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Prognostic value of swirl sign in acute epidural hemorrhage
Hemant Kumar Beniwal1, Musali Siddartha Reddy2, Golapudi Prakash Rao1, Manne Srikrishnaditya1, Anisha Beniwal3
1 Department of Neurosurgery, Gandhi Medical College and Hospital, Telangana, India
2 Department of Neurosurgery, SVS Medical College and Hospital, Mahbubnagar, Telangana, India
3 Department of Critical Care Medicine, Max Hospital, Saket, New Delhi, India
Correspondence Address:
Hemant Kumar Beniwal,
Department of Neurosurgery, 4th Floor, Gandhi Medical College and Hospital, Padma Rao Nagar, Secunderabad - 500 003, Telangana
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/ajns.AJNS_68_21
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Objective: The purpose of this study is to analyze and evaluate the incidence, prognostic value, and impact of swirl sign on the outcome of patients who underwent surgical treatment for epidural hematoma. Materials and Methods: A retrospective analytical study on 307 acute epidural hematoma (AEDH) patients with and without swirl sign was conducted at our hospital between 2015 and 2019. All the patients in this study were treated initially as per the protocols of advanced trauma life support and surgically treated by craniotomy and evacuation of epidural hematoma. Patients with other concomitant intracerebral injuries such as subdural hematoma and contusion and those who were managed conservatively were excluded from the study. Various factors such as age, sex, mechanism of injury, Glasgow Coma Scale (GCS) score at admission, time from injury to surgery, preoperative mydriasis, location of bleed, midline shift, location of fracture, volume of hematoma, duration of stay in the hospital, and GCS score at discharge were taken into consideration and compared in between patients with and without swirl sign. Outcomes were assessed at the end of 6 months using the Glasgow Outcome Scale. Results: Of the 307 patients who were operated for epidural hemorrhage, 92 had swirl sign (29.96%) and the rest had no swirl sign. Univariate analysis revealed a significant correlation between the presence of swirl sign and age, preoperative mydriasis, and time from injury to surgery. The patients with the swirl sign had an unfavorable outcome at the end of 6 months which was statistically significant. Conclusion: It can be concluded that those patients with swirl sign in AEDH had an unfavorable outcome compared to those without swirl sign. Therefore, aggressive treatment and early surgery play an important role in the outcomes of the patients. |
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