Acute-to-chronic subdural hematoma: radiographic and clinical progression from acute subdural hematoma

Adrian Liebert* (First author), Emily Hirschmann (Co-author), Thomas Eibl (Co-author), Alexander Hammer (Co-author), Hans-Herbert Steiner (Co-author), Karl-Michael Schebesch (Co-author), Leonard Ritter (Last author)

*Corresponding author for this work

Research output: Contribution to journalOriginal Article (Journal)peer-review


INTRODUCTION: The pathogenesis of chronic subdural hematoma (CSDH) has not been completely understood. However, different mechanisms can result in space-occupying subdural fluid collections, one pathway can be the transformation of an original trauma-induced acute subdural hematoma (ASDH) into a CSDH.

MATERIALS AND METHODS: All patients with unilateral CSDH, requiring burr hole trephination between 2018 and 2023 were included. The population was distributed into an acute-to-chronic group (group A, n = 41) and into a conventional group (group B, n = 282). Clinical and radiographic parameters were analyzed. In analysis A, changes of parameters after trauma within group A are compared. In analysis B, parameters between the two groups before surgery were correlated.

RESULTS: In group A, volume and midline shift increased significantly during the progression from acute-to-chronic (p < 0.001, resp.). Clinical performance (modified Rankin scale, Glasgow Coma Scale) dropped significantly (p = 0.035, p < 0.001, resp.). Median time between trauma with ASDH and surgery for CSDH was 12 days. Patients treated up to the 12th day presented with larger volume of ASDH (p = 0.012). Before burr hole trephination, patients in group A presented with disturbance of consciousness (DOC) more often (p = 0.002), however less commonly with a new motor deficit (p = 0.014). Despite similar midline shift between the groups (p = 0.8), the maximal hematoma width was greater in group B (p < 0.001).

CONCLUSION: If ASDH transforms to CSDH, treatment may become mandatory early due to increase in volume and midline shift. Close monitoring of these patients is crucial since DOC and rapid deterioration is common in this type of SDH.

Original languageEnglish
Article number247
Pages (from-to)247
Number of pages8
Issue number1
Publication statusPublished - 30 May 2024


  • Humans
  • Hematoma, Subdural, Chronic/surgery
  • Hematoma, Subdural, Acute/surgery
  • Male
  • Female
  • Aged
  • Disease Progression
  • Middle Aged
  • Aged, 80 and over
  • Adult
  • Trephining/methods
  • Glasgow Coma Scale
  • Retrospective Studies


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