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SPONTANEOUS RECOVERY OF CHRONIC SUBDURAL HEMATOMA:Resolving Subdural Hematoma I: Clinical and roentgenological considerations Kimiyoshi HIRAKAWA 1 , Norio NAKAMURA 1 , Keiji SANO 1 1Dept. of Neurological Surgery, Tokyo Univ. School of Med. pp.661-670
Published Date 1967/7/1
DOI https://doi.org/10.11477/mf.1406202238
  • Abstract
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(1) Spontaneous recovery from chronic subdural he-matoma without surgical intervention has observed in six cases in the Department of Neurological Sur-gery, University of Tokyo Hospital. Case reports of these six, which are about 4 per cent of our to-tal number of chronic subdural hematoma during past 15 years, have been described in detail. Maximal follow up periods is as long as 9 years. Some common clinical and roentgenological features are pointed out in the cases of spontaneous recovery as described below.

(2) Chronic subdural hematoma is devided into three types, rapid, moderate and slow, in view of clinical rapidity after the development of various symptoms. And from the clinical course after the onset of symp-toms, they are classified into three, acute exacerba-tion, gradually progressive and intermittent course of type. Cases of spontaneous recovery belong to the slow and intermittent course of type. They are not accompanied with prominent focal signs and symptoms of the cerebral hemisphere.

(3) On the antero-posterior view of carotid angiography in case of chronic subdural hematoma, variations of configuration of avascular area are noticed. They are devided in three types after the shape of lens, convexo-convex type, plano-convex type and con-vexo-concave type. The last type is peculiar to the spontaneous recovery.

(4) The course of regression or resolving can be de-tected roentgenographically by the transformation of avascular area, beginning with convexo-convex type, through plano-convex type, to the convexo-concave type and disappearance. This is the reverse relationship to that of Norman29) who has made comment in 1956 on the formation and expansion of the encapsulated hematomas.

(5) Chronic subdural hematoma should be treated sur-gically. In some of the exceptional cases, sponta-neous recovery ocurr. Its criteria is as follow, 1) the younger the better, although it ocurres in any age groups.

2) the manifestation of various symptoms is slow-, its clinical course is intermittent without focal signs of hemisphere and it does not show the tendancy of rapid progress.

3) convexo-concave type of avascular area on the carotid angiographs strongly suggests the sponta-neous recovery.


Copyright © 1967, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 2185-405X 印刷版ISSN 0006-8969 医学書院

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