2100 sdh patients identified over 4 patterns of cytotoxic

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Non-Cognitive Predictors of Student Success:A Predictive Validity Comparison Between Domestic and International Students

Patterns of cytotoxic edema on

MRI suggest that subdural

hematomas can injure the

underlying cortex via multiple

mechanisms.

INTRO

• Subdural hematomas (SDHs) are highly morbid.

Cytotoxic edema (CE) is thought to account for some of

this morbidity, but the patterns and mechanisms of this

complication have not been well studied in humans.

METHODS1. All patients presenting with an SDH who received an

MRI within 2 weeks at a single institution from 2015-

2019.

2. MRIs were reviewed for SDH-related CE, defined as

restricted diffusion not better explained by alternative

etiologies (e.g. embolic stroke, parenchymal

hemorrhage, diffuse axonal injury, vasculopathy-

associated stroke).

RESULTS

• Two distinct patterns of CE were observed: cortical

restricted diffusion immediately adjacent to the SDH

not well explained by herniation (peri-SDH CE, Figure

1A and B), and restricted diffusion distant from the

SDH in the territories of the posterior or anterior

cerebral artery (herniation-pattern CE, Figure 1C and

D). The peri-SDH pattern was associated with seizures

in many (but not all) cases (Table 1).

CONCLUSIONS

• SDHs cause CE via multiple mechanisms. Herniation

likely causes many cases.1 Peri-SDH CE may result from

seizures in some cases,2 but other cases may result

from regional hypoperfusion, cortical spreading

depolarizations, or direct toxic effects of the SDH.3,4

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Diffusion-weighted imaging reveals distinct patterns of cytotoxic edema in subdural hematoma patientsDavid Robinson MD, Emily Orth, Jed Hartings PhD, Dan Woo MD, and Brandon Foreman MD

robin2dv@ucmail.uc.edu

B

D

A

C D

Figure 1: Examples of SDH-related ischemia

2100 SDH patients identified over 4 years

213 patients underwent MRI imaging within two weeks of SDH diagnosis

14 patients with alternative causes:3 with embolic source11 with vasculopathy*

30 patients with restricted diffusion

consistent with cytotoxic edema

16 patients with SDH-related cytotoxic

edema

Figure 2: Flow diagram of study*Includes atherosclerosis, presumed vasospasm, and blunt cerebrovascular injury from trauma.

Table 1: Characteristics of patients with SDH-related cytotoxic edemaAbbreviations: GCS=Glasgow coma scale on admission, mRS=modified Rankin Scale, determined at 3 months from ictus.*Defined as surgery within 24 hours of symptom/trauma onset

Disclosures:• The authors deny any relevant disclosures.

PatientID

Initial GCS

Cytotoxic edema pattern Seizures Hypotension

Emergent surgery*

Neuroworsening

3-month mRS

1 14 Peri-SDH - + - + 52 11 Peri-SDH + - + + 53 15 Peri-SDH + - - + 64 15 Peri-SDH - - - + 15 14 Peri-SDH + - - + 66 15 Peri-SDH + - - - 07 14 Peri-SDH - - - + 08 15 Peri-SDH + - - - 09 3 Herniation - + + - 610 4 Herniation - - + - 611 6 Herniation - - + - 612 7 Herniation - + + - 113 14 Herniation - - - + 114 4 Herniation - - + - 515 3 Both - - + - 116 6 Herniation - - - - 6

References:• 1.) Abe M, Udono H, Tabuchi K, Uchino A, Yoshikai T, Taki K. Analysis of

ischemic brain damage in cases of acute subdural hematomas. Surg Neurol. 2003; 59: 464-72; discussion 472.

• 2.) Milligan TA, Zamani A, Bromfield E. Frequency and patterns of MRI

abnormalities due to status epilepticus. Seizure. 2009; 18: 104-108.

• 3.) Takano K, Latour LL, Formato JE et al. The role of spreading depression in

focal ischemia evaluated by diffusion mapping. Ann Neurol. 1996; 39: 308-

318.

• 4.) Miller JD, Bullock R, Graham DI, Chen MH, Teasdale GM. Ischemic brain

damage in a model of acute subdural hematoma. Neurosurgery. 1990; 27: 433-

439.