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Sample records for chronic subdural hematoma

  1. Bilateral Biconvex Frontal Chronic Subdural Hematoma Mimicking Extradural Hematoma

    OpenAIRE

    Agrawal, Amit

    2010-01-01

    Chronic subdural hematoma (CSDH) is one of the most common clinical entities encountered in daily neurosurgical practice. The advent of computed tomography (CT) has made a major impact on the radiological diagnosis of CSDH. Although unilateral chronic isodense subdural hematomas as a result of indirect signs of a space-occupying lesion are easily recognizable on CT, bilateral CSDH may cause considerable difficulty, particularly when it is biconvex in shape as discussed in the present case. A ...

  2. Chronic subdural hematoma in capoeira sport.

    Science.gov (United States)

    Türkoğlu, Erhan; Serbes, Gökhan; Sanli, Metin; Sari, Onur; Sekerci, Zeki

    2008-01-01

    Chronic subdural hematomas in young people is extremely rare and has some provoking factors such as V-P shunts, arachnoid cyst, anticoagulant drug usage, vigorous sports and coagulopathies. A static or dynamic mechanical load is almost always delivered to skull associated with either mild or severe head trauma. A 25-year old-man who was previously healthy has complained of intermittent headache for six months. He had been interested in capoiera (Brazilian exciting sport) for two years and has had no any evidence of head injury. After admission, he was operated immediately because of chronic subdural hematoma. We report a patient who is the first chronic subdural hematoma in the literature due to playing capoeira. PMID:18382976

  3. Chronic subdural hematoma following electro convulsive therapy

    Directory of Open Access Journals (Sweden)

    Debasish Saha

    2012-01-01

    Full Text Available Subdural hematoma is a rare but serious complication following electroconvulsive therapy (ECT, a frequently used treatment modality in the management of various psychiatric morbidities including bipolar affective disorder (BAD. There are very few reports of intracranial bleeding following ECT in the literature. A 38-year-old female, known case of BAD for last fifteen years receiving ECT, presented with the symptoms of dysphasia, headache, left sided paresis, and sudden deterioration of sensorium. Computed tomography (CT scan of the brain was suggestive of left-sided fronto parietal chronic subdural hematoma with midline shift that was drained successfully.

  4. Chronic subdural hematoma with persistent hiccups: A case report

    OpenAIRE

    Yushin Takemoto; Akihito Hashiguchi; Koichi Moroki; Hajime Tokuda; Junichi Kuratsu

    2016-01-01

    Supratentorial hiccup is a rare condition and no patients with persistent hiccups and chronic subdural hematoma have been reported. A 38-year-old man with intractable hiccups, headache, and nausea was admitted to our hospital. Computed tomography revealed a supratentorial chronic subdural hematoma on the left side. After burr hole surgery to remove the hematoma his hiccups disappeared immediately and he was discharged home on the 3rd postoperative day with no neurological deficits. Although t...

  5. Chronic subdural hematoma infected by propionibacterium acnes: a case report.

    Science.gov (United States)

    Yamamoto, Shusuke; Asahi, Takashi; Akioka, Naoki; Kashiwazaki, Daina; Kuwayama, Naoya; Kuroda, Satoshi

    2015-01-01

    We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage. PMID:25759659

  6. Tratamiento mdico de un hematoma subdural crnico Medical treatment of a chronic subdural hematoma

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    Antonio Guevara Melcn

    2012-03-01

    Full Text Available Se presenta una paciente portadora de un hematoma subdural crnico postraumtico, que se trat mdicamente y se logr su desaparicin en el curso de varios meses, sin tratamiento quirrgico y sin signos evolutivos de empeoramiento neurolgico. La furosemida fue usada como medicamento bsico en su tratamiento. Se adjuntan imgenes que confirman el valor de este punto de vista teraputico.This is the case of a patient carrier of a post-traumatic chronic subdural hematoma clinically treated achieving its disappearance over some months without surgical treatment and evolutionary signs of neurologic worsening. The furosemide was used as basic drug in its treatment. The images confirming the value of this point of therapeutical view are enclosed.

  7. Chronic subdural hematoma fluid and its computerized tomographic density

    International Nuclear Information System (INIS)

    Laboratory and in vivo CT analysis were performed on 19 chronic subdural hematomas and five subdural hygromas. In these 25 hematoma samples, red blood cells (RBC), hematocrit, and hemoglobin (Hgb) varied greatly, though, these values correlated well with the CT densities. Plasma protein content was fairly constant with an average of 7.1+-0.8g/dl. There were four hematoma samples with RBC of less than 20x104μl or Hgb of less than 2.0g/dl. Their CT values ranged between 18 and 23 H.U., which were considered close to the in vivo serum level CT density. Five hygroma fluid showed no RBC and very little protein content of less than 0.4g/dl. CT density ranged between -2 and 13 H.U. The edge effect of the skull was experimentally studied using a phantom skull filled with water. This revealed a remarkable overshoot of the CT values within ten pixels from the inner wall of the skull. Visual observation of the original CT pictures revealed four low density hematomas and seven mixed density ones. When compared to the density of the ventricular cavity, all of the low density hematomas and the supernatant part of the mixed density ones were clearly higher in density. All five hygromas appeared CSF dense or lower. In conclusion, because of the edge effect by the skull, thin subdural fluids could not be diagnosed by CT alone. Thick subdural fluids could be differentiated as either hematoma or hygroma by their CT densities. Subdural hematomas had in vivo CT densities of at least serum level or approximately 20 H.U., while subdural hygromas had densities close to CSF. These characteristics were best appreciated by visual observation of the CT scan films. (J.P.N.)

  8. Chronic spinal subdural hematoma; Spinales chronisches subdurales Haematom

    Energy Technology Data Exchange (ETDEWEB)

    Hagen, T.; Lensch, T. [Radiologengemeinschaft, Augsburg (Germany)

    2008-10-15

    Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma. (orig.) [German] Spinale subdurale Haematome sind im Vergleich zu epiduralen Haematomen selten, chronische Verlaufsformen noch seltener. Ursaechlich sind neben Lumbalpunktionen und traumatischen Verletzungen auch Blutgerinnungsstoerungen, Gefaessmalformationen und Tumoren. Aufgrund der Kompression von Myelon und Cauda equina kommt es zu zunehmenden Ruecken- oder radikulaeren Schmerzen mit anschliessender Paraparese sowie einer Darm- und Blasenstoerung, weshalb in den meisten Faellen eine operative Entlastung durchgefuehrt wird. Magnetresonanztomographisch stellen sich die Haematome meist als thorakale bzw. lumbale subdurale Raumforderungen dar, die Signalintensitaet variiert mit dem Blutungsalter. Wir berichten ueber den klinischen Verlauf und die bildgebende Diagnostik von 3 Patienten mit spinalen chronischen subduralen Haematomen. (orig.)

  9. Initial hematoma pressure and clinical recurrence of chronic subdural hematoma in cases where percutaneous subdural tapping was performed

    International Nuclear Information System (INIS)

    Percutaneous subdural tapping for chronic subdural hematoma (CSDH) can measure initial hematoma pressure, which cannot be measured using burr-hole craniotomy. Initial hematoma pressure has not been discussed as a risk factor for recurrence. We evaluated the clinical features for recurrence, which included initial hematoma pressure. The study involved 71 unilateral CSDH cases whose initial hematoma pressure was measured using percutaneous subdural tapping. Clinical recurrence was identified in 19 cases (23%). Age, sex, neurological grading, alcohol consumption, presence of head injury, hypertension, diabetes mellitus, antiplatelet, anticoagulant medication, hematoma volume on computed tomography (CT) images, and initial hematoma pressure were compared between non-recurrence and recurrence groups. The initial hematoma pressure was 12.64.5 cmH2O in the non-recurrence group, and 15.56.2 cmH2O in the recurrence group (p<0.05). The other factors did not differ significantly except hematoma volume on CT images (9245 ml in the non-recurrence group and 12343 ml in the recurrence group, p<0.05). Cases with high initial hematoma pressure should be closely observed. (author)

  10. Recent Changes in Risk Factors of Chronic Subdural Hematoma

    OpenAIRE

    Sim, Yang-Won; Min, Kyung-Soo; Lee, Mou-Seop; Kim, Young-Gyu; Kim, Dong-Ho

    2012-01-01

    Objective Chronic subdural hematoma (CSDH) is a typical disease that is encountered frequently in neurosurgical practice. The medications which could cause coagulopathies were known as one of the risk factors of CSDH, such as anticoagulants (ACs) and antiplatelet agents (APs). Recently, the number of patients who are treated with ACs/APs is increasing, especially in the elderly population. With widespread use of these drugs, there is a need to study the changes in risk factors of CSDH patient...

  11. Clinical studies on cerebral blood flow in chronic subdural hematoma

    International Nuclear Information System (INIS)

    Cerebral blood flow (CBF) and clinical symptoms were examined between pre- and post-operations in twenty-four patients with unilateral chronic subdural hematoma. The following results were obtained by intravenous 133Xe method : 1. There was a reducing tendency of the CBF (hemisphere) on hematoma side, in most cases. While, the groups of headache and disturbances of consciousness did not give a laterality between hematoma and opposite side without the group of hemiparesis. 2. The absolute values of the CBF in the groups of headache and disturbances of consciousness were correlated with the clinical symptoms. In the group of hemiparesis, the laterality between hematoma and opposite side was correlated with the clinical symptoms. 3. In the group of hemiparesis, the F-flow (fast-flow) had sensitive reaction more than the ISI (initial slope index) with symptomatic improvement. 4. It was found that there was not an increase in the absolute value of the CBF, which was under the normal limit between pre- and post-operations in the case without improvement. By SPECT (Method of IMP), the following results were obtained : 1. There was the area of defect at the location of hematoma and the CBF tended to reduce at the subcortical white matter and at the basal ganglia of hematoma side. 2. The CBF of the contralateral hematoma side in the hemisphere of cerebellum was also tended to reduce. (author)

  12. The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma

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    Juković Mirela

    2014-01-01

    Full Text Available Introduction. Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. Material and Methods: A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, inlcuding the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. Results. The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier than the rightsided ones to present its symptoms although the average hematoma diameter value was almost the same. Conclusion. The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.

  13. Hypothalamo-Pituitary Dysfunction in Patients With Chronic Subdural Hematoma

    Czech Academy of Sciences Publication Activity Database

    Hána, V.; Kosák, M.; Masopust, V.; Netuka, D.; Lacinová, Z.; Kršek, M.; Marek, J.; Pecen, Ladislav

    2012-01-01

    Roč. 61, č. 2 (2012), s. 161-167. ISSN 0862-8408 Grant ostatní: GA MZd(CZ) NS9794 Institutional research plan: CEZ:AV0Z10300504 Keywords : hypopituitarism * subdural hematoma * brain injury * growth hormone deficiency Subject RIV: ED - Physiology Impact factor: 1.531, year: 2012

  14. Anticoagulation therapy a risk factor for the development of chronic subdural hematoma

    DEFF Research Database (Denmark)

    Aspegren, Oskar P.; strand, Ramona; Lundgren, Maria I.; Romner, Bertil

    2013-01-01

    Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy.......Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy....

  15. Contralateral acute subdural hematoma occurring after evacuation of subdural hematoma with coexistent contralateral subdural hygroma

    Science.gov (United States)

    Sun, Hsiao-Lun; Chang, Chih-Ju; Hsieh, Cheng-Ta

    2014-01-01

    Burr-hole craniostomy with closed-system drainage is a safe and effective method for the management of chronic subdural hematoma. However, contralateral acute subdural hematoma has been reported to be a rare and devastating complication. Only 3 cases have been described in the literature. Herein, we reported an 80-year-old male with chronic subdural hematoma and contralateral subdural hygroma. The burr-hole craniostomy with closed-system drainage was initially performed to treat the chronic subdural hematoma. Three days after surgery, weakness of the extremities developed, and contralateral acute subdural bleeding within the previous subdural hygroma was diagnosed by CT scan of the brain. The pathophysiological mechanism of this rare complication was discussed, and the relevant literature was also reviewed. PMID:24983286

  16. A case of acoustic neurinoma associated with chronic subdural hematoma after gamma knife radiosurgery

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    Sho, Atsuko; Asaeda, Masahiro; Ohtake, Minoru [Tottori Univ., Yonago (Japan). Inst. of Neurological Sciences] [and others

    2002-09-01

    A 72-year-old female presented with a unique case of acoustic neurinoma with a cystic component followed by the chronic subdural hematoma manifesting as trigeminal neuralgia, facial palsy and trunchal ataxia 7 months after gamma knife radiosurgery. Magnetic resonance imaging demonstrated a loss of central contrast enhancement at the postoperative residual tumor mass and a large cyst associated with a hematoma in the subdural space. A right suboccipital craniectomy was performed. A biopsy of the mass and the membrane was performed following aspiration of the brown-reddish fluid collection. The histological diagnosis was acoustic neurinoma with a hemorrhagic necrosis. The membranous tissue mimicked an outer membrane obtained from chronic subdural hematoma. The postoperative course was satisfactory and preoperative symptom have been alleviated. In this case, the chronic subdural hematoma occurred at posterior fossa during the development of cysts caused by the radiosurgery, because the subdural space had been connected with the subarachnoid space after the first operation. The development of cysts or hematoma should be taken into consideration as possible complications following treatment with gamma knife radiosurgery for acoustic neurinomas. (author)

  17. Mechanism of subdural effusion evolves into chronic subdural hematoma: IL-8 inducing neutrophil oxidative burst.

    Science.gov (United States)

    Tao, Zhiqiang; Lin, Yingying; Hu, Maotong; Ding, Shenghong; Li, Jianwei; Qiu, Yongming

    2016-01-01

    Chronic subdural hematoma (CSDH) is still a mysterious disease. Though great success has been has achieved by neuro-surgery treatment, the origin and development of CSDH remains unknown. Tremendous clinical observations have found the correlation of subdural effusion (SDE) and CSDH. However, systematic elucidation of CSDH's origin and progression is lacking while almost all the current hypothesis only explained partial phenomenon. This hypothesis proposes Interleukin (IL)-8 inducing neutrophil respiratory burst is the crucial impact when SDE evolves into CSDH. IL-8 initially secreted by dural border layer cells, accumulates and the concentration of IL-8 rises in the SDE cavity. Accompanied by the formation of neo-membrane under the dura meninges, IL-8 firstly prompts to establish the neo-vasculature in it, and then attracts lymphocytes aggregation in the neo-membrane. Both the newly recruited lymphocytes and endothelial cells assist the further elevation of local IL-8 concentration. When the IL-8 concentration elevated to a particular level, it attracts neutrophils to the inner wall of neo-vessels and primes them to oxidative burst. Lysosomes and superoxide released by these neutrophils make the fragile neo-capillary became leaky, and subsequently the plasma and blood cells run into SDE. However, as long as the erythrocytes come into the cavity, they shall bind large quantity of IL-8 and decrease IL-8 concentration to a lower level relatively that reduce the neutrophils recruit. When this negative feedback is stagnancy, for example, the SDE space is so large in elder man who is experiencing brain atrophy, the neo-vessels have to release more erythrocytes to bind IL-8, the liquid cavity will expand and the high intracranial pressure symptoms appeared. Our hypothesis holds potential for the proper therapeutic intervention of CSDH. IL-8 antagonist and other anti-inflammation drugs like macrolides antibiotics, glucocorticoid and atorvastatin might be optional to resist the liquid cavity expanding as actually occurs obvious bleeding soon. PMID:26804595

  18. Clinical usefulness of determination of NSE contents in drainage fluid of patients with chronic subdural hematoma

    International Nuclear Information System (INIS)

    Objective: To investigate the relationship between the neuron-specific enolase (NSE) contents of serum and drainage fluid in patients with chronic subdural hematoma (CSDH). Methods: Serum and drainage fluid NSE contents were determined with RIA right after and 24, 48, 72, 96, 120 hours after trephining in 28 patients with CSDH as well as 28 controls (once and serum only). Results: The serum contents of NSE in the patients were significantly higher than those in the controls (P<0.01). The drainage fluid contents of NSE were correlated with the patients concurrent own serum NSE contents (r=0.917) and were higher than the respective serum NSE value (P<0.01). All the NSE contents dropped continuously throughout the observation period. Conclusion: Changes of drainage fluid NSE contents might reflect progress of the degree of nervous tissue injury in patients with chronic subdural hematoma. (authors)

  19. Chronic Subdural Hematoma after Eccentric Exercise Using a Vibrating Belt Machine

    OpenAIRE

    Park, Hey-Ran; Lee, Kyeong-Seok; Bae, Hack-Gun

    2013-01-01

    We report a case of bilateral chronic subdural hematoma (CSDH) in a 75-year-old man after exercise using a vibrating belt machine on the head. He suffered from headache and intermittent left side numbness for ten days. He denied any head injuries except eccentric exercise using a vibrating belt on his own head for 20 days. An MRI revealed bilateral CSDH. The hematoma was isodense on the CT scan. We made burr-holes on the both sides under local anesthesia. We identified the neomembrane and dar...

  20. The level of circulating endothelial progenitor cells may be associated with the occurrence and recurrence of chronic subdural hematoma

    Directory of Open Access Journals (Sweden)

    Yan Song

    2013-01-01

    Full Text Available OBJECTIVES: The onset of chronic subdural hematoma may be associated with direct or indirect minor injuries to the head or a poorly repaired vascular injury. Endothelial progenitor cells happen to be one of the key factors involved in hemostasis and vascular repair. This study was designed to observe the levels of endothelial progenitor cells, white blood cells, platelets, and other indicators in the peripheral blood of patients diagnosed with chronic subdural hematoma to determine the possible relationship between the endothelial progenitor cells and the occurrence, development, and outcomes of chronic subdural hematoma. METHOD: We enrolled 30 patients with diagnosed chronic subdural hematoma by computer tomography scanning and operating procedure at Tianjin Medical University General Hospital from July 2009 to July 2011. Meanwhile, we collected 30 cases of peripheral blood samples from healthy volunteers over the age of 50. Approximately 2 ml of blood was taken from veins of the elbow to test the peripheral blood routine and coagulation function. The content of endothelial progenitor cells in peripheral blood mononuclear cells was determined by flow cytometry. RESULTS: The level of endothelial progenitor cells in peripheral blood was significantly lower in preoperational patients with chronic subdural hematomas than in controls. There were no significant differences between the two groups regarding the blood routine and coagulation function. However, the levels of circulating endothelial progenitor cells were significantly different between the recurrent group and the non-recurrent group. CONCLUSIONS: The level of circulating endothelial progenitor cells in chronic subdural hematoma patients was significantly lower than the level in healthy controls. Meanwhile, the level of endothelial progenitor cells in recurrent patients was significantly lower than the level in patients without recurrence. Endothelial progenitor cells may be related to the occurrence and recurrence of chronic subdural hematoma.

  1. Chronic subdural hematomas as evaluated by measns of SPECT, CT and EEG topography

    International Nuclear Information System (INIS)

    Nineteen patients with chronic subdural hematomas were reviewed, and, in an attempt to delineate the pathophysiology of this condition, evaluations were made by means of single-photon-emission tomography (SPECT), computed tomography (CT), and electroencephalographic (EEG) topography. Choronic subdural hematomas were classified into three types on the basis of their SPECT appearances: Type I: normal cerebral blood flow (CBF) in the basal ganglionic region, with or without a decreased mean cerebral hemispheric CBF on the affected side; Type II: decreased basal ganglionic as well as mean cerebral hemispheric CBF on the affected side; Type III: Diffuse, marked reduction of CBF on both sides. In 11 patients with headaches, the SPECT images were often classified as Type I, in which there was a normal regional CBF in the basal ganglia. In the majority, CT scans revealed either hypo- or iso-density in the lesions, with a minimal midline shift. No evidence of focal slow waves was seen on the EEG topograms. On the other hand, 6 patients with hemiparesis demonstrated, on their SPECT images, a relative reduction of both hemispheric and basal ganglionic CBF, as designated as Type II. CT showed high- or mixed-density, and focal slow waves were found on the EEG topograms. Subsequent measurements of the CBF after the evacuation of the hematomas in 13 patients disclosed a 10-20% increase in both hemispheric and basal ganglionic CBF, particularly in patients younger than 65. The present clinical studies suggest a critical role of CBF, especially basal ganglionic CBF, in the pathophysiology of chronic subdural hematomas. (author)

  2. PATOBIOLOGÍA DEL HEMATOMA SUBDURAL CRÓNICO.

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    Rubén Sabogal Barrios

    2008-01-01

    Full Text Available Treatment of subdural cronic hematoma in all ages is a therapeutic challenge. Chronic subdural hematoma is a disease that can be fatal without surgical treatment. A variety of treatment options like subdural tapping, endoscopic washout, shunting and craniotomy have been discussed. In chronic subdural hematoma, spontaneous resolution with conservative treatment is not an common therapeutic method because it has causes high mortality, requires long periods of time, and finally, many patients need surgical treatment. The etiology, physiopathology and surgical alternatives in the treatment of subdural chronic hematoma is discussed.

  3. Clinical study of cerebral blood flow in bilateral chronic subdural hematoma measured by {sup 99m}Tc-HMPAO SPECT

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    Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru [Kushiro Neurosurgical Hospital, Hokkaido (Japan); Aburano, Tamio

    2000-08-01

    Cerebral blood flow (CBF) in 34 patients with bilateral chronic subdural hematoma was measured by {sup 99m}Tc-HMPAO SPECT before operation. The regional CBF was measured in 26 regions of the 10 cortical regions, putamen, thalamus and cerebellar hemisphere on both sides. According to the thickness of subdural hematoma, the thicker hematoma side was measured and examined as the thick hematoma side, and the other side as the thin hematoma side. Thirty four cases with bilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms :13 cases with headache (headache group), 10 cases with hemiparesis (hemiparesis group), 5 cases with tetraparesis (tetraparesis group) and 6 cases with consciousness disturbance or dementia (consciousness disturbance group), and into two groups according to the degree of midline brain shift on MRI: 14 cases of non-shifted group and 20 cases of shifted group. The average CBF of 34 patients in each region indicated a regional CBF reduction in the frontal, parietal and occipital cortices on the thin hematoma side, and in the putamen on the thick hematoma side. In the headache group, the regional CBF reduction on the thin hematoma side was found in the frontal, parietal and occipital cortices compared with the corresponding regions on the thick hematoma side, and in thalamus on the thick hematoma side. In the hemiparesis and tetraparesis groups, there was no statistically significant CBF reduction between the thick and thin hematoma sides. In the consciousness disturbance group, the CBF reduction in whole brain was remarkably significant. By the degree of the midline brain shift, the CBF reductions between the thick and thin hematoma sides were observed. Namely, in the shifted group, the CBF reductions were noted in the frontal, parietal and occipital cortices in the thin hematoma side, and in the putamen in the thick hematoma side. We concluded that the CBF reduction of bilateral chronic subdural hematoma was bilaterally found in the hemiparesis and tetraparesis groups, and which was finally observed in whole brain in the consciousness disturbance group. (author)

  4. Clinical study of cerebral blood flow in bilateral chronic subdural hematoma measured by 99mTc-HMPAO SPECT

    International Nuclear Information System (INIS)

    Cerebral blood flow (CBF) in 34 patients with bilateral chronic subdural hematoma was measured by 99mTc-HMPAO SPECT before operation. The regional CBF was measured in 26 regions of the 10 cortical regions, putamen, thalamus and cerebellar hemisphere on both sides. According to the thickness of subdural hematoma, the thicker hematoma side was measured and examined as the thick hematoma side, and the other side as the thin hematoma side. Thirty four cases with bilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms :13 cases with headache (headache group), 10 cases with hemiparesis (hemiparesis group), 5 cases with tetraparesis (tetraparesis group) and 6 cases with consciousness disturbance or dementia (consciousness disturbance group), and into two groups according to the degree of midline brain shift on MRI: 14 cases of non-shifted group and 20 cases of shifted group. The average CBF of 34 patients in each region indicated a regional CBF reduction in the frontal, parietal and occipital cortices on the thin hematoma side, and in the putamen on the thick hematoma side. In the headache group, the regional CBF reduction on the thin hematoma side was found in the frontal, parietal and occipital cortices compared with the corresponding regions on the thick hematoma side, and in thalamus on the thick hematoma side. In the hemiparesis and tetraparesis groups, there was no statistically significant CBF reduction between the thick and thin hematoma sides. In the consciousness disturbance group, the CBF reduction in whole brain was remarkably significant. By the degree of the midline brain shift, the CBF reductions between the thick and thin hematoma sides were observed. Namely, in the shifted group, the CBF reductions were noted in the frontal, parietal and occipital cortices in the thin hematoma side, and in the putamen in the thick hematoma side. We concluded that the CBF reduction of bilateral chronic subdural hematoma was bilaterally found in the hemiparesis and tetraparesis groups, and which was finally observed in whole brain in the consciousness disturbance group. (author)

  5. Psychiatric manifestation of chronic subdural hematoma: The unfolding of mystery in a homeless patient

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    Sujita Kumar Kar

    2015-01-01

    Full Text Available The clinical manifestation of chronic subdural hematoma is not limited to neurological deficits or cognitive impairment. It may present with behavioral abnormalities. When the behavioral abnormalities present without obvious neurological deficits and in the absence of trauma, it leads to misdiagnosis. A trivial trauma may cause intracranial bleed that is either missed or ignored in the clinical history. This case report highlights the clinical picture of a homeless patient who presented with withdrawn and disorganized behavior, apathy and poverty of speech in the absence of any neurological deficit. His clinical presentation led to a possibility of psychosis and he was started on antipsychotics. He had developed extrapyramidal side effects in low dose of antipsychotic without any clinical benefit in his clinical picture. Neuroimaging done to rule out any possible organicity-revealed bilateral subdural hematoma, which was later evacuated by neurosurgical intervention in multiple settings and the patient had improved. This case report unfolds the mystery behind the psychotic presentation in a homeless adult.

  6. Etizolam, an anti-anxiety agent, attenuates recurrence of chronic subdural hematoma--evaluation by computed tomography.

    Science.gov (United States)

    Hirashima, Yutaka; Kuwayama, Naoya; Hamada, Hideo; Hayashi, Nakamasa; Endo, Shunro

    2002-02-01

    Etizolam, an anti-anxiety agent which is an antagonist of platelet-activating factor receptors, was administered to patients with chronic subdural hematoma (CSH) after hematoma removal to assess the effectiveness for preventing recurrence compared with control patients not given the drug after surgery. The remaining volumes of subdural hematomas on brain computed tomography were measured approximately 1 month after removal. Volume in the etizolam group (15 patients) was significantly smaller than in the control group (24 patients). Hematoma recurrence was not detected in the etizolam group 3 months after surgery, but occurred in the control group. The difference was significant. Etizolam administration may be useful for the prevention of recurrence of CSH. PMID:11944589

  7. Chronic Subdural Hematoma Associated with Spontaneous Intracranial Hypotension: Therapeutic Strategies and Outcomes of 55 Cases

    Science.gov (United States)

    TAKAHASHI, Koichi; MIMA, Tatsuo; AKIBA, Yoichi

    2016-01-01

    Spontaneous intracranial hypotension (SIH) has increasingly been recognized, and it is well known that SIH is sometimes complicated by chronic subdural hematoma (SDH). In this study, 55 cases of SIH with SDH were retrospectively analyzed, focusing on therapeutic strategies and outcomes. Of 169 SIH cases (75 males, 84 females), 55 (36 males, 19 females) were complicated by SDH. SIH was diagnosed based on clinical symptoms, neuroimaging, and/or low cerebrospinal fluid pressure. Presence of orthostatic headache and diffuse meningeal enhancement on magnetic resonance imaging were regarded as the most important criteria. Among 55 SIH with SDH cases, 13 improved with conservative treatment, 25 initially received an epidural blood patch (EBP), and 17 initially underwent irrigation of the hematomas. Of the 25 initially treated with EBP, 7 (28.0%) needed SDH surgery and 18 (72.0%) recovered fully without surgery. Of 17 SDH cases initially treated with surgery, 6 (35.7%) required no EBP therapy and the other 11 (64.3%) needed EBP and/or additional SDH operations. In the latter group, 2 cases had transient severe complications during and after the procedures. One of these 2 cases developed a hoarse voice complication. Despite this single, non-severe complication, all enrolled in this study achieved good outcomes. The present study suggests that patients initially receiving SDH surgery may need additional treatments and may occasionally have complications. If conservative treatment is insufficient, EBP should be performed prior to hematoma irrigation. PMID:26489406

  8. Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery

    DEFF Research Database (Denmark)

    Poulsen, Frantz Rom; Munthe, Sune; Søe, Morten; Halle, Bo

    2014-01-01

    OBJECTIVE: Recurrence rates of between 5% and 25% have been reported following surgery for chronic subdural hematoma (CSH). A previous study showed that the treatment with angiotensin converting enzyme (ACE) inhibitors decreases the risk of recurrence. To test the effects of ACE inhibitors on the...... recurrence CSH and CSH remnant six weeks after surgery, we conducted a prospective double-blinded randomized controlled clinical trial on patients with CSHs from July 2009 until October 2012. PATIENTS AND METHODS: Patients eligible for burr hole surgery for CSH were randomized into either an ACE inhibitor...... period was performed. RESULTS: Forty-seven patients were included in the randomized study. The patients' preoperative Glasgow Coma Scale scores were 15. None of the patients in the randomized group developed a recurrence after surgery. Measurements of the sizes of the CSH before and six weeks after...

  9. Usefulness of the coronal computed angiotomography in diagnosis of the isodense chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Asari, Shoji; Kunishio, Katsuzo; Sunami, Norio; Yamamoto, Yuji (Matsuyama Shimin Hospital, Ehime (Japan)); Satoh, Toru

    1984-06-01

    CT diagnosis of isodense chronic subdural hematoma (SDH) is difficult and often a source of false-negative results. Coronal computed angiotomographic views were very useful for the diagnosis of isodense chronic SDH, even if thin or bilateral. Seven chronic SDH cases in which the precontrast scans demonstrated the same density as the brain were studied. Patients were placed in a supine position with the head extended and the gantry was angled at approximately 60/sup 0/ to the canthomeatal line in order to obtain coronal computed angiotomographs. Contrast enhancement was achieved by the intravenous ''minimum dose bolus'' injection method. Three of the seven cases showed changes secondary to mass effect such as shift of the ventricle, compression, or obliteration of the Sylvian fissures and cortical sulci. Five cases showed a high-density line with medial convexity or in parallel with the inner table of the skull and 2 cases showed a high-density dotted line away from the inner table. The high-density line or dots represented the superficial cerebral veins or cortical branches of the middle cerebral artery which were displaced medially by the hematoma. Thus, all the cases could be correctly diagnosed. When these findings are obtained, angiography may be unnecessary. Moreover, computed angiotomography is decidedly advantageous in that it is not only useful for the diagnosis of hematoma but also provides a clear and simultaneous visualization of the pathological and anatomical changes in the neighboring structures such as the cerebral parenchyma, cisterns, and ventricles. Such information is not obtainable by angiography or digital subtraction angiography.

  10. Usefulness of the coronal computed angiotomography in diagnosis of the isodense chronic subdural hematoma

    International Nuclear Information System (INIS)

    CT diagnosis of isodense chronic subdural hematoma (SDH) is difficult and often a source of false-negative results. Coronal computed angiotomographic views were very useful for the diagnosis of isodense chronic SDH, even if thin or bilateral. Seven chronic SDH cases in which the precontrast scans demonstrated the same density as the brain were studied. Patients were placed in a supine position with the head extended and the gantry was angled at approximately 600 to the canthomeatal line in order to obtain coronal computed angiotomographs. Contrast enhancement was achieved by the intravenous ''minimum dose bolus'' injection method. Three of the seven cases showed changes secondary to mass effect such as shift of the ventricle, compression, or obliteration of the Sylvian fissures and cortical sulci. Five cases showed a high-density line with medial convexity or in parallel with the inner table of the skull and 2 cases showed a high-density dotted line away from the inner table. The high-density line or dots represented the superficial cerebral veins or cortical branches of the middle cerebral artery which were displaced medially by the hematoma. Thus, all the cases could be correctly diagnosed. When these findings are obtained, angiography may be unnecessary. Moreover, computed angiotomography is decidedly advantageous in that it is not only useful for the diagnosis of hematoma but also provides a clear and simultaneous visualization of the pathological and anatomical changes in the neighboring structures such as the cerebral parenchyma, cisterns, and ventricles. Such information is not obtainable by angiography or digital subtraction angiography. (author)

  11. Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by {sup 99m}Tc-HMPAO SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Okuyama, Tohru; Saito, Koji; Fukuyama, Kohichi; Yamamoto, Kouki; Morimoto, Mamoru [Kushiro Neurosurgical Hospital, Hokkaido (Japan); Aburano, Tamio

    2000-02-01

    Cerebral blood flow (CBF) measured by {sup 99m}Tc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the hemiparesis group. And such disturbance was finally observed as the CBF reductions in whole brain in the consciousness disturbance group. (author)

  12. Clinical study of cerebral blood flow in unilateral chronic subdural hematoma measured by 99mTc-HMPAO SPECT

    International Nuclear Information System (INIS)

    Cerebral blood flow (CBF) measured by 99mTc-HMPAO SPECT before operation was studied in 60 patients with unilateral chronic subdural hematoma. The regional CBF was measured in 26 regions of the fronto-occipital 10 cortices, putamen, thalamus and cerebellar hemisphere on both sides. Sixty cases with unilateral chronic subdural hematoma were classified into four groups on the basis of clinical symptoms: 17 cases with headache (headache group), 34 cases with hemiparesis (hemiparesis group) and 9 cases with consciousness disturbance or dementia (consciousness disturbance group), and into three groups on the basis of the degree of midline brain shift on MRI: 7 cases of mild shift group, 24 cases of moderate shift group and 29 cases of severe shift group. The average CBF in 60 patients in each region indicated that the regional CBF was reduced in frontal, occipital cortices and cerebellum on the non-hematoma side, and in putamen and thalamus on the hematoma side. In the headache group, the regional CBF reduction on the non-hematoma side was found in only frontal and occipital cortices compared with the corresponding regions on the hematoma side. In the hemiparesis group, the regional CBF was reduced in frontal and occipital cortices on the non-hematoma side and in putamen and thalamus on the hematoma side. The part of CBF reduction in both hemispheres was also noted in the hemiparesis group. In the consciousness disturbance group, the CBF reduction was markedly noted in whole brain. The CBF reductions in frontal and occipital cortices on the non-hematoma side and in putamen, thalamus and cerebellum on the hematoma side was not mutually related with the degree of midline brain shift. We concluded that the disturbance of CBF in chronic subdural hematoma was started from frontal and occipital cortices on the non-hematoma side observed in the headache group, and which was extended to putamen and thalamus on the hematoma side and a part of both hemispheres observed in the hemiparesis group. And such disturbance was finally observed as the CBF reductions in whole brain in the consciousness disturbance group. (author)

  13. Traumatic lumbar spinal subdural hematoma

    OpenAIRE

    Gordon, William E.; Brent Y. Kimball; Arthur, Adam S

    2014-01-01

    Spinal subdural hematoma (SDH) is a rare and potentially life-threatening condition associated with trauma, lumbar puncture, hemorrhagic disorder, anticoagulant therapy, spinal surgery, tumor, vascular malformations, and spinal or epidural anesthesia. Traumatic SDH is even more uncommon than other forms of SDH with only 10 reported cases in the literature. Following a punch to the head and loss of consciousness, a 35-year-old man reported headaches, right-sided tinnitus, and dull ache behi...

  14. Differential diagnosis of frontal lobe atrophy from chronic subdural hematoma or subdural hygroma on CT in aged patients. Usefulness of CT cisternogram

    Energy Technology Data Exchange (ETDEWEB)

    Hayashi, Hideaki [Osaka Univ. (Japan). Faculty of Medicine

    1995-02-01

    Metrizamide CT cisternograms (CTC) were performed in order to examine the CSF passage to subarachnoid space, cerebral sulci and Sylvian fissure. The old aged 20 patients (from 63 to 88 years old) with the layer of low density area around bilateral frontal lobe (bi-frontal LDA) in plain CT finding were selected from 2000 aged patients hospitalized in Hanwa-Senboku Hospital. In these 20 patients, it was difficult to differentiate frontal lobe atrophy from the chronic subdural hematoma and subdural hygroma. Conservative therapy was applied in 19 patients for their old age or their complicated diseases. Only 1 patient was operated for subdural hygroma. The 20 patients were investigated in EEGs, severity of dementia, disturbance of consciousness, activity of daily life, their clinical course and prognosis. Only 2 of the 11 patients with type 1 CTC findings (cerebral sulci, Sylvian fissure and bi-frontal LDA were simultaneously enhanced by metrizamide) showed disturbance of consciousness and/or delirium for their serious somatic disorders. All of 6 patients with type 3 CTC findings (only bi-frontal LDA was not enhanced by metrizamide) showed disturbance of consciousness. Three patients with type 2 CTC findings (atypical findings) were reported independently. Subdural disorder elevating intracranial pressure were clarified in the cases with type 3 CTC findings. (author).

  15. Differential diagnosis of frontal lobe atrophy from chronic subdural hematoma or subdural hygroma on CT in aged patients. Usefulness of CT cisternogram

    International Nuclear Information System (INIS)

    Metrizamide CT cisternograms (CTC) were performed in order to examine the CSF passage to subarachnoid space, cerebral sulci and Sylvian fissure. The old aged 20 patients (from 63 to 88 years old) with the layer of low density area around bilateral frontal lobe (bi-frontal LDA) in plain CT finding were selected from 2000 aged patients hospitalized in Hanwa-Senboku Hospital. In these 20 patients, it was difficult to differentiate frontal lobe atrophy from the chronic subdural hematoma and subdural hygroma. Conservative therapy was applied in 19 patients for their old age or their complicated diseases. Only 1 patient was operated for subdural hygroma. The 20 patients were investigated in EEGs, severity of dementia, disturbance of consciousness, activity of daily life, their clinical course and prognosis. Only 2 of the 11 patients with type 1 CTC findings (cerebral sulci, Sylvian fissure and bi-frontal LDA were simultaneously enhanced by metrizamide) showed disturbance of consciousness and/or delirium for their serious somatic disorders. All of 6 patients with type 3 CTC findings (only bi-frontal LDA was not enhanced by metrizamide) showed disturbance of consciousness. Three patients with type 2 CTC findings (atypical findings) were reported independently. Subdural disorder elevating intracranial pressure were clarified in the cases with type 3 CTC findings. (author)

  16. Outcomes of chronic subdural hematoma drainage in nonagenarians and centenarians: a multicenter study.

    Science.gov (United States)

    Lee, Lester; Ker, Justin; Ng, Hui Yu; Munusamy, Thangaraj; King, Nicolas Kon Kam; Kumar, Dinesh; Ng, Wai Hoe

    2016-02-01

    OBJECT Chronic subdural hemorrhage (SDH) or hematoma is a condition that affects elderly individuals. With advances in medical care, the number of nonagenarians and centenarians will increase. However, surgical treatments in this age group are associated with high rates of morbidity and mortality. Because no data are available on the rates of survival among elderly patients with chronic SDHs who undergo surgical drainage or receive only conservative care, the goal of this study was to determine survival rates in patients 90 years of age or older with symptomatic chronic SDHs. METHODS The authors conducted a retrospective analysis of patient data that were collected at 3 hospitals over a 13-year period (from January 2001 to June 2013). The data from patients 90 years or older with symptomatic chronic SDHs and who were offered surgical treatment were included in the analysis. Patients who underwent surgical treatment were included in the surgical group and patients who declined an operation were included in the conservative care group. The patients' Charlson Comorbidity Index score, Karnofsky Performance Scale score, dates of death, presenting symptoms, Glasgow Coma Scale score, length of stay in the hospital, discharge location, side of the SDH, and neurological improvements at 30-day and 6-month follow-ups were recorded. Data were statistically analyzed with Fisher exact test, Kaplan-Meier curves, and logistic regression. RESULTS In total, 101 patients met the inclusion criteria of this study; 70 of these patients underwent surgical drainage, and 31 received conservative care. Patients in the surgical group had statistically significantly (p < 0.001) higher survival at both the 30-day and 6-month follow-ups, with 92.9% and 81.4% of the patients in this group surviving for at least 30 days and 6 months, respectively, versus 58.1% and 41.9%, respectively, in the conservative care group. Moreover, the mean overall length of survival of 34.4 28.7 months was longer in the surgical group than it was in the conservative care group (11.3 16.6 months). Overall, 95.7% of patients in the surgical group exhibited an improvement in neurological status after the SDH drainage, whereas none of the patients in the conservative care group showed any neurological improvement during their hospital stay. The surgical complication rate was 11.4%, and the overall rate of chronic SDH recurrence after surgery was 12.9%. CONCLUSIONS Surgical drainage of chronic SDHs in nonagenarians and centenarians is associated with lower incidence of inpatient death and higher 30-day and 6-month survival rates. PMID:26162032

  17. Spinal Subdural Hematoma Following Meningioma Removal Operation

    OpenAIRE

    Jun, Hyo Sub; Oh, Jae Keun; Park, Young Seok; Song, Joon Ho

    2014-01-01

    Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation can occur, the development of a symptomatic spinal hematoma after craniotomy has been anecdotally reported and it is uncommon reported after a supratentorial meningioma removal operation. We report a case of spinal subdural hematoma following a supratentorial meningioma removal operation and discuss the mechanism of spinal subdural hematoma (SSDH) development. A 54-year-old woman presented with lumbago a...

  18. Preoperative angiotensin converting enzyme inhibitor usage in patients with chronic subdural hematoma: Associations with initial presentation and clinical outcome.

    Science.gov (United States)

    Neidert, Marian C; Schmidt, Tobias; Mitova, Tatyana; Fierstra, Jorn; Bellut, David; Regli, Luca; Burkhardt, Jan-Karl; Bozinov, Oliver

    2016-06-01

    The aim of this study is to analyze the association of preoperative usage of angiotensin converting enzyme (ACE) inhibitors with the initial presentation and clinical outcome of patients with chronic subdural hematoma (cSDH). Patients treated for cSDH between 2009 and 2013 at our institution were included in this retrospective case-control study. Medical charts were reviewed retrospectively and data were analyzed using descriptive and inferential statistics. Out of 203 patients (58 females, mean age 73.2years), 53 (26%) patients were on ACE inhibitors before their presentation with cSDH. Median initial hematoma volume in individuals with ACE inhibitors (179.2±standard error of the mean [SEM] 13.0ml) was significantly higher compared to patients without ACE inhibitors (140.4±SEM 6.2ml; p=0.007). There was an increased probability of surgical reintervention in the ACE inhibitor group (12/53, 23% versus 19/153, 12%; p=0.079), especially in patients older than 80years (6/23, 26% versus 3/45, 7%; p=0.026). ACE inhibitors are associated with higher hematoma volume in patients with cSDH and with a higher frequency of recurrences requiring surgery (especially in the very old). We hypothesize that these effects are due to ACE inhibitor induced bradykinin elevation causing increased vascular permeability of the highly vascularized neomembranes in cSDH. PMID:26898577

  19. MRI findings of traumatic spinal subdural hematoma

    International Nuclear Information System (INIS)

    To describe the MR imaging findings of traumatic spinal subdural hematoma. We retrospectively reviewed the MR images of six patients, with symptoms of acute spinal cord or cauda equena compression after trauma, together with spinal subdural hematoma. We analyzed the extent, location, configuration and signal intensity of the lesions. In five of sex cases, hematomas were distributed extensively throughout the thoracolumbosacral or lumbosacral spinal levels. In five cases they were located in the dorsal portion of the thecal sac, and in one case, in the ventral portion. On axial images, hematomas showed a concave or convex contour, depending on the amount of loculated hematoma. A lobulated appearance was due to limitation of free extension of the hematoma within the subdural space at the lateral sites (nerve root exist zone) at whole spine levels, and at the posteromedian site under lumbar 4-5 levels. In cases of spinal subdural hematoma, the lobulated appearance of hematoma loculation in the subdural space that bounds the lateral sites at al spinal levels and at the posteromedian site under L4-5 levels is a characteristic finding. (author)

  20. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Chung Dae; Song, Chang Joon; Lee, Jeong Eun; Choi, Seung Won [Chungnam National University, Daejeon (Korea, Republic of)

    2009-02-15

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease.

  1. Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

    International Nuclear Information System (INIS)

    Spinal subdural hematoma is a rare disease. Simultaneous intracranial and spinal subdural hematoma is extremely rare and only 14 such cases have been reported. We report here on two cases of simultaneous intracranial and spinal subdural hematoma that occurred following a fall-down head injury and intracranial surgery, and we discuss the pathogenesis of the disease

  2. Burr-hole Irrigation with Closed-system Drainage for the Treatment of Chronic Subdural Hematoma: A Meta-analysis

    Science.gov (United States)

    XU, Chen; CHEN, Shiwen; YUAN, Lutao; JING, Yao

    2016-01-01

    There is controversy among neurosurgeons regarding whether irrigation or drainage is necessary for achieving a lower revision rate for the treatment of chronic subdural hematoma (CSDH) using burr-hole craniostomy (BHC). Therefore, we performed a meta-analysis of all available published reports. Multiple electronic health databases were searched to identify all studies published between 1989 and June 2012 that compared irrigation and drainage. Data were processed by using Review Manager 5.1.6. Effect sizes are expressed as pooled odds ratio (OR) estimates. Due to heterogeneity between studies, we used the random effect of the inverse variance weighted method to perform the meta-analysis. Thirteen published reports were selected for this meta-analysis. The comprehensive results indicated that there were no statistically significant differences in mortality or complication rates between drainage and no drainage (P > 0.05). Additionally, there were no differences in recurrence between irrigation and no irrigation (P > 0.05). However, the difference between drainage and no drainage in recurrence rate reached statistical significance (P < 0.01). The results from this meta-analysis suggest that burr-hole surgery with closed-system drainage can reduce the recurrence of CSDH; however, irrigation is not necessary for every patient. PMID:26377830

  3. Age determination of subdural hematomas: survey among radiologists.

    Science.gov (United States)

    Postema, F A M; Sieswerda-Hoogendoorn, Tessa; Majoie, C B L M; van Rijn, R R

    2014-08-01

    Abusive head trauma is a severe form of child abuse. One important diagnostic finding is the presence of a subdural hematoma. Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as dating subdural hematomas can lead to identification of a suspect. The aim of our study is to describe the current practice among radiologists in the Netherlands regarding the age determination of subdural hematomas in children. This is a cross-sectional study, describing the results of an online questionnaire regarding dating subdural hematomas among pediatric and neuro-radiologists in the Netherlands. The questionnaire consisted of sociodemographic questions, theoretical questions and eight pediatric cases in which the participants were asked to date subdural hematomas based on imaging findings. Fifty-one out of 172 radiologists (30 %) filled out the questionnaire. The percentage of participants that reported it was possible to date the subdural hematoma varied between 58 and 90 % for the eight different cases. In four of eight cases (50 %), the age of the subdural hematoma as known from clinical history fell within the range reported by the participants. None of the participants was "very certain" of their age determination. The results demonstrate that there is a considerable practice variation among Dutch radiologists regarding the age determination of subdural hematomas. This implicates that dating of subdural hematomas is not suitable to use in court, as no uniformity among experts exists. PMID:24553773

  4. Two case series reports: 8 cases of arachnoid Temporoparietal cysts (middle fossa & sylvian fissure) and 2 cases of chronic subdural hematoma

    Science.gov (United States)

    Meshkini, Ali; Meshkini, Mohammad

    2012-01-01

    Abstract: Background: Arachnoid cysts are common intracranial space-occupying lesions which are often found in middle fossa and temporal regions of the skull. Many of these lesions are asymptomatic but some might appear as space-occupying lesions. Almost arachnoid cyst rupture, either following a trauma or spontaneously can result in intracystic hemorrhage, subdural hematoma and hygroma. The present study presents two case series including 8 cases of arachnoid cysts in temporal region and 2 cases of subdural hemorrhage. Methods: Demographic data and clinical and neuroimaging features of 8 patients were evaluated. Results: A total of 8 patients with arachnoid cysts in temporal region were assessed: age range 3 to 27 years old, 5 male and 3 female. The most important complains of the patients during their visit were seizure (3 cases), headache (4 cases), increased head circumference (1 case), parietotemporal arachnoid cyst in right (4 cases) and left hemisphere (4 cases). The conservative treatment and follow-up were performed in 6 out of 8 patients. In the other 2 patients, for craniotomy surgery with hematoma evacuation was performed. Furthermore, in the surgery the fenestration of arachnoid cyst wall into the basal cisterns as well as low pressure cysto-peritoneal shunt was performed. Conclusions: The risk of annual hemorrhage for patients with arachnoid cyst is very low. However, when the hemorrhage occurs it is treated by hematoma evacuation in most cases, but sometimes there is a need for fenestration of the cyst into basal cisterns under endoscopy, microsurgical or cystoperitoneal shunt. Keywords: Arachnoid cyst, Middle fossa, Chronic subdural hematoma

  5. Spontaneous acute subdural hematoma in a patient with multiple myeloma

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2012-01-01

    Full Text Available Acute spontaneous subdural hematoma in a patient of multiple myeloma receiving chemotherapy is an unknown event, needing an urgent neurosurgical management. We report this patient who presented with progressive neurological deterioration and a low platelet count. She was successfully managed by craniotomy and evacuation of subdural hematoma with intraoperative transfusion of platelets. The acute spontaneous subdural hematoma in her was probably related to the bleeding diathesis due to thrombocytopenia associated with chemotherapy.

  6. [Postspinal subacute subdural hematoma: case report].

    Science.gov (United States)

    Doğanay, Ferdi; Pirbudak, Lütfiye; Gül, Rauf; Alptekin, Mehmet; Kaplan, Nurgül

    2013-01-01

    The development of intracranial subdural hematoma after spinal anesthesia is a rare and serious complication that can be fatal if untreated. Needle puncture to the dura mater can cause leakage of cerebrospinal fluid, and lead to stretching and rupture of the meningeal blood vessels with resultant bleeding. A 24-year-old patient, with a completely normal history and laboratory analysis, has got a L4-5 level spinal anesthesia well done at first try, using a Quinke 25 G needle and 12,5 mg bupivacaine heavy. The first day after spinal anesthesia, the patient started to have a headache. He applied to another hospital where he received conservative treatment with a diagnosis of post-spinal headache. But, persistence of the headache made the patient refer to our pain clinic. The headache was located behind the left ear non-postural in nature, and was associated with tinnitus. Emergency cranial computerized tomography was obtained and acute fronto-temporo-parietal subdural hematoma was reported. After spinal anesthesia, continued atypical headache and presence of tinnitus must alert against an underlying subdural hematoma. Early diagnosis can be made by history of the patient combined with neurological and radiological imaging methods. PMID:24104535

  7. Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ishige, Naoki; Sunami, Kenro; Sato, Akira; Watanabe, Osamu (Chiba Rosai Hospital (Japan))

    1984-06-01

    A case of calcified subdural hematoma associated with hypertensive intracerebral hemorrhage is reported. A left frontal subdural hematoma with left putaminal hemorrhage was incidentally found when a CT scan was performed to evaluate right hemiparesis and aphasia in a 55-year-old man. The putaminal hemorrhage was not very extensive, but his clinical symptoms were rather serious. Not only the putaminal hemorrhage, but also the presence of the calcified subdural hematoma was considered to have caused his clinical deterioration. The subtotal removal of the calcified subdural hematoma brought about a good result.

  8. Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage

    International Nuclear Information System (INIS)

    A case of calcified subdural hematoma associated with hypertensive intracerebral hemorrhage is reported. A left frontal subdural hematoma with left putaminal hemorrhage was incidentally found when a CT scan was performed to evaluate right hemiparesis and aphasia in a 55-year-old man. The putaminal hemorrhage was not very extensive, but his clinical symptoms were rather serious. Not only the putaminal hemorrhage, but also the presence of the calcified subdural hematoma was considered to have caused his clinical deterioration. The subtotal removal of the calcified subdural hematoma brought about a good result. (author)

  9. MR imaging evaluation of subdural hematomas in child abuse

    International Nuclear Information System (INIS)

    MR imaging is the most accurate modality for determining the presence, number, and aging of subdural hematomas. Based on seven patients studied with CT and MR imaging, MR imaging should be the gold standard in child abuse evaluations. Since the history of child abuse is often ambiguous, MR imaging can assist in dating when the injury occurred. MR imaging in two perpendicular planes is needed, with one plane having both T1- and T2-weighted sequences. Chronic subdural hematomas on CT often have the same density as cerebrospinal fluid and may be misdiagnosed as atrophy or unrecognized. Therefore, the child may be returned into a dangerous situation and subjected to recurrent episodes of battering

  10. MRI findings in spinal subdural and epidural hematomas

    Energy Technology Data Exchange (ETDEWEB)

    Braun, Petra [Department of Radiology, Hospital La Plana, Ctra. De Vila-real a Borriana km. 0.5, 12540 Vila-real (Castello) (Spain)], E-mail: PetraBraun@gmx.de; Kazmi, Khuram [Department of Radiology, Penn State Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA 17033 (United States); Nogues-Melendez, Pablo; Mas-Estelles, Fernando; Aparici-Robles, Fernando [Department of Radiology, La Fe Hospital, Avenida Campanar, 21, 46009 Valencia (Spain)

    2007-10-15

    Background: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. Patients and Methods: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. Results: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. Discussion: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.

  11. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Osama Shukir Muhammed Amin

    2014-02-01

    Full Text Available Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient’s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

  12. The outcome of the acute subdural hematoma

    International Nuclear Information System (INIS)

    Thirty-five cases of acute subdural hematoma (ASDH) were reviewed and divided into two groups of A and B according to the outcome. The findings of computed tomography (CT) and the time interval between head trauma and surgical intervention were investigated to know the factors that influence the prognosis in ASDH. Group A, 18 patients, had a poor outcome. Fifteen patients out of 18 had the removal of hematoma and decompression craniectomy with 10 deaths, 4 vegetative states and 1 severe disability. Three patients died without surgery. Group B, 17 patients, were treated surgically in the same way as in group A and all patients had a good recovery with 14 making a full recovery and 3 with a moderate disability. Surgical mortality was 31.3% and overall mortality was 37.1%. The features of the CT findings in 18 patients of group A were as follows. Eleven patients had midline shift of more than 15 mm, 9 had subdural high density area of more than 15 mm and 12 patients had bilateral collapse of the lateral ventricles. The charactaristic finding of CT recognized in all patients of group A was disappearance of the ambient cistern. On the contrary, in 17 patients of group B the displacement of the intracranial structure was not so severe as in group A. The midline shift of 14 patients was less than 7.5 mm, the width of subdural high density area of 15 patients was less than 7.5 mm and the ambient cistern was recognized in 12 patients. For 11 patients out of 15 in group A, the operation was performed within 6 hours following the onset of head trauma, however, 9 patients died, one in a vegetative state and one had severe disability postoperatively. Thirteen patients out of 17 in group B were operated on later than 6 hours after the onset of the head trauma, and yet took a good outcome. (J.P.N.)

  13. Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma. A prospective study to investigate use as conservative therapy

    International Nuclear Information System (INIS)

    Inflammatory reaction is very important for formation of the neomembrane of chronic subdural hematoma (CSDH). The present study evaluated medical treatment with the platelet-activating factor receptor antagonist, etizolam, for the resolution of CSDH, and the factors indicating surgery or conservative therapy. Alternate patients were assigned to the etizolam group or control group without medical treatment. Patients in the etizolam group received 3.0 mg etizolam per day for 14 days. A total of 53 patients were followed up for at least 6 months. Univariate analysis of differences in demographic characteristics, clinical findings, and initial computed tomography (CT) findings, and multiple logistic regression analysis of the relationship between etizolam treatment and requirement for surgery using age, sex, low density of hematoma on CT, and paresis as confounders were performed. Etizolam treatment (adjusted odds ratio [OR] 0.156, 95% confidence interval [CI] 0.024-0.999, p=0.049) was negatively correlated with requirement for surgery. Low density of hematoma (adjusted OR 0.125, 95% CI 0.019-0.846, p=0.033) was found to be an independent negative predictor, and paresis as an initial symptom (adjusted OR 6.35, 95% CI 1.04-38.7, p=0.045) was an independent positive predictor of requirement for surgery. Etizolam administration can promote the resolution of CSDH, especially at the stage of hygroma appearing as low density on CT. Surgery is recommended if the patient presents with paresis. (author)

  14. Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma--a prospective study to investigate use as conservative therapy.

    Science.gov (United States)

    Hirashima, Yutaka; Kurimoto, Masanori; Nagai, Shoichi; Hori, Emiko; Origasa, Hideki; Endo, Shunro

    2005-12-01

    Inflammatory reaction is very important for formation of the neomembrane of chronic subdural hematoma (CSDH). The present study evaluated medical treatment with the platelet-activating factor receptor antagonist, etizolam, for the resolution of CSDH, and the factors indicating surgery or conservative therapy. Alternate patients were assigned to the etizolam group or control group without medical treatment. Patients in the etizolam group received 3.0 mg etizolam per day for 14 days. A total of 53 patients were followed up for at least 6 months. Univariate analysis of differences in demographic characteristics, clinical findings, and initial computed tomography (CT) findings, and multiple logistic regression analysis of the relationship between etizolam treatment and requirement for surgery using age, sex, low density of hematoma on CT, and paresis as confounders were performed. Etizolam treatment (adjusted odds ratio [OR] 0.156, 95% confidence interval [CI] 0.024-0.999, p = 0.049) was negatively correlated with requirement for surgery. Low density of hematoma (adjusted OR 0.125, 95% CI 0.019-0.846, p = 0.033) was found to be an independent negative predictor, and paresis as an initial symptom (adjusted OR 6.35, 95% CI 1.04-38.7, p = 0.045) was an independent positive predictor of requirement for surgery. Etizolam administration can promote the resolution of CSDH, especially at the stage of hygroma appearing as low density on CT. Surgery is recommended if the patient presents with paresis. PMID:16377949

  15. Warfarin-associated fetal intracranial subdural hematoma: a case report

    OpenAIRE

    Fujiwara, Kana; Aoki, Shigeru; Kurasawa, Kentaro; Okuda, Mika; Takahashi,Tsuneo; Hirahara, Fumiki

    2014-01-01

    Key Clinical Message We present a case in which to of fetal subdural hematoma developing despite that the maternal the prothrombin time by international normalized ratio (PT/INR) during pregnancy was within the normal range.

  16. Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas

    OpenAIRE

    Rong Li; Cheryl Ann Palmer; Vishnu V. B. Reddy

    2011-01-01

    We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are ...

  17. Relationship between the natural history of chronic subdural hematoma and enhancement of the inner membrane on post-contrast CT scan

    International Nuclear Information System (INIS)

    The purpose of this study was to determine the features and natural history of the inner membrane in CSDH (chronic subdural hematoma) patients using pre- and post-contrast CT scans. Twenty-four patients with CSDH (28 hematomas) who underwent pre- and post-contrast CT scanning prior to surgery ware studied. CSDH was classified according to the internal architecture as the homogeneous (HM) type, the laminar (LM) type, the separated (SP) type, and the trabecular (TR) type. For each type, the enhancement of the inner membrane, the outer membrane, and trabeculae was evaluated. Enhancement of the inner membrane develops as the stage of CSDH progresses. Although the inner membrane was not enhanced in the HM type, it was enhanced in almost all of the patients with the other types (p <0.0001). In 13% of patients with the LM type, 29% with the SP type, and 40% with the TR type, the inner membrane was moderately or markedly enhanced. The outer membrane was not thickened in any patient. In 88% of the patients who had contralateral hemiparesis on admission and 42% of those who did not have hemiparesis, the inner membrane was clearly enhanced (p=0.0166). This indicated that blood flow to the inner membrane from the pia matter induced hypoperfusion of the brain parenchyma beneath the hematoma in addition to the effect of direct compression. Contrast CT scanning may be useful for diagnosing the extent of enlargement of the inner membrane, predicting the risk of local brain damage, and evaluating the stage in the natural history of CSDH. (author)

  18. Analysis of infantile subdural hematoma caused by abuse

    International Nuclear Information System (INIS)

    We report infantile subdural hematoma caused by abuse. Between January 2006 and December 2009, 10 cases of definite and highly suspicious abusive subdural hematoma in infants were treated at Nara Medical University Hospital. The mean age was 5.4 months. On CT examination, severe cerebral swelling was seen in 8 (80%) and wide spreading cerebral ischemia and atrophy in 9 (90%). Retinal hemorrhage was commonly seen in this series (90%). Subdural drainage and/or subdural-peritoneal shunt surgeries were performed in 6 cases, and intensive combined therapy of mild hypothermia and barbiturate was adapted in 7 cases. Favorable outcome was achieved in only 3 cases. In spite of aggressive treatment, clinical outcome are still bad. In our series, assailants were predominantly not father but mother. There were various and complex factors for child abuse. Cautious insight and suspicion are necessary to detect abusive injuries in infants. It is very important to endeavor to prevent recurrences of abusive injuries. (author)

  19. Recurrent subdural hematoma secondary to headbanging: A case report

    OpenAIRE

    Naoki Nitta; Junya Jito; Kazuhiko Nozaki

    2015-01-01

    Background: "Headbanging" is the slang term used to denote violent shaking of one′s head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. Case Description: A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock conce...

  20. An Atropa belladonna L. poisoning with acute subdural hematoma.

    Science.gov (United States)

    Cikla, Ulas; Turkmen, Suha; Karaca, Yunus; Ayaz, Faik Ahmet; Ayaz, Ahmet Faik; Turedi, Suleyman; Gunduz, Abdulkadir

    2011-12-01

    Atropa belladonna L. is a plant long known to cause poisoning. But no cases of acute subdural hematoma resulting from such poisoning have been reported so far. Care must also be taken in terms of acute pancreatitis and rhabdomyolysis in cases of such poisoning. The plant may sometimes be mistaken for the Caucasian blueberry, V. arctostaphylos L. At least one anti-cholinesterase toxidrome finding was determined in all the nine cases of belladonna poisoning in this series. No elevated creatine kinase was reported in one case with acute subdural hematoma and hyperamylasemia. PMID:21540312

  1. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008-2012

    Directory of Open Access Journals (Sweden)

    Agon Y Mekaj

    2015-01-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008-2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3% were males and 31 (22.7% females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%. The head trauma has been responsible for CSDH in 88 patients (64.3%, while the main symptom was headache (92 patients or 67.1%. One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%. The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety.

  2. Surgical treatment of 137 cases with chronic subdural hematoma at the university clinical center of Kosovo during the period 2008–2012

    Science.gov (United States)

    Mekaj, Agon Y.; Morina, Arsim A.; Mekaj, Ymer H.; Manxhuka-Kerliu, Suzana; Miftari, Ermira I.; Duci, Shkelzen B.; Hamza, Astrit R.; Gashi, Musli M.; Xhelaj, Mentor R.; Kelmendi, Fatos M.; Morina, Qamile Sh.

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is frequent pathology in neurosurgical practice. The aim of this study is to present the first series of patients with CSDH, who got surgically treated in Clinic of Neurosurgery, University Clinical Center of Kosovo. Materials and Methods: This is a retrospective study that included 137 patients with CSDH who had been treated during the period 2008–2012. The data were collected and analyzed from the archives and protocols of the University Clinical Center of Kosovo. Patients were analyzed in many aspects such as age, gender, etiological factors, clinical features, localization, diagnoses, methods of surgical interventions, recurrences and mortality of patients. Results: From 137 patients with CSDH, 106 (77.3%) were males and 31 (22.7%) females. Average age of patients was 62.85 years. Analyzed according to the decades, the highest number of causes with CSDH was between 70 and 79 years (46%). The head trauma has been responsible for CSDH in 88 patients (64.3%), while the main symptom was headache (92 patients or 67.1%). One burr-hole trepanation with closed drainage system has been used in majority of cases (in 101 patients or 73.7%). The recurrence of CSDH was 6.5%, whereas mortality 2.9%. Conclusion: CSDH is more common in elderly patients. The male-female ratio is 3.4:1. Like other authors we also think that treatment with one burr-hole and drainage is a method of choice, because of its simplicity and safety. PMID:25883478

  3. Neurological and functional outcomes of subdural hematoma evacuation in patients over 70 years of age

    Directory of Open Access Journals (Sweden)

    Patrick Mulligan

    2013-01-01

    Full Text Available Background: Subdural hematoma (SDH is a common disease entity treated by neurosurgical intervention. Although the incidence increases in the elderly population, there is a paucity of studies examining their surgical outcomes. Objectives: To determine the neurological and functional outcomes of patients over 70 years of age undergoing surgical decompression for subdural hematoma. Materials and Methods: We retrospectively reviewed data on 45 patients above 70 years who underwent craniotomy or burr holes for acute, chronic or mixed subdural hematomas. We analyzed both neurological and functional status before and after surgery. Results: Forty-five patients 70 years of age or older were treated in our department during the study period. There was a significant improvement in the neurological status of patients from admission to follow up as assessed using the Markwalder grading scale (1.98 vs. 1.39; P =0.005, yet no improvement in functional outcome was observed as assessed by Glasgow Outcome Score. Forty-one patients were admitted from home, however only 20 patients (44% were discharged home, 16 (36% discharged to nursing home or rehab, 6 (13% to hospice and 3 (7% died in the postoperative period. Neurological function improved in patients who were older, had a worse pre-operative neurological status, were on anticoagulation and had chronic or mixed acute and chronic hematoma. However, no improvement in functional status was observed. Conclusion: Surgical management of SDH in patients over 70 years of age provides significant improvement in neurological status, but does not change functional status.

  4. Bilateral subdural hematoma secondary to accidental dural puncture

    Directory of Open Access Journals (Sweden)

    Sofía Ramírez

    2015-08-01

    Full Text Available We report the case of a 25-year-old woman, who received epidural analgesia for labor pain and subsequently presented post-dural puncture headache. Conservative treatment was applied and epidural blood patch was performed. In the absence of clinical improvement and due to changes in the postural component of the headache, a brain imaging test was performed showing a bilateral subdural hematoma. The post-dural puncture headache is relatively common, but the lack of response to established medical treatment as well as the change in its characteristics and the presence of neurological deficit, should raise the suspicion of a subdural hematoma, which although is rare, can be lethal if not diagnosed and treated at the right time.

  5. Spontaneous disappearance of acute subdural hematoma on CT scan

    International Nuclear Information System (INIS)

    We encountered a patient with a severe head injury complicated by DIC in whom the serial CT scans revealed the disappearance of the subdural hematoma. A 65-year-old man received a heavy blow to the head in a traffic accident. On admission, the patient was in a coma (Glasgow's coma scale: 5 points), showing anisocoria (right > left) and left hemiplegia. He later deteriorated in ataxic respiration and died 23 hours after the trauma. In a blood-coagulation examination done 2 hours after the trauma, the bleeding time was 9 minutes, the coagulation time was more than 60 minutes, the serum fibrinogen was less than 15 mg/dl, and the serum FDP was above 160 ug/ml; a diagnosis of DIC was thus made. CT scans 1 hour after the trauma showed acute subdural hematoma in the right cerebral hemisphere, a medial displacement of the lateral ventricles, and a traumatic subarachnoid hemorrhage. In CT scans taken 21 hours after the trauma, however, the subdural hematoma had disappeared, while a diffuse swelling of the cerebrum, mottled high-density areas along the cerebral sulci, and high-density areas in the posterior horns of the bilateral ventricles as well as in the cerebello-pontine angle were observed for the first time. These changes in the CT findings are considered to be due to the decrease in the viscosity of the subdural hematoma caused by the markedly enhanced activity of the fibrolytic system with DIC and by subsequent diffusion into intracranial spaces under the increased intracranial pressure associated with the development of cerebral edema. (author)

  6. Post-traumatic epidural and subdural hematomas of the spinal cord in MR imaging

    International Nuclear Information System (INIS)

    Diagnostics of epi- and subdural hematomas of the spinal cord is discussed on the basis of 1992 records of Konstancin Rehabilitation Center. 54 patients with symptoms of partial or complete cord injury were submitted to MR imaging. In 4 cases (7.5%) epi- and subdural hematoma was found to contribute to neurological condition of the patient. MRI determines indications for surgical intervention. (author)

  7. Spontaneous Spinal Subdural Hematoma Developed After Weightlifting: A case Report and Review of Literature

    OpenAIRE

    JiEun Park; SooMi Lim; Jeong Hyun Yoo

    2011-01-01

    Spontaneous spinal subdural hematoma is a rare disease. Several predisposing factors are reported including impaired clotting due to therapeutic anti-coagulation or hematologic disorder, vascular anom-aly, intraspinal tumor, and iatrogenic causes such as lumbar puncture or spinal anesthesia.We report a rare case of spontaneous spinal subdural hematoma developed after weightlifting in a healthy young man treated with conservative treatment.

  8. A rare, high cervical traumatic spinal subdural hematoma.

    Science.gov (United States)

    Berhouma, Moncef; Al Dahak, Nouman; Messerer, Rostom; Al Rammah, Mohamed; Vallee, Bernard

    2011-04-01

    Spinal subdural hematomas (SSDH) are rare lesions occurring in association with a wide variety of conditions, including anticoagulation, coagulation disorders, spinal anesthesia, lumbar puncture, spinal tumors and vascular malformations. SSDH resulting from trauma are the exception. We present a 62-year-old woman with a rare post-traumatic focal SSDH at C1 with bulbomedullary compression, treated successfully with surgery. A review of the literature revealed 26 patients with traumatic SSDH. The aim of this report is to describe the clinical presentation, imaging characteristics and management of traumatic SSDH. The controversial pathogenesis is also discussed. PMID:21277780

  9. Hematoma subdural intracraniano ps-anestesia subaracnidea: relato de dois casos e reviso de 33 casos da literatura / Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature / Hematoma subdural intracraneal postanestesia subaracnoidea: relato de dos casos y revisin de 33 casos de la literatura

    Scientific Electronic Library Online (English)

    Jane Auxiliadora, Amorim; Diana Souza Canuto dos Anjos, Remgio; Otvio, Damzio Filho; Marcos Aureliano Guerra de, Barros; Valentina Nicole, Carvalho; Marcelo Moraes, Valena.

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano uma complicao rara ps-anestesia subaracnidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crnico ps-anestesia subaracnidea, diagnosticados aps a evoluo clnica prolongada de cefaleia ps-puno dural (CPP [...] D) e analisamos outros 33 casos encontrados em reviso da literatura. RELATO DOS CASOS: Nos 35 pacientes (idade entre 20-88 anos, 19 homens), 14 tinham mais de 60 anos (40%) sendo 12 (86%) homens. A relao se inverte no grupo de pacientes mais jovens ( Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicacin rara postanestesia subaracnoidea. Relatamos aqu dos casos de mujeres que desarrollaron hematoma subdural crnico postanestesia Subaracnoidea, diagnosticados posteriormente a la evolucin clnica prolongada de cefalea p [...] ostpuncin dural (CPPD), y analizamos otros 33 casos encontrados en una revisin de la literatura. RELATO DE LOS CASOS: En los 35 pacientes (edad entre 20 y 88 aos, 19 hombres), 14 tenan ms de 60 aos (40%) siendo 12 (86%) hombres. La relacin se invierte en el grupo de pacientes ms jvenes ( Abstract in english BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other [...] 33 cases found on literature review. CASE REPORTS: In 35 patients (ages 20-88 years, 19 males), 14 were older than 60 years (40%), of which 12 (86%) were males. The relationship is inverted in the group of younger patients (

  10. Traumatic Acute Subdural Hematoma Extending from the Posterior Cranial Fossa to the Cerebellopontine Angle

    OpenAIRE

    Salih GULSEN; Sonmez, Erkin; Yilmaz, Cem; Nur ALTINORS

    2009-01-01

    Posterior cranial fossa subdural hematomas and extension of the subdural hematoma to the cerebellopontine angle is rarely seen and the concurrent development of acute peripheral facial palsy and the management strategy have not previously been reported in this pathology because of its rarity. We present this case to emphasize that minor head trauma may lead to a posterior cranial fossa hematoma extending to the cerebellopontine angle and cause peripheral facial palsy in patients using aspirin...

  11. [Cranial subdural hematoma after inadvertent dural puncture at epidural anesthesia].

    Science.gov (United States)

    Mori, Sayano; Kanai, Akifumi; Hoka, Sumio

    2005-04-01

    Intracranial subdural haematoma has been reported to be an exceptionally rare complication of accidental dural puncture. An accidental lumbar dural puncture occurred in a 36-yr-old male undergoing orthopedic knee surgery. On the morning after the operation, the patient complained of severe occipital headache, although this was relieved with loxoprofen and rest. This was assumed to be a postdural puncture headache (PDPH) because it had a postural component (it was worse on sitting up). On the third day after the operation, the patient developed a severe diffuse headache together with nausea, which did not subside with analgesia and bed rest. Magnetic resonance imaging of the head showed a small acute subdural hematoma in the bilateral temporooccipital region with no mass effect. The patient was conscious and oriented. There was no focal neurological deficit. The patient was managed conservatively with bed rest and intravenous fluids. His condition improved without surgical decompression and was discharged on the 40 th day after the operation. Severe and prolonged PDPH shoud be considered as a warning sign of an intracranial complication. PMID:15852633

  12. Spinal subdural hematoma following cranial surgery: A case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Jinping Liu

    2011-01-01

    Full Text Available Spinal subdural hematoma (SDH following a cranial surgery is extremely rare. We described a 26-year-old patient who developed an SDH at L3-S1 level after the excision of intraventricular meningioma. He was surgically treated with an excellent outcome. It is postulated that the SDH resulted from downward migration of intracranial hematoma.

  13. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed.

    Science.gov (United States)

    Cincu, Rafael; de Asis Lorente, Francisco; Rivero, David; Eiras, Jos; Ara, Jos Ramn

    2009-10-01

    Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia) and later on can manifest as rebleeding and neurological deterioration. PMID:19838395

  14. Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

    Directory of Open Access Journals (Sweden)

    Cincu Rafael

    2009-01-01

    Full Text Available Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and developed massive rebleeding on the third day following initial evacuation of hematoma. This case illustrates that a patient with routine normal coagulation profile and adequate hemostasis can still harbor platelet dysfunction (in present case due to polycythemia and later on can manifest as rebleeding and neurological deterioration.

  15. Traumatic interhemispheric subdural hematoma extending above the tentorium demonstrated as a low-density mass

    International Nuclear Information System (INIS)

    This report presents a case of traumatic interhemispheric subdural hematoma extending above the right tentorium, which showed a low-density mass in the CT scan and which brought up a problem of differential diagnosis from subdural empyema because the patient had a long history of bilateral chronic otitis media. The 47-year-old man fell downstairs while drunk; this accident was followed by an increasing member of incidents of headache and vomiting, and he was admitted on the 15th day after the episode. Upon admission, his mental state was slightly dull; a neurologic examination revealed a mild choked disc and increased DTRs on the left. There was otorrhea and hearing difficulty on the left side, and his blood pressure was slightly elevated (170/110 mmHg). The laboratory data were negative except for an increased blood-sedimentation ratio (50/80 mm) and 1 + CRP. The precontrast CT scan demonstrated a lentiform low-density mass in the posterior part of the interhemispheric fissure extending above the right tentorium, with an unusual mass effect for the volume and a location of this mass. The postcontrast CT scan showed a marked enhancement of the falx and the tentorium around the mass. Furthermore, the pneumatization of the mastoid cells was markedly decreased. An operation was performed following the day of admission; when subdural hematoma was confirmed, it was evacuated and irrigated. The postoperative course was excellent, and the low-density mass had disappeared by the time of a follow-up CT scan 19 days after the operation. (J.P.N.)

  16. Multifocal subdural hematomas as the presenting sign of acquired hemophilia A: a case report

    Science.gov (United States)

    2014-01-01

    Background Acquired hemophilia A (AHA) is a rare coagulopathy linked to a variety of etiologies including autoimmune diseases, neoplasms, diabetes, respiratory diseases, and the post-partum state. While bleeding in AHA is often seen in mucocutaneous or intramuscular locations, intracranial and intraspinal bleeds are exceedingly rare. Case presentation We report an unusual case of spontaneous multifocal subdural hematomas in a 25year old Asian woman with lupus who presented with headache and backache, and was found to have an elevated partial thromboplastin time (PTT) level and new diagnosis of AHA. Conclusions Subdural hematomas as the initial sign of AHA are all but unknown in the medical literature. We bring this entity to the attention of the neurology community because lumbar puncture and/or conventional angiogram are often indicated in the work-up of idiopathic multifocal subdural hematomas, but may be dangerous in patients with AHA. PMID:24606868

  17. Acute subdural hematoma secondary to cerebral venous sinus thrombosis: Case report and review of literature.

    Science.gov (United States)

    Bansal, Hanish; Chaudhary, Ashwani; Mahajan, Anuj; Paul, Birinder

    2016-01-01

    Cerebral venous sinus thrombosis is a rare type of stroke primarily affecting young women. Diagnosis is generally delayed or overlooked due to a wide spectrum of clinical symptoms. Subdural hematoma secondary to cerebral venous sinus thrombosis is very rare. We report a case of 40-year-old female with cerebral venous sinus thrombosis who presented to us with an acute subdural hematoma and subarachnoid hemorrhage besides venous infarct. Management of such patients is complicated due to the rarity of the condition and contraindication for the use of anticoagulation. We conducted a thorough literature search through PubMed and could find only nine cases of spontaneous subdural hematoma secondary to cerebral venous sinus thrombosis. PMID:27057237

  18. Re-estimation of acute subdural hematoma in children caused by trivial household head trauma

    International Nuclear Information System (INIS)

    The objective of this study was to identify characteristics of acute subdural hematoma in children caused by a trivial household head trauma from a modem neurosurgical and medicolegal standpoint. We performed a retrospective study of 25 children younger than 48 months hospitalized for acute subdural hematoma from December 1, 1993, through February 28, 2003. Inclusion criteria were as follows: acute subdural hematoma caused by trivial household trauma and a history of trauma corroborated by a caretaker, absence of physical injuries consistent with child abuse, fundoscopic examinations performed by a pediatric ophthalmologist, absence of fractures on general bone survey, and child abuse ruled out by long-term follow-up (more than 5 years). Twenty-one of the patients were boys, and 4 were girls. The patients ranged in age from 6 to 17 months, with an average age of 8.5 months. In 17 of 25 patients trauma had been caused by falls to the floor while standing with support or while sitting. Most of the patients were admitted to the hospital because of generalized convulsions or seizures that had developed soon after a trivial household trauma. Fifteen of the 25 (60%) patients had retinal or preretinal hemorrhage and 9 patients had bilateral retinal hemorrhage. Computed tomography showed fluid-type acute subdural hematomas at the frontal convexity or in the interhemispheric fissure in 18 of 25 (72%) patients. Fourteen of 25 (56%) patients had pre-existing external hydrocephalus (enlargements of the subarachnoid space). The long-term outcomes included normal mental development (IQ≥80) in 18 cases, mild mental retardation (IQ<80) in 7 cases, and epilepsy in 3 cases. Acute subdural hematoma in children caused by trivial household trauma is a clinical entity distinct from acute subdural hematoma caused by child abuse or shaken-baby syndrome. (author)

  19. Acquired Hemophilia A with a Rare Presentation of Acute Subdural Hematoma.

    Science.gov (United States)

    Sehara, Yoshihide; Hayashi, Yuka; Mimuro, Jun

    2015-01-01

    An 80-year-old man was admitted for acute subdural hematoma caused by a mild brain injury. His coagulation test showed an isolated prolongation of activated partial thromboplastin time (aPTT). Though the subdural hematoma did not progress, oozing bleed from the wound of tracheostomy continued. Failure of correction on aPTT mixing test supported the presence of an inhibitor to a coagulation factor. Once the diagnosis of acquired hemophilia A (AHA) was made, steroid therapy was performed, which leads him to complete remission of AHA. Isolated prolongation of aPTT can be the key to diagnose a rare coagulopathy, such as AHA. PMID:26491582

  20. HEMATOMA SUBDURAL EN PACIENTE CON LEUCEMIA MIELODE CRONICA: REPORTE DE CASO

    OpenAIRE

    Carlos Fernando Lozano-Tangua; Luis Rafael Moscote-Salazar; Gabriel Alcala-Cerra; Sandra Milena Castellar Leones; Diego Batero

    2009-01-01

    El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis), coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada prolife...

  1. Posttraumatic retroclival acute subdural hematoma: Report of two cases and review of literature

    Directory of Open Access Journals (Sweden)

    Sridhar Krishnamurthy

    2010-01-01

    Full Text Available Traumatic retroclival hematomas are uncommon lesions usually associated with significant trauma. Majority of the reported hematomas are epidural; and in the pediatric population. Retroclival acute subdural hematomas (RSDH are very rare, with only two previous cases reported in English literature. An 18-year-old man presented with headache and no deficits following an accident. Computer tomography (CT scan and magnetic resonance imaging (MRI showed an acute RSDH extending into the spinal subdural space. He developed bilateral sixth nerve palsies, with symptoms of raised intracranial pressure within the next 24 hours. He underwent evacuation of hematoma with a good outcome. Another 19-year-old man presented with neck pain following a fall from a moving bus. He had no neurological deficits. CT scan showed a RSDH extending across the craniovertebral junction. He was managed conservatively with good outcome.

  2. Angiographically Occult Vascular Malformation of the Cauda Equina Presenting Massive Spinal Subdural and Subarachnoid Hematoma

    OpenAIRE

    Kim, Ji-Hyun; Lee, Sun-Ho; Kim, Eun-Sang; Eoh, Whan

    2011-01-01

    We report a case of a non traumatic spinal subdural hematoma or subarachnoid hematoma manifesting as lumbago, leg pain and bladder dysfunction that showed angiographically occult vascular malformation (AOVM). Although the spinal angiogram did not reveal any vascular abnormality, the follow-up magnetic resonance image showed AOVM. Complete surgical removal was performed due to the aggravated bladder dysfunction. This case highlights the need to consider bleeding due to spinal AOVM, even when a...

  3. A Motion Simulator Ride Associated With Headache and Subdural Hematoma: First Case Report.

    Science.gov (United States)

    Scranton, Robert A; Evans, Randolph W; Baskin, David S

    2016-02-01

    We report the first case report of symptomatic bilateral subdural hematomas (SDH) associated with riding a centrifugal motion simulator ride. A previously healthy 55-year-old male developed new onset daily headaches 1 week after going on the ride that were due to symptomatic bilateral SDH requiring operative intervention with a full recovery. There was no history of other trauma or other systemic or intracranial abnormality to account for the development of the SDH. We review the headaches and other clinical features associated with chronic SDH. Twelve cases of roller coaster headaches due to SDH associated with riding roller coasters have been reported. The pathophysiology is reviewed, which we believe is the same mechanism that may be responsible in this case. Although it is possible that this neurovascular injury is truly rare, it is also possible that this injury is underreported as patients and physicians may not make the association or physicians have not reported additional cases. The risk of this injury likely increases with age, as the size of the subdural space increases, and may support the maxim that "roller coasters and simulators are for kids." PMID:26581189

  4. Fenestration of bone flap during decompressive craniotomy for subdural hematoma

    Science.gov (United States)

    Nguyen, Ha Son; Doan, Ninh; Wolfla, Christopher; Pollock, Glen

    2016-01-01

    Background: Persistent/recurrent extra-axial hemorrhage may occur after decompression of a subdural hematoma (SDH) followed by an immediate replacement of bone flap. A fenestration of the bone flap may encourage extra-axial fluid absorption; however, the literature has not explored this technique. Methods: Forty-four consecutive patients who underwent surgical decompression of SDH with immediate replacement of bone flap were divided into two groups: Fenestration (F), n = 33, and no fenestration (NF), n = 11. Fenestration involves placement of twist drill holes 12 cm apart throughout the bone flap. Clinical data (age, sex, history of antiplatelet/anticoagulation [AA], and presence of drains) were collected. The size of bone flap, postoperative volume, and midline shift (MLS) were measured. A univariate analysis was performed for continuous variables; Fisher's exact test was performed for categorical variables. Results: For postoperative volume, NF group exhibited 94.4 15.5 cm3, while F group exhibited 47.3 15.5 cm3 (P = 0.04); no AA exhibited 62.9 12.3 cm3, while AA exhibited 100.5 19.0 cm3 (P = 0.07); no drains exhibited 110.1 29.6 cm3, while drains exhibited 63.0 9.1 cm3 (P = 0.14). For postoperative MLS, NF group exhibited 4.8 1.1 mm, while F group exhibited 2.5 1.1 mm (P = 0.16); no AA exhibited 2.3 1.0 mm, while AA exhibited 5.8 1.4 mm (P = 0.048); no drains exhibited 4.6 2.2 mm, while drains exhibited 3.8 0.7 mm (P = 0.70). Accounting for fenestration status and AA status: For F group, AA status did not correlate with postoperative volume or MLS significantly; for NF group, history of AA exhibited higher postoperative value 129.2 26.5 cm3, compared to no history of AA at 59.5 16.2 cm3 (P = 0.03). Conclusion: Our results suggest that fenestration prior to the immediate replacement of bone flap after surgical decompression of SDH has the potential to reduce extra-axial fluid accumulation.

  5. Comparison Between Cerebral Tissue Oxygen Tension and Energy Metabolism in Experimental Subdural Hematoma

    DEFF Research Database (Denmark)

    Nielsen, Troels Halfeld; Engell, Susanne I; Johnsen, Rikke Aagaard; Schulz, Mette K; Gerke, Oke; Hjelmborg, Jacob; Toft, Palle; Nordstrøm, Carl-Henrik

    2011-01-01

    BACKGROUND: An experimental swine model (n = 7) simulating an acute subdural hematoma (ASDH) was employed (1) to explore the relation between the brain tissue oxygenation (PbtO(2)) and the regional cerebral energy metabolism as obtained by microdialysis, and (2) to define the lowest level of PbtO...

  6. Extensive subdural hematoma in full term neonate due to falcine laceration

    Directory of Open Access Journals (Sweden)

    V. Umamaheswara Reddy

    2015-03-01

    Full Text Available Subdural hematoma in supratentorial location occur due to rupture of bridging veins or by laceration of falx, the latter entity being extremely uncommon cause of hemorrhage in full term new-born neonate who has been delivered by non-instrumental vaginal delivery. Compressive effects on the fetal parietal bones by rigid maternal pelvic structures result in frontaloccipital elongation and vertical or oblique molding. This in turn causes cranio-caudal stretching of both the falx and tentorium. Normally the give-away is at the falcine and tentorial junctions, rarely only falcine laceration can result. Most of massive subdural hematomas due to falx laceration, tentorial laceration or occipital diastasis have a rapid lethal course or patients may have permanent neurological disability. We describe a case of full term neonate who had extensive subdural and parenchymal hemorrhage resulting from falcine tear.

  7. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion.

    Science.gov (United States)

    Mattei, Tobias A; Rehman, Azeem A; Dinh, Dzung H

    2015-10-01

    Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas. PMID:26430602

  8. Hematoma subdural agudo traumático: estudo de 110 pacientes Acute traumatic subdural haematomas: study of 110 cases

    OpenAIRE

    Nicandro de Figueiredo Neto; Johnny Wesley G. Martins; Miguel Parage Filho; Luiz Augusto Casulari Roxo da Motta; Paulo Andrade de Mello; Ronaldo Sérgio Santana Pereira

    1996-01-01

    Apresentamos uma série consecutiva de 110 pacientes com hematoma subdural agudo traumático (HSDA) admitidos no serviço de emergência do HBDF no período de 1°-janeiro a 1°-dezembro-1994. Todos os pacientes foram atendidos de acordo com o mesmo protocolo. Houve predominância do sexo masculino (79%), com idade variando entre 14 e 70 anos, sendo os atropelamentos (34%) e os acidentes automobilísticos (20%) as causas mais comuns. A maioria dos pacientes (85,7%) foi admitida muito grave, com 8 pont...

  9. Spontaneous acute subdural hematoma as an initial presentation of choriocarcinoma: A case report

    Directory of Open Access Journals (Sweden)

    Rocque Brandon G

    2008-06-01

    Full Text Available Abstract Introduction Diverse sequelae of central nervous system metastasis of choriocarcinoma have been reported, including infarction, intra or extra axial hemorrhages, aneurysm formation and carotid-cavernous fistula. Here we report a case of subdural hematoma as the first presentation of choriocarcinoma. Case presentation The patient is a 34-year-old woman whose initial presentation of widely metastatic choriocarcinoma was an acute subdural hematoma, requiring decompressive craniectomy. Histopathologic examination of the tissue showed no evidence of choriocarcinoma, but the patient was found to have diffuse metastatic disease and cerebrospinal fluid indices highly suggestive of intracranial metastasis. Conclusion Choriocarcinoma frequently metastasizes intracranially. We review the diverse possible manifestations of this process. In addition, the cerebrospinal fluid:serum beta-human chorionic gonadotropin ratio is an important factor in diagnosing these cases. Finally, the role of the neurosurgeon is discussed.

  10. HEMATOMA SUBDURAL EN PACIENTE CON LEUCEMIA MIELODE CRONICA: REPORTE DE CASO

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Lozano-Tangua

    2009-01-01

    Full Text Available El hematoma subdural cronico se define como una colección sanguíneo fibrinoide en el espacio existente entre las meninges duramadre y aracnoides, debido a traumas, infecciones (empiema y meningitis, coagulopatías u otras causas. En este se puede precisar durante la intervención quirúrgica la presencia de cápsula o membranas. Entre las diversas causas de hematoma subdural crónico se encuentra la leucemia mieloide crónica que es un síndrome mieloproliferativo, donde se ve una acentuada proliferación de glóbulos blancos de la serie granulocítica, que infiltran la sangre, médula ósea, cerebro entre otros tejidos. Presentamos brevemente un caso de esta interesante y no infrecuente asociación.

  11. Hematoma subdural aps puno inadvertida da dura-mter: relato de caso

    OpenAIRE

    Wallace Lage Duarte; Fabiano Souza Arajo; Marcelo Figueiredo Almeida; Dbora Grimberg Geber; Carlos Henrique Viana de Castro

    2008-01-01

    JUSTIFICATIVA E OBJETIVOS: A cefalia ps-puno da dura-mter complicao bastante conhecida das anestesias subaracnidea e peridural, e o tratamento mais difundido o tampo sangneo. O tampo sangneo alivia totalmente a cefalia na grande maioria dos pacientes, e nos demais no h melhora ou, apenas, melhora parcial. Nesses casos, prudente buscar diagnsticos diferenciais, como o hematoma subdural ou pneumoencfalo. Os mtodos de imagem so extremamente teis nessas situaes. O ob...

  12. Hematoma subdural aps puno inadvertida da dura-mter: relato de caso

    Directory of Open Access Journals (Sweden)

    Wallace Lage Duarte

    2008-08-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A cefalia ps-puno da dura-mter complicao bastante conhecida das anestesias subaracnidea e peridural, e o tratamento mais difundido o tampo sangneo. O tampo sangneo alivia totalmente a cefalia na grande maioria dos pacientes, e nos demais no h melhora ou, apenas, melhora parcial. Nesses casos, prudente buscar diagnsticos diferenciais, como o hematoma subdural ou pneumoencfalo. Os mtodos de imagem so extremamente teis nessas situaes. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano aps puno inadvertida da dura-mter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado fsico ASA II, foi admitido para realizao de dermolipectomia abdominal, aps ter-se submetido gastroplastia redutora. Durante anestesia peridural, houve perfurao acidental da dura-mter. O paciente evoluiu com sintomas de cefalia ps-puno da dura-mter que foram tratados com tampo sangneo, com melhora parcial. Houve, posteriormente, piora da cefalia, e a ressonncia nuclear magntica de encfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperao total aps 30 dias. CONCLUSES: A ocorrncia de hematoma subdural complicao rara, mas grave da perfurao de dura-mter. O diagnstico difcil e deve ser sempre cogitado quando a cefalia ps-puno da dura-mter no se resolve com o tampo sangneo ou piora com sua realizao. No esclarecimento diagnstico fundamental o auxlio de um mtodo de imagem.

  13. Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report

    OpenAIRE

    Park, Yong Jin; Kim, Seok Won; Ju, Chang Il; Wang, Hui Sun

    2012-01-01

    Spontaneous cervical SDH with no underlying pathology is a very unusual condition. To the best of the authors' knowledge, only two cases have been previously reported. A 48-year-old female patient was admitted to our emergency room due to severe neck pain following standing up position with rapid onset of hemiparesis. MRI revealed a dorsolateral subdural hematoma from C3-C5 with cord compression. An emergency laminectomy was planned, but motor weakness gradually improved during surgical prepa...

  14. Outcome of burr hole surgery in the emergency room for severe acute subdural hematoma

    International Nuclear Information System (INIS)

    We have performed burr hole surgery in the emergency room for severe acute subdural hematoma from April 2007 in twenty five patients. All patients were deep comatose and showed cerebral herniation sign with bilateral pupillary abnormalities. Burr hole surgeries were performed as soon as possible after CT evaluation. Continually decomporresive craiectomies were followed if clinical improvements were achieved and mild baribiturate-moderate hypothermia combined (MB-MH) therapy was induced postoperatively in some cases. The mean average was 65.6 years (range 16-93). The causes of head injuries were traffic accident in 9, fall down in 13 and unknown in 3. The mean Glasgow coma scale (GCS) on admission was 4.4 (range 3-9). The mean time interval from arrival to burr hole surgery was 33.5 minutes (range 21-50 minutes). Decompressive craniectomy was indicated in 14 cases and MB-MH therapy was induced in 13 cases. The overall clinical outcome consisted of good recovery in 3, moderate disability in 2, severe disability in 3, persistent vegetative state in 3 and death in 14. Favorable results can be expected even in patients with serious acute subdural hematoma. Emergent burr hole surgery was effective to decrease intracranial pressure rapidly and to save time. So active burr hole surgery in the emergency room is strongly recommended to all cases of severe acute subdural hematoma. (author)

  15. Hematoma subdural crónico calcificado. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Ariel Varela Hernández

    2008-01-01

    Full Text Available El hematoma subdural crónico constituye una enfermedad frecuente en la práctica neuroquirúrgica cotidiana. Su diagnóstico se realiza actualmente de forma temprana en la mayoría de los pacientes, a partir de la introducción de las modernas técnicas de imagenología. Se presenta el caso de un enfermo de 84 años de edad con historia de cefalea, mutismo acinético y cuadriparesia, cuyo examen tomográfico mostró una colección extraxial supratentorial hemisférica derecha con calcificación masiva; se practicó la exéresis mediante una craneotomía y el estudio histopatológico confirmó el diagnóstico de hematoma subdural crónico. Se concluye que, al constituir la calcificación masiva del hematoma subdural crónico una rara forma de presentación imagenológica en la actualidad, deben contemplarse otras entidades en el diagnóstico diferencial como neoplasias y malformaciones vasculares intracraneales; por otro lado, aumenta la complejidad quirúrgica ya que es imprescindible la práctica de una craneotomía para la evacuación de la lesión.

  16. Spontaneous Resolution of Non-traumatic Cervical Spinal Subdural Hematoma Presenting Acute Hemiparesis: A Case Report.

    Science.gov (United States)

    Park, Yong Jin; Kim, Seok Won; Ju, Chang Il; Wang, Hui Sun

    2012-09-01

    Spontaneous cervical SDH with no underlying pathology is a very unusual condition. To the best of the authors' knowledge, only two cases have been previously reported. A 48-year-old female patient was admitted to our emergency room due to severe neck pain following standing up position with rapid onset of hemiparesis. MRI revealed a dorsolateral subdural hematoma from C3-C5 with cord compression. An emergency laminectomy was planned, but motor weakness gradually improved during surgical preparation. The patient showed substantial clinical improvement and complete recovery was confirmed after 7 days of conservative management without surgical treatment. To determine a differential diagnosis distinct from other conditions such as cervical epidural hematoma, a lumbar spinal puncture was performed. Follow-up MRI performed 10 days after admission revealed complete resolution of the hematoma. We report an extremely rare case of spontaneous cervical spinal subdural hematoma (SDH), present a review of relevant literature, and discuss the etiology, pathogenesis, and prognosis of this case. PMID:25983826

  17. [A case of occult AVM diagnosed 17 years after subdural hematoma in the neonatal period].

    Science.gov (United States)

    Pooh, K; Nakagawa, Y; Jofuku, N; Matsuura, H; Fukuda, K; Endo, S; Matsumoto, K

    1996-06-01

    There have been few reports on cerebral arteriovenous malformation (AVM) of newborns. We present here an interesting case of occult AVM diagnosed 17 years after an episode of acute subdural hematoma in the neonatal period. The cause of subdural hematoma had remained unclear and the patient had suffered from an intractable epilepsy of 17 years duration. Seizures were mainly characterized by drop attacks and included other seizure types such as complex partial seizure and generalized tonic clonic seizure. The symptoms had gradually become worse and the intervals between the occurrences of symptoms had become shorter. An interictal scalp EEG showed a focal spike in the left temporoparietal lobe. CT and MRI of that region demonstrated a porencephalic cyst which was supposed to have resulted from an old hematoma. There were no vascular abnormalities in angiography. Temporoparietal craniotomy and a corticogram were performed. The cortex with a focus was resected and the disappearance of a focal spike in the corticogram was confirmed during operation. Microscopically the cortex included AVM with gliosis. The initial postoperative course was good and seizures disappeared immediately after the operation. However, the symptoms of drop attacks observed before operation began to occur again 3 months later. The fact of postoperative recurrence suggests that the long history of the patient's seizures originating from AVM may have produced secondary epileptic foci. PMID:8677004

  18. Good outcomes in a patient with a Duret hemorrhage from an acute subdural hematoma

    Science.gov (United States)

    Nguyen, Ha Son; Doan, Ninh B; Gelsomino, Michael J; Shabani, Saman; Mueller, Wade M

    2016-01-01

    Background Secondary brain stem injury is associated with transtentorial herniation, and manifests as Duret hemorrhages. Such an injury has been considered a terminal brain stem event with a high morbidity and mortality, sometimes discouraging continuation of care. However, there have been rare instances where patients have had reasonable recovery. We report another case, emphasizing that such an injury by itself should not deter aggressive measures, as good outcomes remain a possibility. Case presentation A 37-year-old male sustained a right subdural hematoma after a mechanical fall while intoxicated. He presented initially with a Glasgow Coma Scale 15. Three days later, he exhibited acute neurological deterioration to Glasgow Coma Scale 4, requiring intubation and mannitol. Repeat scan demonstrated enlarging right subdural hematoma with worsening shift; brain stem hemorrhage was noted at pontomesencephalic junction. Patient was immediately taken for subdural hematoma evacuation. The following day, patient was able to sluggishly follow commands in all four extremities. He had a short stay for inpatient rehabilitation and underwent autologous cranioplasty at 3 months. On examination, he was awake, alert, and oriented to self, time, and location; he exhibited dysarthric speech, right ptosis, but followed commands in all four extremities with no focal motor weakness. Conclusion In contrast to the common belief, patients suffering from a Duret hemorrhage can still have a good outcome. Duret hemorrhages may not represent a fatal injury. The finding from this paper suggests the finding of Duret hemorrhages on imaging should not deter aggressive measures especially in patients with lesions causing significant mass effects. Overall clinical status should drive surgical options and clinical course. PMID:26869816

  19. Hematoma subdural de medula espinhal associada ao uso de anticoagulante oral Hematoma subdural de la médula espinal asociado al uso de anticoagulante oral Spine subdural hematoma: a rare complication associated with vitamin K antagonist (VKA

    Directory of Open Access Journals (Sweden)

    Uri Adrian Prync Flato

    2009-01-01

    Full Text Available O hematoma subdural de medula espinhal (HSDME é uma complicação rara decorrente do uso de antagonistas de vitamina K (AVK e de diagnostico difícil. Este artigo apresenta um caso com complicação ameaçadora à vida: um paciente octogenário portador de fibrilação atrial de início recente em uso de AVK. A história e o exame físico inicialmente se apresentavam normais, associados com a elevação dos valores de coagulograma supraterapêuticos (INR > 10. Após 24 horas da admissão hospitalar, o paciente apresentou tetraparesia progressiva, evidenciando na ressonância nuclear magnética (RNM de medula espinhal um HSDME (Figura 1. Após reversão completa da hipocoagulação e intervenção neurocirúrgica o paciente obteve melhora do quadro neurológico.El hematoma subdural espinal (HSE es una complicación rara proveniente del uso de antagonistas de vitamina K (AVK y de diagnostico difícil. Este artículo presenta un caso con complicación amenazadora para la vida: un paciente octogenario portador de fibrilación auricular de inicio reciente, en uso de AVK. Inicialmente, la historia y el examen físico se presentaban normales, asociados a la elevación de los valores de coagulograma supra terapéuticos (INR > 10. Tras 24 horas del ingreso hospitalario, el paciente presentó tetraparesia progresiva. Al realizarse una resonancia nuclear magnética (RNM de médula espinal, se evidenció un HSE (Figura 1. Tras reversión completa de la hipocoagulación e intervención neuroquirúrgica el paciente obtuvo mejora del cuadro neurológico.Spinal subdural hematoma (SSDH is a rare condition, which is difficult to diagnose, related to Vitamin K Antagonist. This a case report of a life-threatening situation in a octogenarian patient with a history of recent atrial fibrillation that received K-Vitamin Antagonist (KVA therapy. The history and the clinical assessment were normal at the admission, associated with increase in the coagulation parameters (INR >10. Twenty-four hours after the admission, the patient developed progressive tetraparesis and a Magnetic Resonance Imaging (MRI was performed, disclosing the evidence of a SSDH (Figure 1. An emergency neurosurgical intervention was performed associated with normalization of the coagulation parameters. After the procedure, the patient presented improvement of the neurological symptoms.

  20. Clinicopathological study of acute subdural haematoma in the chronic healing stage. Clinical, histological and ultrastructural comparisons with chronic subdural haematoma.

    Science.gov (United States)

    Yamashima, T; Yamamoto, S

    1984-07-01

    Seven cases of acute subdural haematoma in the chronic healing stage, were studied clinicopathologically. Operation was not performed until 17-30 days after major trauma, and revealed subdural granulation tissue of irregular thickness, but no visible inner membranes. Although this capsule contained blood pigment and numerous macrophages, new haemorrhagic foci or eosinophilic infiltrations were extremely rare. Capsular vessels generally had thick vascular walls, distinct basement membranes and tight endothelial junctions. Perivascular blood substance was presumably not secondary haemorrhage from these vessels, but residue from the acute subdural haematoma itself. The possibility of transition from this haematoma to chronic subdural haematoma is discussed. PMID:6483072

  1. Hematoma subdural agudo traumático: estudo de 110 pacientes Acute traumatic subdural haematomas: study of 110 cases

    Directory of Open Access Journals (Sweden)

    Nicandro de Figueiredo Neto

    1996-06-01

    Full Text Available Apresentamos uma série consecutiva de 110 pacientes com hematoma subdural agudo traumático (HSDA admitidos no serviço de emergência do HBDF no período de 1°-janeiro a 1°-dezembro-1994. Todos os pacientes foram atendidos de acordo com o mesmo protocolo. Houve predominância do sexo masculino (79%, com idade variando entre 14 e 70 anos, sendo os atropelamentos (34% e os acidentes automobilísticos (20% as causas mais comuns. A maioria dos pacientes (85,7% foi admitida muito grave, com 8 pontos ou menos na Escala de Coma Glasgow (ECG, o que influenciou diretamente na mortalidade. A tomografia computadorizada de crânio foi o exame diagnóstico de escolha que mostrou serem as contusões e o inchaço cerebral ("swelling" as lesões intracranianas associadas mais freqüentes. A cirurgia foi realizada em 45,1% dos pacientes, e, em sua maioria, através de craniotomia fronto-têmporo-parietal ampla, com drenagem do hematoma, seguida de plástica da dura-mater. Em 54,9% as condições clínicas não permitiram a realização da cirurgia; neste grupo, cerca de 69,6% estavam em coma profundo à admissão, com 3 pontos na ECG. A letalidade cirúrgica foi de 61,2% e esteve diretamente relacionada à condição clínica inicial e à idade do paciente. A letalidade, incluindo todos os pacientes cirúrgicos e não cirúrgicos com HSDA, mesmo aqueles admitidos já com sinais de falência de tronco cerebral, foi de 79,5%. Além destes pacientes que faleceram, cerca de 7% evoluíram sem seqüelas ou com seqüelas mínimas; outros 11,4% com seqüelas de moderadas a paves e 2,1 % permaneceram em estado vegetativo persistente. Nossos dados estão de acordo com os da literatura no que se refere a elevada taxa de morbidade e mortalidade dos pacientes com HSDA.We report a series of 110 patients with acute traumatic subdural hematoma (ASDH admitted at HBDF emergency within 1994 (January Is1 to December PJ.All patients were treated according to the same protocol. There was a predominance of males (79%, with ages ranging from 14 to 70, being car accidents (20% and car-pedestrian accidents (34% the most frequent causes The majority of patients (85.7% was admitted in very serious condition, with a score of 8 points on the Glasgow Coma Scale (GCS or lesser, which directly influenced the mortality rates. CT scan was the diagnostic procedure of choice, and it showed contusion and brain swelling to be the most frequent associated intracranial lesions. Surgery was carried out in 45.1% of cases and, in most instances, through an ample fronto-temporo-parietal craniotomy, with hematoma drainage and dural reconstitution. In 54.9% of cases, clinical conditions did not allow surgery and in this group, 69.6%

  2. Chronic subdural haematoma, an unusual injury from playing basketball

    OpenAIRE

    Keller, T. M.; M. C. Holland

    1998-01-01

    Although the literature records instances of acute epidural haematoma and acute subdural haematoma related to playing basketball, there has not been a report of chronic subdural haematoma as a basketball injury. With the burgeoning interest in this sport in the United Kingdom and Europe, the possibility of this particular neurotrauma increases. Such an injury, along with the diagnosis and management of this often insidious lesion, is documented in this case report. ???

  3. Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso

    Directory of Open Access Journals (Sweden)

    Flora Margarida Barra Bisinotto

    2012-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma subdural intracraniano é uma complicação rara após raquianestesia. O diagnóstico é muitas vezes difícil porque os sintomas iniciais são os mesmos da cefaleia pós-punção da dura-máter. O objetivo é relatar o caso de um hematoma subdural diag nosticado precocemente, após uma raquianestesia realizada com agulha de calibre fino e punção única. RELATO DO CASO: Paciente de 48 anos, ASA I, submetida a raquianestesia para cirurgia de correção de incontinência urinária. Foi realizada a raquianestesia com agulha 27G Quincke e punção única. A cirurgia foi sem intercorrências, e a paciente recebeu alta hospitalar. Após 48 horas da punção raquidiana, a paciente relatou cefaleia de início súbito, de forte intensidade, acometendo principalmente a região orbitária, mas também a região temporal, com melhora importante no decúbito dorsal e acompanhada de dois episódios de vômitos. Foi solicitada tomografia de crânio que revelou a presença de um hematoma subdural agudo frontotemporoparietal esquerdo. Foi indicado tratamento conservador com analgésicos, dexametasoma e hidantoína. Após 17 dias, apresentou quadro de cefaleia intensa, acompanhada de dormência e paresia do membro superior direito, e distúrbio da fala e comportamento. O hematoma foi drenado cirurgicamente. A paciente evoluiu bem sem sequelas. CONCLUSÕES: A cefaleia é a complicação mais frequente após raquianestesia e é considerada de evolução benigna. Faz com que diagnósticos potencialmente fatais, como o hematoma subdural, não sejam feitos em muitos casos, ou sejam tardios. Este caso descreve uma ocorrência rara, um hematoma subdural agudo após uma raquianestesia com agulha fina em uma paciente sem fatores de risco para sangramento

  4. A case of diffuse hemispheric gyral high density on CT scan following acute subdural hematoma in children

    International Nuclear Information System (INIS)

    A case of diffuse hemispheric gyral high density area following acute subdural hematoma was reported. A 2 - 10/12 year-old male was admitted to our hospital in comatous state after head injury by fall. Neurological examination revealed deep coma with anisocoria (R < L), absence of light reflex and positive bilateral Babinski reflex. CT scan disclosed left acute subdural hematoma with remarkable midline shift and tentorial herniation sign. Emergency decompressive craniectomy was performed. Posttraumatic hydrocephalus appeared after 10 days. So, ventriculoperitoneal shunt was done. The patient became gradually improved, but was in appalic state. 23 days after craniectomy, suddenly diffuse hemispheric gyral high density appeared on plain CT scan. In spite of this change, no clinical change was found. This high density spontaneously disappeared 10 days after appearance. Cerebral infarction-like phenomenon on postoperative CT scan of acute subdural hematoma in infants was sometimes reported. This phenomenon was sometimes accompanied with hemorrhagic infarction-like high density on CT scan. Diffuse hemispheric gyral high density was probably a kind of those hemorrhagic infarction-like phenomenon. Possible mechanism of this peculiar high density is discussed on the basis of characteristics of child's cerebral artery and pathophysiology of cerebral infarction. (author)

  5. Age determination of subdural hematomas with CT and MRI: A systematic review

    International Nuclear Information System (INIS)

    Objectives: To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. Methods: We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and performed data extraction. Medians with interquartile ranges were calculated. Differences were tested with a Mann–Whitney U or Kruskal–Wallis H test. Results: We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p < 0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p = 0.000) and hyperdensity (p = 0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p = 0.108 and p = 0.194, respectively). Conclusions: Most time intervals of the different appearances of SDHs on CT and MRI are broad and overlapping. Therefore CT or MRI findings cannot be used to accurately date SDHs

  6. A calvarial acute subdural hematoma migrating into the spinal canal in a young male.

    Science.gov (United States)

    Köksal, Vaner; Özdemir, Bülent

    2015-10-01

    It is not common for an acute subdural hematoma (SDH) in the supratentorial region to show rapid resolution or migration during the clinical course. In this report, we present a rare case where the SDH in the supratentorial region was observed to rapidly migrate into the lumbar spinal canal, leading to severe radiculopathy. A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal. He had vomited 3 times after the onset of pain. No stiff neck was found, and the computed tomography showed an ASDH over the outer layer of the right hemisphere, causing a 7- to 8-mm shift. During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. Acute SDH associated with a minor head trauma may migrate from the supratentorial compartment into the spinal canal by the help of elastic cerebral tissues in young adults and children. PMID:26314217

  7. Age determination of subdural hematomas with CT and MRI: A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Sieswerda-Hoogendoorn, Tessa, E-mail: t.sieswerda@amc.nl [Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Postema, Floor A.M., E-mail: f.a.postema@amc.nl [Faculty of Medicine, University of Amsterdam, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Verbaan, Dagmar, E-mail: d.verbaan@amc.nl [Department of Neurosurgery, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Majoie, Charles B., E-mail: c.b.majoie@amc.nl [Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands); Rijn, Rick R. van, E-mail: r.r.vanrijn@amc.nl [Section of Forensic Pediatrics, Department of Forensic Medicine, Netherlands Forensic Institute, PO Box 24044, 2490 AA The Hague (Netherlands); Department of Radiology, Academic Medical Center/Emma Children' s Hospital, Meibergdreef 9, 1105 AZ Amsterdam (Netherlands)

    2014-07-15

    Objectives: To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. Methods: We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers independently screened the articles, assessed methodological quality and performed data extraction. Medians with interquartile ranges were calculated. Differences were tested with a Mann–Whitney U or Kruskal–Wallis H test. Results: We included 22 studies describing 973 SDHs on CT and 4 studies describing 83 SDHs on MRI. Data from 17 studies (413 SDHs) could be pooled. There were significant differences between time intervals for the different densities on CT (p < 0.001). Time interval differed significantly between children and adults for iso- and hypodensity (p = 0.000) and hyperdensity (p = 0.046). Time interval did not differ significantly between abused and non-abused children. On MRI, time intervals for different signal intensities on T1 and T2 did not differ significantly (p = 0.108 and p = 0.194, respectively). Conclusions: Most time intervals of the different appearances of SDHs on CT and MRI are broad and overlapping. Therefore CT or MRI findings cannot be used to accurately date SDHs.

  8. Plasma aldosterone and CT findings in head injury, especially in acute subdural hematoma

    International Nuclear Information System (INIS)

    As we have already reported, an increase in the plasma aldosterone level was regulary found after severe head injury. And the values of plasma aldosterone in unconscious patients with increased intracranial pressure were significantly higher than those in patients without unconsciousness. Thus, plasma aldosterone in acute phase of head injury seems to be a sensitive index of increased intracranial pressure. In the present study, we measured plasma aldosterone levels in three groups ; subdural hematoma with mid-line shift (group A), cerebral contusion without mid-line shift (group B) and cerebral conceussion (group C). In group A, the peak value of aldosterone was markedly high (283.9 ± 142.5). In B, the peak value (143.7 ± 27.8) was higher than in C (116.3 ± 35.0). And, correlation between the serum aldosterone levels and CT findings, especially the mid-line shift was found. As a conclusion, the serum levels of aldosterone seems to be associated with intracranial pressure. (author)

  9. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    Science.gov (United States)

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. PMID:26755452

  10. CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin.

    Science.gov (United States)

    Karnik, Niteen D; Sridharan, Kannan; Tiwari, D; Gupta, V

    2014-01-01

    Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (*1/*3). This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin. PMID:25298588

  11. CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

    OpenAIRE

    Karnik, Niteen D.; Sridharan, Kannan; Tiwari, D.; Gupta, V.

    2014-01-01

    Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C...

  12. Extra-Axial Hematoma and Trimethoprim-Sulfamethoxazole Induced Aplastic Anemia: The Role of Hematological Diseases in Subdural and Epidural Hemorrhage

    OpenAIRE

    Menger, Richard P.; Dossani, Rimal H.; Jai Deep Thakur; Frank Farokhi; Kevin Morrow; Bharat Guthikonda

    2015-01-01

    Objective and Importance. To illustrate the development of spontaneous subdural hematoma secondary to aplastic anemia resulting from the administration of trimethoprim-sulfamethoxazole. This is the first report of trimethoprim-sulfamethoxazole potentiating coagulopathy leading to any form of intracranial hematoma. Clinical Presentation. A 62-year-old female developed a bone marrow biopsy confirmed diagnosis of aplastic anemia secondary to administration of trimethoprim-sulfamethoxazole follow...

  13. Pola Kejadian Hematoma Subdural Pada Bayi Yang dirawat di Ruang Rawat Intensif Anak Rumah Sakit Dr. Hasan Sadikin

    Directory of Open Access Journals (Sweden)

    Enny Harliany Alwi

    2009-09-01

    Full Text Available Subdural hematoma (SDH is a common condition in infancy and young children with a poor prognostic. The more studies related SDH with nonaccidental injury. With the aim to identify the characteristics of SDH in infants below 1 year, a retrospective study of infants below 1 year diagnosed as subdural hematoma who were admitted to PICU Hasan Sadikin General Hospital from Januari 2000 to Desember 2003 has been conducted. Infants less than 1 month and SDH developed after neurosurgery intervention were excluded. Fourteen infants met the inclusion criteria's, consisted of 5 (36% girls and 9 (64% boys, most of them were on 1 month of age (57%. Anemia was found on all cases, thrombocyte normal except in 1 case thrombocytopenia (53,000/mm3. PT prolonged in 9 (100% cases and PTT in 5 (56% from 9 cases. Bilirubin total/direct elevated in 4 (80% from 5 cases, SGOT/SGPT elevated in 5 (83% from 6 cases. From 11 cases, 9 (82% cases were IgG anti-CMV positive and 6 (55% cases were IgM anti CMV positive. Conclusions, SDH can be caused by various etiologies, thus a comprehensive examinations to exclude child abuse are needed. The role of CMV infection should be considered as one of SDH etiology.

  14. CYP2C9FNx013 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

    Directory of Open Access Journals (Sweden)

    Niteen D Karnik

    2014-01-01

    Full Text Available Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (FNx011/FNx013. This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin.

  15. A Case Report of Cerebral Venous Thrombosis in Polycythemia Vera Presenting with Intracranial and Spinal Subdural Hematoma.

    Science.gov (United States)

    Sirin, Nermin Grkem; Yesilot, Nilufer; Ekizoglu, Esme; Keles, Nur; Tuncay, Rezzan; Coban, Oguzhan; Bahar, Sara Zarko

    2010-01-01

    Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed concomitant cranial and spinal SDH related to cerebral venous thrombosis (CVT) associated with hemorrhagic venous infarct. Laboratory examinations were consistent with polycythemia vera. There was no history of trauma and previous cranial surgery. Brain angiography did not reveal any evidence of arteriovenous fistula or vascular malformation. Since lower back pain occurred shortly after the headache and there was no other reasonable explanation for spinal hemorrhage, we suppose that the mechanism of spinal SDH is the migration of blood from the intracranial compartment. Therefore, this is the first report of concomitant spinal SDH and cerebral hemorrhage associated with CVT in a patient with myeloproliferative disease. PMID:20671855

  16. Clinical features, treatment and outcome of the acute subdural hematoma in JNTDB. Comparison between Project 1998 and Project 2004

    International Nuclear Information System (INIS)

    The purpose of this study was clarify the clinical features, a change of the therapy and the effect, connection with the outcome of acute subdural hematoma registered on the Japan Neurotrauma Data Bank (JNTDB) presented in 1998 and 2004. Among those, 421 cases in P1998 and 380 cases in P2004 aged more than 6 years who presented with Glasgow Coma Scale (GCS) 8 or less on admission and with acute subdural hematoma (ASDH) on CT findings were retrospectively analyzed. As for the age distribution, two peaks were seen in young aged 16-20 years and old aged 61-65 years. The ratio of the ASDH case in young cases (45 years) decreased compared with P1998. A ratio of traffic accidents decreased, and a ratio of the injury by the fall increased. Surgical treatment was performed to 63.2% (P2004), 65.1% (P1998), and was performed both projects most together by a 46-65 year-old case. Hematoma evacuation group increased to 21.1% from 14.5%, and a burr hole opening decreased to 17.1% (P2004) from 22.3% (P1998). The temperature management was performed to 41.2% (P2004), 20.5% (P1998), especially the younger cases (45 years) in P2004, the temperature management was performed to 56.2%. The overall mortality is 67.7% (P1998), and 54.5% (P2004). The mortality of the temperature management cases was decreased, but the favorable outcome group does not increase. In younger cases (45 years), the favorable outcome group improved to 47.1% (P2004) from 33.3% (P1998) in the hypothermia group, and improved to 45.5% (P2004) from 30.0% (P1998) in the normothermia group. Temperature management after surgical treatment was more common, used to 57.5% (P2004) and 29.2% (P1998). The rate of favorable outcome group tends to increase in the hypothermia and normothermia group with craniotomy, but the mortality was not seen in the difference with the no temperature management group. For the case that used temperature management with a burr hole opening, the effect was not clear. An outcome tends to be good for the case that used temperature management together with craniotomy and will require the accumulation of the further case in future. (author)

  17. Computed tomography of the adult traumatic subdural effusion

    International Nuclear Information System (INIS)

    The present authors, since the installation of the CT scanner in Sept., 1976, have conducted an investigation of 14 adult subdural effusion cases arising from head injury which were available for a follow-up by CT scanning. These cases were examined in the first 13 months after installation. Under CT scanning, subdural effusion was recognized as a low-density area of the subdural space. Our findings indicate that, in spite of the fact that it is a subdural collection, only a limited shift of the midline structure was seen; further, the shrinking of the lateral ventricles of the effusion side was also limited. Judging from the CT findings, the neurological signs and the clinical course, the subdural effusions of the 14 cases could be classified into 2 types: (I) the minimal neurological deficit type and (II) the contusion-effusion type. Representative cases of the above are given, and, in addition, indications of surgery are also mentioned. We further state that, since the subdural effusion cases come under Type I and are characterized by the minimal neurological deficit, in many cases they are apt to be overlooked: hence, the application of CT scanning with special regard to such cases was stressed. In order to differentiate chronic subdural hematoma from subdural effusion under CT scanning, a comparative CT study was made using 20 cases of chronic subdural hematoma, and the difference in CT findings from those of subdural effusion is reported. (author)

  18. Spontaneous development of bilateral subdural hematomas in an infant with benign infantile hydrocephalus: color Doppler assessment of vessels traversing extra-axial spaces

    International Nuclear Information System (INIS)

    We present an infant with macrocrania, who initially demonstrated prominent extra-axial fluid collections on sonography of the brain, compatible with benign infantile hydrocephalus (BIH). Because of increasing macrocrania, a follow-up sonogram of the brain was performed; it revealed progressive enlargement of the extra-axial spaces, which now had echogenic debris. Color Doppler US showed bridging veins traversing these extra-axial spaces, so it was initially thought that these spaces were subarachnoid in nature (positive cortical vein sign). However, an arachnoid membrane was identified superior to the cortex, and there was compression of true cortical vessels beneath this dural membrane. An MRI of the brain showed the extra-axial spaces to represent bilateral subdural hematomas. The pathogenesis of spontaneous development of the subdural hematomas, in the setting of BIH, is discussed. We also emphasize that visualizing traversing bridging veins through extra-axial spaces does not necessarily imply that these spaces are subarachnoid in origin. (orig.)

  19. Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula.

    Science.gov (United States)

    de Aguiar, Guilherme Brasileiro; Veiga, Jos Carlos Esteves; de Almeida Silva, Joo Miguel; Conti, Mario Luiz Marques

    2016-03-01

    Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. PMID:26541324

  20. Temporal fossa arachnoid cyst presenting with bilateral subdural hematoma following trauma: two case reports

    OpenAIRE

    Pillai Promod; Menon Sajesh K; Manjooran Raju P; Kariyattil Rajiv; Pillai Ashok B; Panikar Dilip

    2009-01-01

    Abstract Introduction Intracranial arachnoid cysts are considered to be congenital malformations with a predilection for the temporal fossa. They are often asymptomatic but can sometimes be symptomatic due to enlargement or hemorrhage. There are multiple case reports of arachnoid cysts becoming symptomatic with hemorrhagic complications following head trauma. In such cases, the bleeding is often confined to the side ipsilateral to the arachnoid cyst. Occurrence of contralateral subdural hemat...

  1. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma.

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2012-11-01

    The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH.

  2. [Chronic expanding hematoma of the soleus: a case report].

    Science.gov (United States)

    Pichon, H; Pittet Barbier, L; Pasquier, B; Cartier, J; Saragaglia, D

    2006-11-01

    Trauma-induced hematomas of the limbs usually resorb without sequelae. In certain circumstances which are not fully understood, the hematoma may expand progressively, eventually leading to the development of a tumor-like mass in the soft tissues. We report the case of a chronic expanding hematoma observed in the right soleus muscle of a 75-year-old man. The mass grew +9 cm compared with the other side over a period of two to three years with no notion of recent trauma. Surgical biopsy disclosed a thick capsule containing "chocolate pus". Pathology and cytology examination led to the diagnosis of pseudo-tumor calcinosis subsequent to a hematoma which the patient had developed 34 years earlier when as a mountain guide he had experienced a tear of the soleus muscle. Local care required complete resection of the soleus muscle. The patient was able to resume activities without pain. Well described in the literature, encapsulated hematoma of the limbs is not well known in France. This case illustrated the potentially long latency period (34 years in our patient). Pathologically similar to tumor calcinosis, chronic expanding hematoma should be entertained as a possible diagnosis in a patient with a longstanding mass and a history of past trauma. The differential diagnosis with sarcoma is established by magnetic resonance imaging which reveals a peripheral low intensity signal on T1 and T2 sequences. PMID:17124458

  3. Subdural hematoma in a patient taking imatinib for GIST: a case report and discussion of risk with other chemotherapeutics.

    Science.gov (United States)

    Theodotou, Christian B; Shah, Ashish H; Ivan, Michael E; Komotar, Ricardo J

    2016-03-01

    Although anticancer drugs have existed for over 50 years, targeted drugs have only recently been marketed, and their side effects may not be completely understood. The patient is a 56-year-old woman with a gastrointestinal stromal tumor who presented with headache, nausea, and vomiting lasting 2 weeks. An MRI to rule out brain metastasis found a large right-hemispheric subdural hematoma without metastases. She denied trauma, seizures, or alcohol abuse. Laboratory test results were normal. Eight months prior, she had begun a dose escalation of imatinib, which became the suspected cause of her hemorrhage. The literature was reviewed for reports of intracranial hemorrhage with targeted chemotherapeutics excluding metastases, anticoagulation, and trauma. Multiple events have been documented but only one for imatinib with gastrointestinal stromal tumor. Imatinib is believed to cause platelet dysfunction (missed by standard testing), leading to intracranial hemorrhage. Intracranial hemorrhage risk may be under-reported and neurosurgical consultation for immediate treatment and oncology for reinitiation of chemotherapy are recommended. PMID:26628484

  4. Relationship between intracranial hypertension and cerebral blood flow after craniotomy in cases with traumatic acute subdural hematoma

    International Nuclear Information System (INIS)

    The purpose of this study is to investigate relationship between the duration of initial intracranial hypertension and postoperative cerebral blood flow (CBF) changes in cases with traumatic acute subdural hematoma (ASDH). Intracerebral pressure (ICP) was monitored using ICP catheter in 17 cases with unilateral traumatic ASDH. ICP monitoring was started before craniotomy, and was continued for 7 days. CBF was quantitatively measured at 7 days after craniotomy with 123I-infetamine (IMP) single photon emission computed tomography (SPECT). Clinical outcome was evaluated using Glasgow Outcome Scale (GOS) at the time of discharge. Patients were divided into 2 groups by the duration of intracranial hypertension: patients who presented with intracranial hypertension (>25 mmHg) and received surgical decompression within 6 hours after deterioration (group A, n=9), and patients who presented with intracranial hypertension and received surgical decompression more than 6 hours after deterioration (group B, n=6). In group A, 7 of 9 patients demonstrated ipsilateral hemispheric hyperperfusion, and the clinical outcome was relatively favorable: Good Recovery (GR) 4 cases, Moderately Disabled (MD) 4 cases, and Severely Disabled (SD) 1 case. In group B, 5 of 6 patients demonstrated ipsilateral hemispheric hypoperfusion, and the clinical outcome was unfavorable: SD 4 cases, and Dead 2 cases. These results suggest that the duration of intracranial hypertension affects on postoperative CBF changes. Duration of intracranial hypertension may also affect on clinical outcome directly, or secondary by altering postoperative CBF changes in patients with traumatic ASDH. (author)

  5. Chronic spinal epidural hematoma in hemophilia A in a child

    International Nuclear Information System (INIS)

    A case of chronic spinal epidural hematoma in a thirteen-year-old male, subsequently found to have hemophilia A is reported. Following myelography, surgery was undertaken with clotting factor replacement with relief of cord compression. The patient made an uneventful recovery. (orig.)

  6. Management of Chronic Subdural Haematoma in a Case of Idiopathic Thrombocytopenic Purpura

    OpenAIRE

    Patnaik, Ashis; Sudhansu S Mishra; Senapati, Satya B.; Pattajoshi, Acharya S.

    2012-01-01

    Intracranial hemorrhage is a rare devastating complication of idiopathic thrombocytopenic purpura (ITP), mostly presenting as intraparenchymal or subarachnoid haemorrhage. Isolated chronic subdural haematoma (SDH) is still very rare and the optimal management is unsettled. Spontaneous resolution of chronic SDH in patients with idiopathic thrombocytopenic purpura is possible. We report a case of spontaneous chronic SDH in a patient with ITP with hemiparesis where the haematoma significantly de...

  7. Severe Acute Subdural Hemorrhage in a Patient With Glutaric Aciduria Type I After Minor Head Trauma: A Case Report.

    Science.gov (United States)

    Zielonka, Matthias; Braun, Katrin; Bengel, Andreas; Seitz, Angelika; Kölker, Stefan; Boy, Nikolas

    2015-07-01

    Glutaric aciduria type I is a rare metabolic disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase. Chronic subdural hematomas have been reported in glutaric aciduria type I and are considered as important differential diagnosis of nonaccidental head trauma. However, chronic subdural hematomas are usually thought to remain clinically silent in these patients. Here we report on a hitherto asymptomatic glutaric aciduria type I patient who developed severe, acute subdural hemorrhage after minor accidental head injury at age 23 months. Computed tomography confirmed significant mass effect on the brain necessitating decompressive hemicraniectomy. Subdural hemorrhage caused large hypoxic lesions of the cerebral cortex and subcortical regions resulting in spastic tetraplegia, dystonia, and loss of developmental milestones. This report emphasizes that acute subdural hemorrhage may be a life-threatening complication in glutaric aciduria type I patients after minor head trauma and should be considered in those patients presenting with neurologic deterioration after accidental head injury. PMID:25038128

  8. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Vazquez-Barquero, A.; Pinto, J.I. [Univ. Hospital ' ' Marques de Valdecilla' ' , Santander (Spain). Dept. of Neurosurgery; Abascal, F.; Garcia-Valtuille, R.; Cerezal, L. [Hospital Mompia, Cantabria, (Spain). Dept. of Radiology; Figols, F.J. [Univ. Hospital Marques de Valdecilla, Santander (Spain). Dept. of Pathology

    2000-10-01

    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  9. Chronic nontraumatic spinal epidural hematoma of the lumbar spine: MRI diagnosis

    International Nuclear Information System (INIS)

    An uncommon case of chronic nontraumatic spinal epidural hematoma of the lumbar spine in a 75-year-old woman is reported. The patient presented with a 7-month history of low back pain and bilateral sciatica. Magnetic resonance imaging enabled a correct preoperative diagnosis revealing a nodular, well-circumscribed epidural mass with peripheral enhancement and signal intensities consistent with chronic hematoma, which extended from L2 to L3. Laminectomy of L2-L3 was performed and the hematoma was totally resected. Histological examination of the surgical specimen demonstrated a chronic encapsulated hematoma. No evidence of vascular malformation was found. The patient recovered fully after surgical treatment. (orig.)

  10. Rupture of a small middle cerebral artery aneurysm into middle fossa arachnoid cyst presenting as a chronic subdural haematoma.

    Science.gov (United States)

    Kocaeli, H; Korfali, E

    2008-04-01

    The rupture of an aneurysm into an arachnoid cyst and subdural space is unusual. A 25-year-old man was admitted 2 weeks after having undergone a burr hole drainage for a chronic subdural haematoma elsewhere. An angiogram revealed a small aneurysm at the bifurcation of the middle cerebral artery. The aneurysm was clipped and the cyst communicated with the basal cisterns. To the best of our knowledge, this is the first report of an association of an aneurysm of the middle cerebral artery with an arachnoid cyst presenting as a chronic subdural haematoma. PMID:18311525

  11. [Subdural hemorrhage of aneurysmal origin].

    Science.gov (United States)

    Sánchez, R; Alfaro, A; Perla, C; Blasco, R; Cortés, F; Solís, P

    1994-02-01

    Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding. PMID:8204251

  12. Uncoupling between CBF and oxygen metabolism in a patient with chronic subdural haematoma: case report.

    OpenAIRE

    Ishikawa, 0 T.; Kawamura, S.; Hadeishi, H.; Suzuki, A.; Yasui, N; Shishido, F; Uemura, K

    1992-01-01

    The regional cerebral blood flow (rCBF) and oxygen metabolism of a patient with a chronic subdural haematoma were examined quantitatively, using positron emission tomography (PET). Before operation, the rCBF was decreased slightly throughout the brain, whereas the regional oxygen extraction fraction (rOEF) was increased throughout the brain, with values ranging from 0.36 to 0.60. One month after operation, the rCBF had recovered remarkably in almost all regions and rOEF had decreased to withi...

  13. Chronic pure radiculopathy in patient with organizing epidural hematoma around C8 nerve root

    OpenAIRE

    Kim, Sang-Hyuk; Jeon, Sang-ho; Cho, Jae-lim; Chong, Hung-tae; Kim, Dong-Jun; Kim, Moon-Chan; Eun, Jong-Pil

    2012-01-01

    Spontaneously occurring spinal epidural hematomas are uncommon clinical findings, and the chronic form is the rarest and its most frequent location is the lumbar spine. Pure radicular involvement is far less frequent than myelopathy. We report a case of progressive radiculopathy in a 52-year-old man with spontaneously occurring cervical epidural hematoma (SCEH). The patient had left hand weakness and numbness for 4 months. MRI scan showed small space-occupying lesion around left 8th cervical ...

  14. Acute subdural hematoma and diffuse axonal injury in fatal road traffic accident victims: a clinico-pathological study of 15 patients Hematoma subdural agudo e lesão axonal difusa em vítimas fatais de acidente de trânsito: estudo clínico-patológico de 15 pacientes

    Directory of Open Access Journals (Sweden)

    Sebastião Nataniel Silva Gusmão

    2003-09-01

    Full Text Available OBJECTIVE: Although acute subdural hematoma (ASDH and diffuse axonal injury (DAI are commonly associated in victims of head injury due to road traffic accidents, there are only two clinico-pathological studies of this association. We report a clinical and pathological study of 15 patients with ASDH associated with DAI. METHOD: The patients were victims of road traffic accidents and were randomly chosen. The state of consciousness on hospital admission was evaluated by the Glasgow coma scale. For the identification of axons the histological sections of the brain were stained with anti-neurofilament proteins. RESULTS: Twelve of the 15 patients were admitted to hospital in a state of coma; in three patients, the level of consciousness was not evaluated, as they died before hospital admission. CONCLUSION: The poorer prognosis in patients with ASDH who lapse into coma immediately after sustaining a head injury, as described by several authors, can be explained by the almost constant association between ASDH and DAI in victims of fatal road traffic accidents.OBJETIVO: Embora o hematoma subdural agudo (HSDA e a lesão axonal difusa (LAD estejam frequentemente associados em vítimas de trauma crânio-encefálico causado por acidentes de trânsito, há somente dois estudos clínico-patológicos sobre esta associação. Relatamos o estudo clínico-patológico de 15 pacientes com HSDA associado com LAD. MÉTODO: Os pacientes, vítimas de acidentes de trânsito, foram selecionados aleatoriamente. O estado de consciência à admissão hospitalar foi avaliado pela escala de coma de Glasgow. Para a identificação dos axônios, os cortes histológicos do cérebro foram corados com antisoro anti-proteínas do neurofilamento. RESULTADOS: Doze dos 15 pacientes foram admitidos no hospital em estado de coma; em três pacientes, o nível de consciência não foi avaliado, pois eles faleceram antes da admissão hospitalar. CONCLUSÃO: O pior prognóstico em pacientes com HSDA que apresentam coma imediatamente após serem admitidos por trauma crânio-encefálico, como descrito por vários autores, pode ser explicado pela quase que constante associação entre HSDA e LAD em vítimas fatais de acidentes de trânsito.

  15. FDG-PET imaging for chronic expanding hematoma in pelvis with massive bone destruction

    Energy Technology Data Exchange (ETDEWEB)

    Hamada, Kenichiro [Osaka University Graduate School of Medicine, Department of Nuclear Medicine and Tracer Kinetics, Suita, Osaka (Japan); Osaka University Graduate School of Medicine, Department of Orthopaedic Surgery, Suita, Osaka (Japan); Myoui, Akira; Ueda, Takafumi; Tamai, Noriyuki; Yoshikawa, Hideki [Osaka University Graduate School of Medicine, Department of Orthopaedic Surgery, Suita, Osaka (Japan); Higuchi, Ichiro; Hatazawa, Jun [Osaka University Graduate School of Medicine, Department of Nuclear Medicine and Tracer Kinetics, Suita, Osaka (Japan); Inoue, Atsuo [Osaka University Graduate School of Medicine, Department of Radiology, Suita, Osaka (Japan)

    2005-12-01

    Chronic expanding hematoma is a rare presentation of a hematoma characterized by a persistent increase in size for more than a month after the initial hemorrhage. We present a 65-year-old man with a chronic expanding hematoma in his ilium who was receiving anticoagulant treatment. The patient had a delayed manifestation of a femoral neuropathy with massive bone destruction. 2-Deoxy-[{sup 18}F]fluoro-d-glucose (FDG) positron emission tomography (PET) imaging revealed an increased uptake in the rim of the mass in images acquired 1 h after FDG injection. FDG-PET scans were performed using a dedicated PET scanner (HeadtomeV/SET2400 W, Shimadzu, Kyoto, Japan), and the PET data for the most metabolically active region of interest (ROI) were analyzed. The maximum standardized uptake value (SUVmax) was set to a cut-off point of 3.0 to distinguish between benign and malignant lesions. The SUVmax of the patient's lesion was 3.10, suggesting a malignant lesion. The characteristics of FDG-PET images of chronic expanding hematomas, including the uptake of FDG in the peripheral rim of the mass as a result of inflammation, should be recognized as a potential interpretive pitfall in mimicking a sarcoma. (orig.)

  16. Chronic expanding hematoma extending over multiple gluteal muscles associated with piriformis syndrome.

    Science.gov (United States)

    Kitagawa, Yasuyuki; Yokoyama, Munehiro; Tamai, Kensuke; Takai, Shinro

    2012-01-01

    We report on a patient with an unusual, slowly enlarging hematoma of the left buttock. A 62-year-old man presented with a 6-year history of an enlarging mass of the left buttock. He had first noted the mass 6 years earlier and had had sciatica of the left lower limb for the last 2 months. He denied any history of antecedent trauma. The lesion extended over 3 gluteal muscles (the gluteus medius, gluteus minimus, and piriformis). On microscopic examination, the lesion showed typical signs of chronic expanding hematoma. The sciatica was relieved after surgical removal of the lesion. The lesion had not recurred at the last follow-up 4 years after the operation. The present case suggested that chronic expanding hematoma can extend into multiple muscles due, perhaps, to long-term growth and the anatomical and functional conditions of the affected muscles. Our case also suggests that chronic expanding hematoma can be a cause of piriformis syndrome. PMID:23291848

  17. Traumatic lumbar spinal subdural hematoma

    Directory of Open Access Journals (Sweden)

    William E. Gordon

    2014-12-01

    Our case illustrates rapid resolution of a posttraumatic spinal SDH after treatment with oral corticosteroids. Recognition of blood products on MRI is vital to diagnosis and expedient treatment. There is agreement that prompt laminectomy with evacuation of SDH should be performed before permanent damage to the spinal cord occurs. Including our patient, 4 of 11 reported cases of thoracic or lumbar SDH resolved with conservative treatment.

  18. Full-endoscopic interlaminar removal of chronic lumbar epidural hematoma after spinal manipulation

    Directory of Open Access Journals (Sweden)

    Yen-Po Cheng

    2014-01-01

    Full Text Available Background: Spinal manipulation is widely used for low back pain treatments. Complications associated with spinal manipulation are seen. Lumbar epidural hematoma (EDH is one of the complications reported in the literature. If lumbar chronic EDH symptoms are present, which are similar to those of a herniated nucleus pulposus, surgery may be considered if medical treatment fails. Percutaneous endoscopic discectomy utilizing an interlaminar approach can be successfully applied to those with herniated nucleus pulposus. We use the same technique to remove the lumbar chronic EDH, which is the first documented report in the related literature. Methods: We present a case with chronic lumbar EDH associated with spinal manipulation. Neurologic deficits were noted on physical examination. We arranged for a full-endoscopic interlaminar approach to remove the hematoma for the patient with the rigid endoscopy (Vertebris system; Richard Wolf, Knittlingen, Germany. Results: After surgery, the patient′s radiculopathy immediately began to disappear. Magnetic resonance imaging (MRI follow-up 10 days after the surgery revealed no residual hematoma. No complications were noted during the outpatient department follow up. Conclusions: Lumbar EDH is a possible complication of spinal manipulation. Patient experiencing rapidly progressive neurologic deficit require early surgical evacuation, while conservative treatment may only be applied to those with mild symptoms. A percutaneous full-endoscopic interlaminar approach may be a viable alternative for the treatment of those with chronic EDH with progressive neurologic deficits.

  19. Subdural effusion

    Science.gov (United States)

    A subdural effusion is a rare complication of bacterial meningitis . Subdural effusion is more common in infants and ... Saunders; 2012:chap 53C. Swartz MN, Nath A. Meningitis: bacterial, viral, and other. In: Goldman L, Schafer AI, ...

  20. Chronic Expanding Hematoma of the Adrenal Gland Mimicking a Hemangioma: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyun Jung; Kim, Min Jeong; Ha, Hong Il; Lee, In Jae; Lee, Kwan Seop; Seo, Jin Won [Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang (Korea, Republic of); Yeo, Seung Gu [Dept. of Radiation Oncology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan (Korea, Republic of)

    2013-04-15

    We report a rare case of unilateral chronic expanding hematoma in the left adrenal gland, mimicking a hemangioma on multiphase computed tomography (CT). On CT, the mass showed several enhancing foci of irregular and frond-like shape in the periphery at the hepatic arterial phase and gradual fill-in pattern at the portal venous phase, which was similar with the enhancement pattern of hemangioma.

  1. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

    Energy Technology Data Exchange (ETDEWEB)

    Guillin, Raphael [Rennes University Hospital, Department of Musculoskeletal Imaging, Rennes Cedex 2 (France); Moser, Thomas [Montreal University Hospital, Department of Musculoskeletal Imaging, Montreal (Canada); Koob, Meriam [Strasbourg University Hospital, Department of Pediatric Imaging, Strasbourg (France); Khoury, Viviane [Mc Gill University Health center, Department of Radiology, Montreal (Canada); Chapuis, Madeleine [Rennes University Hospital, Department of Pediatric Orthopedic Surgery, Rennes (France); Ropars, Mickael [Rennes University Hospital, Department of orthopedic surgery, Rennes (France); Cardinal, Etienne [Radiologie Laennec, Montreal (Canada)

    2012-06-15

    The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults. (orig.)

  2. Subperiosteal hematoma of the iliac bone: imaging features of acute and chronic stages with emphasis on pathophysiology

    International Nuclear Information System (INIS)

    The goal of this work is to describe the radiological appearance and clinical presentation of subperiosteal iliac hematoma and present a review of the literature. We retrospectively reviewed the radiological and clinical files of 19 patients (age range: 12-75; mean: 47) who presented with acute or chronic subperiosteal iliac hematomas. Imaging findings and relevant clinical information were recorded. A thorough literature search was performed to find additional cases of this rare condition. Three young patients presented with acute subperiosteal iliac hematoma following a fall. Clinical presentation was characterized by pain and gait disturbance presumed to result from crural nerve compression. Unilateral or bilateral lenticular hematomas deep in the iliacus muscle were demonstrated by CT for all patients while MRI was also available for two of them. In 16 asymptomatic patients, chronic ossified subperiosteal iliac hematomas were incidentally detected by CT. Progressive ossification of acute hematoma was demonstrated at follow-up in two patients. Subperiosteal iliac hematoma is rare but has typical imaging findings that may present acutely in adolescents or chronically in asymptomatic adults. (orig.)

  3. 10 Levels thoracic no-intrumented laminectomy for huge spontaneous spinal subdural hematoma removal. Report of the first case and literature review

    Directory of Open Access Journals (Sweden)

    Visocchi Massimiliano

    2015-01-01

    Conclusion: To our knowledge, the present case is the most extensive laminectomy for a SSDH removal never described before. No postoperative instability occurs in 10 levels thoracic laminectomy in case the articular processes are spared. When major neurological deficits are documented, early decompressive laminectomy with evacuation of hematoma should be considered the best treatment for SSDH.

  4. Bilateral ureteral stones and spontaneous perirenal hematoma in a patient with chronic idiopathic thrombocytopenic purpura.

    Science.gov (United States)

    Akyz, Mehmet; Cal??kan, Selahattin; Kaya, Cevdet

    2012-07-01

    Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hematuria during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm(3)). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical intervention of above 50,000/mm(3) with administration of prednisolone, intravenous immune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively. PMID:22866224

  5. Chronic Expanding Hematoma in the Popliteal Fossa after Pseudoaneurysm Surgery because of Nail Puncture

    Science.gov (United States)

    Deveci, Alper; Ozkurt, Bulent; Simsek, Mehmet Emin; Tabak, Abdullah Yalcin; Bozkurt, Murat

    2014-01-01

    Hematomas caused by surgery or trauma that persist and expand slowly for more than a month are defined as chronic expanding hematomas (CEH). Magnetic resonance imaging (MRI) is useful for the diagnosis. Total excision with the pseudocapsule is the treatment method. Pseudoaneurysms result from arterial wall disruptions and can be mistaken for CEH. We present a rare case report of a 45-year-old man with a large, painful swelling in his left popliteal fossa. He had a puncture wound by a nail 11 years ago and a gradually expanding mass occurred in his popliteal fossa. A pseudoaneurysm was detected and operated a year later. After surgery, a gradually expanding mass recurred in his popliteal fossa. On the arteriography, the popliteal artery was occluded and the blood flow was maintained with collateral vessels. On MRI, an enormous swelling of 115 × 107 × 196 cm in diameter was seen. It was diagnosed as CEH and was excised completely protecting the collateral vessels and there was no recurrence after a year from the surgery. PMID:25610684

  6. Organized chronic subdural haematoma with a thick calcified inner membrane successfully treated by surgery: a case report.

    Science.gov (United States)

    Oda, Shinri; Shimoda, Masami; Hoshikawa, Kaori; Shiramizu, Hideki; Matsumae, Mitsunori

    2010-09-01

    The optimal surgical procedure for patients with calcified and organized chronic subdural haematoma (CSDH), or "armoured brain", has not been established because it is difficult to obtain good re-expansion of the brain after surgery. We present herein the case of a 32-year-old woman with huge calcified CSDH manifesting as refractory headache, periods of unconsciousness, and unsteady gait who obtained favourable results after craniotomy. Thinning of the thick calcified inner membrane using high-speed air drilling was performed after removal of the organized CSDH. The patient obtained good re-expansion after surgery. This observation illustrates that it is possible to perform such a surgery even on a huge calcified CSDH. PMID:21319032

  7. Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program.

    Science.gov (United States)

    Lukasiewicz, Adam M; Grant, Ryan A; Basques, Bryce A; Webb, Matthew L; Samuel, Andre M; Grauer, Jonathan N

    2016-03-01

    OBJECT Surgery for subdural hematoma (SDH) is a commonly performed neurosurgical procedure. This study identifies patient characteristics associated with adverse outcomes and prolonged length of stay (LOS) in patients who underwent surgical treatment for SDH. METHODS All patients in the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) who were treated via craniotomy or craniectomy for SDH between 2005 and 2012 were identified. Patient demographics, comorbidities, and 30-day outcomes were described. Multivariate regression was used to identify predictors of adverse events. RESULTS A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk [RR] = 0.47, p = 0.017). Increased mortality was associated with gangrene (RR = 3.5, p = 0.044), ascites (RR = 3.00, p = 0.006), American Society of Anesthesiologists (ASA) Class 4 or higher (RR = 2.34, p = 0.002), coma (RR = 2.25, p delirium (RR = 1.75, p = 0.016). Serious adverse events were associated with ventilator dependence preoperatively (RR = 1.86, p delirium (RR = 1.40, p = 0.005), ASA Class 4 or higher (RR = 1.36, p = 0.035), and male sex (RR = 1.29, p = 0.037). Similarly, LOS was increased in ventilator dependent patients by 1.56-fold (p = 0.002), in patients with ASA Class 4 or higher by 1.30-fold (p = 0.006), and in delirious patients by 1.29-fold (p = 0.008). CONCLUSIONS Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery. PMID:26315000

  8. Proposal for a prospective multi-centre audit of chronic subdural haematoma management in the United Kingdom and Ireland.

    Science.gov (United States)

    Coulter, Ian C; Kolias, Angelos G; Marcus, Hani J; Ahmed, Aminul I; Alli, Saira; Al-Mahfoudh, Rafid; Borg, Anouk; Cowie, Christopher J A; Hill, Ciaran S; Joannides, Alexis J; Jones, Timothy L; Kailaya-Vasan, Ahilan; Livermore, James L; Narayanamurthy, Harsha; Ngoga, Desire; Shapey, Jonathan; Tarnaris, Andrew; Gregson, Barbara A; Gray, William P; Nelson, Richard J; Hutchinson, Peter J; Brennan, Paul M

    2014-04-01

    BACKGROUND. Chronic subdural haematoma (CSDH) is a common condition that increases in incidence with rising age. Evacuation of a CSDH is one of the commonest neurosurgical procedures; however the optimal peri-operative management, surgical technique, post-operative care and the role of adjuvant therapies remain controversial. AIM. We propose a prospective multi-centre audit in order to establish current practices, outcomes and national benchmarks for future studies. METHODS. Neurosurgical units (NSU) in the United Kingdom and Ireland will be invited to enrol patients to this audit. All adult patients aged 16 years and over with a primary or recurrent CSDH will be eligible for inclusion. OUTCOME MEASURES AND ANALYSIS. The proposed outcome measures are (1) clinical recurrence requiring re-operation within 60 days; (2) modified Rankin scale (mRS) score at discharge from NSU; (3) morbidity and mortality in the NSU; (4) destination at discharge from NSU and (5) length of stay in the NSU. Audit standards have been derived from published systematic reviews and a recent randomised trial. The proposed standards are clinical recurrence rate Ireland. It will inform national guidelines, clinical practice and future studies in order to improve the outcome of patients with CSDH. PMID:24053314

  9. Hematoma and MR imaging at 0.15 T. A review of 100 cases

    International Nuclear Information System (INIS)

    One hundred hematomas were examined by magnetic resonance imaging (MRI) at 0.15 T, all explored in SEpT1 and most in SEpT2. The number of cases examined in the acute phase during the first 48 hours was low: 8 cases. At this SEpT1 period the hematoma appears of elevated signal with good muscle contrast but without contrast in hepatic and cerebral parenchyma. In a weighted T2 sequence, the intense signals of cerebral edema and plasma or serum enables detection of the encephalic lesion. Findings from 68 hematomas observed in the subacute or chronic phase suggest that their appearance is pathognomonic with visualization in SEpT1 of a crown of an intense signal at least equal to that of fat. The only difficulty at this period is the discovery of a hematoma within the fat: orbital, retroperitoneal... The collection of a subdural hematoma usually appears homogeneous, the intensity of the signal varying with red cell concentration and time. In the soft tissues, the intensity of signal is a function of concentration of hemoglobin and its derivatives and of volume of serious effusion. Images of 24 hematomas during the sequelae phase confirmed the appearance of a ''biochemical shell'' without signal in SEpT2 and allowed detection of the hematic contents of an occupying process even after long periods, sometimes after one year

  10. Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication.

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

    Subdural collections or hematomas are frequently observed after shunt placement [7-9, 13], but rarely after ETV [6]. A review of literature revealed 7 cases [1, 5, 6, 10, 12], of which only 1 was symptomatic [5]. We will discuss the causes, management, and methods of prevention of this complication and we will present a case of symptomatic subdural haematoma, following endoscopic third ventriculostomy for illustration.

  11. Suprarrenal hematoma Hematoma suprarrenal

    Directory of Open Access Journals (Sweden)

    Concepcin Guardo B.

    1996-04-01

    Full Text Available Neonatal asymptomatic suprarrenal hemorrhage is relatively frequent; sometimes it is detected only after resolution when a calcification is found; symptomatic forms are rare; most times hemorrhage and hematoma are due to an obstetric trauma and are related to macrosomia, breech presentation, maternal diabetes and neonatal hypoxia. Clinical picture is characterized by abdominal mass and anemia; diagnosis is confirmed by imagenology. Two patients with suprarrenal hematoma from the University Hospital at Cartagena, Colombia, are presented. Both were related with traumatic delivery and cephalohematoma; one of them had oral and gastric bleeding and the othersuffered hematoma infection; diagnosis was done with abdominal ecography and CAT. Both patients recovered with medical treatment. La hemorragia suprarrenal asintomtica del neonato es relativamente frecuente y muchas veces se detecta como una calcificacin local despus de que se resuelve el hematoma. La forma sintomtica es rara y, a menudo, se debe a un trauma obsttrico relacionado con la macrosoma fetal, la presentacin podlica, la diabetes materna o la hipoxia perinatal. Las manifestaciones clnicas son, principalmente, una masa abdominal y anemia importante; el diagnstico se confirma con la imaginologa. Se presentan dos casos de hematoma suprarrenal derecho tratados en el Hospital Universitario de Cartagena, ambos relacionados con un parto traumtico y acompaados de cefalohematomas; uno de ellos present sangrado gastrointestinal alto y el otro infeccin del hematoma suprarrenal. El diagnstico se comprob con la ecografa abdominal y se verific con la tomografa. El tratamiento fue mdico y no se requiri ciruga a pesar de la anemia severa que present uno de los pacientes.

  12. Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

    Science.gov (United States)

    Park, Ik-Seong; Kim, Hoon; Chung, Eun Yong

    2010-01-01

    A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. During conservative treatment under the diagnosis of a subdural hematoma, left cranial nerve palsies were developed (3rd and 6th), followed by scleritis and uveitis involving both eyes. Magnetic resonance imaging (MRI) revealed an unusual tentorium-falx enhancement on gadolinium-enhanced T1-weighted images. Non-specific chronic inflammation of the pachymeninges was noticed on histopathologic examination following an open biopsy. Systemic steroid treatment was initiated, resulting in dramatic improvement of symptoms. A follow-up brain MRI showed total resolution of the lesion 2 months after steroid treatment. IHCP should be included in the differential diagnosis of subtentorial-enhancing lesions. PMID:20856672

  13. A Case of Recurrent Hemorrhages due to a Chronic Expanding Encapsulated Intracranial Hematoma.

    Science.gov (United States)

    Marutani, Akiko; Nagata, Kiyoshi; Deguchi, Jun; Nikaido, Yuji; Kazuki, Syuji

    2015-01-01

    Few case reports of encapsulated intracranial hematoma (EIH) exist, and the mechanisms underlying the onset and enlargement of EIH remain unclear. Here, we report on a 39-year-old woman with an EIH that repeatedly hemorrhaged and swelled and was ultimately surgically removed. In June 2012, the patient visited her local doctor, complaining of headaches. A magnetic resonance imaging (MRI) scan identified a small hemorrhage of approximately 7 mm in her right basal ganglia, and a wait-and-see approach was adopted. Six months later, her headaches recurred. She was admitted to our department after MRI showed tumor lesions accompanying the intermittent hemorrhaging in the right basal ganglia. After admission, hemorrhaging was again observed, with symptoms progressing to left-sided hemiplegia and fluctuating consciousness; thus, a craniotomy was performed. No obvious abnormal blood vessels were observed on the preoperative cerebral angiography. We accessed the lesion using a transcortical approach via a right frontotemporal craniotomy and removed the subacute hematoma by extracting the encapsulated tumor as a single mass. Subsequent pathological examinations showed that the hematoma exhibited abnormal internal vascularization and was covered with a capsule formed from growing capillaries and accumulating collagen fibers, suggesting that it was an EIH. No lingering neurological symptoms were noted upon postoperative follow-up. This type of hematoma expands slowly and is asymptomatic, with reported cases consisting of patients that already have neurological deficits due to progressive hematoma growth. Our report is one of a few to provide a clinical picture of the initial stages that occur prior to hematoma encapsulation. PMID:26500543

  14. Direct subdural scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Keren, G.; Barzilay, Z.; Czerniak, P.; Cohen, B.E.

    1980-06-01

    We report a case of pneumococcal meningitis in an 8 weeks old female infant followed by persistent subdural effusion successsfully treated by repeated subdural taps. The initial delineation of the subdural effusion, the decrease in size and the disappearance of the fluid were demonstrated by direct subdural scintigraphy (D.S.S.). The literature of pneumoccocal meningitis, its diagnosis, treatment and complications are reviewed, and it is suggested that direct subdural scintigraphy should be employed as a diagnostic aid in the evaluation and follow up of subdural effusions.

  15. Bilateral Ureteral Stones and Spontaneous Perirenal Hematoma in a Patient with Chronic Idiopathic Thrombocytopenic Purpura

    OpenAIRE

    Akyz, Mehmet; al??kan, Selahattin; Kaya, Cevdet

    2012-01-01

    Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hem...

  16. Percutaneous drainage of a postoperative intraspinal hematoma using a Tuohy needle

    International Nuclear Information System (INIS)

    A 78-year-old man developed a large subdural hematoma extending from T12 to L3 levels following L3 laminectomy and L3-5 posterior spinal fusion. He had associated neurological signs and symptoms. MR imaging showed typical signal characteristics of a subacute intraspinal subdural hematoma. Percutaneous drainage was successfully performed under CT guidance by inserting a Tuohy needle through the L3 laminectomy defect. The catheter packaged with the Tuohy needle was inserted cranially into the hematoma and 30 ml of blood was aspirated. Follow-up MR imaging confirmed resolution of the hematoma and the patient made a rapid recovery. (orig.)

  17. Rupture of distal anterior cerebral artery aneurysm presenting only subdural hemorrhage without subarachnoid hemorrhage: a case report

    OpenAIRE

    Song, Tae-Wook; KIM, SUNG-HYUN; Jung, Seung-Hoon; Kim, Tae-Sun; Joo, Sung-pil

    2016-01-01

    Intracranial aneurysm rupture usually manifests with subarachnoid hemorrhage, often combined with intracerebral hemorrhage with intraventricular hemorrhage extension. In rare cases, however, these aneurysms present only as subdural hematomas. Recently, we treated a 48-years-old female patient who presented only with subdural hematoma. Interestingly, she did not have a history of trauma. Computed tomography angiography and digital subtraction angiography revealed a 5 × 3 mm sized aneurysm at t...

  18. Subdural abscess in infant and child

    International Nuclear Information System (INIS)

    Two cases of subdural abscess in infant and child treated with irrigation via burr holes were reported. The first case was a 1.4-year-old boy with right hemiparesis and mental retardation since severe head trauma at 9 months old. The patient with manifested with an acute onset of high fever followed by disturbance of consciousness and convulsive seizures 2.5 months prior to admission to our department. During admission in the other hospital, the diagnosis of septicemia caused by E. coli was made by blood cultures when CT scan demonstrated a huge lentiform low density area over the right hemisphere and contralateral crescent low density area. The low density area on the right side was well circumscribed by high density rim which was enhanced by contrast medium. Under the diagnosis of bilateral subdural abscess secondary to septicemia caused by E. coli, irrigation of the purulent cavity was carried out. The contralateral low density area was found to be chronic subdural effusion. The second case of 3-month-old infant who complained of high fever, neck stiffness, unconsciousness and right hemiconvulsions 8 days prior to admission. CT scan showed bilateral crescent low density areas indicating subdural effusion. Subdural punctures performed via the fontanelle revealed pus in the left subdural space and xanthocromic fluid in the right side. The low density area on CT scan was changed to the lentiform high density area circumscribed smooth high density rim during the course of the patient. The subdural abscess was treated with irrigation via burr holes. In this report, the etiology of the subdural abscess and route of infection in addition to follow up study of CT findings were presented with the literature. (author)

  19. Intracranial hypotension - a look beyond “bilateral subdural hematomas”

    International Nuclear Information System (INIS)

    Full text: The intracranial hypotension (ICH) is a disorder due to spontaneous or iatrogenic CSF leak and a low intracranial pressure. The clinical presentation is characterized by drug resistant orthostatic headache, nausea, vomiting, dizziness, neck pain and etc. The intracranial hypotension is defined as a benign disorder and the treatment is predominantly conservative. Due to this fact it is very important to differentiate this entity from subdural hematomas and hygromas which are treated surgically. Magnetic resonance imaging has revolutionized the diagnosis of ICH. Nowadays there are a lot of clinical and imaging features of this disorder. Regardless of clinical varieties and atypical forms, MRI gives enough information for the correct or probable diagnosis in the vast majority of the cases. The initial imaging resemblance with posttraumatic subdural hematomas and hygromas can result in giving the wrong diagnosis and therefore performing unneeded surgical interventions. the aim of this presentation is to discuss the contemporary criteria, algorithm and imaging features of ICH

  20. Recurrence of Subdural Haematoma in a Population-Based Cohort Risks and Predictive Factors

    Science.gov (United States)

    Schmidt, Linnea; Grtz, Sanne; Wohlfahrt, Jan; Melbye, Mads; Munch, Tina Noergaard

    2015-01-01

    Objectives To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients. Methods The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 19962011. Information on potential predictors was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR) were estimated using Poisson regression. Results Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.431.80), older age (>70 years compared to 2049 years; RR 1.41, 95% CI: 1.211.65), alcohol addiction (RR 1.20, 95% CI:1.041.37), surgical treatment (RR 1.76, 95% CI:1.581.96), trauma diagnoses (RR 1.14, 95% CI:1.031.27), and diabetes mellitus (RR 1.40, 95% CI:1.111.74). Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14% for all patients) was found in surgically treated males with diabetes mellitus. Conclusions The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed. PMID:26465602

  1. Subdural Empyema in Children

    OpenAIRE

    Mohammed A. Hendaus

    2013-01-01

    Subdural Empyema in infants and children might be life threatening if not managed properly. A search of the Pub Med database was carried out using a combination of the following terms: Subdural empyema, children, and management. Neurosurgical textbooks were reviewed as well. The prevalence, etiology, clinical features, investigations and management of SDE are reviewed in this article. Conservative management with antibiotics and follow up imaging is recommended if there are no focal deficits,...

  2. Subdural effusion following purulent meningitis

    International Nuclear Information System (INIS)

    The authors experienced 6 cases of subdural effusion following purulent meningitis. All patients were less than one year old. Subdural puncture revealed subdural effusion in all cases. CT scan was performed in 4 cases at an acute stage and showed a low density area in the anterior parietal region. In 3 of them, although neurological symptoms disappeared after subdural puncture, CT findings did not improve. Follow-up CT scan revealed ventricular dilatation and cerebral atrophy. CT is considered to be useful for diagnosis of subdural effusion after meningitis and follow-up the effect of treatment. (Ueda, J.)

  3. A rare complication of spinal anesthesia: Intracranial subdural hemorrhage

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

    Full Text Available Spinal (subarachnoid anesthesia (SA is a widely used general-purpose anesthesia. Postdural Puncture Headaches (PDPHs represent one of the principal complications of spinal anesthesia. A 21-year-old man underwent inguinal herniorrhaphy and orchiectomy using spinal anesthesia. Postoperatively, our patient started to have a headache with nausea. The patient received symptomatic therapy, but the severe headache persisted even in the supine position, with his vital signs and neurological examination being normal. Cranial MRI showed a bilateral subdural hematoma from his frontal to temporal region. A postdural puncture headache is a frequent complication after spinal anesthesia. However, serious complications, such as an intracranial subdural hemorrhage, can rarely occur. [Arch Clin Exp Surg 2015; 4(1.000: 54-56

  4. Polymicrobial subdural empyema

    DEFF Research Database (Denmark)

    Greve, Thomas; Clemmensen, Dorte; Ridderberg, Winnie; Pedersen, Lisbeth N; Møller, Jens K

    2011-01-01

    The authors report a case of a subdural empyema (SDE) caused by a coinfection with Streptococcus intermedius and Streptococcus pneumoniae, initially considered a S. intermedius infection only. An otherwise healthy 11-year-old female was admitted to the hospital after 5 days of illness. Symptoms....... The empyema was evacuated twice, day 8 and 18, with good results. Primary samples showed growth of S. intermedius only. The severity of the clinical picture elicited supplementary samples, which were additionally positive for S. pneumoniae by an in-house specific lytA PCR and/or a commercial antigen...

  5. Acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery: a case report

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

    Full Text Available Abstract Introduction Spinal anesthesia is a widely used general purpose anesthesia. However, serious complications, such as intracranial subdural hemorrhage, can rarely occur. Case presentation We report the case of a 73-year-old Japanese woman who had acute onset of intracranial subdural hemorrhage five days after spinal anesthesia for knee arthroscopic surgery. Conclusion This case highlights the need to pay attention to acute intracranial subdural hemorrhage as a complication after spinal anesthesia. If the headache persists even in a supine position or nausea occurs abruptly, computed tomography or magnetic resonance imaging of the brain should be conducted. An intracranial subdural hematoma may have a serious outcome and is an important differential diagnosis for headache after spinal anesthesia.

  6. Recurrence of Subdural Haematoma in a Population-Based Cohort - Risks and Predictive Factors

    DEFF Research Database (Denmark)

    Schmidt, Linnea; Gørtz, Sanne; Wohlfahrt, Jan; Melbye, Mads; Munch, Tina Noergaard

    2015-01-01

    subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43-1.80), older age (>70 years compared to 20-49 years; RR 1.41, 95% CI: 1.21-1.65), alcohol addiction (RR 1.20, 95......% CI:1.04-1.37), surgical treatment (RR 1.76, 95% CI:1.58-1.96), trauma diagnoses (RR 1.14, 95% CI:1.03-1.27), and diabetes mellitus (RR 1.40, 95% CI:1.11-1.74). Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14...

  7. Acute subdural empyema

    International Nuclear Information System (INIS)

    The patient, a 19-year-old male, began suffering from severe headache, vomiting, and high fever. Two days later the patient was admitted in a semicomatose state and with left hemiplegia. Nuchal rigidity and choked disc were not noticed. WBC count was 12,500/mm3. CT scan disclosed marked swelling of the right cerebral hemisphere with midline shift. Except for a small lucent space in the parafalcial region, no extracerebral collection was noted in either pre- or post-contrast scans. Plain craniograms showed clouding of the left frontal, ethmoidal, and sphenoidal sinuses. Carotid angiography revealed prolongation of the circulation time and stenosis of the supraclinoidal portion of the right carotid artery. Right fronto-parietal decompressive craniectomy was performed. Subdural empyema was found and evacuated. Curettage and drainage of the empyema in the paranasal sinuses were also done. A bone defect 4 mm in diameter was detected on the medial-upper wall of the left frontal sinus. The causative organism was confirmed as α-Streptococcus. Both systemic and local antibiotics were administered and the patient recovered well and was discharged without any neurological deficit. The authors emphasized that cerebral angiography is necessary for its accurate diagnosis of subdural empyema in its acute stage and that emergency intracranial and rhino-otological operations should be concomitantly performed. (author)

  8. Delayed traumatic hematomas of the brain: the early manifestations of CT

    International Nuclear Information System (INIS)

    Objective: To study the CT manifestations of delayed traumatic hematomas of the brain and evaluate their diagnostic significance in predicting the delayed traumatic brain hematoma. Methods: The manifestations of initial CT studies and follow-up CT examinations of 31 delayed traumatic brain hematomas were analyzed. Another 50 CT studies of head trauma without delayed brain hematomas were included randomly as control. Results: The abnormal findings of CT studies of the 31 delayed traumatic brain hematomas included: (1) Decreased density of the local brain parenchyma and disappeared difference between gray and white matter of the same area in 18 cases; (2) Local subarachnoid space hemorrhage in 24 cases; (3) Slight mass effect of local brain parenchyma in 16 cases. (4) Subdural hematoma in 9 cases. The locations of the abnormalities were roughly the same with the delayed hematoma except one local subarachnoid space hemorrhage, which was in the opposite of the delayed hematoma. The appearing rate of those abnormal findings in the control group was low and the difference was statistically significant. Conclusion: The decrease of density of local brain parenchyma, the disappeared difference between the gray and white matter, local subarachnoid space hemorrhage, and local swollen of brain presented in the initial CT study of the patient with heat trauma should be taken as indicators of delayed hemorrhage of the same area of brain, and it is necessary to do follow-up CT studies to exclude it

  9. Spontaneous cerebral intraparenchymatous hematoma: computed tomography findings

    International Nuclear Information System (INIS)

    The objective of this study was to identify the most frequent aspects of spontaneous cerebral intraparenchymatous hematoma found at computed tomography examinations. We reviewed, retrospectively, the computed tomography studies of 250 patients with spontaneous intracerebral hemorrhage carried out in three hospitals in Rio de Janeiro, Brazil. The results showed deep intracerebral hematomas showed the highest incidence and were observed in 54.4% of the cases (136 patients) followed by lobar hemorrhage in 34.8% of the cases (87 patients). Cerebellar hemorrhage and brainstem bleeding were more rarely observed, occurring in 8.4% (21 patients) and 2.4% (six patients) of the cases, respectively. Chronic headache was the most frequent symptom whereas hypertension was observed in the majority of the cases. Blood draining into the ventricular system occurred more frequently in patients with deep hematomas. (author)

  10. Computed tomographic evolution of post-traumatic subdural hygroma in young adults

    International Nuclear Information System (INIS)

    The authors report on two cases of post-traumatic subdural hygroma that were encountered in young adults. Serial computed tomograms were taken immediately following trauma and for more than 4 weeks thereafter. In the case of a 28-year-old man with a skull fracture, an initial CT scan revealed a thin crescentic subdural collection in the right frontal area. A successive CT scan on the 36th postoperative day revealed developed subdural hygroma, and the CSF-like fluid was surgically evacuated. In the second case, involving an 18-year-old man, a very thin bifrontal subdural collection was found on the initial CT scan, and on the 15th post-traumatic day CT scan demonstrated a bifrontal subdural hygroma. No surgical treatment was carried out, and the follow-up CT scan on the 29th post-traumatic day demonstrated no change in size. The two young patients were slightly symptomatic during the period involved, and the repeat unenchanced CT scans showed subdural lesions of less than brain density, even in the chronic stage. (orig.)

  11. Large coronary intramural hematomas

    DEFF Research Database (Denmark)

    Antonsen, Lisbeth; Thayssen, Per; Jensen, Lisette Okkels

    2015-01-01

    coronary vessel wall pathology, with poorly understood underlying pathogenic mechanisms. Affected individuals may present with a broad spectrum of symptoms ranging from acute coronary syndromes (ACS) to cardiogenic shock or even sudden cardiac death. The disease entity causes challenges in terms of both......Isolated spontaneous coronary intramural hematoma is a unique subset of spontaneous coronary artery dissection that is characterized by a hemorrhage limited to the medial-adventitial layers, causing subsequent hematoma formation without visible intimal flaps. It is an infrequent and serious...... diagnostics and treatment strategy. Coronary intramural hematomas can also occur iatrogenically, as a complication to percutaneous coronary intervention (PCI). Coronary angiography (CAG) has limited diagnostic value in the absence of intimal dissections, and lesions are often angiographically ambiguous...

  12. Spontaneous cerebral intraparenchymatous hematoma: computed tomography findings; Hematoma intraparenquimatoso cerebral espontaneo: aspectos a tomografia computadorizada

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Celso Monteiro [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Programa de Pos-graduacao em Radiologia]. E-mail: celsomsoares@ig.com.br; Carvalho, Antonio Carlos Pires [Universidade Federal, Rio de Janeiro, RJ (Brazil). Faculdade de Medicina. Dept. de Radiologia

    2001-02-01

    The objective of this study was to identify the most frequent aspects of spontaneous cerebral intraparenchymatous hematoma found at computed tomography examinations. We reviewed, retrospectively, the computed tomography studies of 250 patients with spontaneous intracerebral hemorrhage carried out in three hospitals in Rio de Janeiro, Brazil. The results showed deep intracerebral hematomas showed the highest incidence and were observed in 54.4% of the cases (136 patients) followed by lobar hemorrhage in 34.8% of the cases (87 patients). Cerebellar hemorrhage and brainstem bleeding were more rarely observed, occurring in 8.4% (21 patients) and 2.4% (six patients) of the cases, respectively. Chronic headache was the most frequent symptom whereas hypertension was observed in the majority of the cases. Blood draining into the ventricular system occurred more frequently in patients with deep hematomas. (author)

  13. Arachnoid cysts with intracystic and subdural haematoma

    International Nuclear Information System (INIS)

    Two cases of arachnoid cysts with acute intracystic and subdural haematomas are described. CT examination was performed in both cases, and showed a hyperdense expansion with thinning of the inner table of the skull. The different ways in which subdural haematomas associated with arachnoid cysts may be seen on CT are discussed. (orig.)

  14. Arachnoid cysts with intracystic and subdural haematoma.

    Science.gov (United States)

    Romero, F J; Rovira, M; Ibarra, B; Piqueras, J; Rovira, M

    1989-05-01

    Two cases of arachnoid cysts with acute intracystic and subdural haematomas are described. CT examination was performed in both cases, and showed a hyperdense expansion with thinning of the inner table of the skull. The different ways in which subdural haematomas associated with arachnoid cysts may be seen on CT are discussed. PMID:2743985

  15. Arachnoid cysts with intracystic and subdural haematoma

    Energy Technology Data Exchange (ETDEWEB)

    Romero, F.J.; Rovira, M. Jr.; Ibarra, B.; Piqueras, J.; Rovira, M. (Hospital General ' Vall d' Hebron' , Barcelona (Spain). Servicio de Neuroradiologia)

    1989-05-01

    Two cases of arachnoid cysts with acute intracystic and subdural haematomas are described. CT examination was performed in both cases, and showed a hyperdense expansion with thinning of the inner table of the skull. The different ways in which subdural haematomas associated with arachnoid cysts may be seen on CT are discussed. (orig.).

  16. Rectus sheath hematoma

    OpenAIRE

    Osinbowale, Olusegun; Bartholomew, John R

    2008-01-01

    Abstract Abstract Rectus sheath hematoma (RSH) is a known complication of anticoagulation therapy and a source of potential morbidity and mortality. Early diagnosis and appropriate treatment may help to prevent complications including hemodynamic instability, the abdominal compartment syndrome or multiorgan dysfunction. Although the diagnosis can be made clinically, it can be confirmed with computed tomography of the abdomen. Most patients can b...

  17. Sinusitis-induced subdural empyema.

    OpenAIRE

    Skelton, R.; Maixner, W; Isaacs, D. (David)

    1992-01-01

    Over a 17 year period, 1975-91, 10 children were managed who had sinusitis-induced subdural or extradural empyema. Their ages ranged from 6 to 14 years, with a mean of 11 years. All presented with worsening headaches, fever, vomiting, all had neurological abnormalities, and all had symptoms or signs suggestive of sinusitis. Initial computed tomography gave normal results in five cases and the empyema was diagnosed on the second or third scan. All patients had symptoms for at least one to two ...

  18. Acute epidural hematoma in children

    International Nuclear Information System (INIS)

    The clinical features and sequential changes of CT findings in children with acute epidural hematoma were correlated with the patient's age. Of the 373 children admitted for head injury during the past 8 years, 61 had an acute traumatic intra-cranial hematoma, and 38 of these had acute epidural hematoma. None of the patients with acute epidural hematoma was under 2 years of age, 15 were 2-6 years old, and 23 were 7-15 years old. In the pre-school group, the numbers of boys and girls were approximately equal, but in the older group boys outnumbered girls. Epidural hematoma was most often parietal (12 patients). Nine patients had posterior fossa hematomas; 30 (78.9%) had skull fractures, and the incidence was not related to the patient's age. In 28 of the 38 patients, CT scans were examined repeatedly for 24 hours. In 15 of them (53.6%), the size of the hematoma increased. In school-aged children, the hematoma tended to be larger than in pre-school children. In four patients with pneumocephalus, the hematoma increased in size. Eleven of the 13, whose hematomas did not increase in size, had skull fractures. (author)

  19. Spontaneous Rectus Sheath Hematoma

    OpenAIRE

    Alla, Venkata M.; Karnam, Showri M.; Kaushik, Manu; Porter, Joann

    2010-01-01

    Abdominal wall pathology is a frequently overlooked cause of acute abdomen. Increasing use of antiplatelet and anticoagulant therapies has led to an increase in the incidence of spontaneous rectus sheath hematoma (RSH). A high index of suspicion is needed for diagnosis as it can closely mimic other causes of acute abdomen. Herein, we report a case of RSH presenting with abdominal pain in which there was a significant delay in diagnosis. We wish to highlight the need to increase awareness amon...

  20. Bilateral Symmetrical Parietal Extradural Hematoma

    OpenAIRE

    Agrawal, Amit

    2011-01-01

    The occurrence of bilateral extradural hematomas (EDH) is an uncommon consequence of craniocerebral trauma, and acute symmetrical bilateral epidural hematomas are extremely rare. We discuss the technique adopted by us for the management of this rare entity. A 55-year-old patient presented with history of fall of branch of tree on her head. She had loss of consciousness since then and had multiple episodes of vomiting. Examination of the scalp was suggestive of diffuse subgaleal hematoma. Her ...

  1. Hematoma intraparenquimatoso cerebral espontâneo: aspectos à tomografia computadorizada Spontaneous cerebral intraparenchymatous hematoma: computed tomography findings

    Directory of Open Access Journals (Sweden)

    Celso Monteiro Soares

    2005-02-01

    Full Text Available OBJETIVO: Identificar os aspectos mais freqüentes do hematoma intraparenquimatoso cerebral espontâneo observados na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os exames de tomografia computadorizada de 250 pacientes com hematoma intraparenquimatoso cerebral espontâneo, provenientes de três diferentes hospitais da cidade do Rio de Janeiro. RESULTADOS: O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, equivalendo a 54,4% (136 casos, seguido do lobar com 34,8% (87 casos. Mais raramente, observou-se sangramento cerebelar em 8,4% (21 casos e do tronco cerebral em 2,4% (seis casos dos pacientes. CONCLUSÃO: A cefaléia foi o sintoma mais comum e a hipertensão arterial foi o sinal mais freqüentemente apresentado. A drenagem do hematoma para o sistema ventricular ocorreu mais comumente nos hematoma profundos.OBJECTIVE: To identify the most frequent aspects of spontaneous cerebral intraparenchymatous hematoma found at computed tomography examinations. MATERIALS AND METHODS: We reviewed, retrospectively, the computed tomography studies of 250 patients with spontaneous intracerebral hemorrhage carried out in three hospitals in Rio de Janeiro, Brazil. RESULTS: Deep intracerebral hematomas showed the highest incidence and were observed in 54.4% of the cases (136 patients followed by lobar hemorrhage in 34.8% of the cases (87 patients. Cerebelar hemorrhage and brainstem bleeding were more rarely observed, occurring in 8.4% (21 patients and 2.4% (six patients of the cases, respectively. CONCLUSION: Chronic headache was the most frequent symptom whereas hypertension was observed in the majority of the cases. Blood draining into the ventricular system occurred more frequently in patients with deep hematomas.

  2. Expanding traumatic intracerebral contusion/hematoma

    OpenAIRE

    Yadav Yad; Basoor Abhijeet; Jain Gaurav; Nelson Adam

    2006-01-01

    Background and Aims: Delayed traumatic hematomas and expansion of already detected hematomas are not uncommon. Only few studies are available on risk factors of expanding hematomas. A prospective study was aimed to find out risk factors associated with such traumatic lesions. Materials and Methods: Present study is based on 262 cases of intracerebral hematomas / contusions out of which 43 (16.4%) hematomas expanded in size. computerized tomography (CT) scan was done in all the patie...

  3. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

    Full Text Available Vinodan Paramanathan, Ardalan ZolnourianQueen's Hospital NHS Foundation Trust, Burton on Trent, Staffordshire DE13 0RB, UKAbstract: Spontaneous intraorbital hematoma is an uncommon clinical entity seen in ophthalmology practice. It is poorly represented in the literature. Current evidence attributes it to orbital trauma, neoplasm, vascular malformations, acute sinusitis, and systemic abnormalities. A 65-year-old female presented with spontaneous intraorbital hematoma manifesting as severe ocular pains, eyelid edema, proptosis, and diplopia, without a history of trauma. Computer tomography demonstrated a fairly well defined extraconal lesion with opacification of the paranasal sinuses. The principal differential based on all findings was that of a spreading sinus infection and an extraconal tumor. An unprecedented finding of a spontaneous orbital hematoma was discovered when the patient was taken to theater. We discuss the rarity of this condition and its management.Keywords: hemorrhage, ophthalmology, spontaneous, intra-orbital, hematoma

  4. Hepatostomy for central hepatic hematomas

    International Nuclear Information System (INIS)

    Two patients with central hepatic hematomas are presented. Hepatostomy tube drainage provided prompt healing of the cavities without complications. The technique is presented as a safe and effective alternative to hepatic resection without compromising the established principles of management

  5. [Chronic traumatic aneurysm of the thoracic aorta; report of a case].

    Science.gov (United States)

    Yokoyama, Yukifusa; Tamaki, S; Yokote, J; Mutsuga, M; Ohata, N; Suzuki, T; Nakashima, M

    2004-10-01

    We report a rare case of chronic traumatic aneurysm of the thoracic aorta. A 23-year-old man flew down from the fifth floor of his apartment for an attempted suicide. He suffered right subdural hematoma, bilateral hemothorax, lung contusions, and many other traumas. He was paralyzed by the fracture and dislocation of the first lumbar vertebra. Posterior fixation of lumbar vertebra and the segmental resection of the jejum were performed on the first and third day, respectively. He recovered well; however, he complained his nocturnal dyspnea on the forty-fifth day. Detailed examinations showed that bilateral bronchi were compressed by the aneurysm of thoracic aorta. Elective operation was performed on the sixty third day. Psudoaneurysm, 5 cm in diameter, was disclosed in the aortic isthmus. Graft replacement was undergone with the cardiopulmonary bypass. His postoperative course was uneventful, and he was transferred for the rehabilitation of his paralysis on the eigty-eighth day. PMID:15510822

  6. Prevention of Hematomas and Seromas

    OpenAIRE

    Bullocks, Jamal; Basu, C. Bob; Hsu, Patrick; Singer, Robert

    2006-01-01

    Hematoma and seroma formation in surgical wounds has negative effects on wound healing and subsequent morbidity to patients. This is of particular pertinence in cosmetic procedures in which the patient has chosen to undergo surgery electively. Over the past several decades there has been considerable interest in the use of ancillary techniques to assist in closing wounds and achieving hemostasis to prevent hematoma and seroma formation. These techniques include application of tissue sealants ...

  7. Traumatic posterior fossa epidural hematoma

    International Nuclear Information System (INIS)

    In this paper three acute cases and two subacute cases are reported. CT findings in acute cases show two different types. ''Type I'' shows crescent or lenticular high density area which is not enhanced after contrast infusion. ''Type II'' shows lenticular low density area with membranous high density region in its medial side after contrast infusion. In subacute cases plain CT scan shows lenticular iso or low density area with membranous high density region in its medial side. Forty five cases of posterior fossa epidural hematoma in the review of literature of this country are discussed. Disturbances of the consciousness are the most predominant symptoms in acute cases, while in subacute cases cerebellar signs, vomiting, headache and choked disc are noted. Angiographical examinations may not always be valuable in collecting the direct information of the existence of the epidural hematoma. Liquor cavity in the posterior fossa which is thought to serve as a buffer action of hematoma is about 20 ml, so we discuss about the volume of hematoma, especially of 20 ml, associated with clinical course and prognosis. Volume of epidural hematoma is one of the most important factors affecting clinical course and prognosis. In summary of these our experiences, we again emphasize the value of CT scan as the rapid, noninvasive, accurate radiological examination in the diagnosis of traumatic posterior fossa epidural hematoma. (author)

  8. Episodic Aphasia Associated With Cortical Spreading Depression After Subdural Hemorrhage Evacuation.

    Science.gov (United States)

    Shah, Nirav H; Adams, David

    2016-01-01

    Cortical spreading depression (CSD) has been associated with many pathological entities including migraine, trauma, hemorrhage, and mitochondrial disease. The clinical diagnosis remains challenging without the other concomitant features such as headache because CSD can mimic seizure or acute stroke. Wereport of a 77 year-old right handed man with a left subdural hematoma evacuation that subsequently developed episodic aphasia, slurred speech, right nasolabial fold flattening, and right pronator drift. In this case report, we discuss our multimodal diagnostic approach and treatment in a patient with episodic aphasia and neurological deficits in order to propose the diagnosis of cortical spreading depression. CSD should be considered when focal deficits in brief episodes occur after stroke and seizures have been ruled out. Treatment choices as illustrated by this case report can have an impact on outcome and resolution of episodes. PMID:26740859

  9. Episodic Aphasia Associated With Cortical Spreading Depression After Subdural Hemorrhage Evacuation

    Science.gov (United States)

    Shah, Nirav H.

    2016-01-01

    Cortical spreading depression (CSD) has been associated with many pathological entities including migraine, trauma, hemorrhage, and mitochondrial disease. The clinical diagnosis remains challenging without the other concomitant features such as headache because CSD can mimic seizure or acute stroke. Wereport of a 77 year-old right handed man with a left subdural hematoma evacuation that subsequently developed episodic aphasia, slurred speech, right nasolabial fold flattening, and right pronator drift. In this case report, we discuss our multimodal diagnostic approach and treatment in a patient with episodic aphasia and neurological deficits in order to propose the diagnosis of cortical spreading depression. CSD should be considered when focal deficits in brief episodes occur after stroke and seizures have been ruled out. Treatment choices as illustrated by this case report can have an impact on outcome and resolution of episodes. PMID:26740859

  10. On the differential diagnosis of the abdominal aorta aneurysm and retroperitoneal paraaortal hematoma

    International Nuclear Information System (INIS)

    Chronic retroperitoneal paraaortal hematoma appeared to be a rare disease. Paraaortal hematoma should be differentiated from abdomen aorta aneurysm and retroperitoneal tumor, for it requires no surgical intervention. Computerized tomography CT was shown to be the most sensitive method in differential diagnosis. CT with intravenous contrast intensification displayed complete information on aorta size, its aneurysms, extention of the disease, degree of dissemination into adjacent blood vessels and tissues. Retention of contrast media in the vessels occurred with 5 min delay and the blood was shown to free from the contrast substance up to that moment. The phenomenon permitted to distinguish thrombosed aneurysm from paraaortal tumor or hematoma

  11. Postpartum spinal subdural hematoma: irrelevant epidural blood patch: a case report.

    Science.gov (United States)

    Choe, Won Joo; Kim, Ji Yeon; Yeo, Hyeok Jae; Kim, Jun Hyun; Lee, Sang-Il; Kim, Kyung-Tae; Park, Jang Su; Kim, Jung Won

    2016-04-01

    We report a healthy patient with postpartum headache and neck stiffness which were diagnosed as symptoms of pseudoaneurysm of vertebral artery. She had received a Cesarean section under the spinal anesthesia, and complaint of headache and neck stiffness. Epidural blood patches were done twice, but symptoms persisted. Eight days later, she experienced sensory disturbance and emergent laminectomy was done. When persistent postpartum headache occurs after epidural blood patch, more precise differential diagnosis should be made and considering other possible pathologies. PMID:27066211

  12. Subdural haematoma in a patient with immune thrombocytopenic purpura.

    OpenAIRE

    Meena A; Murthy J

    1999-01-01

    A patient with bilateral subdural haematomas in association with idiopathic thrombocytopenic purpura is documented. She was managed successfully with platelet rich plasma and immunosuppressive therapy with steroids.

  13. Optimal management of hemophilic arthropathy and hematomas

    Directory of Open Access Journals (Sweden)

    Lobet S

    2014-10-01

    Full Text Available Sébastien Lobet,1,2 Cedric Hermans,1 Catherine Lambert1 1Hemostasis-Thrombosis Unit, Division of Hematology, 2Division of Physical Medicine and Rehabilitation, Cliniques Universitaires Saint-Luc, Brussels, Belgium Abstract: Hemophilia is a hematological disorder characterized by a partial or complete deficiency of clotting factor VIII or IX. Its bleeding complications primarily affect the musculoskeletal system. Hemarthrosis is a major hemophilia-related complication, responsible for a particularly debilitating chronic arthropathy, in the long term. In addition to clotting factor concentrates, usually prescribed by the hematologist, managing acute hemarthrosis and chronic arthropathy requires a close collaboration between the orthopedic surgeon and physiotherapist. This collaboration, comprising a coagulation and musculoskeletal specialist, is key to effectively preventing hemarthrosis, managing acute joint bleeding episodes, assessing joint function, and actively treating chronic arthropathy. This paper reviews, from a practical point of view, the pathophysiology, clinical manifestations, and treatment of hemarthrosis and chronic hemophilia-induced arthropathy for hematologists, orthopedic surgeons, and physiotherapists. Keywords: hemophilia, arthropathy, hemarthrosis, hematoma, physiotherapy, target joint

  14. Psychological barriers in long term non-operative treatment of retroperitoneal hematoma

    Directory of Open Access Journals (Sweden)

    Bogdan Socea

    2015-04-01

    Full Text Available The retroperitoneal hematoma can have, mainly, a traumatic etiology - blunt abdominal trauma (falls from height, road accidents, aggression of any kind, etc., or open (incised wounds, puncture, penetration or gunshot wounds. Ruptured arterial aneurysms can cause hemorrhage in the retroperitoneal space. There is also spontaneous retroperitoneal trauma in patients with chronic treatment with anticoagulant or antiaggregant drugs (1. Hemorrhage in the retroperitoneal space can be iatrogenic, after surgical, open or laparoscopic, interventions (2, 3. A particular type of retroperitoneal hematoma is the psoas muscle hematoma in patients with chronic oral anticoagulant treatment (Acenocumarol, Warfarin. The management of the retroperitoneal hematoma, whatever the cause may be, is, for most of the time, difficult. In case of traumatic etiology, the retroperitoneal hematoma is not the only lesion, being frequently associated with severe hollow or parenchymal organs injury or vascular lesions, which highlights the importance of a complete and precise clinical inventory of the lesions. The decision between an aggressive, surgical or interventional attitude and a conservative one, with monitoring, is often taken under pressure. Especially difficult are the cases in which the imaging results of the lesions is uncertain, when the patient presents hemodynamic instability, when other lesions can not be excluded, or when the parietal peritoneum is ruptured and the retroperitoneal hematoma gets into the peritoneal cavity, the patient presenting haemoperitoneum. For most of the time, these cases have indication for exploratory laparotomy, for a diagnostic, not therapeutic, goal.

  15. SUBDURAL HYGROMA PRESENTING AS DEMENTIA WITH KLUVER-BUCY SYMPTOMS

    OpenAIRE

    Duggal, Harpreet S.; Khess, Christoday R. J.; Nizamie, S. Haque

    1999-01-01

    Dementia is not an uncommon presentation in psychiatric practice. Of the various causes of reversible dementia, subdural hygroma is a lesser-known potentially reversible cause. A case of dementia with Kluver-Bucy symptoms secondary to subdural hygroma is described and implications of Kluver-Bucy symptoms in dementia are discussed.

  16. Is human fracture hematoma inherently angiogenic?

    LENUS (Irish Health Repository)

    Street, J

    2012-02-03

    This study attempts to explain the cellular events characterizing the changes seen in the medullary callus adjacent to the interfragmentary hematoma during the early stages of fracture healing. It also shows that human fracture hematoma contains the angiogenic cytokine vascular endothelial growth factor and has the inherent capability to induce angiogenesis and thus promote revascularization during bone repair. Patients undergoing emergency surgery for isolated bony injury were studied. Raised circulating levels of vascular endothelial growth factor were seen in all injured patients, whereas the fracture hematoma contained significantly higher levels of vascular endothelial growth factor than did plasma from these injured patients. However, incubation of endothelial cells in fracture hematoma supernatant significantly inhibited the in vitro angiogenic parameters of endothelial cell proliferation and microtubule formation. These phenomena are dependent on a local biochemical milieu that does not support cytokinesis. The hematoma potassium concentration is cytotoxic to endothelial cells and osteoblasts. Subcutaneous transplantation of the fracture hematoma into a murine wound model resulted in new blood vessel formation after hematoma resorption. This angiogenic effect is mediated by the significant concentrations of vascular endothelial growth factor found in the hematoma. This study identifies an angiogenic cytokine involved in human fracture healing and shows that fracture hematoma is inherently angiogenic. The differences between the in vitro and in vivo findings may explain the phenomenon of interfragmentary hematoma organization and resorption that precedes fracture revascularization.

  17. Microwave Hematoma Detector for the Rapid Assessment of Head Injuries

    Energy Technology Data Exchange (ETDEWEB)

    Hadded, W.; Chang, J.; Rosenbury, T.; Dallum, G.; Welsch, P.; Scott, D.; Duarte, D.; Acevedo-Bolton, V.

    2000-02-11

    A non-invasive microwave device for the detection of epi/subdural hemorrhaging (hematoma) is under current development. The final device will be highly portable and allow real time assessment of head injuries, thereby satisfying early detection needs of the field technician as well as providing a tool for repetitious monitoring of high-risk individuals. The device will adopt the advanced technology of micropower impulse radar (MIR) which is a state of the art low cost ultra wide band (UWB) microwave radar developed here at LLNL. It will consist of a MIR transmitting and receiving module, a computer based signal processing module, and a device-to-patient signal coupling module--the UWB antenna. The prototype design is being guided by the needs of the patient and the practitioner along with the prerequisites of the technology including issues such as the specificity of the device, efficacy of diagnosis, accuracy, robustness, and patient comfort. The prototype development follows a concurrent approach which .includes experiments designed to evaluate requirements of the radar and antenna design, phantom development to facilitate laboratory investigations, and investigation into the limits of adapting pre-existing non-medical MIR devices to medical applications. This report will present the accomplishments and project highlights to date in the fiscal year 1999. Future project projections will also be discussed.

  18. Interventricular septum hematoma during cineventriculography

    Directory of Open Access Journals (Sweden)

    Melzer Christoph

    2008-01-01

    Full Text Available Abstract Background Intraseptal hematoma and subsequent myocardial infarction due to accidental contrast agent deposition complicating diagnostic cineventriculography is a previously undescribed complication of angiography. Case presentation A 61 year old man was admitted at intensive care unit because of unstable angina pectoris 1 hour after coronary angiography. Transthoracic contrast echocardiography showed a non-perfused area in the middle of interventricular septum with an increase of thickening up to 26 mm. Review of cineventriculography revealed contrast enhancement in the interventricular septum after contrast medium injection and a dislocation of the pigtail catheter tip. Follow up by echocardiography and MRI showed, that intramural hematoma has resolved after 6 weeks. After 8 weeks successful stent implantation in LAD was performed and after 6 month the patient had a normal LV-function without ischemic signs or septal thickening demonstrated by stressechocardiography. Conclusion A safe and mobile position of the pigtail catheter during ventriculography in the middle of the LV cavity should be ensured to avoid this potentially life-threatening complication. For assessment and absolute measurement of intramural hematoma contrast-enhanced echocardiography is more feasible than MRI and makes interchangeable results.

  19. Cervical Ligamentum Flavum Hematoma: A Case Report

    OpenAIRE

    Haghnegahdar, Ali; Sedighi, Mahsa; Rahmanian, Abdolkarim; Baghban, Fahim

    2015-01-01

    Study Design Case report. Objective To report the first case of ligamentum flavum hematoma after cervical spine instrumentation 11 years after the index surgery. Methods After performing bilateral C3 and C4 laminectomy, we observed a dark greenish discoloration over the ligamentum flavum, which was opened. We evacuated 15 mL of subacute hematoma. Results The first ligamentum flavum hematoma of the cervical spine that occurred after spinal instrumentation with sublaminar hooks. Conclusion Liga...

  20. Subungual frictional hematoma due to overriding toe

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-07-01

    Full Text Available We report a male patient of 77 years with subungual frictional hematoma secondary to the deformity of his toe (overriding toe, this finding was incidental during his examination due to the presence of seborrheic keratosis on the scalp.Subungual hematomas of the nails are common it could be cause by major and minor trauma predominantly on the big toe, the different toe deformity predispose to have subungual frictional hematoma like in the present clinical case.

  1. Tuberculous brain abscess and subdural empyema in an immunocompetent child: Significance of AFB staining in aspirated pus

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2012-01-01

    Full Text Available Tuberculous brain abscess and subdural empyema are extremely rare manifestations of central nervous system tuberculosis. Here, we report a case of an 11-year-old immunocompetent child who developed temporal lobe abscess and subdural empyema following chronic otitis media. A right temporal craniotomy was performed and the abscess was excised. The Ziehl Nielsen staining of the aspirated pus from the temporal lobe abscess yielded acid fast bacilli. Prompt administration of antituberculous treatment resulted in complete recovery of the child. Even though the subdural abscess was not drained, we presume that to be of tubercular aetiology. Ours is probably the first case of brain abscess and subdural empyema due to Mycobacterium tuberculosis reported in the same child. This case is being reported because of its rarity and to stress the importance of routine staining for tubercle bacilli in all cases of brain abscess, especially in endemic areas, as it is difficult to differentiate tuberculous from pyogenic abscess clinically as well as histopathologically.

  2. Spontaneous spinal epidural hematoma diagnosed by CT scan

    International Nuclear Information System (INIS)

    A case of spinal epidural hematoma diagnosed by CT scan is reported. A 58-year-old man was admitted on June 18, 1984. He had had a sudden onset of severe low-back pain 7 days before admission and had developed paraparesis and numbness of the lower limbs 4 day before admission. Physical examination revealed weakness in the lower limbs, with the reflexes there decreased. The Babinski reflex and the Chaddock reflex were, however, present on both sides. Sensory disturbances were noted below L2. Urinary incontinence was present, too. Metrizamide myelography revealed an epidural mass which was located from the power part of T11 to the upper part of L2. A CT scan revealed a biconvex, relatively high-density mass in the posterior spinal canal. On the day of admission, a laminectomy was performed from T11 to L1, and the epidural hematoma was evacuated. The postoperative course was uneventful. Spinal epidural hematoma is uncommon. A CT scan can be used for an early diagnosis of this lesion. According to the review of the CT findings in 15 reported cases, including our case, CT reveals a smoothly marginated biconvex homogeneous density mass. The density of the hematoma decreases with the time. An acute type (within 3 days) is high-density, while a chronic type has a relatively high or isodensity. The acute type is easily differentiated from other epidural masses, such as a herniated disc, an epidural abscess, and an epidural tumor. On the other hand, the diagnosis of the chronic type is not always easy. (author)

  3. MR imaging of hyperacute intracranial hematomas

    International Nuclear Information System (INIS)

    A modification of the gradient-recalled-echo (GRE) pulse sequence, which we called hematoma sensitive GRE, was compared with CT and spin-echo (SE) MR images for patients suffering from parenchymal hemorrhage in the hyperacute stage (within 6 hours). In the hyperacute stage, CT was most sensitive to hematoma, and hematomas were visualized more clearly on GRE than SE. Hematomas and the surrounding tissues were almost isointense relative to white matter on T1-weighted images (WI), and hyperintense on T2-WI of SE. But they were visualized at different intensity from each other on GRE. Hematomas were hyperintense including hypointensity, and plasma was more hyperintense (similar to cerebrospinal fluid), and edematous tissue was slightly hyperintense relative to white matter. The changes of tissue surrounding hematoma were not detected on CT. Hematomas were iso- or hyperintense on SE in the acue stage, and were slightly hyperintense including hypointense areas with a surrounding hypointense rim on GRE. The change of intensity of hematoma was delayed on GRE compared to SE. This phenomenon was caused by lack of sensitivity to the intracellular methemoglobin. Thus it is possible to visualize the contents of hematoma on GRE in the acute stage. (author)

  4. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Neely, John C. [Marshall University School of Medicine, Huntington, WV (United States); Jones, Blaise V. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Crone, Kerry R. [Cincinnati Children' s Hospital Medical Center, Division of Neurosurgery, Cincinnati, OH (United States)

    2008-03-15

    Epidural hematoma (EDH) is a common sequela of head trauma in children. An increasing number are managed nonsurgically, with close clinical and imaging observation. We report the case of a traumatic EDH that spontaneously decompressed into the subgaleal space, demonstrated on serial CT scans that showed resolution of the EDH and concurrent enlargement of the subgaleal hematoma. (orig.)

  5. Intra-uterine hematoma in pregnancy

    DEFF Research Database (Denmark)

    Glavind, K; Nøhr, S; Nielsen, P H; Ipsen, L

    1991-01-01

    In 60 patients with a live fetus and an intra-uterine hematoma (IUH) proven by ultrasonic scanning the outcome of pregnancy was spontaneous abortion in 12% and premature delivery in 10%. No correlation between the outcome of the pregnancy and the maximum size of the hematoma or the week of...

  6. Hematoma subperiosteal de órbita: relato de caso Subperiosteal hematoma of the orbit: case report

    Directory of Open Access Journals (Sweden)

    Jacinto Barbosa Lay Chaves

    2007-08-01

    Full Text Available Descrevemos um paciente de 16 anos que após traumatismo crânio-encefálico leve evoluiu com dor ocular, hematoma palpebral unilateral e proptose do olho esquerdo. Tomografia computadorizada de órbitas evidenciou hematoma subperiosteal em órbita esquerda. Foi realizada drenagem cirúrgica da coleção. O hematoma subperiosteal de órbita, apesar de raro, deve ser incluído como etiologia de proptose ocular e seu diagnóstico deve ser precoce a fim de evitar a morbidade associada.We describe a sixteen years old male patient that suffered a craniocerebral trauma and presented at the emergency room, with ocular pain, palpebral hematoma and left eye proptosis. Orbital computed tomography showed left subperiosteal orbital hematoma. A surgical drainage was performed. Subperiosteal hematoma of the orbit is a rare cause of proptosis; its early diagnosis must be made in order to avoid possible complications.

  7. Epidural hematoma after routine epidural steroid injection

    Science.gov (United States)

    Alkhudari, Azzam M.; Malk, Craig S.; Rahman, Abed; Penmetcha, Taruna; Torres, Maria

    2016-01-01

    Background: There are few reported cases of an epidural spinal hematoma following interventional pain procedures. Case Description: We report a case of a spinal epidural hematoma in a patient with no known risk factors (e.g. coagulopathy), who underwent an epidural steroid injection (ESI) in the same anatomic location as two previously successful ESI procedures. Conclusion: Early detection was the key to our case, and avoiding sedation allowed the patient to recognize the onset of a new neurological deficit, and lead to prompt diagnosis as well as surgical decompression of the resultant hematoma.

  8. 4 cases of iliopsoas hematoma associated with hemophilia

    International Nuclear Information System (INIS)

    Four patients were diagnosed as having iliopsoas hematoma associated with hemophilia by CT scanning. The site and disappearance of hematoma were observed on CT. It was suggested that hematoma occurs inside the iliacus or posoas muscle in cases of iliopsoas hematoma complicated by hemophilia or coagulation and that it occurs in the pelvic wall of the iliacus muscle in cases of iliopsoas hematoma uncomplicated by coagulation abnormality. (Namekawa, K.)

  9. Anestesia subdural aps puno peridural: relato de dois casos Anestesia subdural despus puncin peridural: relato de dos casos Subdural anesthesia after epidural puncture: two case reports

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vsquez

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais so realizadas amplamente no nosso meio. A anestesia subdural acidental aps puno peridural uma complicao rara. O objetivo deste relato descrever dois casos de injeo subdural que coincidentemente ocorreram de forma consecutiva realizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado fsico ASA I, a realizar procedimento cirrgico de retirada de clculo renal. Optou-se por anestesia peridural. Aps 30 minutos do incio da anestesia, o paciente mantinha-se comunicativo mas sonolento com SpO2 de 100%, quando lentamente comeou a apresentar diminuio da SpO2 chegando a 80%. Apresentava-se inconsciente com apnia e anisocoria. A partir deste momento foi levantada hiptese diagnstica de anestesia subdural acidental. O paciente foi ento intubado e mantido em ventilao controlada mecnica. Terminada a cirurgia, foi encaminhado para a sala de recuperao, recebendo alta aps 6 horas, sem nenhuma alterao clnico-neurolgica. Caso 2: Paciente do sexo feminino, 82 anos, estado fsico ASA II, programado para procedimento cirrgico de fixao de fratura transtrocanteriana. Optou-se por anestesia peridural contnua. Assim como no caso anterior, aps 30 minutos, a paciente comeou a apresentar diminuio da SpO2 para 90%. Mostrava-se inconsciente e com anisocoria; entretanto, sem apnia. Optou-se por manter a paciente sob vigilncia constante, no sendo necessria intubao. A hiptese diagnstica aventada tambm neste caso foi de anestesia subdural acidental. Terminada a cirurgia, a paciente foi encaminhada sala de recuperao ps-anestsica, tendo alta aps 4 horas, sem nenhuma alterao clnico-neurolgica. CONCLUSES: Anestesia subdural acidental uma complicao extremamente rara. A hiptese diagnstica de anestesia subdural acidental, nestes casos, limitou-se aos dados clnicos. As complicaes do bloqueio subdural podem ser das mais variadas, mas na sua grande maioria so de fcil resoluo, desde que sejam diagnosticadas e tratadas rapidamente.JUSTIFICATIVA Y OBJETIVOS: Anestesias conductivas peridurales son realizadas ampliamente en el medio nuestro. La anestesia subdural accidental despus puncin peridural es una complicacin rara. El objetivo de este relato es describir dos casos de inyeccin subdural que coincidentemente ocurrieron de forma consecutiva realizadas por el mismo anestesiologista. RELATO DE LOS CASOS: Caso 1: Paciente del sexo masculino, 41 aos, estado fsico ASA I, a realizar procedimiento quirrgico de retirada de clculo renal. Se opt por anestesia peridural. Despus de 30 minutos del inicio de la anestesia, el paciente se mantena comunicativo ms sooliento con SpO2 de 100%, cuando lentamente comenz a presentar disminucin de la SpO2 llegando a 80%. Se presentaba inconsciente con apnea y anisocoria. A partir de este momento fue levantada hiptesis diagnstica de anestesia subdural accidental. El paciente fue entonces intubado y mantenido en ventilacin controlada mecnica. Terminada la ciruga, fue encaminado para la sala de recuperacin, recibiendo alta despus de 6 horas, sin ninguna alteracin clnico-neurolgica. Caso 2: Paciente del sexo femenino, 82 aos, estado fsico ASA II, programada para procedimiento quirrgico de fijacin de fractura transtrocanteriana. Se opt por anestesia peridural continua. As como en el caso anterior, despus de 30 minutos, la paciente comenz a presentar disminucin de la SpO2 para 90%. Se mostraba inconsciente y con anisocoria; entretanto, sin apnea. Entonces, se opt por mantener la paciente bajo vigilancia constante, no siendo necesaria intubacin. La hiptesis diagnstica aventada tambin en este caso fue de anestesia subdural accidental. Terminada la ciruga, la paciente fue encaminada a la sala de recuperacin ps-anestsica, teniendo alta despus de 4 horas, sin ninguna alteracin clnico-neuro

  10. Anestesia subdural aps puno peridural: relato de dois casos / Subdural anesthesia after epidural puncture: two case reports / Anestesia subdural despus puncin peridural: relato de dos casos

    Scientific Electronic Library Online (English)

    Carlos Escobar, Vsquez; Tomio, Tomita; Antonio, Bedin; Renato Almeida Couto de, Castro.

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais so realizadas amplamente no nosso meio. A anestesia subdural acidental aps puno peridural uma complicao rara. O objetivo deste relato descrever dois casos de injeo subdural que coincidentemente ocorreram de forma consecutiva rea [...] lizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado fsico ASA I, a realizar procedimento cirrgico de retirada de clculo renal. Optou-se por anestesia peridural. Aps 30 minutos do incio da anestesia, o paciente mantinha-se comunicativo mas sonolento com SpO2 de 100%, quando lentamente comeou a apresentar diminuio da SpO2 chegando a 80%. Apresentava-se inconsciente com apnia e anisocoria. A partir deste momento foi levantada hiptese diagnstica de anestesia subdural acidental. O paciente foi ento intubado e mantido em ventilao controlada mecnica. Terminada a cirurgia, foi encaminhado para a sala de recuperao, recebendo alta aps 6 horas, sem nenhuma alterao clnico-neurolgica. Caso 2: Paciente do sexo feminino, 82 anos, estado fsico ASA II, programado para procedimento cirrgico de fixao de fratura transtrocanteriana. Optou-se por anestesia peridural contnua. Assim como no caso anterior, aps 30 minutos, a paciente comeou a apresentar diminuio da SpO2 para 90%. Mostrava-se inconsciente e com anisocoria; entretanto, sem apnia. Optou-se por manter a paciente sob vigilncia constante, no sendo necessria intubao. A hiptese diagnstica aventada tambm neste caso foi de anestesia subdural acidental. Terminada a cirurgia, a paciente foi encaminhada sala de recuperao ps-anestsica, tendo alta aps 4 horas, sem nenhuma alterao clnico-neurolgica. CONCLUSES: Anestesia subdural acidental uma complicao extremamente rara. A hiptese diagnstica de anestesia subdural acidental, nestes casos, limitou-se aos dados clnicos. As complicaes do bloqueio subdural podem ser das mais variadas, mas na sua grande maioria so de fcil resoluo, desde que sejam diagnosticadas e tratadas rapidamente. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Anestesias conductivas peridurales son realizadas ampliamente en el medio nuestro. La anestesia subdural accidental despus puncin peridural es una complicacin rara. El objetivo de este relato es describir dos casos de inyeccin subdural que coincidentemente ocurrieron d [...] e forma consecutiva realizadas por el mismo anestesiologista. RELATO DE LOS CASOS: Caso 1: Paciente del sexo masculino, 41 aos, estado fsico ASA I, a realizar procedimiento quirrgico de retirada de clculo renal. Se opt por anestesia peridural. Despus de 30 minutos del inicio de la anestesia, el paciente se mantena comunicativo ms sooliento con SpO2 de 100%, cuando lentamente comenz a presentar disminucin de la SpO2 llegando a 80%. Se presentaba inconsciente con apnea y anisocoria. A partir de este momento fue levantada hiptesis diagnstica de anestesia subdural accidental. El paciente fue entonces intubado y mantenido en ventilacin controlada mecnica. Terminada la ciruga, fue encaminado para la sala de recuperacin, recibiendo alta despus de 6 horas, sin ninguna alteracin clnico-neurolgica. Caso 2: Paciente del sexo femenino, 82 aos, estado fsico ASA II, programada para procedimiento quirrgico de fijacin de fractura transtrocanteriana. Se opt por anestesia peridural continua. As como en el caso anterior, despus de 30 minutos, la paciente comenz a presentar disminucin de la SpO2 para 90%. Se mostraba inconsciente y con anisocoria; entretanto, sin apnea. Entonces, se opt por mantener la paciente bajo vigilancia constante, no siendo necesaria intubacin. La hiptesis diagnstica aventada tambin en este caso fue de anestesia subdural accidental. Terminada la ciruga, la paciente fue encaminada a la sala de recuperacin ps-anestsica, teniendo alta despus de 4 horas, sin

  11. Cervical Ligamentum Flavum Hematoma: A Case Report.

    Science.gov (United States)

    Haghnegahdar, Ali; Sedighi, Mahsa; Rahmanian, Abdolkarim; Baghban, Fahim

    2016-02-01

    Study Design?Case report. Objective?To report the first case of ligamentum flavum hematoma after cervical spine instrumentation 11 years after the index surgery. Methods?After performing bilateral C3 and C4 laminectomy, we observed a dark greenish discoloration over the ligamentum flavum, which was opened. We evacuated 15 mL of subacute hematoma. Results?The first ligamentum flavum hematoma of the cervical spine that occurred after spinal instrumentation with sublaminar hooks. Conclusion?Ligamentum flavum hematoma might happen even after a long delay (in our case, 11 years) from spinal instrumentation (sublaminar hooks). In symptomatic patients, evacuation is the treatment of choice. In cases of instrument adhesion to the surrounding intracanal tissues, removal should be done meticulously after performing a complete release. PMID:26835213

  12. Delayed extradural hematoma : a case report.

    Directory of Open Access Journals (Sweden)

    Alappat J

    2002-07-01

    Full Text Available Three patients of delayed extradural hematoma (EDH were seen in the last one year among forty eight consecutively treated cases of EDH. All the three hematomas were evacuated. Awareness of this entity and a high degree of vigilance are strongly recommended to detect such cases. Repeat CT should always be done, especially after decompression by either surgical or medical means, recovery from shock or whenever there is evidence of even minimal bleeding under a skull fracture on initial CT scan.

  13. Rectus sheath hematoma: three case reports

    OpenAIRE

    Kapan Selin; Turhan Ahmet N; Alis Halil; Kalayci Mustafa U; Hatipoglu Sinan; Yigitbas Hakan; Aygun Ersan

    2008-01-01

    Abstract Introduction Rectus sheath hematoma is an uncommon cause of acute abdominal pain. It is an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. It could occur spontaneously or after trauma. They are usually located infraumblically and often misdiagnosed as acute abdomen, inflammatory diseases or tumours of the abdomen. Case presentation We reported three cases of rectus sheath hematoma presenting with a mass in the ...

  14. Serial computed tomographies in subdural effusions following purulent meningitis

    International Nuclear Information System (INIS)

    The subdral effusion complicating acute purulent meningitis were visualized in seven children by means of cranial computed tomography (CCT). All these children were infants less than two years old; four were male, and three were female. The etiologic organisms could be cultured in three cases: Group B Streptococcus, Diplococcus pneumoniae, and Hemophilus influenza. The others could not be cultured. The subdural effusion could be detected by CCT on the 5th day after the onset in the earliest case and on the 30th day in the latest case. Four cases of them were resolved by chemotherapy and subdural taps, two cases were resolved spontaneously by chemotherapy only, and one case was resolved by means of a subdural-peritoneal shunt operation. The subdural taps through the anterior fontanelle were done in five cases. The fluids obtained by the subdural taps showed a bloody fluid in one case, a blood-tinged fluid in two cases, and a yellowish or brown-coloured fluid not including red cells in two cases. These fluids had a higher protein content than the CSF. These children were followed-up after the discharge. Their psychomotor development was good and they showed no epileptic complications. (author)

  15. Spontaneous subdural empyema in falciparum malaria : a case study

    Directory of Open Access Journals (Sweden)

    S. Dwarakanath, A. Suri , A.K. Mahapatra

    2004-09-01

    Full Text Available Clinical history : Malaria is one of the most common diseases in the tropical countries. Cerebralmalaria is usually a diffuse symmetric encephalopathy with focal signs being unusual.Methods : We present a three-year old girl lapsing into unconsciousness following a seizure whileundergoing treatment for malaria. Imaging revealed a large heterogenous density, left hemisphericacute subdural haematoma with brain herniation. Investigations revealed anaemia, thrombocytopeniaand positive peripheral blood smear for falciparum malaria.Results : Treatment involved surgical evacuation of the clot and the associated subdural empyema,intravenous quinine and antibiotics.Conclusion : This is the second case report of spontaneous subdural empyema in complicatedfalciparum malaria and highlights a rare but surgically manageable complication.

  16. Zero drift of intraventricular and subdural intracranial pressure monitoring systems

    Directory of Open Access Journals (Sweden)

    CHEN Li

    2013-04-01

    Full Text Available 【Abstract】Objective: To assess zero drift of intra-ventricular and subdural intracranial pressure (ICP moni-toring systems. Methods: A prospective study was conducted in pa-tients who received Codman ICP monitoring in the neuro-surgical department from January 2010 to December 2011. According to the location of sensors, the patients were ca-tegorized into two groups: intraventricular group and sub-dural group. Zero drift between the two groups and its as-sociation with the duration of ICP monitor were analyzed. Results: Totally, 22 patients undergoing intraven-tricular ICP monitoring and 27 receiving subdural ICP moni-toring were enrolled. There was no significant difference in duration of ICP monitoring, zero drift value and its absolute value between intraventricular and subdural groups (5.38 d± 2.58 d vs 4.58 d±2.24 d, 0.77 mm Hg±2.18 mm Hg vs 1.03 mm Hg± 2.06 mm Hg, 1.68 mm Hg±1.55 mm Hg vs 1.70 mm Hg±1.53 mm Hg, respectively; all P>0.05. Absolute value of zero drift in both groups significantly rose with the increased duration of ICP monitoring (P<0.05 while zero drift value did not. Moreover, daily absolute value in the intraventricular group was sig-nificantly smaller than that in the subdural group (0.27 mm Hg± 0.32 mm Hg vs 0.29 mm Hg±0.18 mm Hg, P<0.05. Conclusion: This study demonstrates that absolute value of zero drift significantly correlates with duration of both intraventricular and subdural ICP monitoring. Due to the smaller daily absolute value, ICP values recorded from intraventricular system may be more reliable than those from subdural system. Key words: Intracranial pressure; Equipment failure; Cerebral ventricles; Subdural space

  17. Peri-ictal complexity loss as determined by approximate entropy analysis in the electrocorticogram obtained from chronic subdural recordings in patients with refractory temporal lobe epilepsy Análise por entropia aproximada da perda de complexidade peri-ictal no eletrocorticograma de pacientes com epilepsia refratária com origem no lobo temporal

    Directory of Open Access Journals (Sweden)

    Adhemar Pettri Filho

    2006-12-01

    Full Text Available RATIONALE: The development of closed-loop devices suitable for use in the treatment of epileptic patients would very likely rely on the adequate development of paradigms able to forecast the occurrence of seizures. In this paper, we studied the usefulness of approximate enthropy, of a non-linear paradigm, in this patient population. METHODS: We applied approximate entropy (ApEn analysis to study the variability in the complexity of the peri-ictal electrocorticogram (ECoG of patients with refractory epileptic seizures of the temporal lobe origin. Three patients were implanted with chronic subdural grids. The ApEn algorithm measured the complexity of interictal, peri-ictal and ictal phases. We selected one representative channel disclosing interictal activity for each patient and two channels per patient with ictal recordings. RESULTS: In all patients, we found one channel where the interictal activity registered in the ECoG was associated with high complexity and where ApEn was higher than 0.59. But in the other two channels, for each patient that presented interictal/ictal transitions, clinical manifestations of epileptic seizures occurred around 3.5 seconds after the entropy drop, when entropy was below 0.5. In contrast, when entropy was higher than 0.5, clinical manifestation occurred 9.5 seconds after the entropy drop. The 3.5 seconds shorter delay possibly indicates focal activity in the channel analyzed. CONCLUSIONS: Our results suggest that ApEn may be a useful instrument for early detection of epileptic activity. Its application may be indicated for prevention and diagnosis of epileptic seizures.RACIONAL: O desenvolvimento de aparatos retroalimentáveis para o tratamento de pacientes epilépticos dependerá em grande parte do desenvolvimento adequado de paradigmas que possam antever as crises. Neste trabalho, estudamos a utilidade da entropia aproximada (ApEn, um paradigma não-linear, em pacientes portadores de epilepsia. MÉTODOS: Aplicamos a análise de entropia aproximada (ApEn no estudo de variabilidade da complexidade do eletrocorticograma (ECoG de pacientes com epilepsia refratária com origem no lobo temporal. Três pacientes foram implantados com matrizes de eletrodos subdurais. O algoritmo ApEn mediu a complexidade das fases interictal, peri-ictal e ictal. Selecionamos um canal representativo de cada paciente manifestando atividade interictal e dois canais de cada paciente com registro ictal. RESULTADOS: Em cada paciente, encontramos um canal cuja atividade interictal registrada no ECoG foi associada a alta complexidade com ApEn maior que 0.59. Nos outros dois canais, para cada paciente que apresentou transição interictal/ictal, as manifestações clínicas das crises epilépticas ocorreram cerca de 3.5 segundos depois após a queda da entropia abaixo de 0.5. Em comparação, quando a entropia foi maior que 0.5, as manifestações clínicas ocorreram 9,5 segundos após a queda da entropia. A curta latência (3.5 segundos indicou possivelmente o local de início da atividade focal. CONCLUSÕES: Nossos resultados sugerem que ApEn pode ser um instrumento útil na detecção precoce da atividade epiléptica. Sua aplicação pode estar indicada na prevenção ou diagnóstico das crises epilépticas.

  18. Evaluation of Risk Factors for Rectus Sheath Hematoma.

    Science.gov (United States)

    Sheth, Heena S; Kumar, Rohit; DiNella, Jeannine; Janov, Cheryl; Kaldas, Hoda; Smith, Roy E

    2016-04-01

    Rectus sheath hematoma (RSH) develops due to rupture of epigastric arteries or the rectus muscle. Although RSH incidence rate is low, it poses a significant diagnostic dilemma. We evaluated the risk factors for RSH, its presentation, management, and outcomes for 115 patients hospitalized with confirmed RSH by computed tomography scan between January 2005 and June 2009. More than three-fourth (77.4%) of the patients were on anticoagulation therapy, 58.3% patients had chronic kidney disease (CKD) stage ?3, 51.3% had abdominal injections, 41.7% were on steroids/immunosuppressant therapy, 37.4% had abdominal surgery/trauma, 33.9% had cough, femoral puncture was performed in 31.3% of patients, and 29.5% were on antiplatelet therapy. Rectus sheath hematoma was not an attributable cause in any of the 17 deaths. Mortality was significantly higher in patients with CKD stage ?3 (P = .03) or who required transfusion (P = .007). Better understanding of RSH risk factors will facilitate early diagnoses and improve management. PMID:25294636

  19. Computer tomography of intracranial tumours and hematomas

    International Nuclear Information System (INIS)

    The value of computed tomography (CT) for the diagnosis of intracranial tumors and hematomas was investigated in a retrospective study comprising 220 patients. All C.T.scans are reviewed and described in detail. To assess the diagnostic accuracy, the original interpretation of the C.T.scans was compared with that of conventional neuroradiological and neurophysiological examinations. The aspect on C.T. of the various types of tumors and hematomas proved to vary widely and specific features were seldom seen. This holds particularly for the malignant tumors. Benign tumors such as meningeomas, adenomas and neurilemmomas showed a rather easily identifiable and almost identical picture of the C.T.scan, and diagnosis had to be based mainly on differences in localization. The hematomas, with the exception of the older intracerebral ones, showed the most characteristic C.T.abnormalities. (Auth.)

  20. Delayed epidural hematoma after mild head injury

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    Radulović Danilo

    2005-01-01

    Full Text Available Background. Traumatic delayed epidural hematoma (DEH can be defined as insignificant or not seen on the initial CT scan performed after a trauma but seen on the subsequent CT scan as a “massive” epidural bleeding. Case report. We presented two cases of traumatic DEH after mild head injury. Both patients were conscious and without neurological deficit on the admission. Initial CT scan did not reveal intracranial hematoma. Repeated CT scan, that was performed after neurological deterioration, revealed epidural hematoma in both cases. The patients were operated with a favorable surgical outcome. Conclusion. Traumatic DEH could occur in the patients with head injuries who were conscious on the admission with a normal initial CT scan finding. Early detection of DEH and an urgent surgical evacuation were essential for a good outcome.

  1. Traumatic cervical epidural hematoma in an infant

    Directory of Open Access Journals (Sweden)

    Vithal Rangarajan

    2013-01-01

    Full Text Available An 8-month-old male infant had presented with a history of a fall from the crib a fortnight ago. He had developed progressive weakness of both lower limbs. On examination, the infant had spastic paraplegia. Magnetic resonance (MR imaging of the cervical spine showed an epidural hematoma extending from the fourth cervical (C4 to the first dorsal (D1 vertebral level with cord compression. The patient had no bleeding disorder on investigation. He underwent cervical laminoplasty at C6 and C7 levels. The epidural hematoma was evacuated. The cervical cord started pulsating immediately. Postoperatively, the patient′s paraplegia improved dramatically in 48 hours. According to the author′s literature search, only seven cases of post-traumatic epidural hematoma have been reported in pediatric patients, and our patient is the youngest. The present case report discusses the etiopathology, presentation, and management of this rare case.

  2. Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child.

    Science.gov (United States)

    Khilji, Muhammad Faisal; Jeswani, Niranjan Lal; Hamid, Rana Shoaib; Al Azri, Faisal

    2016-01-01

    Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing's reflex and papilledema of left eye. MRI (magnetic resonance imaging) of the brain showed left temporal extra-axial cystic lesion of 5.40 × 4.10 cm in size, representing arachnoid cyst, with bilateral frontoparietal subdural hygromas. Cyst was partially drained through left temporal craniectomy and subdural hygromas were drained through bilateral frontal burr holes. Postoperatively the child recovered uneventfully and was discharged on the seventh postoperative day. Histopathology proves it to be arachnoid cyst of the brain with subdural CSF (cerebrospinal fluid) collection or hygroma. PMID:26989525

  3. Atypical CT findings of acute epidural hematomas

    International Nuclear Information System (INIS)

    One of the classic CT findings is characterized by a lenticular high density in acute epidural hematomas. However, several atypical CT findings in acute epidural hematomas have been reported lately. We have ourselves met three cases of acute epidural hematomas, in which there were low-or isodensity spots within typical high-density areas. Case 1: a 74-year-old male, a victim of a traffic accident, showing a high degree of anemia (Ht: 14%, Hb: 2.8 g/dl.) secondary to massive subcutaneous hemorrhage resulting from traumatic DIC. His CT, taken 12 hours after the head injury, disclosed bubble-like low density spots in a typical high-density area. Case 2: a 9-month-old baby boy, who had fallen to the ground from a height of 25 cm, was also anemic on admission (Ht: 17%, Hb: 5.2 g/dl.). An initial CT-scan, 7 hours after head injury, again disclosed a huge low density spot in the center of a typical high-density area. Case 3: an 11-year-old girl, involved in a car accident. A CT-scan, taken 4.5 hours after head injury, showed a low-density spot in the center of a high-density area. In her case, however, there was no evidence of significant anemia. In these three cases, the CT findings were close to one another in appearance, namely, classic lenticular high-density areas, spotted with round low-or isodensity areas within those hematomas. The causative factors have been thought be one of the following: a markedly low hemoglobin value, a time difference in the coagulation process within the same hematomas, or a possible leakage of CSF into the hematomas from a dural tear. It seemed that no single causative factor was responsible in these three cases; rather, it seems that multiple factors had progressed simultaneously. (author)

  4. Percutaneous catheter drainage of complicated traumatic perirenal hematoma: case report

    Energy Technology Data Exchange (ETDEWEB)

    Han, Young Min; Jin, Kong Yong; Jeong, Su Hyun; Park, Jong Kwan [Chonbuk National University Medical School, Chonju (Korea, Republic of)

    2002-08-01

    A perirenal hematoma very commonly occurs after trauma. Treatment differs according to the degree of renal injury, though many cases are managed conservatively and complications are rare. We report tow cases in which successful treatment of a perirenal hematoma involved percutaneous catheter drainage; in one there was bowel obstruction, and in the other the hematoma was infected.

  5. Percutaneous catheter drainage of complicated traumatic perirenal hematoma: case report

    International Nuclear Information System (INIS)

    A perirenal hematoma very commonly occurs after trauma. Treatment differs according to the degree of renal injury, though many cases are managed conservatively and complications are rare. We report tow cases in which successful treatment of a perirenal hematoma involved percutaneous catheter drainage; in one there was bowel obstruction, and in the other the hematoma was infected

  6. Burrhole simulation for an intracranial hematoma simulator.

    Science.gov (United States)

    Acosta, Eric; Liu, Alan; Armonda, Rocco; Fiorill, Mike; Haluck, Randy; Lake, Carol; Muniz, Gilbert; Bowyer, Mark

    2007-01-01

    Traumatic head injuries can cause internal bleeding within the brain. The resulting hematoma can elevate intracranial pressure, leading to complications and death if left untreated. A craniotomy may be required when conservative measures are ineffective. To augment conventional surgical training, a Virtual Reality-based intracranial hematoma simulator is being developed. A critical step in performing a craniotomy involves cutting burrholes in the skull. This paper describes volumetric-based haptic and visual algorithms developed to simulate burrhole creation for the simulator. The described algorithms make it possible to simulate several surgical tools typically used for a craniotomy. PMID:17377222

  7. Subcorneal hematomas in excessive video game play.

    Science.gov (United States)

    Lennox, Maria; Rizzo, Jason; Lennox, Luke; Rothman, Ilene

    2016-01-01

    We report a case of subcorneal hematomas caused by excessive video game play in a 19-year-old man. The hematomas occurred in a setting of thrombocytopenia secondary to induction chemotherapy for acute myeloid leukemia. It was concluded that thrombocytopenia subsequent to prior friction from heavy use of a video game controller allowed for traumatic subcorneal hemorrhage of the hands. Using our case as a springboard, we summarize other reports with video game associated pathologies in the medical literature. Overall, cognizance of the popularity of video games and related pathologies can be an asset for dermatologists who evaluate pediatric patients. PMID:26919354

  8. Intramural duodenal hematoma as a complication of therapy with Warfarin: a case report and literature review; Hematoma intramural duodenal como complicacao de terapia anticoagulante com Warfarin: relato de caso e revisao da literatura

    Energy Technology Data Exchange (ETDEWEB)

    Faria, Juliano [Universidade Federal de Sao Paulo (UNIFESP/EPM), SP (Brazil). Dept. de Diagnostico por Imagem]. E-mail: drjuliano@uol.com.br; Pessoa, Roberta; Hudson, Marcelo; Vitoi, Silvio; Villela, Ovidio; Torres, Jose; Paula, Mara Delgado [Hospital Marcio Cunha, Ipatinga, MG (Brazil). Servico de Diagnostico por Imagem; Bemvindo, Aloisio [Hospital Marcio Cunha, Ipatinga, MG (Brazil). Servico de Terapia Intensiva

    2004-12-01

    We report a case of a patient receiving chronic oral anticoagulant therapy with Warfarin who presented with acute intestinal obstruction. Computed tomography showed intramural duodenal hematoma. Treatment was conservative with correction of the coagulation parameters and observation. This case exemplifies the usefulness of conservative therapy and computed tomography in patients with acute small bowel obstruction receiving anticoagulant therapy. (author)

  9. Hematoma subdural agudo espontâneo e hemorragia intracerebral em paciente com microangiopatia trombótica gestacional

    OpenAIRE

    Sâmia Yasin Wayhs; Joise Wottrich; Douglas Prestes Uggeri; Fernando Suparregui Dias

    2013-01-01

    Pré-eclâmpsia, síndrome HELLP (hemólise, elevação de enzimas hepáticas e plaquetopenia) e fígado gorduroso agudo da gestação são as principais causas de microangiopatia trombótica e disfunção hepática grave durante a gestação, representando um spectrum do mesmo processo patológico. Relatou-se aqui o caso de uma gestante com 35 semanas internada em unidade de terapia intensiva no pós-operatório imediato de cesariana por morte fetal, com náuseas, vômitos e icterícia. Diagnosticaram-se pré-eclâm...

  10. Spontaneous rectus sheath hematoma during rivaroxaban therapy

    OpenAIRE

    Ibrahim Kocayigit; Yusuf Can; Salih Sahinkus; Ercan Aydin; Mehmet Bulent Vatan; Harun Kilic; Huseyin Gunduz

    2014-01-01

    Rivaroxaban is an oral anticoagulant agent that directly inhibits Factor Xa and interrupts both the intrinsic and extrinsic pathway of the coagulation cascade and is currently indicated for use in patients for atrial fibrillation and prophylaxis of deep venous thrombosis. The present case reports of spontaneous rectus sheath hematoma during rivaroxaban therapy for atrial fibrillation in a 75-year-old woman.

  11. Preoperative cisternoscintigraphy as a guide to therapeutic decision making for cystic subdural hygroma: case report

    International Nuclear Information System (INIS)

    We report a case of a patient with cystic subdural hygroma who underwent pre-operative Tc-99m DTPA cistrenoscintigraphy to determine the course of operation. A 68-year-old female was admitted to the department of neurosurgery because of scute subarachnoid hemorrhage. After emergency ventricular drainage, the hydrocephalus and cystic subdural hygroma in the right fronto-temporal area developed. She underwent Tc-99m DTPA cisternoscintigraphy to evaluate the type of hydrocephalus, which revealed obstructive communicating hydrocephalus and the communication between the subdural hygroma and the subarachnoid space. As a result of these findings, she underwent the ventriculo-peritoneal shunt operation without removal of the subdural hygroma. Post-operative brain CT showed nearly normalized shape and size of the right ventricle and disappearance of subdural hygroma. We recommend the pre-operative cisternoscintigraphy in patients with complex hygroma to evaluate the communication between subdural hygroma and the subarachnoid space.=20

  12. Subdural porous and notched mini-grid electrodes for wireless intracranial electroencephalographic recordings

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    Salam MT

    2014-12-01

    Full Text Available Muhammad Tariqus Salam,1 Sbastien Glinas,1 Sbastien Desgent,2 Sandra Duss,2 Flix Bernier Turmel,1,3 Lionel Carmant,2 Mohamad Sawan,1 Dang Khoa Nguyen3 1Polystim Neurotechnologies Laboratory, Polytechnique Montral, QC, Canada; 2Research Center, Sainte-Justine University Hospital Center (CHU Sainte-Justine, Universit de Montral, QC, Canada; 3Neurology Service, Department of Medicine, Notre-Dame Hospital, Centre Hospitalier de l'Universit de Montral (CHUM, QC, Canada Background: Intracranial electroencephalography (EEG studies are widely used in the presurgical evaluation of drug-refractory patients with partial epilepsy. Because chronic implantation of intracranial electrodes carries a risk of infection, hemorrhage, and edema, it is best to limit the number of electrodes used without compromising the ability to localize the epileptogenic zone (EZ. There is always a risk that an intracranial study may fail to identify the EZ because of suboptimal coverage. We present a new subdural electrode design that will allow better sampling of suspected areas of epileptogenicity with lower risk to patients. Method: Impedance of the proposed electrodes was characterized in vitro using electrochemical impedance spectroscopy. The appearance of the novel electrodes on magnetic resonance imaging (MRI was tested by placing the electrodes into a gel solution (0.9% NaCl with 14 g gelatin. In vivo neural recordings were performed in male Sprague Dawley rats. Performance comparisons were made using microelectrode recordings from rat cortex and subdural/depth recordings from epileptic patients. Histological examinations of rat brain after 3-week icEEG intracerebral electroencephalography (icEEG recordings were performed. Results: The in vitro results showed minimum impedances for optimum choice of pure gold materials for electrode contacts and wire. Different attributes of the new electrodes were identified on MRI. The results of in vivo recordings demonstrated signal stability, 50% noise reduction, and up to 6 dB signal-to-noise ratio (SNR improvement as compared to commercial electrodes. The wireless icEEG recording system demonstrated on average a 2% normalized root-mean-square (RMS deviation. Following the long-term icEEG recording, brain histological results showed no abnormal tissue reaction in the underlying cortex. Conclusion: The proposed subdural electrode system features attributes that could potentially translate into better icEEG recordings and allow sampling of large of areas of epileptogenicity at lower risk to patients. Further validation for use in humans is required. Keywords: epilepsy, seizure, monitoring, surgery, electrodes

  13. Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery

    International Nuclear Information System (INIS)

    We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that ''silent'' (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery. (orig.)

  14. Streptococcal pharyngitis: an uncommon cause of subdural empyema.

    Science.gov (United States)

    Walden, Jeffrey Howard; Hess, Bryan; Rigby, Michael

    2015-01-01

    A 7-year-old girl with an unremarkable medical history presented to a local paediatric emergency department with a 7-day history of fever, sore throat and vomiting, and a 1-day history of rash. She was admitted to the hospital, with presumed Kawasaki disease. A few hours after admission, the patient had sudden onset of two witnessed tonic-clonic seizures and subsequent decreased mental status. She was transferred to the paediatric intensive care unit and started on broad-spectrum antibiotics. On hospital day 2, cerebral spinal fluid cultures and blood cultures grew Streptococcus pyogenes, and repeat physical examination was consistent with acute streptococcal pharyngitis. On hospital day 3, the patient developed left-sided hemiparesis and had another witnessed seizure. A CT scan was obtained and revealed a subdural abscess. She was transferred to a tertiary care centre and underwent craniotomy with evacuation of her subdural abscess. Surgical cultures eventually grew S. pyogenes. PMID:26385939

  15. Spontaneous subdural empyema in falciparum malaria : a case study

    OpenAIRE

    S. Dwarakanath, A. Suri , A.K. Mahapatra

    2004-01-01

    Clinical history : Malaria is one of the most common diseases in the tropical countries. Cerebralmalaria is usually a diffuse symmetric encephalopathy with focal signs being unusual.Methods : We present a three-year old girl lapsing into unconsciousness following a seizure whileundergoing treatment for malaria. Imaging revealed a large heterogenous density, left hemisphericacute subdural haematoma with brain herniation. Investigations revealed anaemia, thrombocytopeniaand positive peripheral ...

  16. Spinal Subdural Abscess: A Rare Complication of Decubitus Ulcer

    OpenAIRE

    Usoltseva, Natalia; Medina-Flores, Rafael; Rehman, Ateeq; Samji, Swetha; DCosta, Matthew

    2014-01-01

    Spinal subdural abscess (SSA) is an uncommon entity. The exact incidence is unknown, with very few cases reported in the literature. This condition may result in spinal cord compression, thus constituting a medical and neurosurgical emergency. The pathogenesis of SSA is not well-described, and the available knowledge is based on case observations only. There is only one case report that describes direct seeding from decubitus ulcers as a possible mechanism for development of SSA. We report a ...

  17. Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness

    OpenAIRE

    Bruner, David I.; Littlejohn, Lanny; Pritchard, Amy

    2012-01-01

    While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an i...

  18. Spontaneous intraneural hematoma of the sural nerve.

    Science.gov (United States)

    Richardson, Shawn S; McLawhorn, Alexander S; Mintz, Douglas N; DiCarlo, Edward F; Weiland, Andrew J

    2015-04-01

    Symptomatic intraneural hemorrhage occurs rarely. It presents with pain and/or weakness in the distribution following the anatomic innervation pattern of the involved nerve. When a purely sensory nerve is affected, the symptoms can be subtle. We present a previously healthy 36-year-old female who developed an atraumatic, spontaneous intraneural hematoma of her sural nerve. Sural dysfunction was elicited from the patient's history and physical examination. The diagnosis was confirmed with magnetic resonance imaging, and surgical decompression provided successful resolution of her preoperative symptoms. To our knowledge, this entity has not been reported previously. Our case highlights the importance of having a high index of suspicion for nerve injury or compression in patients whose complaints follow a typical peripheral nerve distribution. Prior studies have shown that the formation of intraneural hematoma and associated compression of nerve fibers result in axonal degeneration, and surgical decompression decreases axonal degeneration and aids functional recovery. PMID:25311865

  19. Webino syndrome presented with pontine hematoma

    OpenAIRE

    Ayşin Kısabay; Eda Çakıroğlu; Deniz Selçuki

    2012-01-01

    Webino syndrome is considered a special form of bilateral internuclear ophthalmoplegia.It is characterized by bilateral absence of adduction, nystagmic abduction of both eyes, convergence deficiency and mostly with exotropia. Ischemic, demyelinating and infectious etiologies have been described. A 57 years old male patient is found worthy for presentation since there are eye findings compatible with very rarely encountered Webino syndrome secondary to pontine hematoma.

  20. Webino syndrome presented with pontine hematoma

    Directory of Open Access Journals (Sweden)

    Ayşin Kısabay

    2012-12-01

    Full Text Available Webino syndrome is considered a special form of bilateral internuclear ophthalmoplegia.It is characterized by bilateral absence of adduction, nystagmic abduction of both eyes, convergence deficiency and mostly with exotropia. Ischemic, demyelinating and infectious etiologies have been described. A 57 years old male patient is found worthy for presentation since there are eye findings compatible with very rarely encountered Webino syndrome secondary to pontine hematoma.

  1. Hematoma extradural intrarraquidiano espontneo: relato de caso

    OpenAIRE

    TANURI FABIANO DA CUNHA; GUERREIRO NILTON EDUARDO; NAKANO HIROSHI; HAMAMOTO OSMI

    1999-01-01

    Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro sbito de sndrome de compresso medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nvel de sensibilidade em C4. Foi diagnosticado, por ressonncia magntica, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente atravs de laminectomia. A paciente encontra-se em acompanhamento fisioterpico e evolui com melhora da motricidade e s...

  2. Hematoma extradural intrarraquidiano espontneo: relato de caso

    Directory of Open Access Journals (Sweden)

    TANURI FABIANO DA CUNHA

    1999-01-01

    Full Text Available Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro sbito de sndrome de compresso medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nvel de sensibilidade em C4. Foi diagnosticado, por ressonncia magntica, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente atravs de laminectomia. A paciente encontra-se em acompanhamento fisioterpico e evolui com melhora da motricidade e sensibilidade.

  3. Spontaneous bilateral extrapleural hematoma: a case report

    OpenAIRE

    Hu, Sheng-I; Lee, Shih-Chun; Chang, Hung; Kuo, Yen-Shou

    2015-01-01

    Extrapleural hematoma (EPH) is a rare condition characterized by the accumulation of blood in the extrapleural space. EPH is generally identified by computed tomography (CT), which shows an inward displacement of extrapleural fat due to intrathoracic peripheral fluid accumulation (Ann Ital Chir 75(83): 5, 2004; J Korean Radiol Soc 49: 8997, 2003; Monaldi Arch Chest Dis 63(3): 166169, 2005). EPH has been reported to be associated with chest trauma and injuries. However, the correlation betwe...

  4. MR imaging of epidural hematoma in the lumbar spine

    International Nuclear Information System (INIS)

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk extrusions. (orig.)

  5. MR imaging of epidural hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Dorsay, Theodore A.; Helms, Clyde A. [Duke University Medical Center, Department of Radiology, Erwin Road, Room 1504, Durham, NC 27710 (United States)

    2002-12-01

    To bring attention to the MR imaging appearance of epidural hematoma (EDH) in the lumbar spine as a small mass often associated with disk herniation or an acute event. This paper will show our experience with this entity and describe criteria for its MR imaging appearance. Design and patients. Thirteen cases of prospectively diagnosed EDH of the lumbar spine were compared with 12 cases of prospectively diagnosed prominent epidural extrusion. Our criteria were retrospectively evaluated by the two authors for their presence or absence in each case. The chi-square test for nominal data was applied. MR imaging criteria utilized to distinguish EDH from disk herniation at our institution include: (1) signal different from disk, (2) high signal on T1-weighted images, either centrally or peripherally, (3) teardrop- or egg-shaped mass, in the sagittal plane, (4) size greater than half the vertebral body height in a craniocaudal dimension, (5) primarily retrosomatic epidural location, (6) plasticity - the mass is seen to conform closely to the contours of bone (e.g., in the lateral recess), (7) little or no disk space narrowing unless associated with disc herniation. Chi-square analysis demonstrated each criterion to significantly differentiate between EDH and extrusion. Only six of 13 EDH cases went to surgery in spite of their relatively large size. Two of six patients were diagnosed as having epidural clot consistent with hematoma at the time of surgery. The four patients who were not diagnosed at surgery revealed only small disk herniations or fragments of disk. The occurrence of EDH is more frequent than previously suspected. Spontaneous EDH is frequently associated with disk herniation and acute events such as sneezing or coughing. Most cases of spontaneous EDH will resolve prior to surgery with only the minority becoming chronic in order to be seen at surgery as an encapsulated mass. MR imaging can reliably identify EDH and distinguish between EDH and large disk extrusions. (orig.)

  6. Surgical treatment of supra- and infratentorial epidural hematoma.

    Science.gov (United States)

    Xiaoyu, Wang; Guoping, Li

    2013-01-01

    Supra- and infratentorial acute epidural hematoma (SIEDH) is a common type of posterior fossa epidural hematoma (PFEDH), representing 11- 64% of all PFEDHs. Although SIEDH is associated with typical characteristics, it might be difficult to diagnose when presenting as infratentorial acute epidural hematoma, which is clinically silent and has nonspecific symptoms. However, this type of hematoma can often be rapidly deteriorating, causing a sharp rise in intracranial pressure that leads to a life-threatening foramen magnum herniation. Early diagnosis and management of SIEDH are imperative. Traditional surgical management has always required relatively large craniotomies, larger than the hematoma itself, to expose its edge, and then tack up the dura matter). It usually opens the window and emphasizes retention of the bone bridge outside the transverse sinus. This method can effectively eliminate the hematoma, but it is associated with larger postoperative wound, longer operation time, larger skull defect, and more complications. Hence, exploration into a better surgical method is direly needed. PMID:23756966

  7. Penetrating Aortic Ulcers after Absorption of Intramural Hematoma

    OpenAIRE

    Aidala, Enrico; Bardi, Gianluca; Ohye, Richard G.

    2005-01-01

    We report a case of a type B aortic intramural hematoma, which rapidly expanded, with ulcer-like projections, after complete absorption of the hematoma. One month after the initial presentation, a new computed tomographic scan showed the appearance of a thin ulcer-like projection in the aortic wall. Three months later, after the patient reported a new episode of chest pain, a computed tomographic scan revealed 2 penetrating ulcers and rapid aortic dilation; the aortic hematoma had been comple...

  8. Minimally Invasive Surgical Treatment of Acute Epidural Hematoma: Case Series

    Science.gov (United States)

    2016-01-01

    Background and Objective. Although minimally invasive surgical treatment of acute epidural hematoma attracts increasing attention, no generalized indications for the surgery have been adopted. This study aimed to evaluate the effects of minimally invasive surgery in acute epidural hematoma with various hematoma volumes. Methods. Minimally invasive puncture and aspiration surgery were performed in 59 cases of acute epidural hematoma with various hematoma volumes (13–145 mL); postoperative follow-up was 3 months. Clinical data, including surgical trauma, surgery time, complications, and outcome of hematoma drainage, recovery, and Barthel index scores, were assessed, as well as treatment outcome. Results. Surgical trauma was minimal and surgery time was short (10–20 minutes); no anesthesia accidents or surgical complications occurred. Two patients died. Drainage was completed within 7 days in the remaining 57 cases. Barthel index scores of ADL were ≤40 (n = 1), 41–60 (n = 1), and >60 (n = 55); scores of 100 were obtained in 48 cases, with no dysfunctions. Conclusion. Satisfactory results can be achieved with minimally invasive surgery in treating acute epidural hematoma with hematoma volumes ranging from 13 to 145 mL. For patients with hematoma volume >50 mL and even cerebral herniation, flexible application of minimally invasive surgery would help improve treatment efficacy. PMID:27144170

  9. Bilateral isodense epidural hematoma: case report / Hematoma epidural isodenso bilateral: relato de caso

    Scientific Electronic Library Online (English)

    Rodrigo, Mendona; Telmo T.F., Lima; Leandro I., Dini; Cludio L.L., Krebs.

    2005-09-01

    Full Text Available Apresentamos o caso de um homem de 23 anos com traumatismo craniano grave. A TC de crnio demonstrou um volumoso hematoma epidural bilateral, isodenso com o crebro, sendo uma armadilha ao diagnstico. So apresentados um breve relato, estudo da imagem tomogrfica e reviso da literatura. [...] Abstract in english We present a case of a severe head injuried 23 year-old male patient. The initial CT scan disclosed bilateral epidural hematoma, isodense with the brain, thus being a pitfall in diagnosis. Brief case report, image and literature rewiew are presented. [...

  10. Hematoma intraparenquimatoso cerebral espontâneo: aspectos à tomografia computadorizada Spontaneous cerebral intraparenchymatous hematoma: computed tomography findings

    OpenAIRE

    Celso Monteiro Soares; Antonio Carlos Pires Carvalho

    2005-01-01

    OBJETIVO: Identificar os aspectos mais freqüentes do hematoma intraparenquimatoso cerebral espontâneo observados na tomografia computadorizada. MATERIAIS E MÉTODOS: Foram analisados, retrospectivamente, os exames de tomografia computadorizada de 250 pacientes com hematoma intraparenquimatoso cerebral espontâneo, provenientes de três diferentes hospitais da cidade do Rio de Janeiro. RESULTADOS: O hematoma intraparenquimatoso cerebral profundo foi o de maior incidência, equivalendo a 54,4% (136...

  11. Spontaneous Arachnoid Cyst Rupture with Subdural Hygroma in a Child

    OpenAIRE

    Muhammad Faisal Khilji; Niranjan Lal Jeswani; Rana Shoaib Hamid; Faisal Al Azri

    2016-01-01

    Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. A case of a nine-year-old boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days. Examination showed a young, fully conscious oriented boy with positive Cushing’s reflex and papilledema of left eye. MRI (ma...

  12. Subdural injection of contrast medium during cervical myelography

    International Nuclear Information System (INIS)

    Three patients (1 dog, 2 horses) are described where myelography was complicated, purportedly by injection of contrast medium into the meninges superficial to the subarachnoid space, Contrast medium injected in this location in a cadaver tended to accumulate dorsally within the vertebral canal, deep to the dura mater but superficial to the subarachnoid space, The ventral margin of the pooled contrast medium had a wavy or undulating margin and the dorsal margin was smooth, pooled contrast medium was believed to be sequestered within the structurally weak dural border cell layer between the dura mater and arachnoid membrane, or the so-called subdural space

  13. Spontaneous Spinal Epidural Hematoma; a Case Report

    Directory of Open Access Journals (Sweden)

    Maryam Motamedi

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma (SSHE is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52 year-old male referred to emergency department following severe low back pain.

  14. Spontaneous Spinal Epidural Hematoma; a Case Report.

    Science.gov (United States)

    Motamedi, Maryam; Baratloo, Alireza; Majidi, Alireza; Rahmati, Farhad; Shahrami, Ali

    2014-01-01

    Spontaneous spinal epidural hematoma (SSHE) is a rare entity can have several reasons. Its prevalence in population is 0.1 per 100,000 with the male to female ratio of 1/4:1. For the first time Jackson in 1869 reported a case of SSHE and after that, it was declared as several hundred cases in literatures. Here, a case of SSHE was reported in a 52-year-old male referred to emergency department following severe low back pain. PMID:26495379

  15. Idiopathic Adrenal Hematoma Masquerading as Neoplasm

    OpenAIRE

    SASAKI, KAZUKI; Yamada, Terumasa; GOTOH, KUNIHITO; Kittaka, Hirotada; Takahashi, Hidenori; Yano, Masahiko; Ohigashi, Hiroaki; ISHIKAWA, Osamu

    2012-01-01

    We report herein a case of idiopathic adrenal hematoma. A 59-year-old Japanese man was referred to our hospital for evaluation of a 7.0 cm mass in the right upper abdominal cavity. The tumor was suspected to originate from either the posterior segment of the liver or the right adrenal gland. His chief complaint was weight loss of 8 kg over the previous 6 months. He had no past medical history and took no medications, including no anticoagulants. Laboratory data were almost normal except for a...

  16. Prognostic factors in intraparenchymatous hematoma with ventricular hemorrhage.

    Science.gov (United States)

    Ruscalleda, J; Peiró, A

    1986-01-01

    Intraventricular hemorrhage following intraparenchymatous hematoma is thought to be a frequent and often fatal event. Computerized tomography has proved to be valuable for its diagnosis. Hospital records of seventy-eight patients with intraparenchymatous hematoma and intraventricular hemorrhage diagnosed by computerized tomography were retrospectively reviewed to evaluate initial clinical features and CT findings in order to assess potential prognostic factors. PMID:3951686

  17. Prognostic factors in intraparenchymatous hematoma with ventricular hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Ruscalleda, J.; Peiro, A.

    1986-01-01

    Intraventricular hemorrhage following intraparenchymatous hematoma is thought to be a frequent and often fatal event. Computerized tomography has proved to be valuable for their diagnosis. Hospital records of seventy-eight patients with intraparenchymatous hematoma and intraventricular hemorrhage diagnosed by computerized tomography were retrospectively reviewed to evaluate initial clinical features and CT findings in order to assess potential prognostic factors. (orig.).

  18. Prognostic factors in intraparenchymatous hematoma with ventricular hemorrhage

    International Nuclear Information System (INIS)

    Intraventricular hemorrhage following intraparenchymatous hematoma is thought to be a frequent and often fatal event. Computerized tomography has proved to be valuable for their diagnosis. Hospital records of seventy-eight patients with intraparenchymatous hematoma and intraventricular hemorrhage diagnosed by computerized tomography were retrospectively reviewed to evaluate initial clinical features and CT findings in order to assess potential prognostic factors. (orig.)

  19. Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment

    Directory of Open Access Journals (Sweden)

    Fahri Halit Besir

    2011-01-01

    Full Text Available Context: Retroperitoneal hematoma may usually occur as a result of trauma. A life threatening retroperitoneal hematoma is not expected complication of anticoagulation treatment and rarely reported. Low molecular weight heparins (Enoxaparin which are used as effective and safe medicine in the venous thromboemboly treatment have some major complications such as hematomas of different organs. We aim to present a giant spontaneous retroperitoneal hematoma after anticoagulant treatment of pulmonary embolism with enoxaparin. Case Report: A 73-year-old male patient with the diagnosis of pulmonary embolism underwent anticoagulant treatment (enoxaparin. In the second day of admission, the patient had an episode of abdominal and back pain. Abdominal ultrasonography and computerized tomographic scan revealed a giant retroperitoneal hematoma. Enoxaparin treatment was then stopped and the supportive treatment was started. In the following days, hemoglobin levels returned to normal and a control CT revealed regression of hematoma size. Conclusion: The anticoagulant treatment with enoxaparin may lead to severe hematomas. Therefore, the clinical suspicion is required especially in elderly patients and patients with impaired renal function for retroperitoneal hematoma, when they suffer from acute abdominal pain.

  20. Subgaleal hematoma presenting as a manifestation of Factor XIII deficiency

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Don; Taragin, Benjamin [Albert Einstein College of Medicine, Department of Radiology, Montefiore Medical Center, Bronx, NY (United States)

    2009-06-15

    Extracranial hematoma without significant head trauma is uncommon. We discuss a 9-year-old girl who presented with sudden head swelling, bilateral proptosis, extraocular muscle palsy, and progressive visual disturbance after hair braiding. The diagnosis of a large subgaleal hematoma with extension into the superior aspect of the orbits was made, requiring surgical drainage. Hematologic workup revealed an underlying Factor XIII deficiency. (orig.)

  1. Subcapsular hematoma of the liver in a neonate: case report

    Energy Technology Data Exchange (ETDEWEB)

    Im, Soo Ah; Lim, Gye Yeon [The Catholic University of Korea, Seoul (Korea, Republic of)

    2005-07-15

    Subcapsular hematoma of the liver in the neonate is an uncommon clinical presentation, although these tumors are frequently found upon perinatal autopsy. We describe the sonographic and MR findings of a subcapsular hematoma of the liver in a neonate having a clinical history of an inserted umbilical venous catheter, necrotizing enterocolitis and sepsis, and we also include a review of the relevant literature.

  2. CT guided stereotactic evacuation for hypertensive intracerebral hematoma

    International Nuclear Information System (INIS)

    Sixty-one cases of hypertensive intracerebral hematoma were evacuated by CT guided stereotactic method. The operation was performed in the CT room under general anesthesia using the KOMAI-NAKAJIMA STEREOTACTIC DEVICE. This instrument has a micromanipulater that can be used for various kinds of stereotactic procedures. Three dimensional position of the target point (aspiration point of the hematoma) was determined on the film obtained from CT scanning of the patient in the stereotactic system. If the hematoma was small, the target point was enough to be one point at the center of the hematoma, but in case of the large hematoma, several target points were given according to the shape of hematoma. The probe, ordinarily a steel tube 4 mm in outer diameter, was inserted through brain to the target point and the hematoma was aspirated through a silicon tube connected to a vacuum system. Among 61 cases examined, 30 cases of thalamic hemorrhage were operated upon and 36 cases were not operated. They were classified according to the volume of hematoma into 3 groups as follows: A=less than 10 ml, B=11-25 ml, C=more than 25 ml. The operated cases were compared with the non operated cases on the improvement of consciousness in each group. In the A group, the operated patients in the level I recovered more slowly than the non operated patients, but in the level II patients, this was reversed. In the B group, the operated patients improved more quickly except the level I patients. In the C group, almost all of non operated patients died. Thus, this operation was very useful in improving consciousness of level II or III patients independent of hematoma volume. It accelerated the recovery of motor function in the level I. This non inversive technique is considered effective for the removal of deep intracerebral hematoma. (author)

  3. Longterm surgery of posttraumatic intracranial hematoma

    Directory of Open Access Journals (Sweden)

    Babochkin D.S.

    2012-03-01

    Full Text Available Purpose. Research objective — studying of consequences of the operated traumatic intracranial hematomas in the remote period. Material. The nearest and remote results of the operated traumatic intracranial hematomas at 105 patients in terms from 6 months till 3 years are analyzed. During research the anamnesis was studied, neurologic investigation, and also research cognitive functions by means of scale MMSE, the test of drawing of hours, a scale of studying of alarm/depression HADS, learning of 5 words, scale quality of life SF-36. Results. It is established, that in the remote period the condition of the majority of patients gradually improves, at the same time, frequent enough and expressed consequences which are necessary for analyzing with the purpose of optimization of outcomes and the forecast at the given disease are observed. The special attention should be given again developing complications to which it is possible to carry epileptic seizures and behavioral-memorable infringements. Conclusion. Studying of the remote consequences of this heavy kind of craniocereberal trauma allows to optimize results of treatment and to provide complex medical, labor, social and family adaptation

  4. Post-thyroidectomy hematoma : a rare but potentially fatal complication

    Directory of Open Access Journals (Sweden)

    Sudhir M Naik

    2015-10-01

    Full Text Available Background/ objectives: Post-thyroidectomy hematoma is a rare but fatal complication of thyroidectomy. The incidence of hematoma has dropped to less than 2-3% due to better preoperative preparation & major refinements in surgical techniques. Setting: Department of ENT, Head & Neck Sur-gery, KVG Medical College, Sullia. Case report: We report a case of post- thyroidectomy hematoma in an elective surgery done for a large thyroid. The hematoma occurred 15 minutes after surgery & was managed success-fully under general anaesthesia. Intervention: Urgent evacuation of the hematoma was done under general anaesthesia & bleeders were re-ligated. 2 pints of A+ blood was transfused. Conclusion: Post-thyroidectomy hematoma leading to airway obstruction is a fatal complication which needs emergency management. Post-operative care include attention to the drain, careful monitoring in the recovery room & appreciation of subtle signs of respiratory distress. So every thyroidectomy case can bleed & cause hematoma complication. Prevention & early intervention can avoid fatal complications.

  5. Hematoma extradural intrarraquidiano espontneo: relato de caso Spontaneous extradural spinal hematoma: case report

    OpenAIRE

    FABIANO DA CUNHA TANURI; NILTON EDUARDO GUERREIRO; HIROSHI NAKANO; OSMI HAMAMOTO

    1999-01-01

    Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro sbito de sndrome de compresso medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nvel de sensibilidade em C4. Foi diagnosticado, por ressonncia magntica, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente atravs de laminectomia. A paciente encontra-se em acompanhamento fisioterpico e evolui com melhora da motricidade e s...

  6. Changes in signal intensity of cerebral hematoma in magnetic resonance

    International Nuclear Information System (INIS)

    Magnetic resonance is highly sensitive for the detection of intraparenchymatous hemorrhage. The evolution of hematoma over time translates into changes in signal intensity. This means that we can determine when the hematoma presented and, in addition. follow its course. On the other hand, many intracranial processes developing association with hemorrhage, the recognition of which is, in some cases, of importance. We have studied 60 cerebral hematomas and have described the changes that will take place in their signal and the reasons for them. (author)

  7. Spontaneous ligamentum flavum hematoma in the lumbar spine

    International Nuclear Information System (INIS)

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  8. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

    Keynan, Ory; Ashkenazi, Ely; Floman, Yizhar [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Smorgick, Yossi [Israel Spine Center at Assuta Hospital, Tel Aviv (Israel); Assaf Harofeh Medical Center, Department of Orthopedic Surgery, Zerifin (Israel); Schwartz, Allan J. [Hadassah University Hospital, Department of Radiology, Section of Neuroradiology, Jerusalem (Israel)

    2006-09-15

    Lumbar or sacral nerve root compression is most commonly caused by intervertebral disc degeneration and/or herniation. Less frequently, other extradural causes may be implicated, such as infection, neoplasm, epidural hematoma, or ligamentum flavum pathology. We present the case of a patient with spontaneous ligamentum flavum hematoma compressing the L4 nerve root, without antecedent trauma. Although exceedingly rare, the diagnosis of ligamentum flavum pathology in general, and that of ligamentum flavum hematoma in particular, should be considered on those rare occasions when the etiology of lumbar or sacral nerve root compressions appears enigmatic on radiological studies. Usually surgical treatment produces excellent clinical outcome. (orig.)

  9. Microsurgical excision of hematoma of the lumbar ligamentum flavum.

    Science.gov (United States)

    Takeno, Kenichi; Kobayashi, Shigeru; Miyazaki, Tsuyoshi; Yayama, Takafumi; Baba, Hisatoshi

    2010-07-01

    Hematoma of the lumbar ligamentum flavum is a very rare cause of sciatica. A 72-year-old man presented with left-sided sciatica and paresthesia of the lateral aspect of his left foot. From CT and MRI findings, he was diagnosed as having a hematoma embedded in the ligamentum flavum, which compressed the dura mater at the L5/S1 disc level. After an adequate surgical field was obtained with a microscope and a Casper retractor, the hematoma of the ligamentum flavum could be excised via a unilateral approach and satisfactory decompression of the cauda equina and nerve roots were obtained. PMID:20537575

  10. MRI of spinal hematoma as a result of lumbar puncture

    International Nuclear Information System (INIS)

    A 59-year-old woman was suspected of having meningitis. A lumbar puncture was performed for CSF analysis; however, a traumatic tap induced hemorrhage in the subarachnoid space and formed a hematoma from the L3 to the S1 level. This resulted in a paraparesis. Myelography showed a band-like filling defect and a subsequent computed tomography (CT) myelogram showed a soft tissue mass in the intradural space. T1 weighted magnetic resonance imaging revealed a lesion with moderate hyperintensity within the dural sac, hinting that the lesion was a hematoma. Laminectomy was performed, and the hematoma was entirely removed. (orig.)

  11. First report of hepatic hematoma after presumed Bothrops envenomation

    Directory of Open Access Journals (Sweden)

    Fernanda Cristina Cunha

    2015-10-01

    Full Text Available ABSTRACTIn Latin America, Bothrops envenomation is responsible for the majority of accidents caused by venomous snakes. Patients usually present local edema, bleeding and coagulopathy. Visceral hemorrhage is extremely rare and considered a challenge for diagnosis and management. We report the first case of hepatic hematoma owing to the bothropic envenomation in a 66-year-old man who was bitten in the left leg. He presented local edema, coagulopathy, and acute kidney injury. Radiological findings suggested hepatic hematoma, with a volume of almost 3 liters. The hepatic hematoma was gradually absorbed without the need for surgical intervention with complete resolution in 8 months.

  12. Computed tomographic investigations on intraventricular hematomas

    International Nuclear Information System (INIS)

    This work investigated in 106 patients with intraventricular hematomas all the known factors which can have an influence on prognosis: age, sex, anamnesis of the patients, size, extent and localization of the intracranial bleeding, underlying angiopathy and differences between arterial and venous and spontaneous and traumatic bleedings. It was shown that the state of mind was the deciding prognostic factor, whereby viligance was the cumulative expression of all other investigated influences. A computed tomography (CT) examination is deciding in the question of operative hydrocephalus care. In 13 patients it was further shown, how clearly CT results and brain dissection allowed themselves to be compared. The computed tomographic examination method is best suited to achieve even physiological and more extensive prognostic possibilities. (orig.)

  13. Intra-Abdominal Hematoma Following Enoxaparin Injection.

    Science.gov (United States)

    Chung, Kin Tong

    2016-01-01

    An elderly patient, who was being treated for therapeutic enoxaparin for a couple of days due to suspected deep vein thrombosis, was admitted to hospital following a collapse and severe abdominal pain. She was in hypovolemic shock and was fluid resuscitated. Ultrasound scan and computed tomography (CT) scan showed a large pelvic hematoma. Radiologists also suspected a possibility of bleeding from inferior epigastric artery following a CT angiogram. The patient was stabilized and transferred to intensive care unit (ICU) for further hemodynamic supports and close monitoring. The patient was then transferred back to the general ward when she was stable. She was managed conservatively as there were no more signs of active bleeding. Unfortunately, she died of recurrent bleeding three days after ICU discharge. PMID:27158226

  14. CD36-Mediated Hematoma Absorption following Intracerebral Hemorrhage: Negative Regulation by TLR4 Signaling

    OpenAIRE

    Fang, Huang; Chen, Jing; Lin, Sen; Wang, Pengfei; Wang, YanChun; Xiong, XiaoYi; Yang, QingWu

    2014-01-01

    Promoting hematoma absorption is a novel therapeutic strategy for intracerebral hemorrhage (ICH); however, the mechanism of hematoma absorption is unclear. The present study explored the function and potential mechanism of CD36 in hematoma absorption using in vitro and in vivo ICH models. Hematoma absorption in CD36-deficient ICH patients was examined. Compared with patients with normal CD36 expression, CD36-deficient ICH patients had slower hematoma adsorption and aggravated neurologic defic...

  15. Giant vulvar hematoma during pregnancy after sexual intercourse: A case report

    OpenAIRE

    Hacivelioglu, Servet; Haydardedeoglu, Bulent; Simsek, Erhan; Cok, Tayfun

    2013-01-01

    Abstract. Lower genital tract hematomas are rarely seen in clinical practice. Although one can frequently see vulvar hematomas when delivering a baby, there are few reports on vulvar hematomas in pregnant patients. Here the authors present a case on a giant vulvar hematoma in a pregnant patient that developed after usual sexual intercourse. Due to the enlarging hematoma and unbearable pain, an operation was offered to the patient. Under general anesthesia, a 5-cm vertical incision was made on...

  16. Subdural infusion of dexamethasone inhibits leukomyelitis after acute spinal cord injury in a rat model

    Czech Academy of Sciences Publication Activity Database

    Kwiecien, J. M.; Jarocz, B.; Urdzíková, Lucia; Rola, R.; Dabrowski, W.

    2015-01-01

    Roč. 53, č. 1 (2015), s. 41-51. ISSN 1641-4640 Institutional support: RVO:68378041 Keywords : spinal cord injury * leukomyelitis * macrophages * subdural infusion * dexamethasone Subject RIV: FH - Neurology Impact factor: 1.568, year: 2014

  17. Subdural collections associated with pediatric bacterial meningitis MR imaging

    International Nuclear Information System (INIS)

    To evaluate meningitis complications caused by spontaneously resolving sterile subdural (SD) effusions in children, the authors used CT and MR imaging to examine six children (age range, 2 months to 5 years) with bacterial meningitis; two patients also underwent Gadolinium-enhanced MR imaging. Seven SD collections were identified, ranging from nearly isointense (two) to hyperintense (five) relative to cerebrospinal fluid. Both collections evaluated with gadolinium enhanced markedly. Although the presence of hyperintense, enhancing SD collections might suggest that they were empyemas, all patients were clinically stable or improving. This contrasted with the acutely ill adolescents with otorhinologic-related empyemas who required immediate extensive craniotomy. Clinical factors (age, type of bacteria, severity of illness) might be more helpful than MR features to assess clinical status and surgical requirements

  18. [Subamniotic hematoma: 3D and color Doppler imaging in the differential diagnosis of placental masses and fetal outcome].

    Science.gov (United States)

    Volpe, G; Volpe, N; Fucci, L; Campobasso, G; De Robertis, V; Schonauer, L M; Volpe, P

    2008-06-01

    The aim of this study was to evaluate the role of 3D and color Doppler (CD) imaging in prenatal diagnosis and management of placental subamniotic hematoma and to speculate about the prenatal diagnosis of the solid and cystic placental masses protruding from the fetal surface of the placenta. Five pregnancies in which a large mass was seen protruding from the fetal surface of the placenta were studied in the period between January 2006 and January 2008. 3D and color flow imaging were settled in order to monitor the sonographic features of the mass during pregnancy, to evaluate the continuity of the solid portion of the mass with the fetal placental surface and to detect the blood flow signals within the mass. This study reports the clinical outcome and the histologic findings of five cases of subamniotic hematomas detected in the course of prenatal ultrasound examinations between January 2006 and January 2008. Sonographic features of the mass protruding from the chorionic plate show a consistence typical of a solid mass, in the recent subamniotic hematoma, or a predominantly cystic mass in the chronic subamniotic hematoma. Neither adverse clinical correlations nor structural nor chromosomal fetal abnormalities were found after delivery. The joint and the continuity of the solid portion of the mass with the fetal placental surface were correctly identified by prenatal ultrasound 3D examination. The CD imaging was conclusive in order to detect the absence of blood flow within the solid part of these masses. In conclusion prenatal sonographic features in recent subamniotic hematomas include the detection of a complex structure overlying the fetal plate of the placenta next to the cord insertion, covered by a thin membrane (the amnion), containing a predominantly solid mass arising from the chorionic plate. Differential diagnosis has to be done between recent subamniotic hematoma and placental chorioangioma by the use of color flow imaging: it displays blood flow within the mass in the case of chorioangioma, and conversely demonstrates the lack of color flow signals in the hematoma. The 3D imaging is conclusive in order to identify the continuity of the solid mass with the fetal placental surface. The chronic subamniotic hematomas are predominantly cystic structures in which there is a solid component attached to the fetal surface of placenta, representing a retracted clot and/or a fibrin deposit, underlying the hematoma. The main differential diagnosis in the case of a cystic mass overlying the fetal plate of the placenta, covered by a thin membrane, during the ultrasound examination, is between a placental cyst and a large pseudocysts of the umbilical cord at the placental insertion. In the case of a pseudocyst, the transonic formation is clear and lacks of a solid mass within. The correct differential diagnosis between subamniotic hematoma and the pseudocysts of the umbilical cord is required because of the association between chromosomal anomalies and pseudocysts. PMID:18547988

  19. Multiple subdural abscesses following colonic perforation - a rare complication of a ventriculoperitoneal shunt

    International Nuclear Information System (INIS)

    A case of colonic perforation by a ventriculoperitoneal shunt, its subsequent migration and protrusion from the anal orifice is reported. The shunt reservoir and ventricular catheter were removed percutaneously, and the disconnected peritoneal catheter was pulled out through the anus. Blood culture grew Klebsiella pneumoniae and Streptococcus fecalis. CT scan showed multiple subdural abscesses with evidence of ventriculitis. Removal of the shunt (as described), evacuation of subdural pus and systemic antibiotics resulted in complete recovery. (orig.)

  20. Correlations Between Subdural Empyema and Paraclinical as well as Clinical Parameters amongst Urban Malay Paediatric Patients

    OpenAIRE

    Nayan, Saiful Azli Mat; Abdullah, Mohd Shafie; Naing, Nyi Nyi; Haspani, Mohd Saffari Mohd; Md Ralib, Ahmad Razali

    2008-01-01

    Paediatric subdural empyema is frequently seen in developing Asean countries secondary to rinosinusogenic origins. A cross-sectional analysis on the surgical treatment of intracranial subdural empyema in Hospital Kuala Lumpur (HKL), a major referral center, was done in 2004. A total number of 44 children who fulfilled the inclusion criteria were included into this study. The methods of first surgery, volume of empyema on contrasted CT brain, improvement of neurological status, re-surgery, mor...

  1. Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

    International Nuclear Information System (INIS)

    A 52-year-old woman treated for acute myeloproliferative disease developed progressive stupor. CT showed obstructive hydrocephalus resulting from unexplained mass effect on the fourth ventricle. MRI revealed bilateral extra-axial collections in the posterior cranial fossa, giving high signal on T1- and T2-weighted images, suggesting subacute subdural haematomas. Subdural haematomas can be suspected on CT when there is unexplained mass effect. MRI may be essential to confirm the diagnosis and plan appropriate treatment. (orig.)

  2. MRI Changes of the Spinal Subdural Space after Lumbar Spine Surgeries: Report of Two Cases

    OpenAIRE

    Sakai, Toshinori; Sairyo, Koichi; Bhatia, Nitin N.; Miyagi, Ryo; Tamura, Tatsuya; Katoh, Shinsuke; Yasui, Natsuo

    2011-01-01

    Although magnetic resonance imaging (MRI) is frequently used to assess the lumbar spine, there are few reports in the medical literature that have evaluated using MRI immediately following spinal surgery. Furthermore, descriptions of the subdural changes after lumbar spine surgery are also infrequent. In this paper, we present two cases with subdural change seen on MRI immediately after lumbar surgery. Both the patients had mild symptoms that resolved spontaneously, and the follow-up MRI scan...

  3. Changes in signal intensity of cerebral hematoma in magnetic resonance. Claves en la semiologia del hematoma cerebral en resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Galant, J.; Poyatos, C.; Marti-Bonmarti, L.; Martinez, J.; Ferrer, D.; Dualde, D.; Talens, A. (Universidad de Valencia (Spain). Facultad de Ciencias Quimicas)

    1992-01-01

    Magnetic resonance is highly sensitive for the detection of intraparenchymatous hemorrhage. The evolution of hematoma over time translates into changes in signal intensity. This means that we can determine when the hematoma presented and, in addition. follow its course. On the other hand, many intracranial processes developing association with hemorrhage, the recognition of which is, in some cases, of importance. We have studied 60 cerebral hematomas and have described the changes that will take place in their signal and the reasons for them. (author)

  4. Epidural Hematoma In The Newborn Infant : A Case Report

    Directory of Open Access Journals (Sweden)

    Aslihan KOSEOGLU

    2010-12-01

    Full Text Available Traumatic epidural hematoma (EDH represents a rare head injury complication in the newborn. EDH is seen in 2-3 % of all head injuries in the pediatric population. A case of epidural hematoma by an accidental trauma due to the dropping of the patient to the labor room floor was reported. The male newborn's birth weight was 2650 gr. His neurologic examination revealed left hemiparesis. A solid epidural hematoma was recognized on Computed Tomography (CT. The hematoma was decompressed surgically. He was discharged from the hospital at the 3th day. The treatment of the newborn EDH is controversial. Treatment may be conservative, surgical or interventional needle aspiration. Etiology and treatment of the newborn EDH are discussed.

  5. Spontaneous epidural hematoma at lumbar facet joint: a case report

    International Nuclear Information System (INIS)

    Spontaneous epidural hematomas (SEHs) of the lumbar spine are rare. The pathogenesis is not entirely clear, but several reports have suggested that bleeding originating in the venous epidural plexus is the cause. This is the second report of a SEH thought to be the result of facet joint hemorrhage with no previous synovial cyst formation. A magnetic resonance image revealed a mass beginning in the left epidural space and continuing through to the left L5-S1 facet joint. Surgically, the epidural hematoma, which was covered by a very thin translucent membrane, was visualized directly. A histopathological examination revealed the wall of the epidural hematoma to be composed of very thin fibrous connective tissue with no synovium lining. The purpose of this study was to report a case of an epidural hematoma originated from lumbar facet joint, diagnosed by radiological examination, and to present a review of the subject literature

  6. Spontaneous epidural hematoma at lumbar facet joint: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Seung Eun; Lee, Sang Ho; Jo, Byung June; Yoon, Deug Hee; Paeng, Sung Suk [Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Inje University College of Medicine, Seoul (Korea, Republic of)

    2005-10-15

    Spontaneous epidural hematomas (SEHs) of the lumbar spine are rare. The pathogenesis is not entirely clear, but several reports have suggested that bleeding originating in the venous epidural plexus is the cause. This is the second report of a SEH thought to be the result of facet joint hemorrhage with no previous synovial cyst formation. A magnetic resonance image revealed a mass beginning in the left epidural space and continuing through to the left L5-S1 facet joint. Surgically, the epidural hematoma, which was covered by a very thin translucent membrane, was visualized directly. A histopathological examination revealed the wall of the epidural hematoma to be composed of very thin fibrous connective tissue with no synovium lining. The purpose of this study was to report a case of an epidural hematoma originated from lumbar facet joint, diagnosed by radiological examination, and to present a review of the subject literature.

  7. Idiopathic intraparenchymal hematoma of the liver in a neonate

    International Nuclear Information System (INIS)

    Hepatic hematomas in newborn infants are not frequently detected clinically, but are often found at perinatal autopsies. These hematomas of the liver are usually subcapsular in location. A variety of etiologies for such hematomas has been implicated, such as trauma, sepsis, and coagulopathies. We present a neonate who presented with jaundice and abdominal distention. Initial imaging studies revealed a large intraparenchymal lesion of the liver, which was at first thought to be suspicious for neoplasm; however, MRI showed the lesion to be hemorrhagic and follow-up sonographic studies showed total resolution of this lesion, compatible with hematoma. The intraparenchymal location and the idiopathic nature of this lesion distinguish this case from others previously reported. (orig.)

  8. Hepatostomy for central hepatic hematomas. [/sup 198/Au tracer technique

    Energy Technology Data Exchange (ETDEWEB)

    Gewertz, B.L.; Olsen, W.R.

    1975-04-01

    Two patients with central hepatic hematomas are presented. Hepatostomy tube drainage provided prompt healing of the cavities without complications. The technique is presented as a safe and effective alternative to hepatic resection without compromising the established principles of management.

  9. Idiopathic intraparenchymal hematoma of the liver in a neonate

    Energy Technology Data Exchange (ETDEWEB)

    Amodio, John; Fefferman, Nancy; Rivera, Rafael; Pinkney, Lynne; Strubel, Naomi [Division of Pediatric Radiology, Department of Radiology, New York University Medical Center, 560 1st Avenue, New York, NY 10016 (United States)

    2004-04-01

    Hepatic hematomas in newborn infants are not frequently detected clinically, but are often found at perinatal autopsies. These hematomas of the liver are usually subcapsular in location. A variety of etiologies for such hematomas has been implicated, such as trauma, sepsis, and coagulopathies. We present a neonate who presented with jaundice and abdominal distention. Initial imaging studies revealed a large intraparenchymal lesion of the liver, which was at first thought to be suspicious for neoplasm; however, MRI showed the lesion to be hemorrhagic and follow-up sonographic studies showed total resolution of this lesion, compatible with hematoma. The intraparenchymal location and the idiopathic nature of this lesion distinguish this case from others previously reported. (orig.)

  10. Pathomechanism of ring enhancement in intracerebral hematomas on CT

    International Nuclear Information System (INIS)

    As a simulation of hypertensive intracerebral hematoma, about 3.5 ml of autologus venous blood were injected into an artificial cavity of a unilateral cerebral hemisphere in dogs. The cavity was made by the insertion and inflation of a balloon canula near the basal ganglia region of the dog. At the acute stage after the injection, the hematoma showed a round-shaped and homogeneous high density. 9 days later, a positive ring enhancement appeared around this high-density area in most of the cases. Subsequently, the hematoma changed into an isodensity with a tendency toward the concentric concentration of the ring enhancement and to the final low-density stage with a spotted enhancement in the center. That is our experimental intracerebral hematoma of the dog showed a pattern of the chronological course of the CT appearance quite similar to that of clinical cases of hypertensive intracerebral hematomas. At the onset of the ring enhancement, many new and immature capillaries were noted in the adjacent tissue of the hematoma, corresponding to the positive enhancement. The new capillaries were gradually shifted to the center of the hematoma; the enhancement also coincided with them. The ultrastructures of these new capillaries were examined electronmicroscopically. There was some resemblance to the capillaries of muscle with many pinocytotic vesicles and shallowed tight junctions. These experimental facts suggest that the enhancement phenomenon occurred in close relationship to the newly produced hypervascularization of the capillaries around the hematoma, which was a phenomenon of the healing process of the lesion. Therefore, the pathomechanism of the enhancement was thought to be involved the pooling of the contrast media in the increased vascular bed as well as a loss of blood brain barrier in these newly produced immature capillaries. (J.P.N.)

  11. Muscle hematoma: A critically important complication of alcoholic liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Chiyo Sugiyama, Akifumi Akai, Noriyoshi Yamakita, Tsuneko Ikeda, Keigo Yasuda

    2009-09-01

    Full Text Available An iliopsoas hematoma can occur either spontaneously or secondary to trauma or bleeding tendency due to hemophilia and anticoagulant therapy. Although liver cirrhosis is commonly associated with coagulopathy, iliopsoas hematoma is very rare. We herein, present a case of bilateral iliopsoas hematoma in a patient with alcoholic cirrhosis, and review the literature on muscle hematoma associated with cirrhosis. A 56-year-old man with alcoholic cirrhosis was admitted in a state of shock with anemia. The cause of anemia could not be detected, and the patient was treated conservatively. The site of bleeding was not detected with either gastroduodenal endoscopy or upper abdominal computed tomography, the latter of which did not include the iliopsoas muscle. He died on the 10th day of admission and bilateral iliopsoas hematomas were found on autopsy. An iron stain was positive in the iliopsoas muscle. Eight cases of muscle hematoma associated with cirrhosis, including the present case, were found in a review of the literature. Four of these cases involved the rectus abdominis muscle, 3 involved the iliopsoas muscle and 1 involved combined muscles. Alcoholic cirrhosis accounted for 75% of the cases. One case (12.5% was associated with virus-related cirrhosis, and another with combined virus- and alcohol-related cirrhosis. The mortality rate was 75% despite early diagnosis and low risk scores for cirrhosis. Muscle hematoma in patients with cirrhosis is closely related to alcoholism, and the mortality rate of the condition is extremely high. In conclusion, muscle hematoma should be recognized as an important complication of cirrhosis.

  12. Unilateral proptosis and extradural hematoma in a child with scurvy

    Energy Technology Data Exchange (ETDEWEB)

    Verma, Sumit; Sivanandan, Sindhu; Seth, Rachna; Kabra, Shushil [All India Institute of Medical Sciences (AIIMS), Department of Pediatrics, New Delhi (India); Aneesh, Mangalasseril K.; Gupta, Vaibhav [All India Institute of Medical Sciences (AIIMS), Department of Radiodiagnosis, New Delhi (India)

    2007-09-15

    We report a 3-year-old boy with unilateral proptosis, painful swelling of the right thigh and aphasia. He had radiographic evidence of scurvy in the limbs and bilateral frontal extradural hematomas with a mass lesion in the left orbit on MRI. He was treated with vitamin C and on follow-up 8 weeks later had recovered with no evidence of the orbital mass on clinical or radiological study. Scurvy manifesting as proptosis and extradural hematoma is rare. (orig.)

  13. MRI evaluation of postoperative epidural hematoma after lumbar spine surgery

    International Nuclear Information System (INIS)

    Pain or numbness in the lower extremities often persists after lumbar spine surgery and it is not rare for such symptoms to occur anew. We performed a retrospective comparative study in 66 cases to determine whether there were differences in post-operative symptoms based on the presence of an epidural hematoma diagnosed by postoperative MRI. An epidural hematoma was identified in 30 of the cases, but not in the other 36 cases. The incidence of buttocks pain was 40.0% in the epidural hematoma group (EH group), as opposed to 16.7% among those without an epidural hematoma (non-EH group), and the difference between the two groups was significant (P=0.034). The incidence of pain in the lower extremities was 40.0% in the EH group, as opposed to 16.7% in the non-EH group, and the difference between the two groups was significant (P=0.034). However, there were no difference between the groups in low back pain, lower extremity numbness, presence of muscular weakness, or rate of improvement in Japanese Orthopedic Association (JOA) score. All of the postoperative hematomas resolved spontaneously. The result of the study showed that some epidural hematomas cause postoperative symptoms to persist and make the short-term outcome unsatisfactory even through the long-term results are ultimately satisfactory. (author)

  14. Subcapsular hepatic hematoma. Serious complication during pregnancy Hematoma subcapsular hepático. Grave complicación del embarazo

    OpenAIRE

    Viviana de la Caridad Sáez Cantero; María Teresa Pérez Hernández

    2010-01-01

    Subcapsular hepatic hematoma is a rare complication during pregnancy, but potentially lethal and usually related to severe pre-eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes and diminished platelets). Maternal and perinatal mortality in these cases is high, hence the importance of early diagnosis and timely and multidisciplinary treatment. This paper is a review on the subject, held in Ebsco, Hinari and Sci databases.El hematoma subcapsular hepático es una complicación rara de...

  15. CT finding of right retroperitoneal space : analysis of extension of right perirenal hematoma

    International Nuclear Information System (INIS)

    To understand the structure and character of the right retroperitoneal space by analysis of the extension of retroperitoneal hematoma in patients with traumatic right renal injuries. We retrospectively reviewed CT scans of 13 patients with right retroperitoneal hematomas caused by right renal injury. At te renal level, we analyzed the relation of a hematoma contacting psoas muscle with other retroperitoneal compartmental hematomas. At the suprarenal level, a perirenal hematoma and a hematoma contacting the diaphragm were analyzed according to their relation with intrahepatic IVC and pericaval hematoma. Below renal hilar level, all hematomas contacting psoas muscle, observed in eight cases, were connected with retrorenal extension of anterior pararenal hematoma. At the suprarenal level, intrahepatic pericaval hematomas were not, in all 13 cases, connected with a hematoma contacting the diaphragm, but with a perirenal hematoma. At the upper suprarenal level, the only pericaval hematomas containing a medial component of perirenal hematoma extended superiorly to the upper one third of the tenth thoracic vertebral body. The anterior renal fascia envelops perirenal space except in its medial aspect. In the upper suprarenal region, the anterior and posterior planes of the anterior renal fascia unite to fuse with diaphragmatic fascia, but along the medial aspect they fuse with intrahepatic pericaval connective tissue and posteromedial diaphragm, respectively

  16. [Spontaneous perirenal hematoma in a lupic patient on haemodialysis treatment and with renal cysts].

    Science.gov (United States)

    Loureiro, Juliana Lins; Mendonça, Katienne Goes; Pacheco, Georgia de Araújo; Soutinho, Maria Fernanda Lucena; Presídio, Gustavo Álvares; Ferreira, André Felipe dos Santos; da Silva, Agenor Antônio Barros; da Ressurreição, Fernando Melro Silva; Gouveia, Ebeveraldo Amorim; de Oliveira, Carlos Alexandre Ferreira; Medeiros, Marcio Fernando Costa; Bernardo, Rogério César Correia

    2013-01-01

    The spontaneous perirenal hemorrhage usually presents as sudden pain in the side ipsilateral, no history of trauma. Acquired cystic kidney disease is a common finding in chronic hemodialysis patients. However, spontaneous bleeding from the rupture of the cyst is a rare clinical entity. We describe the case of a female patient, 45 years old, with controlled hypertension for 8 years, chronic renal failure for 15 years and lupus nephritis 2 years ago, undergoing hemodialysis three times a week since 2006, and who presented concurrently acquired cystic kidney disease. She was admitted to the emergency department complaining of sudden onset of pain in the thoraco-abdominal left. Perirenal hematoma was diagnosed by ultrasound and computed tomography of the abdomen. The patient underwent embolization of left renal artery, with good evolution. PMID:23812574

  17. Unsuspected organic disease in chronic schizophrenia demonstrated by computed tomography

    International Nuclear Information System (INIS)

    Unsuspected intracranial pathology was demonstrated in 12 of 136 chronic schizophrenic patients examined by computed tomography (CT). Seven cases of cerebral infarction were found, and one each of porencephalic cyst, meningioma, cystic enlargement of the pineal body, and two of subdural haematoma. Attention is drawn to the value of CT in demonstrating organic disease in schizophrenia. (author)

  18. Analysis on the risk factors of bacterial meningitis complicated with subdural effusion

    Directory of Open Access Journals (Sweden)

    Zhi JIANG

    2015-08-01

    Full Text Available Objective To investigate the risk factors of bacterial meningitis complicated with subdural effusion. Methods The clinical data of children with bacterial meningitis in our hospital were collected and analyzed retrospectively. Logistic regression analysis was used to investigate the risk factors for subdural effusion. Results A total of 128 cases were divided into control group (N = 64 and subdural effusion group (N = 64. There was no significant difference on serum erythrocyte sedimentation rate (ESR, C-reactive protein (CRP, and white blood cell (WBC between 2 groups (P > 0.05, for all. Compared with control group, cerebrospinal fluid (CSF WBC (Z = 3.126, P = 0.003, CSF protein (Z = 4.928, P = 0.000 and serum procalcitonin (PCT;Z = 2.823, P = 0.007 in subdural effusion group were significantly higher, while CSF glucose (t = 2.166, P = 0.033 was significantly lower. After treatment, CSF WBC (Z = 2.467, P = 0.012 in subdural effusion group was still significantly higher than that of control group, and CSF glucose (t = 4.938, P = 0.000 was still significantly lower. Logistic regression analysis showed that WBC in CSF (P = 0.027, CSF protein (P = 0.002 and serum PCT (P = 0.014 were independent risk factors for bacterial meningitis complicated with subdural effusion. Conclusions CSF examination of children with bacterial meningitis reveals significant increase of CSF WBC, CSF protein and serum PCT, suggesting concurrent subdural effusion is easily occurred.DOI: 10.3969/j.issn.1672-6731.2015.08.012

  19. Effects of chronic ingestion of tritiated water on prenatal brain development

    International Nuclear Information System (INIS)

    In view of the anticipated increased use of atomic energy in industry, the possible long-term effects of chronic radiation exposure were studied in five generations of rats. Female rats (F0) were given tritiated drinking water (3HOH;3μCi/ml) from adolescence (60 days) until and throughout pregnancy. A separate study showed that the maximum radioactivity in the urine is reached in 30 days, and in the blood in 42 days. In the newborns, the highest specific activity was in the nucleic acid fraction, but total radioactivity was mainly due to the water (body fluids) compartment. No signs of radiation illness or increase in cataract formation in the mothers were observed. The food and water intake and body weight changes before pregnancy were normal. The course and the outcome of pregnancy were also normal. However, 60% of the newborns (F1) exhibited hematomas, edemas, and subdural hemorrhages, which disappeared at 30 days of age. Bollod analysis of the F1 offspring at various ages did not reveal significant differences from the controls, except for a significant decrease in alkaline phosphatase. Newborn body weight and cerebral weight were also normal. On the other hand, cerebral DNA, protein, and protein/DNA were significantly lower. 3HOH administration was then continued throughout weaning, adolescence, and next pregnancies, to give F3, F4, and F5 generations. The newborns in F3--F5 showed no more cerebral damage than those in F1, i.e., there was no cumulative effect of radiation; presumably the maximum radioactivity level was already attained in F1. As the generations progressed, the radiation damage to the developing brain became less pronounced; a possibility of inducible DNA repair has been discussed

  20. Effects of chronic ingestion of tritiated water on prenatal brain development. [Rats

    Energy Technology Data Exchange (ETDEWEB)

    Zamenhof, S.; van Marthens, E.

    1979-01-01

    In view of the anticipated increased use of atomic energy in industry, the possible long-term effects of chronic radiation exposure were studied in five generations of rats. Female rats (F/sub 0/) were given tritiated drinking water (/sup 3/HOH;3..mu..Ci/ml) from adolescence (60 days) until and throughout pregnancy. A separate study showed that the maximum radioactivity in the urine is reached in 30 days, and in the blood in 42 days. In the newborns, the highest specific activity was in the nucleic acid fraction, but total radioactivity was mainly due to the water (body fluids) compartment. No signs of radiation illness or increase in cataract formation in the mothers were observed. The food and water intake and body weight changes before pregnancy were normal. The course and the outcome of pregnancy were also normal. However, 60% of the newborns (F/sub 1/) exhibited hematomas, edemas, and subdural hemorrhages, which disappeared at 30 days of age. Bollod analysis of the F/sub 1/ offspring at various ages did not reveal significant differences from the controls, except for a significant decrease in alkaline phosphatase. Newborn body weight and cerebral weight were also normal. On the other hand, cerebral DNA, protein, and protein/DNA were significantly lower. /sup 3/HOH administration was then continued throughout weaning, adolescence, and next pregnancies, to give F/sub 3/, F/sub 4/, and F/sub 5/ generations. The newborns in F/sub 3/--F/sub 5/ showed no more cerebral damage than those in F/sub 1/, i.e., there was no cumulative effect of radiation; presumably the maximum radioactivity level was already attained in F/sub 1/. As the generations progressed, the radiation damage to the developing brain became less pronounced; a possibility of inducible DNA repair has been discussed.

  1. A clinical evaluation of the Camino subdural screw and ventricular monitoring kits.

    Science.gov (United States)

    Chambers, I R; Mendelow, A D; Sinar, E J; Modha, P

    1990-03-01

    The aim of this study was to compare readings of intracranial pressure from a ventricular catheter with those obtained from a Camino catheter-tipped transducer. The Camino transducer was evaluated in two ways: firstly, when it was inserted by a subdural screw, and secondly, when it was inserted into a ventricular catheter using a ventricular monitoring kit. Data were recorded for 376 hours for the subdural screw method and for 486 hours for the ventricular monitoring kit. Average pressure readings were calculated every 5 minutes (10 half-minute values), and regression analysis was performed. For the subdural screw method, the correlation coefficient was 0.945 (gradient, 1.04; intercept, -5.51. The results from the ventricular monitoring kit showed that the correlation coefficient was 0.901 (gradient, 0.93; intercept, -0.92. The correlation between recordings of ventricular fluid pressure and the Camino recordings obtained from both subdural screw insertions and ventricular monitoring kits was good, with the subdural screw method proving more accurate and reliable in clinical use. PMID:2320210

  2. The treatment of brain abscess and subdural empyema

    International Nuclear Information System (INIS)

    The treatment of brain abscess and subdural empyema in regard to the changes in operative procedure and the indication of conservative treatment after the introduction of CT was investigated by examining the records of 34 patients treated in the past 22 years. Fifteen cases were in the pre-CT era and 19 were after the introduction of CT. There was no significant difference in age, sex, and cause between the two groups. As for the treatment, all of the patients who were treated conservatively without CT died. But with CT monitoring, some patients could be treated by only chemotherapy and its clinical results were excellent. The mean diameter of the abscess cavity in patients treated by chemotherapy only was 2.6 cm. As for the operative cases without CT, total removal of the abscess was performed in almost all of the patients and their clinical course was poor. However by detecting the exact location of the abscess with CT, aspiration or drainage of the abscess was performed and the clinical course was improved. The mean diameter of the abscess cavity in the patients treated surgically was 4.8 cm. It was concluded that it is possible to treat patients with abscesses by only chemotherapy when the diameter of the abscess cavity is samller than 3 cm, and that when the lesions are larger than 3 cm, it is advisable to aspirate or drain the abscess cavity instead of totally removing the abscess. (author)

  3. Empiema subdural secundario a sinusitis: Descripcin de un caso peditrico / Subdural empyema secondary to sinusitis: A pediatric case report

    Scientific Electronic Library Online (English)

    A., Herrero; I., San Martn; L., Moreno; M., Herranz; J.C., Garca; E., Bernaola.

    2011-12-01

    Full Text Available Presentamos el caso de un varn de 9 aos derivado al servicio de Urgencias por proptosis ocular derecha y cefalea progresiva en el contexto de una sinusitis, diagnosticado dos das antes por clnica y radiologa compatible y en tratamiento con amoxicilina-clavulnico. A la exploracin fsica destac [...] a proptosis derecha con ligera limitacin para la mirada conjugada. Con la sospecha de una posible complicacin neurolgica de la sinusitis, se realiza tomografa axial computarizada (TAC) craneal, observando empiema subdural frontal derecho. Ingresa para tratamiento antibitico endovenoso con cefotaxima, vancomicina y metronidazol. Es valorado por los servicios de Neurociruga, Ciruga Maxilofacial y Otorrinolaringologa (ORL) infantil, decidindose nicamente drenaje del foco primario, con actitud neuroquirrgica expectante. El paciente evoluciona favorablemente con progresiva desaparicin de los sntomas. Se realizan resonancias magnticas peridicas, que muestran clara mejora hasta resolucin completa del empiema. Tras 4 semanas de antibioterapia iv., y tras la normalizacin clnica y radiolgica, el paciente es dado de alta. Abstract in english We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial explo [...] ration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged.

  4. Acute cervical epidural hematoma: case report Hematoma epidural cervical agudo: relato de caso

    Directory of Open Access Journals (Sweden)

    GUILHERME BORGES

    2000-09-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.Paciente de 74 anos acordou noite sentindo fortes dores na regio da nuca acompanhadas de ansiedade e desconforto torcico e respiratrio. A internao emergencial em clinica cardiolgica no demonstrou problemas cardacos. Com a progresso do quadro neurolgico traduzida por quadriplegia severa foi realizada uma puno lombar para afastar hiptese de meningite, sendo retirados cerca de 20 ml de liquor. Trinta minutos imediatamente aps a puno lombar foi observada completa remisso do dficit neurolgico. Transferido para um hospital geral a tomografia computadorizada demonstrou extenso hematoma epidural espinal em nivel C4/C5 com extenso a C7/Th1, bem como hemangioma do sexto corpo vertebral (C6. A ressonncia magntica demonstrou as mesmas leses. Observando-se os parmetros clnicos e neurolgicos, optou-se por tratamento conservador. Dezoito meses aps este episdio o paciente se apresenta normal, sem deficit residual. Neste artigo, relatamos um caso de completa recuperao de dficit neurolgico devido a hematoma epidural espinal, aps forma no usual de descompresso medular.

  5. [Aortic intramural hematoma fissuration: atypical presentation in an aircraft pilot].

    Science.gov (United States)

    Fozzato, Francesca; Prioli, Maria Antonia; Santini, Francesco; Menini, Fabio; Pavan, Michela; Guarise, Paola; Vassanelli, Corrado

    2010-02-01

    Aortic intramural hematoma is a life-threatening thoracic aortic pathology. In this report we describe a case of fissuration of an aortic intramural hematoma with atypical clinical presentation, which occurred in an aircraft pilot. The patient was admitted to our emergency room with transient chest pain developed during a flight landing, followed only by persistent abdominal pain. The ECG and cardiac enzymes were normal. A portable two-dimensional transthoracic echocardiogram showed aortic root dilation and pericardial effusion. Transesophageal echocardiography showed aortic intramural hematoma with fissuration into the pericardial space. The angio-computed tomography confirmed the diagnosis. Two hours after admission the patient, with signs of cardiac tamponade, underwent Bentall surgical intervention without complications. PMID:20408481

  6. Intra-bleb hematoma and hyphema following digital ocular compression

    Directory of Open Access Journals (Sweden)

    Sagar Bhargava

    2014-01-01

    Full Text Available We report successful outcome of a huge post- trabeculectomy intra-bleb hematoma and hyphema that occurred following digital ocular compression. The patient was a 64-year-old lady suffering from bilateral primary angle closure glaucoma and cataract. She was on anti-platelet therapy. She underwent single-site phacoemulsification, intra-ocular lens implantation and trabeculectomy with mitomycin C in the right eye. The trabeculectomy was under-filtering. She was asked to perform digital ocular compression thrice daily. On 15 th post-operative day, she presented with a huge intra-bleb hematoma and hyphema. The hematoma did not respond to conservative measures and was drained to prevent bleb failure. We recommend caution in the consideration of digital ocular compression in patients on prophylactic anti-coagulation.

  7. Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation.

    Science.gov (United States)

    Fagnoul, David; Herpain, Antoine; Vincent, Jean-Louis; De Backer, Daniel

    2013-01-01

    We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any complications in this patient, insertion of an intra-aortic balloon may have led to aortic rupture or embolic events. Transesophageal echocardiography should be performed, when available, prior to insertion of an intra-aortic balloon for counterpulsation in patients who have undergone cardiopulmonary resuscitation. PMID:24553517

  8. The Relationship Between Computed Tomography Density Values and Platelet Number and Function in Acute Intracerebral Hematomas

    OpenAIRE

    NL, Ebru; Ulu, Sena; zdin, ?erife; Baki, Elif Dogan; Kaar, Emre; Beker Acay, Mehtap; Karavelio?lu, Ergn; Y?lmaz, Emel; Uzel Tas, Hanife

    2015-01-01

    Objective: The linear relationship between density of hematomas on unenhanced computed tomography and hemoglobin levels were shown before. However, there are no studies about the effects of platelet count and functions on density values of hematomas. Our aim is to investigate the relationship between the density of hematomas measured on unenhanced Computed Tomography scans and platelet count and functions.Materials and Methods: Seventy seven patients diagnosed with intracranial hematoma by un...

  9. Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Chung, Seung Eun [Dept of Diagnostic Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of); Lee, Sang Ho [Dept. of Neurosurgery, Wooridul Spine Hospital, Seoul (Korea, Republic of); Kim, Tae Hong [Dept. of Neurosurgery, Sanggye Paik Hospital, Inje University College of Medicine, Seoul (Korea, Republic of); Choi, Gun [Dept. of Neurosurgery, Seoul Wooridul Hospital, Seoul (Korea, Republic of); Paeng, Sung Suk [Dept of Radiology, Wooridul Spine Hospital, Seoul (Korea, Republic of)

    2011-05-15

    A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

  10. Characteristic MRI and MR Myelography Findings for the Facet Cyst Hematoma at T12-L1 Spine: A Case Report

    International Nuclear Information System (INIS)

    A facet cyst is a very rare condition in the thoracolumbar spine and more so, hemorrhage into a cyst is extremely rare. We present a case of a facet cyst hematoma in the T12-L1 spine. A 69-year-old woman complained of chronic back pain with right lower extremity pain, and weakness for 3 years. MRI and MR myelography showed an extradural mass at the T12-L1 level with heterogeneous signal intensity on both T1-and T2-weighted images, which was continuous to the right T12-L1 facet joint. The neighboring facet joint showed severe degeneration on the CT scan. The mass a was simple hematoma covered with a thin fibrous membrane and connected with facet joint macroscopically and microscopically. The pathogenesis of the facet cyst hematoma is not clear but it can compress nerve roots or dura mater and cause radiculopathy or cauda equina syndrome. Surgical removal should be recommended for symptomatic relief.

  11. Jejunal Intramural Hematoma with Bowel Obstruction in a 5-year-old Boy: A Case Report

    International Nuclear Information System (INIS)

    Intramural hematoma of the jejunum is rare and can be classified as trauma-related or occurring spontaneously. Spontaneous intramural hematoma commonly occurs in patients treated with warfarin. We report a case of intramural hematoma of the jejunum with intestinal obstruction in a 5-year-old boy who had neither a definite history of trauma nor the tendency to bleed

  12. Retrobulbar Hematoma in Blow-Out Fracture after Open Reduction

    Directory of Open Access Journals (Sweden)

    Ji Seon Cheon

    2013-07-01

    Full Text Available Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process and method for prevention of retrobulbar hematoma using a scalp vein set tube and a negative pressure drainage system.

  13. Sickle cell disease with orbital infarction and epidural hematoma

    International Nuclear Information System (INIS)

    Although bone infarction is a common feature in sickle cell disease, the involvement of the orbit is an unusual complication. Intracranial bleeding is another uncommon and serious complication. Few cases of orbital infarction alone have been reported. We report imaging findings (CT, bone scan, MRI) in a 16-year-old boy with sickle cell disease with orbital infarction and epidural hematoma. The precise cause of epidural hematoma is not well known, but it is probably related to vaso-occlusive episodes and the tearing of small vessels. (orig.)

  14. Hematoma epidural secundario a anestesia espinal: Tratamiento conservador Epidural hematoma secondary to spinal anesthesia: Conservative treatment

    Directory of Open Access Journals (Sweden)

    M. Bermejo

    2004-11-01

    Full Text Available Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80% y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas, cirugía vertebral previa, hepatopatías, fármacos, etc. El tratamiento quirúrgico en forma de laminectomía descompresiva realizada de forma precoz suele ser necesario y es el tratamiento de elección en muchas ocasiones, pero en determinadas condiciones como la que nos ocupa, sin síntomas compresivos, sin un carácter progresivo o bien que estos disminuyan rápidamente, puede optarse por un tratamiento conservador en forma de analgesia y corticoterapia, siempre bajo un estricto control que permita actuar de forma rápida ante cualquier eventualidad negativa en su evolución.Introduction: Epidural hematoma secondary to neuroaxial anesthesia is a rare complication, but highly relevant due to its clinical and medico-legal implications. According to some authors, its incidence can reach 1/190,000-1/200,000 for peridural punctures and 1/320,000 for spinal punctures. Early diagnosis and treatment within the first 6-12 hours is the main aspect related to its therapeutic management. However, in some cases such as the one reported here, surgery is not required and the patient can be managed with a conservative treatment. Clinical case: A 73-year-old patient, ASA IV, with a history of cirrhosis associated to portal hypertension, hypersplenism, COPD, obesity, hypertensive cardiopathy and tricuspid failure. He was scheduled for prostate alcoholization after ruling out surgery. Preoperative blood analyses showed a prothrombin activity of 80% and 90,000 platelets. Several failed attempts of spinal puncture were done, but general anesthesia was finally required with spontaneous ventilation through laryngeal mudpack, propofol, fentanyl and sevoflurane. Clinical manifestations appeared after 36 hours, with non-irradiated severe lumbar pain and plantar cutaneous areflexia. The presence of epidural hematoma at the L1-L4 level was confirmed through NMR. Given the absence of flaccid paraparesis, sphincter involvement or other sensitive-motor signs and after consultation with the Rachis Unit and the Neurology Service, a conservative treatment and an expecting attitude were agreed based on analgesia and strict neurological monitoring, both clinical and radiological. The evolution of the patient was favorable in the next days. Discussion: Certain clinical conditions can affect the appearance of hematoma after performing a central regional blockade: low molecular weight heparins, difficult punctures, previous vertebral surgery, hepatopathies, drugs, etc. Early surgical treatment based on decompression laminectomy is usually required and it is the treatment agreed in many cases, but in some patients such as this one, with no compressive symptoms, no progression of symptoms or a rapid improvement of symptoms, a conservative treatment based on analgesia and corticotherapy can be decided, always with a strict control in order to allow a quick intervention if there is a negative event in the evolution of the patient.

  15. Hematoma de msculo iliopsoas na vigncia de tratamento com varfarina Hematoma de msculo iliopsoas en la vigencia de tratamiento con warfarina Iliopsoas muscle hematoma during treatment with warfarin

    OpenAIRE

    Gabriel Zago; Marcelo Campos Appel-da-Silva; Luiz Claudio Danzmann

    2010-01-01

    A varfarina droga amplamente utilizada na preveno de fenmenos tromboemblicos e o conhecimento de seus efeitos adversos faz-se necessrio para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguneas seja complicao potencial nesses pacientes, a ocorrncia de sangramento retroperitoneal rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do msculo iliopsoas durante tratamento com a referida droga, ps-implante de prtese artica metlica,...

  16. Multiple remote epidural hematomas following pineal gland tumor resection

    OpenAIRE

    Jeong-Wook Lim; Seung-Hwan Yang; Jong-Soo Lee; Shi-Hun Song

    2010-01-01

    In cases of pineal tumor combined with obstructive hydrocephalus, preoperative ventriculostomy or ventriculoperitoneal shunting is typically required prior to tumor resection. The objectives of preoperative ventriculostomy are gradual reduction of intracranial pressure and consequent preoperative brain protection. Here we report a case of pineal tumor resection with preoperative ventriculostomy that was complicated by multiple epidural hematomas. While postoperative intracranial hemorrhage ma...

  17. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sam Soo [Seoul City Boramae Hospital, Seoul (Korea, Republic of); Han, Moon Hee; Kim, Hyun Beom [College of Medicine, Seoul National University, Seoul (Korea, Republic of)] [and others

    2000-01-01

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  18. MR imaging and clinical findings of spontaneous spinal epidural hematoma

    International Nuclear Information System (INIS)

    To describe the MR imaging and clinical findings of spontaneous spinal epidural hematoma. The MR and clinical findings in six patients (M:F=3D4:2;adult:child=3D3:3) with spontaneous spinal epidural hematoma were reviewed. Five patients without any predisposing factor which might cause the condition and one with acute myelogenous leukemia were included. Emergency surgery was performed in two patients, and the other four were managed conservatively. The epidural lesion involved between three and seven vertebrae (mean:4.5), and relative to the spinal cord was located in the posterior-lateral (n=3D4), anterior (n=3D1), or right lateral (n=3D1) area. The hematoma was isointense (n=3D1) or hyperintense (n=3D5) with spinal cord on T1-weighted images, and hypointense (n=3D2) or hyperintense (n=3D4) on T2-weighted images. It was completely absorbed in four of five patients who underwent follow-up MR imaging, but not changed in one. The clinical outcome of these patients was complete recovery (n=3D4), spastic cerebral palsy (n=3D1), or unknown (n=3D1). Because of the lesion's characteristic signal intensity; MR imaging is very useful in the diagnosis and evaluation of spontaneous spinal epidural hematoma. (author)

  19. [Clinical case of the month. Spontaneous hematoma and acquired hemophilia].

    Science.gov (United States)

    Legrand, D A; Minon, J M; Hoffer, E

    2012-10-01

    Acquired haemophilia is a rare disease, 50% of the cases are idiopathic. We report a case admitted in cardiology for spontaneous hematoma. Observation of isolated prolonged activated partial thromboplastin time (aPPT) without anticoagulation treatment and the absence of correction with normal plasma suggested diagnosis. Confirmation of inhibitors to FVIII allowed perfusions of activated prothrombin complex concentrates. PMID:23167157

  20. Fatal spontaneous rectus sheath hematoma in a patient with cirrhosis

    Directory of Open Access Journals (Sweden)

    McCarthy Danielle

    2010-01-01

    Full Text Available Rectus sheath hematoma (RSH is an uncommon and often misdiagnosed condition. This well-described entity is typically self-limited. In rare cases, the condition may be fatal. We report a case of a patient with cirrhosis who died of progressive RSH and its subsequent complications.

  1. Magnetic resonance imaging of hematomas in a 0.02 T magnetic field

    International Nuclear Information System (INIS)

    One intramuscular calf hematoma, 2 ankle hematomas and 4 cephalhematomas were imaged at various ages in a low magnetic field (0.02 T). At least one spin echo (SE) multislice image and a series of inversion recovery images (IR) were made varying the inversion time for estimation of the relaxation time T1. T1 tended to shorten and T2 to stay unchanged. With an unsuitable pulse sequence the hematomas were not visible. They were best seen with short TIs. The images of one of the ankle hematomas and the calf hematoma were compared with sonographic findings. The appearances of the hematomas varied during aging with both imaging modalities. The hematomas were easier to detect with magnetic resonance imaging than with ultrasound, also when aging. (orig.)

  2. Bilingual aphasia due to spontaneous acute subdural haematoma from a ruptured intracranial infectious aneurysm.

    Science.gov (United States)

    Vajramani, Girish V; Akrawi, Hawar; McCarthy, Rosaleen A; Gray, William P

    2008-09-01

    We report a case of spontaneous subdural haematoma due to ruptured intracranial infectious aneurysm, presenting with bilingual aphasia and illustrating differential language recovery. A 62-year-old right-handed bilingual gentleman, with a diagnosis of infective endocarditis, developed headache and became expressively aphasic in the English language. Three days later he was receptively and expressively aphasic in both English and Arabic. Cranial MRI scans showed a left-sided acute subdural haematoma with mass effect and midline shift. Contrast CT brain scans showed an enhancing speck adjacent to the clot and cerebral angiogram confirmed a distal middle cerebral artery aneurysm. He underwent image-guided craniotomy, evacuation of the subdural haematoma and excision of the aneurysm. Histopathological examination was consistent with an infectious intracranial aneurysm. Postoperatively his aphasia did not improve immediately. He had widened pulse pressure due to severe aortic regurgitation, confirmed on echocardiography. He underwent aortic valve replacement and mitral valve repair, following which his aphasia recovered gradually. Initially the recovery of his language was limited to Arabic. About a week later he recovered his English language as well. At 3-year follow-up he is doing well and has no neurological deficits. His aphasia has recovered completely. The present case is unique because of (a) presence of pure subdural haematoma, and (b) the differential susceptibility and recovery of native (L1) and acquired language (L2) in presence of a common pathology. The neurology of language in a bilingual is analysed and possible mechanisms discussed. PMID:18599195

  3. Gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture

    International Nuclear Information System (INIS)

    We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment. (orig.)

  4. Hematoma aps anestesia peridural: tratamento conservador. Relato de caso Hematoma posterior a la anestesia peridural: tratamiento conservador. Relato de caso Hematoma after epidural anesthesia: conservative treatment. Case report

    Directory of Open Access Journals (Sweden)

    Edno Magalhes

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma associado compresso espinhal aps anestesia peridural uma complicao neurolgica grave, apesar da pequena incidncia relatada (1:150.000. um episdio agudo, e o tratamento tradicionalmente aplicado a descompresso cirrgica de urgncia. Mais recentemente, em casos especficos, o tratamento com corticosteride tem sido aplicado como alternativa, com boa recuperao neurolgica. O objetivo deste relato foi expor um caso de hematoma peridural com tratamento conservador e recuperao neurolgica completa. RELATO DO CASO: Paciente do sexo feminino, 34 anos, estado fsico ASA I, sem qualquer histrico de coagulopatia ou terapia anticoagulante, submetida anestesia peridural com puno nica, em L2-L3, para tratamento cirrgico de varizes nos membros inferiores. Oito horas aps a anestesia regional, ela ainda apresentava bloqueio motor completo (escala de Bromage, reduo das sensibilidades trmica e dolorosa abaixo do nvel L3, hiperalgesia na regio plantar esquerda, preservao dos reflexos tendinosos e ausncia de dor lombar. A tomografia computadorizada revelou hematoma peridural em L2 com compresso do saco dural. Dez horas aps a puno peridural no havia progresso dos sinais e sintomas neurolgicos. Optou-se, ento, pelo tratamento com metilprednisolona em infuso venosa contnua (5,3 mg.kg-1 na primeira hora e 1,4 mg.kg-1.h-1 nas 23 horas subseqentes. Oito horas aps o incio do tratamento, a paciente recuperou as sensibilidades trmica e dolorosa, e houve regresso total do bloqueio motor. Na 12 hora, deambulava e referia dor na ferida operatria. O hematoma peridural no foi visualizado em nova tomografia computadorizada na 14 hora aps o incio do tratamento. A paciente recebeu alta hospitalar 86 horas depois do incio do tratamento conservador, sem comprometimento neurolgico. Uma tomografia computadorizada de controle, aps sete meses, mostrou o canal vertebral completamente normal. CONCLUSES: A eficincia da abordagem conservadora mostrou-se uma alternativa importante interveno cirrgica em casos especficos. A avaliao da progresso ou a estabilizao do comprometimento neurolgico, sobretudo aps a oitava hora aps a puno peridural, essencial para a escolha do tratamento.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresin espinal despus de la anestesia peridural es una complicacin neurolgica grave, a pesar de la pequea incidencia relatada (1:150.000. Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresin quirrgica de urgencia. Recientemente, en casos especficos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperacin neurolgica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperacin neurolgica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 aos, estado fsico ASA I, sin ningn historial de coagulopata o terapia anticoagulante, sometida a la anestesia peridural con puncin nica, en L2-L3, para tratamiento quirrgico de vrices en los miembros inferiores. Ocho horas despus de la anestesia regional, todava presentaba bloqueo motor completo (escala de Bromage, reduccin de las sensibilidades trmica y dolorosa por debajo del nivel L3, hiperalgesia en la regin plantar izquierda, preservacin de los reflejos tendinosos y ausencia de dolor lumbar. La tomografa computadorizada revel hematoma peridural en L2 con compresin del saco dural. Diez horas despus de la puncin peridural no haba progresin de las seales y sntomas neurolgicos. Se opt entonces por el tratamiento con metilprednisolona en infusin venosa continua (5,3 mg.kg-1 en la primera hora y 1,4 mg.kg-1.h-1 en las 23 horas siguientes. Ocho horas despus del inicio del tratamiento, la paciente recuper las sensibilidades trmica y dolorosa y la regresin total del bloqueo motor. En la 12 h

  5. CT of blunt renal injury; correlation of renal injury and retroperitoneal hematoma

    International Nuclear Information System (INIS)

    The this study was performed to evaluate whether the extent and location of retroperitoneal hematoma correlate with the severity of renal injury. We evaluated the CT findings of 27 patients with renal trauma. The retroperitoneal hematoma were subdivided into perirenal hematoma(PRH), anterior pararenal hematoma(APH), posterior parareneal hematoma(PPH) and interfascial hematoma(IFH). The perirenal hematoma(PRH) was classified as grade I, II and III according to the amount of hematoma. PRH was present in all 27, PPH in 8, IFH in 3 patients and APH was not observed. Grade I PRH was present in 7 (70%) of 10 minor injury (contusion, intrarenal hematoma), grade III PRH in2(20%) of 10 minor injury and in 7 (41.2%) of 17 major and catastrophic injury (laceration, fracture, shattered kidney and renal pedicle injury). Eight PPH were present only in the major and catastrophic injury and 3 IFH in each of intrarenal hematoma, laceraton and pedicle injury. The location and extent of PRH and PPH correlated somewhat with the severity of renal injury, while the presence of IFH and APH did not correlate with severity of the renal injury

  6. The importance of serial CT scanning in the diagnosis and treatment of delayed traumatic intracerebral hematoma

    International Nuclear Information System (INIS)

    Between January, 1980, and December, 1982, 99 cases of traumatic intracranial hemorrhage were admitted to our hospital. Of these cases, we analyzed 25 cases which had been submitted to initial CT scanning within 4 hours after head trauma. We found 17 cases which had no hematoma on the initial CT scan but which were found to have formed intracerebral hematoma on a repeated CT scan. We found that we could classify the delayed traumatic intracerebral hematoma into two types: Type I hematoma, which had a relatively bad outcome, and Type II hematoma which had a relatively good outcome. The neurological sign comes to deteriorate in accordance with the hematoma formation in Type I, while the neurological sign remains unchanged or takes an uphill course in accordance with hematoma formation in Type II. We recognized some differences between the two types both in the time from trauma to hematoma formation and in the serial CT findings. However, we could not differentiate the two types of hematoma on the basis only of the initial CT findings, probably because of a dynamic change in the damaged brain tissue. There seems to be no means to predict the course of delayed traumatic intracerebral hematoma; therefore, we stress the importance of strict observation both of the clinical course and of the serial CT findings in order to diagnose and to choose an appropriate course of therapy, medical or surgical. (author)

  7. Atenolol prevents the formation of expansive hematoma after rhytidoplasty / O atenolol previne a formao de hematoma expansivo aps ritidoplastia

    Scientific Electronic Library Online (English)

    Amanda Castilho, Moreira; Marcio, Moreira; Sanderland Jos Tavares, Gurgel; Yasmin Castilho, Moreira; Eguimar Roberto, Martins; Raphael Chalbaud Biscaia, Hartmann; Djalma Jos, Fagundes.

    2014-10-01

    Full Text Available Objetivo: avaliar o uso perioperatrio do atenolol na reduo da incidncia de hematoma ps-ritidoplastia. Mtodos: entre janeiro de 2007 e fevereiro de 2013 foram randomizados 80 pacientes em dois grupos: Grupo A (n=26) recebeu atenolol perioperatrio com objetivo de manter frequncia de puls [...] o (FP) 60 por minuto, Grupo B (n=54) no recebeu atenolol. Ambos os grupos foram submetidos mesma tcnica anestsico-cirrgica. A presso arterial (PA) e FP, formao de hematoma e a necessidade de drenagem foram monitorizados. Houve seguimento at o 90 dia de ps-operatrio. As variveis foram analisadas entre os dois grupos utilizando-se o teste de ANOVA. As variveis contnuas foram apresentadas como mdia ( Desvio-padro) e as diferenas foram comparadas utilizando-se o t de Student. Foram considerados significantes os valores p Abstract in english Objective: To evaluate the perioperative use of atenolol in reducing the incidence of hematoma after rhytidoplasty. Methods: Between January 2007 and February 2013, 80 patients were randomized into two groups: Group A (n = 26) received perioperative atenolol in order to maintain heart rate (PR [...] ) around 60 per minute; Group B (n = 54) did not receive atenolol. Both groups underwent the same anesthetic and surgical technique. We monitored blood pressure (BP), HR, hematoma formation and the need for drainage. Patients were followed-up until the 90th postoperative day. The variables were compared between the groups using the ANOVA test. Continuous variables were presented as mean standard deviation and the differences were compared with the Student's t test. Values of p d" 0.05 were considered significant. Results: In group A the mean BP (110-70mmHg 7.07) and HR (64 / min 5) were lower (p d" 0.05) than in group B (135-90mmHg 10.6) and (76 / min 7.5), respectively. There were four cases of expansive hematoma in group B, all requiring reoperation for drainage, and none in group A (p d" 0,001). Conclusion: The perioperative use of atenolol caused a decrease in blood pressure and heart rate and decreased the incidence of expanding hematoma after rhytidectomy.

  8. Trombo aortico intraluminal e hematoma intramural apos manobra de ressuscitacao cardiopulmonar / Aortic luminal thrombus and intramural hematoma after cardiopulmonary resuscitation

    Scientific Electronic Library Online (English)

    David, Fagnoul; Antoine, Herpain; Jean-Louis, Vincent; Daniel, De Backer.

    2013-12-01

    Full Text Available Descrevemos o caso de um paciente com hematoma intramural e trombo flutuante aps ressuscitao cardiopulmonar. Esse homem, de 92 anos de idade, teve uma parada cardaca causada por fibrilao atrial e testemunhas iniciaram imediatamente manobras manuais de ressuscitao cardiopulmonar. Ao ser admit [...] ido no hospital, o paciente apresentava-se em choque cardiognico, sendo, ento, imediatamente submetido a ecocardiografia transesofgica. Alm de uma parede anterior acintica, o exame da aorta torcica descendente mostrou um hematoma intramural e um trombo intra-artico flutuante a uma distncia de 40cm do arco dental. No havia disseco da aorta. O trombo foi atribudo compresso artica durante a ressuscitao cardiopulmonar. Embora o trombo artico e o hematoma intramural no tenham se associado a qualquer complicao nesse paciente, a insero de um balo intra-artico poderia ter levado a uma ruptura da aorta ou a eventos emblicos. Recomenda-se a realizao de ecocardiografia transesofgica, quando disponvel, antes da insero de um balo intra-artico de contrapulsao em pacientes submetidos ressuscitao cardiopulmonar. Abstract in english We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography [...] was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any complications in this patient, insertion of an intra-aortic balloon may have led to aortic rupture or embolic events. Transesophageal echocardiography should be performed, when available, prior to insertion of an intra-aortic balloon for counterpulsation in patients who have undergone cardiopulmonary resuscitation.

  9. Spontaneous cervical epidural hematoma: Report of a case managed conservatively

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

    Full Text Available Spontaneous spinal epidural hematoma is a rare cause of acute spinal cord compression. A 25-year-old male presented with a history of sudden onset of complete quadriplegia with sensory loss below the neck along with loss of bowel and bladder control. He had no history of any constitutional symptoms. He reported 10 days later. He was managed conservatively and after two weeks of intensive rehabilitation he had complete neural recovery. The spontaneous recovery of neurological impairment is attributed to the spreading of the hematoma throughout the epidural space, thus decreasing the pressure with partial neural recovery. Conservative treatment is a fair option in young patients who present late and show neurological improvement. The neurological status on presentation will guide the further approach to management.

  10. A rare cause of duodenal obstruction: Intramural hematoma

    Directory of Open Access Journals (Sweden)

    Gokcen Coban

    2014-06-01

    Full Text Available Small bowel obstruction due to intramural hematoma secondary to anticoagulant therapy is a rare complication. Other risk factors include hemophilia, idiopathic thrombocytopenic purpura, leukemia, lymphoma, myeloma, chemotherapy, vasculitis, pancreatitis, and pancreatic cancer. The presentation of patients is usually with abdominal pain, nause and vomiting. The patients who were admitted to the emergency clinic with acute abdominal pain and had a history of anticoagulant use with prolonged international normalized ratios should alert to search for intraabdominal hematoma. Herein, we present a patient who was admitted to the emergency clinic with acute abdominal pain, severe nausea and vomiting, and diagnosed by abdominal computed tomography. [Cukurova Med J 2014; 39(3.000: 650-653

  11. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    Energy Technology Data Exchange (ETDEWEB)

    Fernando, Sujan [University of Missouri-Kansas School of Medicine, Department of Medicine, Kansas City, MO (United States); Obaldo, Ruby E. [The University of Kansas Medical Center, Department of Radiology, Kansas City, MO (United States); Walsh, Irene R. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Emergency Medicine, Kansas City, MO (United States); Lowe, Lisa H. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

    2008-08-15

    Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

  12. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    International Nuclear Information System (INIS)

    Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

  13. Dengue Fever With Rectus Sheath Hematoma: A Case Report

    OpenAIRE

    Sharma, Anurag; Bhatia, Sonia; Singh, Rajendra Pratap; Malik, Gaurav

    2014-01-01

    Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH) is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an unc...

  14. Hematoma of Rectus Sheath Following Subcutaneous Enoxaparin Injection

    Directory of Open Access Journals (Sweden)

    Shahram Firoozbakhsh

    2013-05-01

    Full Text Available Anticoagulation drugs are frequently used to prevent deep vein thrombosis in high-risk patients. Subcutaneous low molecular weight heparin (LMWH is increasingly used in both hospitalized patients and outpatient settings. This necessitates familiarity of both health care providers and patients with such treatment and vigilance on possible complications. Here we present a case of hematoma of rectus sheath that occurred following subcutaneous injection of enoxaparin and was successfully treated with conservative management

  15. Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach

    OpenAIRE

    Mantelas, Michael; Katsiki, Niki; Antonitsis, Polychronis; Kyurdzhieva, Ellada; Mikhailidis, Dimitri P.; Hatzitolios, Apostolos

    2011-01-01

    Rectus sheath hematoma (RSH) is an uncommon clinical event usually associated with trauma or coagulation disorders. It can also occur spontaneously. RSH usually runs a benign course but it can present with hypovolemic shock. When conservative management fails, surgical exploration becomes mandatory. We propose a technique of emergency ligation of the inferior epigastric artery. This is a simple approach as this artery originates at the posterior rectus sheath above the inguinal ligament. This...

  16. Spontaneous Pulmonary Hematoma with No Underlying Causes: A Case Report

    OpenAIRE

    Lee, Eun Joo; Park, Sang Hoon; Park, Ho Hyun; Park, Seung Heon; Lee, Jung Yeon; Lee, Woo Surng; Yoon, Sun-Young

    2015-01-01

    A 57-year-old male patient was admitted to our center because of a cystic mass on the lower portion of the right major fissure that was found incidentally by chest X-ray. He did not have a history of trauma or anticoagulant use. The lesion was removed by video-assisted thoracoscopic surgery. Pathological examination revealed an organizing pulmonary hematoma without any complications, and a follow-up chest X-ray after 1 year showed no recurrence.

  17. Spontaneous Pulmonary Hematoma with No Underlying Causes: A Case Report.

    Science.gov (United States)

    Lee, Eun Joo; Park, Sang Hoon; Park, Ho Hyun; Park, Seung Heon; Lee, Jung Yeon; Lee, Woo Surng; Yoon, Sun-Young

    2015-10-01

    A 57-year-old male patient was admitted to our center because of a cystic mass on the lower portion of the right major fissure that was found incidentally by chest X-ray. He did not have a history of trauma or anticoagulant use. The lesion was removed by video-assisted thoracoscopic surgery. Pathological examination revealed an organizing pulmonary hematoma without any complications, and a follow-up chest X-ray after 1 year showed no recurrence. PMID:26508925

  18. Intramuscular Hematomas Caused by Anticoagulant Therapy: Is Advanced

    Directory of Open Access Journals (Sweden)

    Nilgn INAR

    2010-09-01

    Full Text Available Oral anticoagulant therapy (OAT is very effective in the prevention of cerebralembolism, especially in certain cardiac diseases. Hematomas are the majorcomplication of OAT. It may threaten the patients life by bleeding into the vitalstructures. Herein, we describe four patients with hematomas in the psoas,quadriceps, pectoral, or rectus abdominis muscles accompanied by anemiaduring warfarin therapy for atrial fibrillation and artificial heart valves. Computedtomography and magnetic resonance imaging helped us establish a definitivediagnosis in each case. Our patients were three women and one man. Theirinternational normalized ratios were within the therapeutic range during thisperiod. They suffered from minor traumas, such as falls or a hit while takingwarfarin therapy. All anticoagulation treatments were discontinued for approximately1 week after the episode of bleeding. Although conservative managementwas sufficient for three patients, one patient had surgical decompression due toa rectus abdominis hematoma with retroperitoneal hemorrhage. There were noepisodes of bleeding or other complications after starting oral anticoagulanttherapy during the follow-up. The common aspects of our cases were older ageand a history of minor trauma. As a result, we suggest that special attentionneeds to be paid to the patients under anticoagulant therapy, especially those atan advanced age, and to warn them avoid trauma. (Archives of Neuropsychiatry2010; 47: 267-70

  19. Subcapsular hepatic hematoma. Serious complication during pregnancy Hematoma subcapsular hepático. Grave complicación del embarazo

    Directory of Open Access Journals (Sweden)

    Viviana de la Caridad Sáez Cantero

    2010-12-01

    Full Text Available Subcapsular hepatic hematoma is a rare complication during pregnancy, but potentially lethal and usually related to severe pre-eclampsia or HELLP syndrome (hemolysis, elevated liver enzymes and diminished platelets. Maternal and perinatal mortality in these cases is high, hence the importance of early diagnosis and timely and multidisciplinary treatment. This paper is a review on the subject, held in Ebsco, Hinari and Sci databases.El hematoma subcapsular hepático es una complicación rara del embarazo, pero potencialmente letal, generalmente relacionada con pre-eclampsia grave o síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetas disminuidas. La mortalidad materna y perinatal en estos casos es elevada, de ahí la importancia del reconocimiento precoz y tratamiento oportuno y multidisciplinario. El presente trabajo constituye una revisión sobre el tema, realizada en las bases de dato Ebsco, Hinari y Scielo.

  20. Difficult Airway due to Retropharyngeal Hematoma after Stabbing to the Neck

    Directory of Open Access Journals (Sweden)

    Kouhei Iwashita

    2014-07-01

    Full Text Available Reports of retropharyngeal hematoma have been scarce in the anesthesiology literature. We report a patient whose trachea was difficult to intubate due to retropharyngeal hematoma after stabbing to the neck. A woman with a knife injury to the common carotid artery required emergency carotid arterioplasty. When tracheal intubation was attempted, marked swelling of the posterior pharyngeal wall made the vocal cords impossible to visualize. Preoperative computed tomography showed a retropharyngeal hematoma. The patient required mechanical ventilation for 2 days.

  1. Renal Cell Carcinoma Metastasis from Biopsy Associated Hematoma Disruption during Robotic Partial Nephrectomy

    OpenAIRE

    Christopher Caputo; Ziho Lee; Andrew Harbin; Daniel Eun

    2014-01-01

    We describe a case in which a patient with a past medical history of ovarian cancer received a diagnostic renal biopsy for an incidentally discovered renal mass. During left robotic partial nephrectomy (RPN), a perinephric hematoma was encountered. The hematoma was not present on preoperative imaging and was likely a result of the renal biopsy. The renal cell carcinoma (RCC) and the associated hematoma were widely excised with negative surgical margins. On follow-up imaging at five months pos...

  2. Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma

    OpenAIRE

    Ciceri David P; Artz Katie S; Puana Rudolph B; Ponzo John A; Lazott Laurie W; Culp William C

    2007-01-01

    Abstract Background We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise. Case presentation A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical v...

  3. Pontine tegmentum hematoma: report of a case with pure hemiplegia / Hematoma do tegmento pontino: relato de caso com hemiplegia pura

    Scientific Electronic Library Online (English)

    ANTONIO CARLOS DE PDUA, MILAGRES; FLVIO, ALE; JOO CARLOS PAPATERRA, LIMONGI.

    1998-03-01

    Full Text Available Os autores relatam o caso um paciente de sexo masculino de 50 anos de idade com hipertenso arterial sistmica que apresentava um hematoma pontino. A nica manifestao clnica era caracterizada por sndrome piramidal pura sem outros sinais ou sintomas neurolgicos. A ausncia de acometimento de out [...] ras estruturas do tronco cerebral neste caso decorre possivelmente de variao da anatomia vascular do segmento pontino do tronco cerebral e constitui evento pouco comum em hematomas dessa regio. Abstract in english The authors report the case of a 50 year-old hypertensive male patient with a pontine hematoma. The clinical presentation was characterized by pure pyramidal deficit signs (no other signs or symptoms were present). A pure hemiplegia syndrome, although common in supratentorial lesions, is considered [...] to be a rare event in pontine vascular lesions. The pathophysiologic mechanisms of these neurological findings are unclear. The exclusive involvement of the pyramidal tract in this case is likely due to a variation in the vascular anatomy of the pons but, in some cases, a vascular malformation may be the cause.

  4. Hypertensive thalamic hematoma treated by CT stereotactic evacuation (with two cases reports)

    International Nuclear Information System (INIS)

    Objective: To investigate new surgical method to treat hypertensive thalamic hematoma. Methods: Two medial-degree coma patients with hypertensive thalamic hematoma were treated by CT stereotactic evacuation. Results: One week after operation the two patients regained consciousness. The function of paraplegic appendage restored partly, and one patient could take care of himself. Conclusion: CT stereotactic evacuation to treat hypertensive thalamic hematoma has the advantages of small trauma, little complication and good clinical results. The authors suggest that it be selected firstly in treating hypertensive thalamic hematoma

  5. Escherichia coli positive infratentorial subdural empyema secondary to mastoiditis and underlying cholesteatoma.

    Science.gov (United States)

    Mirza, Omar; Varadarajan, Vinay; Youshani, Amir Saam; Willatt, David J

    2014-01-01

    Infratentorial subdural empyema is a neurosurgical emergency that is associated with an alarmingly high morbidity and mortality if appropriate management is delayed. It is an important differential to consider when confronted with a patient with a reduced Glasgow Coma Scale, focal neurology and symptoms of raised intracranial pressure in the presence of a head and neck infection. It is also important that the primary team managing these patients is aware of the many pathogens that may be involved, including Escherichia coli. Early recognition, prompt diagnosis, timely involvement of the appropriate multidisciplinary teams, including neurosurgery, otorhinolaryngology, radiology and microbiology should be sought, and urgent intervention are imperative in avoiding a fatal outcome. This article presents a case of E coli-positive infratentorial subdural empyema secondary to mastoiditis due to underlying cholesteatoma, and a review of the pertinent literature. PMID:24777089

  6. Anatomy and development of the meninges: implications for subdural collections and CSF circulation

    Energy Technology Data Exchange (ETDEWEB)

    Mack, Julie [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Squier, Waney [John Radcliffe Hospital, Department of Neuropathology, Oxford (United Kingdom); Eastman, James T. [Lancaster General Hospital, Department of Pathology and Laboratory Medicine, Lancaster, PA (United States)

    2009-03-15

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system. (orig.)

  7. Anatomy and development of the meninges: implications for subdural collections and CSF circulation

    International Nuclear Information System (INIS)

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system. (orig.)

  8. Computed tomography in epidural abscess, subdural empyema, meningitis, and brain abscess

    International Nuclear Information System (INIS)

    Computerised tomography cannot be of great help in diagnosing meningitis. Examination of the cerebrospinal fluid remains essential. After the inflammation of the meninges has progressed to some stage of encephalitis, the formation of an abscess can be located via computed tomography. It is characterised by the ring-type abscess capsule. Computed tomography for diagnostic purposes is superior to cerebral scanning, which demonstrates enhanced activity, but does not show the formation of a membrane, so essential for differential diagnosis. Furthermore, computed tomography shows the adjacent anatomical structures and answers the questions of displacements and threatening invasion of the ventricle system. Epidural and subdural abscesses can also be located by computed tomography. Therapy can begin directly after computerised tomography, whereas in scintigraphy only a non-specific enhanced activity is present, which often does not allow differentiation between epidural and subdural location. (orig.)

  9. Subdural haematoma in Plasmodium falciparum and Plasmodium vivax mixed infection presenting multiple clinical complications

    OpenAIRE

    Devaraju, Punith B.; Padukone, Shashiraja; Shivakumar R Veerabhadraiah; Ramachandrappa, Vijayakumar S.; Panji, Narayan; Chandrappagowda, Pruthvi B.; Rudrappa, Maheshmurthy B.; Gowda, D Channe; Achur, Rajeshwara N.

    2013-01-01

    A 40-year-old man was admitted to hospital with a 5 day history of fever, restlessness and altered sensorium. Peripheral blood smears showed a Plasmodium vivax and Plasmodium falciparum mixed infection as revealed by the presence of rings, schizonts and gametocyte forms of the parasites. The patient soon became unconscious due to subdural haematoma (SDH) associated with disseminated intravascular coagulation and thrombocytopenia. Immediate intervention with a right fronto-parieto temporal cra...

  10. Age related outcome in acute subdural haematoma following traumatic head injury.

    LENUS (Irish Health Repository)

    Hanif, S

    2009-09-01

    Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH\\'s) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland\\'s national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.

  11. A rare clinical case of subdural hemorrhage in a patient with scrub typhus

    OpenAIRE

    Aradhna Sharma; Tarun Sharma(Department of Theoretical Physics, Tata Institute of Fundamental Research, Homi Bhabha Road, Colaba-400005, India); Anuradha Sood

    2016-01-01

    Scrub typhus is a common infectious disease with a self-limiting course but may potentially cause a fatal outcome in some cases. We here present a case report of a patient diagnosed with scrub typhus and was given effective antibiotic therapy. Initially, the patient improved significantly but had sudden clinical deterioration on day five and presented with subdural hemorrhage. Orientia tsutsugamushi the causative agent of scrub typhus may be considered as a causal or provoking factor for cere...

  12. Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

    International Nuclear Information System (INIS)

    A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H2O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan. (author)

  13. Hematoma intraneural experimental em ratos: avaliao da recuperao funcional e histomorfometria neural Experimental intraneural hematoma model in rats: evaluation of functional recovery and neural histomorphometry

    Directory of Open Access Journals (Sweden)

    Gean Paulo Scopel

    2007-01-01

    Full Text Available A formao do hematoma intraneural com comprometimento de nervos perifricos pode ocorrer aps trauma ou coagulopatias. O tratamento expectante ou abordagem cirrgica descompressiva ainda no esto definidos. Foram estudados 40 ratos da raa Wistar divididos em 4 grupos. No grupo A realizou-se injeo intraneural de 0,2 ml de sangue autgeno no nervo citico direito. No grupo B, aps produo do hematoma, fez-se descompresso imediata com epineurotomia longitudinal. No grupo D realizamos liberao imediata do hematoma com neurlise interfascicular. No grupo C (CONTROLE apenas realizou-se a exposio do nervo citico sem formao de hematoma. A avaliao da funo nervosa foi feita com o ndice de Funo Citica de Bain-Mackinnon-Hunter (IFC. O grupo A apresentou IFC inicial de -28,43, com recuperao funcional no 5 dia. A drenagem imediata desse hematoma atravs de uma epineurotomia longitudinal (B determinou retorno da funo citica normal desde o 1 dia (IFC= -14,42. Tratando o hematoma atravs da neurlise interfascicular observamos um IFC inicial de -23,69 e retorno da funo citica normal no 3 dia. Os parmetros histomorfomtricos apontaram melhora dos parmetros de isquemia aps os 2 tipos de interveno cirrgica aplicadas neste estudo. No houve diferena entre os tipos de intervenes aplicadas.Emergence of intraneural hematoma with involvement of peripheral nerves can occur after trauma or coagulation disorders. The decision for expectant management or decompressive surgical techniques is still controversial. Forty male Wistar rats were divided into 4 groups. In group A, an intraneural injection of autologous blood was provided at the right sciatic nerve. In group B, after the hematoma creation, a longitudinal epineurotomy was performed. In the group C (sham-operated, the sciatic nerve was exposed without hematoma. In group D. immediately after the hematoma creation, an interfascicular neurolysis was performed. Nerve function recovery was assessed using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI. At the end of the study, the animals were sacrificed and a specimen of the sciatic nerve at compression midpoint was removed for morphometric analysis. Group A displayed an initial SFI of -28.43, with full functional recovery on the fifth day. Immediate drainage of the hematoma by longitudinal epineurotomy (group B promoted recovery of normal sciatic function on the first day (SFI -14.42. Addressing the hematoma via interfascicular neurolysis resulted in an initial SFI of -23.69 and recovery of normal sciatic function on the third day. The morphometric variables indicated an improvement of ischemic parameters following both types of surgical intervention.

  14. Optoacoustic detection and monitoring of blast-induced intracranial hematomas in rats

    Science.gov (United States)

    Petrov, Andrey; Wynne, Karon E.; Prough, Donald S.; Dewitt, Douglas S.; Petrov, Yuriy; Petrov, Irene Y.; Parsley, Margaret A.; Esenaliev, Rinat O.

    2014-03-01

    Patients with acute intracranial hematomas often require surgical drainage within the first four hours after traumatic brain injury (TBI) to avoid death or severe neurologic disability. CT and MRI permit rapid, noninvasive diagnosis of hematomas, but can be used only at a major health-care facility. At present, there is no device for noninvasive detection and characterization of hematomas in pre-hospital settings. We proposed to use an optoacoustic technique for rapid, noninvasive diagnosis and monitoring of hematomas, including intracranial hematomas. Unlike bulky CT and MR equipment, an optoacoustic system can be small and easily transported in an emergency vehicle. In this study we used a specially-designed blast device to inflict TBI in rats. A near-infrared OPO-based optoacoustic system developed for hematoma diagnosis and for blood oxygenation monitoring in the superior sagittal sinus (SSS) in small animals was used in the study. Optoacoustic signals recorded simultaneously from the SSS and hematomas allowed for measurements of their oxygenations. The presence of hematomas was confirmed after the experiment in gross pictures of the exposed brains. After blast the hematoma signal and oxygenation increased, while SSS oxygenation decreased due to the blastinduced TBI. The increase of the oxygenation in fresh hematomas may be explained by the leakage of blood from arteries which have higher blood pressure compared to that of veins. These results indicate that the optoacoustic technique can be used for early diagnosis of hematomas and may provide important information for improving outcomes in patients with TBI or stroke (both hemorrhagic and ischemic).

  15. Pregnancy Outcomes in Pregnant Women with Subchorionic Hematoma

    OpenAIRE

    Victoria V. Barinova; Anna V. Kovaleva; Maria P. Dmitrieva

    2015-01-01

    Background: The role of subchorionic hematoma (SCH) in the first trimester of pregnancy remains open for discussion. Some authors claim that SCH does not affect the pregnancy; others have found that it is a serious risk factor for adverse pregnancy outcome. The objective of the present study was to explore the outcomes of pregnancy in patients with SCH diagnosed in the first trimester. Methods and Results: The study involved 194 pregnant women who were in terms of 6 to12 weeks: 115 women w...

  16. Pontine tegmentum hematoma: report of a case with pure hemiplegia

    Directory of Open Access Journals (Sweden)

    MILAGRES ANTONIO CARLOS DE PDUA

    1998-01-01

    Full Text Available The authors report the case of a 50 year-old hypertensive male patient with a pontine hematoma. The clinical presentation was characterized by pure pyramidal deficit signs (no other signs or symptoms were present. A pure hemiplegia syndrome, although common in supratentorial lesions, is considered to be a rare event in pontine vascular lesions. The pathophysiologic mechanisms of these neurological findings are unclear. The exclusive involvement of the pyramidal tract in this case is likely due to a variation in the vascular anatomy of the pons but, in some cases, a vascular malformation may be the cause.

  17. Dengue Fever with rectus sheath hematoma: a case report.

    Science.gov (United States)

    Sharma, Anurag; Bhatia, Sonia; Singh, Rajendra Pratap; Malik, Gaurav

    2014-04-01

    Dengue fever, also known as breakbone fever, is an infectious tropical disease caused by the Dengue virus. It is associated with a number of complications, which are well documented. However, Dengue fever associated with rectus sheath hematoma (RSH) is a very rare complication. Only one case report has been published prior supporting the association of Dengue fever with RSH. We report a case of Dengue fever who presented with RSH and was successfully treated conservatively. RSH is also an uncommon cause of acute abdominal pain. It is accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric vessel or muscle tear. PMID:25161976

  18. Unusual Case of Overt Aortic Dissection Mimicking Aortic Intramural Hematoma.

    Science.gov (United States)

    Disha, Kushtrim; Kuntze, Thomas; Girdauskas, Evaldas

    2016-04-01

    We report an interesting case in which overt aortic dissection mimicked two episodes of aortic intramural hematoma (IMH) (Stanford A, DeBakey I). This took place over the course of four days and had a major influence on the surgical treatment strategy. The first episode of IMH regressed completely within 15 hours after it was clinically diagnosed and verified using imaging techniques. The recurrence of IMH was detected three days thereafter, resulting in an urgent surgical intervention. Overt aortic dissection with evidence of an intimal tear was diagnosed intraoperatively. PMID:27066437

  19. Hematomas intracerebrais hipertensivos: a propósito de 50 casos

    OpenAIRE

    José Carlos Lynch; Ricardo Alves; Ricardo Ribeiro; José Geraldo Lima

    1985-01-01

    São analisados 50 pacientes com hematomas hipertensivos supratentoriais. A literatura pertinente é revista. As várias proposições de tratamento desta patologia são apresentadas e analisadas. Os autores também propõem uma rotina de tratamento para os hematomas hipertensivos supratentoriais.

  20. Spontaneous retroperitoneal hematoma from rupture of an aneurysm of the ovarian artery following delivery.

    Science.gov (United States)

    Guillem, P; Bondue, X; Chambon, J P; Lemaitre, L; Bounoua, F

    1999-07-01

    We describe a case involving spontaneous retroperitoneal hematoma caused by rupture of an aneurysm of the right ovarian artery 4 days after delivery in a multiparous woman. Diagnosis was achieved by arteriography. Bleeding was stopped by embolization via selective arteriography. Hematoma was drained by lomboscopy. The pathophysiological mechanisms underlying development and treatment of these aneurysms are discussed. PMID:10398743

  1. Sonographic and radiological presentation of a hematoma of the duodenum: a case report

    International Nuclear Information System (INIS)

    Sonographic and radiological presentation of a hematoma of the duodenum: a case report. The authors reported a case of intramural hematoma of the third and fourth portions of the duodenum, investigated by ultrasonography and upper gastro-intestinal study. The diagnosis was suspected by ultrasonography and confirmed by the radiological examination. (author)

  2. Noninvasive, optoacoustic detection and characterization of intra- and extracranial hematomas and cerebral hypoxia

    Science.gov (United States)

    Petrov, Andrey; Prough, Donald S.; Petrov, Yuriy; Petrov, Irene Y.; Robertson, Claudia S.; Asokan, Vasantha; Agbor, Adaeze; Esenaliev, Rinat O.

    2015-03-01

    Early diagnosis of intracranial hematomas is necessary to improve outcome in patients with traumatic brain injury (TBI). CT and MRI can diagnose intracranial hematomas, but cannot be used until the patient arrives at a major healthcare facility, resulting in delayed diagnosis. Near infrared spectroscopy may suggest the presence of unilateral intracranial hematomas, but provides minimal information on hematoma type and location due to limitations associated with strong light scattering. We have used optoacoustics (which combines high endogenous optical contrast with the resolution of ultrasound) to diagnose hematomas and monitor cerebral oxygenation. We performed animal and clinical studies on detection and characterization of hematomas and on monitoring cerebral hypoxia by probing the superior sagittal sinus (SSS). Recently, we built a medical grade, multi-wavelength, OPO-based optoacoustic system tunable in the near infrared spectral range. We developed new patient interfaces for noninvasive, transcranial measurements in the transmission mode in the presence of dense hair and used it in patients with TBI. The optoacoustic system was capable of detecting and characterizing intra- and extracranial hematomas. SSS blood oxygenation was measured as well with the new interface. The obtained results indicate that the optoacoustic system in the transmission mode provides detection and characterization of hematomas in TBI patients, as well as cerebral venous blood oxygenation monitoring. The transmission mode approach can be used for optoacoustic brain imaging, tomography, and mapping in humans.

  3. CT findings and clinical analysis of subcortical hematomas in elderly patients

    International Nuclear Information System (INIS)

    Ten elderly patients (73-87 years, 78.4 years on the average) with subcortical hematomas were divided into two groups according to the shape of the hematoma on a CT scan: a lobulated group (6 patients) and a global group (4 patients). The lobulated group had a history of hypertension in one patient. The hematomas extended widely around the parietal lobe and were accompanied by perifocal edema, brain shifts and subarachnoid hemorrhages, deep consciousness disturbances, and poor prognosis of life and function. Amyloid depositions in the arteries around the hematomas were confirmed histologically in one patient. The global group had a history of hypertension in two patients. The hematomas were localized in the parietal, temporal, or occipital lobe without perifocal edema, brain shift and subarachnoid hemorrhages, and accompanied by mild consciousness disturbances. The life prognosis was good, but the functional prognosis was poor, with a subsequent development of dementia. A lobulated subcortical hematoma is thought to be due to amyloid angiopathy, while a global subcortical hematoma is thought to be due to hypertension. A surgical evacuation is seldom indicated for either type of subcortical hematoma in elderly patients. (author)

  4. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator Fibrinlise com infuso de rtPA e drenagem estereotxica de hematoma intracerebral espontneo profundo

    OpenAIRE

    Jos Augusto Nasser; Asdrubal Falavigna; Mrcio Bezerra; Victor Martinez; Gabriel Freitas; Armando Alaminos; Antnio Bonatelli; Fernando Ferraz

    2002-01-01

    PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There...

  5. Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

    Directory of Open Access Journals (Sweden)

    Bansal Ujjwal

    2010-01-01

    Full Text Available Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of a kidney usually caused by a subcapsular hematoma associated with high blood pressure and occasional renal failure. It is named after Dr. Irvin Page who first demonstrated in 1939 that wrapping cellophane tightly around animal kidneys could cause hypertension. Various management options are mentioned in literature and depend upon the severity of hematoma. Percutaneous drainage is a successful option for the management of subcapsular hematoma in hemodynamic stable patients.

  6. Sharp tooth induced sublingual hematoma in a patient with elevated international normalized ratio

    Directory of Open Access Journals (Sweden)

    John Baliah

    2015-01-01

    Full Text Available Sublingual hematoma secondary to anticoagulation is a rare fatal condition. Hemorrhagic complications of warfarin are well-known. This particular case is unique because the patient was on warfarin for the past 2 years but did not develop the sublingual hematoma. However, a trauma by an attrited sharp cusp triggered the episode of the sublingual hematoma in this patient. Being a medical emergency, patient was promptly hospitalized in cardiac care unit and managed by medical team. The patient was transfused with 2 units of fresh frozen plasma and warfarin was temporarily stopped for 4 days. Alternate day regimen of warfarin was started after 4 days, and international normalized ratio dropped to 3. In dental management, enameloplasty of the mandibular first molar tooth was done to prevent trauma and ulcer development in the floor of the mouth. The hematoma resolved, and no new hematoma formation was observed for a period of 6 months.

  7. In-hospital mortality after pre-treatment with antiplatelet agents or oral anticoagulants and hematoma evacuation of intracerebral hematomas.

    Science.gov (United States)

    Stein, Marco; Misselwitz, Björn; Hamann, Gerhard F; Kolodziej, Malgorzata; Reinges, Marcus H T; Uhl, Eberhard

    2016-04-01

    Pre-treatment with antiplatelet agents is described to be a risk factor for mortality after spontaneous intracerebral hemorrhage (ICH). However, the impact of antithrombotic agents on mortality in patients who undergo hematoma evacuation compared to conservatively treated patients with ICH remains controversial. This analysis is based on a prospective registry for quality assurance in stroke care in the State of Hesse, Germany. Patients' data were collected between January 2008 and December 2012. Only patients with the diagnosis of spontaneous ICH were included (International Classification of Diseases 10th Revision codes I61.0-I61.9). Predictors of in-hospital mortality were determined by univariate analysis. Predictors with P<0.1 were included in a binary logistic regression model. The binary logistic regression model was adjusted for age, initial Glasgow Coma Score (GCS), the presence of intraventricular hemorrhage (IVH), and pre-ICH disability prior to ictus. In 8,421 patients with spontaneous ICH, pre-treatment with oral anticoagulants or antiplatelet agents was documented in 16.3% and 25.1%, respectively. Overall in-hospital mortality was 23.2%. In-hospital mortality was decreased in operatively treated patients compared to conservatively treated patients (11.6% versus 24.0%; P<0.001). Patients with antiplatelet pre-treatment had a significantly higher risk of death during the hospital stay after hematoma evacuation (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.24-4.97; P=0.010) compared to patients without antiplatelet pre-treatment treatment (OR: 0.9; 95% CI: 0.79-1.09; P=0.376). In conclusion a higher rate of in-hospital mortality after pre-treatment with antiplatelet agents in combination with hematoma evacuation after spontaneous ICH was observed in the presented cohort. PMID:26690758

  8. Hematoma retroperitoneal de causa infrecuente: A propsito de un caso Retroperitoneal hematoma of unusual cause: A case report

    Directory of Open Access Journals (Sweden)

    Daniel lvarez G

    2012-01-01

    Full Text Available El hematoma retroperitoneal espontneo (HRE se define como una coleccin hemtica espontnea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas ms frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difcil realizar el diagnstico al ingreso del paciente, ya que la presentacin clnica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las tcnicas de imagen, especialmente la angiografa, tomografa computada y resonancia magntica, son una herramienta fundamental en el diagnstico y manejo oportuno del cuadro. Presentamos el caso de un varn de 56 aos de edad con diagnstico de VIH en tratamiento, que debut como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imgenes, se diagnostic un HRE cuyo estudio histolgico revel un Linfoma de Burkitt.The spontaneous retroperitoneal hematoma (SRH is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

  9. [Non-lethal brain stem hematomas in hypertensive patients].

    Science.gov (United States)

    Morel-Maroger, A; Metzger, J; Bories, J; Gardeur, D; Verger, J B; Noël, M C

    1982-01-01

    Brain stem hemorrhages (peduncular, pontine, medullary) were demonstrated by CT scan in hypertensive patients, the outcome being favorable without surgical intervention. Such lesions are considered as being usually massive and fatal. A review of the literature show that hemorrhages in the brain stem represent 5 to 9 p. cent of intraparenchymatous hemorrhages, and are usually located in the pons. A favorable course was known to occur before the use of computed tomography: the rare cases described were often related to subacute hematomas in young normotensive subjects which could be treated by surgery with or without ventricular shunting. Clinical diagnosis is based on the rapid progressive course of the disorder and the location of the lesion. Computed tomography provides an immediate correlation between anatomical and clinical findings, and allows a better evaluation of semiological and prognostic features that were previously considered well established. A major element appears to be the degree to which the hematoma is tolerated. As far as possible neurosurgical procedures should be avoided in hypertensive patients. PMID:7146726

  10. Traumatic Posterior Fossa Epidural Hematomas and Their Complications

    Directory of Open Access Journals (Sweden)

    Ali DALGIÇ

    2007-12-01

    Full Text Available Background: Traumatic posterior fossa epidural hematomas (TPFEDH occur infrequently however their mortality and morbidity are higher than supratentorial epidural hematomas. Signs and symptoms may be silent or nonspecific, even though they may show rapid progression and deterioration from consciousness to coma, thus they would cause fatal results. Recently, practice of computerized tomography (CT has grown up and replaced the use of direct X-ray to detect calvarial fractures and other traumatic pathologies, therefore patients with posterior fossa trauma were diagnosed earlier.Material and Methods: We presented eight cases who suffered from TPFEDHs treated in our clinics between the years 2002 and 2006. Five cases were operated immediately however 3 cases were treated conservatively. One of the operated cases died immediately after surgery. Postoperative complications of cerebral sinus thrombosis and pseudomeningocele were observed in two cases. Alive cases were discharged a few days after surgery.Conclusion: Mortality decreases in TPFEDHs since they could be diagnosed earlier with widespread use of CT and treated successfully. In addition, it is easier to decide whether conservative or surgical therapy is efficient because CT findings should correlate with clinical findings. However, few complications such as cerebral sinus thrombosis and pseudomeningocele occur infrequently. Furthermore these cases must be monitored carefully during postoperative period for a new neurological finding.

  11. Head trauma and CT with reference to epidural hematoma

    International Nuclear Information System (INIS)

    Computed tomography (CT) is useful to detect lesions in patients with mild head trauma in its acute stage which may be followed by a lucid interval of hours to several days before exact diagnosis is made, or in serious patients with impairment in state of consciousness. Non-enhanced scan can determine the location of the lesion in 94% of patients with brain tumor, and enhanced scan can do in more than 98%. CT can reveal many anatomical changes due to trauma. Of these pathological changes, epidural hematoma is often caused by the damage of the middle meningeal artery or its branch. Therefore, CT should be performed if a bone-fracture line runs across the meningeal artery. CT is also applicable for the patients with some brain symptoms such as those who had not immediate post-traumatic unconsciousness but have developed impairment in state of consciousness after a lucid interval, or those who have persistent headache even if they have no impairment in stage of consciousness. In CT findings, the margin of hematoma and normal cerebral tissues is usually clear in acute causes but unclear in subacute cases. (Ueda, J.)

  12. Spectrum of intracranial subdural empyemas in a series of 45 patients: Current surgical options and outcome

    OpenAIRE

    Tewari Manoj; Sharma Rewati; Shiv Vinod; Lad Santosh

    2004-01-01

    Background: The subject of subdural empyema (SDE) is reviewed on the basis of experience with 45 cases. Methods: Records of 45 patients with SDE were analyzed. There were 35 males and 10 females in the series. The majority of the patients were either infants (22.2%) or in their second and third decade of life (37.8%). For supratentorial SDE, craniotomy was done in 5 cases (11.1%). In six cases (13.3%) two burr-holes and in the rest of the cases multiple burrholes ...

  13. Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI

    International Nuclear Information System (INIS)

    We report two cases of hyperacute spinal subdural haematoma secondary to lumbar spinal anaesthesia, identified with MRI. Prompt diagnosis of this infrequent, potentially serious complication of spinal anaesthesia is essential, as early surgical evacuation may be needed. Suggestive MRI findings in this early phase include diffuse occupation filling of the spinal canal with poor delineation of the spinal cord on T1-weighted images, and a poorly-defined high-signal lesion with a low-signal rim on T2-weighted images. (orig.)

  14. Subdural haematoma in Plasmodium falciparum and Plasmodium vivax mixed infection presenting multiple clinical complications.

    Science.gov (United States)

    Devaraju, Punith B; Padukone, Shashiraja; Veerabhadraiah, Shivakumar R; Ramachandrappa, Vijayakumar S; Panji, Narayan; Chandrappagowda, Pruthvi B; Rudrappa, Maheshmurthy B; Gowda, D Channe; Achur, Rajeshwara N

    2013-12-01

    A 40-year-old man was admitted to hospital with a 5 day history of fever, restlessness and altered sensorium. Peripheral blood smears showed a Plasmodium vivax and Plasmodium falciparum mixed infection as revealed by the presence of rings, schizonts and gametocyte forms of the parasites. The patient soon became unconscious due to subdural haematoma (SDH) associated with disseminated intravascular coagulation and thrombocytopenia. Immediate intervention with a right fronto-parieto temporal craniectomy, evacuation of the SDH and intravenous quinine administration resulted in the patient's complete recovery within 8 days of admission, and he was discharged in good clinical condition. PMID:23988631

  15. Traumatic hematomas in deep middle portion of the cerebrum case report

    International Nuclear Information System (INIS)

    Recently we have encountered three cases of small traumatic hematoma in deep middle portion of the cerebrum. Patient 1: A 55-year-old male was admitted to our hospital 2-days after the traffic accident. CTscan showed small hematoma around septum pellucidi and fornix and in the posterior horn of left lateral ventricle. Patient 2: A 54-year-old male was admitted to our hospital a day after the head injury. CTscan showed hematoma in the supraventral portion of the third ventricle. Patient 3: A 27-year-old male was admitted to our hospital a day after the head injury. CTscan showed hematoma around quadrigeminal cistern and midbrain. Three cases reported here are traumatic hematomas without mass effect, which were pointed out only by autopsy. On traumatic hematoma in the deep middle portion of the brain we have only a few reports. On the mechanism of this bleeding Lindenberg and Kohno reported that the bleeding is caused by outward bending of the skull in injury. Lindenberg et al insisted that when traumatic force goes through corpus callosum over stretching of corpus callosum caused bleeding and that shearing force can damage septum pellucidi and fornix. Although these small hematomas are absorbed gradually functional prognosis is poor. Especially Korsakov syndrome and left hemiparesis in patient 1 shows no sign of recovery. In patient 2 and patient 3 decreased mental activity and hemiparesis have continued. Treatment of these cases cannot be surgical, as far as severe brain edema does not appeared. (author)

  16. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    International Nuclear Information System (INIS)

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization

  17. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2007-08-15

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

  18. Bilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery.

    Science.gov (United States)

    Li, Zhao-Jian; Sun, Peng; Dou, Yi-He; Lan, Xiao-Lei; Xu, Jian; Zhang, Chun-Yong; Wang, Jian-Peng

    2012-01-01

    A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication. PMID:23006878

  19. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  20. Neonatal adrenal hematoma with urinary tract infection: Risk factor or a chance association?

    Directory of Open Access Journals (Sweden)

    Abdelhadi M Habeb

    2014-01-01

    Full Text Available Neonatal adrenal hematoma is a rare finding that can be discovered incidentally or presents with various symptoms. However, urinary tract infection (UTI has not been reported in association with this condition. We report on a 4-week old child with massive unilateral adrenal hematoma discovered incidentally during a routine abdominal ultrasound scan for UTI. The mass resolved spontaneously after several months with no complications. The diagnosis and ma-nagement of infantile suprarenal mass and the possible link between this child′s UTI and the adrenal hematoma are discussed.

  1. Hematomas intracerebral espontâneos estudo de 121 casos

    OpenAIRE

    Lineu Cesar Werneck; Rosana Hermínia Scola; Leila Elizabeth Ferraz

    1991-01-01

    Foram analisados retrospectivamente 121 pacientes com hematomas intracerebrais espontâneos (HIE): com média de idade de 53,4 ±14,8 anos, 62,8% do sexo masculino, tempo médio de sangramento na admissão de 36 horas (3 horas a 12 dias); 63,5% estavam acima de 7 na escala de Glasgow e 81,9% com grau igual ou maior que 3 na escala de Botterel. Os HIE eram: em gânglios da base em 45,5%, multilobares em 14,7%, lobares em 22,8%, no tronco cerebral em 4% e cerebelares em 2%. Seus diâmetros médios eram...

  2. Imaging management of spontaneous giant esophageal intramural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Hagel, J. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Bicknell, S.G.; Haniak, W. [Lions Gate Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)]. E-mail: sbicknel@interchg.ubc.ca

    2007-04-15

    A woman, aged 84 years, presented to our emergency department with posteriorly radiating chest pain that began following dinner. She reported no change in bowel habits, hematochezia, or melena. She had previous peptic ulcer disease and a long-standing history of gastroesophageal reflux disease. Her medications included acetylsalicylic acid and rabeprazole. Electrocardiogram and troponin analyses were negative for ischemic heart disease. The emergency physician suspected an aortic dissection, and computed tomography (CT) chest and abdomen scans were performed with and without IV and oral contrast. The aorta was normal and the noncontrast images demonstrated a hyperdense mass (not shown) that did not enhance consistent with a large intramural hematoma extending from the upper esophagus (level of T2 vertebral body) to the fundus of the stomach (Figures 1A and B). (author)

  3. Unusual Presentation of Pulmonary Hematoma after Blunt Chest Wall Trauma

    Directory of Open Access Journals (Sweden)

    Reza Bagheri

    2014-02-01

    Full Text Available A 25-year-old man was admitted in hospital due to right side hemopneumothorax secondary to car accident. A chest tube was inserted. During the hospitalization days, chest CT scan revealed a 3cmx3 cm oval-shaped density located in the right upper lobe. Since he was in a good general condition, he was discharged from hospital after removal of chest tube and a follow-up chest CT-scan was recommended. In the chest CT scan that was performed 3 months later (Figure 1, the oval-shaped density was increased in size. There was no endobronchial lesion in bronchoscopic evaluation. Surgery was recommended He was underwent thoracotomy and the lesion was resected (Figure 2. It was post-traumatic pulmonary hematoma (Figure 3.

  4. Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

    Directory of Open Access Journals (Sweden)

    Chih Ming Lin

    2011-08-01

    Full Text Available A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

  5. Acute subdural empyema. With special reference to CT findings and surgical treatment; case report

    Energy Technology Data Exchange (ETDEWEB)

    Sasahira, Masahiro; Takagi, Kenichi; Hashimoto, Kazumasa; Inou, Satoshi; Arai, Toshimoto (Dokkyo Univ., School of Medicine, Tochigi (Japan))

    1983-05-01

    The patient, a 19-year-old male, began suffering from severe headache, vomiting, and high fever. Two days later the patient was admitted in a semicomatose state and with left hemiplegia. Nuchal rigidity and choked disc were not noticed. WBC count was 12,500/mm/sup 3/. CT scan disclosed marked swelling of the right cerebral hemisphere with midline shift. Except for a small lucent space in the parafalcial region, no extracerebral collection was noted in either pre- or post-contrast scans. Plain craniograms showed clouding of the left frontal, ethmoidal, and sphenoidal sinuses. Carotid angiography revealed prolongation of the circulation time and stenosis of the supraclinoidal portion of the right carotid artery. Right fronto-parietal decompressive craniectomy was performed. Subdural empyema was found and evacuated. Curettage and drainage of the empyema in the paranasal sinuses were also done. A bone defect 4 mm in diameter was detected on the medial-upper wall of the left frontal sinus. The causative organism was confirmed as ..cap alpha..-Streptococcus. Both systemic and local antibiotics were administered and the patient recovered well and was discharged without any neurological deficit. The authors emphasized that cerebral angiography is necessary for its accurate diagnosis of subdural empyema in its acute stage and that emergency intracranial and rhino-otological operations should be concomitantly performed.

  6. Spectrum of intracranial subdural empyemas in a series of 45 patients: Current surgical options and outcome

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    Tewari Manoj

    2004-07-01

    Full Text Available Background: The subject of subdural empyema (SDE is reviewed on the basis of experience with 45 cases. Methods: Records of 45 patients with SDE were analyzed. There were 35 males and 10 females in the series. The majority of the patients were either infants (22.2% or in their second and third decade of life (37.8%. For supratentorial SDE, craniotomy was done in 5 cases (11.1%. In six cases (13.3% two burr-holes and in the rest of the cases multiple burrholes were done to evacuate the empyema. Craniectomy was done in three cases (6.7%, of which two had posterior fossa SDE. All patients received appropriate preoperative and postoperative broad-spectrum antibiotics. Results: There was good recovery in 35 (77.8% patients, six patients (13.3% had moderate disability, two patients (4.4% had severe disability, and two (4.4% died. Three patients who developed recollection at operation site required evacuation of residual SDE. Median follow-up was 3 years (range 4 months to 3 years. Conclusion: Emergent evacuation of SDE using multiple burr-holes and irrigation of the subdural cavity with saline for 24 hours results in a satisfactory outcome in cases with SDE.

  7. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    Science.gov (United States)

    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  8. Compression syndrome of the inferior caval vein by intraabdominal hematomas following reanimation

    International Nuclear Information System (INIS)

    The case report describes the diagnostic imaging of intrahepatic hematomas with caval compression and thrombosis, in particular the function of sonography, computed tomography and digital substraction angiography. Differential diagnosis and therapy are discussed. (orig.)

  9. Diagnosis of epidural hematoma by brain scan and perfusion study: case report

    International Nuclear Information System (INIS)

    By using the arterial and venous phases of an anterior cerebral perfusion study, which showed downward displacement of the sagittal sinus, and the finding of a rim on the delayed scans, the specific diagnosis of epidural hematoma was established

  10. Severe upper airway obstruction due to delayed retropharyngeal hematoma formation following blunt cervical trauma

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    Ciceri David P

    2007-03-01

    Full Text Available Abstract Background We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise. Case presentation A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway. Conclusion Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

  11. Spontaneous cervical epidural hematoma: a case report and review of the literature; Hematoma epidural cervical espontaneo: a proposito de un caso y revision de la bibligrafia

    Energy Technology Data Exchange (ETDEWEB)

    Aparici, F.; Mas, F.; Solera, M. C.; Moro, G. [Hospital Universitario La Fe. Valencia (Spain)

    2002-07-01

    We present the case of a 78-year-old woman with a spontaneous spinal epidural hematoma that presented with sudden interscapular pain accompanied by left hemiparesis and a significant improvement 15 minutes later. Initially diagnosed as angina, the persistence of pain in dorsal cervical spine suggested the need to perform magnetic resonance imaging (MRI). The images demonstrated a lesion in the epidural spinal canal at level C3-D2 that presented a heterogeneous signal intensity, with hyperintense areas in T1-weighted sequences and hypointense areas in gradient-echo sequences, with no sign of compression myelopathy. A diagnosis of epidural hematoma was established and, given the favorable clinical course, conservative treatment was indicated. The second MRI study showed the complete resorption of the epidural hematoma. (Author) 12 refs.

  12. Self-Inflicted Intraoral Hematoma in a Cardiac Patient Receiving Oral Anticoagulant Therapy- A Case Report

    OpenAIRE

    Shantala Arunkumar; Preethi A. Poonja; Shyam Amur; Sattur, Atul P.; Burde, Krishna N.; Venkatesh S Anehosur

    2015-01-01

    Intraoral hematoma secondary to systemic anticoagulant therapy is rare, but it is a potentially fatal condition requiring immediate medical management. Case report: Here we report a case of self-inflicted hematoma in the anterior maxillary gingival region in a 65year old female cardiac patient who was on systemic anticoagulant therapy with a poor periodontal condition, manifesting as a periodontal swelling for a period of one week. Oral anticoagulant therapy is cons...

  13. Subcapsular renal hematoma after ureterorenoscopy: An unknown complication of a known procedure

    OpenAIRE

    Bansal Ujjwal; Sawant Ajit; Dhabalia Jayesh

    2010-01-01

    Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of ...

  14. Hematomas intraparenquimatosos espontâneos experiência com 134 casos

    OpenAIRE

    Jorge L. Kraemmer; Carlos A. Guimarães Bastos; Albert V. Berthier Brasil; Eliseu Paglioli Neto; Nelson Pires Ferreira

    1992-01-01

    São estudados 134 casos de hematomas intraparenquimatosos espontâneos. Os pacientes são divididos em 6 grupos, obedecendo a critérios de topografia, nível de consciência e volume do hematoma. O tratamento variou segundo o grupo, sendo conservador, com ou sem monitorização da pressão intracraniana, ou cirúrgico. Os resultados mostraram maior mortalidade (p

  15. Growing Organized Hematomas Following Gamma Knife Radiosurgery for Cerebral Arteriovenous Malformation : Five Cases of Surgical Excision

    OpenAIRE

    Park, Jung Cheol; Ahn, Jae Sung; Kwon, Do Hoon; Kwun, Byung Duk

    2015-01-01

    Organized hematoma is a rare complication that can develop following gamma knife radiosurgery (GKS) for cerebral arteriovenous malformation (AVM). Here, we describe 5 patients with growing organized hematomas that developed from completely obliterated AVMs several years after GKS. The patients were 15, 16, 30, 36, and 38 years old at the time of GKS, respectively, and 3 patients were female. Four AVMs were located in the lobe of the brain, and the remaining AVM were in the thalamus. Between 2...

  16. Late Intrahepatic Hematoma Complicating Transjugular Intrahepatic Portosystemic Shunt for Budd-Chiari Syndrome

    International Nuclear Information System (INIS)

    Late intrahepatic hematoma is a rare complication of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We describe a patient with Budd-Chiari syndrome (BCS), who presented with a large inrahepatic hematoma 13 days after TIPS. Review of the literature reveals only two previous cases, both occurring in patients with BCS and presenting after a similar time interval. This potentially serious complication appears to be specific for TIPS in BCS

  17. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    OpenAIRE

    Tugan Tezcaner; Yahya Ekici; Mahir K?rnap; Feride Kural; Gkhan Moray

    2014-01-01

    INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disorder of hematopoietic cells. Gastrointestinal complications of PNH are rare and mostly related with intravascular thrombosis or intramural hematoma. PRESENTATION OF CASE: We describe a case of a man with PNH complicated by intramural duodenal hematoma initially treated with supportive care. Three months after his first admission; he was admitted to the emergency department with abdominal pain, nausea and vomi...

  18. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation

    OpenAIRE

    Abbas, Asad; AFZAL, Kamran; Athar A. MUJEEB; Tabassum SHAHAB; Khalid, Mohd.

    2013-01-01

    How to Cite This Article: Abbad A, Afzal K, Mujeeb AA, Shahab T, Khalid M. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation. Iran J Child Neurol. 2013  Spring;7(2):47-50.Abstract Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initi...

  19. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

    OpenAIRE

    Nasser Jos Augusto; Falavigna Asdrubal; Bezerra Mrcio; Martinez Victor; Freitas Gabriel; Alaminos Armando; Bonatelli Antnio; Ferraz Fernando

    2002-01-01

    PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There...

  20. The effect of topical applications performed after subcutaneous heparin injection on development of bruise and hematoma

    OpenAIRE

    Mehtap Dursun; Reva Balci Akpinar

    2014-01-01

    Objective: Bruising and hematoma, which appear after the subcutaneous heparin injection, are local side effects of heparin. The purpose of this study was to investigate the effect of Vitamin K, adrenaline, and aluminum-potassium-sulphate, which are topically administered on injection area, on development of the bruising and the hematoma caused by the subcutaneous heparin injection. Material and Method: The study was conducted as single group post-test experimental model with control group....

  1. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator Fibrinlise com infuso de rtPA e drenagem estereotxica de hematoma intracerebral espontneo profundo

    Directory of Open Access Journals (Sweden)

    Jos Augusto Nasser

    2002-06-01

    Full Text Available PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.OBJETIVO: Estudo prospectivo em 10 pacientes com infuso de tromboltico (rtPA dentro do hematoma cerebral profundo supratentorial e drenagem estereotxica. MTODO: Entre 1999 e 2000 10 pacientes com hematomas de profundidade foram selecionados para infuso de rtPA e drenagem do cogulo espontnea. RESULTADO: Todos os casos obtiveram 80% de reduo do volume do hematoma medidos por TC no terceiro dia. A presso intracraniana estava normalizada no terceiro dia. No houve complicaes locais ou sistmicas relacionadas com o uso deste tromboltico. Os resultados comparados foram mostrados pela Escala de Prognstico de Glasgow com 6 pacientes em GrauV, 3 pacientes em Grau IV e 1 paciente em Grau III aps trs meses. CONCLUSO: Tratamento precoce e drenagem com tcnica neurocirrgica minimamente invasiva pode fazer estes pacientes terem uma recuperao da conscincia mais rpida e assim serem reabilitados mais precocemente evitando complicaes secundrias.

  2. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

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    Shimodaira Masanori

    2013-01-01

    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

  3. Vertex extradural hematoma in association with Paget′s disease of the skull

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    Ramesh V

    2005-01-01

    Full Text Available Paget′s disease of skull usually causes neurological complications such as basilar invagination, cranial neuropathies, etc. Occurrence of extradural hematoma in association with Paget′s disease of skull is rare. A 48 year old man presented with headache and right upper limb weakness, two days after a fall from scooter. CT Scan of brain showed a large extradural hematoma at the vertex with the cranial vault showing features of Paget′s disease. At surgery, no skull fracture or injury to the superior sagittal sinus was evident. There was diffuse oozing from the inner table of the skull, which showed features of Paget′s disease. The extradural hematoma was evacuated and the patient made good recovery.He deteriorated a few hours after surgery. Follow up CT Scan showed diffuse brain swelling with minimal recollection of hematoma. Re-exploration showed a small recollection which was evacuated and the part of the oozing diseased skull was excised. The patient recovered completely. This is the first reported case of vertex extradural hematoma in association with the Paget′s disease of skull. The unusual features are the absence of skull fracture and injury to the superior sagittal sinus. The increased vascularity of the skull due to Paget′s disease has caused the hematoma by diffuse oozing from the inner table.

  4. Clinical appraisal of stereotactic hematoma aspiration surgery for hypertensive thalamic hemorrhage

    International Nuclear Information System (INIS)

    Three hundred and four patients with hypertensive thalamic hemorrhage were managed by medical treatment, ventricular drainage, or CT-controlled stereotactic aspiration surgery (AS). The therapeutic results of the 6-month outcome were analyzed and correlated with the volume of the hematoma. A hematoma volume of 20 ml was thought to be the critical size in determining whether the outcome would be favorable or unfavorable. Indications for AS are suggested as follows. In patients with a small-sized hematoma having a volume of less than 10 ml use of AS should be restricted to patients with severe paralysis or other neurological complications and the elderly (aged 70 years or older). For patients with a medium-sized hematoma having a volume between 10 ml and 20 ml, AS is indicated for patients having severe paralysis and disturbances of consciousness. For patients with a large-sized hematoma having a volume of 20 ml or more, AS increases not only the survival rate of patients but also reduces the number of bedridden patients. We conclude that AS opens up a new avenue of surgical treatment for hypertensive thalamic hemorrhage, which has been no indication for hematoma evacuation by conventional craniotomy. (author)

  5. Spontaneous perforation of an intramural rectal hematoma: Report of a case

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    Zhu-Lin Li

    2012-01-01

    Full Text Available Spontaneous hematomas are rare and most occur secondary to hematologic disorders or during anticoagulant therapy. Most spontaneous hematomas occur above the sigmoid colon, and rarely in the rectum. Herein we present the case of a patient with a spontaneous perforating hematoma of the rectum who presented with severe abdominal pain after a bloody stool. The hemoglobin level decreased by 33 g/L within 20 h. An abdominal sonogram showed a hydrops in the lower abdomen with a maximum depth of 7.0 cm. A hematoma, 8 cm × 6 cm × 5 cm in size, was noted intra-operatively in the rectosigmoid junction, with a 1.5-cm perforation in the hematoma and active hemorrhage. Thus, a partial rectectomy and sigmoidostomy were performed. Three months later, a second operative procedure to re-establish intestinal continuity was performed. The patient is in good condition 12 mo after the last surgery. In addition to this case, the causes of spontaneous perforating hematomas and the treatment are discussed.

  6. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation

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    Asad ABBAS

    2013-06-01

    Full Text Available How to Cite This Article: Abbad A, Afzal K, Mujeeb AA, Shahab T, Khalid M. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation. Iran J Child Neurol. 2013  Spring;7(2:47-50.Abstract Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies,the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis andintervention. References:1. Phillips TW, Kling TF Jr, McGillicuddy JE. Spontaneous ventral spinal epidural hematoma with anterior cordsyndrome: report of a case. Neurosurgery 1981;9:440-3.2. Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous spinal epidural hematoma in children. Pediatr Neurol1998;19:302-7. Review.3. Penar PL, Fischer DK, Goodrich I, Bloomgarden GM, Robinson F. Spontaneous spinal epidural hematoma. IntSurg 1987;72:218-21.4. Noth I, Hutter JJ, Meltzer PS, Damiano ML, Carter LP. Spinal epidural hematoma in a hemophilic infant. Am JPediatr Hematol Oncol 1993;15:131-4. Review.5. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg1984;61:143-8.6. Alva NS. Traumatic spinal epidural hematoma of a 10-month-old male: a clinical note. Pediatr Neurol2000;23:88-9. Review.7. Aminoff MJ: Vascular disorders of the spinal cord, in Davidoff RA (ed: Handbook of the Spinal Cord.Infections and Cancer, Vol 5. New York: Marcel Dekker, 1986, pp 271-273.8. Blount J, Doughty K, Tubbs RS, Wellons JC, Reddy A, Law C, et al. In utero spontaneous cervical thoracicepidural hematoma imitating spinal cord birth injury. Pediatr Neurosurg 2004;40:23-7.9. Iguchi T, Ito Y, Asai M, Ito J, Okada N, Murakami M. [A case of spontaneous spinal epidural hematoma]. No ToHattatsu 1993;25:267-70. Review. Japanese.10. Nagel MA, Taff IP, Cantos EL, Patel MP, Maytal J, Berman D. Spontaneous spinal epidural hematoma in a7-year-old girl. Diagnostic value of magnetic resonance imaging. Clin Neurol Neurosurg 1989;91:157-60.11. Metzger G, Singbartl G. Spinal epidural hematoma following epidural anesthesia versus spontaneous spinalsubdural hematoma. Two case reports. Acta Anaesthesiol Scand 1991;35:105-7.12. Patel H, Garg BP. Increasing irritability with sudden onset of flaccid weakness. Semin Pediatr Neurol 1996;3:192-7.13. Tewari MK, Tripathi LN, Mathuriya SN, Khandelwal N, Kak VK. Spontaneous spinal extradural hematomain children. Report of three cases and a review of the literature. Childs Nerv Syst 1992;8:53-5. Review.14. Pecha MD, Able AC, Barber DB, Willingham AC. Outcome after spontaneous spinal epidural hematoma in children: case report and review of the literature. Arch Phys Med Rehabil 1998;79:460-3. Review.

  7. Post meningitis subdural hygroma: anatomical and functional evaluation with 99mTc-ethylene cysteine dimer single photon emission tomography/computed tomography

    International Nuclear Information System (INIS)

    Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. 99mTc-ethylene cysteine dimer (99mTc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If 99mTc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management. (author)

  8. Subdural and depth electrode placement in the brain for validation of MEG in partial epilepsy

    Science.gov (United States)

    Siadat, Mohammad-Reza; Elisevich, Kost; Soltanian-Zadeh, Hamid; Jafari-Khouzani, Kourosh; Bowyer, Susan

    2006-03-01

    Localization of epileptogenic zones in extratemporal epilepsy is a challenging problem. We speculate that using all modalities of data in an optimal way can facilitate the localization of these zones. In this paper, we propose the following steps to transfer all modalities of data in a single reference coordinate system: 1) Segmentation of subdural and depth electrodes, and cortical surface. 2) Building 3D models of the segmented objects. 3) Registration of preoperative MRI and postoperative CT, and magnetoencephalography (MEG). The above steps result in fusion of all modalities of data, objects of interests (electrodes and cortical surface), MEG analysis results and brain mapping findings. This approach offers a means by which an accurate appreciation of the zone of epileptogenicity may be established through optimal visualization and further quantitative analyses of the fused data. It also provides a ground for validation of less expensive and noninvasive procedures, e.g., scalp EEG, MEG.

  9. A rare clinical case of subdural hemorrhage in a patient with scrub typhus

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    Aradhna Sharma

    2016-02-01

    Full Text Available Scrub typhus is a common infectious disease with a self-limiting course but may potentially cause a fatal outcome in some cases. We here present a case report of a patient diagnosed with scrub typhus and was given effective antibiotic therapy. Initially, the patient improved significantly but had sudden clinical deterioration on day five and presented with subdural hemorrhage. Orientia tsutsugamushi the causative agent of scrub typhus may be considered as a causal or provoking factor for cerebrovascular accidents in regions where scrub typhus is endemic. Patients should be followed strictly during convalescence in such cases especially in those who have received delayed treatment. [Int J Basic Clin Pharmacol 2016; 5(1.000: 223-224

  10. Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient

    International Nuclear Information System (INIS)

    Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement of both compartments has never been reported, to our knowledge. We present an HIV-positive patient with such kind of combined involvement. Diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic response to antituberculous chemotherapy. Magnetic resonance imaging is the diagnostic procedure of choice in order to determine the exact level, site, and size of the disease. Tuberculosis of the spine should always be considered in the differential diagnosis of spinal cord compression if the patient lives in or comes from a region where tuberculosis is endemic or if the patient is immunocompromised. (orig.)

  11. Pregnancy Outcomes in Pregnant Women with Subchorionic Hematoma

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    Victoria V. Barinova

    2015-09-01

    Full Text Available Background: The role of subchorionic hematoma (SCH in the first trimester of pregnancy remains open for discussion. Some authors claim that SCH does not affect the pregnancy; others have found that it is a serious risk factor for adverse pregnancy outcome. The objective of the present study was to explore the outcomes of pregnancy in patients with SCH diagnosed in the first trimester. Methods and Results: The study involved 194 pregnant women who were in terms of 6 to12 weeks: 115 women with SCH (Group 1 and 79 apparently healthy pregnant women (Group 2. A missed miscarriage was observed in 27/23% women of Group 1 and in 4/5% of Group 2 (P<0.05, recurrent threat of miscarriage in 27/23% and in 4/5%, recurrent bleeding in 14/12% and 2/3%, and the short cervix syndrome in 22/19% and 5/6% women, respectively. Conclusion: The results of our study show that the presence of SCH adversely affects the first half of pregnancy, leading to recurrent threatened abortion, recurrent threat of miscarriage, missed miscarriage until 12 weeks of gestation, and the short cervix syndrome.

  12. Hemophilia and child abuse as possible causes of epidural hematoma: case report Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso

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    Fernando Campos Gomes Pinto

    2003-12-01

    Full Text Available INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.INTRODUÇÃO: Traumatismo crânio-encefálico é importante conseqüência de abuso infantil. Mecanismos fisiopatológicos específicos do abuso infantil são responsáveis pela ''whiplash shaken-baby syndrome'', o que favoreceria o aparecimento de hemorragias intracranianas. RELATO DE CASO: Relatamos o caso de uma criança que desenvolveu hematoma extradural após trauma de pequena intensidade. Foi feito diagnóstico inicial de abuso infantil, mas investigações subseqüentes levaram ao diagnóstico de hemofilia A. CONCLUSÃO: Embora o hematoma extradural não esteja intimamente relacionado com abuso infantil, esta etiologia deve ser sempre considerada quando o mecanismo de trauma relatado estiver fora de proporção com as lesões encontradas.

  13. Intramural esophageal hematoma after elective injection sclerotherapy Hematoma intramural esofágico após escleroterapia eletiva de varizes

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    Hannah Pitanga Lukashok

    2009-12-01

    Full Text Available CONTEXT: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. Methods - This is a retrospective observational study made at the "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. RESULTS: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%. Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. CONCLUSION: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.CONTEXTO: Apesar do fato de que a escleroterapia endoscópica de varizes esofágicas vem sendo largamente substituída pela técnica de ligadura elástica, a escleroterapia é ainda rotineiramente utilizada em muitas instituições, especialmente em países em desenvolvimento. O hematoma intramural esofágico é uma complicação rara da escleroterapia e os fatores de risco para seu desenvolvimento ainda não estão completamente estabelecidos. OBJETIVO - Demonstrar a incidência do hematoma intramural esofágico pós-escleroterapia no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, e discutir os possíveis fatores envolvidos. MÉTODOS: Este é um estudo retrospectivo observacional realizado no Hospital Universitário Clementino Fraga Filho, através da revisão dos prontuários médicos de todos os pacientes submetidos a escleroterapia endoscópica de varizes esofágicas entre abril de 2000 e novembro de 2005. Uma avaliação das características clínicas, laboratoriais e endoscópicas desses pacientes e dos descritos na literatura foi realizada. A revisão da literatura foi feita através de pesquisa no MEDLINE. RESULTADOS: Foram realizados 1.433 procedimentos de escleroterapia endoscópica de varizes esofágicas em 397 pacientes, com incidência de hematoma intramural esofágico de 4 casos (0,28%. Três dos quatro pacientes desenvolveram complicações adicionais e um falecimento foi consequência direta do hematoma intramural esofágico. Dezenove casos bem documentados de hematoma intramural esofágico foram descritos na literatura. Na maioria dos casos o hematoma intramural esofágico ocorreu a partir da quarta sessão de escleroterapia endoscópica de varizes esofágicas e distúrbios de coagulação estavam presentes. CONCLUSÃO: O hematoma intramural esofágico é complicação rara da escleroterapia e a incidência no hospital onde foi realizada esta pesquisa foi similar à observada na literatura. Este estudo sugere que essa complicação resulta de mucosa fragilizada por sessões previa de escleroterapia endoscópica de varizes esofágicas. Distúrbios da coagulação, apesar de não serem essenciais, podem contribuir para a formação e extensão do hematoma através da submucosa esofágica.

  14. Retroperitoneal hematoma following rofecoxib and enoxaparin coadministration in a patient with atrial fibrillation

    International Nuclear Information System (INIS)

    There are very few published reports implicating enoxaparin as a factor in retroperitoneal hematoma. We report a patient who developed a retroperitoneal hematoma after using enoxaparin for paroxysmal atrial fibrillation. A 72 year old man was admitted with a history of low back pain, radiating beyond the back to the buttocks. His medical history was positive for bilateral knee osteoarthritis. On his physical examination his vital signs were: temperature 36.8, blood pressure 100/70 mm Hg, pulse 72/min, respiratory rate 16/min. X-ray of both the knees showed bilateral osteoarthritic changes. Computerized tomography scan of the spine showed lumbar spinal stenosis and he was referred to a Neurosurgeon, who finds the patient not fit surgical intervention. ECG showed atrial fibrillation. He was given enoxaparin one mg/kg every 12 hour and digoxin. Abdominal computed tomography revealed a right retroperitoneal hematoma and no aortic aneurysm was noted and enoxaparin and rofecoxib were discontinued. His general condition improved. The factors that increase the risk of bleeding in patients receiving enoxaparin are use of high doses of enxaparin, advanced stage, renal impairment, and the concomitant use of drugs affecting hemostasis. Retroperotoneal hematoma should be considered in the different diagnosis in patients receiving enoxaparin and experiencing unexplained decreases in hemoglobin and hematocrit. In the order of precedence of radiologic diagnostic procedures for fast diagnosis of a retroperitoneal hematoma, abdominal CT-scan is the preferred method

  15. Large Esophageal Hematoma Following Transesophageal Echocardiography-Guided Device Closure of Atrial Septal Defect.

    Science.gov (United States)

    Sasikumar, Deepa; Mahadevan, Krishnamoorthy K

    2016-01-01

    A 47-year-old woman with a large ostium secundum atrial septal defect (ASD) and severe pulmonary artery hypertension underwent device closure of ASD under transesophageal echocardiography guidance. She developed a massive esophageal hematoma which was diagnosed 4 days after the procedure. The use of dual antiplatelets after the device closure further aggravated the hematoma. As the patient remained stable and the site of leak could not be identified by contrast studies, she was managed conservatively with nil per mouth, broad-spectrum antibiotics, and continuous nasogastric aspiration. We were faced with the risk of thromboembolism after stopping antiplatelets versus the risk of increasing peri-esophageal hematoma if they were continued. With careful monitoring for thrombus formation on the device, the antiplatelets were stopped and the hematoma resolved. The hematoma resolved by 10 days, and the antiplatelets were restarted gradually. Iatrogenic esophageal injury is an important cause of esophageal perforation, which is a condition with high mortality and morbidity. Esophageal perforation following device closure of ASD is particularly challenging as the scenario is worsened by the use of antiplatelets and they have to be discontinued with the attendant risk of thromboembolism. PMID:26494543

  16. Comparison of clinical outcomes of intraventricular hematoma between neuroendoscopic removal and extraventricular drainage

    International Nuclear Information System (INIS)

    The efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre- and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation. (author)

  17. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

    Directory of Open Access Journals (Sweden)

    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  18. Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Tatsuya; Sakai, Toshinori; Sairyo, Koichi; Katoh, Shinsuke; Yasui, Natsuo [The University of Tokushima Graduate School, Department of Orthopedics, Institute of Health Biosciences, Tokushima (Japan); Takao, Shoichiro [The University of Tokushima Graduate School, Department of Radiology, Institute of Health Biosciences, Tokushima (Japan); Kagawa, Seiko [The University of Tokushima Graduate School, Department of Human Pathology, Institute of Health Biosciences, Tokushima (Japan)

    2010-03-15

    Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma. (orig.)

  19. Olfactory hallucinations elicited by electrical stimulation via subdural electrodes: Effects of direct stimulation of olfactory bulb and tract

    OpenAIRE

    Kumar, Gogi; Juhasz, Csaba; Sood, Sandeep; Asano, Eishi

    2012-01-01

    In 1954, Penfield and Jasper briefly described that percepts of unpleasant odor were elicited by intraoperative electrical stimulation of the olfactory bulb in patients with epilepsy. Since then, few peer-reviewed studies have reported such phenomena elicited by stimulation mapping via subdural electrodes implanted on the ventral surface of frontal lobe. Here, we determined what types of olfactory hallucinations could be reproduced by such stimulation in children with focal epilepsy. This stu...

  20. Ligamentum flavum hematoma: a case report and literature review Hematoma del ligamento amarillo: caso clínico y revisión de la literatura Hematoma de ligamento amarelo: relato de caso e revisão da literatura

    OpenAIRE

    Ericson Sfreddo; Marcelo Teodoro Ezequiel Guerra

    2012-01-01

    The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion ...

  1. An in vivo model of anti-inflammatory activity of subdural dexamethasone following the spinal cord injury.

    Science.gov (United States)

    Kwiecien, Jacek M; Jarosz, Bozena; Oakden, Wendy; Klapec, Michal; Stanisz, Greg J; Delaney, Kathleen H; Kotlinska-Hasiec, Edyta; Janik, Rafal; Rola, Radoslaw; Dabrowski, Wojciech

    2016-01-01

    Current therapies to limit the neural tissue destruction following the spinal cord injury are not effective. Our recent studies indicate that the injury to the white matter of the spinal cord results in a severe inflammatory response where macrophages phagocytize damaged myelin and the fluid-filled cavity of injury extends in size with concurrent and irreversible destruction of the surrounding neural tissue over several months. We previously established that a high dose of 4mg/rat of dexamethasone administered for 1 week via subdural infusion remarkably lowers the numbers of infiltrating macrophages leaving large amounts of un-phagocytized myelin debris and therefore inhibits the severity of inflammation and related tissue destruction. But this dose was potently toxic to the rats. In the present study the lower doses of dexamethasone, 0.125-2.0mg, were administered via the subdural infusion for 2 weeks after an epidural balloon crush of the mid-thoracic spinal cord. The spinal cord cross-sections were analyzed histologically. Levels of dexamethasone used in the current study had no systemic toxic effect and limited phagocytosis of myelin debris by macrophages in the lesion cavity. The subdural infusion with 0.125-2.0mg dexamethasone over 2 week period did not eliminate the inflammatory process indicating the need for a longer period of infusion to do so. However, this treatment has probably lead to inhibition of the tissue destruction by the severe, prolonged inflammatory process. PMID:26851684

  2. Self-Inflicted Intraoral Hematoma in a Cardiac Patient Receiving Oral Anticoagulant Therapy- A Case Report

    Directory of Open Access Journals (Sweden)

    Shantala Arunkumar

    2015-01-01

    Full Text Available Intraoral hematoma secondary to systemic anticoagulant therapy is rare, but it is a potentially fatal condition requiring immediate medical management. Case report: Here we report a case of self-inflicted hematoma in the anterior maxillary gingival region in a 65year old female cardiac patient who was on systemic anticoagulant therapy with a poor periodontal condition, manifesting as a periodontal swelling for a period of one week. Oral anticoagulant therapy is considerably imperative to prevent thromboembolic complications in various medical conditions, in such patients there are chances for spontaneous bleeding or hematoma by means of minor trauma due to sharp teeth or dental prosthesis in the mouth leading to life threatening complications such as partial or complete airway blockage. Therefore,directives about possible bleeding complications secondary to anticoagulant drugs in the oral cavity and the importance of maintaining oral health hygiene are necessary for the patient.

  3. A "pseudo-cavernoma" - an encapsulated hematoma of the choroid plexus.

    Science.gov (United States)

    Dey, Mahua; Turner, Michael S; Pytel, Peter; Awad, Issam A

    2011-06-01

    We present the first report of an intraventricular encapsulated hematoma, mimicking cavernous malformation on imaging and gross lesion appearance. A 47-year-old female on anticoagulation therapy for atrial fibrillation presented with left upper extremity apraxia, neglect, and mild gait imbalance. Her brain CT scan and MRI revealed multilobulated lesions involving the choroid plexus in the atria of both lateral ventricles. The intraoperative appearance was that of encapsulated mass, with blood clots at different stages of liquefaction and organization, all consistent with the gross appearance of a cavernous malformation. However, histopathologic examination demonstrated hematoma with components at different ages, and normal vessel infiltration without any hint of cavernous malformation histology, or underlying neoplasia. Encapsulated hematoma should be considered in the differential diagnosis of hemorrhagic intraventricular masses. PMID:21435884

  4. Solid Right Ventricular Compression by Intraventricular Septum-Hematoma Induced after Percutaneous Coronary Intervention

    Science.gov (United States)

    El-Battrawy, Ibrahim; Akin, Ibrahim; Münz, Benedikt; Leistner, David Manuel; Behnes, Michael; Henzler, Thomas; Haubenreisser, Holger; Papavassiliu, Theano; Borggrefe, Martin; Lehmann, Ralf

    2016-01-01

    Intraventricular septum-hematoma is a rare complication following percutaneous coronary intervention (PCI). This complication may represent a challenge for accurate diagnosis and treatment. This case report is about a 60-year-old male patient being admitted with an acute coronary syndrome. Despite successful PCI with drug eluting stent implantation into the right coronary artery (RCA) the patient complained about recurrent angina pectoris according to Canadian Cardiovascular Society (CCS) class IV. Cardiac magnetic resonance imaging and transthoracic echocardiography revealed a massive 4.9 × 9.2 cm sized end-diastolic septum-hematoma, which compromised right ventricular cavity. Emergent recoronary angiography ruled out further contrast extravasation from the RCA. Conservative treatment was intended after discussion in the “heart-team.” The patient completely recovered with nearly complete resolution of the hematoma after 6 months.

  5. Retroperitoneal hematoma associated with femoral neuropathy: a complication under antiplatelets therapy.

    Directory of Open Access Journals (Sweden)

    Nakao A

    2001-12-01

    Full Text Available We report a case of retroperitoneal hematoma presenting as femoral nerve pulsy on antiplatelet therapy. The patient, a 78-year-old man who had undergone antiplatelet treatment using ticlopidine, was admitted to our hospital with complaints of sudden-onset low abdominal and back pain. Computed tomography showed an iso-density mass in the right retroperitoneum within the psoas muscle. We made a diagnosis of retroperitoneal hematoma compressing the femoral nerve and performed an operation to remove the hematoma in order to decompress the femoral neuropathy. Postoperatively, the patient rapidly recovered from the femoral neuropathy. In the particular case in which no antagonist against the ticlopidine is available, surgical decompression could produce a good outcome.

  6. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso

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    Ivan Hack

    1984-03-01

    Full Text Available Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos.

  7. Spinal epidural hematoma caused by pseudogout: a case report and literature review.

    Science.gov (United States)

    deSouza, R M; Uff, C; Galloway, M; Dorward, N L

    2014-06-01

    Study Design Case report. Objective We present the first reported case of spontaneous spinal epidural hematoma secondary to calcium pyrophosphate crystal deposition disease (pseudogout) in a 75-year-old woman. Methods A retrospective review of the patient's case notes was undertaken and the limited literature on this subject reviewed. Results This patient presented with sudden-onset lower limb paresis, sensory loss, urinary retention, and back pain. Magnetic resonance imaging showed an epidural hematoma, which was evacuated. Histologic specimens of the clot showed calcium pyrophosphate dihydrate crystal deposits (pseudogout). Conclusion The importance of histopathologic review of surgical specimens is highlighted when considering the differential diagnosis of apparently spontaneous spinal epidural hematoma. PMID:25072005

  8. Chronic encapsulated intracerebral hematoma: Three case reports and a literature review

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    Akira Nishiyama

    2014-01-01

    Conclusion: We should keep in mind that CEIH is a differential diagnosis for intracerebral space-occupying lesions. This report describes these three cases and discusses imaging findings and characteristics of CEIH.

  9. Practical CT classification for thalamic hemorrhage. Relationship between localization of hematoma and prognosis

    International Nuclear Information System (INIS)

    The study was designed to establish CT classification for predicting prognosis of thalamic hemorrhage. A retrospective analysis was made on CT scans from 100 patients with hypertensive thalamic hemorrhage less than 4 cm. Four lines were drawn on axial CT scans at the level of the pineal body: (A) line between the lateral edge of the anterior horn and the midpoint of the third ventricle; (B) vertebral line to the sagittal line from the midpoint of the third ventricle; (C) line between the lateral edge of the trigone and the midpoint of the third ventricle; and (D) line between the lateral edge of the anterior horn and the lateral edge of the trigone. According to the lateral extension, the location of hematoma fell into three types: anterior type in which the center of hematoma was located between lines A and B (type A); posterior type in which the center of hematoma was located between lines B and C and external margin of hematoma was localized medial to line D (type P); postero-lateral type in which the center of hematoma was located between lines B and C and showed lateral extension beyond line D (type PL). Severe hemiparesis was observed in 15.3% for type A, 21.8% for type P, and 59.3% for type PL. Good prognosis was seen in 84.7% for type A, 70.9% for type P, and 12.5% for type PL. Acute disturbance of consciousness was significantly observed in patients with medial extension of hematoma (86.4%) as compared with those without it (21.4%). These results indicated that CT classification is a simple means for predicting functional outcome of motor paresis and consciousness disturbance in patients with thalamic hemorrhage. (N.K.)

  10. Clinical study of treatment of cerebral hemorrhage: remove the intracranial hematoma with a minimal invasive procedure

    International Nuclear Information System (INIS)

    Objective: To study the feasibility and factors of minimal invasive intracranial hematoma removing procedure as a treatment of cerebral hemorrhage. Methods: From May, 2000 to September, 2003, 33 patients with intracerebral hemorrhage underwent minimal invasive intracranial hematoma removing procedure and from May, 1997 to September, 2000, 27 patients with cerebral hemorrhage received conservative treatments. Two groups were compared and analyzed. The quantity of hemorrhage and the indication of procedure were also studied. Results: State of an illness has no significant difference between the two groups (P<0.05). The rate of recovery were higher in the group undergoing the procedure (57.6%) than in the control group (14.8%) (P<0.05). The rate of handicap were lower in the procedure group (24.0%) than in the control group (60.0%) (P<0.05). The mortality were also lower in the procedure group (24.2%) than in the control group (63.0%) (P<0.01). In the control group no patient with a hematoma larger than 70 ml survived. In the procedure group patients with hematoma larger than 70 ml had less chance of survival than the other patients (P<0.01). The mortality rate were respectively 50%, 5.6%, 33.3% when the procedure was done in super early, early, delayed stage. The mortality rate was higher in the super early stage than in early stage (P<0.05). Conclusion: The minimal invasive intracranial hematoma removing procedure has a better clinical outcome than the conservative treatment. The procedure reduces obviously mortality rate and increase the quality of survival. Multiple puncturing and draining or craniotomy are recommended to remove huge hematoma. The earlier treatment brings better clinical effects. This technique is simple, less invasive and provides good clinical outcome, which is worth recommendation

  11. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

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    Birkholz Torsten

    2010-01-01

    Full Text Available A 77-year-old man suffered hypoxemic cardiac arrest by supraglottic and tracheal airway obstruction in the emergency department. A previously unknown cervical fracture had caused a traumatic retropharyngeal-mediastinal hematoma. A lifesaving surgical emergency tracheostomy succeeded. Supraglottic and tracheal obstruction by a retropharyngeal-mediastinal hematoma with successful resuscitation via emergency tracheostomy after hypoxemic cardiac arrest has never been reported in a context of trauma. This clinically demanding case outlines the need for multidisciplinary airway management systems with continuous training and well-implemented guidelines. Only multidisciplinary staff preparedness and readily available equipments for the unanticipated difficult airway solved the catastrophic clinical situation.

  12. Hematoma of the proximal nail fold due to oximeter in a child

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    Patricia Chang

    2014-01-01

    Full Text Available Boy 4 years old, hospitalized due to hemorrhagic chickenpox and sepsis during his clinical examination besides hemorrhagic crust, vesicles and bullous he has also a cutaneous red lesion localized at the right proximal nail fold of the big toenail (Fig. 1, dermatoscopic view of the lesion (Fig. 2. The diagnosis of hematoma of the proximal nail fold due to oximeter was done. The proximal nail fold hematomas due to oximeter are uncommon dermatoses at this level that are caused for the pressure of the oximeter and it has been seeing in patient in Unit Intensive or Intermediate Unit Care since 2007.

  13. Acute Retroperitoneal Hematoma After Psoas Catheter Placement in a Patient with Myeloproliferative Thrombocytosis and Aspirin Therapy.

    Science.gov (United States)

    Warner, Nafisseh S; Duncan, Christopher M; Kopp, Sandra L

    2016-01-15

    Retroperitoneal hematoma is a rare complication of psoas catheter placement, typically occurring several days after placement and in the setting of anticoagulation. We present the case of a patient with a history of myeloproliferative thrombocytosis receiving aspirin therapy who underwent total hip arthroplasty with preoperative psoas catheter placement complicated by immediate development of a large retroperitoneal hematoma. It is likely that the combination of aspirin therapy and thrombocytosis paradoxically placed the patient at increased risk for hemorrhagic complications. Regional techniques should be used cautiously in patients with myeloproliferative disorders, even in the presence of supraphysiologic platelet counts. PMID:26779603

  14. Nontraumatic subperiosteal orbital hematoma associated with ethmoid sinusitis: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Sung Soo; Han, Jong Kyu; Baek, Byoung Joon; Oh, Mee Hye; Jou, Sung Shick; Kim, Hyung Hwan; Bae, Won Kyung; Kim, Il Young [Soonchunhyang University, Cheonan Hospital, Cheonan (Korea, Republic of)

    2007-08-15

    Subperiosteal hematoma of the orbit is a rare disease and most of the cases occur in young adult males as a result of direct facial or orbital trauma. In the absence of direct facial or orbital trauma, nontranmatic subperiosteal orbital hematoma has rarely been reported in association with a sudden elevation of cranial venous pressure or venous congestion, systemic diseases associated with a bleeding diathesis and paranasal sinusitis. We report here on a rare case of subperiosteal orbital hemaboma associated with ethmoid sinusitis, as was seen on CT imaging.

  15. MR demonstration of spontaneous acute epidural hematoma of the thoracic spine

    International Nuclear Information System (INIS)

    Two patients with spontaneous epidural hematoma of the thoracic spine are presented. The magnetic resonance (MR) examination performed within the first hours following the onset of symptoms demonstrated an epidural elongated lesion impinging on the spinal cord, compatible with hematoma. In one of the patients this finding was surgically confirmed. The second patient improved under steroid treatment. The MR findings were highly suggestive of the pathological nature of the lesion. The MR examination should replace other diagnostic procedures, such as computerised tomography (CT) and myelography. (orig.)

  16. Hemophilia and child abuse as possible causes of epidural hematoma: case report Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso

    OpenAIRE

    Fernando Campos Gomes Pinto; Fabrizio Frutos Porro; Liliana Suganuma; Ricardo Bragança de Vasconcellos Fontes; Almir Ferreira De Andrade; Raul Marino Jr.

    2003-01-01

    INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epi...

  17. A new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report

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    Arasho Belachew

    2010-11-01

    Full Text Available Abstract Introduction The trigemino-cardiac reflex is defined as the sudden onset of parasympathetic dysrhythmia, sympathetic hypotension, apnea, or gastric hypermotility during stimulation of any of the sensory branches of the trigeminal nerve. Clinically, trigemino-cardiac reflex has been reported to occur during neurosurgical skull-base surgery. Apart from the few clinical reports, the physiological function of this brainstem reflex has not yet been fully explored. Little is known regarding any predisposing factors related to the intraoperative occurrence of this reflex. Case presentation We report the case of a 70-year-old Caucasian man who demonstrated a clearly expressed form of trigemino-cardiac reflex with severe bradycardia requiring intervention that was recorded during surgical removal of a large subdural empyema. Conclusion To the best of our knowledge, this is the first report of an intracranial infection leading to perioperative trigemino-cardiac reflex. We therefore add a new predisposing factor for trigemino-cardiac reflex to the existing literature. Possible mechanisms are discussed in the light of the relevant literature.

  18. Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome

    Science.gov (United States)

    Salgado, German Alcoba; Ferreira, Cristiane Rbia; Felipe-Silva, Alosio; Gilio, Alfredo Elias

    2015-01-01

    The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.

  19. ADVANCED UVEAL MELANOMA WITH SUBDURAL METASTASIS MIMICKING MENINGEOMA - A CASE REPORT

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    Predrag Kovačević

    2011-03-01

    Full Text Available Uveal melanoma is a rare malignancy. Its clinical course is highly agressive. At thetime of diagnosis, extraocular extension is present in most of the cases.We present a case of 69-year-old white man admitted for sharp orbital pain. Advanced uveal melanoma was diagnosed. We found black-colored tumor rotruding from the left eye and multiple cutaneous metastases on the scalp. CT scan revealed intracranial tumor mimicking meningeoma in the left parietal region. Lymhogenous metastases were not found and other hematogenous metastases were excluded. After biopsy of the eye tumor and excisional biopsy of one skin tumor, the uveal melanoma was diagnosed and the left orbital exenteration and extirpation of intracranial tumor were performed. The reconstruction was performed using galeacutaneous flap harvested from craniotomy flap. Postoperative course was uneventful and the patient was released from pain. He refused the additional oncological treatment. After four months, he died of liver metastatic disease.The uveal melanoma is highly aggressive malignancy and isolated subdural metastasis is quite rare. The reconstruction with transposed galeacutaneous flap is versatile and secure technique after orbital exenteration.

  20. Broad ligament hematoma causing fetal death in a case of fracture pelvis.

    Science.gov (United States)

    Malhotra, N; Malhotra, B; Deka, D; Takkar, D

    2001-09-01

    Although motor ventricular accidents complicates 6-7% of all pregnancies, the experience of pelvic fractures in near term gravid patients is limited. We present a unique case of fetal death caused by bilateral broad ligament hematomas following maternal pelvic fracture which improved our understanding of management of such cases. PMID:11516815

  1. Medial gastrocnemius hematoma mimicking deep vein thrombosis: report of a case.

    Science.gov (United States)

    Liu, S H; Chen, W S

    1989-06-01

    Tennis leg, strain of the medial head of the gastrocnemius muscle, may follow a trivial trauma in athletic and nonathletic activities. Complete or partial tears of the musculotendinous unit may result in a hematoma. Clinical manifestations of gastrocnemius hematoma in a 64-year-old man with local swelling, pain and tenderness that was aggravated by passive dorsiflexion of the ankle joint, mimicked deep vein thrombosis. Failure to appreciate the precedent trivial trauma and the localized swelling and ecchymosis led to delayed diagnosis and inappropriate heparinization. The definite diagnosis was established by CT scan which revealed a local soft tissue mass within the gastrocnemius consistent with a hematoma. A compartment syndrome developed the day after heparinization and was adequately treated by discontinuation of heparin, aspiration and rest. Differentiation between tennis leg and deep vein thrombosis is of paramount importance, since the etiology, treatment and prognosis of these two clinical entities are quite different. Venography is recommended as specifically diagnostic for deep vein thrombosis while CT scan for gastrocnemius hematoma. PMID:2794964

  2. Liver hematoma for close abdominal traumatisms.A practice with a conservative strategy

    International Nuclear Information System (INIS)

    Liver traumatisms is a complex therapeutic problem.Within the last few years, the development of modern scanning procedures and patient control have rendered possible improvement in diagnosis and elevate follow-up of liver contusions, thus favoring a nonsurgical therapeutic approach in carefully selected patients.The purpose of this study is to evaluate selection parameters and evolutive control which are considered the efficient variables for non surgical treatment of traumatic liver hematoma.Case material was selected from among 157 patients in four hospital centers in Montevideo suffering from occluded hepatic traumatisms.Thirty five among them had hematomas and were selected, having previously been subject to CT scanning, as a basis for this study by reason of their being apt to receive primary non surgical management.Other favorable elements taken into account were their hemodynamic stability of special care units.Fibrolaparoscopy was used as an additional diagnostic and therapeutic tool.Ninety four percent of these patients were discharged without need of resorting to surgery.There were no deaths in our series.Two patients were operated due to rupture of hematoma and ensuing hemodynamic de compensation and two others had to undergo evacuation of residual intra abdominal collections.All cases were followed by CT scanning up to the complete resolution of hematoma

  3. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    Directory of Open Access Journals (Sweden)

    Tugan Tezcaner

    2014-01-01

    CONCLUSION: We report a rare intestinal obstruction case caused by stricture at the level of ligamentum Treitz with PNH. The possibility simply has to be borne in mind that strictures can be occurring at hematoma, ischemia or inflammation site of gastrointestinal tract.

  4. Retroperitoneal hematoma compressing a single functioning kidney: an unusual cause of obstructive renal failure.

    Science.gov (United States)

    Monge, M; Vaida, I; Modeliar, S S; Solanilla, A; Airapetian, N; Presne, C; Makdassi, R; Fournier, A; Choukroun, G

    2007-05-01

    We report a case of a retroperitoneal hematoma occurring in a patient under anticoagulation therapy for deep-venous thrombosis and presenting as an anuric acute renal failure. A coexisting polycythemia vera led to misdiagnosis that could have been life-threatening. A woman, known for polycythemia vera and a single functioning right kidney, was admitted with mild abdominal pain in a context of recent deep venous thrombosis under low-molecular weight heparin. Clinical examination revealed hepatomegaly associated with polycythemia vera. Biochemical evaluation disclosed an acute renal failure, and renal ultrasonography showed no dilation of the renal pelvis. Retroperitoneal hematoma resulted in shock, progressive anemia and obstructive renal failure, related to renal pelvic compression. A right renal indwelling catheter was introduced to restore urine flow after one hemodialysis session, and an inferior vena cava filter was placed because of anti-coagulation contra-indication. However, pulmonary embolism occurred, so that oral anticoagulants were introduced. The hematoma resorbed spontaneously, and a year after this episode, the patient is still alive and well. Retroperitoneal hematoma is a rare cause of obstructive acute renal failure and a life-threatening complication of anti-coagulation therapy. PMID:17542341

  5. Spinal Epidural Hematoma Following Cupping Glass Treatment in an Infant With Hemophilia A.

    Science.gov (United States)

    Fruchtman, Yariv; Dardik, Rima; Barg, Assaf Arie; Livnat, Tami; Feldman, Zeev; Rubinstein, Marina; Grinberg, Gahl; Rosenberg, Nurit; Kenet, Gili

    2016-06-01

    A 6 months old infant, diagnosed with a rare mutation causing severe hemophilia A, presented with spinal epidural hematoma. Parents later admitted the infant had glass cupping therapy performed within 2 weeks of the onset of symptoms. The rare mutation, rare bleeding complication, and the eventual course of therapy applied in this case will be discussed in our case report. PMID:26844816

  6. Intramural hematoma or aortic dissection – a diagnostic and therapeutic problem. A case report

    Science.gov (United States)

    Suder, Bogdan; Wasilewski, Grzegorz; Sadowski, Jerzy; Kapelak, Bogusław

    2015-01-01

    The authors present a case report of a 60-year-old patient with an ascending aortic aneurysm along with the associated diagnostic and therapeutic problems. The choice of therapy in patients with aortic intramural hematoma is difficult and should be based on comprehensive evaluation of the patient's status as well as on the experience of the radiologist and surgeon. PMID:26702280

  7. Hematoma de músculo iliopsoas na vigência de tratamento com varfarina Hematoma de músculo iliopsoas en la vigencia de tratamiento con warfarina Iliopsoas muscle hematoma during treatment with warfarin

    Directory of Open Access Journals (Sweden)

    Gabriel Zago

    2010-01-01

    Full Text Available A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais.La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrencia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales.Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

  8. The role of CT in pelvic fracture. CT finding of retro-peritoneal hematoma and indication of transcatheter arterial embolization

    International Nuclear Information System (INIS)

    Although retro-peritoneal hematoma accompanying a pelvic fracture has been treated by arterial ligation formerly, it is associated with a high mortality rate and a transcatheter arterial embolization has now become the first choice of treatment. Meanwhile, the usefulness of computed tomography (CT) in traumatized patient has been reported frequently. Our hospital also employs CT positively as an examination following plain radiography in the cases with pelvic fracture. However, while indication of angiography is seen in several reports, the amount of retro-peritoneal hematoma as an index has not been reported. In the present study, we examined 112 patients given CT at the time of examination at the emergency center of our hospital between April 1, 1988, and June 30, 1997, and classified the amount of retro-peritoneal hematoma on CT into 5 groups to discuss indication of angiography. In the cases with moderate or massive amount of retro-peritoneal hematomas, cases with shock state exceeded 60% and the amount of hematoma was considered to reflect the circulation profile to a certain extent. As the amount of retro-peritoneal hematoma increased, the number of cases given embolization also increased; embolization was performed in 29 cases (61.7%) among those which had moderate or massive amount of hematoma. From the above findings, it was predicted that the amount of retro-peritoneal hematoma could be one of the deciding factors for indication of angiography. However, as there are cases falling into a shock state due to gradual increase of hematoma or associated with injuries in other organs, careful observation is needed for the cases judged out of indication. (author)

  9. Gestational trophoblastic disease and bilateral renal subcapsular hematoma, an unusual form of clinical presentation

    International Nuclear Information System (INIS)

    Full text: Introduction: Gestational trophoblastic disease (GTD)includes a heterogeneous group of rare diseases which originate in the trophoblastic epithelial proliferation placental βHCG elevation. Recognizes clinico pathological mainly 4 ways: hydatidiform mole (partial and complete), invasive mole, placental site tumor coriocarcioma, latter being highly aggressive to spread through the blood. The most common sites of metastasis are lung, liver and CN S. The presentation with renal and bilateral subcapsular hematoma is a rarity with few reports in the literature. It is a potentially curable disease chemotherapy, even in advanced stages. Case report: A 28 years with complete hydatidiform mole A P in 2006. Login low back pain in May/2011. Urinary tract ultrasonography and CT pelvis tx- ab d- subcapsular hematomas showed bilateral bulky, up to 6 cm. nodule right lung. R M ab d- pelvic supports multiple hepatic hematomas secundarismo renal subcapsular. The study cancer and brain CT were normal and βHCG of 256,000 mIU / ml. The FIGO prognostic score was higher than 7 constituting high-risk disease. Urological behavior was watchful waiting. Q T received 3 cycles of PE B type, followed by EMA- CO, obtaining βHCG normalization after the 3rd. this protocol cycle, completing two additional cycles of consolidation to November/2011. Complete remission was obtained and frank imagenological reduction hematomas. In February/2012 βHCG rise is observed. Cranial CT and MRI confirmed single lesion right parietal being operated on. The A- P confirms metastases choriocarcinoma support. Get Q T Type E P for 4 cycles with normalization of βHCG maintaining the time of this communication. Discussion and Conclusions: The choriocarcinoma is an unusual entity being chemosensitive clinical presentation with a renal subcapsular hematomas. presents For a patient who responded completely to the cisplatin -based Q T that evolution has a single brain metastasis treated with surgery and Q T. It aspects discussed diagnostic, prognostic and therapeutic

  10. Ligamentum flavum hematoma: a case report and literature review Hematoma del ligamento amarillo: caso clínico y revisión de la literatura Hematoma de ligamento amarelo: relato de caso e revisão da literatura

    Directory of Open Access Journals (Sweden)

    Ericson Sfreddo

    2012-01-01

    Full Text Available The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cauda equina syndrome. The magnetic resonance imagining (MRI showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.El objetivo es presentar un caso raro de un hematoma ligamento flavum en la región lumbar, discutir su fisiopatología y el tratamiento y revisión de la literatura. Una mujer de 68 años presentó claudicación neurogénica debido a la espondilolistesis lumbar degenerativa y que se convirtió en un repentino empeoramiento con el síndrome de cauda equina. Una imagen de resonancia magnética (RM mostró signos de degeneración de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografía del ligamento amarillo. La paciente fue sometida a laminectomía y fijación lumbar. Su evolución fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a pesar del dolor que se controla con medicamentos simples. Aunque raro, parece que el hematoma del ligamento amarillo tiene relación con la degeneración y la ruptura de pequeños vasos asociadas a micro-traumas en la columna vertebral. Su fisiopatología no está bien definida y el tratamiento es similar a otros procesos de compresión de la columna vertebral.O objetivo é apresentar um caso raro de hematoma do ligamento amarelo na região lombar, discutir sua fisiopatologia e tratamento e revisar a literatura. Uma mulher de 68 anos apresentou-se com claudicação neurogênica devido à doença degenerativa lombar e espondilolistese que evoluiu para uma piora súbita com a síndrome da cauda equina. A imagem por ressonância magnética (IRM mostrou sinais de degeneração da coluna lombar, com um canal vertebral estreito de L2 a S1, ântero-listese de L4 L5 e, posteriormente no nível da L1-L2, um processo expansivo arredondado e hiperintenso em T1 e com bordas hipointensas em T2 ponderada, compatível com hematoma na topografia do ligamento amarelo. A paciente foi submetida a laminectomia e fixação lombar. Sua evolução foi boa no período pós-operatório e, aos 18 meses de follow-up andou sozinha, apesar da dor que é controlada com medicamentos simples. Mesmo sendo raro, parece que o hematoma do ligamento amarelo tem uma relação com a degeneração e ruptura de pequenos vasos associadas a microtraumas na coluna vertebral. Sua fisiopatologia ainda não é bem definida e o tratamento é semelhante ao de outros processos de compressão da coluna vertebral.

  11. Decompressive craniectomy for acute subdural haematoma: An overview of current prognostic factors and a discussion about some novel prognostic parametres

    International Nuclear Information System (INIS)

    Objective: To identify specific factors that can be used to predict functional outcome and to assess the value of decompressive craniectomy in patients with acute subdural haematoma. Methods: The retrospective study was done at the Zonguldak Karaelwas University Practice and Research Hospital, Turkey, and included 34 trauma patients who had undergone decompressive craniectomy for acute subdural haematoma from 2001 to 2009. At the 30th day of the operation, the patients were grouped as survivors and non-survivors. Besides, based on their Glasgow Outcome Scale, which was calculated 6 months post-operatively, the patients were divided into two functional groups: favourable outcomes (4-5 on the scale), and unfavourable outcomes (1-3 on the scale). The characteristics of the groups were compared using SPSS 15 for statistical analysis. Results: One-month mortality was 38.2% (n=13) and 6-month total mortality reached 47% (n=16). Patients with higher pre-operative revised trauma score, Glasgow coma scale, partial anterial pressure of carbon dioxide, arterial oxygen pressure, Charlson co-morbidity index score, blood glucose level, blood urea nitrogen, and lower age had a higher rate of survival and consequently a favourable outcome. Higher platelet values were only found to be a determinant of higher survival at the end of the first month without having any significant effect on the favourable outcome. Conclusion: In patients of traumatic acute subdural haematoma whose Glasgow coma scale on arrival was < 8, a massive craniectomy along with the evacuation of the haematoma, may be considered as a treatment option for intra-operative and post-operative brain swelling. But in patients with a score of 3 on arrival and bilaterally fixed and dilated pupils, decompressive craniectomy is unnecessary. (author)

  12. Diagnosis of epidural hematoma by brain scan and perfusion study: case report. [/sup 99m/Tc tracer techniques

    Energy Technology Data Exchange (ETDEWEB)

    Buozas, D.J.; Barrett, I.R.; Mishkin, F.S.

    1976-11-01

    By using the arterial and venous phases of an anterior cerebral perfusion study, which showed downward displacement of the sagittal sinus, and the finding of a rim on the delayed scans, the specific diagnosis of epidural hematoma was established.

  13. Hematoma subcapsular esplnico en paciente portador de rasgo falciforme Sub capsular splenic hematoma in a sickle cell trait carrier. Case report

    Directory of Open Access Journals (Sweden)

    Diego Ugalde

    2011-09-01

    Full Text Available Drepanocytic anemia is an uncommon hereditary disease in Chile. The heterozygous state of drepanocytic anemia or "sickle trait" has a frequency of 8% among Afro-Americans. A small number of patients carrying hemoglobin S are homozygous, with clinical manifestations of hemolytic anemia and thrombotic disease. Sickle trait is usually asymptomatic. We report a 59-year-old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan showed the presence of a subcapsular splenic hematoma that was managed conservatively. Sickle cell induction with sodium metabisulphite was positive. Hemoglobin electrophoresis confirmed the sickle trait.

  14. Hematoma renal subcapsular espontneo secundario al empleo de antiagregantes plaquetarios / Spontaneous renal sub-capsular hematoma after the use of antiplatelet

    Scientific Electronic Library Online (English)

    Toms Lzaro, Rodrguez Collar; Basily, Valds Estvez; Joan, Laffita Zamora; Evelio, Bueno Snchez; Jorge Luis, Germn Meliz.

    2014-06-01

    Full Text Available Paciente masculino de 65 aos de edad, con antecedentes de habrsele colocado stent coronario y tratamiento antiagregante plaquetario con Aspirina y Clopidogrel. A los 21 das comenz a presentar dolor en el flanco y la fosa ilaca derechos, nuseas y vmitos. En el examen fsico inicial se detect [...] dolor y aumento de volumen en las zonas referidas y los signos vitales normales. El ultrasonido abdominal revel coleccin perirrenal derecha bien delimitada y riones de tamao y ecoestructura normal. La tomografa axial computarizada evidenci la presencia de una imagen renal subcapsular derecha, con densidades de lquido, con compresin extrnseca de un rin estructuralmente normal. Al da siguiente del ingreso comenz a presentar fiebre de 38 C. Se suspendi el tratamiento antiagregante plaquetario y a los 7 das se realiz lumbotoma y drenaje del hematoma; se obtuvo alrededor de 400 mL de sangre carmelitosa. El paciente evolucion satisfactoriamente. Se concluye que el hematoma renal subcapsular espontneo es una complicacin inusual del uso de antiagregantes plaquetarios que necesita manejo multidisciplinario. La tomografa axial computarizada es indispensable para el diagnstico imagenolgico de certeza. La compresin renal por su gran tamao, as como el dolor y la aparicin de fiebre, justifican su drenaje quirrgico. Abstract in english A case of a 65 year-old male patient with a history of having received a coronary stent and antiplatelet therapy with Aspirin and Clopidogrel is presented here. He complained of pain in the right flank and iliac fossa nausea and vomiting 21 days after the procedure. At initial physical examination [...] , normal vital signs but pain and increased volume in the aforementioned areas were detected. Abdominal ultrasound revealed well defined right perirenal collection and normal size kidneys and echotexture. Computed tomography showed the presence of a right subcapsular renal image with liquid density and extrinsic compression of a structurally normal kidney. The day after admission the patient ran a fever of 38 C. Antiplatelet therapy was discontinued and lumbotomy and drainage of the hematoma was performed 7 days latter; about 400 mL of brownish blood was obtained. The patient progressed satisfactorily. It is concluded that spontaneous subcapsular renal hematoma is a rare complication of antiplatelet requiring multidisciplinary management.Computed tomography imaging is required for diagnosis. The renal compression due to its large size as well as pain and fever, justify their surgical drainage.

  15. Angiographic Embolization of a Postpartum Vulvovaginal Hematoma in a Patient with Situs Inversus Totalis: An Effective Second-Line Treatment

    OpenAIRE

    Dahdouh, Elias M.; Jacques Balayla; Johanne Dubé

    2013-01-01

    Situs inversus totalis is a rare congenital anomaly where asymmetrical positioning of internal organs may affect the surgical and radiological management of certain conditions. Vulvovaginal hematoma is a life-threatening complication of vaginal delivery whose primary treatment usually consists of incision and drainage of the hematoma and ligation of the responsible vessels, followed by wound packing. Failure of these measures to control the bleeding was previously considered as an indication ...

  16. Surgical Management of Left Upper Quadrant Sided Rectus Sheath Hematoma Occurred by Coughing in a Hemodialysis Patient

    OpenAIRE

    Yun, Sangchul; Cho, Sungwoo; Kim, Zisun; Chong, Han Ul; Kim, Jae Joon

    2015-01-01

    Rectus sheath hematoma (RSH) is a rarely-occurring disease that is usually associated with anticoagulation, trauma, or spontaneous events. Most spontaneous rectus sheath hematomas may be relieved with conservative management. However, some extreme situations need surgical approach. Respecting the fact that the inferior epigastric artery mainly supplies the rectus abdominis muscle, interrupting its proximal side would cease the bleeding. We present a stepped procedure of ligation of the inferi...

  17. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2011-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  18. Warfarin-induced sublingual hematoma mimicking Ludwig angina: Conservative management of a potentially life-threatening condition.

    LENUS (Irish Health Repository)

    Cashman, Emma

    2012-02-01

    Sublingual hematoma secondary to excessive anticoagulation is a rare, life-threatening condition. Reports in the literature have emphasized the importance of a prompt reversal of the causative coagulopathy by intravenous administration of vitamin K and fresh frozen plasma. In the event of an unstable airway, surgical intervention via tracheostomy or cricothyroidectomy is advocated. We report a case of sublingual hematoma that was treated conservatively, and we discuss the presentation and management of this entity.

  19. "Rabbit Ear" scalp deformity caused by massive subdural effusion in infant following bilateral burr-hole drainage

    Directory of Open Access Journals (Sweden)

    Guru Dutta Satyarthee

    2013-01-01

    Full Text Available Subdural effusion (SDE in an infant is a rare clinical scenario, which may be secondary to a variety of etiologies. Massive SDE is an extremely rare complication of head injury. It usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management includes burr-hole alone, burr-holes with subdural drain placement, twist drill craniotomy with drain and even craniotomy. The authors report a rare case of progressive massive SDE, which despite bilateral burr-hole placement and drainage failed and presented with visual deterioration and massive bulge of scalp at burr-hole sites producing rabbit ear sign in a 10 month old infant. Ultimately cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous burr-hole placement. Astonishingly not only complete resolution of hygroma, but visual recovery also took place. Patient is doing well at 6 months following shunt with regaining normal vision and appropriate developmental milestones. A magnetic resonance imaging scan of brain at last follow-up revealed mild ventriculomegaly with subduro-peritoneal shunt in situ and rest of brain was unremarkable. Such cases have not been reported in literature until date.

  20. Preventive effect of aggressive blood pressure lowering on hematoma enlargement in patients with ultra-acute intracerebral hemorrhage

    International Nuclear Information System (INIS)

    The preventive effect of aggressive blood pressure lowering on hematoma enlargement was investigated in patients with ultra-acute spontaneous intracerebral hemorrhage (ICH). Retrospective review of 248 patients (145 males, 103 females) with spontaneous ICH treated in our hospital between 2005 and 2008 identified patients with ultra-acute ICH who were directly taken to our institute by ambulance within 3 hours after onset. Patients who could not be assessed twice by computed tomography (CT) within 24 hours after arrival were excluded. Systolic blood pressure (SBP) was aggressively controlled in all patients using intravenous nicardipine to below 140 mmHg as soon as possible after diagnosis of ICH with CT. Hematoma enlargement was defined as increase in volume of more than 33% or more than 12.5 ml in the first 24 hours. Hematoma enlargement was observed in 11 of the 73 patients (15.0%). The time course of SBP change was not significantly different in patients with and without hematoma enlargement. The incidence of hematoma enlargement in patients with ultra-acute ICH in this study was 15.0%, which was lower than that in other series in which blood pressure was not reduced aggressively. This finding suggests that aggressive SBP lowering to below 140 mmHg has a preventive effect on hematoma enlargement in patients with ultra-acute ICH. (author)

  1. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns

    Directory of Open Access Journals (Sweden)

    Upendra Hansda

    2013-01-01

    Full Text Available Hutchinson-Gilford progeria syndrome (HGPS is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.

  2. Aspiration of coagulated hematoma in the third and fourth ventricles via paracele anterior horn puncture.

    Science.gov (United States)

    Tao, Zhi-Qiang; Ding, Sheng-Hong

    2016-02-01

    Intraventricular hemorrhage (IVH) is a neurological urgency with a high mortality and unfavorable prognosis. Fast removal of intraventricular blood should be considered as a priority. The current treatments of IVH mainly focus on external ventricular drain and endoscopic aspiration, but neither way can remove the blood in the fourth ventricle easily and relieve the compression of brainstem. Here we report a unique procedure to solve this problem. A 41-year-old male patient who had suffered sudden attack of headache and disturbance of consciousness for 2 h was diagnosed as having high density lesion in the whole ventricular system by computed tomographic (CT) imaging. An emergent bilateral ventriculopuncture and intraventricular hematoma removal under non-line-of-sight was performed immediately; the catheter was extended to the fourth ventricle to maximally remove the hematoma. Postoperative CT scan demonstrated total removal of IVH and no sign of extra brain damage. PMID:27033269

  3. Medical image of the week: uvula hematoma secondary to endotracheal intubation

    Directory of Open Access Journals (Sweden)

    Natt B

    2013-09-01

    Full Text Available A 53 year old male with no significant past medical history admitted for acute cholecystitis, underwent an uneventful laparoscopic cholecystectomy. Per anesthesia report, intubation was difficult. A few hours after extubation, he complained of dyspnea and a choking sensation. Examination showed a hematoma of the uvula with elongation and abnormal position of the uvula anterior to the soft palate. The patient was given a dose of intravenous steroids and anti-histamine with resolution of his symptoms over time.

  4. Spontaneous Cervical Epidural Hematoma Mimicking Stroke: A New Perspective on Diagnosis and Treatment

    OpenAIRE

    Alp Yurter; Paul E. Kaloostian

    2013-01-01

    Objective: The authors report an extremely rare case of stroke-mimicking, spontaneous cervical epidural hematoma treated with tissue plasminogen activator (TPA). Case Report: We report the case of a 69-year-old female presenting with left-sided hemiparesis of the arm and leg. She was administered by TPA because she was thought to have an ischemic stroke and intracranial CT showed no hemorrhage. However, her neurological condition continued to decline, and MRI of her cervical spine revealed a ...

  5. Extraosseous Extension Caused by Epidural Hematoma in Gaucher Disease Mimicking Malignant Bone Tumor

    OpenAIRE

    KUBO, TADAHIKO; Shimose, Shoji; Fujimori, Jun; Shimizu, Ryo; Ochi, Mitsuo

    2013-01-01

    Gaucher disease is an inherited autosomal-recessive disorder caused by the defective hydrolysis of glucocerebroside. The resultant hepatosplenomegaly, hematological changes, and orthopedic complications are the predominant symptoms. However, extraosseous manifestation of Gaucher disease, mimicking malignant bone tumor, is supposed to be rare. No reports of extraosseous manifestation of Gaucher disease caused by epidural hematoma were identified in the English literature. A 64-year-old man vis...

  6. Heart Failure Due to a Post-Traumatic Calcified Pericardial Hematoma

    OpenAIRE

    Manhas, Amit H.; Martin, Robert T.; Reul, George J.; Stainback, Raymond F.

    2008-01-01

    Chest-wall trauma can produce bleeding into the pericardium and initiate a process of inflammation, calcification, and scarring that may eventually produce pericardial constriction. Herein, we present an unusual case of a man who experienced chest trauma at age 16 years, and developed heart failure 40 years later secondary to a large, calcified pericardial hematoma. During its prolonged genesis, the pericardial mass became deeply embedded in the myocardium and produced evidence of both constr...

  7. A Case of Colorectal Cancer with Metastasis to the Chest Wall and Subsequent Hematoma Formation

    OpenAIRE

    Stember, Joseph N.; Thakral, Charu; Shiau, Maria C

    2013-01-01

    We report a rare case of a patient with colorectal cancer with chest wall metastases. The development of bleeding at the site of the metastasis ultimately resulted in the development of a hematoma, necessitating resection of the tumor along with part of the chest wall. Literature on chest wall metastases of colonic adenocarcinoma is reviewed and discussed. The teaching point is that a chest wall mass seen on imaging should prompt consideration of metastatic cancer in the differential diagnosi...

  8. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor

    Science.gov (United States)

    Krisht, Khaled M.; Karsy, Michael; Shah, Lubdha M.; Schmidt, Meic H.; Dailey, Andrew T.

    2016-01-01

    Background: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass. PMID:26904368

  9. Recurrent massive bleeding due to dissecting intramural hematoma of the esophagus: Treatment with therapeutic angiography

    Directory of Open Access Journals (Sweden)

    Jaejun Shim, Jae Young Jang, Young Hwangbo, Seok Ho Dong, Joo Hyeong Oh, Hyo Jong Kim, Byung-Ho Kim, Young Woon Chang, Rin Chang

    2009-11-01

    Full Text Available Spontaneous or traumatic intramural bleeding of the esophagus, which is often associated with overlying mucosal dissection, constitutes a rare spectrum of esophageal injury called dissecting intramural hematoma of the esophagus (DIHE. Chest pain, swallowing difficulty, and minor hematemesis are common, which resolve spontaneously in most cases. This case report describes a patient with spontaneous DIHE with recurrent massive bleeding which required critical management and highlights a potential role for therapeutic angiography as an alternative to surgery.

  10. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor

    Directory of Open Access Journals (Sweden)

    Khaled M Krisht

    2016-01-01

    Full Text Available Background: Malignant peripheral nerve sheath tumors (MPNSTs of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7-T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2-3 months to re-evaluate the size of the mass.

  11. Spinal subarachnoid hematoma in a woman with HELLP syndrome: a case report

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    Fujimaki Hisako

    2012-06-01

    Full Text Available Abstract Introduction Subarachnoid hemorrhages of spinal origin are extremely rare during pregnancy. We present the case of a patient with hemolytic anemia, elevated liver enzymes and low platelet count (the so-called HELLP syndrome, a potentially life-threatening complication associated with pre-eclampsia, who presented with an idiopathic spinal subarachnoid hematoma. Case presentation At 29 gestational weeks, a 35-year-old Japanese woman was diagnosed with HELLP syndrome based on bilateral leg paralysis, diminished sensation and reflexes, and laboratory findings. The pregnancy was immediately brought to an end by Cesarean delivery. Post-operatively, an MRI scan revealed a space-occupying lesion in her thoracic spinal canal. Emergency decompression was followed by total laminectomy. A subarachnoid hematoma, partially extending as far as the ventral side, was removed. After thorough washing and drain placement, the operation was completed with the suturing of artificial dura mater. Eight months post-operatively, her lower extremity sensation had improved to a score of 8 out of 10, but improvements in her muscular strength were limited to slight gains in her toes. MRI scans taken two months post-operatively revealed edematous spinal cord changes within her medulla. Conclusions A subarachnoid hematoma during pregnancy is extremely rare, possibly due to increased coagulability during pregnancy. However, this complication is potentially devastating should a clot compress the spinal cord or cauda equina. While several causes of hematoma have been proposed, we speculate that the factors underlying hemorrhagic diathesis in our case were the decreased platelet count characteristic of HELLP syndrome and vascular fragility due to elevated estrogen levels, in addition to increased abdominal pressure during pregnancy and pressure from the gravid uterus resulting in ruptured vessels around the spinal cord. In cases displaying a progressive lesion and severe neurological signs, prompt decompression is crucial.

  12. MR demonstration of a unilateral olivary hypertrophy caused by pontine tegmental hematoma

    International Nuclear Information System (INIS)

    Two patients with unilateral olivary hypertrophy (OH) following a pontine tegmental hematoma are presented. Both showed palatal myoclonus and one patient showed an extremity myorhythmia on the opposite side of OH. The magnetic resonance (MR) examination demonstrated an abnormal unilateral hyperintense lesion in the ventral part of medulla oblongata on T2-weighted images. The MR findings were highly suggestive of the pathological nature of the lesion, showing the value of MR. (orig.)

  13. An incidentally detected hepatic subcapsular hematoma in a very low birth weight newborn: a case report

    OpenAIRE

    Ahn, Hye Shin; Chang, Yun-Woo; Lee, Dong Whan; Kwon, Kui Hyang; Yang, Seung Boo

    2010-01-01

    Introduction A hepatic subcapsular hematoma in a neonate shows a non-specific presentation such as the presence of an abdominal mass without symptoms of hemorrhage and is clinically less distinguished as compared to cases detected during an autopsy. Case presentation A neonate was delivered by vaginal delivery after 29 weeks and three days gestation with breech presentation. In a laboratory study, there were slightly increased levels of liver enzymes but the platelet count and hemoglobin leve...

  14. Spinal Epidural Hematoma Caused by Pseudogout: A Case Report and Literature Review

    OpenAIRE

    deSouza, R. M.; Uff, C.; Galloway, M; Dorward, N. L.

    2013-01-01

    Study Design Case report. Objective We present the first reported case of spontaneous spinal epidural hematoma secondary to calcium pyrophosphate crystal deposition disease (pseudogout) in a 75-year-old woman. Methods A retrospective review of the patient's case notes was undertaken and the limited literature on this subject reviewed. Results This patient presented with sudden-onset lower limb paresis, sensory loss, urinary retention, and back pain. Magnetic resonance imaging showed an epidur...

  15. Extradural hematoma surgery in a child with Hutchinson–Gilford progeria syndrome: Perioperative concerns

    OpenAIRE

    Upendra Hansda; Jyotsna Agarwal; Chitralekha Patra; Pragati Ganjoo

    2013-01-01

    Hutchinson-Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injurie...

  16. Facial and neck hematoma after carotid artery stenting: an uncommon misadventure in endovascular carotid revascularization

    OpenAIRE

    Grandhi, Ramesh; Gande, Abhiram; Zwagerman, Nathan Thomas; Jankowitz, Brian Thomas

    2013-01-01

    The complication rates of carotid artery stenting (CAS) vary from 3.0% to 4.4%, and most commonly include ischemic stroke, intracranial hemorrhage, or groin complications. We present the rare complication of a patient who underwent CAS for a symptomatic 90% left internal carotid artery stenosis and developed an expanding cervical hematoma after the procedure with imminent respiratory compromise. After intubation, an arteriogram revealed perforation of the external carotid artery trunk, proxim...

  17. Hematoma esofágico intramural: de la disección a la perforación Intramural esophageal hematoma: Dissection of the perforation

    Directory of Open Access Journals (Sweden)

    Martin Gómez Zuleta

    Full Text Available El hematoma esofágico intramural es una entidad infrecuente, con pocos casos registrados en la literatura. Existen factores de riesgo que favorecen la aparición de esta condición como las náuseas y el vómito. Su presentación clínica más frecuente es la tríada de hematemesis, disfagia y dolor torácico. El tratamiento es conservador en la mayoría de los casos. En este trabajo presentamos nuestra experiencia en 7 casos recolectados durante los últimos 8 años, en los cuales se puede apreciar todo el espectro de la enfermedad desde la disección submucosa hasta la perforación del esófagoIntramural esophageal hematomas are rare with few cases reported in the literature. Risk factors that affect the incidence of this condition include nausea and vomiting, but its most common clinical presentation is the triad of hematemesis, dysphagia and chest pain. Conservative treatment is best in most cases. We present our experience in 7 cases collected during the last 8 years in which you can see the entire spectrum of the disease from submucosal dissection to perforation of the esophagus

  18. Prediction of prognosis in patients with epidural hematoma by a new stereological method

    International Nuclear Information System (INIS)

    Epidural hematoma (EH) is a serious clinical event observed in 2% of head trauma patients. Studies regarding the effects of epidural hematoma volume (EHV) on prognosis are not sufficient. In this study, we applied the volume fraction approach of the stereological method to estimate the hematoma to brain volume fraction (HBVF), and investigated the relation between the HBVF and prognosis. Fifty-nine EH patients (46 male and 13 female subjects, with average age of 21 years) admitted to the emergency clinic were included. The HBVF was estimated on the printed films of cranial computed tomography scans. For this purpose, common point counting grids were superimposed over the scan frames. According to the clinical results, patients were divided into three groups as complete recovery (43), disability (8) and exitus (8). The HBVF was compared with the clinical results. HBVF was determined as 4.6% in the patients with recovery, 8.1% in disability, and 7.6% in exitus patients. The HBVF values were lowest in recovery patients, and the difference between the recovery and the other two groups was statistically significant (p=0.007). However, there was no statistically significant difference in HBVF between disability and exitus patients (p>0.05). In conclusion, the HBVF can be an important tool to determine prognosis, and it can be measured using the volume fraction approach of stereological methods as developed in the present study. (author)

  19. Rare complication after a transrectal ultrasound guided prostate biopsy: a giant retroperitoneal hematoma.

    Science.gov (United States)

    Chiancone, Francesco; Mirone, Vincenzo; Fedelini, Maurizio; Meccariello, Clemente; Pucci, Luigi; Carrino, Maurizio; Fedelini, Paolo

    2016-05-24

    Common complications related to transrectal ultrasound (TRUS) guided prostatic needle biopsy are hematuria, hematospermia, and hematochezia. To the best of our knowledge, we report the second case of a very large hematoma extending from the pelvis into the retroperitoneal space in literature.A 66-year-old man with a serum prostate-specific antigen (PSA) of 5.4 ng/ml was admitted to our department for a TRUS-guided prostatic needle biopsy. Laboratory values on the day before biopsy, including coagulation studies, were all normal. The patients did not take any anticoagulant drugs. No immediate complications were encountered. Nevertheless, 7 hours after the biopsy, the patient reached our emergency department with severe diffuse abdominal pain, hypotension, tachycardia, and confusional state. He underwent an ultrasonography and then a computed tomography (CT) scan that showed "a blood collection in the pelvis that extending to the lower pole of left kidney associated with a focus of active contrast extravasation, indicating active ongoing prostate bleeding." Consequently, he underwent a diagnostic angiography that showed no more contrast extravasation, without the need of embolization. Management of hematoma has been conservative and hematoma was completely reabsorbed 4 months later. PMID:26616460

  20. Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings

    International Nuclear Information System (INIS)

    An acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it. A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism. Although testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion

  1. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

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    Amitabh Sagar

    2010-01-01

    Full Text Available We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

  2. Endoscopic surgery versus conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage (ECMOH): study protocol for a randomized controlled trial

    OpenAIRE

    Zan Xin; Li Hao; Liu Wenke; Fang Yuan; Ma Junpeng; Lan Zhigang; Li Xi; Liu Xin; You Chao

    2012-01-01

    Abstract Background Spontaneous intracerebral hemorrhage is a disease with high morbidity, high disability rate, high mortality, and high economic burden. Whether patients can benefit from surgical evacuation of hematomas is still controversial, especially for those with moderate-volume hematomas in the basal ganglia. This study is designed to compare the efficacy of endoscopic surgery and conservative treatment for the moderate-volume hematoma in spontaneous basal ganglia hemorrhage. Methods...

  3. Possibility of the conservative management of acute epidural hematoma from the point of views of serial CT scan and the consciousness level

    International Nuclear Information System (INIS)

    Nowadays serial computerized tomography is often performed in the diagnosis and care of patients with acute epidural hematoma. In the treatment of acute epidural hematoma, serial computerized tomography has shown dynamic changes in the hematoma, and the careful observation of clinical signs has reduced the number of operative cases. Moreover, some good outcomes of cases of acute epidural hematoma have appeared as a result of conservative management. Since the introduction of computerized tomography, we have treated 79 cases of acute epidural hematoma. The mortality rate has been 12.7 % (10 cases), while there have been 60 good-outcome cases, including 22 non-surgical cases (27.8 %). In an attempt to make clear the possibility of the conservative management of acute epidural hematoma, we made a comparative study of surgical good-outcome cases and conservative good-outcome cases from the points of view of serial computerized tomography and the consciousness level. We reached the following conclusions: The guidelines for the conservative management of acute epidural hematoma are: 1) Glasgow coma scale: more than 14 points, 2) Volume of hematoma on CT: less than 20 ml, as determined by the volume-summation method, 3) No mass sign of hematoma on CT, 4) No or only transient forcal neurological signs, and 5) The above factors (1)-(4) have no tendency to get worse within 6 hours after head trauma. (author)

  4. Dynamic CT perfusion imaging in the study of perihematomal hypoperfusion injury in subacute and chronic intracerebral hemorrhage

    International Nuclear Information System (INIS)

    Objective: To study the alteration of cerebral blood flow adjacent to the hematoma in subacute and chronic intracerebral hemorrhage (ICH), and to investigate its correlative factors. Methods: Pre-contrast and dynamic perfusion CT were performed in 12 cases of ICH with the basal ganglia. The volume of hematomas were measured, and the ratios of side-to-side of the regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT) and time-to-peak (TTP) were calculated in 11 of 12 cases. Results: The maximum and minimum of hematoma were 72.21 ml and 13.68 ml respectively, and the mean was 26.83 ml. The gradient of perihematomal hypoperfusion was revealed by rCBF maps in 11 cases, and by rCBV maps in 10 cases. The perihematomal hyperperfusion was demonstrated by rCBV maps in 1 case. The hypoperfusion of the affected hemisphere was observed in 2 cases. The areas of delayed TTP and MTT were revealed in 11 cases and 10 cases, respectively. In the regions surrounding the hemorrhage, the reduction in rCBF and the delay in MTT were most pronounced within 2 mm of the hematoma perimeter, and the reduction in rCBV correlated with the volume of hemorrhage clearly. There was no correlation between the changes in rCBF, rCBV, MTT and TTP and the time from symptom onset to CT perfusion imaging. Conclusion: In the phases of subacute and chronic intracerebral hemorrhage, the hypoperfusion surrounding the hematoma remains existing. The changes of rCBV in the perilesional regions correlate with the volume of hemorrhage. Perfusion CT and its parameters analysis may play an increasing role in delineating the hypoperfusion around hematomas, and may provide valuable information on the individual clinic therapy and prognostic evaluation of ICH. (authors)

  5. Olfactory hallucinations elicited by electrical stimulation via subdural electrodes: effects of direct stimulation of olfactory bulb and tract.

    Science.gov (United States)

    Kumar, Gogi; Juhász, Csaba; Sood, Sandeep; Asano, Eishi

    2012-06-01

    In 1954, Penfield and Jasper briefly described that percepts of unpleasant odor were elicited by intraoperative electrical stimulation of the olfactory bulb in patients with epilepsy. Since then, few peer-reviewed studies have reported such phenomena elicited by stimulation mapping via subdural electrodes implanted on the ventral surface of the frontal lobe. Here, we determined what types of olfactory hallucinations could be reproduced by such stimulation in children with focal epilepsy. This study included 16 children (age range: 5 to 17 years) who underwent implantation of subdural electrodes to localize the presumed epileptogenic zone and eloquent areas. Pairs of electrodes were electrically stimulated, and clinical responses were observed. In case a patient reported a perception, she/he was asked to describe its nature. We also described the stimulus parameters to elicit a given symptom. Eleven patients reported a perception of smell in response to electrical stimulation while the remaining five did not. Nine patients perceived an unpleasant smell (like bitterness, smoke, or garbage) while two perceived a pleasant smell (like strawberry or good food). Such olfactory hallucinations were induced by stimulation proximal to the olfactory bulb or tract on either hemisphere but not by that of orbitofrontal gyri lateral to the medial orbital sulci. The range of stimulus parameters employed to elicit olfactory hallucinations was comparable to those for other sensorimotor symptoms. Our systematic study of children with epilepsy replicated stimulation-induced olfactory hallucinations. We failed to provide evidence that a positive olfactory perception could be elicited by conventional stimulation of secondary olfactory cortex alone. PMID:22554977

  6. The Double-Blind Stick-and-Swap Technique for True Lumen Reentry After Subintimal Crossing of Coronary Chronic Total Occlusions.

    Science.gov (United States)

    Christopoulos, Georgios; Kotsia, Anna P; Brilakis, Emmanouil S

    2015-09-01

    Subintimal dissection and reentry techniques are widely used in chronic total occlusion (CTO) interventions; however, inability to reenter into the distal true lumen is a common cause of failure. In some patients, subintimal hematoma may develop, compressing the lumen and hindering reentry. We describe 3 CTO cases in which the distal vessel could not be visualized after subintimal crossing, in spite of attempts to decompress the subintimal hematoma. Bidirectional "blind" puncture was performed with the Stingray wire through both ports of the Stingray balloon, followed by exchange of the Stingray wire for a Pilot 200 guidewire (the "double-blind stick-and-swap" technique) achieving distal true lumen reentry. PMID:26332885

  7. Subperiosteal hematoma and orbital compression syndrome following minor frontal trauma in sickle cell anemia: case report / Hematoma subperisteo e compresso orbitria aps trauma frontal leve na anemia falciforme: relato de caso

    Scientific Electronic Library Online (English)

    Fernando, Procianoy; Mauro, Brando Filho; Antonio Augusto Velasco e, Cruz; Victor Marques, Alencar.

    2008-04-01

    Full Text Available Relatamos o caso de uma menina de 11 anos com doena falciforme, trazida sala de emergncia aps ser atingida por um bloco de barro na regio frontal esquerda. Apresentava ao exame proptose do olho esquerdo, edema palpebral, diminuio da acuidade visual e defeito pupilar aferente, sem quaisquer s [...] inais inflamatrios como febre, hiperemia ou aumento de sensibilidade. A tomografia computadorizada de rbitas demonstrou um extenso hematoma subperisteo superomedial na rbita esquerda. A paciente foi tratada com cantotomia, cantlise e drenagem cirrgica do hematoma. Dois dias aps a drenagem, ela permaneceu com um hematoma subperisteo e a acuidade visual diminuda. Uma ampla explorao atravs de inciso no sulco palpebral superior revelou um rebordo orbitrio superior espessado, e mltiplos defeitos sseos ao longo do teto da rbita com sangramento persistente. Foi realizada hemostasia com cera ssea. A compresso orbitria foi resolvida, e a paciente recuperou a acuidade visual normal prvia. Abstract in english We report the case of an 11-year-old girl with sickle cell disease who presented to the emergency room after being hit by a mud pie in the left frontal region. Examination evidenced left eye proptosis, eyelid swelling, reduced visual acuity and afferent pupillary defect, without any inflammatory sig [...] ns such as fever, hyperemia or tenderness. Computed tomography of the orbits showed a large superomedial subperiosteal hematoma in the left orbit. The patient was treated with canthotomy, cantholysis and surgical draining of the hematoma. Two days after drainage she persisted with a subperiosteal hematoma and low visual acuity. A wide exploration of the orbital roof through a lid crease approach disclosed a thickened superior orbital rim with multiple bone defects along the roof and with continuous bleeding. Hemostasis was accomplished with bone wax. Orbital compression was resolved and the patient recovered her previous normal visual acuity.

  8. Volume-Dependent Overestimation of Spontaneous Intracerebral Hematoma Volume by the ABC/2 Formula

    International Nuclear Information System (INIS)

    Background: Although the ABC/2 formula has been widely used to estimate the volume of intracerebral hematoma (ICH), the formula tends to overestimate hematoma volume. The volume-related imprecision of the ABC/2 formula has not been documented quantitatively. Purpose: To investigate the volume-dependent overestimation of the ABC/2 formula by comparing it with computer-assisted volumetric analysis (CAVA). Material and Methods: Forty patients who had suffered spontaneous ICH and who had undergone non-enhanced brain computed tomography scans were enrolled in this study. The ICH volume was estimated based on the ABC/2 formula and also calculated by CAVA. Based on the ICH volume calculated by the CAVA method, the patients were divided into three groups: group 1 consisted of 17 patients with an ICH volume of less than 20 ml; group 2 comprised 13 patients with an ICH volume of 20 to 40 ml; and group 3 was composed of 10 patients with an ICH volume larger than 40 ml. Results: The mean estimated hematoma volume was 43.6 ml when using the ABC/2 formula, compared with 33.8 ml when using the CAVA method. The mean estimated difference was 1.3 ml, 4.4 ml, and 31.4 ml for groups 1, 2, and 3, respectively, corresponding to an estimation error of 9.9%, 16.7%, and 37.1% by the ABC/2 formula (P<0.05). Conclusion: The ABC/2 formula significantly overestimates the volume of ICH. A positive association between the estimation error and the volume of ICH is demonstrated

  9. Diffusion-weighted imaging provides support for secondary neuronal damage from intraparenchymal hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Forbes, K.P. [Department of Radiology, Children' s National Medical Center, 111 Michigan Avenue NW, 20010-2970, Washington DC (United States); Division of Neuroradiology, Barrow Neurological Institute, St. Joseph' s Hospital and Medical Center, 350 West Thomas Road, AZ 85013, Phoenix, AZ (United States); Pipe, J.G. [MRI Department, Barrow Neurological Institute, St. Joseph' s Hospital and Medical Center, 350 West Thomas Road, AZ 85013, Phoenix, AZ (United States); Heiserman, J.E. [Division of Neuroradiology, Barrow Neurological Institute, St. Joseph' s Hospital and Medical Center, 350 West Thomas Road, AZ 85013, Phoenix, AZ (United States)

    2003-06-01

    It is controversial whether an intracerebral hematoma (ICH) causes ischemia of surrounding brain. By virtue of its high sensitivity to acute cerebral infarction, diffusion-weighted imaging (DWI) helps answer this question. We used this technique to assess the parenchyma surrounding ICH for restricted diffusion. Echoplanar DWI (b 1000 s/mm{sup 2}) and conventional MRI sequences were performed in 30 subjects (symptom duration 7-75 h) with primary ICH, mean volume: 13{+-}15 cm{sup 3}. We calculated mean apparent diffusion coefficients (ADC) within high signal regions around the hematoma on DWI or T2-weighted images and within the ICH itself, comparing them to the contralateral brain. We used the Student's t -test to examine for differences between these regions and linear regression to relate changes to the age of the ICH. A thin rim of high signal on DWI and a wider rim on T2-weighted images surrounded all hematomas. The ADC within the rim on DWI showed a maximum reduction of 40%, in two patients imaged within 10 h of symptom onset. They rose during the first day (r{sup 2}=0.84; P <0.03) and then showed a mild decrease, becoming the same as ADC in other areas of the brain (r{sup 2}=0.5; P <0.03). The rim on T2-weighting showed a mean increase of 50% and ADC within the ICH were reduced by a mean of 38%; these variations showed no relationship with ICH age and no group showed any relationship with ICH size. The ADC within the three regions was significantly different from each other. The presence of restricted diffusion in the parenchyma surrounding ICH provides support for secondary neuronal damage. (orig.)

  10. Diffusion-weighted imaging provides support for secondary neuronal damage from intraparenchymal hematoma

    International Nuclear Information System (INIS)

    It is controversial whether an intracerebral hematoma (ICH) causes ischemia of surrounding brain. By virtue of its high sensitivity to acute cerebral infarction, diffusion-weighted imaging (DWI) helps answer this question. We used this technique to assess the parenchyma surrounding ICH for restricted diffusion. Echoplanar DWI (b 1000 s/mm2) and conventional MRI sequences were performed in 30 subjects (symptom duration 7-75 h) with primary ICH, mean volume: 13±15 cm3. We calculated mean apparent diffusion coefficients (ADC) within high signal regions around the hematoma on DWI or T2-weighted images and within the ICH itself, comparing them to the contralateral brain. We used the Student's t -test to examine for differences between these regions and linear regression to relate changes to the age of the ICH. A thin rim of high signal on DWI and a wider rim on T2-weighted images surrounded all hematomas. The ADC within the rim on DWI showed a maximum reduction of 40%, in two patients imaged within 10 h of symptom onset. They rose during the first day (r2=0.84; P 2=0.5; P <0.03). The rim on T2-weighting showed a mean increase of 50% and ADC within the ICH were reduced by a mean of 38%; these variations showed no relationship with ICH age and no group showed any relationship with ICH size. The ADC within the three regions was significantly different from each other. The presence of restricted diffusion in the parenchyma surrounding ICH provides support for secondary neuronal damage. (orig.)

  11. Upper Airway Hematoma Secondary to Warfarin Therapy: A Systematic Review of Reported Cases.

    Science.gov (United States)

    Karmacharya, Paras; Pathak, Ranjan; Ghimire, Sailu; Shrestha, Pragya; Ghimire, Sushil; Poudel, Dilli Ram; Khanal, Raju; Shah, Shirin; Aryal, Madan Raj; Alweis, Richard L

    2015-11-01

    Upper airway hematoma (UAH) is a rare but life-threatening complication of oral anticoagulants requiring early recognition. However, no consensus exists regarding the best approach to treatment. We therefore, sought to systematically review the published literature on UAH to elaborate its demographic and clinical characteristics, treatment, complications, and outcomes. A systematic electronic search of PubMed and EMBASE for case reports, case series, and related articles of UAH related to warfarin published from inception (November 1950) to March 2015 was carried out. Categorical variables were expressed as percentage and continuous variables as mean standard deviation (SD). Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) version 20.0. All cases were reported to have UAH as a complication of anticoagulation therapy with warfarin. Demographic and clinical characteristics, treatment, complications and outcomes of UAH were studied. Thirty-eight cases of UAH were identified from 34 reports in the literature. No gender preponderance (male = 52.78%) was seen and the average age of presentation was 60.11 12.50 years. Dysphagia, sore throat, and neck swelling were the most common symptoms and the mean international normalized ratio (INR)at presentation was 8.07 4.04. Most cases had sublingual hematoma (66.57%) followed by retropharyngeal hematoma (27.03%). Of the cases, 48.65% were managed conservatively while the rest underwent either cricothyrotomy or intubation with the time to resolution being 7.69 5.44 days. UAH is a rare butpotentially serious complication of warfarin therapy. It is more common in the elderly population with supratherapeutic INR; inciting events were present in many cases. Overall, it has a good prognosis with significant morbidity present only if concomitant respiratory compromise is present. Reversal of anticoagulation with low threshold for artificial airway placement in the event of airway compromise leads to a favorable outcome in most cases. PMID:26713297

  12. Hematoma and abscess formation caused by Mycoplasma hominis following cesarean section

    Directory of Open Access Journals (Sweden)

    Hisato Koshiba,Akemi Koshiba

    2011-01-01

    Full Text Available Hisato Koshiba1,2, Akemi Koshiba1,2, Yasushi Daimon3, Toshifumi Noguchi1,2, Kazuhiro Iwasaku2, Jo Kitawaki21Department of Obstetrics and Gynecology, Kyoto Prefectural Yosanoumi Hospital, Kyoto, Japan; 2Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan; 3Department of Clinical Laboratory, Kyoto Prefectural Yosanoumi Hospital, Kyoto, JapanAbstract: Mycoplasma species cannot be identified by routine bacteriological culture methods and are resistant to common antimicrobial agents. Mycoplasma hominis usually colonizes the lower urogenital tract and causes pyelonephritis, pelvic inflammatory disease, chorioamnionitis, rupture of fetal membranes, preterm labor, postpartum fever, postabortal fever, and neonatal infection. This organism is highly prevalent in cervicovaginal cultures of sexually active women. M. hominis, M. genitalis, Ureaplasma urealyticum, and U. parvum may invade and infect placental and fetal tissues, leading to adverse pregnancy outcomes. M. hominis occasionally causes nongenitourinary infection of the blood, wounds, central nervous system, joints, or respiratory tract. We present a case of a 27-year-old woman who developed abdominal wound hematoma and abscess after cesarean section. The wound was drained, but her high fever persisted, in spite of antibiotic treatment using flomoxef sodium and imipenemcilastatin sodium. Because the exudate exhibited M. hominis growth in an anaerobic environment, we administered the quinolone ciprofloxacin. This therapy resolved her fever, and her white blood cell count and C-reactive protein level diminished to the normal ranges. To our knowledge, there are four published articles regarding the isolation of M. hominis from postcesarean incisions. Based on the current study and the literature, infection by this pathogen may cause hematoma formation with or without abscess after cesarean section or in immunosuppressed postoperative patients. In such cases, physicians may need to suspect Mycoplasma infection and initiate appropriate antibacterial treatment as soon as possible in order to avoid persistent fever.Keywords: Mycoplasma hominis, cesarean section, hematoma, abscess

  13. Hematomas intraparenquimatosos espontâneos supratentoriais: a proposito de 28 casos

    OpenAIRE

    Nelson Pires Ferreira; Daniel Loureiro Chaves; Jorge Luiz Kraemer

    1980-01-01

    Os autores analisam 28 pacientes com hematomas intraparenquimatosos espontâneos supratentoriais. Comentam as diversas topografias baseadas no estudo angiográfico, a mortalidade e a morbilidade da patologia. Os resultados são analisados em relação a presença de hipertensão arterial sistêmica, ao comprometimento da consciência e à topografia do processo expansivo. Chamam a atenção para a indefinição da escolha e da oportunidade do tratamento cirúrgico identificada na literatura.

  14. Massive Hemothorax Occurring with Intramural Hematoma of the Descending Aorta in the Early Postpartum Period.

    Science.gov (United States)

    Yun, Jeong Hee; Jeon, Yeong Jeong; Hong, Tae Hee; Byun, Joung Hun; Hwang, Sang Won; Park, Jae Hong

    2016-04-01

    Postpartum aortic intramural hematoma (IMH) is a rare but potentially lethal condition. We report a case of aortic IMH with massive hemothorax in a postpartum woman. The patient was a 31-year-old woman who had delivered twins by cesarean section. Two days after delivery, she complained of sudden-onset dyspnea. Chest computed tomography revealed a massive left hemothorax. Exploratory thoracotomy was performed, and we found a defect measuring approximately 6 mm in the adventitial layer of the thoracic aorta and an IMH. We repaired the defect primarily, and no more bleeding was observed. The patient was discharged on the 19th postoperative day without any complications. PMID:27066436

  15. Massive Hemothorax Occurring with Intramural Hematoma of the Descending Aorta in the Early Postpartum Period

    Science.gov (United States)

    Yun, Jeong Hee; Jeon, Yeong Jeong; Hong, Tae Hee; Byun, Joung Hun; Hwang, Sang Won; Park, Jae Hong

    2016-01-01

    Postpartum aortic intramural hematoma (IMH) is a rare but potentially lethal condition. We report a case of aortic IMH with massive hemothorax in a postpartum woman. The patient was a 31-year-old woman who had delivered twins by cesarean section. Two days after delivery, she complained of sudden-onset dyspnea. Chest computed tomography revealed a massive left hemothorax. Exploratory thoracotomy was performed, and we found a defect measuring approximately 6 mm in the adventitial layer of the thoracic aorta and an IMH. We repaired the defect primarily, and no more bleeding was observed. The patient was discharged on the 19th postoperative day without any complications. PMID:27066436

  16. Intratesticular hematoma after blunt scrotal trauma: a case series and algorithmbased approach to management

    Science.gov (United States)

    Gonzalez, Christopher M.

    2014-01-01

    We present our experience with intratesticular hematoma (ITH) without rupture of the tunica albuginea following blunt scrotal trauma and present an algorithm for management. We reviewed the charts of 3 patients who presented between 2006 and 2013 with this finding. Time from the incident to presentation ranged from 5 hours to 4 days. All patients underwent at least one scrotal ultrasound reviewed by the same urologist. Two patients underwent surgical exploration and all patients had resolution of pain within one to two days. Management of ITH should be centered on the patient's pain severity as well as serial ultrasound findings. PMID:25667770

  17. The effect of brain hematoma location on volumetric inductive phase shift spectroscopy of the brain with circular and magnetron sensor coils: a numerical simulation study.

    Science.gov (United States)

    Rojas, R; Rubinsky, B; Gonzlez, C A

    2008-06-01

    This numerical simulation study addressed the effects of the location of a discrete brain hematoma on the volumetric inductive phase shift of the brain measured with an induction circular sensor coil and an induction magnetron sensor coil. The theoretical study simulates the brain cavity as a circular sphere transversely centered with respect to the circular and magnetron sensor coils. As a case study for the effects of hematoma location, we employed similar size simulated spherical hematomas placed at three different positions from the center of the brain outward. A three-dimensional finite element analysis of the field equations in the frequency range from 100 kHz to 100 MHz revealed a substantial effect of hematoma location on the ability of both the circular and magnetron sensors to detect the hematomas. In particular it was found that there are frequencies, which may be related to resonance, at which the occurrence of the hematomas has no effect on the volumetric inductive phase shift of the brain. Furthermore it was found that the relative sensitivity of circular and magnetron sensor coils with respect to the occurrence of hematoma varies with the location of the hematoma. PMID:18544824

  18. The effect of brain hematoma location on volumetric inductive phase shift spectroscopy of the brain with circular and magnetron sensor coils: a numerical simulation study

    International Nuclear Information System (INIS)

    This numerical simulation study addressed the effects of the location of a discrete brain hematoma on the volumetric inductive phase shift of the brain measured with an induction circular sensor coil and an induction magnetron sensor coil. The theoretical study simulates the brain cavity as a circular sphere transversely centered with respect to the circular and magnetron sensor coils. As a case study for the effects of hematoma location, we employed similar size simulated spherical hematomas placed at three different positions from the center of the brain outward. A three-dimensional finite element analysis of the field equations in the frequency range from 100 kHz to 100 MHz revealed a substantial effect of hematoma location on the ability of both the circular and magnetron sensors to detect the hematomas. In particular it was found that there are frequencies, which may be related to resonance, at which the occurrence of the hematomas has no effect on the volumetric inductive phase shift of the brain. Furthermore it was found that the relative sensitivity of circular and magnetron sensor coils with respect to the occurrence of hematoma varies with the location of the hematoma

  19. Cranial MR imaging of abused children

    International Nuclear Information System (INIS)

    The diagnosis of intracranial sequelae of child abuse has important clinical and legal implications. CT findings are often subtle or nonspecific. Acutely, a small interhemispheric subdural hematoma (IHSDH) is seen, which may be difficult to distinguish from the falx. In chronic or recurrent abuse, ventricular dilatation and extracerebral fluid collections are encountered that may be difficult to distinguish from atrophy. Four abused children underwent MR imaging and, in each case, MR demonstrated the nature and extent of abnormalities with greater accuracy than CT. In acute abuse (two cases), the IHSDH was diagnosed with greater confidence than on CT, and convexity subdural collections were identified which could not be detected on CT. In chronic abuse (two cases) the subdural location of extracerebral collections and the extent of parenchymal damage was better appreciated on MR than CT

  20. Quantification of subarachnoid hemorrhage by three-dimensional computed tomography. Correlation between hematoma volume and symptomatic vasospasm

    International Nuclear Information System (INIS)

    Subarachnoid hemorrhage (SAH) volume was measured by three-dimensional computed tomography (3D-CT) and the correlation examined between the SAH volume and the occurrence of symptomatic vasospasm (SVS). Experimental (in vitro) hematomas were made with blood obtained from 10 volunteers. The hematoma volume was determined by actual measurements and by 3D-CT using a CT number in the range of 40-80 Hounsfield units (HU) on days 1, 4, 7, 11, and 14. The coefficients on days 1 and 4 were relatively high and the correlation between measured and estimated volumes was significant on days 7, 11, and 14. 3D-CT was also performed in 50 patients with SAH at onset (day 0) and on days 1, 4, 7, and 14. The hematoma volume including the volume of normal structures was automatically calculated (V1). The volume of normal structures (V2) with CT numbers of 40-80 HU was calculated in another 50 patients without intracranial lesions as 12 ml. The total hematoma volume was defined as V1 minus mean V2. The mean SAH volume was 44, 36, 21, 11, and 8 ml on days 0, 1, 4, 7, and 14, respectively. The hematoma volumes were significantly larger in patients with SVS than in patients without SVS at all time points. The minimum hematoma volume in patients with SVS was 92, 76, 42, 24, and 12 ml on days 0, 1, 4, 7, and 14, respectively. This method allows the quantitative determination of SAH volume based on 3D-CT, and may be useful in clinical studies of cerebral vasospasm. (author)