steady recovery.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eNumerous factors may lead to TBI, such as socioeconomic discrepancies alongside simple or multifaceted falls caused by intoxication. Because of the severity of the issue, we might refer to it as a \u0026lsquo;silent pandemic\u0026rsquo;, most attributable to road traffic accidents remaining the most likely cause of mortality in young, adult, and elderly populations. Therefore, it is known that in Europe, 200\u0026ndash;300:100,000 individuals sustain TBI, where we attribute severe skull trauma to the so-called extraaxial hemorrhagic lesions, including ASH, and EDH [\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e]. The recurrence of chronic bilateral subdural hematoma is higher than that of unilateral subdural hematoma, which indicates that there is a higher chance of recurrence because of a cerebral re-expansion. This may cause the artery to tear and the brain parenchyma to shift, resulting in a postoperative pneumocephalus and an accumulation of cerebrospinal fluid in the same hematoma chamber, both of which will increase the likelihood of recurrences. [\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eASH would most likely require an emergency craniotomy or a decompressive craniectomy. This may be dependent on the age, sex, and neurological examination of the patient, where younger male individuals with unremarkable clinical assessments may undergo surgical evacuation via decompressive craniectomy. Even when coupled, decompressive craniectomy is usually associated with greater mortality [\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e]. ASH, whose brain injury is severe in most cases, with rapid onset and bleeding of up to 85% for the bridged veins, or can be present epidural hematoma where the median meningeal artery is the most probable cause, is occasionally managed conservatively. However, hematoma expansion may reach 5\u0026ndash;65% and the management of ASH consists of surgical evacuation, either via medicated trepanation or craniotomy. Few postoperative studies reveal persistent subdural hematomas ranging from 0.35\u0026ndash;23%, all of which may be managed by meningeal artery embolization. Solid materials, polyvinyl alcohol particles, gelatin spirals and sponges, liquids (i.e., n-butyl 2-cyanoacrylate), or any combination of these, may be employed in embolization. [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\n\u003cp\u003eReplacement therapy comprising vitamin K, fresh frozen plasma, or Factor VIII, which aids in releasing or evacuating clots without causing further hemorrhage, may be warranted for reversal or termination of anticoagulants such as Warfarin which will raise the risk of thromboembolism. Pre-operative Warfarin and patient prothrombin time may also be indicative of peri- and postoperative mortality in the elderly. Because of this, the main recommendation is the implementation of GCS, which considers both increases and decreases in ICP. Pupil inspection and CT data are also included. It should be mentioned that patients whose initial GCS was less than 15 had a 5 mm displacement in the cerebral midline on CT due to the absence of surgical management [\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e]. A study comparable to this case report was conducted between 2014 and 2017 at a trauma center. Of the patients registered, 1407 (31%) sustained TBI. These patients presented with AcSH, for which surgical evacuation was performed in 336 (24%) and 245 (73%) received craniotomies. Ninety-one patients underwent decompressive craniectomies, 11% received both, and conservative management was completed in 982. As a result, the percentage of patients who underwent obstructive surgery ranged from 5\u0026ndash;51% with a p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001 [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e]. [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case of a patient with spontaneous acute subdural hematoma confirmed by MRI the formation of cystic glial changes so an emergency surgical intervention was recommended due to his clinical condition, there was no time for good conservative treatment so the success of said intervention It was suggested within the first 24 hours after injury for ideal recovery.We recommend osteoplastic craniotomy, which was initially performed for a positive postoperative cosmetic result in the patient. Therefore, the patient had an excellent motor response and psychomotor development in just a few days, so it was decided to discharge him.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eASH Acute subdural hematoma\u003c/p\u003e\n\u003cp\u003eICP intracranial pressure\u003c/p\u003e\n\u003cp\u003eCD Craniectomy decompressive\u003c/p\u003e\n\u003cp\u003eCO craniotomy\u003c/p\u003e\n\u003cp\u003eCT Computer tomography\u003c/p\u003e\n\u003cp\u003eMRI Magnetic resonance imaging\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAll authors have read and agreed to the published version of the manuscript.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding was not obtained for this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was carried out according to the last revision of the Helsinki Declaration regarding medical research on human subjects. The CARE checklist has been followed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConcept for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA written, informed consent from the patient was obtained\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study does not generate or analyze any new data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eno\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no conflict of interest disclosed by the authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization, DES; methodology, D.E.S..; software, D.E.S., and G.S.; validation, I.B., and B.C; formal analysis, G.S., and G.F.; investigation, D.E.S. resources, M.B; and E.S. data curation, G.E.U. and G.S.; writing\u0026mdash;original draft preparation, D.A.E.S., writing\u0026mdash;review and editing, D.A.E.S., visualization, D.R, and M.B., supervision, G.S., and B.C.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWilberger J, Harris M, Diamond D. et al. Acute subdural hematoma. 1991 Feb;74(2):212-8. doi: 10.3171/jns.1991.74.2.0212.\u003c/li\u003e\n\u003cli\u003eAl-Mufti F, Maye SA. et al. Neurocritical Care of Acute Subdural Hemorrhage. 2017 Apr;28(2):267-278. doi: 10.1016/j.nec.2016.11.009.\u003c/li\u003e\n\u003cli\u003eManivannan S, Spencer R, Marei O, Mayo I, Elalfy O, Martin J, Zaben M. et al. Acute subdural hematoma in the elderly. PMID: 34862284 2021 Dec 3. doi: 10.1136/bmjopen-2021-050786\u003c/li\u003e\n\u003cli\u003eKulesza B, Mazurek M, Nogalski A, Rol R.et al. Factors with the strongest prognostic value associated with in-hospital mortality rate. 2021 Oct. PMCID: PMC8476473 doi: 10.1007/s00068-020-01460-8.\u003c/li\u003e\n\u003cli\u003eChen FM, Wang K, Xu KL, Wang L, Zhan TX, Cheng F, Wang H, Zuo-Bing C, Gao L, Feng X. et al. Predictors of acute intracranial hemorrhage and recurrence of chronic subdural hematoma. 2020 Mar. PMID: 32169039 doi: 10.1186/s12883-020-01669-5\u003c/li\u003e\n\u003cli\u003eRan KR, Vattipally VN, Giwa VA, Myneni S, Ra D. et al. Craniotomy versus craniectomy for traumatic acute subdural hematoma. 2024 Jan. doi: 10.1016/j.jocn.2023.11.021.\u003c/li\u003e\n\u003cli\u003eFan G, Wang H, Ding J, Xu C, Liu Y, Wang C, Li Z. et al. Application of Absolute Alcohol in the Treatment of Traumatic Intracranial Hemorrhage. 2020 Aug. PMID: 32903661 doi: 10.3389/fneur.2020.00824\u003c/li\u003e\n\u003cli\u003eKARIBE H, HAYASHI T, HIRANO T, KAMEYAMA M, NAKAGAWA A, TOMINAGA T. et al. Surgical Management of Traumatic Acute Subdural Hematoma in Adults. 2014 Oct. PMID: 25367584 doi: 10.2176/nmc.ra.2014-0204\u003c/li\u003e\n\u003cli\u003eEssen TAV, Lingsma HF, Pisică D, Singh RD, Volovici V. et al. Surgery versus conservative treatment for traumatic acute subdural haematoma. PMID: 35526554 2022 Jul. doi: 10.1016/S1474-4422(22)00166-1.\u003c/li\u003e\n\u003cli\u003eYang Y, Chen W, Mo H, Liang J, Li G, Zhong X, Chen Q, Chen M, Tang W. et al. Acute epidural-like subdural hematoma. 2022 Jan. PMID: 33529691 doi: 10.1016/j.neuchi.2021.01.015.\u003c/li\u003e\n\u003cli\u003eLeitgeb J, Mauritz W, Brazinova A, Janciak I, Majdan M, Wilbacher I, Rusnak M. et al. Outcome after severe brain trauma due to acute subdural hematoma. August 2012 https://doi.org/10.3171/2012.4.JNS111448\u003c/li\u003e\n\u003cli\u003eMartins WA, Teixeira AB, Frigeri TM, Paglioli E. et al. Spontaneous subdural hematoma associated to Duret h. march 2015 https://doi.org/10.1016/j.inat.2014.11.003\u003c/li\u003e\n\u003cli\u003eHerath HM, Matthias AT, Kulatunga A. et al. Acute on chronic bilateral subdural hematoma. Nov. 2017 DOI 10.1186/s13104-017-2969-y\u003c/li\u003e\n\u003cli\u003eChong-Chia MY. Et al. Development of a delayed chronic subdural hematoma. July 2020. https://doi.org/10.1002/emp2.12198\u003c/li\u003e\n\u003cli\u003eCiochon UM, Steuble-Brandt EG, Stavngaard T. et al. Acute Tentorial Subdural Hematoma Caused by Rupture of the Posterior Cerebral Artery. February 2020. https://doi.org/10.3390/diagnostics10030175\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"5f8126bc-5bcb-494f-a2b8-c4e16ab0730a","identifier":"10.13039/501100018647","name":"RUDN University","awardNumber":"22/N0","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Peoples' Friendship University of Russia","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Acute subdural hematoma, cystic-glial changes, Trauma, Osteoplastic craniotomy ","lastPublishedDoi":"10.21203/rs.3.rs-3967434/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3967434/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis report attempts to examine a controversial case of trauma-associated acute subdural hematoma (ASH). In that case, surgical intervention indicates an intraoperative craniectomy with trephine evacuation or, if the patient is eligible, a Decompressive Craniectomy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Case Description\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 51-year-old male was referred to our emergency room due to severe dysarthria and left hemiparesis precipitated by a traumatic event to the right frontoparietal region. demonstrated an (ASH) associated with areas of cystic-glial transformation. Confirmed by CT and follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA case that illustrates and favors surgical intervention for evacuation with priority and recovery by osteoplastic craniotomy as a treatment and approaches to subdural hematoma, hematoma, and postoperative compliance after said procedure.\u003c/p\u003e","manuscriptTitle":"Acute Subdural Hematoma Regarding Glial Cystic Changes– A Case Report and Literature Review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-20 18:22:13","doi":"10.21203/rs.3.rs-3967434/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5d4eebe6-80a3-4861-ab6a-a8d9bd497f44","owner":[],"postedDate":"February 20th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":28825998,"name":"Neurosurgery"}],"tags":[],"updatedAt":"2024-02-20T18:22:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-02-20 18:22:13","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3967434","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3967434","identity":"rs-3967434","version":["v1"]},"buildId":"FbvkV6FR0MCFSLy54lSbu","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}