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Sample records for chronic subdural hematoma

  1. Chronic subdural hematoma following electro convulsive therapy.

    Science.gov (United States)

    Saha, Debasish; Bisui, Bikash; Thakurta, Rajarshi Guha; Ghoshmaulik, Sumanta; Singh, Om Prakash

    2012-04-01

    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. PMID:23162198

  2. [Chronic subdural hematoma - assessment and management].

    Science.gov (United States)

    Gautschi, O P; Gallay, M N; Kress, T T; Korte, W C; Hildebrandt, G

    2010-10-20

    Subdural hematomas (SDH) are associated with an increased morbidity and mortality and generally occur as chronic SDH among older patients. The most frequent signs and symptoms - like headache, alteration of consciousness, gait impairment and hemiparesis - are also prevalent among other diseases, which has to be taken into account in the differential diagnosis. In the case of symptomatic patients with focal neurological deficits, a surgical intervention should be considered, whereas in case of asymptomatic patients or patients with only slight headaches, also a conservative treatment with a clinical and radiological follow-up might be a possibility. Also after surgical intervention, the recurrence rate is between 5 and 33%. Therefore, all patients with chronic SDH depict, irrespective of the indication for an oral anticoagulation, a challenge for the treating physicians. PMID:20960397

  3. Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Seidu A. Richard

    2014-12-01

    Full Text Available Background: Chronic subdural hematoma (CSDH is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR. Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.

  4. Chronic Subdural Hematoma Following Electro Convulsive Therapy

    OpenAIRE

    Saha, Debasish; Bisui, Bikash; Thakurta, Rajarshi Guha; Ghoshmaulik, Sumanta; Singh, Om Prakash

    2012-01-01

    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 sens...

  5. Benefits of Artcereb on the irrigation of chronic subdural hematoma

    International Nuclear Information System (INIS)

    Chronic subdural hematoma is thought to be an easily treatable disease. However, its recurrence rate is approximately 10%, and such cases require re-operation. We compared the recurrance rate of chronic subdural hematoma with irrigation using either saline or the artificial cerebrospinal fluid Artcereb. We divided the patients into 2 groups. A total of 60 patients in the normal saline group (hematoma, n=58; bilateral hematoma, n=2) underwent irrigation with saline between March 2007 and July 2009. A total of 61 patients in the Artcereb group (hematoma, n=54; bilateral hematoma, n=7) underwent irrigation using Artcereb between August 2009 and May 2011. We performed irrigation via 1 burr hole with 500-1000 ml of either normal saline or Artcereb under local anesthesia and observed until recurrence or disappearance of the hematomas on CT scan. We researched the recurrence rate of the hematomas. Recurrence of the hematomas were observed in 8 cases (13%) in the normal saline group and 5 cases (8.2%) in the Artcereb group. No statistically significant differences were observed. Among those patients who did not receive anticoagulants, the recurrence rate was 6/54 (11%) in the normal saline group and 1/49 (2.0%) in the Artcereb group (p<0.10). Our study showed the possibility that the postoperative recurrence rate of chronic subdural hematoma was lower using Artcereb than saline for irrigation. (author)

  6. 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)

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

    Directory of Open Access Journals (Sweden)

    Jukovi? 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.

  8. Chronic Subdural Hematoma a Review of 58 Cases

    Directory of Open Access Journals (Sweden)

    Fuad S. Haddad

    1964-01-01

    Full Text Available From this short review, immerges a syndrome of the chronic subdural hematoma. The patient is usually an elderly male', with a hisory of moderate or severe trauma to the head incurred about 2 months prionjto admission, with or witout immediate headache which subsides, then recurs lllb6ut two to three weeks prior to admission. The headache becomes severer and the patient may develop a hemiparesis most frequently contralaterally, would become drowsy and may enter coma if not diagnosed and treated early. On examination, he would show dulled mental capacities and possibly papilloedema, with or without a hemiparesis and in one fifth of the cases a peculiar type of disturbance of gait. If there has been waxing and waning of the symptomatology in the past few days. this adds to the completeness of the picture. Although there is a syndrome that caracteriscs cases of subdural hematomas, the picture can be very varied and there is no doubt that the final diagnosis rests with angiography, which shows a typical appearance of an avascular lens shaped area just under tho parietal bone on the AP films or in some cases under the frontal bone in oblique film

  9. 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

    Ro?. 61, ?. 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

  10. Hematoma subdural crónico asociado a quiste aracnoideo: Presentación de 12 casos / Chronic subdural hematoma associated with arachnoid cyst: Report of 12 cases

    Scientific Electronic Library Online (English)

    M., Gelabert-González; D., Castro-Bouzas; A., Arcos-Algaba; J.M., Santín-Amo; L., Díaz-Cabanas; R., Serramito-García; E., Arán-Echabe; A., Prieto-González; A., García-Allut.

    2010-06-01

    Full Text Available Objetivos. Analizar las características clínicas, neurológicas y resultado neurorradiológico de una serie de pacientes con quiste aracnoideo asociado a un hematoma subdural crónico. Pacientes y método. Revisamos retrospectivamente 12 casos de pacientes con quiste aracnoideo que presentaron como comp [...] licación un hematoma subdural crónico. Resultados. Entre enero de 1984 y abril de 2008, 12 pacientes (0.9%) de 1.253 casos con hematoma subdural crónico presentaban un quiste aracnoideo intracraneal. La localización de los quistes fue en 10 casos en la fosa temporal y los otros dos en la convexidad. Los síntomas de presentación fueron cefalea en 6 pacientes (50%), seguidos por convulsiones (3 casos). En once pacientes se realizó agujero de trépano y drenaje del HSC, la paciente de más edad fue tratada de forma conservadora. Únicamente se trataron 3 quistes aracnoideos mediante craneotomía y fenestración, con resolución completa del quiste. Conclusiones. Los pacientes con quiste aracnoideo, sobre todo si esta localizado en la fosa temporal, tienen un mayor riesgo de sufrir un hematoma subdural crónico. La primera opción terapéutica es el drenaje del hematoma subdural y si persiste la sintomatología deberá tratarse el quiste aracnoideo. Abstract in english Introduction. We designed this study to investigate the clinical, neurological, and radiological outcome of patients with chronic subdural hematoma related to an intracranial arachnoid cysts. Patients and methods. Medical records of 12 cases of patients with arachnoids cyst complicated with chronic [...] subdural hematoma were retrospectively reviewed. Results. Between January 1984 and April 2008, 12 patients (0.9%) of 1.253 cases of chronic subdural hematoma surgically treated in our hospital had associated arachnoid cyst. Arachnoid cysts were located in the middle fossa (10 cases) and convexity (2 cases). The most frequent symptom was headache (6 cases), followed by seizures (3 cases). Eleven patients underwent burr hole and drainage; the oldest patient was treated conservatively. Conclusions. Patients with AC, especially when these are located in temporal fossa, appear to harbour a life-long risk of contracting subdural hematoma. Hematoma evacuation is adequate at first operation and if arachnoid cyst is symptomatic or preoperative symptoms persist, additional arachnoid cyst surgery should be considered.

  11. [Intermittent paraparesis as manifestation of a bilateral chronic subdural hematoma].

    Science.gov (United States)

    Schaller, B; Radziwill, A J; Wasner, M; Gratzl, O; Steck, A J

    1999-07-27

    Chronic subdural haematomas are mainly related to slight or moderate head trauma with consecutive lesion of bridge or cortical veins and bleeding in the subdural space. Further predisposing factors are known impairment of coagulation (coagulopathies, treatment with anticoagulants, alcohol abuse), risk factors for degenerative disease of the arteries (diabetes mellitus, arterial hypertension), and development of pressure gradients (hydrocephalus, epileptic seizures, lumbar puncture, CSF drainage and cerebral atrophy). Chronic subdural haematomas appear bilaterally in 20 to 25% of cases. We report on a 69-year-old male with a 4-day history of intermittent, proximal, painless paraparesis (BMA grade M2-5) without a trigger event. Sensibility was normal in all qualities and vigilance was not disturbed. Computed tomography of the neurocranium revealed a bitemporally located chronic subdural haematoma with extension to parietal on both sides. Trepanation was performed over the tuber parietale and temporoparietally on both sides, with release of 150 ml fluid. The neurologic deficits regressed totally within 12 hours postoperatively. To the best of our knowledge, we are the first to describe the clinical paradox of intermittent, painless paraparesis with preserved sensibility and without disturbances of vigilance, as manifestation of a chronic subdural haematoma possibly leading to impairment of cerebral blood flow in the area of the middle cerebral artery. Small changes in systemic blood pressure lead to changes in cerebral perfusion pressure due to vessel compression by the haematoma, thus explaining the intermittent character of the clinical presentation. PMID:10464909

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

    International Nuclear Information System (INIS)

    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)

  13. Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma

    International Nuclear Information System (INIS)

    A 9-year-old boy had been diagnosed at the age of 9 months as having a cerebellar medulloblastoma and had received 40 Gy of radiation therapy to the brain after removal of the tumor. Cerebral angiography at the time of initial diagnosis did not show any evidence of occlusive disease involving the internal carotid circulation. At the age of 6 years, the patient developed generalized seizures. On examination, he was drowsy and had right hemiparesis. CT scan demonstrated a low-density area in the left frontal lobe. Cerebral angiography showed a marked narrowing of the bilateral internal carotid arteries with moyamoya vessels. The patient was treated medically with aspirin (100 mg/day) and anticonvulsants. His neurological deficits improved gradually. At the age of 8 years, there was no recurrence of the tumor although a slight left subdural hematoma was seen on CT scan. On August 10, 1993, at the age of 9 years, he was admitted for treatment of a developing subdural hematoma. MRI showed a chronic subdural hematoma with thick outer and inner membranes. Cerebral angiography showed occlusion of the left internal carotid artery which fed the right frontal lobe through moyamoya vessels, marked narrowing of the right internal carotid artery distal to the ophthalmic artery, moyamoya vessels at the base, and cortical revascularization througth the ophthalmic, posterior cerebral and middle meningeal arteries. Trepanation and aspiration of the hematoma were performed. The outer me the hematoma were performed. The outer membrane of the hematoma was about 2 mm thick and the hematoma cavity was filled with a partially organized hematoma. In this case, we speculate that development of the chronic subdural hematoma involved the following factors: 1) transdural external-internal carotid anastomosis after radiation-induced cerebrovasculopathy; 2) repeated mild head trauma due to gait disturbance after removal of the cerebellar tumor; and 3) administration of acetylsalicylic acid. (author)

  14. Hematoma subdural espinal no traumático / Nontraumatic spinal subdural hematoma

    Scientific Electronic Library Online (English)

    Carlos, Casallo-Quiliano; Dennis, Dávila-García; Catherine, Ruiz-Perea; Ronald, Pineda-García.

    2014-10-01

    Full Text Available Un paciente varón de 88 años, en diálisis por insuficiencia renal crónica, presentó cervicalgia intensa y, progresivamente, déficit sensitivo motor completo dependiente de ventilación mecánica. La tomografía cervicodorsal y la resonancia magnética (RM) inicial sugirieron varios diagnósticos, entre e [...] llos hematoma subdural espinal. El tiempo de protrombina y el INR estaban ligeramente fuera del rango normal y las plaquetas eran normales. La RM contrastada hecha al cuarto día indicaba la probable presencia de un hematoma espinal. Se realizó una punción lumbar, la que confirmó in hematoma subdural espinal en fase crónica. Se evacuó 60 mL, sin obtener mejora clínica neurológica. No fue posible realizar una RM de control, debido a la condición clínica del paciente. El paciente falleció debido a una sepsis de foco respiratorio. Abstract in english A 88yearold male receiving hemodialysis for chronic renal insufficiency, developed cervical pain and progressively motor/sensitive deficit with mechanic ventilation support. Computed tomography and Magnetic resonance imaging (MRI) admission showed a variety of diagnostics, inclunding spinal subdural [...] hematoma. Prothrombin time and international normalized ratio (INR) were slightly out of range, with normal platelets amount. MRI after four days found a spinal subdural hematoma, confirmed with lumbar puncture. Sixty cc was evacuated without neurologic amelioration. A new MRI was impossible to perform. He died due a respiratory sepsis.

  15. Intrahemispheric subdural hematoma complicated with chronic neurologic diseases

    International Nuclear Information System (INIS)

    Two patients had interhemispheric subdural hematoma (ISH) without clinical signs or symptoms characteristic of ISH. The first patient, a 74-year-old woman with 7 years' history of Parkinson's disease, complained of unresponsiveness and akinesia. The treatment for suspected worsening of the disease failed to improve her conditions. Computed tomography (CT) showed hyperdensity along the falx from the frontal falx over the tentorium. Subsequent CT on the 23rd hospital day showed disappearance of hyperdensity, confirming ISH. The second patient, a 76-year-old woman with multiple cerebral infarction, was referred for loss of consciousness and vomiting. Neurological examination failed to reveal additional or augmented neurological deficits. Computed tomography showed a right parasagittal thin crescent hyperdensity with a flat medial border and a convex lateral border, extending from the anterior falx to the mid-falx. The hyperdensity disappeared on the 47th hospital day. These findings suggest the usefulness of CT as the only procedure when ISH features are not seen. (Namekawa, K.)

  16. 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...

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

    Scientific Electronic Library Online (English)

    Yan, Song; Zhitao, Wang; Li, Liu; Dong, Wang; Jianning, Zhang.

    1084-10-01

    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 obser [...] ve 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.

  18. MR Imaging of Shaken Baby Syndrome Manifested as Chronic Subdural Hematoma

    OpenAIRE

    Lee, Yul; Lee, Kwan Seop; Hwang, Dae Hyun; Lee, In Jae; Kim, Hyun Beom; Lee, Jae Young

    2001-01-01

    Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanc...

  19. 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 presenly 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)

  20. Dexamethasone treatment in chronic subdural haematoma / Tratamiento con dexametasona del hematoma subdural crónico

    Scientific Electronic Library Online (English)

    P.D., Delgado-López; V., Martín-Velasco; J.M., Castilla-Díez; A., Rodríguez-Salazar; A.M., Galacho-Harriero; O., Fernández-Arconada.

    2009-08-01

    Full Text Available RESUMEN Introducción. El hematoma subdural crónico (HSC) es una entidad clínica bien conocida por los neurocirujanos, cuyo tratamiento habitual es la evacuación del mismo a través de alguna modalidad de trepanación. A pesar de los excelentes resultados así obtenidos, pueden ocurrir diversas complica [...] ciones, algunas de las cuales son potencialmente graves o mortales. Además, la tasa de recidivas puede alcanzar el 25% de los casos. Presentamos una aproximación novedosa al manejo del HSC, basada en la utilización de dexametasona como tratamiento de elección en la gran mayoría de los pacientes. Pacientes y métodos. Se analizaron los historiales médicos de 122 pacientes consecutivos diagnosticados de HSC. Al ingreso todos los pacientes sintomáticos fueron clasificados mediante la Escala de Puntuación de Markwalder (EPM). Aquellos con EPM de 1-2 fueron asignados al Protocolo de Dexametasona (4mg cada 8h, re-evaluación a las 72h y disminución progresiva de dosis) y aquellos con EPM de 3-4 se asignaron, en general, al Protocolo Quirúrgico (único mini-trépano tipo twist-drill frontal, sin irrigación y drenaje a sistema cerrado). El seguimiento clínico se realizó mediante TAC y valoración neurológica en la consulta externa. Resultados. En el período entre Marzo 2001 y Mayo 2006, se trataron 122 pacientes con HSC (69% varones) con una mediana de edad de 78 años (rango 25-97). El 73% de los pacientes presentaban algún déficit neurológico (EPM 2-3-4). No se trataron pacientes asintomáticos (EPM 0). La asignación inicial de tratamientos fue: 101 dexametasona, 15 drenaje subdural, 4 craneotomía y 2 no recibieron tratamiento. Precisaron drenaje 22 pacientes inicialmente asignados a dexametasona (21.8%). Se obtuvo resultado favorable (EPM 0-12) en el 96% y 93.9% de los tratados con dexametasona y drenaje, respectivamente. La mediana de estancia fue de 6 días para el grupo de dexametasona y para la serie al completo (rango 1-41), y de 8 días para el grupo intervenido (rango 5-48). La mortalidad global fue del 0.8% y la proporción de reingresos debido al HSD del 14.7% (todos mejoraron o estabilizaron su EPM). Ocurrieron complicaciones médicas en 34 pacientes (27.8%), fundamentalmente descompensaciones hiperglucémicas leves. El seguimiento mediano extrahospitalario de la serie fue de 25 semanas (rango 8-90), con dos únicas pérdidas. Discusión. La utilización de dexametasona en el HSC se basa en sus propiedades antiangiogénicas sobre la membrana del coágulo subdural, según se desprende de estudios experimentales y de las muy escasas observaciones clínicas publicadas. El tratamiento quirúrgico del HSC es conocido que obtiene excelentes resultados, aunque no existen ensayos bien diseñados que comparen ambas modalidades terapéuticas. La experiencia que aporta esta serie nos permite realizar una serie de consideraciones clínicas: el tratamiento del HSC con dexametasona es factible y se compara positivamente con el tratamiento quirúrgico (evitó dos tercios de las intervenciones en nuestra serie); creemos que la historia natural del HSC permite un período de prueba con dexametasona (48-72h) sin someter a riesgo de deterioro irreversible al paciente; se elimina toda la morbilidad asociada a las intervenciones y las recidivas; no provoca complicaciones significativas; reduce la estancia media; no impide ni perjudica un ulterior tratamiento quirúrgico; es una terapia bien tolerada y entendida por el paciente y sus acompañantes y, posiblemente, abarata costes. Los autores proponen un protocolo de manejo que no pretende sustituir al tratamiento quirúrgico sino ofrecer una alternativa efectiva y segura. Conclusión. Los datos obtenidos de esta larga serie retrospectiva sugieren que la utilización de dexametasona en el HSC es una opción factible y segura. En nuestra experiencia, curó o mejoró a dos tercios de todos los pacientes, hecho que debe ser corroborado por otros autores. La verdadera efectividad de esta terapia podría ser objeto, idealmente, de un ensayo aleat

  1. Hematoma subdural crônico tratamento cirúrgico e resultados em 96 pacientes operados / Chronic subdural hematoma: surgical treatment and results in 96 operated patients

    Scientific Electronic Library Online (English)

    J. Francisco, Salomão; Renê D., Leibinger; José Carlos, Lynch.

    1990-03-01

    Full Text Available Os autores apresentam os resultados cirúrgicos de 96 casos de hematoma subdural crônico operados por meio de orifícios de trépano ou pequenas trefinas: 78 pacientes (81,3%) foram considerados curados, 6 (6,2%) apresentaram seqüelas e 12 (12,5%) faleceram. Os óbitos de natureza neurocirúrgica foram r [...] elacionados à intensidade do comprometimento neurológico por ocasião da cirurgia. A idade avançada associada à presença de doenças sistêmicas também teve influência na mortalidade. Seqüelas neurológicas foram observadas principalmente em pacientes submetidos a reoperações por reacúmulo do hematoma e em portadores de lesões bilaterais. Os autores chamam a atenção para a ocorrência de hipotensão intracraniana associada a colapso cerebral. A importância do diagnóstico precoce e cirurgia imediata são enfatizadas. Abstract in english Ninety-six patients with chronic subdural hematoma were treated surgically and their clinical features presented in detail. Carotid angiography gave the correct diagnosis in all patients. CT scan was performed in 38 and was diagnostic in 92.1% of the cases. The clots were removed through burr-holes [...] or small trephines: 78 (81.3%) patients were cured, 6 (6.2%) had permanent disabilities and 12 (12.5%) died. Operative mortality was related to the degree of neurological impairment, advanced age and systemic diseases. Neurologic sequelae were mostly related to reoperations due to recurrence of the hematoma and bilateral clots, as well. Low intracranial pressure syndrome with brain colapse was seen in 3 cases and treated with lumbar injection of saline solution. The delay in diagnosis and operation as cause of bad outcome is stressed.

  2. Psychiatric Manifestation of Chronic Subdural Hematoma: The Unfolding of Mystery in a Homeless Patient

    Science.gov (United States)

    Kar, Sujita Kumar; Kumar, Deepak; Singh, Paramjeet; Upadhyay, Pankaj Kumar

    2015-01-01

    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. PMID:25969617

  3. Effectiveness of Kampo medicine Gorei-san for chronic subdural hematoma

    International Nuclear Information System (INIS)

    Chronic subdural hematomas (CSDHs) are basically treated by surgery. In some cases with no or minimum symptoms, however, they may be treated conservatively. In the present study, we evaluated the therapeutic effect of a Kampo medicine (Japanese traditional herbal medicine), Gorei-san, in the treatment of those CSDHs. Gorei-san 7.5 g t.i.d. was orally administered for 4 weeks in 22 patients with 27 CSDHs. Maximum thickness of the hematoma was followed up on CT scan for 4 to 29 weeks after administration of Gorei-san. In 7 of 22 patients, tranexamic acid and/or carbazochrome sodium sulfonate were also administrated. Gorei-san was effective in 23 of 27 CSDHs. In 12 of them, the hematoma was completely disappeared within 14 weeks after administration. In the other 11 CSDHs, the thickness was decreased. In those effective cases, thickness began to decrease 3 to 4 weeks after administration of Gorei-san. It was more effective in CSDHs with iso-/high or mixed density than with low density on CT. It was not effective in 4 out of 27 CSDHs. No apparent adverse effect was noted in the present series of patients. The present study suggests that a Kampo medicine, Gorei-san, is a useful option in the conservative treatment of CSDHs with no or minimum symptoms. (author)

  4. Pathophysiological study of chronic subdural hematoma and communicating hydrocephalus with delayed MRI using Gd-DTPA (Magnevist)

    International Nuclear Information System (INIS)

    Concerning the pathophysiology of chronic subdural hematoma and communicating hydrocephalus, recent studies have been made, but no definitive conclusion has yet been attained. To study their complicated mechanisms, we examined a delayed MRI which was performed 4 hours after the intravenous injection of Gd-diethylenetriaminepentaacetic acid (Gd-DTPA) on 5 cases of subdural hygroma, 3 cases of chronic subdural hematoma after irrigation, one case of hydrocephalus with glioblastoma, and one case of Parkinson syndrome. In every case of subdural hygroma, it was certified that Gd-DTPA was leaked into the cavity of the subdural space. This is perhaps because the outer and inner membranes of the subdural hygroma consist of fibroblasts and of capillary vessels with fenestration; the leakage of blood composition through this fenestration may promote the growth of the membrane and the cavity. The leakage of Gd-DTPA decreased after irrigation, and it did not recur. In the case of hydrocephalus with gioblastoma, there was leakage of Gd-DTPA into the ventricles surrounding the tumor. This may be because of the destruction of the blood-cerebrospinal fluid barrier; perhaps this is associated with the cause of the communicating hydrocephalus. (author)

  5. Incidental diagnosis of two intracranial aneurysms following surgical evacuation of chronic subdural hematoma.

    Science.gov (United States)

    Das, Joe M; Rajmohan, B P; Sharmad, M S; Peethambaran, Anilkumar

    2015-01-01

    The development of subarachnoid hemorrhage (SAH) following evacuation of chronic subdural hematoma (CSDH) is a very rare phenomenon. SAH in this context occurring secondary to intracranial aneurysm rupture is still rare. We report a case of an elderly lady who presented with right hemiplegia and altered sensorium. Computed tomography (CT) scan of the brain revealed a left fronto-temporoparietal CSDH with midline shift, which was promptly evacuated surgically via a single burr-hole. Postoperatively, her level of consciousness deteriorated and there was increased the amount of drain. Emergency CT of the brain revealed diffuse SAH. CT cerebral angiogram revealed one aneurysm each in the right internal carotid artery and anterior communicating artery. Meanwhile, her consciousness level improved on conservative management. The relatives were not keen for further follow-up. PMID:25972954

  6. 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 nce 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)

  7. Bilateral calcified chronic subdural hematoma. Further pathogenetic and clinical consideration on the so-called "armored brain".

    Science.gov (United States)

    Spadaro, A; Rotondo, M; Di Celmo, D; Simpatico, S; Parlato, C; Zotta, D C; Albanese, V

    1987-01-01

    Calcified chronic subdural hematomas after shunting procedures for treatment of hydrocephalus have been rarely described. When the calcified wall is so large to extensively cover the surface of the cerebral hemispheres, this instance has been defined "Armored Brain". The Authors report the case of an eleven-year-old patient affected by triventricular hydrocephalus due to aqueductal stenosis, that was treated by a ventriculoatrial shunt. The post-operative course was uneventful and the patient recovered completely from the preexisting neurological deficits. Nevertheless, a CT scan performed 2 and 1/2 years later, revealed the development of a bilateral calcified chronic subdural hematoma, to such extent to configure a so-called "Armored Brain". Clinical course, pathogenesis and treatment of such kind of pathology are discussed in light of the data reported from the literature. PMID:3668658

  8. Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery : a randomized trial

    DEFF Research Database (Denmark)

    Poulsen, Frantz Rom; Munthe, Sune

    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 perindopril 5mg or placebo treatment daily for three months prior to surgery. Cerebral CT scans were performed after six weeks, and clinical follow-ups were performed three months after surgery. Additionally, a retrospective analysis of the data and CT scans from all nonrandomized patients from the same time 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 surgery revealed no difference between the placebo and perindopril-treated groups. In the retrospective group (245 patients), there was no correlation between the risk of recurrence and ACE inhibitor treatment. CONCLUSION: Our data suggest that perindopril does not diminish the size of residual CSHs six weeks after burr hole surgery and that ACE inhibitors do not decrease the risk of CSH recurrence.

  9. Hematoma subdural crónico: Análisis de 95 casos

    Scientific Electronic Library Online (English)

    Miguel, Esquivel Miranda; Melissa, Arias Quirós; Mayra, Cartín Brenes; María José, Suárez Sánchez; Lizbeth, Salazar-Sánchez.

    2012-03-01

    Full Text Available El Hematoma Subdural crónico es una patología relativamente frecuente que predomina en adultos  mayores. Es de inicio insidioso, su diagnóstico se basa en el cuadro clínico y estudios radiológicos como la tomografía axial computarizada (TAC), el manejo es predominantemente quirúrgico y su pronóstico [...] es bueno. Se analiza en el presente estudio, una muestra de 95 expedientes clínicos de pacientes con dicho diagnóstico, síntomas iniciales, TAC pre y post diagnóstico, tratamiento y evolución Abstract in english Chronic subdural hematoma is a relatively common disease prevalent in elderly patients. It has an insidious onset, and its diagnosis is based on clinical and radiologic studies like computalized tomography( CT). Its´ management is usually surgical and it has a good prognosis. This study, analyzed a [...] sample of 95 medical records of patients with this diagnosis, initial symptoms, pre and post CT diagnosis, treatment and outcome

  10. Rapid spontaneous resolution and redistribution of acute subdural hematoma in a patient with chronic alcoholism: a case report

    International Nuclear Information System (INIS)

    We report a case of a 54-year-old man who had documented traumatic acute subdural hematoma. He suffered from a transient episode of confusion and a follow-up CT scan of brain 6 h after the initial scan showed resolution and redistribution of the subdural hematoma. In this case report, we review the literature for the underlying pathophysiology of this uncommon phenomenon

  11. Intravenous Fluid Administration May Improve Post-Operative Course of Patients with Chronic Subdural Hematoma: A Retrospective Study

    Science.gov (United States)

    Janowski, Miroslaw; Kunert, Przemyslaw

    2012-01-01

    Background The treatment of chronic subdural hematoma (cSDH) is still charged of significant risk of hematoma recurrence. Patient-related predictors and the surgical procedures themselves have been addressed in many studies. In contrast, postoperative management has infrequently been subjected to detailed analysis. Moreover variable intravenous fluid administration (IFA) was not reported in literature till now in the context of cSDH treatment. Methodology/Principal Findings A total of 45 patients with cSDH were operated in our department via two burr hole craniostomy within one calendar year. Downward drainage was routinely left in hematoma cavity for a one day. Independent variables selected for the analysis were related to various aspects of patient management, including IFA. Two dependent variables were chosen as measure of clinical course: the rate of hematoma recurrence (RHR) and neurological status at discharge from hospital expressed in points of Glasgow Outcome Scale (GOS). Univariate and multivariate regression analyses were performed. Hematoma recurrence with subsequent evacuation occurred in 7 (15%) patients. Univariate regression analysis revealed that length of IFA after surgery influenced both dependent variables: RHR (p?=?0.045) and GOS (p?=?0.023). Multivariate regression performed by backward elimination method confirmed that IFA is a sole independent factor influencing RHR. Post hoc dichotomous division of patients revealed that those receiving at least 2000 ml/day over 3 day period revealed lower RHR than the group with less intensive IFA. (p?=?0.031). Conclusions/Significance IFA has been found to be a sole factor influencing both: RHR and GOS. Based on those results we may recommend administration of at least 2000 ml per 3 days post-operatively to decrease the risk of hematoma recurrence. PMID:22532865

  12. 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.

  13. Hematoma within the Outer Membrane of the Arachnoid Cyst Located in the Middle Fossa: A Mechanism of Development of Chronic Subdural Hematoma Associated with Arachnoid Cysts

    Directory of Open Access Journals (Sweden)

    Yasuhiko Hayashi

    2014-04-01

    Full Text Available It is well known that chronic subdural hematoma (CSDH occasionally arises in patients harboring an arachnoid cyst (AC located in the middle fossa. Although the pathogenesis of CSDH associated with ACs remains unknown, several possible mechanisms have been proposed. In many reported cases, the patients with ACs in the middle fossa would be symptomatic according to development of CSDH. A 9-year-old girl presenting with a headache, nausea, and diplopia was referred to our department. Magnetic resonance imaging showed an AC in the left-side middle fossa and ipsilateral CSDH with a remarkable mass effect. Irrigation of the CSDH, partial removal of the outer membrane of the AC and CSDH, and endoscopic cystocisternostomy were performed to relieve her symptoms. Postoperative clinical course was excellent. Histopathological examination of the outer membrane of the CSDH demonstrated an arachnoid cell layer and hemorrhage from the granulation inside the membrane, and collagen fibers outside the membrane. These findings strongly suggested that the membrane and the content of the CSDH were derived from the outer membrane of the AC, and the CSF including the hemorrhage within the membrane, respectively. Laceration and hemorrhage from granulation tissue within the outer membrane of the AC are considered as one of the developmental mechanisms of the CSDH associated with AC in the middle fossa.

  14. A case with Parkinsonism secondary to bilateral subdural hematoma

    Directory of Open Access Journals (Sweden)

    Adalet Ar?kano?lu

    2011-03-01

    Full Text Available Subdural hematoma is a rare cause of secondary Parkinsonism. In this study, we presented a case of Parkinsonian syndrome caused by a bilateral subdural hematoma. The patient’s Parkinsonism completely healed following successful surgical removal of the hematomas without any anti-parkinson drug.

  15. 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)

  16. 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

  17. Involvement of hypoxia-inducible factor-1? and vascular endothelial growth factor in the mechanism of development of chronic subdural hematoma

    International Nuclear Information System (INIS)

    Vascular endothelial growth factor (VEGF), a potent inducer of angiogenesis and vascular permeability in diverse physiological and pathological conditions, may be involved in the pathophysiology of chronic subdural hematoma (CSDH). The present study investigated the source and mechanisms for the induction of VEGF in CSDH by measuring the concentration of VEGF in the hematoma of 102 patients (122 hematomas) using the enzyme-linked immunosorbent assay technique. The relationship between the VEGF concentration in hematoma and the intrahematoma membranous structure confirmed by preoperative T2*-weighted magnetic resonance image was examined in 46 of these patients. VEGF and hypoxia-inducible factor-1? (HIF-1?) expression was immunohistochemically studied and microvessel density (MVD) in the outer membrane was identified using anti-CD31 antibody in 30 patients. VEGF and HIF-1? were positive in the outer membranes of all 30 patients. VEGF expression was significantly correlated to HIF-1? expression (rs= 0.651, p=0.0084) and VEGF concentration in the hematoma (rs=0.654, p=0.0013). VEGF concentration in layered hematomas, which have intrahematoma membranous structure, was significantly higher than in non-layered hematomas (p<0.01). Although MVDs of the outer membranes were comparable to those described in tumors, there was no significant relationship with VEGF expression. The present study suggests that VEGF in CSDH, which may be induced it VEGF in CSDH, which may be induced in the neomembrane by HIF-1 release, may give rise to the excessive development of fragile microvessels and hyperpermeability, resulting in the enlargement of CSDH. (author)

  18. Hematoma subdural em Pediatria Diagnosticar e tratar precocemente / Subdural hematoma in pediatrics - Early diagnosis and treatment

    Scientific Electronic Library Online (English)

    Marisa, Carvalho; Ema, Leal; Margarida, Santos; José, Ramos; Luís, Távora; Deolinda, Barata.

    2011-06-01

    Full Text Available Introdução: O hematoma subdural agudo não traumático é uma entidade rara em Pediatria. A presença de sintomas neuro­lógicos de instalação aguda associada a anticoagulação obriga à exclusão desta entidade. Caso clínico: Apresentamos o caso de uma criança, do sexo masculino, de sete anos de idade, com [...] prótese mitral mecâ­nica, medicada com varfarina, que recorreu ao serviço de urgência por cefaleias intensas e progressivas, associadas a alteração no estado de consciência e convulsões. A nível laboratorial o INR (In­ternational Normalized Ratio) era de 4,2. Foi admitida na Unidade de Cuidados Intensivos Pediátricos (UCIP) em coma com aniso­coria. Iniciou ventilação mecânica, medidas anti-edema cerebral e antiepilépticos.O exame de imagem mostrou hematoma subdural agudo à esquerda, com desvio da linha média. Foi submetida a craniotomia descompressiva, 56 horas após o início da sintomato­logia, com recuperação clínica e actualmente sem sequelas. Conclusão: Este caso clínico ilustra a importância da sus­peição clínica de hematoma subdural em doentes anticoagula­dos, bem como a necessidade de optimização das condições cirúrgicas e da utilização das técnicas não invasivas na monitori­zação do nível de consciência. Abstract in english Introduction: Non-traumatic acute subdural hematoma is a rare entity in children. In the presence of acute neurological symptoms associated with long termanticoagulation, it is manda­tory to rule out this entity. Case report: We report the case of a seven-year-old boy, with mechanical mitral valve p [...] rosthesis under warfarin treat­ment, presenting severe and progressive headache associated with altered level of consciousness and seizures. Laboratory studies revealed a high value of International Normalized Ratio(INR: 4,2). He was admitted to the Pediatric Intensive Care Unit in a coma with anisocoria. He was mechanically ventilated and started on specific measures to reduce cerebral edemain ad­dition to anticonvulsants. Cranial computerized tomography (CT scan) revealed acute left subdural hematoma, with midline shift. Fifty-six hours after the onset of symptoms, he was submitted to decompressive craniectomy. There was progressive clinical re­covery with neurological and imaging improvement and an excel­lent outcome. Discussion: This case illustrates the importance of the clinical suspicion of a subdural hematoma in patients treated with anticoagulants, as well as the need of optimizing surgical condi­tions and the use of non invasive techniques for monitoring the level of consciousness.

  19. Presentación clínica del hematoma subdural crónico en adultos: el gran simulador Clínica del Hematoma Subdural Crónico

    Scientific Electronic Library Online (English)

    Fernando, Martínez.

    2007-06-01

    Full Text Available Resumo Introdução: o hematoma subdural crônico (HSDC) é uma doença relativamente comum em adultos com mais de 60 anos. Sua apresentação clínica clássica é uma síndrome neurológica focal progressiva com sinais e sintomas de hipertensão endocraniana, em pacientes que de maneira geral tem antecedentes [...] de traumatismo craniano (TEC) nas duas ou três semanas anteriores à consulta. No entanto, o HSDC pode se apresentar sob diferentes formas o que dificulta seu diagnóstico. Material e métodos: são analisados os aspectos clínicos de 63 pacientes portadores de HSDC que consultaram no Hospital de Tacuarembó em um período de 59 meses. Resultados: os pacientes tinham entre 30 e 88 anos sendo 73% do sexo masculino; 67% tinham antecedentes de TEC. A apresentação mais freqüente foi um quadro progressivo de déficit focal ou hipertensão endocraniana. Em dois casos o déficit foi brusco, simulando um ataque cerebrovascular. Em três pacientes não havia registro de antecedente traumático e clinicamente se propôs um processo tumoral expansivo. Em 11 casos os sintomas iniciais foram da esfera neuropsíquica, simulando uma "demência". Em 18 casos houve depressão de vigília, sendo brusca em cinco, levando a proposição de um ataque cerebrovascular hemorrágico ou isquêmico. Em seis pacientes o sintoma mais destacado era cefaléia permanente sem outros sinais ou sintomas. Conclusões: a HSDC pode se apresentar com distintas "máscaras clínicas", simulando processos expansivos tumorais, ataques cerebrovasculares hemorrágicos ou isquêmicos, ataques isquêmicos transitórios ou demências. Em pessoas com mais de 60 anos com um quadro progressivo e de instalação insidiosa, mesmo com ausência de traumatismo craniano, deve-se suspeitar desta patologia. Abstract in spanish Introducción: el hematoma subdural crónico (HSDC) es una enfermedad relativamente común en mayores de 60 años. Su presentación clínica clásica es un síndrome neurológico focal progresivo con síntomas y signos de hipertensión endocraneana, en un paciente que generalmente tiene antecedentes de traumat [...] ismo craneano (TEC) al menos dos o tres semanas previas a la consulta. Sin embargo, el HSDC puede presentarse bajo diferentes formas clínicas que dificultan su diagnóstico. Material y método: se analizan los aspectos clínicos de 63 pacientes portadores de HSDC que consultaron en el Hospital de Tacuarembó en un período de 59 meses. Resultados: los pacientes tenían entre 30 y 88 años, 73% eran hombres. En 67% de los pacientes había antecedente de TEC. La forma de presentación más frecuente fue un cuadro progresivo de déficit focal o hipertensión endocraneana. En dos casos el déficit fue brusco, simulando un ataque cerebrovascular. En tres pacientes el antecedente traumático no fue recogido y se planteó clínicamente un proceso expansivo tumoral. En 11 casos los síntomas iniciales fueron de la esfera neuropsíquica, simulando una "demencia". En 18 casos hubo depresión de vigilia, siendo brusca en cinco de ellos, lo que llevó al planteo de ataque cerebrovascular hemorrágico o isquémico. En seis pacientes el síntoma cardinal era la cefalea permanente sin otros síntomas o signos. Conclusiones: el HSDC puede presentarse con distintas "máscaras clínicas", simulando procesos expansivos tumorales, ataques cerebrovasculares hemorrágicos o isquémicos, ataques isquémicos transitorios o demencias. Se debe entonces tener un alto índice de sospecha de esta enfermedad frente a individuos mayores de 60 años con un cuadro progresivo y de instalación insidiosa aun en ausencia de traumatismo de cráneo Abstract in english Summary Background: chronic subdural hematoma (CSDH-HSDC) is a relatively common disease in adults older than 60 years. The classic clinical presentation is a progressive focal neurologic syndrome with signs and symptoms of endocranial hypertension in patients that usually offer history of cranial t [...] raumatism (CT-TEC) of at least two or three weeks prior to consulting. Howe

  20. 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 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.)

  1. Coagulação intravascular disseminada e hematoma subdural: relato de caso Disseminated intravascular coagulation and subdural hematoma: a case report

    Directory of Open Access Journals (Sweden)

    C. E. Cavalcanti

    1985-09-01

    Full Text Available Os autores apresentam caso de hematoma subdural agudo, evacuado na presença de coagulopatia, e fazem considerações necessárias para a compreensão da etiopatogenia da enfermidade.The authors present a case of acute subdural haematoma evacuated in the presence of a coagulopathy. Some elements necessary for the understanding of the etiopathogenesis of the disease are discussed.

  2. Coagulação intravascular disseminada e hematoma subdural: relato de caso / Disseminated intravascular coagulation and subdural hematoma: a case report

    Scientific Electronic Library Online (English)

    C. E., Cavalcanti; E., Jansen.

    1985-09-01

    Full Text Available Os autores apresentam caso de hematoma subdural agudo, evacuado na presença de coagulopatia, e fazem considerações necessárias para a compreensão da etiopatogenia da enfermidade. [...] Abstract in english The authors present a case of acute subdural haematoma evacuated in the presence of a coagulopathy. Some elements necessary for the understanding of the etiopathogenesis of the disease are discussed. [...

  3. Correlation of the Beta-Trace Protein and Inflammatory Cytokines with Magnetic Resonance Imaging in Chronic Subdural Hematomas : A Prospective Study

    Science.gov (United States)

    Park, Ki-Su; Park, Seong-Hyun; Hwang, Sung-Kyoo; Kim, Chaekyung

    2015-01-01

    Objective Magnetic resonance imaging (MRI) of chronic subdural hematoma (CSDH) detects various patterns, which can be attributed to many factors. The purpose of this study was to measure the level of interleukin-6 (IL-6), interleukin-8 (IL-8), and highly specific protein [beta-trace protein (?TP)] for cerebrospinal fluid (CSF) in CSDHs, and correlate the levels of these markers with the MRI findings. Methods Thirty one patients, treated surgically for CSDH, were divided on the basis of MRI findings into hyperintense and non-hyperintense groups. The concentrations of IL-6, IL-8, and ?TP in the subdural fluid and serum were measured. The ?TP was considered to indicate an admixture of CSF to the subdural fluid if ?TP in the subdural fluid (?TPSF)/?TP in the serum (?TPSER)>2. Results The mean concentrations of IL-6 and IL-8 of the hyperintense group (n=17) of T1-WI MRI were 3975.1±1040.8 pg/mL and 6873.2±6365.4 pg/mL, whereas them of the non-hyperintense group (n=14) were 2173.5±1042.1 pg/mL and 2851.2±6267.5 pg/mL (p<0.001 and p=0.004). The mean concentrations of ?TPSF and the ratio of ?TPSF/?TPSER of the hyperintense group (n=13) of T2-WI MRI were 7.3±2.9 mg/L and 12.6±5.4, whereas them of the non-hyperintense group (n=18) were 4.3±2.3 mg/L and 7.5±3.9 (p=0.011 and p=0.011). Conclusion The hyperintense group on T1-WI MRI of CSDHs exhibited higher concentrations of IL-6 and IL-8 than non-hyperintense group. And, the hyperintese group on T2-WI MRI exhibited higher concentrations of ?TPSF and the ratio of ?TPSF/?TPSER than non-hyperintense group. These findings appear to be associated with rebleeding and CSF admixture in the CSDHs. PMID:25932289

  4. Dural metastases with subdural hematoma from prostate cancer / Hematoma subdural secundario a metástasis durales de cáncer de próstata

    Scientific Electronic Library Online (English)

    M., Cobo Dols; S., Gil Calle; E., Villar Chamorro; I., Ales Díaz; A., Montesa Pino; J., Alcaide García; V., Gutiérrez Calderón; F., Carabante Ocón; J. J., Bretón García; M., Benavides Orgaz.

    2005-08-01

    Full Text Available Decribimos el caso de un paciente de 54 años de edad con cáncer de próstata avanzado con hematoma subdural no traumático secundario a metástasis durales. Había recibido previamente tratamiento hormonal y quimioterapia basada en docetaxel. En la resonancia magnética se mostraba el hematoma subdural e [...] n el contexto de metástasis leptomeníngeas y durales. Hay que destacar esta forma tan inusual de metástasis de un cáncer de próstata y el mal pronóstico que conlleva esta complicación. Abstract in english We reported a case of subdural effusion secondary to dural metastasis of prostatic cancer. A 54-year-old man was referred for headache, vomiting and gait disturbance. He had undergone hormonal therapy and docetaxel-based chemotherapy for prostatic cancer. The magnetic resonance imaging of the brain [...] showed extensive leptomeningeal carcinomatosis and cranial dural metastases, and subdural hematoma. This is a very rare situation and bad prognosis.

  5. Correlation of hyperdense and hypodense areas in the computerized tomogram of subdural hematomas

    International Nuclear Information System (INIS)

    CT findings of 51 patients with acute, subacute and chronic subdural hematomas were studied. The results showed that direct signs (hyperdensity, isodensity, and hypodensity) and indirect signs (midline-shift, expansive lesion, compression of ventricles, and occlusion of the subarachnoid space) can be distinguished. The following diagnostic procedure is proposed in cases of subdural hematoma: 1. In cases with both, direct and indirect CT signs, no further diagnostic exploration is necessary. 2. In cases without direct signs, application of contrast medium may lead to diagnosis. 3. Cases without direct or indirect signs showing clinical symptoms require further investigation by angiography, or CT control. (orig.)

  6. 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)

  7. Hematoma subdural crónico calcificado. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Ariel Varela Hern\\u00E1ndez

    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.

  8. Rapid spontaneous resolution of an acute subdural hematoma: Case report

    International Nuclear Information System (INIS)

    We present a case of acute subdural hematoma which was rapidly resolved without surgical intervention. This 31 year old man had a hematoma of which thickness was 9 mm and was paraplegic due to fracture-dislocation of thoracic spine at the level of TII-12 Rapid recovery of consciousness despite of sizable hematoma made to take a serial CT scanning instead of immediate surgical interventions. The hematoma was resolved within 4 hours without surgery. Possible mechanism of this rapid spontaneous resolution is discussed with brief review of the related literature

  9. 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

  10. Enlarged cerebrospinal fluid spaces in infants with subdural hematomas

    International Nuclear Information System (INIS)

    Computed tomography in 16 infants with subdural hematomas showed enlarged basal cisterns, a wide interhemispheric fissure, prominent cortical sulci, and varying degrees of ventricular enlargement. Radionuclide cisternography in eight of the 16 patients showed findings consistent with enlargement of the subarachnoid space rather than those of communicating hydrocephalus. Clinical findings and brief follow-up showed no convincing evidence for cerebral atrophy in 13 patients. These findings suggest that the enlarged subarachnoid space, which is encountered in some infants and may be a developmental variant, predisposes such infants to subdural hematomas

  11. Relations among traumatic subdural lesions.

    OpenAIRE

    Lee, K. S.; Doh, J. W.; Bae, H G; Yun, I. G.

    1996-01-01

    Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASD...

  12. Delayed post-operative contralateral epidural hematoma in a patient with right-sided acute subdural hematoma: a case report

    OpenAIRE

    Saberi, Hooshang; Meybodi, Ali Tayebi; Meybodi, Keyvan Tayebi; Habibi, Zohreh; Mirsadeghi, Sayed Mohammad Haji

    2009-01-01

    Head injury is one of the leading causes of death and disability in traumatic accidents. Post-operative contralateral epidural hematomas after surgery for acute subdural hematoma seem to be rare. In this case, expansion and spontaneous resolution of a fractural epidural hematoma contralateral to the side of acute subdural hematoma is presented. The importance of immediate post-operative computed tomography is also highlighted to detect delayed traumatic mass lesions.

  13. [Bilateral subdural hematoma secondary to accidental dural puncture].

    Science.gov (United States)

    Ramírez, Sofía; Gredilla, Elena; Martínez, Blanca; Gilsanz, Fernando

    2015-01-01

    We report the case of a 25-year-old woman, who received epidural analgesia for labour 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. PMID:25935854

  14. Bilateral subdural hematoma secondary to accidental dural puncture.

    Science.gov (United States)

    Ramírez, Sofía; Gredilla, Elena; Martínez, Blanca; Gilsanz, Fernando

    2015-01-01

    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. PMID:26123149

  15. Subdural Hematoma and Postdural Puncture Headache from Intrathecal Pump Placement Resolved with Lumbar Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Andrew Ng

    2014-09-01

    Full Text Available Intrathecal drug delivery systems are commonly used in the management of chronic pain, cancer pain and neuromuscular disorders with muscle spasticity. The complications associated with in-trathecal pump placement include persistent cerebrospinal fluid (CSF leak, hygroma, meningitis, and granuloma formation. A severe persistent CSF leak may cause postdural puncture headache along with acute intracranial subdural hematoma, which can be potentially life threatening. Surgical exploration with dural repair is required to treat this severe complication when conservative treatments fail. We present a case report of severe persistent CSF leak after intrathecal pump revision that resulted in a subdural hematoma and postdural puncture headache. In this case, an epidural blood patch was performed using epidural catheter under fluoroscopic guidance to target the site of CSF leak and to avoid damaging the intrathecal catheter. This patient’s headache was resolved and intrathecal catheter remained intact after this blood patch.

  16. Arachnoid cyst and associated subdural hematoma. Observations on conventional roentgenographic and computerized tomographic diagnosis.

    Science.gov (United States)

    LaCour, F; Trevor, R; Carey, M

    1978-02-01

    Information about computerized tomography (CT) of arachnoid cysts of the middle fossa (ACMF) is increasing, and it appears that certain CT characteristics may be diagnostic. The association of ACMF and subdural hematoma has been emphasized previously but is not common knowledge. We present three new cases of ACMF and associated subdural hematoma studied by plain roentgenograms, EEG, conventional brain scanning, CT scanning, and angiography. The cysts were clearly shown in each case by CT scan, but no subdural hematoma was visualized in our first two cases. Angiography was necessary to establish the associated hematoma. We review and emphasize computerized tomographic characteristics that may be pathognomonic of ACMF. It is suggested that angiography be included in the study of patients symptomatic with ACMF because associated subdural hematoma is not an uncommon lesion and may fail to visualize on CT scan. Angiography still remains the most conclusive study to establish or exclude the diagnosis of subdural hematoma. PMID:623534

  17. Unilateral optic neuropathy following subdural hematoma: a case report

    Directory of Open Access Journals (Sweden)

    Witte Otto W

    2010-01-01

    Full Text Available Abstract Introduction Unilateral optic neuropathy is commonly due to a prechiasmatic affliction of the anterior visual pathway, while losses in visual hemifields result from the damage to brain hemispheres. Here we report the unusual case of a patient who suffered from acute optic neuropathy following hemispherical subdural hematoma. Although confirmed up to now only through necropsy studies, our case strongly suggests a local, microcirculatory deficit identified through magnetic resonance imaging in vivo. Case presentation A 70-year-old Caucasian German who developed a massive left hemispheric subdural hematoma under oral anticoagulation presented with acute, severe visual impairment on his left eye, which was noticed after surgical decompression. Neurologic and ophthalmologic examinations indicated sinistral optic neuropathy with visual acuity reduced nearly to amaurosis. Ocular pathology such as vitreous body hemorrhage, papilledema, and central retinal artery occlusion were excluded. An orbital lesion was ruled out by means of orbital magnetic resonance imaging. However, cerebral diffusion-weighted imaging and T2 maps of magnetic resonance imaging revealed a circumscribed ischemic lesion within the edematous, slightly herniated temporomesial lobe within the immediate vicinity of the affected optic nerve. Thus, the clinical course and morphologic magnetic resonance imaging findings suggest the occurrence of pressure-induced posterior ischemic optic neuropathy due to microcirculatory compromise. Conclusion Although lesions of the second cranial nerve following subdural hematoma have been reported individually, their pathogenesis was preferentially proposed from autopsy studies. Here we discuss a dual, pressure-induced and secondarily ischemic pathomechanism on the base of in vivo magnetic resonance imaging diagnostics which may remain unconsidered by computed tomography.

  18. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão 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 revisión de 33 casos de la literatura

    Scientific Electronic Library Online (English)

    Jane Auxiliadora, Amorim; Diana Souza Canuto dos Anjos, Remígio; Otávio, Damázio Filho; Marcos Aureliano Guerra de, Barros; Valentina Nicole, Carvalho; Marcelo Moraes, Valença.

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPP [...] D) e analisamos outros 33 casos encontrados em revisão 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 relação se inverte no grupo de pacientes mais jovens ( Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara postanestesia subaracnoidea. Relatamos aquí dos casos de mujeres que desarrollaron hematoma subdural crónico postanestesia Subaracnoidea, diagnosticados posteriormente a la evolución clínica prolongada de cefalea p [...] ostpunción dural (CPPD), y analizamos otros 33 casos encontrados en una revisión de la literatura. RELATO DE LOS CASOS: En los 35 pacientes (edad entre 20 y 88 años, 19 hombres), 14 tenían más de 60 años (40%) siendo 12 (86%) hombres. La relación se invierte en el grupo de pacientes más jóvenes ( 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 (

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

    OpenAIRE

    Gulsen, Salih; Sonmez, Erkin; Cem YILMAZ; 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...

  20. Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso / Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report / Hematoma subdural intracraneal: una rara complicación después de la raquianestesia: relato de caso

    Scientific Electronic Library Online (English)

    Flora Margarida Barra, Bisinotto; Roberto Alexandre, Dezena; Daniel Capucci, Fabri; Tania Mara Vilela, Abud; Livia Helena, Canno.

    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 precocement [...] e, 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 Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara posterior a la raquianestesia. El diagnóstico es en muchas ocasiones difícil, porque los síntomas iniciales son los mismos de la cefalea postpunción de la duramadre. El objetivo de este estudio, es relatar el caso [...] de un hematoma subdural diagnosticado rápidamente, y posterior a una raquianestesia realizada con una aguja de calibre fino y punción única. RELATO DEL CASO: Paciente de 48 años, ASA I, sometida a la raquianestesia para la cirugía de corrección de incontinencia urinaria. Fue realizada la raquianestesia con una aguja 27G Quincke y una punción única. La cirugía transcurrió sin problemas, y la paciente recibió alta. Después de 48 horas de efectuada la punción raquídea, la paciente relató cefalea de inicio súbito, de fuerte intensidad, afectando principalmente la región orbitaria, pero también la región temporal, con una mejoría importante en el decúbito dorsal, y acompañada de dos episodios de vómitos. Se le solicitó la tomografía de cráneo que arrojó un hematoma subdural agudo frontotemporoparietal izquierdo. Fue indicado un tratamiento conservador con analgésicos, dexametasoma e hidantoína. Después de 17 días, debutó con un cuadro de cefalea intensa, seguida de adormecimiento y paresia del miembro superior derecho, y un disturbio del habla y del comportamiento. El hematoma fue drenado quirúrgicamente. La paciente evolucionó bien y sin secuelas. CONCLUSIONES: La cefalea es la complicación más frecuente después de la raquianestesia y se le considera de evolución benigna. Ella logra que diagnósticos potencialmente fatales, como el hematoma subdural, se eviten en muchos casos o se hagan más tarde. Este caso describe una aparición rara, un hematoma subdural agudo posterior a una raquianestesia con una aguja fina en una paciente sin factores de riesgo para el sangramiento Abstract in english BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma

  1. Hematoma subdural intracraniano: uma rara complicação após raquianestesia: relato de caso Hematoma subdural intracraneal: una rara complicación después de la raquianestesia: relato de caso Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report

    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 sangramentoJUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara posterior a la raquianestesia. El diagnóstico es en muchas ocasiones difícil, porque los síntomas iniciales son los mismos de la cefalea postpunción de la duramadre. El objetivo de este estudio, es relatar el caso de un hematoma subdural diagnosticado rápidamente, y posterior a una raquianestesia realizada con una aguja de calibre fino y punción única. RELATO DEL CASO: Paciente de 48 años, ASA I, sometida a la raquianestesia para la cirugía de corrección de incontinencia urinaria. Fue realizada la raquianestesia con una aguja 27G Quincke y una punción única. La cirugía transcurrió sin problemas, y la paciente recibió alta. Después de 48 horas de efectuada la punción raquídea, la paciente relató cefalea de inicio súbito, de fuerte intensidad, afectando principalmente la región orbitaria, pero también la región temporal, con una mejoría importante en el decúbito dorsal, y acompañada de dos episodios de vómitos. Se le solicitó la tomografía de cráneo que arrojó un hematoma subdural agudo frontotemporoparietal izquierdo. Fue indicado un tratamiento conservador con analgésicos, dexametasoma e hidantoína. Después de 17 días, debutó con un cuadro de cefalea intensa, seguida de adormecimiento y paresia del miembro superior derecho, y un disturbio del habla y del comportamiento. El hematoma fue drenado quirúrgicamente. La paciente evolucionó bien y sin secuelas. CONCLUSIONES: La cefalea es la complicación más frecuente después de la raquianestesia y se le considera de evolución benigna. Ella logra que diagnósticos potencialmente fatales, como el hematoma subdural, se eviten en muchos casos o se hagan más tarde. Este caso describe una aparición rara, un hematoma subdural agudo posterior a una raquianestesia con una aguja fina en una paciente sin factores de riesgo para el sangramientoBACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge ne

  2. An unexplained organized subdural hematoma requiring craniotomy in a term infant: Diagnostic dilemma in physical child abuse

    OpenAIRE

    Etus, Volkan; Ceylan, Savas

    2003-01-01

    Subdural hematomas are uncommon in term infants. Here we report a case of organized subdural hematoma in a twenty days old term baby boy, who was admitted because of seizures. Organized subdural hematoma presented as a space-occupying lesion over the cerebral convexity of this infant. There was no definite history of trauma and the findings of physical and laboratory examinations were unremarkable.Discussing this case, the diagnostic priority in a term infant presenting with subdural hemorrha...

  3. 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...

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

    Directory of Open Access Journals (Sweden)

    Liu Jinping

    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.

  5. 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%

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

    Scientific Electronic Library Online (English)

    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.

    1996-06-01

    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%), c [...] om 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. Abstract in english 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%

  7. 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 hydrocephalents 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)

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

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    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.

  9. A Case of Dural Arteriovenous Fistula Presenting as Acute Subdural Hematoma

    Science.gov (United States)

    Saito, Atsushi; Kawaguchi, Tomohiro; Sasaki, Tatsuya; Nishijima, Michiharu

    2014-01-01

    Dural arteriovenous fistula (AVF) presenting with subdural hematoma is relatively rare. We report a case of dural AVF presenting as acute subdural hematoma (ASDH) and provide a review of the literature. A 56-year-old man presented with disturbance of consciousness. Computed tomography demonstrated a right ASDH and a small right occipital subcortical hematoma. Cerebral angiography showed a dural AVF on the occipital convexity draining into the cortical veins. Emergent endovascular embolization was immediately performed and the shunt flow disappeared. Hematoma removal and external decompression were safely conducted. Combined therapy successfully recovered the patient's consciousness level. This rare case of dural AVF presenting with ASDH was treated with combined treatments of endovascular and open surgery. PMID:24926261

  10. Acute traumatic subdural hematoma in infancy and childhood classification and treatment from CT findings

    International Nuclear Information System (INIS)

    Acute traumatic subdural hematoma in infancy and childhood has much difference from that in adult on their symptom, clinical course, and indication of surgical treatment. The aim of this study is to examine their clinical course and CT findings just after the injury and to evaluate the treatment modality for types of complex this disease. As the result of these examination, SDH patients are divided into five categories in account of their CT findings, especially according to the relationship between the hemispheric swelling and the amount of SDH. Simple SDH type shows classical clinical course and surgical treatment are frequently essential in rapidly progressive cases. Isodensity hemispheric swelling (IHS) type is more frequently seen in CT findings which shows thin SDH and prominent brain swelling. This IHS (a subtype of diffuse brain injury) type should be recognized for their favourable outcome under conservative treatment. Other three types are; contusion with SDH, acute excerbation of chronic SDH, and battered child. Indication of surgical treatment will be decided considering to the volume of hematomas. (author)

  11. Decompression hyperostosis: cranial hyperostosis mimicking bilateral subdural hematoma on brain scintigraphy

    International Nuclear Information System (INIS)

    Scintigraphic findings suggestive of bilateral subdural hematoma developed after successful decompression of communicating hydrocephalus. These findings were secondary to cranial hyperostosis. The similarity of brain scintigraphic findings in the two disorders is pointed out, and the necessity of correlating brain scintigraphs with skull radiographs is stressed. (U.S.)

  12. Hematoma subdural intracraniano pós-anestesia subaracnóidea: relato de dois casos e revisão de 33 casos da literatura Hematoma subdural intracraneal postanestesia subaracnoidea: relato de dos casos y revisión de 33 casos de la literatura Intracranial subdural hematoma post-spinal anesthesia: report of two cases and review of 33 cases in the literature

    Directory of Open Access Journals (Sweden)

    Jane Auxiliadora Amorim

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPPD e analisamos outros 33 casos encontrados em revisão 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 relação se inverte no grupo de pacientes mais jovens (JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara postanestesia subaracnoidea. Relatamos aquí dos casos de mujeres que desarrollaron hematoma subdural crónico postanestesia Subaracnoidea, diagnosticados posteriormente a la evolución clínica prolongada de cefalea postpunción dural (CPPD, y analizamos otros 33 casos encontrados en una revisión de la literatura. RELATO DE LOS CASOS: En los 35 pacientes (edad entre 20 y 88 años, 19 hombres, 14 tenían más de 60 años (40% siendo 12 (86% hombres. La relación se invierte en el grupo de pacientes más jóvenes (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 (< 60 years, in which we observed twice as many women (14:7. Two peaks of higher incidence were observed: 30-39 years (31% and 60-69 years (29%. The length of time from the beginning of symptoms until diagnosis ranged from 4 hours to 29 weeks. Headache was the main complaint in 26/35 (74.3% patients; changes in the level of consciousness in 14/35 (40.0%; vomiting in 11/35 (31,4%; hemiplegia or hemiparesis in 8/35 (22.9%; diplopia or VI nerve paresis in 5/35 (14.3%; and language disorders in 4/35 (11.4%. Contributing factors included: pregnancy, multiple punctures, use of anticoagulants, intracranial vascular abnormalities, and brain atrophy. In 15 cases, a contributing factor was not mentioned. Four out of 35 patients (11.4% remained with neurologic sequelae, and 4/35 (11.4% died. CONCLUSIONS: The presence of any of the signs or symptoms mentioned above should alert for the possibility of an intracranial subdural hematoma as a complication of puncture of the dura mater, especially in those patients with PDPH for more than one week, at which time investigation by neuroimaging is necessary.

  13. Traumatic interhemispheric subdural hematoma extending above the tentorium demonstrated as a low-density mass. From the standpoint of differential diagnosis for the subdural empyema

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    Katagiri, Kunihiko; Takaki, Tadahiro; Fukushima, Takeo; Tomonaga, Masamichi (Fukuoka Univ. (Japan))

    1984-04-01

    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 number 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.

  14. Low Molecular Weight Heparin Induced Delayed Traumatic Clival Subdural Hematoma Associated With Isolated Abducens Nerve Palsy in a Child

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    Mehmet Faik ÖZVEREN

    2012-06-01

    Full Text Available Traumatic clival subdural hematoma is a very rare clinical entity. This rarity can result in delayed or missed diagnoses. Although several hypotheses are proposed to explain this lesion, the exact pathophysiology remains to be unknown.We present a case of low-molecular-weight heparin induced clival subdural hematoma, extending to the left cerebellopontine angle and causing left abducens nerve palsy which occured six days after trauma.

  15. Low Molecular Weight Heparin Induced Delayed Traumatic Clival Subdural Hematoma Associated With Isolated Abducens Nerve Palsy in a Child

    OpenAIRE

    Mehmet Faik ÖZVEREN; Ayberk, G?yas; Nur D?KMEN; Mesut Emre YAMAN

    2012-01-01

    Traumatic clival subdural hematoma is a very rare clinical entity. This rarity can result in delayed or missed diagnoses. Although several hypotheses are proposed to explain this lesion, the exact pathophysiology remains to be unknown.We present a case of low-molecular-weight heparin induced clival subdural hematoma, extending to the left cerebellopontine angle and causing left abducens nerve palsy which occured six days after trauma.

  16. Spontaneous acute subdural hematoma due to fondaparinux: Report of two cases

    Science.gov (United States)

    Fryburg, Karsten; Nguyen, Ha Son; Cohen-Gadol, Aaron A.

    2011-01-01

    Background: Spontaneous acute subdural hematomas (SDHs) are rare. Risk factors for development of these hematomas include conditions such as hypertension, vascular abnormalities such as aneurysm or arteriovenous malformation, or consumption of anticoagulants. Case Description: Here, the authors report two patients who suffered from spontaneous acute SDH while taking fondaparinux for venous thromboembolism prophylaxis. One patient suffered from a remote episode of traumatic brain injury and underwent a decompressive craniectomy 3 weeks prior to presentation, whereas the other patient had been self-medicating with aspirin. Conclusion: To our knowledge, these two patients illustrate the first cases of spontaneous acute SDH formation most likely attributed to consumption of fondaparinux. PMID:21660271

  17. Occult falcine meningioma unmasked following nearly complete hemorrhagic transformation with resultant spontaneous acute interhemispheric subdural hematoma

    Science.gov (United States)

    Krishnan, Prasad; Jena, Manaranjan; Kartikueyan, Rajaraman

    2015-01-01

    Sudden-onset monoplegia with features of vomiting and headache usually signals an intracranial cerebrovascular event. We describe a 62-year-old man in whom this presentation was the result of the rare occurrence of an almost complete hemorrhagic transformation of a falcine meningioma with resultant acute interhemispheric subdural hematoma, and discuss the risk factors and possible mechanisms that may lead to such an event. The need for careful examination of the available radiology and aggressive tumor removal is stressed. PMID:25552860

  18. Diagnóstico angiográfico dos hematomas subdurais: valor da fase venosa em incidência sagital / Angiographic diagnosis of subdural hematoma: value of the venous phase in saggital incidence

    Scientific Electronic Library Online (English)

    José, Zaclis; Rolando A., Tenuto.

    1955-12-01

    Full Text Available Êste trabalho tem por fim demonstrar o valor da fase venosa em incidência sagital no diagnóstico angiográfico dos hematomas subdurais. Êle é baseado em 8 casos verificados cirürgicamente, dois dos quais com hematoma bilateral, compreendendo um total de 10 hematomas subdurals demonstrados pela angiog [...] rafia cerebral. Em 9 exemplares a elipse avascular que caracteriza essa entidade nosológica só apareceu na fase venosa; sòmente em um caso êsse sinal patognomônico foi claramente revelado na fase arterial em incidência ântero-posterior. O arteriograma mostra, apenas, às mais das vêzes, deslocamento da artéria cerebral anterior e seus ramos para o lado oposto àquele em que se encontra o hematoma, como acontece nos casos de lesões expansivas em geral. Menos freqüentemente os principais troncos arteriais do encéfalo não sofrem modificações no seu trajeto, apesar do espaço intracraniano ocupado pelos hematomas. A existência de hematoma subdural no interior de um hemicrânio sem desvio da artéria cerebral anterior, embora não implique necessàriamente na existência de outra coleção sangüínea do lado oposto, é altamente sugestiva dessa dupla lesão. A exploração bilateral nesses casos é, portanto, obrigatória. Dos três casos desta série em que a angiografia em um dos lados revelou a elipse avascular característica e artéria cerebral anterior com trajeto normal, a angiografia do lado oposto resultou positiva em dois dêles e negativa em um. Pôsto que alguns Serviços especializados não sejam dotados de equipamento para angiografia em séries, o autor recomenda o flebograma em incidência sagital como tempo obrigatório, mesmo que para tanto seja necessária nova injeção de contraste. Abstract in english This repport aims to demonstrate the value of the venous phase, in sagittal incidence, for the angiographic diagnosis of subdural hematoma. It is based on eight such cases, all of them with surgical confirmation. Six of the patients had unilateral hematomas and the remaining two had bilateral blood [...] collections. Ten subdural hematomas were, then, diagnosed by means of cerebral angiography. In only one instance the elliptical non vascularized area which constitutes the pathognomonic sign of the above referred nosological entity could be seen, under frontal projection, right in the arterial phase. In the other cases the specific diagnosis of subdural hematoma would not be achieved if the venous phase had not been taken in account. The arterial displacement seen in most cases of subdural hematoma gives no help for specific diagnosis; such a displacement may occur in any case of space-occupying lesion. Besides, existence of subdural hematomas with no arterial dislocation, is a known condition, mainly in that cases of bilateral subdural blood collections. On the other hand a single, unilateral hematoma with no shifting of the anterior cerebral artery to the opposite side is also suitable. In the last three cases of this series, there was no significant displacement of the anterior cerebral artery; the venous phase, in antero-posterior incidence, and further surgical exploration, showed the hematomas to be bilateral in two; in the third of these cases the anterior cerebral artery had a normal course, in spite of the space taken by a single hematoma. Thus, if the venous phase shows the characteristic picture of subdural hematoma - avascular area - with no displacement in the arterial phase, it does not mean necessarily that the hematoma is bilateral. Nevertheless angiography on opposite side must always be done. Since in angiographic diagnosis of subdural hematoma the accuracy of the venous phase, in sagittal projection seems to be proven, we think that the above mentioned step of the examination has to be done even if, in order to achieve it, a new injection of contrast may be required.

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

    Scientific Electronic Library Online (English)

    Uri Adrian Prync, Flato; Paulo Sérgio, Rheder; Helio Penna, Guimarães; Elias Silva, Flato; Paulo, Cretella.

    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. Abstract in spanish 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. Abstract in english 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 histor [...] y 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. 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.

  1. Hematoma subdural agudo espontâneo e hemorragia intracerebral em paciente com microangiopatia trombótica gestacional / Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy

    Scientific Electronic Library Online (English)

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

    2013-06-01

    Full Text Available 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-eclâmpsia pós-parto e fígado gorduroso agudo da gestação. Houve evolução tardia com hematoma subdural agudo e hemorragia intracerebral, sendo realizado tratamento neurocirúrgico. A paciente foi a óbito por anemia hemolítica refratária, com sangramento espontâneo em múltiplos órgãos. Pré-eclâmpsia, síndrome HELLP e fígado gorduroso agudo da gestação são processos patológicos que podem se sobrepor e se associar a complicações potencialmente fatais, como a hemorragia intracraniana aqui descrita. Sua detecção e diagnóstico precoces são fundamentais para a instituição de manejo adequado e sucesso do tratamento. Abstract in english Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The c [...] ase of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.

  2. Paresia VI par craneal por hematoma subdural retroclival y espinal postraumático: presentación de un caso y revisión de la literatura / Abducens nerve palsy due to postraumatic retroclival and spinal subdural hematoma: case report and literature review

    Scientific Electronic Library Online (English)

    I., Catalá-Antúnez; C. de, Quintana-Schmidt; P., Clavel-Laria; G., Montes-Graciano; J., Molet-Teixidó.

    2011-08-01

    Full Text Available Introducción: Los hematomas retroclivales postraumáticos son extremadamente infrecuentes y casi exclusivos de la edad pediátrica. Únicamente se ha documentado en la literatura un caso de hematoma subdural retroclival postraumático. Caso clínico: Varón de 8 años de edad que tras accidente de biciclet [...] a sufre traumatismo cráneo-encefálico con hiperextensión cervical. A su ingreso presentó Glasgow inicial de 13 y diplopia por paresia del VI par derecho. En la TAC y RM cráneo-cervical se objetivó un hematoma subdural retroclival. Se realizó manejo conservador con colocación de collarín rígido. Se observó recuperación espontánea del VI par a los 6 días presentando únicamente cervicalgia al alta. Presentó resolución clínica y radiológica a los 3 meses del accidente. Conclusión: Las lesiones hemorrágicas retroclivales postraumáticas son típicas de la edad pediátrica por la inmadurez de la unión cráneo-cervical que presentan. El tratamiento de elección es la colocación de un collarín rígido aunque si existe progresión clínica puede ser necesaria la evacuación quirúrgica. Abstract in english Introduction: Retroclival posttraumatic hematomas are extremely rare and almost exclusive to childhood. Only one case of retroclival subdural hematoma has been reported in the literature to date. Case report: An 8-year-old boy suffered a severe head injury with cervical hyperextension as the result [...] of a bicycle accident. On admission his initial Glasgow Coma Score was 13 and he had diplopia due to right palsy of the VI nerve. A retroclival subdural hematoma was observed by CT and MRI of the craneovertebral junction. Management was conservative and a rigid collar was placed. Palsy of VI nerve recovered spontaneously at 6 days and at discharge the patient had only cervical pain. Follow up at 3 months after the accident showed clinical and radiological resolution. Conclusion: Traumatic retroclival hematomas are mainly a pediatric entity due to immaturity of the cranio-cervical junction. Treatment consists of placement of a rigid collar although clinical progression may require surgical evacuation.

  3. Frequency of conservatively managed traumatic acute subdural haematoma changing into chronic subdural haematoma

    International Nuclear Information System (INIS)

    Background: Traumatic brain injury represents a significant cause of mortality and permanent disability in the adult population. Acute subdural haematoma is one of the conditions most strongly associated with severe brain injury. Knowledge on the natural history of the illness and the outcome of patients conservatively managed may help the neurosurgeon in the decision-making process. Methods: We prospectively analysed 27 patients with age ranges 15-90 years, in whom a CT scan diagnosis of acute subdural haematoma was made, and in whom craniotomy for evacuation was not initially performed, to the neurosurgery department of Ayub Teaching Hospital Abbottabad (2008-2011). Patients with deranged bleeding profile, anticoagulant therapy, chronic liver disease, any other associated intracranial abnormalities, such as cerebral contusions, as shown on CT, were excluded from this study. All patients were followed by serial CT scans, and a neurological assessment was done. Results: There were 18 male and 9 female patients, Cerebral atrophy was present in over half of the sample. In 22 of our patients, the acute subdural haematoma resolved spontaneously, without evidence of damage to the underlying brain, as shown by CT or neurological findings. Four patients subsequently required burr hole drainage for chronic subdural haematoma. In each of these patients, haematoma thickness was greater than 10 mm. The mean delay between injury and operation in this group was 15-21 days. Among ttion in this group was 15-21 days. Among these patients 1 patient required craniotomy for haematoma removal due to neurological deterioration. Conclusion: Certain conscious patients with small acute subdural haematomas, without mass effect on CT, may be safely managed conservatively, but due to high risk of these acute subdural haematoma changing into chronic subdural haematoma these patients should be reinvestigated in case of neurological deterioration. (author)

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

    DEFF Research Database (Denmark)

    Nielsen, Troels Halfeld; Engell, Susanne I

    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(2) compatible with intact energy metabolism. METHODS: ASDH was produced by infusion of 7 ml of autologous blood (infusion rate 0.5 ml/min) by a catheter placed subdurally. PbtO(2) and microdialysis probes were placed symmetrically in the injured ("bad-side") and non-injured ("good-side") hemispheres. Intracranial pressure (ICP) was monitored in the "good-side." RESULTS: ICP, cerebral perfusion pressure (CPP), PbtO(2), glucose, lactate, pyruvate, lactate-pyruvate ratio (LP ratio), glutamate, and glycerol were recorded at baseline (60 min) and post trauma (360 min). After the creation of the ASDH, PbtO(2) decreased significantly in both the hemispheres (P 

  5. Hematoma epidural lumbar crónico espontáneo / Chronic spontaneous lumbar epidural hematoma

    Scientific Electronic Library Online (English)

    J.M., Belinchón; J., Campos; J., Merino; J.M., Gallego; C., Barcia.

    2005-12-01

    Full Text Available Presentamos un caso excepcional de estenosis de canal lumbar con síndrome de cola de caballo por un hematoma crónico espontáneo en el espacio epidural L2-L3. Se trata de un varón de 53 años que, sin ninguna clase de antecedente patológico relacionado con el problema actual (traumatismos, punciones l [...] umbares, toma de antiagregantes o anticoagulantes), presenta una colección hemática epidural que va comprimiendo progresivamente la cola de caballo. Las pruebas de imagen mostraron una colección polilobulada, bien delimitada, que se interpretó como quiste sinovial. Tras la cirugía (laminectomía descompresiva y evacuación) se confirmó el diagnóstico con estudio histológico. Tras la operación se recuperó por completo la función neurológica. Abstract in english We report an exceptional case of cauda equina syndrome, caused by a chronic epidural hematoma of the lumbar spine, (L2-L3). A 53 year old man without history of trauma, lumbar punctures or antiagregant medication, suffered from progressive back pain and minor motor deficit in the legs. The etiology, [...] MRI, intraoperative findings and microscopical study are presented and discussed. After surgery there was a complete resolution of the clinical picture.

  6. Chronic Subdural Haematoma in a Case of Hyperthyroidism Presenting with Papilledema

    Directory of Open Access Journals (Sweden)

    2012-12-01

    Full Text Available Subdural hematomas are often life-threatening when acute but chronic subdural hematomas, however, have better prognosis if properly managed. Chronic subdural hematomas are common in the elderly due to shrinkage of brain tissue, but in young patient mostly associated with head injury. It is seen also in young having various coagulopathies associated with blood disorders or drug-induced, but it is very rare. Propylthiouracil (PTU is an oral medication that is used in treatment of hyperthyroidism approved by FDA in July 1947. This medication may rarely cause very serious blood disorders (such as a low number of red cells, white cells, and platelets, especially during the first few months of treatment. We are reporting a rare case of PTU-induced thrombocytopenia leading to chronic subdural haematoma, which presented with established papilledema and signs of raised ICP in a hyperthyroid female and she responded well to surgical management.

  7. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    Takahashi, Hideaki

    1988-12-01

    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.

  9. Use of postmortem computed tomography to reveal acute subdural hematoma in a severely decomposed body with advanced skeletonization.

    Science.gov (United States)

    Sano, Rie; Hirasawa, Satoshi; Awata, Sachiko; Kobayashi, Susumu; Shimada, Takehiro; Takei, Hiroyuki; Takahashi, Yoichiro; Kominato, Yoshihiko

    2013-01-01

    An 81-year-old man was found dead 1 month after he had disappeared following a visit to a hot spring resort in early autumn. The body showed severe postmortem changes with advanced skeletonization from the head to the abdomen as well as putrefactive and autolytic changes in the remaining tissues. The thoracic and abdominal organs had been lost. Naked eye examination revealed soft tissue injuries accompanied by ragged edges and characteristic punctures with no signs of vitality, suggesting that these injuries had been due to postmortem animal scavenging. However, bruises were prominent on the anterior parts of both lower extremities. Postmortem computed tomography (PMCT) scan demonstrated subdural hematoma over the right cerebral hemisphere, although the brain itself had undergone putrefactive and autolytic changes. Subsequent autopsy confirmed the presence of a 140 g acute subdural hematoma, which would likely have been fatal. This case illustrates that PMCT is able to yield important information about possible cause of death, even in a partially skeletonized body. PMID:23000271

  10. 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.

  11. 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 i3% (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)

  12. 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.

  13. Resolution of blepharospasm after chronic subdural haematoma evacuation: A case report.

    Science.gov (United States)

    Velnar, Tomaz; Ravnik, Janez; Bunc, Gorazd

    2012-03-01

    Blepharospasm in connection with chronic subdural haematoma is an uncommon pathology and usually subsides after treatment of the haematoma. Different mechanical and vascular factors may play a role by affecting domapinergic transmission in basal ganglia. A case of a 72-year-old patient is presented, who developed transient blepharospasm as a result of a chronic subdural haematoma and whose symptoms regressed after surgical management. PMID:22327937

  14. [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

  15. Subacute subdural hematoma in a 45-year-old woman with no significant past medical history after a roller coaster ride.

    Science.gov (United States)

    Williams, Kim A; Kouloumberis, Pelagia; Engelhard, Herbert H

    2009-05-01

    Amusement park ride injuries have been newsworthy events for many years. The multitude and severity of these injuries has been reported many times over the past 20 years and includes spinal cord and vertebral injuries, subarachnoid hemorrhage, internal and vertebral artery dissections, and even a few cases of subdural hematoma (SDH). There has also been as many theories to explain these injuries as there have been injuries themselves including how G forces and rotational acceleration can cause both neuroparenchymal and neurovascular injury. PMID:19555640

  16. Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications.

    Science.gov (United States)

    Wittschieber, D; Karger, B; Niederstadt, T; Pfeiffer, H; Hahnemann, M L

    2015-03-01

    Are subdural hygromas the result of abusive head trauma? CT and MR imaging represent important tools for the diagnosis of abusive head trauma in living infants. In addition, in-depth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Therefore, the current knowledge on subdural hygromas is summarized and forensic conclusions are drawn. The most important diagnostic pitfalls, benign enlargement of the subarachnoid space, and chronic subdural hematoma, are discussed in detail. Illustrative cases from forensic practice are presented. Literature analysis indicates that subdural hygromas can occur immediately or be delayed. If other infrequent reasons can be excluded, the presence of subdural hygromas strongly suggests a posttraumatic state and should prompt the physician to search for other signs of abuse. To differentiate subdural hygromas from other pathologies, additional MR imaging of the infant's head is indispensable after initial CT scan. PMID:24948499

  17. 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.)

  18. A case of chronic expanding hematoma resulting in fatal hemoptysis.

    Science.gov (United States)

    Hata, Yoshinobu; Sakamoto, Susumu; Shiraga, Nobuyuki; Sato, Keita; Sato, Fumitomo; Otsuka, Hajime; Goto, Hidenori; Takagi, Keigo; Watanabe, Yoshinori

    2012-10-01

    An 80-year-old woman presented with a huge intrathoracic mass which had increased in size over 4 years. Computed tomography showed a thick calcified capsule and early-enhanced streaks inside the mass. Needle biopsy aspirated pure blood and fibrous connective tissue. F-18 fluorodeoxyglucose positron-emission tomography showed moderate FDG uptake at the periphery with central photon defects. Gallium-67 scintigraphy showed no abnormal uptake. On suspicion of chronic expanding hematoma, we recommended surgical resection, but the patient requested only follow-up. One year later, she was hospitalized with cardiac tamponade and subsequent massive hemoptysis. Repeated embolization was ineffective, and the patient soon succumbed. PMID:23050116

  19. Hematoma subgaleal crónico en un lactante: Presentación de un caso / Chronic subgaleal hematoma in a child: Case report

    Scientific Electronic Library Online (English)

    J.M., Santín-Amo; M., Gelabert-González; J.M., Villa-Fernández; D., Castro-Bouzas; R., Serramito-García; A., García-Allut.

    2011-06-01

    Full Text Available Los hematomas subgaleales neonatales son colecciones sanguinolentas, localizadas entre la galea y el tejido conectivo epicraneal; con frecuencia son infradiagnosticados, y en la mayoría de las ocasiones guardan relación con determinados procedimientos obstétricos como el uso de fórceps o ventosa. En [...] general tienen poco volumen y suelen solucionarse espontáneamente. Ocasionalmente pueden alcanzar gran tamaño y ponen en riesgo la vida del recién nacido; excepcionalmente tienden a la cronificación siendo necesario para su tratamiento emplear procedimientos quirúrgicos. Exponemos el caso de una paciente menor de un año de edad que presenta un hematoma subgaleal secundario a parto asistido con ventosa y que precisó tratamiento quirúrgico. Abstract in english Neonatal subgaleal hematomas are under-diagnosed collections of blood beneath the galea, often caused by certain obstetric procedures such as use of forceps or vacuum. They generally have low volume and often resolve spontaneously. Occasionally, they can achieve a large volume and may endanger the l [...] ive of the affected newborns. Rarely, they become chronic and exceptionally they may require surgical treatment. We report the case of a child under one year of age who was referred to our department because of a subgaleal hematoma secondary to vacuum-assisted delivery that required surgical treatment.

  20. 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

    Scientific Electronic Library Online (English)

    Sebastião Nataniel Silva, Gusmão; José Eymard Homem, Pittella.

    2003-09-01

    Full Text Available 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 p [...] acientes 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. Abstract in english 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 ASD [...] H 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.

  1. 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.

  2. Hematoma cerebeloso a distancia

    Scientific Electronic Library Online (English)

    Tomás, Funes; Santiago, González Abbati; Flavia, Clar; Roberto, Zaninovich; Rubén, Mormandi; Oscar, Stella.

    2010-09-01

    Full Text Available Objetivo. Describir dos casos de hematoma cerebeloso después de cirugía supratentorial: un hematoma subdural (caso 1) y un higroma subdural (caso 2). Material y método. Análisis de las historias clínicas e imágenes de dos pacientes evaluadas en el Hospital de Clínicas y en el Hospital Español en 200 [...] 9. Resultados. Caso 1: Paciente masculino de 70 años, con hemiparesia izquierda y lúcido que después de la evacuación de un hematoma subdural sufrió una hemorragia sobre las folias cerebelosas y presentó hematoma vermiano de 2,5 cm a las 72 horas de la cirugía. La evolución fue desfavorable con un súbito déficit neurológico e insuficiencia cardiorrespiratoria. Caso 2: Paciente femenino de 40 años, con un hematoma vermiano asintomático de 1 cm encontrado en la TAC de control a las 72 horas de la cirugía. Evolución sin déficit neurológico. Conclusión. La cirugía supratentorial con pérdida abundante de LCR sería el factor más importante de esta complicación. El hiperdrenaje de LCR produce relajación del cerebelo con la consiguiente tracción y rotura de las venas puente que van a la tienda, provocando hematomas subdurales e infartos venosos hemorrágicos del cerebelo. Estos dos casos reportados fueron operados sin drenaje subdural aspirativo con pérdida abundante de LCR durante 72 y 48 horas respectivamente, que es el patrón etiológico más frecuente según la mayoría de los autores. Abstract in english Objective. To describe two cases of cerebellar hematomas after supratentorial surgeries: a subdural hematoma (case 1) and subdural hygroma (case 2). Materia and Method. An analysis of the clinical records and images of two patients evaluated during 2009 at the Clinicas Hospital and at the Spanish Ho [...] spital. Results. Case 1, 70 years old male, with a left hemiparesis and a lucid status after evacuation of subdural hematoma suffered a 2.5 cm bleeding in the cerebellar folias and in the vermis after 72 hs of the surgery. The evolution was unfavorable with a sudden neurological deficit and cardiorespiratory failure. Case 2, 40 years old female, with asymptomatic 1 cm vermian hematoma found in the CT scan control after 72 hs of the surgery. Evolution was without neurological deficit. Conlusion. Supratentorial surgery with considerable outflow of cerebrospinal fluid would be the one most important factor in this complication. The cerebrospinal overdrainage produces cerebellar relaxation with the consequent traction and rupture of the brinding veins toward the tentorium, generating subdural haematomas and cerebellar hemorragic venous infarction. These two cases reported were operated with non aspirative subdural drainages with considerable cerebrospinal outflow for 72 and 48 hs respectively, that is the common etiologic pattern according to most of the authors.

  3. Chronic spontaneous lumbar epidural hematoma simulating extradural spinal tumor: a case report.

    Science.gov (United States)

    Matsui, Hiroki; Imagama, Shiro; Ito, Zenya; Ando, Kei; Hirano, Kenichi; Tauchi, Ryoji; Muramoto, Akio; Matsumoto, Tomohiro; Ishiguro, Naoki

    2014-02-01

    Spinal epidural hematoma (SEH) is an uncommon disorder, and chronic SEHs are rarer than acute SEHs. However, there is few reported involving the bone change of the vertebral body in chronic SEHs. We present a case report of lumbar epidural hematoma that required differentiation from extramedullary spinal tumors by a long process because the CT scan revealed scalloping of the vertebral body and review the relevant literature. A 78-year-old man had experienced a gradual onset of low back pain and excruciating pain in both legs. Lumbar MRI on T1-weighted images revealed a space-occupying lesion with a hyperintense signal relative to the spinal cord with no enhancement on gadolinium adminisration. Meanwhile, T2-weighted images revealed a heterogeneous intensity change, accompanying a central area of hyperintense signals with a hypointense peripheral border at the L4 vertebra. Moreover, the CT scan demonstrated scalloping of the posterior wall of the L4 vertebral body which is generally suspected as the CT finding of spainal tumor. During the epidural space exploration, we found a dark red-colored mass surrounded by a capsular layer, which was fibrous and adhered to the flavum and dura mater. Microscopic histological examination of the resected mass revealed a mixture of the relatively new hematoma and the hematoma that was moving into the connective tissue. Accordingly, the hematoma was diagnosed as chronic SEH. The particular MRI findings of chronic SEHs are helpful for making accurate preoperative diagnoses of this pathology. PMID:25130006

  4. [Diagnosis and surgical treatment of traumatic intracranial membrane hematoma of rare localization].

    Science.gov (United States)

    Kadzhaia, N V; Mazepa, V P; Kariev, G M; Goncharuk, O A

    1993-01-01

    The results of treatment of 93 patients with traumatic membrane hematoma of rare location (membrane hematoma of the posterior cranial fossa, epidural hematoma of the anterior cranial fossa, occipital pole, hematoma located over the upper longitudinal sinus, intercerebral subdural hematoma, subdural hematoma of basal location) have been analysed. Difficulties in diagnosis of hematoma are conditioned by a variety of clinical signs. The informative value of the different methods of diagnosis were assessed, peculiarities of surgical intervention noted. PMID:8139193

  5. 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

  6. Spontaneous, chronic expanding posterior thigh hematoma mimicking soft-tissue sarcoma in a morbidly obese pregnant woman.

    Science.gov (United States)

    Everhart, Joshua S; Fajolu, Olukemi K; Mayerson, Joel L

    2015-01-01

    Soft-tissue sarcomas are rare and often confused for more common and benign disorders during diagnosis. Chronic expanding hematomas are particularly difficult to distinguish from soft-tissue malignancy. We describe the case of a morbidly obese patient with a chronic expanding hematoma in the distal posterior thigh whose definitive treatment was delayed 6 months because of her pregnancy status and inability to lie prone for open biopsy. PMID:25566562

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

    International Nuclear Information System (INIS)

    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.

  8. 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.

  9. 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.)

  10. Abdominal chronic expanding hematoma causing iron-deficiency anemia in a dog.

    Science.gov (United States)

    Sebbag, Lionel; Harkin, Kenneth R; Habekost, Allison; Gumber, Sanjeev; Lee, Tiffany

    2014-01-01

    A 2 yr old spayed female mixed-breed Irish wolfhound was referred for assessment of anemia and slowly progressing abdominal distention. At the time of admission, the dog had marked anemia and thrombocytosis, a decreased serum iron concentration, and a normal coagulation profile. An ultrasound examination showed a massive fluid-filled cavitated structure in the abdominal cavity. Paracentesis of that structure yielded a large amount of hemorrhagic fluid with an iron concentration >24 times greater than the serum iron concentration, consistent with chronic sequestration of iron, leading to iron-deficiency anemia. Blood transfusions and incomplete surgical removal of the structure allowed short-term stabilization of the patient, but the dog was euthanized 17 days postsurgery for lethargy and continued abdominal distention. Histopathological evaluation of the structure was consistent with a chronic expanding hematoma. To the authors' knowledge, this is the first reported case of intra-abdominal chronic expanding hematoma in a dog. It is also unique given its features of iron-deficiency anemia caused by internal blood loss. PMID:25028435

  11. Subdural empyema, retropharyngeal and parapharyngeal space abscess: Unusual complications of chronic otitis media

    Directory of Open Access Journals (Sweden)

    Erdevi?ki Ljiljana

    2012-01-01

    Full Text Available Introduction. Otitic complications arise from expansion of the middle ear infection. Subdural empyema is a rare otitic complication, and both retropharyngeal and parapharyngeal abscesses have been described in just a few cases. Case report. A 30-year-old male was, admitted as an emergency case because of breathing difficulties, secretion from the ear, and fever. Clinical examination had shown a purulent, fetid secretion from the ear, swelling on the roof of epipharynx, left tonsil pushed medialy, immobile epiglottis, reduced breathing space. Computed tomography revealed thick hypodense content filling cavity, mastoid entering the posterior cranial fossa, descending down throw the parapharyngeal space to the mesopharynx. On the roof and posterior wall of the epipharynx hypodense collection was also present. Tracheotomy was conducted, and incision of the parapharyngeal and retropharyngeal abscess and radical tympanomastoidectomy were performed. The patient’s state deteriorated on the tenth postoperative day with hemiparesis and consciousness disorder. Magnetic resonance imaging was done. It showed subdural empyema of the left frontoparietal region and next to the falx, so craniotomy and abscess drainage were conducted. Conclusion. Parapharyngeal, retropharyngeal abscess and subdural empyema are rare otitic complications. Adequate antibiotic therapy and radical surgical treatment make possible an outcome with survival.

  12. The repeat CT-findings of the contusional hematoma

    International Nuclear Information System (INIS)

    Twenty-seven cases of traumatic intracerebral hematoma were treated from 1977 to 1979. The intracerebral hematomas are classified into three groups: central type, hematoma within contusional area and contusional hematoma, according to the CT findings and the clinical course. Fourteen of these cases are diagnosed as contusional hematoma which show a normal CT scan, subarachnoidal hemorrhage, subdural hematoma and epidural hematoma without any kind of intracerebral high density in the initial CT scan performed within 6 hours after injury. Ten of the cases were found during conservative treatment; in 2 cases, hematomas were revealed within 24 hours; in 2 more cases within 48 hours, and in 6 cases, within 3 - 5 days following injury. In the other 4 cases, hematoma occurred 1 - 2 days following the emergency evacuation of a subdural hematoma and decompressive craniectomy. Based on the clinical experience outlined above, it is our current practice in diagnosing patients with contusional hematoma to perform repeat CT scanning within 5 - 6 days after injury whenever isodensity or subarachnoidal hemorrhage with a shift in the midline structure is observed in an initial CT scan within 6 hours or whenever an evacuation of the subdural hematoma with decompressive craniectomy is performed. (author)

  13. Diagnosis and follow-up studies of traumatic subdural fluid collection

    International Nuclear Information System (INIS)

    A considerable amount of research has been reported on subdural fluid collection after head trauma since the first case was reported by Dandy in 1912. This research was conducted by means of cerebral angiography, pneumoencephalographic study, and other neurological methods. However, Computed Tomography (CT scan) has become a great new means of neurological diagnosis, especially in the localization of the intracranial mass, and there exists a considerable amount of literature on intracranial disease. Nevertheless, little work has been done in studying the traumatic subdural fluid collection of adults by CT scan. Six cases of this disease in adults have now been analyzed by CT scan. The following results were obtained. (1) It is possible to diagnose traumatic subdural fluid collection using the CT scan alone and to differentiate this disease from brain atrophy and chronic subdural hematoma of the low-density type. (2) The CT scan findings are as follows. The location in all cases is on the bi-frontal tip, the figure is eccentric and symmetrical, and the Hounsfield unit shows 7. There is no relation between the location and the site of the hit. There is no intracranial mass sign. (3) After surgical therapy by the trephine method, the findings of CT scan and the neurological deficits normalized remarkably within 14 days in our cases. (author)

  14. The CT examination of changes in intracranial hematoma density

    International Nuclear Information System (INIS)

    The study was undertaken to assess the changes in the size and densities of intracranial hematoma by analyzing the sequential CT examination of 23 patients at Soonchunhyang College Hospital from Jul. 1980 to Aug. 1981. The results were as follows; 1. The right densities of hematoma were reduced slowly in size and density. 2. The factors influence the rate of changes were the cause of hematoma, hematoma location, age and sex of patient, and initial hematoma size. 3. The CT findings that indicate complete absorption of hematomas were normalization of mass effect, not disappearance of hematoma densities. 4. In intracerebral hematoma, the high density of hematoma reduced it's density and mass effect about 4-6 weeks duration. 5. In subdural hematoma, about 7 weeks after head trauma, the CT findings were normalized

  15. Hematoma espinal / Spinal hematoma

    Scientific Electronic Library Online (English)

    Antonio Javier, García Medina; Grecia María, Giniebra Marín; Juan Carlos, Bermejo Sánchez.

    2013-04-01

    Full Text Available El hematoma epidural espinal es un hallazgo poco frecuente en la práctica médica. Se presenta un caso de una paciente portadora en la región dorsal, donde su forma de presentación también se consideró muy inhabitual y confusa; esta debutó con un dolor precordial con irradiación del brazo izquierdo, [...] la espalda y el estómago, instaurándose después una mielitis transversa dorsal. Se presenta el resultado de la resonancia magnética nuclear dorsal, con consideraciones diagnósticas de los diferentes tipos de hematomas espinales. Se realizó una laminectomía desde D3 a D6 y se evacuó un extenso hematoma epidural desde D1 a D8. Abstract in english Epidural spinal hematoma is an infrequent finding in medical practice. A case of a female patient suffering from a pain in the dorsal region, with its way of presentation was also considered as an unusual and confuse occurrence; it started with precordial pain irradiating left arm, back and stomach, [...] establishing a dorsal transverse myelitis. The result of a nuclear magnetic resonance is presented with diagnostic considerations of different types of spinal hematomas. A laminectomy from D3 to D6 was performed and a large epidural hematoma from D1 to D8 was evacuated.

  16. Hematoma espinal Spinal hematoma

    Directory of Open Access Journals (Sweden)

    Antonio Javier García Medina

    2013-04-01

    Full Text Available El hematoma epidural espinal es un hallazgo poco frecuente en la práctica médica. Se presenta un caso de una paciente portadora en la región dorsal, donde su forma de presentación también se consideró muy inhabitual y confusa; esta debutó con un dolor precordial con irradiación del brazo izquierdo, la espalda y el estómago, instaurándose después una mielitis transversa dorsal. Se presenta el resultado de la resonancia magnética nuclear dorsal, con consideraciones diagnósticas de los diferentes tipos de hematomas espinales. Se realizó una laminectomía desde D3 a D6 y se evacuó un extenso hematoma epidural desde D1 a D8.Epidural spinal hematoma is an infrequent finding in medical practice. A case of a female patient suffering from a pain in the dorsal region, with its way of presentation was also considered as an unusual and confuse occurrence; it started with precordial pain irradiating left arm, back and stomach, establishing a dorsal transverse myelitis. The result of a nuclear magnetic resonance is presented with diagnostic considerations of different types of spinal hematomas. A laminectomy from D3 to D6 was performed and a large epidural hematoma from D1 to D8 was evacuated.

  17. 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

  18. 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.

  19. Acute enlargement of subdural hygroma due to subdural hemorrhage in a victim of child abuse.

    Science.gov (United States)

    Inoue, Hiromasa; Hyodoh, Hideki; Watanabe, Satoshi; Okazaki, Shunichiro; Mizuo, Keisuke

    2015-03-01

    An 11-month-old female baby was found dead by her mother. Cranial postmortem CT prior to the forensic autopsy showed dilatation of bilateral extra-axial spaces and ventricles. The autopsy revealed a new linear fracture of the left parietal bone and occipital bone, and a healed linear fracture of the right parietal bone and occipital bone like a mirror image of the left one as well. Intracranially, 230ml of subdural fluid were collected, which was mixed with blood. There was a fresh hemorrhage around a bridging vein of the left parietal lobe and the dura mater. Moreover, the outer side of the cerebrum and the inner side of the dura mater were covered by a thin membrane, which mater might have been previously formed because of being positive for Fe-staining and anti-CD68 antibody. A subdural hematoma might have been developed when the right side of the skull was previously fractured, which was transformed into a subdural hygroma. Subsequently, it is likely that, after the left side fracture of the skull occurred, the subdural hygroma rapidly enlarged due to hemorrhaging from the bridging vein, which resulted in intracranial hypertension, because microbleeding was detected in the brain stem. Accordingly, we diagnosed the cause and manner of death as intracranial hypertension due to subdural hemorrhage in subdural hygroma, and homicide, including child abuse, respectively. PMID:25457269

  20. A Clinico-dynamic study of acute traumatic intracerebral hematoma by means of CT

    International Nuclear Information System (INIS)

    After the introduction of CT (HITACHI CT-H) in February, 1977, we have examined 11 cases of traumatic intracerebral hematoma (ICH). From the CT findings, including repeat CT scans within a short period, we have classified these cases into four groups. The first group included three cases whose CT revealed a large hematoma. The hematomas were removed immediately, obtaining good results. The second group included three cases whose initial CT revealed a small ICH, but whose repeat CT disclosed a large one, with a deterioration of the clinical state. They were operated on, with good results. The third group consisted of four cases whose ICH developed out of cerebral contusion. Three cases were diagnosed initially as cerebral contusion, but later CT scans revealed large hematomas within the contused areas. Two of them were operated on, with good results. The fourth group consisted of one case whose CT showed and ICH and a large chronic subdural hematoma (SDH). Most of his symptoms disappeared upon only the evacuation of the SDH. From these experiences, we realized especially that repeat CT scanning within a short period was extremely valuable for the management of an acute head injury when the patient became worse under conservative treatment. (author)

  1. A case of benign meningioma presented with subdural hemorrhage.

    Science.gov (United States)

    Kim, Joo-Hwan; Gwak, Ho-Shin; Hong, Eun Kyung; Bang, Chang Whan; Lee, Sang Hyun; Yoo, Heon

    2015-04-01

    Meningiomas are the most common benign intracranial tumors and make up 13-26% of all primary intracranial tumors. Clinical presentation of hemorrhage is rare in these tumors occurring in approximately 1.3% of cases and subdural hemorrhages are even more uncommon. The mechanism of hemorrhage is still unclear and may vary according to histologic type, location and the type of hemorrhage. We experienced a case of 61-year-old woman with a benign meningioma presenting as a subdural hemorrhage. She developed sudden onset of headache right after aggressively coughing. Her headache persisted for a week before she was admitted to the emergency room of National Cancer Center. She had a past medical history of ovarian cancer which had been treated and was allegedly recurrence-free for 2 years. At the time of admission, a headache was the only symptom and imaging studies showed a right frontal hemorrhagic subdural mass lesion accompanying an ipsilateral subdural hematoma. Elective surgery was performed and intraoperative findings revealed the hallmark characteristics of a meningioma with mixed stage diffuse subdural hematoma. Permanent pathology result determined it was a conventional meningioma (World Health Organization grade I). From this case, we discuss the rare presentation of subdural hemorrhage in meningioma and related points by reviewing the literature of previous studies. PMID:25977904

  2. Empyema of preexisting subdural hemorrhage caused by a rare salmonella species after exposure to bearded dragons in a foster home.

    Science.gov (United States)

    Tabarani, Christy M; Bennett, Nicholas J; Kiska, Deanna L; Riddell, Scott W; Botash, Ann S; Domachowske, Joseph B

    2010-02-01

    An infant had a subdural empyema caused by the rare Salmonella species enterica subspecies houtenae (IV) serotype 44:z4,z23:- after only indirect exposure to exotic reptiles in her foster home. Infants recovering from preexisting subdural hematoma are at risk for development of empyema. PMID:20105642

  3. Spinal subdural metastasis

    International Nuclear Information System (INIS)

    A case of metastasis to the thoracic spinal subdural space is reported. Metrizamide myelography showed narrowing of the upper thoracic subarachnoid space. A tumor in the spinal subdural space is unusual; only a few cases have been reported. The myelographic appearance is not specific; and epidural metastasis can produce the same myelographic picture. (orig.)

  4. 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

  5. Epidural hematomas of posterior fossa

    Directory of Open Access Journals (Sweden)

    Radulovi? Danilo

    2004-01-01

    Full Text Available Background. Posterior fossa epidural hematomas represent 7-14% of all traumatic intracranial epidural hematomas. They are most frequently encountered posttraumatic mass lesions in the posterior fossa. The aim of this study was to identify clinical features that could lead to the early diagnosis of posterior fossa epidural hematoma. Methods. Between 1980 and 2002, 28 patients with epidural hematoma of the posterior fossa were operated on at the Institute for Neurosurgery, Belgrade. Clinical course neuroradiological investigations, and the results of surgical treatment of the patients with posterior fossa epidural hematomas were analyzed retrospectively. Results. Almost two thirds of patients were younger than 16 years of age. In 20 cases injury was caused by a fall, in 6 cases by a traffic accident, and in 2 by the assault. Clinical course was subacute or chronic in two thirds of the patients. On the admission Glasgow Coma Scale was 7 or less in 9 injured, 8-14 in 14 injured, and 15 in 5 injured patients. Linear fracture of the occipital bone was radiographically evident in 19 patients, but was intraoperatively encountered in all the patients except for a 4-year old child. In 25 patients the diagnosis was established by computer assisted tomography (CAT and in 3 by vertebral angiography. All the patients were operated on via suboccipital craniotomy. Four injured patients who were preoperatively comatose were with lethal outcome. Postoperatively, 24 patients were with sufficient neurologic recovery. Conclusion. Posterior fossa epidural hematoma should be suspected in cases of occipital injury, consciousness disturbances, and occipital bone fracture. In such cases urgent CAT-scan is recommended. Early recognition early diagnosis, and prompt treatment are crucial for good neurological recovery after surgery.

  6. Nasal septal hematoma

    Science.gov (United States)

    A nasal septal hematoma is collection of blood within the septum of the nose. The septum is the part of the ... A septal hematoma can be caused by: A broken nose Injury to the soft tissue of the area Surgery ...

  7. Cerebral venous sinus thrombosis presenting as subdural haematoma

    International Nuclear Information System (INIS)

    The authors report a 39-year-old woman who presented with intermittent, excruciating nuchal and occipital headache. Magnetic resonance imaging and magnetic resonance angiography scans showed bilateral subdural haematomas with veno-occlusive disease of the superficial and deep venous systems. There were bridging collaterals with scalp veins, bleeds from which could explain the subdural haematoma. There was acute on chronic veno-occlusive disease with an acute rise in intracranial pressure and a bleed from the vein of Galen Copyright (2005) Blackwell Publishing Asia Pty Ltd

  8. Traumatic Aortic Intramural Hematoma

    Directory of Open Access Journals (Sweden)

    Mehmet Özgür Erdo?an

    2013-03-01

    Full Text Available Blunt traumatic aortic injury is a life threatening condition with a mortality rate of 30%. Aortic injury commonly involves the thoracic aorta with pseudoaneurysm and intramural hematoma. Aortic intramural hematoma is a dissection without an intimal tear. Intramural aortic hematoma is an uncommon but potentially lethal aortic disease. TEE, CT, MRI and Multidetector CT can ensure a rapid and accurate diagnosis of intramural hematoma. Management of traumatic aortic intramural hematoma is not well defined in the literature. Significant intramural aortic hematoma in stable patients may remain stable on follow-up imaging. In this study we present a traumatic aortic intramural hematoma which resolved with conservative treatment in a 36 year old man who fell from a height.

  9. CT guided stereotactic evacuation of hypertensive and traumatic intracerebral hematomas

    International Nuclear Information System (INIS)

    Recent advancement of CT system provides not only definite diagnosis and location of intracerebral hematoma but also coordinates of the center of the hematoma. Trials of stereotactic evacuation of the hematoma have been reported by some authors in the cases of subacute or chronic stages of hypertensive intracerebral hemorrhage. In this series, similar surgery has been performed in 33 cases of hypertensive intracerebral hematoma including 22 cases in acute stage, and 2 cases of traumatic hematoma. Clinical outcomes were investigated and the results were considered to be equivalent or rather better in the conventional microsurgery with evacuation of hematoma under direct vision. However, there still remained controversial problems in the cases of threatened herniation signs, because in these cases regular surgery with total evacuation of the hematoma at one time might have been preferable. The benefits of this CT guided stereotactic approach for the evacuation of the hematoma were thought to be as follow: 1) the procedure is simple and safe, 2) operation is readily performed under local anesthesia, and 3) the hematoma was drained out totally by means of urokinase activity. It is our impression that this surgery not only is indicated as emergency treatment for the patients of high-age or in high risk, but also can institute as a routine surgery for the intracerebral hematomas in patients showing no herniation sign. (J.P.N.)

  10. Craneotomía limitada para el tratamiento de los hematomas traumáticos agudos en el adulto mayor / Limited craniotomy as treatment of acute traumatic hematoma in the elderly

    Scientific Electronic Library Online (English)

    Gretel, Mosquera Betancourt; Ariel, Varela Hernández; Denis, Suárez Monné; Yanmara, Bethartes Sotomayor.

    2011-10-01

    Full Text Available Fundamento: el tratamiento quirúrgico de los hematomas yuxtadurales traumáticos en el adulto mayor es un tema complejo y controversial por la elevada mortalidad que lo acompaña. Objetivo: presentar los resultados preliminares de la aplicación de la craneotomía limitada para la evacuación de los hema [...] tomas yuxtadurales traumáticos agudos en el adulto mayor. Método: estudio descriptivo de los resultados del tratamiento quirúrgico de los hematomas yuxtadurales traumáticos agudos en 19 pacientes con 60 años y más, atendidos por el Servicio de Neurocirugía del Hospital Universitario Manuel Ascunce Domenech, en el período de enero de 2008 a diciembre de 2010. Resultados: en 17 pacientes la Tomografía Axial Computarizada de cráneo mostró la presencia de hematomas subdurales agudos hemisféricos. El 58.8 % de los pacientes con hematoma subdural agudo y el 100 % con hematomas intracerebrales fallecieron. Se realizaron 18 craneotomías limitadas, logró sobrevivir el 39 % de los pacientes. Conclusiones: la realización de la craneotomía limitada para la evacuación de este tipo de lesiones primarias, en esta serie, mostró resultados alentadores, poco menos de la mitad de los pacientes lograron sobrevivir con buen pronóstico por lo que se considera es una opción terapéutica a tener en cuenta pendiente de evaluar sus resultados en futuras investigaciones. Abstract in english The surgical treatment of traumatic hematomas in the elderly is a complex and controversial topic due to its associated high mortality rate. Objective: the purpose of this article is to present the preliminary findings on the use of limited craniotomy for the evacuation acute juxtadural traumatic he [...] matomas in the elderly. Method: a descriptive study on the surgical treatment results of acute juxtadural traumatic hematomas was conducted involving 19 elderly patients of 60 years and over treated in the Neurosurgical service at the University Hospital “Manuel Ascunce Domenech” from January 2008 to December 2010. Results: CAT scan results revealed the presence of acute hemispheric subdural hematomas in 17 patients. The 58,8 % of patients diagnosed with acute subdural hematoma as well as the 100 % of those with intracerebral hematomas died. Eighteen limited craniotomies were performed with a 39 % survival rate. Conclusion: this research reveals promising preliminary results for limited craniotomy as the treatment of choice for these primary lesions, owing to the fact that close to 40 % of patients who had this treatment survived with good prognosis what is considered as a therapeutic option pending to assess its results in future research.

  11. Hematoma traumático del psoas

    Scientific Electronic Library Online (English)

    Roberto, Rocco; Laura, Benedetti; Cecilia, Pannocchia; Horacio, Miscione.

    2006-12-01

    Full Text Available Los hematomas del psoas se suelen observar en pacientes con hemofilia u otras discrasias sanguíneas y como complicación de tratamientos anticoagulantes. Con menor frecuencia se pueden ver en personas sanas, debido a la rotura traumática del músculo. Por similares causas se producen hematomas del mús [...] culo ilíaco. La parálisis del nervio femoral es la complicación más grave y frecuente de ambas afecciones. Es habitual denominar a estos cuadros como hematomas del iliopsoas y considerarlos en conjunto por las características anatómicas, etiológicas, patológicas y clínicas que presentan. Describimos el caso de un niño de 12 años y 8 meses de edad, sin coagulopatía conocida, que padeció un hematoma del psoas de origen traumático. Abstract in english Psoas hematomas are usually seen in patients with hemophilia or other blood dyscrasias, and as a complication of anticoagulant treatments. With less frequency they may be found in healthy persons as a result of traumatic muscle rupture. Similar causes produce hematomas in the iliac muscle. The paral [...] ysis of the femoral nerve is the most serious and frequent complication in both conditions. These clinical pictures are often referred to as iliopsoas hematoma and they are generally considered together owing to the anatomic, etiologic, pathologic and clinical features that present. We describe a boy of 12 years and 8 month old, with no coagulopathy, who suffered a psoas hematoma of traumatic origin.

  12. Subdural effusions in children under two years

    International Nuclear Information System (INIS)

    We investigated 161 children under 24 months of age by CT of the skull and reviewed the anamnestic and clinical history. 87 children showed subdural effusions, and 74 did not. There were 33 patients with other pathological findings in CT, and 41 had normal scans. Age and sex distribution as well as localization of the subdural effusions were consistent with the literature. The 87 children with subdural effusions represented 1,7% in a sample of about 5.000 CT scans. CT was the most reliable method for diagnosis of subdural effusions, compared to other techniques. There was a preponderance of small subdural effusions from 1 to 7 mm thickness (51%). Other CT abnormalities accompanying subdural effusions were found. Most frequently the interhemispheric sulcus was dilated and an internal hydrocephalus was present. Also in our group there were 7 anamnestical and 6 clinical symptoms highly diagnostic of subdural effusions. (orig.)

  13. Clinical features and management of posttraumatic subperiosteal hematoma of the orbit

    Directory of Open Access Journals (Sweden)

    Kim Usha

    2011-01-01

    Full Text Available Traumatic subperiosteal hematoma (SpH usually presents late, after the initial trauma. It is generally seen in young males. Computed tomography is the best mode of imaging and helps to rule out orbital fracture or associated subdural hematoma. We present the clinical features and management of four patients seen at the orbit clinic with SpH. Management is based on time of presentation, visual acuity and any communicating bleed. The prognosis of traumatic SpH is excellent if treated with an individualized patient approach.

  14. Cavernosal hematoma mimicking priapism.

    Science.gov (United States)

    Phillips, Elizabeth A; Menchini Fabris, Filippo; Mendoza, Pierre; Munarriz, Ricardo

    2015-04-01

    We present a case of corpus cavernosum hematoma mimicking priapism. A 42-year-old man presented to the emergency room with penile pain and partial erection. Examination revealed partial erection and palpable space-occupying lesion of the corpus cavernosum without lymphadenopathy. Malignant workup was negative. Imaging assisted in diagnosis of unilateral hematoma of the corpus cavernosum. The lesion spontaneously resolved without the need for intervention. PMID:25817127

  15. Hematoma postraumático en riñón patológico / Postraumatic hematoma in pathological kidney

    Scientific Electronic Library Online (English)

    M., Allué López; D., Pascual Regueiro; A., García de Jalón Martínez; P., Serrano Frago; P., Gil Martínez; L.A., Rioja Sanz.

    2003-01-01

    Full Text Available Presentamos un caso de hematoma postraumático en un riñón tumoral. El diagnóstico del hematoma fue realizado mediante escáner abdominal pero no así el tipo tumoral. Fue necesario la revisión quirúrgica y posterior estudio patológico para demostrar un angiomiolipoma como causante del hematoma renal. [...] Abstract in english We want to present a case of postraumatic hematoma in a tumoral kidney. The diagnosis of the hematoma was made by abdominal scanner but not the tumor type. It was necessary the chirurgycal review and patological study to demostrate an angiomyolipoma as the cause of the kidney hematoma. [...

  16. 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.)

  17. 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.)

  18. Sinusitis-induced subdural empyema.

    OpenAIRE

    Skelton, R.; Maixner, W.; Isaacs, D.

    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 ...

  19. Recidiva de empiema subdural postquirúrgico / Postoperative recurrence of subdural empyema

    Scientific Electronic Library Online (English)

    Y., Romero-Pizarro; M., Muñoz-Algarra; C., Fernández-Mateos; I., Sánchez-Romero.

    2011-06-01

    Full Text Available Se presenta un caso de recidiva de infección postquirúrgica en forma de empiema subdural por Proprionibacterium acnes tras un primer empiema drenado en el que no se llegó al diagnóstico microbiológico. P acnes es un microorganismo gram positivo, anaerobio, que forma parte de la flora saprófita de la [...] piel y de otras zonas del organismo. Sin embargo puede producir infecciones, entre otras localizaciones, en el sistema nervioso central (SNC), especialmente infecciones postquirúrgicas en las que puede llegar a ser el segundo germen en frecuencia después de Staphylococcus aureus. Es de crecimiento lento y suele crecer mejor en medios anaeróbicos líquidos. Suele ser resistente al metronidazol y sensible a penicilinas. En las infecciones postquirúrgicas del sistema nervioso central hay que tener en cuenta la posibilidad de este microorganismo, procesar las muestras de forma adecuada y mantenernos en contacto con el Servicio de Microbiología. Abstract in english We present a case of recurrent subdural post-surgical empyema by Proprionibacterium acnes after a first drained empyema in which no microbiological diagnosis was reached. P. acnes is a gram-positive anaerobic organism which is part of the saprophytic flora of the skin and others parts of the body. H [...] owever, it can cause infections, as in the central nervous system, especially post-surgical infections in which can be the second more frequent organism after Staphylococcus aureus. P. acnes grows slowly and shows better growth in liquid anaerobic media. It is usually resistant to metronidazol and sensitive to penicillin. In postoperative central nervous system infections we must take into account the possibility of this organism, process the sample properly and keep touch with the Microbiology Department.

  20. Delayed traumatic intracranial hematoma

    International Nuclear Information System (INIS)

    CT was performed serially within 24 hours after head injury in 64 patients having Glasgow Coma Scale of 14 or less or cranial fracture shown on roentgenogram. Delayed traumatic extradural hematoma was observed within 7-12 hours after head injury in 6 cases (9.4%). This was prominent in the frontal and occipital regions (67%). Good recovery was seen in 83.3%. Delayed traumatic intracerebral hematoma was observed within 6-24 hours after head injury in 17 cases (26.6%). This higher incidence was related to contre coup injury. Conservative treatment was possible in 14 of the 17 patients (82.4%), showing good recovery in 70%. (Namekawa, K.)

  1. Subdural abscess secondary to covert dental sepsis

    OpenAIRE

    Sprott, Mae S.; Hall, K.; Newman, P. K.; Welbury, R. R.; Ingham, H. R.

    1981-01-01

    The bacterial flora of a subdural abscess in a 17-year-old male, with radiological evidence of unilateral infection of the maxillary and frontal air sinuses, was typical of that encountered in the dental sulcus. Extensive examination revealed no primary focus of infection other than apical infection in the 2 upper first molar teeth, which were extracted. Treatment with ampicillin, gentamicin and metronidazole rapidly controlled the subdural infection, and resolution, as evidenced by computeri...

  2. Acute aortic intramural hematoma

    International Nuclear Information System (INIS)

    To evaluate the radiologic findings of acute intramural hematoma of the aorta, and the clinical follow up thereof. Among 34 cases confirmed clinically and radiologically as aortic dissection, and analysis was carried out based on 15 cases in which intramural hematoma without false lumen was demonstrated, on initial CT, 12 cases of in which follow up CT was used and five cases involving an aortogram. Elements such as the shape of the thickened aortic wall, ulcer-like intimal defects, and intimal calcification were examined. Changes in these elements were also examined on follow-up CT. DeBackey types 1 and 3 accounted for one and 14 cases, respectively. Initial precontrast CT demonstrated continuous, crescentic high attenuation areas along the wall of the descending aorta. In postcontrast scans, the crescentic areas were of relatively lower-attenuation and appeared along the aorta wall. Displaced intimal calcifications were seen in nine of fifteen patients. There was no intimal flap on all five aortogram, while aortic wall thickening and atherosclerotic change were demonstrated in four cases and in one case, respectively. Focal ulcers were seen in three cases. Ulcer-like intimal defects were demonstrated in a total of eleven cases (eight on CT, two on aortogram, and one on both). In ten of the twelve cases seen on follow up CT, the thickness of the intramural hematoma was seen to be reduced. Among the 15 cases, the operation was performed in two cases, and the remaining performed in two cases, and the remaining 13 received conservative treatment. In ten cases observed for more than twelve months, a recurrence of symptoms did not occur. Eccentric aortic wall thickening in patients who complain of acute chest pain is the result of acute aortic dissection with intramural hematoma, or a penetrating atherosclerotic ulcer of the aorta. The later may be differentiated from the former by the presence of on ulcer-like intimal defect. When both diseases are limited to the descending aorta, conservative treatment may be effective, unless patients experience persistent or recurrent chest pain, or unless intramural hematoma progresses further

  3. Simultaneous Cranioplasty and Subdural-Peritoneal Shunting for Contralateral Symptomatic Subdural Hygroma following Decompressive Craniectomy

    Science.gov (United States)

    Lin, Muh-Shi; Chen, Tzu-Hsuan; Kung, Woon-Man; Chen, Shuo-Tsung

    2015-01-01

    Background. Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. Material and Methods. Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications. Results. Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma. Conclusion. The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus. PMID:25879062

  4. [Sonographic detection of subdural effusions in infancy].

    Science.gov (United States)

    Deeg, K H; Spitzer, V; Stehr, K

    1984-07-01

    Using the open fontanelle as an acustic window, small frontoparietal subdural effusions are often missed on conventional sagittal or coronar ultrasonographic sections. Using horizontal and frontal skull sections during the first 12 months of life intracranial structures can equally be visualized. In a study of 14 infants aged 6 days to 11 months gray scale ultrasonography was compared to computed axial tomography. The results suggest that horizontal and frontal ultrasonographic skull sections are equally efficient to localize even small subdural effusions without the adverse risks of radiation. PMID:6472299

  5. Intramural aortic hematomas

    International Nuclear Information System (INIS)

    Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can be differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membran are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection. (orig.)

  6. Empiema subdural como complicación de sinusitis Subdural empyema secondary to sinusitis

    Directory of Open Access Journals (Sweden)

    Raúl O Bustos B

    2006-03-01

    Full Text Available El empiema subdural es una complicación infrecuente de la sinusitis en niños. Esta condición se acompaña de una alta morbi mortalidad, por lo que es considerada una emergencia neuro-quirúrgica. Se describe la evolución clínico imagenológica de un escolar previamente sano que cursa con un empiema subdural secundario a una pansinusitis y se discute la presentación clínica, diagnóstico imagenológico y tratamiento médico-quirúrgico de esta patología en base a una revisión de la literaturaSubdural empyema is a rare complication of sinusitis in children. Its clinical presentation represents a neurosurgical emergency and as a scarcely recognized entity a delayed diagnosis rapidly increases its fatal prognosis. We report the clinical and radiological course of an adolescent with a subdural empyema secondary to sinusitis. Clinical and radiological features, laboratory findings and outcome of this condition are discussed based in a review of previously reported cases

  7. 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

  8. Concomitant Subdural Hemorrhage and Intracerebral Hemorrhage due to Brain Metastasis of the Hepatocellular Carcinoma.

    Science.gov (United States)

    Jang, Se Youn; Kim, Choong Hyun; Cheong, Jin Hwan; Kim, Jae Min

    2015-04-01

    Hemorrhagic metastatic brain tumors of hepatocellular carcinoma (HCC) are rare and have been mostly presented as intracranial hemorrhage (ICH). A 51-year-old male patient presented with sudden altered level of consciousness. He suffered from HCC since 2010 and transarterial chemoembolization was performed three times for HCC. The brain computed tomography (CT) scans revealed subdural hematoma (SDH) in the right fronto-temporal area and 6.0×3.5 cm sized ICH in the right parieto-occipital lobe. Brain angiographic CT scans demonstrated that the hemorrhagic lesions did not include any enhancing lesions and vascular abnormalities. We undertook a decompressive craniectomy and evacuation of the acute SDH and ICH. During evacuation of ICH, the yellowish mass was observed in the cortical surface of the right occipital lobe. Pathological examination displayed the findings of metastatic brain tumor from HCC. Metastatic brain tumors should be considered in the differential diagnosis as a cause of spontaneous SDH with ICH. PMID:25977908

  9. 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 ...

  10. Traumatic extradural hematoma of the cervical spine.

    Science.gov (United States)

    Garza-Mercado, R

    1989-03-01

    An example of a traumatic extradural hematoma of the cervical spine that occurred in a 32-year-old man who suffered from chronic ankylosing spondylitis is reported. Progressive sensory and motor deficit ensued some 3 hours after the patient fell from a standing position. The patient landed on his back, striking his head on the floor. After being helped up, he was able to walk unassisted to a nearby chair, where he sat down until his left lower extremity--and shortly afterwards, the right one--became numb and weak. On admission, the patient was found to have tetraparesis that was more pronounced in the lower extremities and associated with incomplete sensation to pinprick at level T7-T10. He also had painless distention of the urinary bladder. After a few hours, the weakness in his limbs increased and his sensory level rose to C5 bilaterally. A horizontal diastatic fracture across the vertebral body of C7 was discovered on plain x-ray films of the spine, and an extradural hematoma extending dorsally from C5 to T1 was revealed by emergency magnetic resonance imaging. After an emergency decompressive cervical laminectomy and removal of the clot, the patient rapidly regained complete neurological function, except with regard to both the urinary bladder and the rectum, which remained abnormal for almost 7 weeks after the operation. PMID:2927616

  11. Pathogenesis of canine aural hematomas.

    Science.gov (United States)

    Dubielzig, R R; Wilson, J W; Seireg, A A

    1984-10-15

    Morphologic examination of 3 ears from 2 dogs with aural hematomas revealed that the hematomas had developed within the pinnal cartilage. The cartilage had fractured from perichondrium to perichondrium and in some areas clefts had formed within the cartilage. Cartilage fracture could have resulted from wave motions set up in the pinna during head shaking. An explosive burst of head shaking exceeding a critical head velocity or a more gentle but sustained head shaking establishing a sinusoidal wave motion within the ear could have caused cartilage fracture. PMID:6501045

  12. Expanding traumatic intracerebral contusion/hematoma

    Directory of Open Access Journals (Sweden)

    Yadav Yad

    2006-01-01

    Full Text Available 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 patients at the time of admission and within 24 hours of injury. Repeat CT scan was done within 24 hours, 4 days and 7 days. Midline shift if any, prothrombin time, activated partial thromboplastin time, bleeding time, clotting time and platelet counts, Glasgow coma scale at admission and discharge and Glasgow outcome score at 6 months follow up were recorded. Results: Twenty six percent, 11.3 and 0% patients developed expanding hematoma in Glasgow Coma scale (GCS of 8 and below, 9-12 and 13-15 respectively. The chances of expanding hematomas were higher in patients with other associated hematomas (17.4% as compared to isolated hematoma (4.8% (Fisher?s exact results P =0.216. All the cases of expanding hematoma had some degree of midline shift and considerably higher proportion had presence of coagulopathy. The results of logistic regression analysis showed GCS, midline shift and coagulopathy as significant predictors for the expanding hematoma. Thirty nine patients (90.7% of the total expanding hematomas developed within 24 hours of injury. Conclusions: Enlargement of intracerebral hematomas is quite common and majority of them expand early after the injury. These lesions were common in patients with poor GCS, associated hematomas, associated coagulopathy and midline shift.

  13. 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.

  14. 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.

  15. Complete nonsurgical resolution of a spontaneous spinal epidural hematoma.

    Science.gov (United States)

    Silber, S H

    1996-07-01

    Spontaneous spinal epidural hematomas (SSEH) are heralded by spinal pain and progressive cord compression syndromes which may lead to permanent neurological disability or death if emergent neurosurgical intervention is delayed. It therefore must be considered early in the differential diagnosis of acute spinal cord compression syndrome. A case of spontaneous spinal epidural hematoma presenting as an acute myelopathy in a clarinet player who chronically used a nonsteroidal anti-inflammatory medication is presented. The case was remarkable for the rare complete spontaneous resolution of neurological function. Approximately 250 cases of SSEH have been reported in the medical literature, although only a handful of these patients have recovered spontaneously. This is the sixth report of such an event. The etiologies, contributing factors, disease progression, and treatment recommendations are discussed. PMID:8768163

  16. 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.

  17. Spontaneous idiopathic spinal epidural hematoma: two different presentations of the same disease / Hematoma epidural espinal espontáneo: dos diferentes presentaciones clínicas de la misma enfermedad / Hematoma epidural espinhal espontâneo: duas diferentes apresentações da mesma doença

    Scientific Electronic Library Online (English)

    Asdrúbal, Falavigna; Orlando, Righesso; Alisson Roberto, Teles; Thiago, Hoesker.

    2010-09-01

    Full Text Available Os autores relatam dois casos de hematoma epidural espinhal espontâneo com diferentes apresentações clínicas e sua revisão da literatura. O primeiro paciente apresentava sinais e sintomas de compressão medular cervical, necessitando de laminectomia de urgência, enquanto no segundo paciente, que era [...] crônico, havia sintomatologia de lombociatalgia por compressão nervosa de evolução de cinco meses e com diagnóstico radiológico de cisto facetário. A intervenção cirúrgica precoce é o tratamento de escolha para os hematomas epidurais espinhais espontâneos. Os hematomas epidurais espinhais espontâneos, conforme a localização na coluna vertebral, diferem na apresentação clínica e no manejo. Na região lombar, o diagnóstico diferencial deve ser feito com patologias degenerativas. Abstract in spanish Fueron relatados dos casos de hematoma epidural espinal espontáneo con diferentes presentaciones clínicas sin factores precipitantes, y fue hecha una breve revisión de la literatura. Nuestro caso 1 tuvo un desarrollo agudo y mostró señales progresivas en la columna cervical que determinaron una lami [...] nectomía descompresiva de emergencia. Por otro lado, el segundo paciente, crónico, fue operado casi cinco meses después de los síntomas iniciales y el diagnóstico radiológico fue de un gran quiste sinovial. La intervención quirúrgica temprana es el tratamiento de elección para hematomas espontáneos epidurales espinales. El tratamiento quirúrgico representa la forma más común de terapia para todos los tipos de presentaciones clínicas. Debemos considerar que el tratamiento conservador (o no) sea más común en casos de presentación leve, principalmente en pacientes con hematoma espinal crónico. Para realizar un diagnóstico diferencial, los cirujanos deben recordar que los hematomas epidurales espinales espontáneos pueden tener distintas presentaciones clínicas según su ubicación. Abstract in english We report two cases of spontaneous spinal epidural hematoma with different clinical presentations without precipitating factors and a brief review of the literature. Our case first developed acute and had progressive cervical spinal cord signs that determined emergency decompressive laminectomy. On [...] the other hand, the second patient, who was chronic, was operated almost five months after the initial symptoms and the radiological diagnosis was a large facet cyst. Early surgical intervention is the chosen treatment for spontaneous spinal epidural hematomas. Spinal surgeons should bear in mind that spontaneous spinal epidural hematomas may have different clinical presentations according to their location in order to perform a differential diagnosis.

  18. 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.

  19. Subungual frictional hematoma due to overriding toe

    OpenAIRE

    Chang Patricia

    2011-01-01

    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.

  20. Empiema subdural como complicación de sinusitis / Subdural empyema secondary to sinusitis

    Scientific Electronic Library Online (English)

    Raúl O, Bustos B; Paula A, Pavéz M; Bernardo J, Bancalari M; Rubén M, Miranda A; Héctor R, Escobar S.

    2006-03-01

    Full Text Available El empiema subdural es una complicación infrecuente de la sinusitis en niños. Esta condición se acompaña de una alta morbi mortalidad, por lo que es considerada una emergencia neuro-quirúrgica. Se describe la evolución clínico imagenológica de un escolar previamente sano que cursa con un empiema sub [...] dural secundario a una pansinusitis y se discute la presentación clínica, diagnóstico imagenológico y tratamiento médico-quirúrgico de esta patología en base a una revisión de la literatura Abstract in english Subdural empyema is a rare complication of sinusitis in children. Its clinical presentation represents a neurosurgical emergency and as a scarcely recognized entity a delayed diagnosis rapidly increases its fatal prognosis. We report the clinical and radiological course of an adolescent with a subdu [...] ral empyema secondary to sinusitis. Clinical and radiological features, laboratory findings and outcome of this condition are discussed based in a review of previously reported cases

  1. Dolor radicular como forma de presentación de un hematoma epidural espontáneo / Radicular pain as way of presentation of a spontaneous spinal epidural hematoma: a case presentation

    Scientific Electronic Library Online (English)

    Isael, Olazábal Armas.

    2011-02-01

    Full Text Available Fundamento: las hemorragias espontáneas dentro del estuche espinal en las edades pediátricas son poco frecuentes. La sangre puede extenderse por el espacio epidural, subdural o intramedular y producir compresión de las estructuras neurales. El espacio epidural es la zona más vulnerable a sufrir el s [...] angrado y dentro de éste su porción posterior. Objetivo: presentar un caso poco frecuente de hematoma epidural espinal cervical espontáneo que debutó con signos radiculares. Caso Clínico: paciente masculino de 14 años de edad con antecedentes de salud que es remitido a la consulta con una historia iniciada siete días antes, caracterizada por: dolor cervical bajo, de moderada intensidad de inicio brusco y que se irradiaba a los dermatomas cervicales 4 a 6 (C4-C6). Al examen físico se pudo constatar dolor al percutir las apófisis espinosas de C4 a C6, hiporreflexia bicipital y reducción de la fuerza en la pinza digital derecha. Se realizó una resonancia magnética nuclear cervical, donde se pudo diagnosticar un hematoma epidural espinal espontáneo que se extendía anteriormente desde C3 a C7. Se decidió el tratamiento médico y el paciente egresó a los doce días libre de manifestaciones clínicas. Conclusiones: la evolución clínica del paciente, el tamaño, la localización del hematoma y tiempo de evolución de la enfermedad son elementos a tener en cuenta a la hora de seleccionar la modalidad del tratamiento, el cual permitirá la reversibilidad de los síntomas y signos neurológicos así como el desarrollo de complicaciones tardías. Abstract in english Background:spontaneous hemorrhages inside the spinal case in pediatric ages are not frequent. The blood may extend over the epidural, subdural or intramedular space, producing compression of neural structures. The epidural space is the most vulnerable area to suffer bleeding and inside of this, its [...] posterior portion. Objective: to present an infrequent case of spontaneous cervical spinal epidural hematoma that started with radicular signs. Clinical case: a 14 years old, masculine patient with health antecedents is remitted to the consulting room with a history initiated seven days before, characterized for: low cervical pain of moderate intensity, of abrupt onset, irradiating to the 4 at 6 cervical dermatomes (C4-C6). To the physical examination was verified pain when striking the C4 to C6, bicipital hyporeflexia and reduction of the force in the right digital forceps. A cervical nuclear magnetic resonance was performed, where a spontaneous spinal epidural hematoma was diagnosed that previously extended from C3 to C7. The medical treatment was decided, the patient was discharged to twelve days, free of clinical manifestations. Conclusions: the patient's clinical evolution, size, localization of the hematoma and the time of evolution of the disease are elements to keep in mind when selecting the modality of the treatment, which will allow the reversibility of symptoms and neurological signs as well as the development of late complications.

  2. Hematoma hepático subcapsular por fasciola

    Scientific Electronic Library Online (English)

    David, Loja Oropeza; José, Alvizuri Escobedo; Maricela, Vilca Vásquez; Roberto, Avilés Gonzaga; Mario, Sánchez Mercado.

    2003-04-01

    Full Text Available Presentamos el caso de una mujer de 22 años de edad, natural de Huaraz con historia de dolor en hipocondrio derecho asociado a náuseas y vómitos que se intensifican tres dias antes de su admisión. Al examen se encuentra disminución del murmullo vesicular en la base del hemitórax derecho. El abdomen [...] es doloroso a la palpación en el epigastrio e hipocondrio derecho. El hígado se palpa a 3 cm debajo del reborde costal; Hemograma con eosinofilia severa. Se aprecia leve colestasis. Ecografía abdominal: Masa hepática heterogénea de 13 cm de diámetro en el lóbulo derecho. Tomografía axial computarizada: Masa subcapsular de 14x8 cm. Gammagrafía: Hígado con área hipocaptadora que muestra ausencia de perfusión al pool vascular. Se somete a laparotomía exploratoria y se encuentra hematoma subcapsular de 800 cc en segmento 6, 7 y 8, el cual se drena. En la evolución persite la eosinofilia y se obtiene Arco 2 positivo para Fasciola. Recibió triclabendazol, actualmente asintomática. Conclusión: La fase invasiva de la fasciolosis humana puede ocasionar hematoma hepático como una complicación rara. La triada de eosinofilia persistente, hepatomegalia dolorosa y fiebre prolongada, orienta a insistir en la búsqueda de fasciolasis en zonas endémicas. Abstract in english The case of a 22 year old woman from Huaraz is presented herein. She suffered from pain at right hypocondrium, associated to nausea and vomits, which intensified three days prior to admission. Upon examining her, a faded gallbladder murmur was found on the base of the right hemithorax. There is pain [...] in the abdomen when touched at the epigastrium and right hypocondrium. The liver is perceived 3 cm beneath the costal edge: White blood count with severe eosinophilia. Mild cholestasis is observed. Abdominal scan: Heterogeneous hepatic mass, with a 13 cm diameter in the right lobe. CAT scan: Subcapsular 14x8 cm mass. Scintiscan: Liver with a low absorption area showing absence of perfusion to the vascular pool. She undergoes an exploratory laparotomy and an 800 cc subcapsular hematoma is found in segment 6, 7 and 8, which is drained. Evolution evidences the persistence of eosinophilia and positive Arc-2 is obtained for Fasciola. She was administered Triclabendazol and is currently asymptomatic. Conclusion: The invasive stage of human fascioliasis may cause hepatic hematoma as a rare complication. The triad of persisting eosinophilia, painful hepatomegalia and prolonged fever leads to insist in the search of fascioliasis in endemic areas.

  3. Surgical management of canine aural hematoma.

    Science.gov (United States)

    Brown, Cyndi

    2010-04-01

    Ear (aural) hematomas occur when blood vessels in the pinna rupture secondary to trauma or excessive head shaking. Blood fills the space between the skin and the cartilage, causing pain and potential deformity of the ear. In this column, I discuss surgical treatment of aural hematomas in the dog. PMID:20305632

  4. Intramural duodenal hematoma as a complication of therapy with Warfarin: a case report and literature review

    International Nuclear Information System (INIS)

    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)

  5. Anestesia subdural após punção peridural: relato de dois casos / Subdural anesthesia after epidural puncture: two case reports / Anestesia subdural después punción peridural: relato de dos casos

    Scientific Electronic Library Online (English)

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

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais são realizadas amplamente no nosso meio. A anestesia subdural acidental após punção peridural é uma complicação rara. O objetivo deste relato é descrever dois casos de injeção subdural que coincidentemente ocorreram de forma consecutiva rea [...] lizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado físico ASA I, a realizar procedimento cirúrgico de retirada de cálculo renal. Optou-se por anestesia peridural. Após 30 minutos do início da anestesia, o paciente mantinha-se comunicativo mas sonolento com SpO2 de 100%, quando lentamente começou a apresentar diminuição da SpO2 chegando a 80%. Apresentava-se inconsciente com apnéia e anisocoria. A partir deste momento foi levantada hipótese diagnóstica de anestesia subdural acidental. O paciente foi então intubado e mantido em ventilação controlada mecânica. Terminada a cirurgia, foi encaminhado para a sala de recuperação, recebendo alta após 6 horas, sem nenhuma alteração clínico-neurológica. Caso 2: Paciente do sexo feminino, 82 anos, estado físico ASA II, programado para procedimento cirúrgico de fixação de fratura transtrocanteriana. Optou-se por anestesia peridural contínua. Assim como no caso anterior, após 30 minutos, a paciente começou a apresentar diminuição da SpO2 para 90%. Mostrava-se inconsciente e com anisocoria; entretanto, sem apnéia. Optou-se por manter a paciente sob vigilância constante, não sendo necessária intubação. A hipótese diagnóstica aventada também neste caso foi de anestesia subdural acidental. Terminada a cirurgia, a paciente foi encaminhada à sala de recuperação pós-anestésica, tendo alta após 4 horas, sem nenhuma alteração clínico-neurológica. CONCLUSÕES: Anestesia subdural acidental é uma complicação extremamente rara. A hipótese diagnóstica de anestesia subdural acidental, nestes casos, limitou-se aos dados clínicos. As complicações do bloqueio subdural podem ser das mais variadas, mas na sua grande maioria são de fácil resolução, 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 después punción peridural es una complicación rara. El objetivo de este relato es describir dos casos de inyección subdural que coincidentemente ocurrieron d [...] e forma consecutiva realizadas por el mismo anestesiologista. RELATO DE LOS CASOS: Caso 1: Paciente del sexo masculino, 41 años, estado físico ASA I, a realizar procedimiento quirúrgico de retirada de cálculo renal. Se optó por anestesia peridural. Después de 30 minutos del inicio de la anestesia, el paciente se mantenía comunicativo más soñoliento con SpO2 de 100%, cuando lentamente comenzó a presentar disminución de la SpO2 llegando a 80%. Se presentaba inconsciente con apnea y anisocoria. A partir de este momento fue levantada hipótesis diagnóstica de anestesia subdural accidental. El paciente fue entonces intubado y mantenido en ventilación controlada mecánica. Terminada la cirugía, fue encaminado para la sala de recuperación, recibiendo alta después de 6 horas, sin ninguna alteración clínico-neurológica. Caso 2: Paciente del sexo femenino, 82 años, estado físico ASA II, programada para procedimiento quirúrgico de fijación de fractura transtrocanteriana. Se optó por anestesia peridural continua. Así como en el caso anterior, después de 30 minutos, la paciente comenzó a presentar disminución de la SpO2 para 90%. Se mostraba inconsciente y con anisocoria; entretanto, sin apnea. Entonces, se optó por mantener la paciente bajo vigilancia constante, no siendo necesaria intubación. La hipótesis diagnóstica aventada también en este caso fue de anestesia subdural accidental. Terminada la cirugía, la paciente fue encaminada a la sala de recuperación pós-anestésica, teniendo alta después de 4 horas, sin

  6. Anestesia subdural após punção peridural: relato de dois casos Anestesia subdural después punción peridural: relato de dos casos Subdural anesthesia after epidural puncture: two case reports

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2003-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais são realizadas amplamente no nosso meio. A anestesia subdural acidental após punção peridural é uma complicação rara. O objetivo deste relato é descrever dois casos de injeção subdural que coincidentemente ocorreram de forma consecutiva realizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado físico ASA I, a realizar procedimento cirúrgico de retirada de cálculo renal. Optou-se por anestesia peridural. Após 30 minutos do início da anestesia, o paciente mantinha-se comunicativo mas sonolento com SpO2 de 100%, quando lentamente começou a apresentar diminuição da SpO2 chegando a 80%. Apresentava-se inconsciente com apnéia e anisocoria. A partir deste momento foi levantada hipótese diagnóstica de anestesia subdural acidental. O paciente foi então intubado e mantido em ventilação controlada mecânica. Terminada a cirurgia, foi encaminhado para a sala de recuperação, recebendo alta após 6 horas, sem nenhuma alteração clínico-neurológica. Caso 2: Paciente do sexo feminino, 82 anos, estado físico ASA II, programado para procedimento cirúrgico de fixação de fratura transtrocanteriana. Optou-se por anestesia peridural contínua. Assim como no caso anterior, após 30 minutos, a paciente começou a apresentar diminuição da SpO2 para 90%. Mostrava-se inconsciente e com anisocoria; entretanto, sem apnéia. Optou-se por manter a paciente sob vigilância constante, não sendo necessária intubação. A hipótese diagnóstica aventada também neste caso foi de anestesia subdural acidental. Terminada a cirurgia, a paciente foi encaminhada à sala de recuperação pós-anestésica, tendo alta após 4 horas, sem nenhuma alteração clínico-neurológica. CONCLUSÕES: Anestesia subdural acidental é uma complicação extremamente rara. A hipótese diagnóstica de anestesia subdural acidental, nestes casos, limitou-se aos dados clínicos. As complicações do bloqueio subdural podem ser das mais variadas, mas na sua grande maioria são de fácil resolução, desde que sejam diagnosticadas e tratadas rapidamente.JUSTIFICATIVA Y OBJETIVOS: Anestesias conductivas peridurales son realizadas ampliamente en el medio nuestro. La anestesia subdural accidental después punción peridural es una complicación rara. El objetivo de este relato es describir dos casos de inyección subdural que coincidentemente ocurrieron de forma consecutiva realizadas por el mismo anestesiologista. RELATO DE LOS CASOS: Caso 1: Paciente del sexo masculino, 41 años, estado físico ASA I, a realizar procedimiento quirúrgico de retirada de cálculo renal. Se optó por anestesia peridural. Después de 30 minutos del inicio de la anestesia, el paciente se mantenía comunicativo más soñoliento con SpO2 de 100%, cuando lentamente comenzó a presentar disminución de la SpO2 llegando a 80%. Se presentaba inconsciente con apnea y anisocoria. A partir de este momento fue levantada hipótesis diagnóstica de anestesia subdural accidental. El paciente fue entonces intubado y mantenido en ventilación controlada mecánica. Terminada la cirugía, fue encaminado para la sala de recuperación, recibiendo alta después de 6 horas, sin ninguna alteración clínico-neurológica. Caso 2: Paciente del sexo femenino, 82 años, estado físico ASA II, programada para procedimiento quirúrgico de fijación de fractura transtrocanteriana. Se optó por anestesia peridural continua. Así como en el caso anterior, después de 30 minutos, la paciente comenzó a presentar disminución de la SpO2 para 90%. Se mostraba inconsciente y con anisocoria; entretanto, sin apnea. Entonces, se optó por mantener la paciente bajo vigilancia constante, no siendo necesaria intubación. La hipótesis diagnóstica aventada también en este caso fue de anestesia subdural accidental. Terminada la cirugía, la paciente fue encaminada a la sala de recuperación pós-anestésica, teniendo alta después de 4 horas, sin ninguna alteración clínico-neuro

  7. Ruptured Intrasellar Superior Hypophyseal Artery Aneurysm Presenting with Pure Subdural Haematoma: Case Report

    OpenAIRE

    Hornyak, M.; Hillard, V.; Nwagwu, C.; Zablow, B. C.; Murali, R.

    2004-01-01

    Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular c...

  8. 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.

  9. The pathophysiology of infant subdural haematomas.

    Science.gov (United States)

    Howard, M A; Bell, B A; Uttley, D

    1993-01-01

    The widely accepted theories concerning the pathophysiology of infant subdural haematoma (SDH) were formulated in the pre-computed tomographic (CT) scan era. Violent shaking is considered to be a crucial cause of SDH in non-accidentally injured infants. This theory has been re-examined in a clinical and CT scan review, and our findings have been correlated with results of recent head injury research. A retrospective review was conducted of all head injured infants (up to 18 months old) treated at Atkinson Morley's Hospital over a recent 20-year period (n = 100). Twenty-eight infants with a SDH were identified. CT scans were reviewed and each SDH greater than 0.5 cm thick was morphometrically analysed. Seventeen infants were Caucasian, 10 were non-Caucasian and one was of mixed race. A race-dependent pattern of SDH pathophysiology was noted, with non-Caucasian infants with a head injury more likely to have a SDH than Caucasian infants (67 v 21%, p Caucasian infants were significantly more likely to have a normal scalp examination despite the impact injury (p 0.5 cm thick) SDH (p infant SDH formation and also suggest that non-accidental injury is a less common cause of SDH than it is believed to be. PMID:8216905

  10. Cutaneous manifestation of renal hematoma after ESWL.

    Science.gov (United States)

    Elizalde-Benito, Francisco-Xavier; Elizalde-Benito, Ángel-Gabriel; Urra-Palos, María; Elizalde-Amatria, Angel-Gabriel

    2013-12-01

    A 73 year-old patient with history of arterial hypertension and regular treatment with antiplatelet agents who presented with an hypotensive episode after extracorporeal shock-wave lithotripsy (ESWL) was diagnosed of right renal hematoma. PMID:24369192

  11. Subdural injection of contrast medium as a complication of myelography

    International Nuclear Information System (INIS)

    In a retrospective evaluation of 654 canine and feline myelograms, 58 were found to have been complicated by injection of the contrast medium into the subdural space. The medium was present predominantly dorsal to the spinalcord, with a sharp dorsal border and an undulating ventral border. Confirmation that this myelographic appearance was due to subdural localisation was achieved using fresh cadavers injected with contrast medium labelled with Indian ink. It was further showed that the dorsal accumulation of contrast medium was due to the denticulate ligaments which restricted the ventral extension of the contrast medium

  12. The dynamics and pathogenesis of traumatic subdural hygromas

    International Nuclear Information System (INIS)

    Of 2005 patients, who had suffered blunt skull trauma, 108 developed post-traumatic subdural hygromas (TSH). CT was used to observe the course of subdural hygromas not treated surgically, with particular reference to the time of their appearance and regression. The relative incidence of TSH, and of the severity of head trauma quanitified on a 5-grade scale was determined in different age groups. From the traumatic changes demonstrated on CT, some conclusions could be drawn regarding the pathogenesis. A hypothetical model has been developed which explains TSH as a result of shearing forces. (orig.)

  13. Subdural haematoma: a potentially serious consequence of spontaneous intracranial hypotension

    OpenAIRE

    Noronha, R. J.; Sharrack, B.; Hadjivassiliou, M.; Romanowski, C.

    2003-01-01

    Background: Spontaneous intracranial hypotension (SIH) is characterised by postural headache and low opening pressure at lumbar puncture without obvious cause. Cranial magnetic resonance imaging often shows small subdural collections without mass effect, dural enhancement, venous sinus dilatation, or downward displacement of the brain. The condition is thought to be benign.

  14. Salmonella intracerebral and subdural abscess--report of two cases.

    OpenAIRE

    Mahapatra, A.K.; Bhatia, R.

    1987-01-01

    Two cases of the rarely encountered Salmonella typhi subdural empyema are reported. The first was in an 11 month old infant and the second in a 25 year old adult. Neither of them suffered from typhoid fever. The causative organism was not suspected until the culture report was obtained. Both patients responded satisfactorily to therapy.

  15. Acute subdural and intratemporal hematoma as a complication of percutaneous compression of the gasserian ganglion for trigeminal neuralgia / Hematoma subdural e intraparenquimatoso agudo como complicación de la compresión percutánea del ganglio de Gasser

    Scientific Electronic Library Online (English)

    I., Arrese; R.D., Lobato; J.F., Alén; A., Lagares; P., Miranda.

    2005-04-01

    Full Text Available Se presenta el caso de un paciente de 68 años de edad con neuralgia esencial del trigémino que fue operado mediante compresión percutanea del ganglio de Gasser y desarrolló una hemorragia intracraneal que resultó fatal. La complicación se relacionó probablemente con el emplazamiento erróneo del cate [...] ter de Fogarty y el inflado del balón fuera del cavum de Meckel. Se analiza la disposición de las estructuras anatómicas susceptibles de sufrir daño mecánico durante este procedimiento quirúrgico y se comentan algunos aspectos técnicos a tener en cuenta para prevenir el desarrollo de complicaciones como la ocurrida en nuestro paciente. Abstract in english The case of a 68 year-old man who developed a fatal intracranial hemorrhagic complication following percutaneous compression of the gasserian ganglion for trigeminal neuralgia is reported. The complication was likely related to improper placement of the Fogarty catheter into the temporal fossa out o [...] f the Mecke1,s cave. The anatomical structures at risk of damage by misplaced needle or catheter and some relevant thecnical details aimed to prevent extratrigeminal complications related with this and other percutaneous trigeminal lesioning procedures are analyzed.

  16. 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.)

  17. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulovi? 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.

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

    OpenAIRE

    Chiyo Sugiyama, Akifumi Akai

    2009-01-01

    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 anemi...

  19. CT-guided stereotactic evacuation of hypertensive intracerebral hematomas

    International Nuclear Information System (INIS)

    Computerized tomography (CT) is now effective not only for definite diagnosis and location of intracerebral hematomas but also for coordination of the center of a hematoma. CT-guided stereotactic evacuation of hypertensive intracerebral hematoma was performed in 51 cases: 34 of basal ganglionic hematoma with or without ventricular perforation, 11 of subcortical hematoma, 3 of thalamic hematoma and 3 of cerebellar hematoma. Three dimensional CT images or biplane CT images were taken to determine the coordinates of the target point, which was the center of the hematoma. Then, a silicon tube (O.D. 3.5 phi, I.D. 2.1 phi) was inserted into the center of the hematoma through a burr-hole under local anesthesia, and the liquid or solid hematoma was aspirated as completely as possible with a syringe. Urokinase (6,000 I.U./5 ml saline) was administered through this silicon tube every 6 or 12 hours for several days until the hematoma had drained out competely. The silicon tube was taken out when repeated CT scanning revealed no hematoma. The results of clinical follow-ups indicated that this procedure is as good as, or rather better than conventional microsurgery with evacuation of hematoma under direct vision. Moreover this CT-guided stereotactic approach for evacuation of the hematoma has the following advantages: 1) the procedure is simple and safe, 2) operation can be performed under local anesthesia, and 3) the hematoma is drained out completely with the aid of urokinase. Tut completely with the aid of urokinase. This surgery seems indicated as an emergency treatment for high-age or high risk patients and also as a routine surgery for intracerebral hematomas in patients showing no herination signs. (author)

  20. Pulsative hematoma: A penile fracture complication

    Directory of Open Access Journals (Sweden)

    Nale ?or?e

    2007-01-01

    Full Text Available Background. Fracture of the penis is a direct blunt trauma of the erect or semi-erect penis. It can be treated by conservative or surgical means. Retrospective analyses of conservative penile fracture treatment reveal frequent immediate and later complications. Case report. We presented a 41- year-old patient with pulsative hematoma caused by an unusual fracture of the penis. Fracture had appeared 40 days before the admittance during a sexual intercourse. The patient was treated surgically. Conclusion. Pulsative hematoma (pulsative diverticulum is a very rare, early complication of a conservatively treated penile fracture. Surgical treatment has an advantage over surgical one, which was confirmed by our case report.

  1. Traumatic extradural hematoma, analysis of 39 cases

    International Nuclear Information System (INIS)

    The frequency of hematoma in the posterior fossa was higher in these cases than in past reports, suggesting that CT facilitated the diagnosis. The most important factor exacerbating the prognosis was intradural lesions. The prognosis of patients with extradural hematoma alone was satisfactory, irrespective of its clinical severity. The operative prognosis of the patients depended greatly on the earliness of initial treament, and the reduced time in diagnosing because of the advent of CT was thought to be one of the great factors for the improved operative prognosis. (Chiba, N.)

  2. Type III Rectus Sheath Hematoma: A Case Report

    Directory of Open Access Journals (Sweden)

    Yalç?n GÖLCÜK

    2012-01-01

    Full Text Available A rectus sheath hematoma occurs an accumulation of blood in the sheath of the rectus abdominis, secondary to rupture of an epigastric arteries or their branches or rectus muscle tear. The choice of effective treatment of rectus sheath hematoma and the decision to admit the patient to hospital depends on the degree of haemodynamic compromise, coagulation status as well as the type of the hematoma on abdominopelvic computerized tomography scans. In this article, we report a case of spontaneous rectus sheath hematoma presenting with acute abdominal pain associated with a palpable abdominal wall mass. Furthermore, diagnosis, classification, and management of rectus sheath hematoma in the emergency room are discussed.

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

    Directory of Open Access Journals (Sweden)

    Salam MT

    2014-12-01

    Full Text Available Muhammad Tariqus Salam,1 Sébastien Gélinas,1 Sébastien Desgent,2 Sandra Duss,2 Félix Bernier Turmel,1,3 Lionel Carmant,2 Mohamad Sawan,1 Dang Khoa Nguyen3 1Polystim Neurotechnologies Laboratory, Polytechnique Montréal, QC, Canada; 2Research Center, Sainte-Justine University Hospital Center (CHU Sainte-Justine, Université de Montréal, QC, Canada; 3Neurology Service, Department of Medicine, Notre-Dame Hospital, Centre Hospitalier de l'Université de Montréal (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

  4. Ruptured Intrasellar Superior Hypophyseal Artery Aneurysm Presenting with Pure Subdural Haematoma

    Science.gov (United States)

    Hornyak, M.; Hillard, V.; Nwagwu, C.; Zablow, B. C.; Murali, R.

    2004-01-01

    Summary Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular coil embolization of the aneurysm. Angiography immediately after treatment and one month later revealed complete obliteration of the aneurysm. Six months after treatment, the patient remained symptom free. PMID:20587264

  5. Study of near infrared technology for intracranial hematoma detection.

    Science.gov (United States)

    Zhang, Q; Ma, H; Nioka, S; Chance, B

    2000-04-01

    Although intracranial hematoma detection only requires the continuous wave technique of near infrared spectroscopy (NIRS), previous studies have shown that there are still some problems in obtaining very accurate, reliable hematoma detection. Several of the most important limitations of NIR technology for hematoma detection such as the dynamic range of detection, hair absorption, optical contact, layered structure of the head, and depth of detection are reported in this article. A pulsed light source of variable intensity was designed and studied in order to overcome hair absorption and to increase the dynamic range and depth of detection. An adaptive elastic optical probe was made to improve the optical contact and decrease contact noise. A new microcontroller operated portable hematoma detector was developed. Due to the layered structure of the human head, simulation on a layered medium was analyzed experimentally. Model inhomogeneity tests and animal hematoma tests showed the effectiveness of the improved hematoma detector for intracranial hematoma detection. PMID:10938785

  6. Intramural esophageal hematoma after elective injection sclerotherapy Hematoma intramural esofágico após escleroterapia eletiva de varizes

    Directory of Open Access Journals (Sweden)

    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.

  7. Intramural esophageal hematoma after elective injection sclerotherapy / Hematoma intramural esofágico após escleroterapia eletiva de varizes

    Scientific Electronic Library Online (English)

    Hannah Pitanga, Lukashok; Carlos, Robles-Medranda; Marília de Andrade, Santana; Marcia Henriques Magalhães, Costa; Adriana de Almeida, Borges; Cyrla, Zaltmani.

    2009-12-01

    Full Text Available 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. Abstract in english 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. R [...] isk 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 muco

  8. Groin hematoma after electrophysiological procedures-incidence and predisposing factors

    DEFF Research Database (Denmark)

    Dalsgaard, Anja Borgen; Jakobsen, Christina Spåbæk

    2014-01-01

    Abstract Objectives. We evaluated the incidence and predisposing factors of groin hematomas after electrophysiological (EP) procedures. Design. Prospective, observational study, enrolling consecutive patients after EP procedures (Atrial fibrillation: n = 151; Supraventricular tachycardia/Diagnostic EP: n = 82; Ventricular tachycardia: n = 18). Patients underwent manual compression for 10 min and 3 h post procedural bed rest. AF ablations were performed with INR 2-3, ACT > 300, and no protamine sulfate. Adhesive pressure dressings (APDs) were used if sheath size ? 10F; procedural time > 120 min; and BMI > 30. Patient-reported hematomas were recorded by a telephone follow-up after 2 weeks. Results. Hematoma developed immediately in 26 patients (10%) and after 14 days significant hematoma was reported in 68 patients (27%). Regression analysis on sex, age, BMI 25, ACT 300, use of APD, sheath size and number, and complicated venous access was not associated with hematoma, either immediately after the procedure or after 14 days. Any hematoma presenting immediately after procedures was associated with patient-reported hematomas after 14 days, odds ratio 18.7 (CI 95%: 5.00-69.8; P < 0.001). Conclusions. Any hematoma immediately after EP procedures was the sole predictor of patient-reported hematoma after 2 weeks. Initiatives to prevent groin hematoma should focus on the procedure itself as well as post-procedural care.

  9. Cranial CT scan

    Science.gov (United States)

    ... brain Bleeding (for example, chronic subdural hematoma or intracranial hemorrhage) Bone infection Brain abscess or infection Brain damage due to injury Brain tissue swelling or injury Brain tumor or other growth (mass) Cerebral atrophy (loss of ...

  10. Hematomas espontáneos de la pared abdominal Spontaneous Hematomas of the abdominal wall

    Directory of Open Access Journals (Sweden)

    Rafael Cerdán P

    2007-02-01

    Full Text Available Introducción: El hematoma espontáneo de la pared abdominal (HEPA es una entidad de aparición infrecuente y de difícil diagnóstico debido a la similitud clínica con otros procesos agudos. Suele aparecer en pacientes que siguen tratamiento anticoagulante y se caracteriza por su forma de presentación brusca como dolor abdominal agudo. La cirugía puede evitarse en la mayoría de los casos si se diagnostica correctamente mediante pruebas de imagen. Observaciones clínicas: Presentamos 12 casos de HEPA tratados en nuestro Servicio entre los años 1999 y 2005, y realizamos una revisión de esta entidad en cuanto a etiología, factores desencadenantes, diagnóstico y tratamiento. Conclusión: El tratamiento del HEPA debe ser conservador, reservando la cirugía para aquellos casos que presenten deterioro hemodinámico por sangrado activoIntroduction: Spontaneous hematoma of the abdominal wall is infrequent and difficult to diagnose due to its clinical similarity with other acute processes. It is usually associated with patients undergoing anticoagulant therapy and is characterized for its form of abrupt presentation like acute abdominal pain. Surgery can be avoided in most patients if hematoma is correctly diagnosed by imaging tests. Clinical observations: We present 12 cases of spontaneous hematoma of the abdominal wall from 1999 through 2005 and we review the etiology, precipitating factors, diagnosis and treatment of this clinical entity. Conclusion: Treatment of spontaneous hematoma of abdominal wall must be preservative, reserving the surgery for those cases that present hemodynamic compromise by persistent hemorrhage

  11. Hematomas espontáneos de la pared abdominal / Spontaneous Hematomas of the abdominal wall

    Scientific Electronic Library Online (English)

    Rafael, Cerdán P; Sandra, Paterna L; María Eugenia, Guillén S; Sonia, Cantín B; Joaquín, Bernal J; Jesús María, Esarte M.

    2007-02-01

    Full Text Available Introducción: El hematoma espontáneo de la pared abdominal (HEPA) es una entidad de aparición infrecuente y de difícil diagnóstico debido a la similitud clínica con otros procesos agudos. Suele aparecer en pacientes que siguen tratamiento anticoagulante y se caracteriza por su forma de presentación [...] brusca como dolor abdominal agudo. La cirugía puede evitarse en la mayoría de los casos si se diagnostica correctamente mediante pruebas de imagen. Observaciones clínicas: Presentamos 12 casos de HEPA tratados en nuestro Servicio entre los años 1999 y 2005, y realizamos una revisión de esta entidad en cuanto a etiología, factores desencadenantes, diagnóstico y tratamiento. Conclusión: El tratamiento del HEPA debe ser conservador, reservando la cirugía para aquellos casos que presenten deterioro hemodinámico por sangrado activo Abstract in english Introduction: Spontaneous hematoma of the abdominal wall is infrequent and difficult to diagnose due to its clinical similarity with other acute processes. It is usually associated with patients undergoing anticoagulant therapy and is characterized for its form of abrupt presentation like acute abdo [...] minal pain. Surgery can be avoided in most patients if hematoma is correctly diagnosed by imaging tests. Clinical observations: We present 12 cases of spontaneous hematoma of the abdominal wall from 1999 through 2005 and we review the etiology, precipitating factors, diagnosis and treatment of this clinical entity. Conclusion: Treatment of spontaneous hematoma of abdominal wall must be preservative, reserving the surgery for those cases that present hemodynamic compromise by persistent hemorrhage

  12. 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 wh 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.)

  13. Coiling of ventriculo-peritoneal shunt in the subdural space: A possible etiology

    Directory of Open Access Journals (Sweden)

    Kaushik Sil

    2006-01-01

    Full Text Available Migration of ventriculo-peritoneal shunt into the subdural space is a reported but rare complication. We report a case of migration and coiling of both ends of the shunt into the subdural space. We also hypothesize that coiling of the shunt tube during packaging predisposes to elastic recoil and tendency of such migration.

  14. Idiopathic adrenal hematoma masquerading as neoplasm.

    Science.gov (United States)

    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 slight elevation of PIVKA-II. The origin of the tumor was found to be the adrenal gland, as angiography revealed the blood supply to the mass to derive from the right superior and inferior adrenal arteries. A fine needle biopsy of the lesion was unable to confirm the diagnosis. Open right adrenalectomy was performed. The histopathological findings of the surgical specimen revealed a hematoma with normal adrenal tissue. In the absence of any obvious etiology, the diagnosis was idiopathic adrenal hematoma. PMID:22679406

  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. 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.

  17. Treatment of acute traumatic epidural hematoma in infancy and childhood

    International Nuclear Information System (INIS)

    The authors treated 22 cases of epidural hematoma diagnosed by CT scan. This study focused on the analysis of the time-course and development of epidural hematoma using a CT scan. The results are follows: 1. Severe cases must be treated by craniotomy and rapid removal of hematoma. We achieved a zero mortality rate in the cases of infants and children. 2. Normal CT findings were not unusual in cases where the patient was examined within 3 hours after the occurence of the injury. Conservative treatment was indicated for patients with a small amount of epidural hematoma. CT scanning at intervals of 6 hours and 30 hours after the occurence of the injury offer the best correlation in regard to the course of hematoma. 3. Operative treatment is required when the hematoma thickness, measured by CT scan, is more than 20 mm for infants and younger children or 30 mm for school aged children. However, eventhough the thickness of the hematoma maybe less than these guidelines, when progressive deterioration occurs after the CT scan, operative treatment must be considered. 4. Diffuse brain injury is a new clinical entity found by CT scanning. We classified this into 5 types. Of the 5 types, ''diffuse cerebral swelling'' was observed in the initial CT scan of two patients, however, epidural hematoma developed afterwards. Thus, patients with diffuse cerebral swelling with a skull fracture must be closely observed. (J.P.N.)

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

    International Nuclear Information System (INIS)

    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.)

  19. Contrast of artificial subcutaneous hematomas in MRI over time.

    Science.gov (United States)

    Hassler, Eva Maria; Ogris, Kathrin; Petrovic, Andreas; Neumayer, Bernhard; Widek, Thomas; Yen, Kathrin; Scheurer, Eva

    2015-03-01

    In clinical forensic medicine, hematomas and other externally visible injuries build the basis for the reconstruction of events. However, dating of subcutaneous hematomas based on their external aspect is difficult. Magnetic resonance imaging (MRI) has proven its use in dating intracranial hemorrhage. Thus, the aim was to investigate if MRI can also be used for dating subcutaneous hematomas and to analyze an eventual influence of the hematoma shape. In 20 healthy volunteers (11 females, 9 males, aged 26.9?±?3.8 years), 4 ml of autologous blood were injected subcutaneously in the thigh. The hematoma was scanned immediately after the injection, after 3 and 24 h and 3, 7, and 14 days using three sequences with different contrast. Data was analyzed by measuring signal intensities of the hematoma, the muscle, and the subcutaneous tissue over time, and the Michelson contrast coefficients between the tissues were calculated. In the analysis, hematoma shape was considered. Signal intensity of blood in the proton density-weighted sequence reached its maximum 3 h after the injection with a subsequent decrease, whereas the signal intensities of muscle and fatty tissue remained constant. The time course of the Michelson coefficient of blood versus muscle decreased exponentially with a change from hyperintensity to hypointensity at 116.9 h, depending on hematoma shape. In the other sequences, either variability was large or contrast coefficients stayed constant over time. The observed change of contrast of blood versus muscle permits a quick estimate of a hematoma's age. The consideration of the hematoma shape is expected to further enhance dating using MRI. PMID:25416961

  20. 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. 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)

  1. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso Spontaneous epidural spinal hematoma during pregnancy: a case report

    Directory of Open Access Journals (Sweden)

    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.A case of spontaneous dorso-lombar spinal epidural hematoma during pregnancy is reported. The hematoma was removed 8 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The motor deficit remained unchanged post-operatively. The etiology, clinical findings and the value of early laminectomy are discussed.

  2. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso / Spontaneous epidural spinal hematoma during pregnancy: a case report

    Scientific Electronic Library Online (English)

    Ivan, Hack; Mario S., Cademartori; Rosendo S., Mamani; Carmen M., Beltrame; Carlos G., Cademartori.

    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. Abstract in english A case of spontaneous dorso-lombar spinal epidural hematoma during pregnancy is reported. The hematoma was removed 8 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The motor deficit remained unchanged post-operatively. The etiology, clinical findings and the [...] value of early laminectomy are discussed.

  3. Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt.

    Directory of Open Access Journals (Sweden)

    Mitra S

    2001-04-01

    Full Text Available We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.

  4. 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...

  5. 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.)

  6. Dabigatran-related Intracerebral Hemorrhage Resulting in Hematoma Expansion

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Steiner, Thorsten

    2014-01-01

    Warfarin-related intracerebral hemorrhage carries a particularly high risk of neurologic deterioration and death because of a high rate of hematoma expansion of about 50%. Novel oral anticoagulants (NOACs)-apixaban, dabigatran, and rivaroxaban-have a significantly smaller risk of intracerebral hemorrhage (ICH). However, two facts make this situation complicated: First, the risk of hematoma expansion is unknown for NOACs. Second, there is no specific antidote for neither of the NOACs. We present a case that suggests that hematoma expansion may occur after NOAC-related ICH.

  7. 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.)

  8. Spontaneous rectus sheath hematoma: two variant cases.

    Science.gov (United States)

    Sivagnanam, Kamesh; Ladia, Vatsal; Bhavsar, Vedang; Summers, Jeffery; Paul, Timir

    2014-01-01

    We present two variant cases of spontaneous rectus sheath hematoma (SRSH). A 71-year-old woman presented with ST elevation myocardial infarction and was found to have multivessel coronary artery disease. She was treated with aspirin, clopidogrel, eptifibatide, and heparin. Heparin was continued while preoperative workup for coronary artery bypass grafting was done. She developed a large 20x10 cm actively bleeding SRSH while on heparin. It was surgically evacuated. The second case represents an atypical cause of SRSH. A 64-year-old woman with Wegener's Granulomatosis presented with anemia and abdominal pain. Abdominal CT showed a large 22 cm SRSH without active bleeding that was treated conservatively. Both patients did well on follow-up. The incidence of SRSH is likely to increase in the coming years with the increasing use of antithrombotic agents for many disease processes. Clinicians should be aware of typical and atypical presentations of SRSH and its variant management options. PMID:25369220

  9. 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...

  10. 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)

  11. Effects of catheter size on hematoma formation after diagnostic angiography

    International Nuclear Information System (INIS)

    This paper reports on the effect of catheter size or the development of groin hematomas after diagnostic angiography. Four hundred eighty-one patients undergoing diagnostic peripheral angiography were randomized to receive either a 5-F or 7-F catheter. Patients were assessed immediately and 24 hours after the procedure for development of either small (10 cm) hematomas. For 5-F versus 7-F catheters, hematomas developed as follows: small, 9.2% versus 18.0% (P < .05); moderate, 0.8% versus 1.3%; and large, 0.4% versus 0.0%. Findings were similar at 24 hours. The difference in incidence of small hematomas between 5-F and 7-F groups was not related to age, weight, coagulation studies, blood pressure, procedure time, or compression time

  12. 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

  13. 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.)

  14. 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.

  15. Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

    Energy Technology Data Exchange (ETDEWEB)

    Warmuth-Metz, M.; Solymosi, L. [Abteilung fuer Neuroradiologie, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Kuehl, J. [Paediatric Oncology, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany); Krauss, J. [Paediatric Neurosurgery, Klinikum der Bayerischen Julius Maximilians Universitaet, Josef-Schneider-Strasse 11, 97080, Wuerzburg (Germany)

    2004-03-01

    In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2-40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery. (orig.)

  16. Age determination of vessel wall hematoma in spontaneous cervical artery dissection: A multi-sequence 3T Cardiovascular Magnetic resonance study

    Directory of Open Access Journals (Sweden)

    Habs Maximilian

    2011-11-01

    Full Text Available Abstract Background Previously proposed classifications for carotid plaque and cerebral parenchymal hemorrhages are used to estimate the age of hematoma according to its signal intensities on T1w and T2w MR images. Using these classifications, we systematically investigated the value of cardiovascular magnetic resonance (CMR in determining the age of vessel wall hematoma (VWH in patients with spontaneous cervical artery dissection (sCAD. Methods 35 consecutive patients (mean age 43.6 ± 9.8 years with sCAD received a cervical multi-sequence 3T CMR with fat-saturated black-blood T1w-, T2w- and TOF images. Age of sCAD was defined as time between onset of symptoms (stroke, TIA or Horner's syndrome and the CMR scan. VWH were categorized into hyperacute, acute, early subacute, late subacute and chronic based on their signal intensities on T1w- and T2w images. Results The mean age of sCAD was 2.0, 5.8, 15.7 and 58.7 days in patients with acute, early subacute, late subacute and chronic VWH as classified by CMR (p Conclusions Signal intensities of VWH in sCAD vary over time and multi-sequence CMR can help to determine the age of an arterial dissection. Furthermore, findings of this study suggest that the time course of carotid hematomas differs from that of cerebral hematomas.

  17. Empiema subdural secundario a sinusitis: Descripción de un caso pediátrico / Subdural empyema secondary to sinusitis: A pediatric case report

    Scientific Electronic Library Online (English)

    A., Herrero; I., San Martín; L., Moreno; M., Herranz; J.C., García; E., Bernaola.

    2011-12-01

    Full Text Available Presentamos el caso de un varón de 9 años derivado al servicio de Urgencias por proptosis ocular derecha y cefalea progresiva en el contexto de una sinusitis, diagnosticado dos días antes por clínica y radiología compatible y en tratamiento con amoxicilina-clavulánico. A la exploración física destac [...] a proptosis derecha con ligera limitación para la mirada conjugada. Con la sospecha de una posible complicación neurológica de la sinusitis, se realiza tomografía axial computarizada (TAC) craneal, observando empiema subdural frontal derecho. Ingresa para tratamiento antibiótico endovenoso con cefotaxima, vancomicina y metronidazol. Es valorado por los servicios de Neurocirugía, Cirugía Maxilofacial y Otorrinolaringología (ORL) infantil, decidiéndose únicamente drenaje del foco primario, con actitud neuroquirúrgica expectante. El paciente evoluciona favorablemente con progresiva desaparición de los síntomas. Se realizan resonancias magnéticas periódicas, que muestran clara mejoría hasta resolución completa del empiema. Tras 4 semanas de antibioterapia iv., y tras la normalización clínica y radiológica, 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.

  18. Hematoma subcapsular por Fasciolasis / Liver subcapsular hematoma caused by Fasciola hepática. Report of one case

    Scientific Electronic Library Online (English)

    JUAN L, MORALES G; RENATO, ARRIAGADA H; LUIS, SALAS G; CARLOS, MORALES A; FELIPE, FUENTES A; ROBERTO, SANTANA.

    2009-02-01

    Full Text Available Presentamos el caso de una paciente de sexo femenino de 60 años de edad, ingresada en nuestro centro hospitalario por cuadro agudo de dolor abdominal en hipocondrio derecho asociado a vómitos y fiebre. Destaca la presencia de leucocitosis con eosinofilia de 56%. La tomografía computanzada abdominal [...] muestra una colección subcapsular hepática. Durante su evolución presenta abdomen agudo, realizándose una laparoscopía exploratoria que confirma un hematoma subcapsular con presencia de hemopentoneo de escasa cuantía. La serología confirma infección por fasciola hepática. Se realizó su tratamiento con triclabendazol en monodosis. Además, realizamos una revisión de la literatura nacional e internacional sobre el tema, sus manifestaciones clínicas, métodos diagnósticos y tratamiento. Abstract in english We report a 60 years oíd female admitted for pain in the right upper quadrant of the abdomen, vomiting and fever. Initial laboratory showed leukocytosis with 56% of eosinophils. An abdominal CAT sean showed a subcapsular fluid collection in the liver. The patient was operated and the presence of a s [...] ubcapsular hematoma was confirmed. Blood serological tests were positive for Fasciola hepática. The patient was treated with tricabendazole and after one year of follow up, is in good conditions.

  19. Extensive Sensory Block Caused by Accidental Subdural Catheterization during Epidural Labor Analgesia

    Directory of Open Access Journals (Sweden)

    Sheng-Huan Chen

    2006-12-01

    Full Text Available A 32-year-old parturient requested epidural analgesia for labor. A lumbar epidural blockwas performed at the L1-2 interspace. Thirty minutes after the loading dose of the localanesthetic mixture, she suffered numbness in both arms and high sensory block up to the C6dermatome without significant motor blockade. The retained epidural catheter was later confirmedradiologically to be in the subdural space. Accidental subdural catheterization is arare complication of epidural block. Due to the smaller potential space, a subdural injectionusually produces a high level block disproportional to the volume injected. Thus, patientsreceiving epidural block should be closely monitored following injection of local anestheticsregardless of the concentration or volume administered.

  20. An unusual case of neonatal meningococcal meningitis complicated by subdural empyema and hydrocephalus

    Scientific Electronic Library Online (English)

    Y, Ramsamy; P, Mahabeer; M, Archary; R A, Bobat; Y M, Coovadia.

    2013-01-01

    Full Text Available Neisseria meningitidis is a leading cause of pyogenic meningitis worldwide, as well as causing large epidemics in parts of Africa. With the dramatic decline in cases of Haemophilus influenzae B, N. meningitidis has emerged as one of the most common causes of acute bacterial meningitis in children an [...] d adults in South Africa. However, it remains an uncommon cause of meningitis in the neonatal period. Subdural empyema together with hydrocephalus has been infrequently described as a complication of meningococcal meningitis. We report a rare case of neonatal meningococcal meningitis, complicated by subdural empyema and hydrocephalus. To the best of our knowledge only a few cases of neonatal meningococcal meningitis have been reported from South Africa, with none of these cases having the complication of subdural empyema.

  1. A hypothesis of traumatic subdural effusion associated with communicating hydrocephalus in infants and its management.

    Science.gov (United States)

    Yang, Xi; Shen, Lin; Lin, Que Shuang; Li, Ren; Quanmin, Nie; Yongming, Qiu

    2015-03-01

    We report a case with both traumatic subdural effusion (TSE) and associated hydrocephalus. A collapse of the sinuses is known to be present in some infants with external hydrocephalus, but collapsed sinuses have not been previously described in patients with TSE and associated hydrocephalus. Therefore, a preoperative magnetic resonance imaging venography was performed, with thrombosis in the left transverse and sigmoid sinuses identified. The infant was treated with subdural peritoneostomy. We hypothesized that an occlusive cerebral venous sinus thrombosis may well be the culprit, or an exacerbating factor for TSE associated with hydrocephalus. PMID:25675020

  2. 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.

  3. Prediction and Observation of Post-Admission Hematoma Expansion in Patients with Intracerebral Hemorrhage

    OpenAIRE

    Ovesen, Christian; Havsteen, Inger; Rosenbaum, Sverre; Christensen, Hanne

    2014-01-01

    Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24?h after symptom onset, but predominantly occurs in the early hours....

  4. Prediction and observation of post-admission hematoma expansion in patients with intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Ovesen, Christian; Havsteen, Inger

    2014-01-01

    Post-admission hematoma expansion in patients with intracerebral hemorrhage (ICH) comprises a simultaneous major clinical problem and a possible target for medical intervention. In any case, the ability to predict and observe hematoma expansion is of great clinical importance. We review radiological concepts in predicting and observing post-admission hematoma expansion. Hematoma expansion can be observed within the first 24?h after symptom onset, but predominantly occurs in the early hours. Thus capturing markers of on-going bleeding on imaging techniques could predict hematoma expansion. The spot sign observed on computed tomography angiography is believed to represent on-going bleeding and is to date the most well investigated and reliable radiological predictor of hematoma expansion as well as functional outcome and mortality. On non-contrast CT, the presence of foci of hypoattenuation within the hematoma along with the hematoma-size is reported to be predictive of hematoma expansion and outcome. Because patients tend to arrive earlier to the hospital, a larger fraction of acute ICH-patients must be expected to undergo hematoma expansion. This renders observation and radiological follow-up investigations increasingly relevant. Transcranial duplex sonography has in recent years proven to be able to estimate hematoma volume with good precision and could be a valuable tool in bedside serial observation of acute ICH-patients. Future studies will elucidate, if better prediction and observation of post-admission hematoma expansion can help select patients, who will benefit from hemostatic treatment.

  5. 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

  6. Radionuclide imaging of a rectus sheath hematoma caused by insulin injections

    International Nuclear Information System (INIS)

    CT scanning, MRI, and ultrasonography are the imaging procedures of choice for the study of rectus sheath hematomas. A rectus sheath hematoma was evaluated scintigraphically after the intravenous administration of Tc-99m labeled RBC, which confirmed the hematoma, demonstrated the sites of bleeding, and revealed continued bleeding

  7. Giant splenic hematoma can be a hidden condition

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Hangaard, Stine

    2014-01-01

    An otherwise healthy 28-year old male presented to his general practitioner with dyspnoea in the morning and abdominal discomfort through months. Four months earlier, he had experienced a blunt trauma to the left side of his abdomen. Abdominal ultrasonography revealed a splenic hematoma and the patient was admitted to hospital. Vital signs were normal, and blood samples revealed a marginal anaemia and elevated C-reactive protein, but were otherwise normal. Computed tomography showed an 18 centimetre wide splenic hematoma. The patient was referred to another hospital for conservative treatment in the outpatient clinic.

  8. Spontaneous retropharynegeal hematoma: A case report and literature overview

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Ji Hwa [Dept. of Radiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan (Korea, Republic of)

    2014-02-15

    A spontaneous retropharyngeal hematoma is a rare condition with a difficult diagnostic. This disease may rapidly progress to an airway obstruction. The author reports about a case of a 56-year-old man with an acute onset of sore throat, dysphonia and dyspnea. A retropharyngeal high attenuated soft tissue density could be seen on the neck CT. A rapid improvement of the retropharyngeal abnormality was seen on the 3 days follow-up MR imaging. Signal changes caused by blood products which were visible on the MRI images suggested the diagnosis of retropharyngeal hematoma. The patient was conservatively managed.

  9. HEMATOMA SUBCAPSULAR HEPATICO POR FASCIOLASIS / HEPATIC SUBCAPSULAR HEMATOMA CAUSED BY FASCIOLIASIS

    Scientific Electronic Library Online (English)

    Humberto, Rosas L; Carlos, Fiestas F; Richard, Torres M; Giorgio, Aita C; David, Lozada M.

    Full Text Available La fasciolasis hepática es una zoonosis mundialmente difundida, sobre todo en los países productores de ganado; causada por la fasciola hepática. Se manifiesta por dolor abdominal, fiebre, náuseas y vómitos, baja de peso, diarrea, palidez, malestar general e hipereosinofilia. El diagnóstico es inmun [...] ológico y también puede hacerse por recuento de huevos en heces. El hematoma subcapsular e intraparenquimatoso hepático es una complicación rara de la fasciolasis humana pero se debe tener un alto índice de sospecha uniendo epidemiología, clínica, laboratorio e imaginologia para un adecuado diagnóstico y tratamiento. El propósito de reportar estos casos es dar a conocer una patología poco frecuente en la literatura, con una casuística de cuatro pacientes tratados en el lapso de dos años, todos referidos del Departamento de Cajamarca Abstract in english : Hepatic fasciolasis is a worldwide spread zoonoses mainly affecting cattle-raising countries. It is caused by the trematode Fasciola hepática and it is characterized by abdominal pain, fever, nausea and vomitus, weight loss, diahrrea, paleness, general malaise, and hypereosinophilia. Immunological [...] diagnosis as well as stool eggs count may be performed. Hepatic subcapsular and intraparenchymatous hematoma is an infrequent complication of human fascioliasis. Nevertheless, for establishing a proper diagnosis and treatment, any suspicion of its presence must be carefully discarded through, clinical epidemiology, laboratory and imaging exams and procedures. The aim of this study is to expand knowledge on this unfrequently dealt pathology in medical literature by presenting four case reports related to patients undergoing a two-year treatment. All of them had been referred from Departamento de Cajamarca, Peru

  10. Hematoma retroplacentario: su repercusión en la morbi-mortalidad perinatal Retroplacental hematoma: Its repercussion in perinatal morbidity and mortality

    Directory of Open Access Journals (Sweden)

    Armando Avellaneda González

    1997-12-01

    Full Text Available Se realiza un estudio descriptivo en el Hospital Docente Ginecoobstétrico de Matanzas, en el período comprendido de enero de 1985 hasta diciembre de 1991, de los casos clasificados como hematoma retroplacentario. Se habilitó un registro estadístico para la recolección de los datos primarios que permitió el estudio: de un total de 24 902 partos ocurridos hubo 82 hematomas retroplacentarios, con 87 productos (por 5 embarazos gemelares, que arrojó una incidencia de 0,33 %. Se utilizaron los métodos estadísticos del porcentaje; la prueba del x² donde # 0,01 a 0,05 y el hallazgo de medias aritméticas, que permitieron el estudio de variables mediante tablas estadísticas. Se demostró la influencia de la entidad en los indicadores de mortalidad perinatal del centro, donde el hematoma retroplacentario en su forma clínica grave fue la causa de las mayores complicaciones encontradas. También se reporta su efecto en la mortalidad, en el indicador de bajo peso y en el índice de apgar bajo.A descriptive study was performed at the Obstetric and Gynecological Teaching Hospital of Matanzas during the period of January, 1985 to December, 1991 of all cases classified as having retroplacental hematoma. A statistical registry was used for the collection of primary data which allowed to perform the study. From a total number of 24 902 deliveries, there were 82 retroplacental hematomas with 87 products (per 5 twin pregnancies which yields an incidence of 0.33 %. Statistical percentage methods were used, as well as the x² test where 0.01 to 0.05, and the finding of arithmetic mean which allowed the study of variables by means of statistical tables. The influence of this entity in the indicators of perinatal mortality of this center was demonstrated, where retroplacental hematoma in its more severe clinical form was found to be the main cause of the most frequent and severe complications. Its effect on mortality, low birth weight, and on the index of low Apgar score is also reported.

  11. A Case of Spontaneous Acute Subdural Haematoma in Traumatic Carotid- Cavernous Fistula

    OpenAIRE

    Fukui, K.; Miyachi, S.; Kato, M.; Miyazaki, M.

    2000-01-01

    We report a case of acute subdural haematoma in traumatic carotid-cavernous fistula. The patient had a history of head trauma four years ago. Postoperative study revealed CCF of dominant posterior drainage with giant pseudoaneurysm. Thereafter endovascular treatment using detachable balloons and detachable platinum micro-coils made successful occlusion of the fistula preserving the ICA.

  12. 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

    OpenAIRE

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

    2010-01-01

    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 aó...

  13. Intramural hematoma of the esophagus after variceal sclerotherapy.

    Science.gov (United States)

    Salomez, D; Ponette, E; Van Steenbergen, W

    1991-09-01

    Two patients with cirrhosis are presented who developed retrosternal pain and dysphagia immediately after sclerotherapy of esophageal varices. Extensive submucosal bleeding of the esophageal wall was demonstrated radiologically and endoscopically. Complete resolution occurred spontaneously and did not lead to residual complications such as strictures. Intramural hematoma of the esophagus is an unusual complication after endoscopic variceal sclerotherapy. PMID:1743137

  14. HEMATOMA OF THE PROXIMAL NAIL FOLD. REPORT OF 41 CASES

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-04-01

    Full Text Available Background: The proximal fold is an important part of the nail apparatus it contributes to the formation of the nail plate and through the cuticle acts as an impermeable barrier protecting it from any cause.Objective: To know the proximal nail fold hematoma caused by the use of pulse oximeter.Material and Methods: A descriptive study was conducted in 41 patients with proximal nail hematoma secondary to the use of oximetry in patients hospitalized in the Intermediate and Intensive Care Unit at the Hospital General de Enfermedades from December 1, 2007 to December 31, 2010.Results: We studied 41 patients with proximal nail fold hematoma secondary to the use of oximeter, 30 (73.1% were males and 11 (26.8% females. The numbers of fingers affected by pulse oximeter were in one digit. 30 (73.1% cases, in two digits 6 (14.6%, in three digits 3 (7.3%, in 4 digits 1 (2.4% and in 5 digits 1 (2.4% case. The most affected proximal nail fold was right index: 24 (58.5%, right middle 11 (26.8%, right ring 6 (14.6%, left index 12 (29.2%, and left middle 6 (14.6% cases.Conclusions: Hematomas of the proximal nail fold may be caused by different traumatisms. The use of pulse oximeter is one of them.

  15. Multiple remote epidural hematomas following pineal gland tumor resection

    OpenAIRE

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

    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...

  16. Massive scalp hematoma: An unusual presentation of valproic acid toxicity

    OpenAIRE

    Bhaskar, Suryanarayanan; Sobti, S.; Singh, Amit K.

    2012-01-01

    Valproic acid (VPA) is a commonly used broad-spectrum antiepileptic drug especially in children, with various side-effects reported with its usage. Hematologic toxicity is dose related and intracranial bleeding complications have been reported. We are reporting a rare case of massive scalp hematoma requiring surgical intervention, following a trivial fall associated with high-VPA levels.

  17. Hematoma de músculo iliopsoas na vigência de tratamento com varfarina / Iliopsoas muscle hematoma during treatment with warfarin / Hematoma de músculo iliopsoas en la vigencia de tratamiento con warfarina

    Scientific Electronic Library Online (English)

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

    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 sangramen [...] to 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. Abstract in spanish 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 ocurrenc [...] ia 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. Abstract in english 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.

  18. 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.

  19. 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 emondition. 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)

  20. Subacute phase treatment of subperiosteal hematoma of the orbit with epidural hematoma in the frontal cranial fossa: Case report

    Directory of Open Access Journals (Sweden)

    Mikami Taro

    2012-06-01

    Full Text Available Abstract Background Subperiosteal hematoma of the orbit is one of the rare lesions that cause exophthalmos after craniomaxillofacial trauma. Presently, there is no consensus for how to treat this disease. Although some reports have suggested a conservative type of therapy, others have recommended surgical treatments be done during the early stages. Case presentation This case report provides details on the clinical course of a 9-year-old girl with subperiosteal hematoma of the orbit. In this particular patient, a rare case of ipsilateral subfrontal extradural hematoma was also observed. Due to our performing the surgical intervention during the subacute stage, functional complications as well as cosmetic problems were avoided. Conclusion Our results demonstrate that surgical treatments for subperiosteal hematoma of the orbit should be delayed until it can be confirmed that a patient has no other complications. On the other hand, once it has been confirmed that the patient has no other existing problems, immediate surgical therapy with a small skin incision followed by the setting of a drain is recommended in order to achieve an early resolution and avoid complications.

  1. Hematoma após 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 Magalhães

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma associado à compressão espinhal após anestesia peridural é uma complicação neurológica grave, apesar da pequena incidência relatada (1:150.000. É um episódio agudo, e o tratamento tradicionalmente aplicado é a descompressão cirúrgica de urgência. Mais recentemente, em casos específicos, o tratamento com corticosteróide tem sido aplicado como alternativa, com boa recuperação neurológica. O objetivo deste relato foi expor um caso de hematoma peridural com tratamento conservador e recuperação neurológica completa. RELATO DO CASO: Paciente do sexo feminino, 34 anos, estado físico ASA I, sem qualquer histórico de coagulopatia ou terapia anticoagulante, submetida à anestesia peridural com punção única, em L2-L3, para tratamento cirúrgico de varizes nos membros inferiores. Oito horas após a anestesia regional, ela ainda apresentava bloqueio motor completo (escala de Bromage, redução das sensibilidades térmica e dolorosa abaixo do nível L3, hiperalgesia na região plantar esquerda, preservação dos reflexos tendinosos e ausência de dor lombar. A tomografia computadorizada revelou hematoma peridural em L2 com compressão do saco dural. Dez horas após a punção peridural não havia progressão dos sinais e sintomas neurológicos. Optou-se, então, pelo tratamento com metilprednisolona em infusão venosa contínua (5,3 mg.kg-1 na primeira hora e 1,4 mg.kg-1.h-1 nas 23 horas subseqüentes. Oito horas após o início do tratamento, a paciente recuperou as sensibilidades térmica e dolorosa, e houve regressão total do bloqueio motor. Na 12ª hora, deambulava e referia dor na ferida operatória. O hematoma peridural não foi visualizado em nova tomografia computadorizada na 14ª hora após o início do tratamento. A paciente recebeu alta hospitalar 86 horas depois do início do tratamento conservador, sem comprometimento neurológico. Uma tomografia computadorizada de controle, após sete meses, mostrou o canal vertebral completamente normal. CONCLUSÕES: A eficiência da abordagem conservadora mostrou-se uma alternativa importante à intervenção cirúrgica em casos específicos. A avaliação da progressão ou a estabilização do comprometimento neurológico, sobretudo após a oitava hora após a punção peridural, é essencial para a escolha do tratamento.JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresión espinal después de la anestesia peridural es una complicación neurológica grave, a pesar de la pequeña incidencia relatada (1:150.000. Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresión quirúrgica de urgencia. Recientemente, en casos específicos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperación neurológica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperación neurológica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 años, estado físico ASA I, sin ningún historial de coagulopatía o terapia anticoagulante, sometida a la anestesia peridural con punción única, en L2-L3, para tratamiento quirúrgico de várices en los miembros inferiores. Ocho horas después de la anestesia regional, todavía presentaba bloqueo motor completo (escala de Bromage, reducción de las sensibilidades térmica y dolorosa por debajo del nivel L3, hiperalgesia en la región plantar izquierda, preservación de los reflejos tendinosos y ausencia de dolor lumbar. La tomografía computadorizada reveló hematoma peridural en L2 con compresión del saco dural. Diez horas después de la punción peridural no había progresión de las señales y síntomas neurológicos. Se optó entonces por el tratamiento con metilprednisolona en infusión 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 después del inicio del tratamiento, la paciente recuperó las sensibilidades térmica y dolorosa y la regresión total del bloqueo motor. En la 12ª h

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

    Scientific Electronic Library Online (English)

    Edno, Magalhães; Cátia Sousa, Govêia; Luís Cláudio de Araújo, Ladeira; Laura Elisa Sócio de, Queiroz.

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma associado à compressão espinhal após anestesia peridural é uma complicação neurológica grave, apesar da pequena incidência relatada (1:150.000). É um episódio agudo, e o tratamento tradicionalmente aplicado é a descompressão cirúrgica de urgência. Mais recenteme [...] nte, em casos específicos, o tratamento com corticosteróide tem sido aplicado como alternativa, com boa recuperação neurológica. O objetivo deste relato foi expor um caso de hematoma peridural com tratamento conservador e recuperação neurológica completa. RELATO DO CASO: Paciente do sexo feminino, 34 anos, estado físico ASA I, sem qualquer histórico de coagulopatia ou terapia anticoagulante, submetida à anestesia peridural com punção única, em L2-L3, para tratamento cirúrgico de varizes nos membros inferiores. Oito horas após a anestesia regional, ela ainda apresentava bloqueio motor completo (escala de Bromage), redução das sensibilidades térmica e dolorosa abaixo do nível L3, hiperalgesia na região plantar esquerda, preservação dos reflexos tendinosos e ausência de dor lombar. A tomografia computadorizada revelou hematoma peridural em L2 com compressão do saco dural. Dez horas após a punção peridural não havia progressão dos sinais e sintomas neurológicos. Optou-se, então, pelo tratamento com metilprednisolona em infusão venosa contínua (5,3 mg.kg-1 na primeira hora e 1,4 mg.kg-1.h-1 nas 23 horas subseqüentes). Oito horas após o início do tratamento, a paciente recuperou as sensibilidades térmica e dolorosa, e houve regressão total do bloqueio motor. Na 12ª hora, deambulava e referia dor na ferida operatória. O hematoma peridural não foi visualizado em nova tomografia computadorizada na 14ª hora após o início do tratamento. A paciente recebeu alta hospitalar 86 horas depois do início do tratamento conservador, sem comprometimento neurológico. Uma tomografia computadorizada de controle, após sete meses, mostrou o canal vertebral completamente normal. CONCLUSÕES: A eficiência da abordagem conservadora mostrou-se uma alternativa importante à intervenção cirúrgica em casos específicos. A avaliação da progressão ou a estabilização do comprometimento neurológico, sobretudo após a oitava hora após a punção peridural, é essencial para a escolha do tratamento. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: O hematoma asociado a la compresión espinal después de la anestesia peridural es una complicación neurológica grave, a pesar de la pequeña incidencia relatada (1:150.000). Es un episodio agudo y el tratamiento tradicionalmente aplicado es la descompresión quirúrgica de urg [...] encia. Recientemente, en casos específicos, el tratamiento con corticosteroide ha sido aplicado como alternativa y con una buena recuperación neurológica. El objetivo de este relato fue exponer un caso de hematoma peridural con tratamiento conservador y recuperación neurológica completa. RELATO DEL CASO: Paciente del sexo femenino, 34 años, estado físico ASA I, sin ningún historial de coagulopatía o terapia anticoagulante, sometida a la anestesia peridural con punción única, en L2-L3, para tratamiento quirúrgico de várices en los miembros inferiores. Ocho horas después de la anestesia regional, todavía presentaba bloqueo motor completo (escala de Bromage), reducción de las sensibilidades térmica y dolorosa por debajo del nivel L3, hiperalgesia en la región plantar izquierda, preservación de los reflejos tendinosos y ausencia de dolor lumbar. La tomografía computadorizada reveló hematoma peridural en L2 con compresión del saco dural. Diez horas después de la punción peridural no había progresión de las señales y síntomas neurológicos. Se optó entonces por el tratamiento con metilprednisolona en infusión 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 después del inicio del tratamiento, la paciente recuperó las sensibilidades térmica y dolorosa y la regresi

  3. 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)

  4. Absceso prostático por Sthapilococo aureus y empiema subdural: presentación de un caso / Sthapylococcus aureus prostatic abscess and subdural empyema: a case report

    Scientific Electronic Library Online (English)

    F., Cabrera Meirás; A., Sanchís Bonet; O., Blanco Carballo; A., Martín Parada; G., Duque Ruiz; O., Leiva Galvis.

    2007-05-01

    Full Text Available Introducción y objetivo: Presentamos el caso de un paciente con absceso prostático y empiema subdural por Staphilococo aureus. Material y método: Descripción de un caso de un paciente de 51 años de edad diagnosticado de absceso prostático y empiema subdural por Staphilococo aureus. Utilizamos como m [...] étodo de aproximación diagnóstica la sospecha clínica y la exploración física mediante tacto rectal. Como métodos de confirmación diagnóstica, pruebas de imagen, como la tomografía axial computerizada y la ecografía transrectal, que permite además el drenaje del material purulento. Resultados: El cuadro se resolvió con ecografía transrectal y punción-drenaje de la colección y con tratamiento conservador en base a antibioterapia y derivación urinaria. Conclusiones: El absceso prostático es en la actualidad una patología poco frecuente. Dada la gran variedad de presentación de esta entidad, hay que tener un alto grado de sospecha para su diagnóstico y una vez realizado comenzar un tratamiento inmediato agresivo. La ecografía transrectal permite, no sólo el diagnóstico, sino también la punción-drenaje del contenido purulento. El cultivo de las muestras obtenidas identifica el agente causante y la antibioterapia más adecuada. Abstract in english Introduction and objectives: To report one case of prostatic abscess and subdural empyema by Staphylococcus aureus. Methods: We describe the case of a 51 year old male patient who was diagnosed of prostatic abscess and subdural empyema by Staphilococcus aureus. We use clinical presentation and physi [...] cal exploration based on rectal digital examination, as diagnostic approach method. And computerized axial tomography and transrectal ultrasonography, which allows the guided needle drainage of the abscess, as diagnostic confirmation methods. Results: The clinical picture resolved with the transrectal ultrasonography guided needle aspiration of the abscess and conservative treatment with antibiotics and urinary diversion. Conclusions: Prostatic abscess is an uncommon entity nowadays. Provided the great variety of symptoms, a great degree of clinical suspicion is needed for the diagnosis, and once it is got it, immediate aggressive treatment must be initiated. Transrectal ultrasonography allows not only the diagnosis, but also the drainage of the abscess. The culture of the obtained material identifies the etiological agent and the most specific antibiotic therapy.

  5. Atenolol prevents the formation of expansive hematoma after rhytidoplasty / O atenolol previne a formação de hematoma expansivo após ritidoplastia

    Scientific Electronic Library Online (English)

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

    2014-10-01

    Full Text Available Objetivo: avaliar o uso perioperatório do atenolol na redução da incidência de hematoma pós-ritidoplastia. Métodos: entre janeiro de 2007 e fevereiro de 2013 foram randomizados 80 pacientes em dois grupos: Grupo A (n=26) recebeu atenolol perioperatório com objetivo de manter frequência de puls [...] o (FP) ± 60 por minuto, Grupo B (n=54) não recebeu atenolol. Ambos os grupos foram submetidos à mesma técnica anestésico-cirúrgica. A pressão arterial (PA) e FP, formação de hematoma e a necessidade de drenagem foram monitorizados. Houve seguimento até o 90º dia de pós-operatório. As variáveis foram analisadas entre os dois grupos utilizando-se o teste de ANOVA. As variáveis contínuas foram apresentadas como média (± Desvio-padrão) e as diferenças 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.

  6. 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 após ressuscitação cardiopulmonar. Esse homem, de 92 anos de idade, teve uma parada cardíaca causada por fibrilação atrial e testemunhas iniciaram imediatamente manobras manuais de ressuscitação cardiopulmonar. Ao ser admit [...] ido no hospital, o paciente apresentava-se em choque cardiogênico, sendo, então, imediatamente submetido a ecocardiografia transesofágica. Além de uma parede anterior acinética, o exame da aorta torácica descendente mostrou um hematoma intramural e um trombo intra-aórtico flutuante a uma distância de 40cm do arco dental. Não havia dissecção da aorta. O trombo foi atribuído à compressão aórtica durante a ressuscitação cardiopulmonar. Embora o trombo aórtico e o hematoma intramural não tenham se associado a qualquer complicação nesse paciente, a inserção de um balão intra-aórtico poderia ter levado a uma ruptura da aorta ou a eventos embólicos. Recomenda-se a realização de ecocardiografia transesofágica, quando disponível, antes da inserção de um balão intra-aórtico de contrapulsação em pacientes submetidos à ressuscitação 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.

  7. Hematoma retroplacentario: su repercusión en la morbi-mortalidad perinatal / Retroplacental hematoma: Its repercussion in perinatal morbidity and mortality

    Scientific Electronic Library Online (English)

    Armando, Avellaneda González; Jesús, Hernández Cabrera; Carmen, Ulloa Gómez; Marla, Deulofeu Jiménez.

    1997-12-01

    Full Text Available Se realiza un estudio descriptivo en el Hospital Docente Ginecoobstétrico de Matanzas, en el período comprendido de enero de 1985 hasta diciembre de 1991, de los casos clasificados como hematoma retroplacentario. Se habilitó un registro estadístico para la recolección de los datos primarios que perm [...] itió el estudio: de un total de 24 902 partos ocurridos hubo 82 hematomas retroplacentarios, con 87 productos (por 5 embarazos gemelares), que arrojó una incidencia de 0,33 %. Se utilizaron los métodos estadísticos del porcentaje; la prueba del x² donde # 0,01 a 0,05 y el hallazgo de medias aritméticas, que permitieron el estudio de variables mediante tablas estadísticas. Se demostró la influencia de la entidad en los indicadores de mortalidad perinatal del centro, donde el hematoma retroplacentario en su forma clínica grave fue la causa de las mayores complicaciones encontradas. También se reporta su efecto en la mortalidad, en el indicador de bajo peso y en el índice de apgar bajo. Abstract in english A descriptive study was performed at the Obstetric and Gynecological Teaching Hospital of Matanzas during the period of January, 1985 to December, 1991 of all cases classified as having retroplacental hematoma. A statistical registry was used for the collection of primary data which allowed to perfo [...] rm the study. From a total number of 24 902 deliveries, there were 82 retroplacental hematomas with 87 products (per 5 twin pregnancies) which yields an incidence of 0.33 %. Statistical percentage methods were used, as well as the x² test where 0.01 to 0.05, and the finding of arithmetic mean which allowed the study of variables by means of statistical tables. The influence of this entity in the indicators of perinatal mortality of this center was demonstrated, where retroplacental hematoma in its more severe clinical form was found to be the main cause of the most frequent and severe complications. Its effect on mortality, low birth weight, and on the index of low Apgar score is also reported.

  8. 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.

  9. Postpartum spontaneous subcapsular hepatic hematoma related to preeclampsia.

    Science.gov (United States)

    Anyfantakis, Dimitrios; Kastanakis, Miltiades; Fragiadakis, Georgios; Karona, Paraskevi; Katsougris, Nikolaos; Bobolakis, Emmanouil

    2014-01-01

    Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum. PMID:25202460

  10. Language recovery after acute intracerebral hematoma in temporoparietal region.

    Science.gov (United States)

    Kolundži?, Zdravko; Klari?, Andrea Šimi?; Krip, Marija; Gotovac, Nikola; Banoži?, Ljerka; Vodanovi?, Dinah

    2015-01-01

    Arteriovenous malformations are the most common cause of spontaneous intracerebral hemorrhages in older children. Intracerebral hematoma can cause serious lasting neurologic, cognitive, and language deficits, or even possible death. We present the case of a 16-year-old boy who had language impairments after suffering a large hemorrhagic stroke in the left temporoparietal region. All language components, verbal and nonverbal communication, reading, and writing, were found to be affected. These impairments were expected as they are characteristic of the location of the hematoma. After a year of speech language rehabilitation, there was an almost complete recovery of language skills. Quick diagnosis and adequate therapeutic interventions are important to diminish the influence of intracerebral hemorrhage on cognitive and language functions in children. PMID:24532808

  11. Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy

    International Nuclear Information System (INIS)

    Pulmonary hematoma is a rare cause of a pulmonary nodule. Mostly it results from penetrating or blunt chest injuries. The case of a patient is reported, whose chest X-ray showed a pulmonary nodule suspected of malignancy. This patient was maintained permanently on anticoagulants (warfarin derivates) after cardiac valve replacement with a prosthesis. A definite diagnosis could not be established by non-invasive methods. A needle biopsy of the lung was impracticable because of the location of the pulmonary lesion; an exploratory thoracotomy could not be carried out due to a general indication of nonoperability. Control examinations showed that the pulmonary nodule had vanished completely within four months. In consideration of the patient's clinical situation it can be concluded that the pulmonary lesion was caused by a hematoma of the lung. (orig.)

  12. Spontaneous rupture of the kidney with perirenal hematoma.

    Science.gov (United States)

    McDougal, W S; Kursh, E D; Persky, L

    1975-08-01

    Spontaneous rupture of the kidney involves either the collecting system or parenchyma, the latter being associated with a subcapsular or perirenal hematoma. A review was made of 78 cases of spontaneous parenchymal rupture with perirenal hematoma, including 4 of our own. One of these cases is the first description of spontaneous rupture of the kidney secondary to renal vein thrombosis. The patients are usually in the fourth decade of life and present with an acute onset of flank pain, a tender mass and commonly symptoms and signs of shock. Hematuria is often present and generally urography reveals a mass, distorted collecting system and/or non-visualization of the kidney. Tumors are the most common cause followed by vascular diseases, infection, nephritis and blood dyscrasias. Nephrectomy when possible should be performed expeditiously since conservative therapy is uniformly unsuccessful. PMID:1159905

  13. Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

    OpenAIRE

    Dimitrios Anyfantakis; Miltiades Kastanakis; Georgios Fragiadakis; Paraskevi Karona; Nikolaos Katsougris; Emmanouil Bobolakis

    2014-01-01

    Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency depart...

  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. Treatment of canine aural hematoma with an indwelling drain.

    Science.gov (United States)

    Kagan, K G

    1983-11-01

    Aural hematomas in 9 dogs were managed by manual expression through stab incisions in the pinna and placement of indwelling silicone rubber drains, without compression bandaging. The drains were well tolerated. Seromas developed in 2 ears when the drains were removed at 7 and 10 days, but the seromas resolved when the drains were replaced. Healing without deformation of the pinna was obtained when the drains were maintained 13 to 28 days. PMID:12002588

  16. Canine and feline aural hematoma: clinical, experimental, and clinicopathologic observations.

    Science.gov (United States)

    Kuwahara, J

    1986-10-01

    The pathogenesis of canine and feline aural hematoma (AH) was investigated. Clinical observations, selected experimental procedures, and clinicopathologic examinations were done on 40 dogs and 20 cats affected with AH. Eighteen healthy dogs and 14 healthy cats were used as the controls. The results of this investigation provide a valid basis for questioning the conventionally held view that AH is caused by trauma and for postulating that the actual cause is immune mediated. PMID:3490809

  17. 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.)

  18. Intramuscular Hematomas Caused by Anticoagulant Therapy: Is Advanced

    Directory of Open Access Journals (Sweden)

    Nilgün ÇINAR

    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 patient’s 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. 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.

  20. The fate of traumatic subdural hygroma in serial computed tomographic scans.

    OpenAIRE

    Lee, K. S.; Bae, W. K.; Bae, H G; Yun, I. G.

    2000-01-01

    We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolve...

  1. Results of surgery in patients with bilateral independent temporal lobe spiking (BITLS with normal MRI or bilateral mesial temporal sclerosis (MTS investigated with bilateral subdural grids

    Directory of Open Access Journals (Sweden)

    CUKIERT ARTHUR

    2000-01-01

    Full Text Available PURPOSE: The introduction of new technologies in the clinical practice have greatly decreased the number of patients submitted to invasive recordings. On the other hand, some patients with refractory temporal lobe epilepsy have normal MR scans or bilateral potentially epileptogenic lesions. This paper reports the results of invasive neurophysiology and surgical outcome in such patients. METHOD: Sixteen patients were studied. Eleven had normal MRI (Group I and five had bilateral mesial temporal sclerosis (Group II. All patients had BITLS and non-localizatory seizures on video-EEG monitoring. All patients were implanted bilaterally with 32-contacts subdural grids. They were submitted to a cortico-amygdalo-total hippocampectomy at the side defined by chronic electrocorticography (ECoG. RESULTS: In Group I, seizures came from a single side in nine patients. In nine patients, seizures started at one side, spread to the ipsolateral contacts and contralaterally afterwards. On the other hand, in two Group I patients seizures started in one mesial region and spread to the contralateral parahippocampus and neocortex before spreading to ipsolateral contacts. All patients in Group II had seizures starting unilaterally with focal EcoG onset in the mesial regions. Eight Group I patients are seizure-free and three are in Engel's class II. Eighty percent of Group II patients are seizure-free after surgery and one patient is in Engel's class II. CONCLUSION: Good surgical results can be obtained in patients with BITLS. Patients with normal MRI seem to have a worse prognosis when compared to patients with unilateral or even bilateral MTS. Extensive subdural coverage is essential in patients with normal MRI.

  2. Femoral Neuropathy due to Iliacus Muscle Hematoma in a Patient on Warfarin Therapy

    OpenAIRE

    Kong, Woo Keun; Cho, Keun-tae; Lee, Ho Jun; Choi, Jae-sung

    2012-01-01

    Spontaneous hematomas of the iliacus muscle are rare lesions and these are seen in individuals receiving anticoagulation therapy or patients with blood dyscrasias such as hemophilia. It can cause femoral neuropathy and resultant pain and paralysis. Although there is no clear consensus for the treatment of femoral neuropathy from iliacus muscle hematomas, delays in the surgical evacuation of hematoma for decompression of the femoral nerve can lead to a prolonged or permanent disability. We rep...

  3. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

    OpenAIRE

    Parthiban Chandra JKB; Majeed Shiju A

    2008-01-01

    Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 ...

  4. Non-Traumatic Subcapsular Spleen Hematoma in a Patient with Brucellosis

    Directory of Open Access Journals (Sweden)

    Murat Söker

    2005-01-01

    Full Text Available Brucellosis is a zoonotic disease. A characteristic clinical findings are fever, headache, arthralgia and splenomegali. Brucellosis occurs after direct contact with an infected animal or consumption of products of an infected animal. Subcapsular hematoma in the spleen is very rare complication of brucella infection. We report here, an 11 year old patient with brucellosis who admitted to our clinic with subcapsular non-traumatic spleen hematoma. Hematoma and clinical findings were resolved with doxicyclin and streptomycin combination. We emphasised that brucella infection should be keept in mind when non-traumatic subcapsular spleen hematoma occur.

  5. Innovative management of nasal septal hematoma in an infant

    Science.gov (United States)

    Sumitha, R.; Anandan, Ajay Kumar; Govarthanaraj, Aberna

    2015-01-01

    Nasal septal hematoma is a collection of blood between the cartilage or bone and mucoperichondrium or mucoperiosteum of the nose. This condition requires immediate surgical drainage to prevent complications. All patients need nasal packing postoperatively to prevent recurrence. This causes a lot of discomforts due to mouth breathing more in infants who are obligatory nose breathers. They can go for cyanosis in the postoperative period. Here, we discuss the case report of an infant who had tubular nasal pack with endotracheal tube postoperatively to maintain the patency of nose.

  6. Iliopsoas Muscle Hematoma Secondary to Alcoholic Liver Cirrhosis

    OpenAIRE

    Yamashita, Suguru; Tanaka, Nobutaka; Nomura, Yukihiro; Miyahara, Takuya; Furuya, Takatoshi

    2012-01-01

    Iliopsoas muscle hematoma in a patient with alcoholic liver cirrhosis is rarely seen, however it has a high mortality. Thus we should cautiously make a diagnosis and treatment. This is the case of a 60-year-old male. He had a 15-year history of alcoholic liver disease and emphysema. He presented with low back pain after a fall that had happened 2 months before. Due to persistent back pain, he went to see a local physician who, after detailed examination, suspected rupture of bilateral common ...

  7. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    International Nuclear Information System (INIS)

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  8. Extensive spinal epidural hematoma: a rare complication of aortic coarctation

    Energy Technology Data Exchange (ETDEWEB)

    Zizka, J.; Elias, P.; Michl, A. [Dept. of Radiology, Charles University Hospital, Hradec Kralove (Czech Republic); Harrer, J. [Dept. of Cardiac Surgery, Charles University Hospital, Hradec Kralove (Czech Republic); Cesak, T. [Dept. of Neurosurgery, Charles University Hospital, Hradec Kralove (Czech Republic); Herman, A. [1. Dept. of Internal Medicine, Charles University Hospital, Hradec Kralove (Czech Republic)

    2001-07-01

    Development of collateral circulation belongs among the typical signs of aortic coarctation. Cerebral or spinal artery aneurysm formation with increased risk of subarachnoid hemorrhage represent the most common neurovascular complication of this disease. We report a case of a 20-year-old sportsman who developed acute non-traumatic paraplegia as a result of extensive spinal epidural hemorrhage from collateral vessels accompanying aortic coarctation which was unrecognized up to that time. To the best of our knowledge, acute spinal epidural hematoma as a complication of aortic coarctation has not been previously reported. (orig.)

  9. Subphrenic abscess mimicking subcapsular splenic hematoma on computed tomography images

    International Nuclear Information System (INIS)

    The authors describe a case of 70-year-old woman, who developed a subphrenic abscess after D2 gastrectomy. The abscess looked like an acute subcapsular splenic hematoma on computed tomography images. Therefore the patient was reoperated. It turned out during the operation that there was a subphrenic pus collection, while the spleen had been intact. The reason for this complication was unoesophagal fistula. The case report shows limitations of CT images interpretation and a failure that can result from fixed bearing radiological criteria. (author)

  10. Intrahepatic hematoma: hepatic lesion in a newborn with high ?-fetoprotein level

    International Nuclear Information System (INIS)

    Hepatic hematomas are relatively common in fetuses and neonates; most are subcapsular in location. Sometimes their imaging features can be non-specific, so differentiation from other aggressive lesions like hepatoblastoma can be difficult, especially if there is a concurrent high ?-fetoprotein level. We report a case of intrahepatic hematoma with a rising ?-fetoprotein level. (orig.)

  11. CT Fluoroscopy-guided Aspiration of Intracerebral Hematomas: Technique and Outcomes

    Science.gov (United States)

    Hwang, Kihwan; Kwon, O-Ki; Bang, Jae Seung; Oh, Chang Wan

    2015-01-01

    Objective The authors evaluated the feasibility and targeting accuracy of CT fluoroscopy (CTF)-guided catheter placement and aspiration of intracerebral hematoma (ICH)s. Materials and Methods Nine patients (mean age, 63.3 ± 15.3 years) were treated by CTF-guided hematoma aspiration under local anesthesia. The targeting errors in the lesion center, volume of the aspirated hematoma, accuracy of the final catheter position, procedure time, and clinical outcomes were evaluated. Results All catheters were successfully placed in the center of the hematoma. The mean volume of the aspirated hematoma was 20.6 ± 8.8 mL (pre-treatment, 44.7 ± 20.1 mL; post-treatment, 24.1 ± 13.8 mL). The average procedure time was 25.1 minutes (range, 18-32 minutes). In one case with a scanty residual hematoma, the catheter was removed at the end of the procedure. In the remaining eight cases, the catheter was left in the residual hematoma for drainage and all catheter tips were accurately located in the final position. There were no procedure-related complications, including rebleeding and infection. Conclusion CTF-guided ICH aspiration is a feasible, quick, and accurate procedure which could substitute for stereotactic methods. The accurate catheter position provided by real-time observation enables an effective aspiration and drainage of hematomas. PMID:25874179

  12. 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.

  13. Clinical analysis of surgical treatment of traumatic hematomas of the posterior cranial fossa

    International Nuclear Information System (INIS)

    Objective: To discuss the clinical features and surgical outcome of the traumatic hematomas posterior cranial fossa. Methods: Fifteen patients with traumatic hematomas posterior cranial fossa in authors' hospital during the period from 1995 to 1998 were reviewed. Results: Thirteen patients had an occipital skull fracture, 11 pure epidural hematomas among whom 4 had cerebellar contusion and hematomas 4 posterior cranial fossa hematoma with associated cerebral hematoma or contusion, and 5 acute hydrocephalus. Fifteen patients were treated by emergency surgery, 9 had good recovery and 1 had severe disability in GCS between 9 and 15 marking, 1 had good recovery, 1 had severe disability and 3 died in GCS between 3 and 8. Nine patients had good recovery in 11 patient having pure epidural hematoma of posterior cranial fossa. Conclusions: The clinical course of the traumatic hematomas posterior cranial fossa was acute and severe. The GCS value below 9 predicts the poor out-come for patients. Early diagnosis and appropriately and promptly treatment are crucial for achieving good results

  14. [First manic episode in the elderly--consider a subdural haematoma due to head trauma as cause].

    Science.gov (United States)

    Marijnissen, Radboud M; Bakker, Miranda; Stek, Max L

    2010-01-01

    A manic episode in old age presents a diagnostic challenge to the clinician due to the different symptomatology often difficult to distinguish from delirium, dementia, agitated depression and psychosis. To complicate matters further, a first episode of mania in later life is very often based on underlying physical and cerebral pathology ('secondary mania'). Many causes of 'secondary mania', including neurological, systemic or endocrine diseases, infections, intoxications, apnoea, post-thoracic surgery and vitamin B12 deficiency have been described to date, but there have been no reports on subdural haematomas in this context. However, the elderly are more prone to subdural haematomas following head trauma than younger patients. We present two case reports of older patients with a first manic episode in later life probably caused by subdural haematomas. A first episode of mania in later life always requires thorough assessment of the patient to determine physical and cerebral pathology. PMID:20456795

  15. Hematomas renales tras Litotricia Extracorpórea por Ondas de Choque: LEOCH / Renal hematomas after extracorporeal shock-wave lithotripsy: ESWL

    Scientific Electronic Library Online (English)

    Héctor, Pastor Navarro; Pedro, Carrión López; Jesús, Martínez Ruiz; José Mª, Pastor Guzmán; Mariano, Martínez Martín; Julio A., Virseda Rodríguez.

    2009-03-01

    Full Text Available Introducción: La introducción de la fragmentación por ondas de choque en el campo de la litiasis urinaria es una de las mayores aportaciones terapéuticas en la historia de la urología. Es el método de elección para el tratamiento de la mayoría de los cálculos de ubicación renal y ureteral, ya que es [...] un método poco invasivo y con bajo número de complicaciones; pero su aplicación no está totalmente exenta de efectos adversos. Produce traumatismo o lesión más o menos importante en los órganos que atraviesan las ondas de choque, incluido el riñón, donde pueden producir desde una pequeña contusión a hematomas renales con diferente resolución y tratamiento. Material y métodos: Realizamos una revisión de 4.815 litotricias que se han realizado en nuestro servicio, exponiendo siete casos en los que se diagnosticó hematomas renales subcapsulares o perirrenales, con su evolución, manejo y tratamiento. Resultados: Después de las complicaciones urológicas (dolor, obstrucción e infección), las colecciones hemáticas renales y perirrenales ocupan el primer lugar en orden de frecuencia en cuanto a efectos adversos de las ondas de choque, relacionándose fundamentalmente con la potencia de energía aplicada y con el incremento de edad del paciente. Conclusiones: Entre los años 1992-2007 se realizaron 4.815 litotricias con un total de 7 casos de hematomas graves, que representan menos del 1%. El manejo suele ser conservador si bien en ocasiones es necesario el drenaje quirúrgico o incluso la nefrectomía. Abstract in english Introduction: The use of fragmentation due to shock- waves as a treatment of urinary stone was one of the most important therapeutics findings in the history of urology. It´s the first election treatment for most of the calculus at renal and urethral location due to the fact that it is a low invasiv [...] e treatment and it has a few number of complications, but this method also has a few negative side effects, it can caused a more or less important traumatic lesion at the organs which crosses the shock- waves, including the kidney where it can caused a small contusion or renal hematoma with different resolution and treatment. Material and method: We reviewed 4815 extracorporeal shock-wave lithotripsy that we performed in our department in which we found six cases with subcapsular and perirrenal hematoma which we followed up and treated. Results: After the urological complications (pain, obstruction and infection) the renal and perirrenal hematic collections are the most frequent adverse effects of shock- waves used in lithotripsy, these are related to the power of energy used and patient age. Conclusions: Between the years 1992-2007 we performed 4.815 extracorporeal shock-wave lithotripsy finding seven cases of severe hematoma, less then 1%.Treatment of these complications is usually not aggressive though sometimes it is necessary to perform surgical drainage and even nephrectomy.

  16. Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare.

    Science.gov (United States)

    Kafarnik, Christiane; Donaldson, David; Payne, Richard; Holloway, Andrew

    2014-07-01

    A 13-year-old cob mare was presented with exophthalmos and periocular swelling of the left eye. The diagnostic work-up included ocular ultrasound, sonographic examination through the thinned frontal bone, radiography, standing computed tomography of the skull and exploratory osteoplastic surgery. Histopathology was consistent with an organized hematoma. An intradiploic hematoma of the frontal bone was diagnosed 5 years after head trauma, with progressive expansion and deformation of the skull resulting in exophthalmos. Exophthalmos with facial bone deformation was the only clinical finding of intradiploic hematoma. Standing computed tomography (CT) aided the diagnosis to differentiate intradiploic hematoma from other, more common causes of facial bone distortion associated with paranasal sinus diseases. Intradiploic hematoma of possible traumatic origin is a differential diagnosis for sinonasal disease and exophthalmos in the horse. PMID:23953510

  17. Effect of puncture through frontal lobe in the treatment of intracranial hematoma

    Directory of Open Access Journals (Sweden)

    DOU Bo-sheng

    2013-12-01

    Full Text Available This study aims to discuss the effect of an easy puncture through frontal lobe in the treatment of deep brain hematoma. The lesions of 37 patients with basal ganglia hemorrhage were accurately positioned by CT scan. Drainage tube was placed in the center of hematoma through frontal lobe and blood was aspirated. Urokinase 30 × 103 U was injected in the hematoma postoperatively to promote the evacuation of hematoma. Postoperative CT scan showed more than 75% hematoma was cleared in all patients after 3-7 d. Two patients died of complications; 2 patients were severely disabled; 3 rebleeding happened. Almost 33 patients had a good recovery. Minimal invasion, convenient operation and exact location were the adventages of this puncture and it does not need complicated device.

  18. Large Intraluminal Ileal Hematoma Presenting as Small Bowel Obstruction in a Child

    Science.gov (United States)

    Lim, Yun Jung; Nam, So Hyun; Kim, Seon Jeong

    2015-01-01

    Intraluminal small bowel hematoma has been rarely reported in children, as a rare cause of small bowel obstruction. We present a case of an intraluminal ileal hematoma presenting as small bowel obstruction in a child. Computed Tomography (CT) indicated a large intraluminal hyperdense lesion in the distal ileum as the cause of small bowel obstruction. Abdominal ultrasonography (US) showed an echogenic mass-like lesion with multiple septa in the distal ileum. Small bowel obstruction due to a complicated cystic mass was provisionally diagnosed. Histopathologic examination of the resected mass suggested a submucosal ileal hematoma. Although intraluminal small bowel hematoma is rare in children, it can present as an intraluminal cystic mass and should be considered as a rare cause of small bowel obstruction. The US and CT findings of submucosal ileal hematoma could be useful for the diagnosis of such cases in the future. PMID:25901264

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

    Science.gov (United States)

    Baliah, John; Kayalvizhi; Rangdhol, Vishwanath; Livingstone, David

    2015-01-01

    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. PMID:25684931

  20. Evaluation of a technique using the carbon dioxide laser for the treatment of aural hematomas.

    Science.gov (United States)

    Dye, Teresa L; Teague, H Douglas; Ostwald, Donald A; Ferreira, Steven D

    2002-01-01

    A new technique using the carbon dioxide (CO2) laser for the treatment of aural hematomas is described. The laser is used to make an incision into the hematoma to allow for evacuation of the blood, and then multiple, small incisions are made over the surface of the hematoma to stimulate adhesions between the tissue layers. The CO2 laser was used in this fashion to treat 10 aural hematomas in eight dogs. Follow-up ranged from 1 to 23 months. Owners evaluated the cosmetic results following CO2 laser surgery as excellent in three ears, good in five ears, and fair in two ears. Hematomas were resolved in all 10 cases, although two cases developed serosanguineous fluid accumulation that required percutaneous drainage in one case and a second laser procedure in the other case. PMID:12118693

  1. Esclerose hipocampal unilateral com registro subdural de crises temporais contralaterais: relato de caso / Unilateral hippocampal sclerosis with subdural strips in seizures from the contralateral temporal lobe: case report

    Scientific Electronic Library Online (English)

    Carolina, Torres; Victor, Martinez; André, Palmini; Eliseu, Paglioli; Mirna, Portuguez; Jaderson Costa da, Costa; Ney, Azambuja.

    2006-06-01

    Full Text Available INTRODUÇÃO: Pacientes com epilepsia temporal e esclerose hipocampal unilateral tem, na sua grande maioria das vezes, as suas crises e as alterações eletroencefalográficas interictais originando-se do lado da lesão. Mesmo alguns pacientes nos quais os registros de escalpo mostram as crises originando [...] -se da região temporal contralateral à atrofia do hipocampo, registros invasivos têm mostrado que a região de início das crises é, na realidade, ipsilateral à atrofia. No entanto isso talvez não seja verdadeiro para todos pacientes. OBJETIVO: Nesse artigo é relatado uma paciente com atrofia hipocampal unilateral, mas cujas crises, tanto no escalpo quando com registros subdurais, mostram vir da região temporal contralateral. RESULTADO: A paciente tem atrofia hipocampal à direita mas cujo EEG interictal mostrava predomínio de descargas à esquerda, bem como crises vindo daí. O registro com strips subdurais mostrou origem das crises à esquerda. CONCLUSÃO: Possivelmente alguns pacientes com epilepsia temporal têm as crises vindo do hipocampo menos atrófico. Abstract in english INTRODUCTION: Most patients with temporal lobe epilepsy and hippocampal sclerosis have the seizures and the interictal electroencephalographic abnormalities coming from the side of atrophic hippocampus. Even some patients on whom the seizures seem to arise from the contralateral temporal lobe, invas [...] ive recordings have shown that the seizures actually come from that atrophic side. But this may not be always the case. OBJECTIVE: We report a patient with a unilateral hippocampal atrophy and the seizures, seen both on the scalp as well with subdural strips, come from the contralateral temporal lobe. A patient with right hippocampal atrophy had most of the interictal discharges coming from the left temporal lobe, as well her seizures. Invasive recordings with subdural strips also showed seizures arising from the left temporal lobe. CONCLUSION: There might be some patients with temporal lobe epilepsy whose seizures come from the less.

  2. Hematoma retroperitoneal de causa infrecuente: A propósito de un caso / Retroperitoneal hematoma of unusual cause: A case report

    Scientific Electronic Library Online (English)

    Daniel, Álvarez G; Giancarlo, Schiappacasse F; Marcelo, Castro S; Jeannie, Slater M.

    Full Text Available El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. H [...] abitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt. Abstract in english 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 w [...] ith 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.

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

    Directory of Open Access Journals (Sweden)

    Daniel Álvarez G

    2012-01-01

    Full Text Available El hematoma retroperitoneal espontáneo (HRE se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló 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.

  4. Hematoma retrofaríngeo secundário a pequeno trauma contuso no pescoço: relato de caso / Retropharyngeal hematoma secondary to minor blunt neck trauma: case report / Hematoma retrofaríngeo secundario a un pequeño trauma contundente en el cuello: relato de caso

    Scientific Electronic Library Online (English)

    Ahmet Can, Senel; Abdul Kadir, Gunduz.

    2012-10-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O desenvolvimento de hematoma retrofaríngeo após trauma contuso é uma ocorrência rara. Porém, uma lesão ocupando espaço nessa área pode ser fatal, o que exige rápida avaliação e tratamento. Esse tipo de hematoma é clinicamente importante devido à proximidade entre o espaço [...] retrofaríngeo e a via aérea superior. Qualquer edema nesse espaço pode causar uma protuberância da parede posterior da faringe de encontro às vias aéreas e obstruí-las. RELATO DE CASO: Paciente do sexo feminino, 86 anos, que caiu de uma altura de 1,5 m e bateu o pescoço na escada, foi admitida em nosso Departamento de Traumatologia. Tomografia computadorizada e radiografia dos tecidos moles do pescoço foram feitas e mostraram uma grande massa retrofaríngea que se estendia da base do crânio até o nível dos pulmões. A paciente ficou em observação e o tamanho do hematoma diminuiu espontaneamente nos sete dias subsequentes; contudo, devido a uma infecção pulmonar, a paciente foi a óbito no décimo dia. Este relato enfatiza que a drenagem precoce do hematoma retrofaríngeo poderia ter sido considerada neste caso. Embora seja de ocorrência rara, o hematoma retrofaríngeo é um problema que pode ser encontrado em serviços de emergência. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El desarrollo del hematoma retrofaríngeo posterior al trauma contundente es un hecho raro. Sin embargo, una lesión que ocupa un espacio en esa área puede ser fatal, lo que exige una rápida evaluación y el tratamiento adecuado. Ese tipo de hematoma es clínicamente important [...] e debido a la cercanía entre el espacio retrofaríngeo y la vía aérea superior. Cualquier hinchazón en ese espacio puede causar una protuberancia de la pared posterior de la faringe contra las vías aéreas y obstruirlas. RELATO DE CASO: Paciente del sexo femenino, de 86 años, que se cayó de una altura de 1,5 m y se dio con la escalera en el cuello. Fue admitida en nuestro Departamento de Traumatología. Se realizaron la tomografía computadorizada y la radiografía de los tejidos suaves del cuello, lo que arrojó una gran masa retrofaríngea que se extendía desde la base del cráneo hasta el nivel de los pulmones. La paciente permaneció en observación y el tamaño del hematoma se redujo espontáneamente en los siete días posteriores; sin embargo, y debido a una infección pulmonar, la paciente falleció al décimo día. Ese relato nos muestra que el drenaje rápido del hematoma retrofaríngeo podría haber sido considerado en ese caso. Y aunque sea de una baja incidencia, el hematoma retrofaríngeo es un problema que puede ser encontrado en los servicios de emergencia. Abstract in english BACKGROUND AND OBJECTIVES: The development of a retropharyngeal hematoma following a blunt trauma is a rare occurrence. However, a spaceoccupying lesion in this area can be life-threatening and requires rapid assessment and treatment. This is clinically important because of the close proximity of th [...] e retropharyngeal space to the upper airway. Any swelling in the the posterior pharyngeal space may prompt it to bulge anteriorly into the airway and cause its obstruction. CASE REPORT: A 86-year-old woman fell from a height of 1.5 m and hit her neck on stairs and was admitted to our trauma department. A computerized tomography scan and a lateral neck x-ray to observe the soft tissue revealed a large retropharyngeal mass extending from the base of the skull down to the level of the lung. The patient was kept under observation and the hematoma reduced spontaneously in the following seven days although the patient died on the tenth day from pulmonary infection. The report emphasizes that early drainage of a retropharyngeal hematoma should be considered in similar cases. Although rarely encountered, retropharyngeal hematoma is a problem that can be faced in an emergency department.

  5. Hematoma perirrenal espontâneo em paciente lúpica submetida a tratamento hemodialítico e portadora cistos renais adquiridos / Spontaneous perirenal hematoma in a lupic patient on haemodialysis treatment and with renal cysts

    Scientific Electronic Library Online (English)

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

    2013-06-01

    Full Text Available A hemorragia perirrenal espontânea apresenta-se mais comumente como dor súbita no flanco ipsilateral, sem história de trauma. A doença renal cística adquirida é um achado frequente em pacientes sob tratamento hemodialítico crônico. Entretanto, a hemorragia espontânea proveniente da ruptura dos cisto [...] s é uma entidade clínica rara. Descrevemos o caso de uma paciente do sexo feminino, 45 anos, portadora de hipertensão arterial sistêmica controlada há 8 anos, de insuficiência renal crônica por 15 anos e de nefrite lúpica há 2 anos, em tratamento hemodialítico três vezes por semana desde 2006, e que apresentava concomitantemente doença renal cística adquirida. Foi admitida no setor de emergência queixando-se de aparecimento súbito de dor em região toracoabdominal esquerda. Diagnosticou-se hematoma perirrenal por meio de ultrassonografia e tomografia computadorizada de abdômen. A paciente foi submetida à embolização da artéria renal esquerda, com boa evolução. Abstract in english 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 t [...] he 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.

  6. Hematoma intracoronário como manifestação de dissecção espontânea de artéria coronária / Intracoronary hematoma as a manifestation of spontaneous coronary artery dissection

    Scientific Electronic Library Online (English)

    Felipe, Maia; César, Medeiros; Cláudia, Matos; Leonardo, Duarte; Jacqueline Sampaio dos, Santos; Denilsom C., Albuquerque; Miguel A. N., Rati.

    2013-03-01

    Full Text Available A dissecção espontânea de artéria coronária é um quadro de etiologia ainda não bem esclarecida. Diferentes estudos associam essa entidade a período gestacional, estresse físico, doenças do colágeno e vasculites. Em geral, os pacientes não apresentam os fatores de risco clássicos para doença arterial [...] coronária, o que torna obrigatória a suspeita dessa afecção, especialmente em adultos jovens com síndrome coronária aguda. Neste artigo relatamos o caso de paciente do sexo feminino, de 38 anos de idade, com síndrome coronária aguda sem supradesnivelamento do segmento ST e hematoma intracoronário sem dissecção aparente, diagnosticado pelo ultrassom intracoronário, em artéria coronária direita. Não existe, até o presente momento, consenso quanto à melhor forma de tratamento nesses casos. Abstract in english The etiology of spontaneous coronary artery dissection has not been well clarified. Different studies associate it to pregnancy, physical stress, collagen diseases and vasculitis. In general, patients do not have the classic risk factors for coronary artery disease, which makes mandatory the suspici [...] on of this condition, especially in young adults with acute coronary syndromes. We report the case of a 38-year-old female with non-ST segment elevation acute coronary syndrome and intracoronary hematoma with no apparent dissection, diagnosed by intravascular ultrasound, in the right coronary artery. There is no consensus so far on the best way to treat these cases.

  7. 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

  8. 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.

  9. Sinogenic Subdural Empyema in a Ten-Year-Old Boy with Sickle Cell Anemia

    Directory of Open Access Journals (Sweden)

    Ulf Nestler

    2013-10-01

    Full Text Available Objective: Sinogenic subdural empyema remains a neurosurgical emergency, even in the antibiotic era. Sickle cell disease is one of the most frequent hereditary diseases, with an incidence of around 4 in 1000 newborns, which necessitates special considerations before a neurosurgical intervention. Case Description: The case of a 10-year-old boy with sickle cell disease type HbSC is reported, who presented with meningitis about ten days after a nasal sinusitis. CT and MRI showed subdural empyema and immediate intravenous antibiotic treatment was started. The patient received partial exchange transfusion. Craniotomy allowed evacuation of empyema and repairment of a frontobasal dural defect. Endoscopic evacuation of the paranasal sinuses was done in the same anesthesia. After initial good recovery, the patient developed right sided paresis with epileptic seizures a few days later. CT scan revealed three distant empyema recurrencies which were evacuated in a second neurosurgical intervention. The child recovered without neurologic deficit, and control MRI examinations three and twelve months after surgery found frontal and parietal dural thickening as sequelae. Conclusion: Urgent neurosurgical interventions in the presence of sickle cell anemia require special anesthesiologic preparations. An immediate, multidisciplinary approach can lead to a good outcome in these life-threatening situations.

  10. Spontaneous splenic rupture with hematoma in a patient with brucellosis.

    Science.gov (United States)

    Demirdal, Tuna; Okur, Nazan; Demirturk, Nese

    2011-01-01

    Brucellosis is one of the most common zoonotic diseases worldwide with a variable frequency in European countries. Brucellosis is usually transmitted after direct contact with or consumption of dairy products from an infected animal. Initially, our patient, a 65 year-old man, had nonspecific manifestations of fever, malaise, headache, anorexia and arthralgia which are the classic symptoms of this disease. After the diagnosis of brucellosis had been confirmed by blood culture and serology, progressive thrombocytopenia developed in spite of appropriate antibiotic administration. Radiological investigation revealed imaging findings consistent with splenic rupture. The complete recovery was observed after administration of antibiotic therapy and platelet transfusion. Spontaneous rupture of the spleen with subcapsular hematoma is an extremely rare condition in brucellosis. We want to remind clinicians of this rare complication. PMID:22490460

  11. New Perspectives in the Management of Aortic Intramural Hematoma – a literature review

    Directory of Open Access Journals (Sweden)

    Pal Kinga

    2014-08-01

    Full Text Available Aortic intramural hematoma frequently appear in elderly hypertensive patients who suffered a vasa vasorum rupture into the media, presenting clinical symptoms similar to aortic dissection. The current available data suggest a similar treatment strategy as in aortic dissection, although intramural hematoma is a different pathophysiological entity. The issue of the vulnerable contact of the intraaortic plaque, which is prone to rupture and to trigger the formation of an intramural hematoma, has not been elucidated so far. We present a brief literature review regarding complex plaque analysis, which opens a new area in identification of vulnerable patients with intramural hematoma, important for management of these patients and optimization of their treatment in order to avoid complications.

  12. Antiplatelet pretreatment does not increase hematoma volume in experimental intracerebral hemorrhage

    OpenAIRE

    Lauer, Arne; Schlunk, Frieder; Cott, Elizabeth M.; Steinmetz, Helmuth; Lo, Eng H.; Foerch, Christian

    2011-01-01

    While oral anticoagulants are associated with greater hematoma expansion and higher mortality rates in patients with intracerebral hemorrhage (ICH), there is ongoing discussion whether pretreatment with antiplatelet drugs also worsens prognosis. Using an experimental model of ICH, we investigated the effects of antiplatelet pretreatment on hematoma volume and functional outcome. CD-1 mice were treated with acetyl-salicylic acid (ASA, 60?mg/kg per 24?hours), clopidogrel (22.5?mg/kg per 2...

  13. Comando volumen de la tomografía axial computadorizada para el pronóstico y tratamiento del hematoma intracraneal postraumático

    Scientific Electronic Library Online (English)

    Tanía, García Moreira; Paula, Rosales Silva; Abel, Andión Arrazola; René, Rodríguez Rivera; Eduardo, Bory Lescaille; Ferriol, Pérez Benítez.

    2001-03-01

    Full Text Available Se estudiaron 35 pacientes con hematomas intracraneales postraumáticos desde abril de 1995 a febrero de 1997, que fueron diagnosticados por tomografía axial computadorizada (TAC) y a los cuales se le calculó por software con el comando volumen, el volumen de los hematomas. Se comparó el resultado co [...] n el volumen medio en el acto quirúrgico, no hubo diferencia estadística. Se analizaron otras variables como: la situación topográfica, localización, desplazamiento de las estructuras de la línea media, estado neurológico del paciente y la técnica quirúrgica utilizada. Se demostró que a mayor volumen del hematoma, el deterioro neurológico fue mayor, así como la mortalidad. Se vio esta relación más marcada en los procesos agudos (48,6 %). La craneotomía demostró ser de más valor que la trepanación simple. Se concluye que el comando volumen de la TAC es un procedimiento de gran confiabilidad en la valoración neurorradiológica, terapéutica y pronóstica de los hematomas intracraneales postraumáticos. Abstract in english 35 patients with posttraumatic intracranial hematomas were studied from April, 1995, to February, 1997. These patients were diagnosed by computed axial tomography (CAT) and the volumen of the hematomas was calculated by software with the volume command. The result was compared with the average volum [...] e during surgery and no statistical difference was observed. Some other variables as the topographic situation, localization, displacement of the structures of the mean line, the neurological status of the patient and the surgical technique used, were analyzed. It was proved that the larger the hematoma volume was the higher the neurological deterioration and mortality were. This relationship was more significant in the acute processes (48.6 %). Craniotomy proved to have more value than simple trepanation. It was concluded that the volume command of the computed axial tomography is a very reliable procedure in the neuroradiological, therapeutic and prognostic assessment of posttraumatic intracranial hematomas.

  14. Epidural blood patch placed in the presence of an unknown cervical epidural hematoma.

    Science.gov (United States)

    Castillo, Daniel; Tsen, Lawrence C

    2003-09-01

    We discuss a case detailing a favorable outcome of an epidural blood patch performed in the presence of an unknown cervical epidural hematoma. The case highlights the use of a spinal needle for epidural space confirmation, the importance of waiting for final consultation and radiologic testing results before therapeutic intervention when possible, and the use of an epidural blood patch, even in the setting of a known epidural hematoma. PMID:12933422

  15. Hepatic hematoma in a neonate with a high level of alpha-fetoprotein.

    Science.gov (United States)

    Costa, Simonetta; De Carolis, Maria Pia; Savarese, Immacolata; Lacerenza, Serafina; Romagnoli, Costantino

    2008-05-01

    Hepatic hematomas in neonates are uncommon lesions. When they are large or subcapsular in location, they can rupture with clinical signs of hemoperitoneum. We report a case of subcapsular hepatic hematoma (SHH) associated with a high level of alpha-fetoprotein (AFP), for which diagnosis was made with conservative management, following up with the reduction in size at ultrasound examination and the reduction of the level of AFP. PMID:17541634

  16. Subcapsular hepatic hematoma with right hepatic vein thrombosis: a complication of shock wave lithotripsy

    OpenAIRE

    Gordetsky, Jennifer; Hislop, Sean; Orloff, Mark; Butler, Melanie; Erturk, Erdal

    2008-01-01

    Extracorporeal shock wave lithotripsy (ESWL) is a well-established, safe and effective therapeutic modality for surgical treatment of urolithiasis. Hematoma is a rare complication of ESWL and, when it occurs, typically involves the kidney. We report the case of a 71-year-old woman who developed severe, persistent abdominal pain after ESWL for a 9-mm stone at the ureteropelvic junction. Post-treatment CT scan demonstrated a 13 × 6–cm subcapsular hepatic hematoma. A follow-up CT scan showed ...

  17. Subperiosteal Hematoma of orbit an interesting case report and review of literature

    OpenAIRE

    Balasubramanian Thiagarajan

    2014-01-01

    Subperiosteal Hematoma orbit is an uncommon disorder which may occur following injury to orbit. Ofcourse there are other causes that cause this condition as well. This condition has been reported in young adults. This case report discusses a patient who developed subperiosteal hematoma following trivial injury to orbit. Since this condition had occurred following trivial injury to orbit diagnosis was not made pre operatively. It was discovered only on the table. A high index of suspi...

  18. Post-traumatic Lumbar Epidural Hematoma with Neurology: Report of 1 Case

    OpenAIRE

    Cha, Jae-ryong; Park, Ki-bong; Ko, Sang-hun

    2011-01-01

    The purpose of this study was to report a case with post-traumatic spinal epidural hematomas with abnormal neurologic findings, which is uncommon. A 40-year-old man presented at our clinic after a blunt trauma caused by a traffic accident in which he was a pedestrian. After admission, abnormal neurologic symptoms developed including loss of sensation and motor function in his left lower extremity. Magnetic resonance imaging demonstrated a spinal epidural hematoma with 40% canal stenosis at th...

  19. Spontaneous perforation of an intramural rectal hematoma: Report of a case

    Directory of Open Access Journals (Sweden)

    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.

  20. Hematomas cerebelosos: Descripción de una cohorte y pronóstico en función de la actitud terapéutica Cerebellar hematomas: Description of one cohort and prognosis based on therapeutic attitude

    Directory of Open Access Journals (Sweden)

    B. Virgós-Señor

    2006-02-01

    Full Text Available OBJETIVOS. Los hematomas cerebelosos espontáneos (HC representan un 5%-10% de las hemorragias intracraneales. Describimos los factores de riesgo cardiovascular existentes, la presentación clínica de los HC y su relación con la mortalidad, así como la asociación entre el tipo de tratamiento (médico conservador o neuroquirúrgico y la evolución posterior de los enfermos. DISEÑO Y ÁMBITO. Estudio observacional de los pacientes diagnosticados de HC ingresados durante tres años en una Unidad de Cuidados Intensivos de un Hospital de nivel III. PACIENTES. Cincuenta y seis enfermos consecutivos diagnosticados de HC. VARIABLES DE INTERÉS PRINCIPALES. Estudiamos los factores de riesgo cardiovascular, la forma de presentación (con el Glasgow Coma Score [GCS], el tamaño y localización del hematoma y la morbimortalidad de los pacientes (con la Glasgow Outcome Scale [GOS]. RESULTADOS. Se emplean la prueba exacta de Fisher, Chi cuadrado, el cálculo del coeficiente de Spearman entre determinadas variables y análisis de regresión logística. Obtuvieron significación estadística el tamaño del hematoma, el GCS al ingreso y la presencia de hidrocefalia. El tratamiento médico conservador conlleva mayor mortalidad. CONCLUSIONES. Los pacientes con GCS ? 8 y tamaño de hematoma ? 3 cm se benefician de tratamiento quirúrgico. Son factores predictores de mortalidad el GCS inicial y la localización vermiana. No hay más morbilidad por el tratamiento quirúrgico.OBJETIVES. Spontaneous cerebellar hematomas (CH represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical treatment and the subsequent course of the patients. DESIGN AND SCOPE. Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. PATIENTS. Fifty-six consecutive patients diagnosed of CH. VARIABLES OF PRINCIPAL INTEREST. We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS, hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale - GOS. RESULTS. Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. CONCLUSIONS. Patients with GCS ? 8 and hematoma size ? 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment.

  1. Hematomas cerebelosos: Descripción de una cohorte y pronóstico en función de la actitud terapéutica / Cerebellar hematomas: Description of one cohort and prognosis based on therapeutic attitude

    Scientific Electronic Library Online (English)

    B., Virgós-Señor; A.C., Nebra-Puertas; J., Villagrasa-Compaired; J., Van Popta.

    2006-02-01

    Full Text Available OBJETIVOS. Los hematomas cerebelosos espontáneos (HC) representan un 5%-10% de las hemorragias intracraneales. Describimos los factores de riesgo cardiovascular existentes, la presentación clínica de los HC y su relación con la mortalidad, así como la asociación entre el tipo de tratamiento (médico [...] conservador o neuroquirúrgico) y la evolución posterior de los enfermos. DISEÑO Y ÁMBITO. Estudio observacional de los pacientes diagnosticados de HC ingresados durante tres años en una Unidad de Cuidados Intensivos de un Hospital de nivel III. PACIENTES. Cincuenta y seis enfermos consecutivos diagnosticados de HC. VARIABLES DE INTERÉS PRINCIPALES. Estudiamos los factores de riesgo cardiovascular, la forma de presentación (con el Glasgow Coma Score [GCS]), el tamaño y localización del hematoma y la morbimortalidad de los pacientes (con la Glasgow Outcome Scale [GOS]). RESULTADOS. Se emplean la prueba exacta de Fisher, Chi cuadrado, el cálculo del coeficiente de Spearman entre determinadas variables y análisis de regresión logística. Obtuvieron significación estadística el tamaño del hematoma, el GCS al ingreso y la presencia de hidrocefalia. El tratamiento médico conservador conlleva mayor mortalidad. CONCLUSIONES. Los pacientes con GCS ? 8 y tamaño de hematoma ? 3 cm se benefician de tratamiento quirúrgico. Son factores predictores de mortalidad el GCS inicial y la localización vermiana. No hay más morbilidad por el tratamiento quirúrgico. Abstract in english OBJETIVES. Spontaneous cerebellar hematomas (CH) represent 5%-10% of intracranial hemorrhaging. We describe the existing cardiovascular risk factors, clinical presentation of CH and its relationship with mortality and the association between the treatment type (conservative medical or neurosurgical [...] treatment) and the subsequent course of the patients. DESIGN AND SCOPE. Observational study of patients diagnosed of CH admitted over three years in an Intensive Care Unit of a level III Hospital. PATIENTS. Fifty-six consecutive patients diagnosed of CH. VARIABLES OF PRINCIPAL INTEREST. We studied the cardiovascular risk factors, presentation form (with Glasgow Coma Scale- GCS), hematoma size and site, and morbidity-mortality of the patients (with the Glasgow Outcome Scale - GOS). RESULTS. Fisher's exact test, Chi squared, calculation of Spearman's coefficient between certain variables and logistic regression analysis were used. Hematoma size, GCS on admission and presence of hydrocephaly obtained statistical significance. Conservative medical treatment has greater mortality. CONCLUSIONS. Patients with GCS ? 8 and hematoma size ? 3 cm benefit from surgical treatment. Initial GCS and vermian site are mortality predictor factors. There is no more morbidity due to surgical treatment.

  2. Rede hemostática: uma alternativa para a prevenção de hematoma em ritidoplastia / Hemostatic net: an alternative for the prevention of hematoma in rhytidoplasty

    Scientific Electronic Library Online (English)

    André, Auersvald; Luiz Augusto, Auersvald; Maria de Lourdes Pessole, Biondo-Simões.

    2012-03-01

    Full Text Available INTRODUÇÃO: Hematoma é a complicação pós-operatória mais frequente em ritidoplastia. Sua ocorrência aumenta a morbidade e prejudica a recuperação. Pontos de adesão internos para fechamento das áreas descoladas em abdominoplastias evitam o surgimento de seroma. Baseados neste princípio, e com o objet [...] ivo de reduzir o número de pacientes com hematomas em ritidoplastia, foi desenvolvida tática cirúrgica análoga em que se confecciona uma rede hemostática de pontos contínuos e transfixantes de náilon 4-0, englobando a pele e o SMAS-platisma. MÉTODO: Foram incluídos no estudo 366 pacientes consecutivos, submetidos a ritidoplastia de pelo menos o terço médio da face, entre julho de 2009 e setembro de 2011. O grupo A, incluindo os primeiros 120 pacientes avaliados retrospectivamente, foi considerado controle. O grupo B foi constituído pelos demais 246 pacientes, operados com a tática cirúrgica proposta e avaliados prospectivamente. Observaram-se as incidências de hematoma, isquemia e necrose nas primeiras 72 horas de pós-operatório. RESULTADOS: No grupo A, 17 (14,2%) pacientes apresentaram hematoma, enquanto no grupo B não houve nenhum caso. A tática cirúrgica não aumentou significativamente a ocorrência de isquemia: 11 (9,2%) pacientes no grupo A e 16 (6,5%) no grupo B tiveram essa complicação (P Abstract in english BACKGROUND: Hematoma is the most common postoperative complication of rhytidoplasty. Its occurrence increases morbidity and impairs recovery. Internal sutures to close detached areas are used in abdominoplasty to prevent seromas. Taking this into account and in order to reduce the number of patients [...] with hematomas post rhytidoplasty, we have developed a similar surgical procedure in which a hemostatic net is made of continuous nylon 4-0 transfixing stitches to include the skin and the superficial musculoaponeurotic system-platysma. METHODS: A total of 366 patients who underwent rhytidoplasty of at least the middle third of the face between July 2009 and September 2011 were included in the study. Group A was identified as the control group; it included the first 120 patients assessed retrospectively. The remaining 246 patients, who underwent the surgical procedure here proposed and who were evaluated prospectively formed group B. We observed the incidence of hematoma, ischemia, and necrosis in the first 72 postoperative hours. RESULTS: In group A, 17 (14.2%) patients developed hematomas, whereas none occurred in group B. The surgical procedure did not significantly increase the occurrence of ischemia: 11 (9.2%) patients in group A and 16 (6.5%) in group B had this complication (P

  3. Cervical epidural haematoma with clivus fracture: case report Hematoma cervical epidural com fratura de clivus: relato de caso

    Directory of Open Access Journals (Sweden)

    Paulo Mácio Porto de Melo

    2003-06-01

    Full Text Available Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, although the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic, whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.As fraturas de clivus são entidades raras e graves, usualmente associadas a lesões vasculares ou de nervos cranianos, sendo freqüentemente diagnosticadas postmortem. Hematomas epidurais cervicais podem ser traumáticos ou espontâneos, manifestos de forma aguda ou crônica, requerendo tratamento cirúrgico na maior parte das vezes, embora o tratamento conservador possa ser indicado a pacientes com déficits incompletos ou não progressivos. Os autores relatam o caso de uma paciente do sexo feminino, 8 anos, vítima de atropelamento em via pública por veículo automotor em alta velocidade, que foi admitida em glasgow 7, com anisocoria (pupila esquerda midriática. A investigação radiológica evidenciou fratura transversa de clivus, hematoma epidural cervical e lesão axonal difusa. A paciente foi submetida a monitorização da pressão intracraniana, sedação e tratamento conservador com corticoesteróides, com boa evolução. Os autores apresentam também uma revisão da literatura pertinente.

  4. Cervical epidural haematoma with clivus fracture: case report / Hematoma cervical epidural com fratura de clivus: relato de caso

    Scientific Electronic Library Online (English)

    Paulo Mácio Porto de, Melo; Paulo Abdo do Seixo, Kadri; Jean Gonçalves de, Oliveira; Ítalo Capraro, Suriano; Sergio, Cavalheiro; Fernando Menezes, Braga.

    2003-06-01

    Full Text Available As fraturas de clivus são entidades raras e graves, usualmente associadas a lesões vasculares ou de nervos cranianos, sendo freqüentemente diagnosticadas postmortem. Hematomas epidurais cervicais podem ser traumáticos ou espontâneos, manifestos de forma aguda ou crônica, requerendo tratamento cirúrg [...] ico na maior parte das vezes, embora o tratamento conservador possa ser indicado a pacientes com déficits incompletos ou não progressivos. Os autores relatam o caso de uma paciente do sexo feminino, 8 anos, vítima de atropelamento em via pública por veículo automotor em alta velocidade, que foi admitida em glasgow 7, com anisocoria (pupila esquerda midriática). A investigação radiológica evidenciou fratura transversa de clivus, hematoma epidural cervical e lesão axonal difusa. A paciente foi submetida a monitorização da pressão intracraniana, sedação e tratamento conservador com corticoesteróides, com boa evolução. Os autores apresentam também uma revisão da literatura pertinente. Abstract in english Clivus fractures are rare and severe entities, usually associated with vascular or cranial nerve lesions and frequently diagnosed postmortem. Cervical epidural haematomas can be traumatic or spontaneous, manifested in acute or chronic form, and are treated surgically in the majority of cases, althou [...] gh the conservative treatment also can be indicated to patients with incomplete and non-progressive deficits. The authors report the case of a female patient, 8 years old, victim of trampling in public way by a high velocity motorized vehicle, admitted in Glasgow 7, anisocoric pupils (left pupil midriatic), whose radiological investigation showed a transverse fracture of the clivus, cervical epidural haematoma and diffuse axonal injury. The patient was submitted to intracranial pressure monitorization, sedation and conservative treatment with dexamethasone, with good outcome. The authors also present a literature review.

  5. Subdural Empyema as a Result of Silent Otitis Media: Case Report

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    Mehmet Somda?

    2013-03-01

    Full Text Available Silent otitis media is a progressive otogenic disease. This subclinical infectious disease affects the mucosal layers and bony structures of mastoid cells despite intact tympanic membranes. Although there is a significant decrease present in the incidence of the classical mastoiditis in the postantibiotic era, silent mastoiditis which develops as a result of insufficient or inefficient antibiotherapy for otitis media is still a life threatening entity. In this article, a patient with epidural and subdural empyema due to silent mastoiditis is presented. The patient underwent mastoidectomy. After mastoidectomy, the patient is disease free and under control. The aim of the article is to alert the physician about silent otitis media which might easily be misdiagnosed.

  6. Polymicrobial subdural empyema : involvement of Streptococcus pneumoniae revealed by lytA PCR and antigen detection

    DEFF Research Database (Denmark)

    Greve, Thomas; Clemmensen, Dorte

    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 were consistent with classical SDE symptoms and progressed rapidly with finally somnolence before the first neurosurgical procedure despite relevant antibiotic treatment. Primary MRI showed an interhemispheric SDE and a postoperative control CT scan showed progression of the empyema infratentorially. 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 test.

  7. Polymicrobial subdural empyema: involvement of Streptococcus pneumoniae revealed by lytA PCR and antigen detection

    DEFF Research Database (Denmark)

    Greve, Thomas; Clemmensen, Dorte

    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 were consistent with classical SDE symptoms and progressed rapidly with finally somnolence before the first neurosurgical procedure despite relevant antibiotic treatment. Primary MRI showed an interhemispheric SDE and a postoperative control CT scan showed progression of the empyema infratentorially. 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 test.

  8. Spatial memory in nonhuman primates implanted with the subdural pharmacotherapy device.

    Science.gov (United States)

    Ludvig, Nandor; Tang, Hai M; Baptiste, Shirn L; Stefanov, Dimitre G; Kral, John G

    2015-06-01

    This study investigated the possible influence of the Subdural Pharmacotherapy Device (SPD) on spatial memory in 3 adult, male bonnet macaques (Macaca radiata). The device was implanted in and above the subdural/subarachnoid space and cranium overlaying the right parietal/frontal cortex: a circuitry involved in spatial memory processing. A large test chamber, equipped with four baited and four non-baited food-ports at different locations, was used: reaches into empty food ports were counted as spatial memory errors. In this study of within-subject design, before SPD implantation (control) the animals made mean 373.3±114.9 (mean±SEM) errors in the first spatial memory test session. This value dropped to 47.7±18.4 by the 8th session. After SPD implantation and alternating cycles of transmeningeal saline delivery and local cerebrospinal fluid (CSF) drainage in the implanted cortex the spatial memory error count, with the same port locations, was 33.0±12.2 during the first spatial memory test session, further decreasing to 5.7±3.5 by the 8th post-implantation session (P<0.001 for trend). Replacing transmeningeal saline delivery with similar delivery of the GABAA receptor agonist muscimol (1.0mM) by the SPD did not affect the animals' spatial memory performance, which in fact included at least one completely error-free session per animal over time. The study showed that complication-free implantation and use of the SPD over the parietal and frontal cortices for months leave spatial memory processes intact in nonhuman primates. PMID:25771710

  9. Hematoma epidural com paraplegia flácida: complicação de pós-operatório imediato

    Scientific Electronic Library Online (English)

    Rui, Rocha; André, Sarmento; André, Costa; Andreia, Ferreira; Maia, Gonçalves; Rolando, Freitas.

    2014-03-01

    Full Text Available Objetivo: os autores pretendem partilhar a experiência desta complicação cirúrgica major, com o cuidado de realizar uma revisão bibliográfica sumária sobre o tema abordando referências na literatura sobre a incidência e os fatores de risco inerentes a esta patologia. Descrição: apresenta-se um caso [...] clínico, com o devido enquadramento bibliográfico, de um doente do sexo masculino com 70 anos de idade e neoplasia prostática submetido a laminectomia de L2 com artrodese L1-L3 postero-lateral instrumentada por claudicação neurogénea devido a metástase de L2. No pós-operatório imediato instalou-se um quadro de défice neurológico progressivo com paraplegia flácida e necessidade de reintervenção para drenagem de hematoma epidural confirmado por Ressonância Magnética. O doente recuperou neurologicamente após a drenagem do hematoma tendo retomado as suas atividades de vida diária. Comentários: a maioria dos hematomas epidurais pós-operatórios em cirurgia da patologia raquidiana são assintomáticos. A necessidade de drenagem cirúrgica resume-se a 0,1 a 3% dos hematomas diagnosticados, sendo emergente após o início dos défices neurológicos. É necessário ter em atenção os fatores de risco para o desenvolvimento de hematoma epidural sintomático no pós-operatório imediato para antever a sua possibilidade. Abstract in english Objective: The authors want to share the experience of this major surgical complication, and conduct a brief review on the topic addressing references in the literature on the incidence and risk factors associated with this disease. Description: The authors present as clinical case a male patient ag [...] ed 70 years old with prostate cancer who underwent laminectomy of L2 and postero-lateral instrumented fusion of L1-L3 due to neurogenic claudication from L2 metastasis. In the immediate postoperative settled a progressive neurologic deficit with flaccid paraplegia and need for reoperation for drainage of epidural hematoma confirmed by MRI. The patient recovered neurologically after draining the hematoma having resumed their daily activities. Comments: Most epidural hematomas in postoperative pathology of spinal surgery are asymptomatic. The need for surgical drainage boils down to 0.1 to 3% of the hematomas diagnosed, being emergent after the onset of neurological deficits. Physicians must be aware of the risk factors for the development of symptomatic epidural hematoma in the immediate postoperative period to forecast its possibility.

  10. Subcapsular renal hematoma after ureteroscopy with holmium:yttrium-aluminum-garnet laser lithotripsy.

    Science.gov (United States)

    Tao, Wei; Cai, Chun Jie; Sun, Chuan Yang; Xue, Bo Xin; Shan, Yu Xi

    2015-07-01

    Subcapsular renal hematoma (SRH) after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser to treat ureteric stones is a rare complication. We aimed to review our unit's experience of post-URSL subcapsular renal hematoma. From 2006 to 2012, 2059 URSLs using F9.5 rigid ureteroscope were performed in our unit. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' renal function, stone characteristics, and degree of renal hydronephrosis were reviewed. Operative data, postoperative information such as clinical manifestation, changes in blood parameters, CT findings, and subsequent treatment were documented. Of the 2059 patients treated with URSL and Ho:YAG laser, three patients were diagnosed as subcapsular renal hematoma after surgery; the age is 57, 61, and 63 years old, respectively. Preoperative imaging examination showed that two patients and one patient had obstructing middle and proximal ureteral stones ranging in size from 0.8 to 1.6 cm, and three patients had thin renal cortices. The double-J ureteral stents were inserted in all cases regularly. All three subcapsular renal hematoma patients had the loin pain of the operation side and fever, and one patient had significant hemoglobin drop (from 111 to 61 g/L) who need to transfusion. Two patients presented within 24 h of URSL, and one patient presented on day 10. One patient was treated conservatively for 3 weeks and recovered with bed rest, antibiotics, hemostasis, and analgesia with no intervention or drain. The other two patients underwent ultrasonography-guided drainage of the hematoma. Two-month follow-up CT scans or ultrasonography confirmed the resolution of the hematoma in all three cases. Renal subcapsular hematoma after URSL is a rare and one of serious complications. Subcapsular renal hematoma should be considered when patients have the symptoms of significant loin pain after URSL for obstructing ureteral stones with thin renal cortices. The treatment of post-URSL renal subcapsular hematomas needs to be customized for each patient. PMID:25943289

  11. Warfarin Induced Iliopsoas Hematoma Detected by Bedside Emergency Ultrasonography

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    F?rat Bekta?

    2012-01-01

    Full Text Available Warfarin is frequently used as an oral anticoagulant in a variety of clinical settings, e.g. atrial fibrillation or following valvular heart disease. The most serious and common complication associated with anticoagulation using warfarin is bleeding. Hemorrhage into the iliopsoas muscle causing femoral neuropathy is an infrequent complication of anticoagulant therapy. Two women, 53 and 70 year-old, each with a history of mitral valve replacement surgery, presented at the emergency department with right hip pain. They had been taking warfarin 5 mg once a day since their operations. Physical examinations were normal except for the right hip pain,on movement and femoral nerve palsy in the second patient. Prothrombin, activated prothrombin time and international normalized ratio were prolonged. In order to make the differential diagnosis, we decided to perform bedside emergency ultrasound examination. Ultrasound examination of the patients showed an anechoic lesion in the area of the right iliopsoas muscle. They were admitted to hospital for observation and treatment. Fresh frozen plasma and vitamin K were given for treatment. The possibility of iliopsoas hematoma should be considered in any patient with hip pain undergoing anticoagulant treatment.

  12. CLINICAL MANIFESTATIONS OF TRAUMATIC INTRACRANIAL HEMATOMAS WITH DIFFERENT OUTCOMES

    Directory of Open Access Journals (Sweden)

    G. V. Anisimov

    2014-07-01

    Full Text Available Aim – clarification of the clinical progression nature of traumatic intracranial hematoma.Materials and methods. A comparative evaluation of neurological status, vegetative tone, level of stress (SL, and consciousness in 42 menwith different outcomes on neuroreanimation stage.Results. It is shown that in the group of survivors by raise of the level of consciousness focal neurological symptoms come to the fore, revealed on the 10th day in 78.4 % of patients. In the case of lethal outcome to 7–9th day from decompensation and reduce consciousness to atonic stem symptoms prevailed coma at almost all patients. SL and Kerdo index proved to be reliable outcome indicators of acute period of severe traumatic brain injury (TBI. Thus, the preservation of SL and sympathic to the maximum levels for > 5 days served as a poor prognostic sign.Conclusion. In addition to the assessment of consciousness and neurological status in the most acute period of TBI a comprehensive study of laboratory indicators of stress reactions should be included in the diagnostic algorithm which will allow to determine compensatory mechanisms status, to predict their changes and the deterioration of the patient.

  13. Scrotal hematoma as a sign of adrenal hemorrhage in newborns / Hematoma escrotal como um sinal de hemorragia da adrenal no recém-nascido

    Scientific Electronic Library Online (English)

    Renata, Gonçalves; Allan, Abuabara; Rubia Fatima Fuzza, Abuabara; Claudia Aparecida, Feron.

    2011-03-01

    Full Text Available CONTEXTO: Edema e coloração azulada do escroto do recém-nascido podem sugerir uma série de doenças, incluindo torção dos testículos, orquite, edema escrotal e testicular, hidrocele, hérnia inguinal, peritonite meconial, hematocele, tumor testicular e hematoma traumático. Quarenta e dois casos de alt [...] erações escrotais como sinal de hemorragia da glândula adrenal foram encontrados na literatura. RELATO DE CASO: Apresentamos um caso de hematoma escrotal devido a hemorragia da glândula adrenal em um recém-nascido. O tratamento adotado foi conservador, com acompanhamento clínico, com resolução completa em 10 dias. Os possíveis diagnósticos diferenciais são revisados e discutidos. Abstract in english CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of [...] scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

  14. 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

    Scientific Electronic Library Online (English)

    Fernando Campos Gomes, Pinto; Fabrizio Frutos, Porro; Liliana, Suganuma; Ricardo Bragança de Vasconcellos, Fontes; Almir Ferreira de, Andrade; Raul, Marino Jr.

    2003-12-01

    Full Text Available 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 d [...] e 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. Abstract in english 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 develop [...] ed 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.

  15. 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

    Directory of Open Access Journals (Sweden)

    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.

  16. 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.

  17. 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

    Scientific Electronic Library Online (English)

    Ericson, Sfreddo; Marcelo Teodoro Ezequiel, Guerra.

    Full Text Available 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 s [...] úbita 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. Abstract in spanish 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 repent [...] ino 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. Abstract in english 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 cau [...] da 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.

  18. 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 bres cannot be surgical, as far as severe brain edema does not appeared. (author)

  19. CT and MR imaging findings of subdural dermoid cyst extending into right foramen ovale: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Jeong, You Cheol; Park, Cheol Min; Lee, Si Kyeong [Seoul Medical Center, Seoul (Korea, Republic of)

    2006-12-15

    Intracranial dermoid cyst is a rare congenital benign disease, representing less than 0.5% of primary brain tumors. Nevertheless, if ruptured spontaneously or during surgery, it has a poor prognosis due to chemical meningitis. Therefore, it is essential to perform accurate diagnosis and proper treatment. We report an intracranial subdural dermoid cyst that may be misdiagnosed as extracranial or epidural lesion because of extension into the right foramen ovale, and describe the CT and MR imaging findings.

  20. Computed tomography angiography based emergency microsurgery for massive intracranial hematoma arising from arteriovenous malformations

    Directory of Open Access Journals (Sweden)

    Tan Xian-Xi

    2011-01-01

    Full Text Available Background : Digital subtraction angiography (DSA and magnetic resonance angiography are the imaging modalities for the detection of intracranial arteriovenous malformations. However, these modalities are time consuming and cannot be used in emergency conditions. Computed tomography angiography (CTA has also been shown to reliably detect vascular disorders such as cerebral arteriovenous malformations (AVMs. Aims : The purpose of this study was to evaluate the usefulness CTA in the surgical treatment of AVMs and the hematoma evacuation. Patients and Methods : Case records of 18 patients with massive intracranial hematoma secondary to AVMs were retrospectively reviewed. All patients had emergent brain CT and CTA. Follow-up DSA was performed two to three weeks after surgery. The outcome was assessed using Glasgow Outcome Scale (GOS. Results : Emergent CTA demonstrated AVMs and defined the feeding arteries, abnormal vascular nest, and draining veins in all the patients. Fourteen patients underwent hematoma evacuation and total resection of the AVMs, and four patients had hematoma evacuation and a partial resection. Follow-up DSA demonstrated complete resection of AVM in 14/18 patients and partial resection in 4 patients. There were no deaths and none of the patients had rebleeding in the follow up. A GOS scores during follow-up were: GOS 3 in 12 patients, GOS 4 in 4 patients and GOS 2 in 2 patients. Conclusions : CTA can be a reliable and rapid diagnostic tool for detecting underlying AVM in patients presenting with intracranial hematoma and for the pretreatment planning of emergency craniotomy.

  1. 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)

  2. Delayed spinal extradural hematoma following thoracic spine surgery and resulting in paraplegia: a case report

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    Parthiban Chandra JKB

    2008-05-01

    Full Text Available Abstract Introduction Postoperative spinal extradural hematomas are rare. Most of the cases that have been reported occured within 3 days of surgery. Their occurrence in a delayed form, that is, more than 72 hours after surgery, is very rare. This case is being reported to enhance awareness of delayed postoperative spinal extradural hematomas. Case presentation We report a case of acute onset dorsal spinal extradural hematoma from a paraspinal muscular arterial bleed, producing paraplegia 72 hours following surgery for excision of a spinal cord tumor at T8 level. The triggering mechanism was an episode of violent twisting movement by the patient. Fresh blood in the postoperative drain tube provided suspicion of this complication. Emergency evacuation of the clot helped in regaining normal motor and sensory function. The need to avoid straining of the paraspinal muscles in the postoperative period is emphasized. Conclusion Most cases of postoperative spinal extradural hematomas occur as a result of venous bleeding. However, an arterial source of bleeding from paraspinal muscular branches causing extradural hematoma and subsequent neurological deficit is underreported. Undue straining of paraspinal muscles in the postoperative period after major spinal surgery should be avoided for at least a few days.

  3. 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 dadiologic diagnostic procedures for fast diagnosis of a retroperitoneal hematoma, abdominal CT-scan is the preferred method

  4. Lateral abdominal wall hematoma as a rare complication after carotid artery stenting: a case report

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    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.

  5. On the pathogenesis of traumatic intracerebral hematoma with a sequential study of computerized tomography

    International Nuclear Information System (INIS)

    A sequential study with computerized tomography (CT scan) of two cases of traumatic intracerebral hematoma is reported. Case 1 was a 69-year-old man who had a head injury. The initial CT scan, taken 1 hour after his injury, showed a left temporal salt-and-pepper appearance, which proved to be a cerebral contusion. The CT scan 4.5 hours after his injury showed a left temporal high density area instead. An operation was performed, and a massive intracerebral hematoma was observed. Case 2 was a 61-year-old man who was also admitted because of a head injury. The initial CT scan, taken 1 hour after his injury, revealed several bifrontal intracerebral hemorrhagic spots in the low-density areas, suggesting contusion. A secondary CT scan (23 hours) demonstrated that the traumatic intracerebral hematoma had developed into a posttraumatic cerebral contusion. The operation disclosed a hematoma surrounded by contusion. These cases prove that traumatic intracerebral hematoma is often caused by cerebral contusion. (author)

  6. Management and neurological outcome of spontaneous spinal epidural hematoma.

    Science.gov (United States)

    Dziedzic, Tomasz; Kunert, Przemys?aw; Krych, Piotr; Marchel, Andrzej

    2015-04-01

    This study assesses the etiology, clinical management, and outcome of patients with spontaneous spinal epidural hematoma (SSEH). SSEH is an uncommon neurosurgical emergency. We analyzed data from 10 patients (six women, four men) treated for SSEH (mean age, 63.5 years). Five patients had bleeding disorders due to anticoagulant therapy at the time of diagnosis. The initial clinical symptom in most patients was severe pain (n=8). Spinal injury was assessed using the American Spinal Injury Association (ASIA) scale, with six Grade A, one Grade C, and three Grade D patients. Lesions were in the cervicothoracic (n=4), thoracic (n=5), and thoracolumbar regions (n=1). Location was dorsal in seven patients and ventral in three. SSEH extension ranged from three to 15 spinal levels (mean, 6.9 levels). ASIA scale outcomes for the entire group were Grade A, n=2; Grade B, n=1; Grade C, n=1; Grade D, n=2; and Grade E, n=4. Outcomes for patients with no bleeding disorders (n=5) were Grade D, n=1; and Grade E, n=4. Outcomes for patients with bleeding disorders (n=5) were Grade A, n=2; Grade B, n=1; Grade C, n=1; and Grade D, n=1. After surgical treatment, patients improved by at least by one ASIA grade. The patients with mild neurological deficit who were treated conservatively also improved. Emergent spinal cord decompression is the only way to preserve spinal cord function in patients with severe deficit. Coagulation disorders were related to poor neurological status at admission and with poor neurological outcome. Conservative treatment was acceptable in patients with minimal neurological deficit. PMID:25677879

  7. Scrotal hematoma resulting from extracorporeal shock wave lithotripsy for a renal calculus: a sign of retroperitoneal hemorrhage

    OpenAIRE

    Devanathan, Raja; Katz, Darren J.; Dodds, Lachlan J.

    2011-01-01

    We report a rare case of a patient presenting with scrotal hematoma associated with retroperitoneal hemorrhage after extracorporeal shock wave lithotripsy (ESWL). We propose a mechanism for the formation of scrotal hematoma and its importance as a sign of retroperitoneal hemorrhage.

  8. Time Course of Early Postadmission Hematoma Expansion in Spontaneous Intracerebral Hemorrhage

    DEFF Research Database (Denmark)

    Ovesen, Christian; Christensen, Anders Fogh

    2014-01-01

    BACKGROUND AND PURPOSE: Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE. METHODS: We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ?24 hours. RESULTS: Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign-negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, -0.1 to 2.6] mL). CONCLUSIONS: EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472224.

  9. Time course of early postadmission hematoma expansion in spontaneous intracerebral hemorrhage

    DEFF Research Database (Denmark)

    Ovesen, Christian; Christensen, Anders Fogh

    2014-01-01

    BACKGROUND AND PURPOSE: Early hematoma expansion (EHE) in patients with intracerebral hematoma is a promising treatment target. To date, the time course of EHE has remained poorly described. We prospectively investigated the time course of EHE. METHODS: We included consecutive patients presenting spontaneous intracerebral hematoma within 4.5 hours. On admission, patients underwent noncontrast computed tomography (CT) and CT angiography. Serial hematoma volume estimations by transcranial B-mode ultrasound were effected through the contralateral transtemporal bone window by obtaining sagittal, transversal, and coronal diameter and calculating the ABC/2-formula. National Institute of Health Stroke Scale and transcranial B-mode ultrasound were performed consecutively every 30 minutes during the first 6 hours and from 6 to 12 hours every 2 hours. Follow-up CT and ultrasound were performed after ?24 hours. RESULTS: Twenty-five patients with intracerebral hematoma were included; mean (SD) time from onset to CT was108.6 (45.7) minutes. Ten (40%) patients had EHE. In patients with a final clinically significant hematoma expansion >12.5 mL, all EHE occurred within 6 hours after admission scan. EHE in spot sign positive patients continued during the first 5 hours after CT angiography. In spot sign-negative patients, no significant EHE was observed (Friedman test, P=0.476). Neurological deterioration occurred in 5 (20%) patients and was well temporally correlated with EHE. Transcranial B-mode ultrasound demonstrated good volume estimation compared with the follow-up CT with a maximum absolute volume deviation within 7 mL and minimal systematic error (mean deviation, 1.3 [confidence interval, -0.1 to 2.6] mL). CONCLUSIONS: EHE was reliably reflected by transcranial B-mode ultrasound and mainly occurred within the first 7 to 8 hours after symptom onset. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01472224.

  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 treclinical 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. Delayed Onset Neurological Deterioration due to a Spinal Epidural Hematoma after a Spine Fracture

    OpenAIRE

    Ha, Jung Won; Park, Jin Oh; Moon, Eun Su; Choi, Chong Hyuk; Kim, Ju Young; Kim, Hak Sun; Lee, Jeong-Gil

    2007-01-01

    There are no reports of a 7-day delay in the onset of neurological deterioration because of a spinal epidural hematoma (SEH) after a spinal fracture. A hematoma was detected from the T12 to L2 area in a 36-year-old male patient with a T12 burst fracture. On the same day, the patient underwent in situ posterior pedicle instrumentation on T10-L3 with no additional laminectomy. On the seventh postoperative day, the patient suddenly developed weakness and sensory changes in both extremities, toge...

  12. Subarachnoid hemorrhage and intracereebral hematoma following lumboperitoneal shunt for pseudotumor cerebri : a rare complication.

    Directory of Open Access Journals (Sweden)

    Suri A

    2002-10-01

    Full Text Available Placement of lumboperitoneal (LP shunt as a surgical treatment for benign intracranial hypertension (BIH is generally a safe procedure, with complications like mechanical failure, overdrainage and infections. Subarachnoid hemorrhage and intracerebral hematoma were seen after lumboperitoneal shunt in a patient having BIH. These complications were the cause of the patient?s deterioration. After removal of the hematoma and performing a decompressive procedure, patient?s neurological condition improved. The clinical features, investigations and clinical course are described and the literature reviewed.

  13. A large dissecting sub-epicardial hematoma and cardiac tamponade following elective percutaneous coronary intervention.

    Science.gov (United States)

    Kashiwase, Kazunori; Ueda, Yasunori; Ogasawara, Nobuyuki; Oyabu, Jyota; Okada, Katsuki; Murakawa, Tomokazu; Hirayama, Atsushi; Kodama, Kazuhisa

    2008-10-01

    A 70-year-old woman was performed percutaneous coronary intervention at the stenotic lesion of the 1st diagonal branch. Soon after stenting, cardiac tamponade occurred and emergent cardiac surgery was performed. A large epicardial hematoma was observed in the antero-lateral wall that was compressing the distal diagonal branch. The patient died of multi-organ failure 3 days after surgery. An autopsy of her heart revealed an extensive intramural hematoma in the left ventricular wall. There was no evidence of perforation of the stented lesion. The suspected cause was neither coronary perforation nor coronary rupture of target lesion. PMID:18922392

  14. Subperiosteal Hematoma of orbit an interesting case report and review of literature

    Directory of Open Access Journals (Sweden)

    Balasubramanian Thiagarajan

    2014-08-01

    Full Text Available Subperiosteal Hematoma orbit is an uncommon disorder which may occur following injury to orbit. Ofcourse there are other causes that cause this condition as well. This condition has been reported in young adults. This case report discusses a patient who developed subperiosteal hematoma following trivial injury to orbit. Since this condition had occurred following trivial injury to orbit diagnosis was not made pre operatively. It was discovered only on the table. A high index of suspicion and an accurate history is necessary to identify this condition. This case is being reported not only for its rarity but also to stress the importance of eliciting accurate history.

  15. A retropharyngeal-mediastinal hematoma with supraglottic and tracheal obstruction: The role of multidisciplinary airway management

    Directory of Open Access Journals (Sweden)

    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.

  16. Hematoma of the proximal nail fold due to oximeter in a child

    Directory of Open Access Journals (Sweden)

    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.

  17. A new predisposing factor for trigemino-cardiac reflex during subdural empyema drainage: a case report

    Directory of Open Access Journals (Sweden)

    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. Computational Study of Subdural Cortical Stimulation: Effects of Simulating Anisotropic Conductivity on Activation of Cortical Neurons

    Science.gov (United States)

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2015-01-01

    Subdural cortical stimulation (SuCS) is an appealing method in the treatment of neurological disorders, and computational modeling studies of SuCS have been applied to determine the optimal design for electrotherapy. To achieve a better understanding of computational modeling on the stimulation effects of SuCS, the influence of anisotropic white matter conductivity on the activation of cortical neurons was investigated in a realistic head model. In this paper, we constructed pyramidal neuronal models (layers 3 and 5) that showed primary excitation of the corticospinal tract, and an anatomically realistic head model reflecting complex brain geometry. The anisotropic information was acquired from diffusion tensor magnetic resonance imaging (DT-MRI) and then applied to the white matter at various ratios of anisotropic conductivity. First, we compared the isotropic and anisotropic models; compared to the isotropic model, the anisotropic model showed that neurons were activated in the deeper bank during cathodal stimulation and in the wider crown during anodal stimulation. Second, several popular anisotropic principles were adapted to investigate the effects of variations in anisotropic information. We observed that excitation thresholds varied with anisotropic principles, especially with anodal stimulation. Overall, incorporating anisotropic conductivity into the anatomically realistic head model is critical for accurate estimation of neuronal responses; however, caution should be used in the selection of anisotropic information. PMID:26057524

  19. An Experimental Study on the Effect of Subperiosteal Transplantation of Fracture Site Hematoma: Focus on the Scintigraphic Detection

    International Nuclear Information System (INIS)

    It has been reported that hematoma is one of the most crucial factors in fracture healing since callus formation is disturbed by washing out the hematoma near a fracture site. However, it is not clear why the hematoma is important and how it plays a role during the fracture healing. In order to investigate the role of hematoma in the process of fracture healing, the osteogenic potential by subperiosteal transplantation have been studied. Experimental fractures by operation were made at the mid-shaft of the tibia in New Zealand white rabbits. Removal of hematoma at the fracture site was done after 2 and 3 days from experimental fracture, and the removed hematoma was transplanted into the subperiosteal area at the mid-shaft of the ulna of each rabbit. As control groups, we have performed 3 different procedures 1) the hematoma was transplanted into the muscular layers at the thigh and forearm; 2) autologous blood clots were transplanted into the subperiosteal area of the ulna; and 3) sham operation without a transplantation into the subperiosteal area. After transplantation, serial bone scintigraphy and simple radiography were performed at 4 days, 1 week, and 2 weeks to detect an abnormality. The results of bone scintigraphy were positive in 5 of 6 experimental group. However, all in three control groups were negative. Histological observation of the positive bone revealed new bone formation with trabeculation. These results suggest the hematoma in fracture site has osteest the hematoma in fracture site has osteogenic potential in the subperiosteal area which can be demonstrable by bone scintigraphy and histologic findings. Therefore, it is considered that hematoma of the fracture site plays an important role in the process of fracture healing. Further biochemical investigation using various experimental models is mandatory to apply this preliminary result to the treatment of clinical delayed union or nonunion.

  20. Hematoma Disecante de la Parte Torácica de la Aorta: Estudio Anatomopatológico de Siete Casos de Autopsias Dissecting Hematoma of the Thoracic Aorta: Pathology Study of Seven Autopsy Cases

    OpenAIRE

    Julio César Guerini; Andrea Storniolo Squintone; Alba Borchert; Ismael Bernardo Fonseca; Rodolfo Esteban Avila; Luis Santos Spitale

    2011-01-01

    El hematoma disecante de aorta (HDA) se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuestro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Pato...

  1. Manejo conservador de un hematoma compresivo sobre la aurícula derecha en el posoperatorio de cirugía cardíaca / Conservative Management of Compressive Hematoma over Right Atrium Postoperative of Cardiac Surgery

    Scientific Electronic Library Online (English)

    Ricardo, Levin; Marcela, Degrange; Jorge, Balanguer.

    2012-12-01

    Full Text Available La compresión sobre cavidades derechas en el posoperatorio temprano de cirugía cardíaca en un paciente total o parcialmente estable implica un desafío respecto de la conducta a adoptar, especialmente acerca del mejor modo de monitorizar la situación. En esta presentación se describe el caso de un pa [...] ciente de 54 años con múltiples antecedentes clínicos, entre ellos cirugía de revascularización previa, que fue sometido a reemplazo valvular aórtico y mitral (con prótesis biológicas) y plástica tricuspídea. Debido a sangrado masivo en la intervención sin respuesta a la transfusión de hemoderivados, fue reexplorado en quirófano; ante la observación de sangrado difuso, se administró una dosis de factor VII recombinante activado. En el posoperatorio presentó elevación de presiones en la aurícula derecha, en la que se detectó compresión aislada por un hematoma; inicialmente se planteó una conducta conservadora. El paciente fue monitorizado mediante ecocardiograma transesofágico continuo y la conducta estuvo guiada por parámetros de llenado y función ventricular, además de la observación directa y continua del hematoma. Abstract in english Compression over right chambers in the early postoperative course after cardiac surgery in a fully or partially stable patient poses a challenge as to what approach to follow, especially regarding the best management of the situation. This report describes the case of a 54-year-old male patient with [...] a significant clinical history -including previous coronary artery bypass surgery-, who underwent mitral and aortic valve replacement (with bioprostheses), and tricuspid valve repair. Due to massive bleeding unresponsive to transfusion of blood products during surgery, the patient was re-explored in the operating room; a recombinant activated factor VII dose was infused as a result of diffuse bleeding. During postoperative course, the patient presented with high atrium pressure, in which an isolated compression due to hematoma was detected; initially a conservative approach was adopted. The patient was monitored under continuous transesophageal echocardiogram, and management was based on ventricular filling parameters, in addition to direct and continuous observation of the hematoma.

  2. 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...

  3. Hematoma espontáneo del instestino delgado: Reporte de dos casos y revisión de la literatura / Spontaneous small-bowel hematoma: Report of two cases and literature review

    Scientific Electronic Library Online (English)

    Ana M, Cadavid; Juan D, Uribe; Miguel, Mesa; Sandra, Escobar; Luisa F, Sánchez.

    2009-12-01

    Full Text Available El hematoma intramural del yeyuno es una complicación poco frecuente en los pacientes anticoagulados y puede llegar a ser un reto diagnóstico para el médico. Su presentación varía desde dolor abdominal leve y obstrucción intestinal hasta perforación de una víscera hueca. El tratamiento es médico y n [...] o se requiere intervención quirúrgica, excepto en los casos de perforación. Se presenta el caso de dos pacientes que desarrollaron dicha patología como complicación al uso de warfarina, quienes tuvieron un buen desenlace clínico y fueron tratados en forma médica. Abstract in english Spontaneous intramural small-bowel hematoma is a rare complication in patients receiving anticoagulation therapy and may represent a diagnostic challenge. Its clinical presentation varies from mild abdominal pain and intestinal obstruction to perforation. Medical treatment is indicated and surgery i [...] s required only in cases of perforation. We present the cases of two patients who developed intramural spontaneous small-bowel hematoma as a complication of warfarin therapy and who had a good outcome after medical treatment.

  4. The potential contributing effect of ketorolac and fluoxetine to a spinal epidural hematoma following a cervical interlaminar epidural steroid injection: a case report and narrative review.

    Science.gov (United States)

    Chien, George C Chang; McCormick, Zack; Araujo, Marco; Candido, Kenneth D

    2014-01-01

    Cervical interlaminar epidural steroid injections (ESIs) are commonly performed as one part of a multi-modal analgesic regimen in the management of upper extremity radicular pain. Spinal epidural hematoma (SEH) is a rare complication with a reported incidence ranging from 1.38 in 10,000 to 1 in 190,000 epidurals. Current American Society of Regional Anesthesia (ASRA), American Society of Interventional Pain Physicians (ASIPP), and the International Spine Intervention Society (ISIS) recommendations are that non-steroidal anti-inflammatory drugs (NSAIDs) do not need to be withheld prior to epidural anesthesia. We report a case wherein intramuscular ketorolac and oral fluoxetine contributed to a SEH and tetraplegia following a cervical interlaminar (ESI). A 66 year-old woman with chronic renal insufficiency and neck pain radiating into her right upper extremity presented for evaluation and was deemed an appropriate CESI candidate. Cervical magnetic resonance imaging (MRI) revealed multi-level neuroforaminal stenosis and degenerative intervertebral discs. Utilizing a loss of resistance to saline technique, an 18-gauge Tuohy-type needle entered the epidural space at C6-7. After negative aspiration, 4 mL of saline with 80 mg of methyl-prednisolone was injected. Immediately thereafter, the patient reported significant spasmodic-type localized neck pain with no neurologic status changes. A decision was made to administer 30 mg intramuscular ketorolac as treatment for the spasmodic-type pain. En route home, she developed a sudden onset of acute tetraplegia. She was brought to the emergency department for evaluation including platelet and coagulation studies which were normal. MRI demonstrated an epidural hematoma extending from C5 to T7. She underwent a bilateral C5-T6 laminectomy with epidural hematoma evacuation and was discharged to an acute inpatient rehabilitation hospital. Chronic renal insufficiency, spinal stenosis, female gender, and increasing age have been identified as risk factors for SEH following epidural anesthesia. In the present case, it is postulated that after the spinal vascular system was penetrated, hemostasis was compromised by the combined antiplatelet effects of ketorolac, fluoxetine, fish oil, and vitamin E. Although generally well tolerated, the role of ketorolac, a potent anti-platelet medication used for pain relief in the peri-neuraxial intervention period, should be seriously scrutinized when other analgesic options are readily available. Although the increased risk of bleeding for the alternative medications are minimal, they are nevertheless well documented. Additionally, their additive impairment on hemostasis has not been well characterized. Withholding NSAIDs, fluoxetine, fish oil, and vitamin E in the peri-procedural period is relatively low risk and should be considered for all patients with multiple risk factors for SEH. PMID:24850120

  5. Very Low Cerebral Blood Volume Predicts Parenchymal Hematoma in Acute Ischemic Stroke

    DEFF Research Database (Denmark)

    Hermitte, Laure; Cho, Tae-Hee

    2013-01-01

    Parenchymal hematoma (PH) may worsen the outcome of patients with stroke. The aim of our study was to confirm the relationship between the volume of very low cerebral blood volume (CBV) and PH using a European multicenter database (I-KNOW). A secondary objective was to explore the impact of early reperfusion and recanalization.

  6. 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.

  7. Extradural hematoma following double valve replacement under cardiopulmonary bypass: a rare complication.

    Science.gov (United States)

    Kumar, Bhupesh; Bhagat, Hemant; Raj, Ravi; Jayant, Aveek

    2013-01-01

    The primary mechanisms responsible for acute neurological deterioration following cardiopulmonary bypass (CPB) include cerebral embolism, cerebral hypoperfusion and/or inflammatory process triggered by CPB. Extradural hematoma (EDH) following CPB is rare but associated with significant mortality and morbidity. We present a case of EDH following double valve replacement in an adolescent boy. PMID:23287089

  8. Diagnostic problems in retroperitoneal hematomas with atypical course - a case story

    International Nuclear Information System (INIS)

    The possibilities of image methods of examination, in connection with a nontypical jatrogenic retroperitoneal hematoma observed by the authors are discussed. The diagnostic advantages of the angiographic examination of the branches of the abdominal aorta, combined with fine needle aspiration biopsy are pointed out. 6 refs

  9. Spontaneous sublingual and intramural small-bowel hematoma in a patient on oral anticoagulation

    Directory of Open Access Journals (Sweden)

    Sean Johnston

    2012-07-01

    Full Text Available Spontaneous sublingual hematoma and intramural small bowel hematoma are rare and serious complications of anticoagulant therapy. Though previously reported individually, there has been no previous report of the same two complications occurring in a single patient. A 71-year-old Caucasian man, who was on warfarin for atrial fibrillation, presented with difficulty in swallowing due to a sublingual hematoma. He was observed in our intensive care unit, his warfarin was held and he recovered with conservative management. He represented two months later with a two day history of abdominal pain and distension. An abdominopelvic computed tomography (CT scan now showed small bowel obstruction due to intramural small bowel hematoma and haemorrhagic ascites. Again, this was treated expectantly with a good outcome. In conclusion, life threatening haemorrhagic complications of oral anticoagulant therapy can recur. Conservative treatment is successful in most cases, but an accurate diagnosis is mandatory to avoid unnecessary surgery. CT scan is the investigation of choice for the diagnosis of suspected haemorrhagic complications of over coagulation.

  10. 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)

  11. Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention / Desempenho da válvula de pressão fixa com antissifão SPHERA® no tratamento da hidrocefalia e na prevenção da ocorrência de hiperdrenagem

    Scientific Electronic Library Online (English)

    Fernando Campos Gomes, Pinto; Renan Muralho, Pereira; Felippe, Saad; Manoel Jacobsen, Teixeira.

    2012-09-01

    Full Text Available Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS) com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifã [...] o SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%); 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final Abstract in english Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS) implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisipho [...] n device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%), 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome), 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure

  12. The extent of the perihemorrhagic perfusion zone correlates with hematoma volume in patients with lobar intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Beseoglu, Kerim; Etminan, Nima; Steiger, Hans-Jakob; Haenggi, Daniel [Heinrich-Heine-Universitaet Duesseldorf, Department of Neurosurgery, Medical Faculty, Duesseldorf (Germany); Turowski, Bernd [Heinrich-Heine-Universitaet Duesseldorf, Department of Diagnostic and Interventional Radiology, Medical Faculty, Duesseldorf (Germany)

    2014-07-15

    Existing data on perfusion imaging assumes the perihemorrhagic zone (PHZ) in patients with intracerebral hemorrhage (ICH) to be size steady. This study investigates the size of the perihemorrhagic zone (PHZ) in patients with lobar ICH in relation to hematoma volume during the course of treatment using perfusion CT (PCT). The present analysis is based on a previously reported cohort of 20 patients undergoing surgical evacuation for lobar SICH, with pre- and early postoperative PCT scanning. Time to peak of the residue function (T{sub max}) was measured based on the 360 cortical banding method and singular value decomposition. The size of PHZ was determined before and after treatment and correlated with hematoma volume. Preoperative mean hematoma volume constituted 63.0 ml (interquartile ranges (IQR) 39.7-99.4 ml), which correlated significantly (r = 0.563, p = 0.010) with mean PHZ size (5.67 cm, IQR 5.44-8.17 cm). Following a surgical hematoma evacuation, mean hematoma volume was reduced to 2.5 ml IQR 0.0-9.5 ml, which also resulted in a significant reduction of PHZ size to 0.45 cm(IQR 0.0-1.36 cm; p < 0.001). There was no association between postoperative hematoma volume and size of the PHZ. Our findings illustrate that the extent of the PHZ cannot be generally assumed to be constant in size and that this differs significantly following hematoma reduction in patients with space occupying lobar SICH. (orig.)

  13. Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura Hematoma después de raquianestesia tratado conservadoramente: relato de caso y revisión de la literatura Conservative treatment of hematoma after spinal anesthesia: case report and literature review

    Directory of Open Access Journals (Sweden)

    Daniel Segabinazzi

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Durante a realização de anestesia espinal existe o risco de ocorrer sangramentos. A compressão do tecido nervoso, secundária à formação de hematoma, pode determinar o surgimento de lesão neurológica que se não for diagnosticada e tratada a tempo pode ser permanente. A identificação dos fatores de risco, o diagnóstico e o tratamento precoce da compressão são importantes para o prognóstico do paciente. O objetivo deste trabalho foi descrever um caso de hematoma após raquianestesia tratado de forma conservadora e revisar os trabalhos na literatura. RELATO DO CASO: Paciente do sexo masculino, 73 anos, 65 kg, 1,67 m, estado físico ASA III. Foi submetido a raquianestesia para retirada de cateter de diálise peritoneal. Durante a realização da punção ocorreram parestesias no membro inferior direito. Foram injetados 15 mg de bupivacaína hiperbárica a 0,5% sem vasoconstritor. Vinte e quatro horas após a realização do bloqueio o paciente permanecia com anestesia em sela e com dor lombar, e 48 horas após o procedimento apresentou incontinência urinária. A ressonância nuclear magnética demonstrou existência de processo expansivo subaracnóideo, com compressão de raízes nervosas (L4 a S1. Após avaliação do neurocirurgião, instituiu-se tratamento conservador. O paciente recebeu alta hospitalar no 18° dia de pós-operatório, assintomático. CONCLUSÕES: O caso apresentado mostrou boa evolução com o tratamento conservador.JUSTIFICATIVA Y OBJETIVOS: Durante la realización de anestesia espinal existe el riesgo de que ocurran sangramientos. La compresión del tejido nervioso, secundaria a la formación de hematoma puede determinar el aparecimiento de lesión neurológica que, si no se diagnostica y se trata a tiempo, puede ser permanente. La identificación de los factores de riesgo, el diagnóstico y el tratamiento precoz de la compresión son importantes para el pronóstico del paciente. El objetivo de este trabajo fue describir un caso de hematoma después raquianestesia tratado de forma conservadora y revisar los trabajos en la literatura. RELATO DEL CASO: Paciente del sexo masculino, 73 años, 65 kg, 1,67 m, estado físico ASA III. Fue sometido a raquianestesia para retirada de catéter de diálisis peritoneal. Durante la realización de la punción hubo parestesias en el miembro inferior derecho. Se inyectaron 15 mg de bupivacaína hiperbárica a 0,5% sin vasoconstrictor. Veinte y cuatro horas después de la realización del bloqueo el paciente permanecía con anestesia en silla de montar y con dolor lumbar, y 48 horas después del procedimiento presentó una incontinencia urinaria. La resonancia nuclear magnética demostró la existencia de un proceso expansivo subaracnoideo, con compresión de raíces nerviosas (L4 a S1. Después de la evaluación del neurocirujano, se empieza el tratamiento conservador. El paciente recibió alta hospitalaria el 18° día de postoperatorio asintomático. CONCLUSIÓN: El caso presentado mostró una buena evolución con el tratamiento conservador.BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, and early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain persisted and, after 48 hours, the patient presented urinary incontinence. An MRI demonst

  14. Hematoma após raquianestesia tratado conservadoramente: relato de caso e revisão da literatura / Conservative treatment of hematoma after spinal anesthesia: case report and literature review / Hematoma después de raquianestesia tratado conservadoramente: relato de caso y revisión de la literatura

    Scientific Electronic Library Online (English)

    Daniel, Segabinazzi; Betina Comiran, Brescianini; Felipe Gornicki, Schneider; Florentino Fernandes, Mendes.

    2007-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Durante a realização de anestesia espinal existe o risco de ocorrer sangramentos. A compressão do tecido nervoso, secundária à formação de hematoma, pode determinar o surgimento de lesão neurológica que se não for diagnosticada e tratada a tempo pode ser permanente. A iden [...] tificação dos fatores de risco, o diagnóstico e o tratamento precoce da compressão são importantes para o prognóstico do paciente. O objetivo deste trabalho foi descrever um caso de hematoma após raquianestesia tratado de forma conservadora e revisar os trabalhos na literatura. RELATO DO CASO: Paciente do sexo masculino, 73 anos, 65 kg, 1,67 m, estado físico ASA III. Foi submetido a raquianestesia para retirada de cateter de diálise peritoneal. Durante a realização da punção ocorreram parestesias no membro inferior direito. Foram injetados 15 mg de bupivacaína hiperbárica a 0,5% sem vasoconstritor. Vinte e quatro horas após a realização do bloqueio o paciente permanecia com anestesia em sela e com dor lombar, e 48 horas após o procedimento apresentou incontinência urinária. A ressonância nuclear magnética demonstrou existência de processo expansivo subaracnóideo, com compressão de raízes nervosas (L4 a S1). Após avaliação do neurocirurgião, instituiu-se tratamento conservador. O paciente recebeu alta hospitalar no 18° dia de pós-operatório, assintomático. CONCLUSÕES: O caso apresentado mostrou boa evolução com o tratamento conservador. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: Durante la realización de anestesia espinal existe el riesgo de que ocurran sangramientos. La compresión del tejido nervioso, secundaria a la formación de hematoma puede determinar el aparecimiento de lesión neurológica que, si no se diagnostica y se trata a tiempo, puede [...] ser permanente. La identificación de los factores de riesgo, el diagnóstico y el tratamiento precoz de la compresión son importantes para el pronóstico del paciente. El objetivo de este trabajo fue describir un caso de hematoma después raquianestesia tratado de forma conservadora y revisar los trabajos en la literatura. RELATO DEL CASO: Paciente del sexo masculino, 73 años, 65 kg, 1,67 m, estado físico ASA III. Fue sometido a raquianestesia para retirada de catéter de diálisis peritoneal. Durante la realización de la punción hubo parestesias en el miembro inferior derecho. Se inyectaron 15 mg de bupivacaína hiperbárica a 0,5% sin vasoconstrictor. Veinte y cuatro horas después de la realización del bloqueo el paciente permanecía con anestesia en silla de montar y con dolor lumbar, y 48 horas después del procedimiento presentó una incontinencia urinaria. La resonancia nuclear magnética demostró la existencia de un proceso expansivo subaracnoideo, con compresión de raíces nerviosas (L4 a S1). Después de la evaluación del neurocirujano, se empieza el tratamiento conservador. El paciente recibió alta hospitalaria el 18° día de postoperatorio asintomático. CONCLUSIÓN: El caso presentado mostró una buena evolución con el tratamiento conservador. Abstract in english BACKGROUND AND OBJECTIVES: Spinal anesthesia caries the risk of bleeding. Compression of nervous tissue secondary to the formation of a hematoma can cause neurological damage, which, if not diagnosed and treated in a timely fashion, can be permanent. The identification of risk factors, diagnosis, an [...] d early treatment are important for the prognosis. The objective of this report was to describe the case of a hematoma after spinal anesthesia treated conservatively, and review the literature. CASE REPORT: Male patient, 73 years old, 65 kg, 1.67 m, and ASA physical status III, underwent spinal anesthesia for removal of a peritoneal dialysis catheter. During the puncture, the patient experienced paresthesia of the right lower limb. Fifteen milligrams of 0.5% hyperbaric bupivacaine without vasoconstrictor were administered. Twenty-four hours later, saddle anesthesia and lumbar pain persisted and, after 48 hours,

  15. Arachnoid cysts of the middle fossa predispose to subdural haematoma formation fact or fiction?

    Science.gov (United States)

    Page, A C; Mohan, D; Paxton, R M

    1988-01-01

    An association between arachnoid cysts of the middle fossa (ACMF) and complicating subdural haematoma (SDH) has been previously noted. More recently it has been hypothesized that ACMF may predispose to SDH formation. The Plymouth Neurosurgical Unit has treated twenty patients with ACMF between 1976-1985, seven of these being complicated by SDH. There was an age range of 11-56 years in those with SDH. Six of the seven patients with ACMF and SDH gave no significant trauma history. Four of these were males aged 11 to 20 years. The presenting histories, clinical findings and subsequent management of these patients were compared with the age-matched males with SDH alone (twelve patients). In the SDH alone group 100% suffered major skull trauma and 80% had demonstrable skull fractures. In addition the patients with ACMF were compared with patients presenting with other supratentorial arachnoid cysts in Plymouth. Only ACMF were associated with the development of SDH in our study. Three patients demonstrated total masking of the ACMF by isodense intracystic haematoma on computed tomography. In two of these patients the presence of an ACMF was suspected due to plain radiographic and CT enlargement of the middle fossa. It is advocated that with special reference to young males, in the absence of major skull trauma an ACMF should be suspected as a predisposing factor to SDH. Postoperative CT scans for at least one year are advisable in young patients with SDH as demonstration of the presence of an ACMF and SDH affects future management. PMID:3189011

  16. 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 ?HCG 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 ?HCG 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 ?HCG 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 ?HCG rise is observed. Cranial CT and MRI confi 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 ?HCG 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

  17. An Experimental Study on the Effect of Subperiosteal Transplantation of Fracture Site Hematoma: Focus on the Scintigraphic Detection

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Seoung Ho [Donga University College of Medicine, Pusan (Korea, Republic of); Kang, Hung Sik; Chang, Kee Hyun; Lee, Myung Chul; Koo, Kyung Hoi; Seung, Sang Chul [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1990-03-15

    It has been reported that hematoma is one of the most crucial factors in fracture healing since callus formation is disturbed by washing out the hematoma near a fracture site. However, it is not clear why the hematoma is important and how it plays a role during the fracture healing. In order to investigate the role of hematoma in the process of fracture healing, the osteogenic potential by subperiosteal transplantation have been studied. Experimental fractures by operation were made at the mid-shaft of the tibia in New Zealand white rabbits. Removal of hematoma at the fracture site was done after 2 and 3 days from experimental fracture, and the removed hematoma was transplanted into the subperiosteal area at the mid-shaft of the ulna of each rabbit. As control groups, we have performed 3 different procedures 1) the hematoma was transplanted into the muscular layers at the thigh and forearm; 2) autologous blood clots were transplanted into the subperiosteal area of the ulna; and 3) sham operation without a transplantation into the subperiosteal area. After transplantation, serial bone scintigraphy and simple radiography were performed at 4 days, 1 week, and 2 weeks to detect an abnormality. The results of bone scintigraphy were positive in 5 of 6 experimental group. However, all in three control groups were negative. Histological observation of the positive bone revealed new bone formation with trabeculation. These results suggest the hematoma in fracture site has osteogenic potential in the subperiosteal area which can be demonstrable by bone scintigraphy and histologic findings. Therefore, it is considered that hematoma of the fracture site plays an important role in the process of fracture healing. Further biochemical investigation using various experimental models is mandatory to apply this preliminary result to the treatment of clinical delayed union or nonunion.

  18. Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury.

    Science.gov (United States)

    Mitsis, E M; Riggio, S; Kostakoglu, L; Dickstein, D L; Machac, J; Delman, B; Goldstein, M; Jennings, D; D'Antonio, E; Martin, J; Naidich, T P; Aloysi, A; Fernandez, C; Seibyl, J; DeKosky, S T; Elder, G A; Marek, K; Gordon, W; Hof, P R; Sano, M; Gandy, S

    2014-01-01

    Single, severe traumatic brain injury (TBI) which elevates CNS amyloid, increases the risk of Alzheimer's disease (AD); while repetitive concussive and subconcussive events as observed in athletes and military personnel, may increase the risk of chronic traumatic encephalopathy (CTE). We describe two clinical cases, one with a history of multiple concussions during a career in the National Football League (NFL) and the second with frontotemporal dementia and a single, severe TBI. Both patients presented with cognitive decline and underwent [(18)F]-Florbetapir positron emission tomography (PET) imaging for amyloid plaques; the retired NFL player also underwent [(18)F]-T807 PET imaging, a new ligand binding to tau, the main constituent of neurofibrillary tangles (NFT). Case 1, the former NFL player, was 71 years old when he presented with memory impairment and a clinical profile highly similar to AD. [(18)F]-Florbetapir PET imaging was negative, essentially excluding AD as a diagnosis. CTE was suspected clinically, and [(18)F]-T807 PET imaging revealed striatal and nigral [(18)F]-T807 retention consistent with the presence of tauopathy. Case 2 was a 56-year-old man with personality changes and cognitive decline who had sustained a fall complicated by a subdural hematoma. At 1 year post injury, [(18)F]-Florbetapir PET imaging was negative for an AD pattern of amyloid accumulation in this subject. Focal [(18)F]-Florbetapir retention was noted at the site of impact. In case 1, amyloid imaging provided improved diagnostic accuracy where standard clinical and laboratory criteria were inadequate. In that same case, tau imaging with [(18)F]-T807 revealed a subcortical tauopathy that we interpret as a novel form of CTE with a distribution of tauopathy that mimics, to some extent, that of progressive supranuclear palsy (PSP), despite a clinical presentation of amnesia without any movement disorder complaints or signs. A key distinguishing feature is that our patient presented with hippocampal involvement, which is more frequently seen in CTE than in PSP. In case 2, focal [(18)F]-Florbetapir retention at the site of injury in an otherwise negative scan suggests focal amyloid aggregation. In each of these complex cases, a combination of [(18)F]-fluorodeoxyglucose, [(18)F]-Florbetapir and/or [(18)F]-T807 PET molecular imaging improved the accuracy of diagnosis and prevented inappropriate interventions. PMID:25226550

  19. Tauopathy PET and amyloid PET in the diagnosis of chronic traumatic encephalopathies: studies of a retired NFL player and of a man with FTD and a severe head injury

    Science.gov (United States)

    Mitsis, E M; Riggio, S; Kostakoglu, L; Dickstein, D L; Machac, J; Delman, B; Goldstein, M; Jennings, D; D'Antonio, E; Martin, J; Naidich, T P; Aloysi, A; Fernandez, C; Seibyl, J; DeKosky, S T; Elder, G A; Marek, K; Gordon, W; Hof, P R; Sano, M; Gandy, S

    2014-01-01

    Single, severe traumatic brain injury (TBI) which elevates CNS amyloid, increases the risk of Alzheimer's disease (AD); while repetitive concussive and subconcussive events as observed in athletes and military personnel, may increase the risk of chronic traumatic encephalopathy (CTE). We describe two clinical cases, one with a history of multiple concussions during a career in the National Football League (NFL) and the second with frontotemporal dementia and a single, severe TBI. Both patients presented with cognitive decline and underwent [18F]-Florbetapir positron emission tomography (PET) imaging for amyloid plaques; the retired NFL player also underwent [18F]-T807 PET imaging, a new ligand binding to tau, the main constituent of neurofibrillary tangles (NFT). Case 1, the former NFL player, was 71 years old when he presented with memory impairment and a clinical profile highly similar to AD. [18F]-Florbetapir PET imaging was negative, essentially excluding AD as a diagnosis. CTE was suspected clinically, and [18F]-T807 PET imaging revealed striatal and nigral [18F]-T807 retention consistent with the presence of tauopathy. Case 2 was a 56-year-old man with personality changes and cognitive decline who had sustained a fall complicated by a subdural hematoma. At 1 year post injury, [18F]-Florbetapir PET imaging was negative for an AD pattern of amyloid accumulation in this subject. Focal [18F]-Florbetapir retention was noted at the site of impact. In case 1, amyloid imaging provided improved diagnostic accuracy where standard clinical and laboratory criteria were inadequate. In that same case, tau imaging with [18F]-T807 revealed a subcortical tauopathy that we interpret as a novel form of CTE with a distribution of tauopathy that mimics, to some extent, that of progressive supranuclear palsy (PSP), despite a clinical presentation of amnesia without any movement disorder complaints or signs. A key distinguishing feature is that our patient presented with hippocampal involvement, which is more frequently seen in CTE than in PSP. In case 2, focal [18F]-Florbetapir retention at the site of injury in an otherwise negative scan suggests focal amyloid aggregation. In each of these complex cases, a combination of [18F]-fluorodeoxyglucose, [18F]-Florbetapir and/or [18F]-T807 PET molecular imaging improved the accuracy of diagnosis and prevented inappropriate interventions. PMID:25226550

  20. Neuropatía femoral y hematoma bilateral de músculos psoas-iliaco asociados a tratamiento con warfarina / Femoral neuropathy and bilateral hematoma: psoas-iliac muscles associated with a warfarin treatment

    Scientific Electronic Library Online (English)

    Rolando, Rodríguez Fernández; Lays, Rodríguez Amador; Emilio, Buchaca Faxas; Francisco, Fernández Valdez; Lourdes, Suardiaz Martínez; María del Carmen, Aguilar Calleja.

    2012-06-01

    Full Text Available Se presentó un hombre de 70 años que sufrió un hematoma bilateral de los músculos psoas-iliacos como consecuencia del tratamiento con warfarina. Después de 6 d de tratamiento analgésico, valores de índice internacional normalizado inferiores a 1,5 y control del sangrado, se indicó la warfarina para [...] continuar la profilaxis por la prótesis valvular mecánica. Fue egresado con secuelas motoras por la neuropatía femoral y se ha mantenido con tratamiento fisioterapéutico. Se diagnosticó neuropatía por compresión del nervio femoral, por hematoma de los músculos psoas-ilíacos. Los casos de hematomas retroperitoneales son escasos en la literatura médica, en Cuba no encontramos casos publicados. Abstract in english This is the case of a man suffered of a bilateral hematoma of psoas-iliac muscles as a consequence of warfarin treatment. After 6 days od analgesic treatment, values of INR lower than 1,5 and bleeding control warfarin was prescribed to continue the prophylaxis by mechanical valvular prosthesis. He w [...] as discharged with motor sequelae due to femoral neuropathy maintained with a physiotherapy treatment. A neuropathy by compression of femoral nerve due to hematoma of psoas-iliac muscles was diagnosed. The cases of retroperitoneal hematomas are scarce in medical literature and in Cuba there were not published cases.

  1. Hematoma subcapsular esplénico en paciente portador de rasgo falciforme / Sub capsular splenic hematoma in a sickle cell trait carrier. Case report

    Scientific Electronic Library Online (English)

    Diego, Ugalde; Guillermo, Conte; Héctor, Ugalde; Gastón, Figueroa; Marianela, Cuneo; Macarena, Muñoz; Javiera, Mayor.

    1192-11-01

    Full Text Available [...] Abstract in english 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.

  2. Hematoma talámico bilateral simultáneo: Reporte de dos casos y revisión de la literatura / Simultaneous bilateral thalamic hematoma.: Case report and review of literature

    Scientific Electronic Library Online (English)

    José, Vallejos C; Patricio, Mellado T; Isidro, Huete L.

    2006-06-01

    Full Text Available Las hemorragias encefálicas que comprometan diferentes territorios en forma simultánea son infrecuentes y de mal pronóstico. Sus factores de riesgo son múltiples. Reportamos dos pacientes con hematoma talámico bilateral simultáneo, analizamos su presentación clínica, hallazgos imagenológicos y pronó [...] stico neurológico Abstract in english The simultaneous occurrence of brain hemorrhages in different territories is rare and has a poor outcome. The predisposing risk factors and pathophysiological mechanisms are not clearly understood. We describe two patients with simultaneous bilateral thalamic hemorrhages. We analysed the clinical fe [...] atures, radiological images and neurological prognosis

  3. Hematoma renal subcapsular espontáneo secundario al empleo de antiagregantes plaquetarios / Spontaneous renal sub-capsular hematoma after the use of antiplatelet

    Scientific Electronic Library Online (English)

    Tomás Lázaro, Rodríguez Collar; Basily, Valdés Estévez; Joan, Laffita Zamora; Evelio, Bueno Sánchez; Jorge Luis, Germán Meliz.

    2014-06-01

    Full Text Available Paciente masculino de 65 años de edad, con antecedentes de habérsele colocado stent coronario y tratamiento antiagregante plaquetario con Aspirina® y Clopidogrel®. A los 21 días comenzó a presentar dolor en el flanco y la fosa ilíaca derechos, náuseas y vómitos. En el examen físico inicial se detect [...] ó dolor y aumento de volumen en las zonas referidas y los signos vitales normales. El ultrasonido abdominal reveló colección perirrenal derecha bien delimitada y riñones de tamaño y ecoestructura normal. La tomografía axial computarizada evidenció la presencia de una imagen renal subcapsular derecha, con densidades de líquido, con compresión extrínseca de un riñón estructuralmente normal. Al día siguiente del ingreso comenzó a presentar fiebre de 38 ºC. Se suspendió el tratamiento antiagregante plaquetario y a los 7 días se realizó lumbotomía y drenaje del hematoma; se obtuvo alrededor de 400 mL de sangre carmelitosa. El paciente evolucionó satisfactoriamente. Se concluye que el hematoma renal subcapsular espontáneo es una complicación inusual del uso de antiagregantes plaquetarios que necesita manejo multidisciplinario. La tomografía axial computarizada es indispensable para el diagnóstico imagenológico de certeza. La compresión renal por su gran tamaño, así como el dolor y la aparición de fiebre, justifican su drenaje quirúrgico. 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 ºC. 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.

  4. Management of supratentorial epidural hematoma in children: report on 49 patients / Tratamento de hematoma epidural supratentorial em crianças: avaliação em 49 pacientes

    Scientific Electronic Library Online (English)

    Wellingson Silva, Paiva; Almir Ferreira de, Andrade; Luis, Mathias Júnior; Vinicius Monteiro de Paula, Guirado; Robson Luis, Amorim; Nadia Nader, Magrini; Manoel Jacobsen, Teixeira.

    2010-12-01

    Full Text Available Trauma craniocerebral é uma causa frequente de mortalidade e comprometimento neurológico adquirido em crianças. No entanto, hematomas epidurais (HED) são raros em pacientes pediátricos, com poucas series estudando a evolução destes pacientes. Neste estudo, os autores apresentam os resultados de uma [...] casuística de pacientes com HED acompanhados em longo prazo. MÉTODO: Entre janeiro de 2006 e dezembro de 2008, 49 pacientes com HED foram tratados em nossa unidade. Curso clínico, achados radiológicos, e resultados foram avaliados. O estado neurológico foi avaliado com o Glasgow Coma Scale (GCS). A idade variou de 1 dia a 16 anos. A média de acompanhamento foi de 6 meses. RESULTADOS: Na admissão, a maioria dos pacientes apresentava trauma leve e 57% estavam com GCS de 13-15. O sintoma mais comum foi irritabilidade. Os mecanismos de trauma mais frequentes foram queda de altura em 29 casos e acidentes de trânsito em 16 casos. Três destes pacientes apresentavam GCS 3, mas somente um morreu. Verificou-se déficit neurológico tardio em nove pacientes. CONCLUSÃO: Esta lesão pode ocorrer após traumas leves e em crianças alerta com exames neurológicos não focais. No entanto, em crianças com irritabilidade com hematoma subgaleal e história de perda de consciência, tomografia do crânio deve ser realizada. Abstract in english Traumatic head injury is a common cause of mortality and acquired neurological impairment in children. However, pediatric epidural hematomas (EDHs) are not common and few series have studied the evolution of these patients. In this study, we present the results from a sample of patients with EDH wit [...] h long-term follow-up. METHOD: Between January 2006 and December 2008, 49 patients with traumatic EDH were treated at our unit. Clinical course, radiological findings and outcomes were evaluated. Neurological status was assessed using the Glasgow Coma Scale (GCS). The patients' ages ranged from one day to 16 years. The mean follow-up was six months. RESULTS: On admission, most of the patients presented mild trauma and 57% had a GCS of 13-15. The most common symptom was irritability. The most frequent mechanisms of injury were: falling from a height in 29 cases and motor vehicle accidents in 16 cases. Three of these patients presented GCS 3, but only one died. We found a late neurological deficit in nine patients. CONCLUSION: These lesions may occur following mild head trauma and in alert children with nonfocal neurological examinations. However, in children presenting irritability with subgaleal hematomas and a history of loss of consciousness, skull computed tomography must be performed.

  5. 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.

  6. 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.

  7. Serious clopidogrel associated renal hematoma in a type 2 diabetic patient with primary hyperparathyroidism after extracorporeal shock wave lithotripsy.

    OpenAIRE

    Mithat Bahceci; Alpaslan Tuzcu; Ferruh Akay; Cuneyt Agil; Hatice Akay

    2005-01-01

    ABSTRACT Renal hematoma after extracorporeal shock wave lithotripsy SWL is a rare complication. We report a case of a large renal hematoma following SWL that resulted in nephrectomy in a type 2 diabetic patient with primary hyperparathyroidism using clopidogrel due to coronary heart disease CHD. Although it was claimed that preoperative use of clopidogrel was not associated with increased bleeding, all patients who are scheduled for SWL should be interrogated in terms of using of platelet ...

  8. Epidural hematoma associated with spinal fracture in diffuse idiopathic skeletal hyperostosis.

    Science.gov (United States)

    Tauchi, Ryoji; Imagama, Shiro; Satake, Kotaro; Iwase, Toshiki; Ishiguro, Naoki

    2014-01-01

    The authors describe the clinical findings, radiographic appearance and surgical treatment of a spinal epidural hematoma (SEH) associated with spinal fracture in diffuse idiopathic skeletal hyperostosis (DISH). An 81-year-old male patient injured after falling from a 2.5 m tree presented with severe back pain. On plain radiographs and CT images, DISH with anterolateral osteophytes and fused thoracolumbar vertebrae was found along with a T12 fracture. Patient was initially treated with bed rest followed by placement into a body cast. Three weeks later, he presented with incomplete paraplegia of his lower limbs. CT images did not reveal any fracture displacement, but MRI images showed an epidural hematoma compressing the dura mater. The patient was successfully treated by posterior fixation surgery using pedicle screws and rod with vertebroplasty. We aimed to report a unique case of a SEH complicating a spinal fracture in DISH. PMID:24535802

  9. Spinal Epidural Hematoma After Thrombolysis for Deep Vein Thrombosis with Subsequent Pulmonary Thromboembolism: A Case Report

    International Nuclear Information System (INIS)

    A 38-year-old male was initially admitted for left leg swelling. He was diagnosed as having deep vein thrombosis (DVT) in the left leg and a pulmonary thromboembolism by contrast-enhanced chest computed tomography (CT) with delayed lower extremity CT. The DVT was treated by thrombolysis and a venous stent. Four hours later, he complained of severe back pain and a sensation of separation of his body and lower extremities; he experienced paraplegia early in the morning of the following day. Magnetic resonance imaging showed a spinal epidural hematoma between T11 and L2, which decompressed following surgery. We, therefore, report a case of a spinal epidural hematoma after thrombolysis in a case of DVT with a pulmonary thromboembolism

  10. A miniseries of spontaneous intramural esophageal hematoma in hemodialysis patients: a rare cause of dysphagia.

    Science.gov (United States)

    Kumar, Vinod; Mallikarjuna, H M; Gokulnath

    2014-04-01

    Intramural esophageal hematoma (IEH) is an uncommon clinical condition, with a prognosis that is essentially benign. In most cases, a predisposing factor may be seen, with the most common being the history of esophagic instrumentation, food impactions, and thrombocytopenia. We report a miniseries of 3 patients on hemodialysis, who developed IEH. All 3 of them presented with sudden onset and progressively worsening dysphagia and hematemesis. Diagnosis of IEH was established by upper gastrointestinal endoscopy. All patients were managed conservatively, and symptoms of dysphagia and chest pain improved within 6-8 days. Good resolution of hematoma was noted by repeat endoscopy within 2-3 weeks. The reported case of IEH in hemodialysis patients is rare and needs to be identified early when patients present with dysphagia, as anticoagulation during hemodialysis would possibly worsen the clinical condition, the course of which is otherwise benign. PMID:24612400

  11. A Rare Complication of Extracorporeal Shock Wave Lithotripsy: Intrarenal Hematoma Mimicking Pelvis Renalis Tumor

    Science.gov (United States)

    Akbulut, Fatih; Kucuktopcu, Onur; Ucpinar, Burak; Savun, Metin; Ozgor, Faruk; Sonmezay, Erkan; Simsek, Abdulmuttalip; Gurbuz, Gokhan

    2015-01-01

    Extracorporeal shock wave lithotripsy (SWL) is a very commonly used treatment modality for appropriate sized stones. Even though it is a noninvasive treatment technique, major complications may occur following SWL sessions. Herein, we report a 17-year-old male patient, who received 2 sessions of SWL treatment for his left kidney stone, 4 months before his admission. Imaging methods showed an enhanced left renal pelvis mass with contrast-enhanced computerized tomography (CT) and this finding raised a suspicion of pelvis renalis tumor. Diagnostic ureterorenoscopy was planned for the patient and operation revealed a left intrarenal hematoma, which was drained percutaneously during the same operation. Careful history should be taken from patients with renal pelvis masses and intrarenal hematoma formation should be kept in mind, especially if the patient has a previous SWL history. PMID:26064767

  12. Intramural duodenal hematoma after submucosal injection of epinephrine for a bleeding ulcer: case report and review

    Science.gov (United States)

    DIBRA, A.; KËLLIÇI, S.; ÇELIKU, E.; DRAÇINI, Xh.; MATURO, A.; ÇELIKU, E.

    2015-01-01

    We present a case of intramural duodenal hematoma as a complication of endoscopic therapy for a bleeding duodenal ulcer in an adult patient with no evidence of other pathologies. A 18-year-old man was admitted in emergency room with gastrointestinal bleeding manifested by melena. Previous medical history revealed that he had endoscopic sclerotherapy for bleeding duodenal ulcer 5 months before. Endoscopy revealed a Forrest 2a ulcer in the duodenal bulb and sclerotherapy was performed by injecting 10 ml of 0.2% epinephrine and 20 ml of NaCl 0.9% solution. Upper occlusion’s signs appeared 36 hours after the procedure. The hematoma, that was identified by endoscopy and confirmed by MRI and CT scan of the abdomen, caused transient duodenal obstruction. Combined conservative management with nasogastric tube and total parenteral nutrition resulted in reduction of obstructive symptoms within 4 weeks. PMID:25827667

  13. Retroperitoneal hematoma with bone resorption around the acetabular component after total hip arthroplasty: a case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Uchida Kenzo

    2012-09-01

    Full Text Available Abstract Introduction Vascular complications related to cup-fixating screws penetrating the medial acetabular wall during total hip arthroplasty are not uncommon but rarely are associated with serious adverse events in the late post-operative period. Case presentation We present the case of a 77-year-old Japanese woman who developed progressive extensive bone resorption and large hematoma in the acetabulum 13 years after total hip arthroplasty. On admission to our hospital, she was on oral warfarin (1.5mg/day for atrial fibrillation. About 5 months after the initiation of anticoagulant therapy, she suffered a major fall followed by massive subcutaneous and pelvic girdle bleeding, predominantly on the medial side of the right thigh, but a fracture or damage of total hip arthroplasty was not evident on an emergency orthopedic evaluation. One year after the accident, a routine follow-up examination showed an asymptomatic osteolytic lesion in the acetabulum on the right pelvis, and 2 years later our patient noticed progressive pain in her right hip during walking. A large osteolytic lesion was noted in the right acetabulum on a plain radiograph. On high-resolution computed tomography and magnetic resonance imaging, a huge granulomatous lesion in the acetabulum was suggestive of chronic hematoma in intrapelvic and extrapelvic gluteal regions. A closer computed tomography examination showed that one of the screws used for fixation of the acetabular component in the total hip arthroplasty had penetrated the acetabular bone and had reached the pelvic cavity. Surgery was performed in a single session by means of two approaches: anterior midline transperitoneal address to resect the low-density mass lesion followed by posterolateral acetabular implant re-settlement. Conclusions Though rare, total hip arthroplasty-related late vascular complications could be serious and potentially affect the limb and quality of life.

  14. Hematoma neuroaxial após bloqueio peridural. É possível prevenir ou detectar? Relato de dois casos Hematoma neuroaxial posterior al bloqueo epidural. ¿Se puede prevenir o detectar? Relato de dos casos Neuraxial hematoma after epidural anesthesia. Is it possible to prevent or detect it? Report of two cases

    OpenAIRE

    Souza, Rodrigo Lima E.; Luiz Otávio Fernandes Andrade; Joaquim Belchior Silva; Luiz Antônio Carneiro da Silva

    2011-01-01

    JUSTIFICATIVA E OBJETIVOS: Os hematomas espinais são raros e acometem o sistema nervoso central. Podem causar sequelas neurológicas permanentes e morte se não tratados adequadamente. O diagnóstico e tratamento precoces são fundamentais para o bom prognóstico neurológico. O objetivo deste trabalho foi despertar no anestesiologista maior sensibilidade para o diagnóstico e o tratamento precoces dos hematomas espinais, além de aperfeiçoar sua prevenção. RELATO DOS CASOS: Caso 1: Pacie...

  15. 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.

  16. Endovascular Treatment of Incoercible Epistaxis and Epidural Cerebral Hematoma: A Case Report

    OpenAIRE

    Bortoluzzi, M.; Pavia, M.

    2006-01-01

    A young patient with a facial trauma after a road accident was admitted to our department with incoercible epistaxis. A CT scan showed a right pterional acute epidural hematoma (EDH). Angiography demonstrated multiple sources of bleeding of the right sphenopalatine arteries, cause of the epistaxis, and an intracranial leakage of the right middle meningeal artery, responsible for the EDH. The patient immediately underwent embolization of the right internal maxillary artery and right middle men...

  17. Deep Venous Thrombosis in Spine Surgery Patients: Incidence and Hematoma Formation

    OpenAIRE

    Al-Dujaili, Thair M.; Majer, Catalin N.; Madhoun, Tarek E.; Kassis, Sebouh Z.; Saleh, Alaa A.

    2012-01-01

    Deep venous thrombosis (DVT) is a significant health care problem; a variety of factors place spinal surgery patients at high risk for DVT. Our aim is to define the incidence of DVT occurrence in spite of prophylactic measures (mechanical and chemoprophylaxis), and the development of spinal epidural hematoma as a complication of chemoprophylaxis. In a single-center prospective study, 158 patients who underwent spinal surgical procedures were evaluated by clinical evaluation and lower limb Dop...

  18. An unusual cause of the acute abdomen: computed tomography angiography findings of the intestinal intramural hematoma

    International Nuclear Information System (INIS)

    Full text: Introduction: The intestinal intramural hematoma is a rare abdominal emergency condition resulting from submucosal or subserosal hemorrhage. The various causes of this condition are anticoagulant therapy, trauma, surgery, biopsy and spontaneous. The most common cause of this condition is blunt abdominal trauma. Objectives and tasks: In this report we aimed to present computed tomography (CT) angiography findings of the intestinal wall hematoma which is an unusual cause of acute abdomen. Materials and methods: A 67-year-old man presented to our emergency department complaining of severe abdominal pain, nausea and vomiting. The physical examination revealed right upper quadrant and epigastric abdominal tenderness. Sonographic examination revealed free fluid in the right paracolic area and minor pelvis. Due to these findings, the patient underwent CT angiography examination with suspicion of acute intestinal ischemia. Results: Diffuse atherosclerotic calcified plaques in the abdominal aorta and moderate degree stenosis proximal celiac truncus were determined on CT angiography images. Mesenteric arterial system was patent. On CT images most remarkable finding was diffuse wall thickening reaching up to 1.5 cm at the widest part in small intestinal segments. These findings were seen in the right half of abdomen and pelvis, approximately 12 cm and 20 cm small intestinal segment, respectively. The patient was using warfarin and acetylsalicylic acid medication due t and acetylsalicylic acid medication due to heart valve replacement surgery. This history and CT angiography findings were consistent with intestinal mural hematoma. Conclusion: In the differential diagnosis of the acute abdomen, intestinal intramural hematoma must be kept in mind, especially in patients using anticoagulant drugs. In such cases, CT angiographic examination is rapid, effective and reliable method in both determination of the vascular abnormality and evaluation of the intestinal wall pathologies

  19. Organizing hematoma in a child presenting as a 'doughnut lesion' on nuclear scan. Case report.

    Science.gov (United States)

    Harris, V J; Meeks, W; Goldbarg, H

    1977-01-01

    We report a 4 1/2-year-old boy who presented with a 4-week history of frontal headaches and fever, and generalized convulsion 5 months previously. Papilledema, an abnormal EEG and a brain scan with a frontal mass and 'doughnut' sign were found. The association of the clinical history with brain scan findings strongly suggested a brain abscess. At surgery the lesion proved to be an encapsulated hematoma; Histological findings suggest underlying microangiomata. PMID:891302

  20. Retroperitoneal hematoma after coil embolization of cerebral aneurysm -A case report-

    OpenAIRE

    Kim, Hye Young; Kim, Mi-hyun; Jung, Seung Hye; Ryu, Junghee; Jeon, Young-tae; Na, Hyo-seok; Hwang, Jin-young

    2010-01-01

    We present the case of a 57-year-old man who developed retroperitoneal hemorrhage due to unintentional arterial puncture during femoral artery cannulation for Guglielmi detachable coil embolization. On emergence from anesthesia, he developed severe hypotension. Computed tomographic angiogram of the abdomen showed retroperitoneal hematomas around the urinary bladder, liver, and spleen. Because femoral artery cannulation is a common procedure for intravascular embolization in neuroradiologic pr...

  1. HELLP Syndrome Complicated by Subcapsular Hematoma of Liver: A Case Report and Review of the Literature

    OpenAIRE

    Atilla Karateke; Dilek Silfeler; Faruk Karateke; Raziye Kurt; Ayse Guler; Ismail Kartal

    2014-01-01

    Subcapsular liver hematoma (SLH) is a rare complication of severe preeclampsia and HELLP syndrome. These patients must be followed up in intensive care unit for advanced medical support with infused fluid, replacement of blood products, and treatment of underlying disorders. There are a lot of therapeutic options varying from conservative management to surgical treatment including hepatic resection, hepatic artery ligation, and liver transplantation. In this report we aimed to present a 26-ye...

  2. Hemophilia and child abuse as possible causes of epidural hematoma: case report

    OpenAIRE

    Pinto Fernando Campos Gomes; Porro Fabrizio Frutos; Suganuma Liliana; Fontes Ricardo Bragança de Vasconcellos; Andrade Almir Ferreira; Marino Jr. Raul

    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...

  3. Hematoma perirrenal e envolvimento da artéria temporal em paciente com poliarterite nodosa (PAN) / Perirenal hematoma and involvement of the temporal artery in a patient with polyarteritis nodosa (PAN)

    Scientific Electronic Library Online (English)

    Lilian, Schade; Daniela Terumi, Akish; Salun Coelho, Aragão; Gibran Avelino, Frandolo; Eduardo dos Santos, Paiva.

    2009-08-01

    Full Text Available Descrevemos o caso de um paciente masculino, 48 anos, com poliartralgias e mialgias migratórias, associadas a febre e emagrecimento com dois meses de evolução; um episódio de dor testicular bilateral; e cefaleia unilateral pulsátil com espessamento de artéria temporal esquerda sugerindo arterite tem [...] poral. Na evolução, o paciente apresentou hematoma perirrenal esquerdo espontâneo, infartos esplênicos e insuficiência renal aguda oligúrica. Foi tratado com prednisona e ciclofosfamida. Foram realizadas biópsias de artéria temporal esquerda e músculo quadríceps. Os achados clínicos, laboratoriais, radiológicos e intercorrências levaram ao diagnóstico de poliarterite nodosa (PAN). Abstract in english We report the case of a 48-year-old male with a 2-month history of migratory polyarthralgia, and myalgia associated with fever and weight loss; one episode of bilateral testicular pain; and unilateral pulsatile headache with thickening of the left temporal artery suggestive of temporal arteritis. Th [...] e patient evolved with spontaneous left perirenal hematoma, splenic infarcts, and oliguric acute renal failure. Treatment included prednisone and cyclophosphamide. The left temporal artery and the quadriceps muscle were biopsied. Clinical, laboratorial, and radiological findings, as well as the intercurrences, led to the diagnosis of polyarteritis nodosa.

  4. Síndrome de falla multiorgánica secundario a hematoma esplénico por Plasmodium vivax / Mulitorgan dysfunction syndrome due to splenic hematoma secondary to Plasmodium vivax infection

    Scientific Electronic Library Online (English)

    Alirio R., Bastidas; Laura J., Quiroga; Jorge E., Aponte; Maria H., Aztorquiza; Carlos E., Pérez.

    2014-09-01

    Full Text Available Los cuadros de falla orgánica múltiple y mortalidad secundarios a Plasmodium vivax son escasos. Generalmente esta infección es considerada un enfermedad de curso benigno. El compromiso esplénico con la formación de hematoma es una complicación poco frecuente por este parásito pero, al presentarse, p [...] uede asociarse a un compromiso mayor de los sistemas cardiovascular, respiratorio, hematológico, renal y nervioso central; en algunos casos puede ser fatal. Para el diagnóstico de esta complicación se debe tener una alta sospecha clínica y descartar otras enfermedades, por lo cual presentamos el caso de un paciente quien cursó con un cuadro de hematoma esplénico con falla orgánica múltiple con desenlace fatal por Plasmodium vivax . Abstract in english Cases of multiple organ failure and mortality secondary to Plasmodium vivax are scarce, and the infection produced by this parasite is generally considered of a benign nature. Splenic compromise with formation of a haematoma is a complication not usually seen; however, when present, it can be associ [...] ated with a greater compromise of the cardiovascular, respiratory, hematologic, renal and central nervous systems, leading to death in some reports. To diagnose this type of complication, physicians must have a high clinical suspicion and exclude other associated pathologies. We present the case of a patient who developed splenic haematoma associated with multiple organ failure and death secondary to infection with Plasmodium vivax .

  5. Hematoma perirrenal e envolvimento da artéria temporal em paciente com poliarterite nodosa (PAN Perirenal hematoma and involvement of the temporal artery in a patient with polyarteritis nodosa (PAN

    Directory of Open Access Journals (Sweden)

    Lilian Schade

    2009-08-01

    Full Text Available Descrevemos o caso de um paciente masculino, 48 anos, com poliartralgias e mialgias migratórias, associadas a febre e emagrecimento com dois meses de evolução; um episódio de dor testicular bilateral; e cefaleia unilateral pulsátil com espessamento de artéria temporal esquerda sugerindo arterite temporal. Na evolução, o paciente apresentou hematoma perirrenal esquerdo espontâneo, infartos esplênicos e insuficiência renal aguda oligúrica. Foi tratado com prednisona e ciclofosfamida. Foram realizadas biópsias de artéria temporal esquerda e músculo quadríceps. Os achados clínicos, laboratoriais, radiológicos e intercorrências levaram ao diagnóstico de poliarterite nodosa (PAN.We report the case of a 48-year-old male with a 2-month history of migratory polyarthralgia, and myalgia associated with fever and weight loss; one episode of bilateral testicular pain; and unilateral pulsatile headache with thickening of the left temporal artery suggestive of temporal arteritis. The patient evolved with spontaneous left perirenal hematoma, splenic infarcts, and oliguric acute renal failure. Treatment included prednisone and cyclophosphamide. The left temporal artery and the quadriceps muscle were biopsied. Clinical, laboratorial, and radiological findings, as well as the intercurrences, led to the diagnosis of polyarteritis nodosa.

  6. Hematoma after augmentation mammaplasty in a patient with von Willebrand's disease / Hematoma após mamaplastia de aumento em paciente portadora de doença de von Willebrand

    Scientific Electronic Library Online (English)

    Marco Willians Baena, Destro; Áurea Regina, Rodrigues; João Lúcio Rodrigues de, Castro; Cristina, Destro; Luiz Gustavo Capochin, Romagnolo.

    2011-09-01

    Full Text Available Os autores relatam o caso de uma paciente submetida a mamaplastia de aumento, não diagnosticada previamente como portadora de doença de von Willebrand, que teve dois episódios de hematoma no pós-operatório. Entre os distúrbios de coagulação, a doença de von Willebrand deve ser considerada na avaliaç [...] ão pré-operatória, pois afeta cerca de 1% a 3% da população, não é diagnosticada na maioria das pessoas, além de ser duas vezes mais frequente que a hemofilia. A paciente evoluiu bem no pós-operatório e medidas preventivas e terapêuticas são discutidas neste artigo. Abstract in english We present the case of a patient submitted to augmentation mammaplasty who developed 2 hematoma episodes as a result of von Willebrand's disease, which was not previously diagnosed. As a routine part of preoperative evaluation, the patient should always be tested for von Willebrand's disease. This d [...] isease affects 1-3% of the population and occurs twice as often as hemophilia. In our case, the patient recovered quite satisfactorily. Preventive and therapeutic approaches are discussed in this paper.

  7. Hematoma after augmentation mammaplasty in a patient with von Willebrand's disease Hematoma após mamaplastia de aumento em paciente portadora de doença de von Willebrand

    Directory of Open Access Journals (Sweden)

    Marco Willians Baena Destro

    2011-09-01

    Full Text Available We present the case of a patient submitted to augmentation mammaplasty who developed 2 hematoma episodes as a result of von Willebrand's disease, which was not previously diagnosed. As a routine part of preoperative evaluation, the patient should always be tested for von Willebrand's disease. This disease affects 1-3% of the population and occurs twice as often as hemophilia. In our case, the patient recovered quite satisfactorily. Preventive and therapeutic approaches are discussed in this paper.Os autores relatam o caso de uma paciente submetida a mamaplastia de aumento, não diagnosticada previamente como portadora de doença de von Willebrand, que teve dois episódios de hematoma no pós-operatório. Entre os distúrbios de coagulação, a doença de von Willebrand deve ser considerada na avaliação pré-operatória, pois afeta cerca de 1% a 3% da população, não é diagnosticada na maioria das pessoas, além de ser duas vezes mais frequente que a hemofilia. A paciente evoluiu bem no pós-operatório e medidas preventivas e terapêuticas são discutidas neste artigo.

  8. Chronic Diarrhea

    Science.gov (United States)

    ... chronic diarrhea be prevented? Hygiene-related Diseases Chronic Diarrhea What is chronic diarrhea? Diarrhea that lasts for more than 2-4 ... represent a life-threatening illness. What causes chronic diarrhea? Chronic diarrhea has many different causes; these causes ...

  9. 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)hor)

  10. Nonaneurysmal subarachnoid hemorrhage in intramural hematoma of the basilar artery - a case report and literature review

    International Nuclear Information System (INIS)

    Pretruncal (perimesencephalic) nonaneurysmal subarachnoid hemorrhage (SAH) is a benign variant of SAH. Although angiography fails to show a source of the hemorrhage, mild basilar artery narrowing may be observed. The cause of pretruncal nonaneurysmal SAH has not been established. Recent imaging studies have demonstrated that the center of this type of SAH is not around the mesencephalon but is in the prepontine or interpeduncular cistern with the hemorrhage closely associated with the basilar artery. We review the possible sources of hemorrhage in these cisterns and hypothesize that pretruncal nonaneurysmal SAH is caused by a primary intramural hematoma of the basilar artery. Such an intramural hematoma would explain bleeding under low pressure, the location of the hemorrhage anterior to the brainstem, and the typical findings of hemorrhage adjacent to the basilar artery lumen on magnetic resonance imaging and mild basilar artery narrowing on angiography. Hemorrhage in such location is easily found in native computed tomography (CT) images. Crescent, hyperdense thickening of the basilar artery wall is also observed. We have presented this unusual case to highlight the possible mechanism of hematoma formation and underline the importance of MDCT examination in the diagnosis confirmation and also excluding other potentially serious underlying condition that could also lead to non traumatic SAH. (authors)

  11. 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)

  12. Evidence of basal temporo-occipital cortex involvement in stereoscopic vision in humans: a study with subdural electrode recordings.

    Science.gov (United States)

    Gonzalez, Francisco; Relova, José Luis; Prieto, Angel; Peleteiro, Manuel

    2005-01-01

    Stereoscopic vision is based on small differences in both retinal images known as retinal disparities. We investigated the cortical responses to retinal disparities in a patient suffering from occipital epilepsy by recording evoked potentials to random dot stereograms (RDS) from subdural electrodes placed in the parieto-occipito-temporal junction, medial surface of the occipital lobe (pericalcarine cortex) and basal surface of the occipital and temporal lobes (fusiform gyrus). Clear responses to disparity present in RDS were found in the fusiform cortex. We observed that the fusiform responses discriminate the onset from the offset of the stimulus, correlation from uncorrelation, and they show a longer latency than responses found in the pericalcarine cortex. Our findings indicate that the fusiform area is involved in the processing of the stereoscopic information and shows responses that suggest a high level of stereoscopic processing. PMID:15217902

  13. 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

  14. Does closed wound drainage really prevent epidural hematoma after lumbar surgery? Investigation upon postoperative magnetic resonance images

    International Nuclear Information System (INIS)

    In order to determine whether subfascial suction drains prevent epidural hematomas, 31 patients who underwent open lumbar discectomy or one-level decompression laminectomy were prospectively randomized with respect to each surgeon. The drain group (n=18) and the no-drain group (n=13) were comparable in regard to age, sex ratio, and preoperative coagulation indices. All patients underwent MRI the day after surgery and were evaluated for the presence of an epidural hematoma on axial T2-weighted images. All patients in both groups showed significant neurological improvement following surgery and there were no events suggestive of an epidural hematoma, such as intolerable pain or muscle weakness in the lower extremities. Although evidence of an asymptomatic epidural hematoma on the MRI scans was observed in a higher proportion of the patients in the drain group than in the no-drain group (54% vs. 17%), none of the patients who underwent open discectomy in either group were found to have evidence of a hematoma on their MRI scans. The results of the study suggested that suction drains are not required after open lumbar discectomy. (author)

  15. Complementary role of CT and In-111 leukocyte scans in the diagnosis of infected hematoma and thrombosis

    International Nuclear Information System (INIS)

    Patients with traumatic hematomas or those with indwelling catheters who subsequently develop fever and sepsis without clinical localizing signs to indicate an inflammatory focus can present a diagnostic dilemma. Early diagnosis of an infected hematoma or thrombus is important to optimal management. CT can provide, exquisite delineation of anatomy identifying and localizing a post-traumatic fluid collection but cannot reliably distinguish hematoma from abscess in all cases. A thrombus at a catheter tip may be too small to be resolved; when identified, the question of infection again remains. In-111 leukocyte scanning provides a method for identifying or ruling out infection in these situations. The authors performed In-111 leukocyte scans on 15 patients with indwelling catheters. Five of these patients were febrile with positive blood cultures. In-111 leukocyte scans showed positive findings in 8 patients: 5 showed surgically confirmed infected hematomas in the abdomen (3 in the pelvis, 1 in a kidney, 1 in the splenic bed), and 3 showed infected thrombosis in catheter tips. The authors conclude that CT scanning and In-111 leukocyte scanning play complementary roles in the evaluation of traumatic hematomas and thrombosis, the former providing precise anatomic delineation and the latter providing evidence of inflammation

  16. Mucocele and pyocele with marked intracranial extension

    International Nuclear Information System (INIS)

    We present two cases with frontal sinus pyocele and fronto-ethmoid sinus mucocele which showed marked intracranial extension in common. Their intracranial part appeared as a large biconvex mass, which showed iso or slightly low density homogeneously and had gross calcification in the posterior rim. The findings of the paranasal sinuses and the orbit in tomograms and CT scans are thought to be useful in the differential diagnosis from chronic subdural hematoma and so on. (author)

  17. Mucocele and pyocele with marked intracranial extension

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Kazuhiro; Machida, Tohru; Iio, Masahiro

    1984-08-01

    Two cases are presented with frontal sinus pyocele and fronto-ethmoid sinus mucocele in which marked intracranial extension is shown. Their intracranial part appeared as a large biconvex mass, which showed iso or slightly low density homogeneously and had gross calcification in the posterior rim. The findings of the paranasal sinuses and the orbit in tomograms and CT scans are thought to be useful in the differential diagnosis of chronic subdural hematoma.

  18. Subperiosteal hematoma and orbital compression syndrome following minor frontal trauma in sickle cell anemia: case report / Hematoma subperiósteo e compressão orbitária após trauma frontal leve na anemia falciforme: relato de caso

    Scientific Electronic Library Online (English)

    Fernando, Procianoy; Mauro, Brandão 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 doença falciforme, trazida à sala de emergência após ser atingida por um bloco de barro na região frontal esquerda. Apresentava ao exame proptose do olho esquerdo, edema palpebral, diminuição da acuidade visual e defeito pupilar aferente, sem quaisquer s [...] inais inflamatórios como febre, hiperemia ou aumento de sensibilidade. A tomografia computadorizada de órbitas demonstrou um extenso hematoma subperiósteo superomedial na órbita esquerda. A paciente foi tratada com cantotomia, cantólise e drenagem cirúrgica do hematoma. Dois dias após a drenagem, ela permaneceu com um hematoma subperiósteo e a acuidade visual diminuída. Uma ampla exploração através de incisão no sulco palpebral superior revelou um rebordo orbitário superior espessado, e múltiplos defeitos ósseos ao longo do teto da órbita com sangramento persistente. Foi realizada hemostasia com cera óssea. A compressão orbitária foi resolvida, e a paciente recuperou a acuidade visual normal prévia. 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.

  19. Clinical evaluation of a portable near-infrared device for detection of traumatic intracranial hematomas.

    Science.gov (United States)

    Robertson, Claudia S; Zager, Eric L; Narayan, Raj K; Handly, Neal; Sharma, Alok; Hanley, Daniel F; Garza, Homero; Maloney-Wilensky, Eileen; Plaum, Justin M; Koenig, Carolyn H; Johnson, Anne; Morgan, Timothy

    2010-09-01

    The purpose of this multicenter observational clinical study was to evaluate the performance of a near-infrared (NIR)-based, non-invasive, portable device to screen for traumatic intracranial hematomas. Five trauma centers collected data using the portable NIR device at the time a computed tomography (CT) scan was performed to evaluate a suspected traumatic brain injury (TBI). The CT scans were read by an independent neuroradiologist who was blinded to the NIR measurements. Of 431 patients enrolled, 365 patients were included in the per-protocol population analyzed. Of the 365 patients, 96 were determined by CT scan to have intracranial hemorrhages of various sizes, depths, and anatomical locations. The NIR device demonstrated sensitivity of 88% (95% confidence interval [CI] 74.9,95.0%), and specificity of 90.7% (95% CI 86.4,93.7%), in detecting the 50 intracranial hematomas that were large enough to be clinically important (larger than 3.5?mL in volume), and that were less than 2.5?cm from the surface of the brain. For all 96 cases with intracranial hemorrhage, regardless of size and type of hemorrhage, the sensitivity was 68.7% (CI 58.3,77.6%), and specificity was 90.7% (CI 86.4,93.7%). These results confirm the results of previous studies that indicate that a NIR-based portable device can reliably screen for intracranial hematomas that are superficial and of a size likely to be of clinical importance. The NIR device cannot replace CT scanning in the diagnosis of TBI, but the device might be useful to supplement clinical information used to triage TBI patients, and in situations in which CT scanning is not readily available. PMID:20568959

  20. Evaluation of three imaging instruments in dogs with liver hematomas: concise communication

    International Nuclear Information System (INIS)

    Single-gamma emission computerized tomography (ECT) was compared with transmission computerized tomography (TCT) and scintillation-camera imaging (SC) in eight dogs with acute, solitary hematomas in the left liver lobe. The superior performance of TCT was attributed to its inherently better spatial resolution than those of ECT or SC, and to the fact that studies with TCT could be performed during apnea. ECT was more sensitive than SC to small changes in the spatial distribution of radionuclides. In addition, the ECT, by virtue of its sectioning capability, was more sensitive than is SC to differences in radionuclide concentrations at the same depth in an organ

  1. Spontaneous peri-nephric hematoma in a patient with acute kidney injury following Russell's viper envenomation.

    Science.gov (United States)

    Golay, Vishal; Roychowdhary, Arpita; Pandey, Rajendra

    2015-03-01

    Snake bite envenomation is a common cause of acute kidney injury (AKI) in the tropics and severe coagulopathy with bleeding manifestations is usually seen, especially with viperine bites. We present a case of a 34-year-old male who had developed AKI following Russell's viper envenomation along with disseminated intravascular coagulation. The patient was seemingly improving during the course of his treatment but subsequently developed a spontaneous unilateral peri-nephric hematoma and finally succumbed to this complication. This is a rare presentation that can be clinically innoccuous in a disease where there are multiple bleeding manifestations and, carries a very poor outcome. PMID:25758885

  2. Intracranial hematoma and SAH: actual aspects in its interpretation with magnetic resonance

    International Nuclear Information System (INIS)

    A basic understanding of the magnetic properties of Hb degradation products explains the mechanisms and production of the signals occurring at the different stages of the formation and degradation of intracranial hematoma and SAH. Despite the interaction among complex phenomena and the fact that their explanations are not univocal, since many phenomena remain to be understood even in the light of those theories that, at present, most closely agree, the proposed models permit the comprehension and diagnosis of a pathology which, in addition to being common, is diagnostically relevant and serves as paradigm in Radiological research. (Author) 44 refs

  3. Lumbar epidural hematoma following lumbar puncture: the role of high dose LMWH and late surgery. A case report / Hematoma lumbar epidural postpunción lumbar: influencia de dosis altas de LMWH y cirugía diferida

    Scientific Electronic Library Online (English)

    D., Gurkanlar; C., Acikbas; G.K., Cengiz; R., Tuncer.

    2007-02-01

    Full Text Available El hematoma espinal epidural (HEE) es una complicación conocida en la cirugía espinal, pero la incidencia del HEE que da lugar a déficit neurológico es muy rara (0.1%). Los pacientes que necesitan intervenciones en varios niveles lumbares y/o que tienen una coagulopatía preoperatoria tienen un riesg [...] o significativamente mayor de desarrollar un hematoma epidural. La introducción de dosis altas de heparina de bajo peso molecular (HBPM), (30 mgrs. dos veces al día) aumentan la incidencia de hematomas neuroaxiales. La cirugía llevada a cabo dentro de las 8 horas da lugar a un recuperación buena o parcial de la función neurológica. Nuestro paciente fue tratada con dosis altas de HBPM y desarrolló un déficit neurológico debido a un HEE, después de una punción lumbar. Fue operada al cabo de seis días y se recuperó parcialmente de su déficit después de la intervención. La administración actual de dosis altas de HBPM puede dar lugar a HEE, incluso después de una punción lumbar, que se hizo en pocos intentos. Aunque la cirugía realizada en las primeras 8 horas produce una recuperación buena o parcial, la laminectomía y evacuación del hematoma llevada a cabo después de tres días también puede dar lugar a buenos resultados. Abstract in english Spinal epidural hematoma (SEH) is a known complication of spinal surgery, but the incidence of post-surgical SEHs that result in neurologic deficits is extremely rare (0.1%). Patients that require multilevel lumbar procedures and/or have a preoperative coagulopathy are at a significantly higher risk [...] of developing an epidural hematoma. The introduction of higher dose of low molecular weight heparin (LMWH) twice daily 30 mg regimen) increased the reported incidence of neuroaxial hematomas. Surgery performed within 8 hours makes good or partial recovery of neurologic function. Our patient was also started on higher dose of LMWH and developed neurological deficits due to a SEH following lumbar puncture. She underwent operation after six days and she had a mild recovery following the operation. Current administration of high doses of LMWH can cause SEH even after a lumbar puncture, which was performed without multiple attempts. Although surgery performed within 8 hours makes good or partial recovery of neurologic function, laminectomy and epidural hematoma evacuation performed after three days can also have successful results.

  4. Conservative treatment of a left atrial intramural hematoma after left atrial thrombus resection and concomitant mitral valve replacement - case report

    Directory of Open Access Journals (Sweden)

    Schmitz Christoph

    2011-04-01

    Full Text Available Abstract Left atrial intramural hematoma is a seldom cause of left atrial mass. It has been described to occur spontaneously, after interventional procedures, after blunt chest trauma, or after aortocoronary bypass surgery. We present a case of mitral valve replacement together with the removal of a large intraatrial space-occupying lesion. Intraoperative transesophageal echocardiography confirmed a successful resection of this mass. Surprisingly, upon admission to ICU, transesophageal and transthoracic echocardiography revealed a recurrence of an intramural lesion, closest matching a hematoma, which was confirmed by contrast-enhanced computed tomography. Surgical intervention was thoroughly discussed but a conservative management was favoured. 3 months after surgery, a reassessed transthoracic echocardiography and computed tomography demonstrated an almost complete resolution of the pre-existing hematoma.

  5. 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)l vasospasm. (author)

  6. [A case of intrarenal hematoma: role of ultrasonography in the early diagnosis of a possible complication of anticoagulant therapy].

    Science.gov (United States)

    Dugo, Mauro; La Torre, Ermanno; Farneti, Fabrizio; Caberlotto, Adriana; Pasi, Alessandra; Puggia, Riccarda; Gatti, Pierluigi; Maresca, Maria Cristina

    2012-01-01

    Uremia associated with anticoagulant therapy is a high risk factor for bleeding complications in patients undergoing hemodialysis. We report a case of intrarenal hematoma arising in a uremic patient treated with warfarin. The hematoma was rapidly diagnosed by ultrasonography of the abdomen and treated with embolization. Our experience confirms that the availability of an ultrasound facility within the renal unit allows better assessment of our patients, also in the management of the most fearsome and rare complications. Moreover, it strengthens the evidence that uremic patients are at high risk of bleeding complications when treated with oral anticoagulants. PMID:23117741

  7. Serious clopidogrel associated renal hematoma in a type 2 diabetic patient with primary hyperparathyroidism after extracorporeal shock wave lithotripsy

    International Nuclear Information System (INIS)

    Renal hematoma after extracorporeal shock wave lithotripsy SWL is a rare complication. We report a case of a large renal hematoma following SWL that resulted in nephrectomy in a type 2 diabetic patient with primary hyperparathyroidism using clopidogrel due to coronary heart disease CHD. Although it was claimed that preoperative use of clopidogrel was not associated with increased bleeding, all patients who are scheduled for SWL should be interrogated in terms of using of platelet aggregation inhibitors such as clopidogrel, and these drugs should be interrupted appropriately before undergoing SWL. (author)

  8. Compartment syndrome due to massive leg hematoma after primary total hip arthroplasty: a previously unreported complication of fondaparinux.

    Science.gov (United States)

    Hannon, Michael G; Lamont, Justin G

    2012-08-01

    Fondaparinux is an accepted form of deep venous thrombosis prophylaxis after hip arthroplasty. Cited advantages of its use include once-daily administration, standard dosage, and superiority as compared with enoxaparin. However, there have been several case reports of serious associated bleeding complications. We describe the case of a 77-year-old woman who developed a massive leg hematoma in the operative extremity nearly 3 weeks after a primary total hip arthroplasty while on fondaparinux. The patient developed a compartment syndrome requiring decompression of the hematoma, fasciotomy, and subsequent additional plastic surgery for split thickness skin grafting. PMID:22177799

  9. Moessbauer study of the time evolution of the biochemical composition of the hematomas. Relationship with magnetic resonance imaging (MRI)

    International Nuclear Information System (INIS)

    Biochemical constitution of the hematoma is depending of its evolution. In order to obtain a reliable diagnostic of the NMR images in case of vascular accidents, a systematic study of the time-evolution of hematomas has been performed, using Moessbauer spectrometry and complementary technics (ESR and visible absorption spectrophotometry). The change, in the course of time, of HbO2 in deoxyhemoglobin Hb and other denaturation products (MHb, hemi- and hemochromes, ...) are well-recognized on the different spectra. T1 and T2 NMR relaxation times are measured in the same time and their shortening is related to the appearance of the paramagnetic denaturation blood compounds. (orig.)

  10. Natural history of spontaneous aortic intramural hematoma progression: Six years follow-up with cardiovascular magnetic resonance

    Directory of Open Access Journals (Sweden)

    Zhao Lei

    2010-05-01

    Full Text Available Abstract We described a 6 years follow-up of a spontaneous aortic intramural hematoma (IMH with cardiovascular magnetic resonance (CMR examination. Since multiple factors may play roles in the natural history of IMH, the patient experienced the course of progression, which included hematoma absorption, ulcer-like lesion, aneurysm and limited dissection. The initial and follow-up CMR examination included 3D CE MRA and non-enhanced "bright blood" pulse sequence. The inherent advantage of outstanding contrast with plain scan, which shorten the scan time and avoid potential risk of contrast agent, might make the fast gradient echo sequence as an alternative method when following stable IMH.

  11. Predictive value of small ulcers in the evolution of acute type B intramural hematoma

    International Nuclear Information System (INIS)

    Objective: To assess the long-term evolution and predictive factors of type B intramural hematoma (IMH). Material and methods: 34 patients (33 men), mean age: 67 years (47–87) diagnosed with type B IMH by computed tomography (CT) and followed up clinically and by CT yearly. Mean follow-up was 5.9 years (2–13 years). Two evolution patterns were considered: (a) regression and (b) progression. Clinical and imaging variables were analyzed for assessing their predictor values. Results: Evolution at one year was to regression in 56% and to progression in 44% of cases. There were no association among age, sex, other aortic abnormalities, presence of atherosclerotic disease or blood pressure, initial maximum aortic diameter, indexed maximum aortic diameter, IMH thickness or length, presence or absence of mediastinal hematoma and the evolution of type B IMH. Ten patients had small aortic ulcers in the acute phase. The presence of ulcers was related with progression of IMH. No differences were observed in evolution between the control at first year and the last control. Conclusions: The presence of small ulcers is a strong predictor of evolution in acute type B IMH. In addition, the regression group remains completely stable after the first year of evolution.

  12. Hematoma intrahepático y subcapsular posterior a colangiopancreatografía retrógrada endoscópica (CPRE) reporte de un caso y revisión

    Scientific Electronic Library Online (English)

    Miguel, Del Rossi; Yolette, Martínez; César, Louis; Miguel, Garassini Ch.

    2007-09-01

    Full Text Available Las complicaciones de la colangiopancreatografía retrógrada endoscópica (CPRE) terapéutica más frecuentes son: pancreatitis, hemorragia y colangitis. La hemorragia extraluminal, así como las complicaciones que son asociadas con el uso de guía metálica son raras, afortunadamente, pero pueden ser más [...] frecuentes de lo reportado. Nosotros describimos el caso de una paciente de 28 años de edad, con ictericia obstructiva por coledocolitiasis, quien fue sometida a CPRE electiva para extracción de litiasis biliar. Posteriormente se presentó como complicación hematomas hepáticos intraparenquimatoso y subcapsular, probablemente por lesión producida por la guía metálica utilizada durante dicho procedimiento. Esta complicación fue tratada con medidas conservadoras no quirúrgicas con buenos resultados. El diagnóstico y tratamiento precoz de esta complicación pueden evitar la cirugía. Abstract in english The most frequent complications of endoscopic retrograde cholangiopancreatography (ERCP) are pancreatitis, bleeding and cholangitis. A number of less common adverse events have also been described including intraperitoneal bleeding reported in only a small number of patients or as individual case re [...] ports. A case of a 28-year-old female patient with choledocholithiasis is presented. Elective ERCP was performed with stone extraction. Intraparenchymal and subcapsular hepatic hematoma was reported following ERCP as a short term complication probably caused by the guide wire. This complication was treated with conservative measures. Early diagnosis and treatment of this complication can avoid surgery.

  13. Surgical treatment of progressive ethmoidal hematoma aided by computed tomography in a foal

    International Nuclear Information System (INIS)

    A progressive ethmoidal hematoma (PEH) was treated successfully in a 4-week-old Belgian filly by surgical removal, using a frontonasal bone flap. The filly had respiratory stridor, epistaxis, and facial enlargement over the left paranasal sinuses, which had progressively increased in size since birth. Computed tomographic images of the head obtained with the foal under general anesthesia were useful in determining the extent and nature of the soft-tissue mass and planning surgical intervention. On the basis of the histologic appearance of the mass, a diagnosis of PEH was made. Twelve months after surgery, the facial appearance was normal and the abnormal appearance of the ethmoid region on endoscopic evaluation was less obvious, with return of the nasal septum to a normal position. Progressive ethmoidal hematoma is uncommon and, to our knowledge, has not been reported in a neonate. Clinical signs of PEH in this foal were atypical because of the rapid enlargement of the mass, extent of facial deformity, and minimal epistaxis and interoperative hemorrhage

  14. Pancreatite aguda devida a hematoma intramural do duodeno por uso de anticoagulante Acute pancreatitis due to intramural hematoma of the duodenum by use of anticoagulant therapy

    Directory of Open Access Journals (Sweden)

    Samer FARHOUD

    2001-01-01

    Full Text Available Racional - A hemorragia intramural espontânea do duodeno causada por complicações da terapêutica anticoagulante é rara e seu tratamento controverso. Objetivo -- Apresentar a experiência advinda do tratamento de doente com essa condição clínica. Relato do caso - Expõe-se o caso de uma mulher de 71 anos de idade, que há 3 meses fazia uso de anticoagulante oral para tratamento de trombose venosa profunda dos membros inferiores. Apresentou-se com cefaléia e dores abdominais intensas no andar superior do abdome, associadas a náuseas e vômitos. Os exames laboratoriais e de imagem comprovaram o diagnóstico de surto agudo de pancreatite, decorrente de hematoma intramural de duodeno. Os valores de protrombina (49,7 s e o sangramento de tecidos moles cervicais e urinário, sugeriam complicação da terapêutica anticoagulante. Resultados - A terapêutica conservadora foi efetiva, tendo a doente recebido alta, assintomática, no 10º dia de internação. Conclusão - É recomendado o emprego do anticoagulante em doses menores nos doentes de risco e adequado controle dos parâmetros da coagulação. Acredita-se ser ideal a conduta conservadora e recomenda-se a cirurgia somente nos casos que evoluem com complicações.Background - Spontaneous intramural hemorrhage of the duodenum due to anticoagulant therapy is rare and the treatment is controversial. Objective - To present the acquired knowledge with the treatment of these disease. Case report - A 71-year-old women receiving for a 3 month period an anticoagulant therapy presented cervical bleeding of soft tissues and symptoms of acute pancreatitis and high small bowel obstruction. Early noninvasive diagnosis by computed tomographic scan was possible and conservative therapy proved successful in complete resolution of the pancreatitis and obstructive symptoms, with resumption of oral intake in the fourth day of treatment. The frequency of bleeding in high risk patients during warfarin therapy is reduced by less intense therapy, achieving a prothrombin time with an International Normalized Ratio of 2,0 to 3,0. Results -- The use of conservative treatment was helpful and the patient was discharged asymptomatic, 10 days after admission. Conclusion -- It is suggested conservative treatment for intramural hematoma of the duodenum and recommended laparotomy only when complications occur.

  15. Hematoma Disecante de la Parte Torácica de la Aorta: Estudio Anatomopatológico de Siete Casos de Autopsias / Dissecting Hematoma of the Thoracic Aorta: Pathology Study of Seven Autopsy Cases

    Scientific Electronic Library Online (English)

    Julio César, Guerini; Andrea, Storniolo Squintone; Alba, Borchert; Ismael Bernardo, Fonseca; Rodolfo Esteban, Avila; Luis Santos, Spitale.

    1331-13-01

    Full Text Available El hematoma disecante de aorta (HDA) se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuest [...] ro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Patología del Instituto de Medicina Forense de Córdoba, Argentina. Los tejidos fueron fijados en formol al 10%, incluidos en parafina y coloreados con hematoxilina-eosina, tricrómico de Masson y PAS (Peryodic Acid Schiff). De los siete casos presentados cuatro correspondieron a mujeres (57,1%) y tres a hombres (42,8%). Todos los casos estudiados tenían antecedentes de hipertensión arterial. La evolución posible de la disección aórtica incluye: rotura de la adventicia con hemorragia masiva y muerte, comunicación nuevamente con la luz aórtica, propagación al ostium coronario, isquemia de órganos y la formación de un aneurisma. Abstract in english Dissecting aortic hematoma (DAH) is defined as the dissection of the aortic wall by the blood, with formation of a new light. It is the deadliest disease of the aorta and occurs more frequently diagnosed at a rate three times greater than the ruptured aneurysm of the abdominal aorta. Our goal is to [...] present seven cases of DAH observed in autopsies, describe the autopsy findings and comment on the literature. All cases studied belong to the Department of Pathology, Institute of Forensic Medicine of Cordoba, Argentina. The tissues were fixed in 10% formalin, embedded in paraffin and stained with hematoxylin-eosin, Masson trichrome and PAS (Peryodic Acid Schiff). Of all the cases studied, four were women (57.1%) and three men (42.8%). All had a history of hypertension. Evolution of aortic dissection may include: failure of the adventitia with massive hemorrhage and death, again communication with the aortic lumen, spread the coronary ostium, organ ischemia and aneurysm formation.

  16. Hematoma Disecante de la Parte Torácica de la Aorta: Estudio Anatomopatológico de Siete Casos de Autopsias Dissecting Hematoma of the Thoracic Aorta: Pathology Study of Seven Autopsy Cases

    Directory of Open Access Journals (Sweden)

    Julio César Guerini

    2011-12-01

    Full Text Available El hematoma disecante de aorta (HDA se define como la disección de la pared aórtica por la sangre, con formación de una nueva luz. Es la patología letal de la aorta más frecuentemente diagnosticada y ocurre con una frecuencia tres veces mayor que la rotura del aneurisma de la aorta abdominal. Nuestro objetivo es presentar siete casos de HDA observados en autopsias, describir los hallazgos anatomopatológicos y comentar la literatura. Los casos estudiados corresponden al Servicio de Patología del Instituto de Medicina Forense de Córdoba, Argentina. Los tejidos fueron fijados en formol al 10%, incluidos en parafina y coloreados con hematoxilina-eosina, tricrómico de Masson y PAS (Peryodic Acid Schiff. De los siete casos presentados cuatro correspondieron a mujeres (57,1% y tres a hombres (42,8%. Todos los casos estudiados tenían antecedentes de hipertensión arterial. La evolución posible de la disección aórtica incluye: rotura de la adventicia con hemorragia masiva y muerte, comunicación nuevamente con la luz aórtica, propagación al ostium coronario, isquemia de órganos y la formación de un aneurisma.Dissecting aortic hematoma (DAH is defined as the dissection of the aortic wall by the blood, with formation of a new light. It is the deadliest disease of the aorta and occurs more frequently diagnosed at a rate three times greater than the ruptured aneurysm of the abdominal aorta. Our goal is to present seven cases of DAH observed in autopsies, describe the autopsy findings and comment on the literature. All cases studied belong to the Department of Pathology, Institute of Forensic Medicine of Cordoba, Argentina. The tissues were fixed in 10% formalin, embedded in paraffin and stained with hematoxylin-eosin, Masson trichrome and PAS (Peryodic Acid Schiff. Of all the cases studied, four were women (57.1% and three men (42.8%. All had a history of hypertension. Evolution of aortic dissection may include: failure of the adventitia with massive hemorrhage and death, again communication with the aortic lumen, spread the coronary ostium, organ ischemia and aneurysm formation.

  17. Hemorragia suprarrenal que se manifiesta como hematoma escrotal en el recién nacido: A propósito de un caso / Adrenal hemorrhage presenting as a scrotal hematoma in the newborn: A case report

    Scientific Electronic Library Online (English)

    Erbu, Yarci; Sema, Arayici; Fatma, Nur Sari; Fuat, Emre Canpolat; Nurdan, Uras; Ugur, Dilmen.

    2015-06-01

    Full Text Available La hemorragia suprarrenal neonatal es poco frecuente. Se presenta en el 0,2% de los recién nacidos. El 10% de los casos son bilaterales. Puede estar asociada a un traumatismo al nacimiento, peso alto al nacer o un curso neonatal complicado por hipoxia, asfixia, hipotensión o coagulopatía. El hematom [...] a escrotal es una manifestación extremadamente rara de la hemorragia suprarrenal neonatal. La mayoría de los pacientes presentan tumefacción escrotal con coloración azulada. En los recién nacidos, la tumefacción escrotal, con o sin coloración azulada, puede deberse a diferentes causas. Comunicamos un caso inusual de hemorragia suprarrenal neonatal secundaria a asfixia perinatal, que se manifestó con un hematoma escrotal. El diagnóstico de hemorragia suprarrenal neonatal y hematoma escrotal fue ecográfico; el tratamiento conservador evitó la exploración quirúrgica innecesaria. Abstract in english Neonatal adrenal hemorrhage is uncommon. It is present in 0,2% of newborns. Ten percent of the cases occur bilaterally. It can be associated with birth trauma, large birth weight, or neonatal course complicated by hypoxia and asphyxia, hypotension, or coagulopathy. Scrotal hematoma is an extremely r [...] are manifestation of NAH. Most patients present scrotal swelling with bluish discolouration. Scrotal swelling with/without bluish discoloration in newborns may result from different causes. We report an unusual case of neonatal adrenal hemorrage secondary to perinatal asphyxia, associated with SH. Neonatal adrenal hemorrhage and scrotal hematoma were diagnosedby ultrasonography and treated by conservative treatment, avoiding unnecessary surgical exploration.

  18. Antiplatelet therapies are associated with hematoma enlargement and increased mortality in intracranial hemorrhage / El tratamiento antiagregante se asocia a un aumento del tamaño del hematoma y de la mortalidad en la hemorragia intracraneal

    Scientific Electronic Library Online (English)

    J.H. de, Gea-García; M., Fernández-Vivas; R., Núñez-Ruiz; M., Rubio-Alonso; I., Villegas; M., Martínez-Fresneda.

    2012-11-01

    Full Text Available Objetivo: Con el envejecimiento progresivo de la población cada es más frecuente la toma de fármacos antiagregantes para el tratamiento o la prevención de las enfermedades vasculares. El beneficio, en ocasiones, está contrarrestado por el riesgo de hemorragias, especialmente la hemorragia intracrane [...] al (HIC). Nuestro objetivo fue determinar si el tratamiento antiagregante (TAG) provoca un aumento del tamaño del hematoma y de mortalidad en la HIC. Diseño: Estudio de cohortes prospectivo y observacional. Ámbito: Unidad de cuidados intensivos (UCI) del Hospital Universitario Virgen de la Arrixaca (Murcia). Pacientes: Estudiamos a 156 pacientes que ingresaron por HIC no traumática entre Enero de 2006 y Agosto de 2008. Intervenciones: Ninguna. Principales variables: Se recogieron datos demográficos, antecedentes personales, parámetros clínicos y analíticos, así como, el volumen del hematoma al ingreso y a las 24 horas, además de la mortalidad. Resultados: Entre los pacientes estudiados, 37 (24%) tomaban TAG. Los antiagregados eran de mayor edad (69±11 vs 60±15 años, p=0,001) y con mayor frecuencia diabéticos (38 vs 15%, p=0,003). No hubo diferencias en el volumen del hematoma al ingreso entre los dos grupos pero este fue significativamente mayor a las 24 horas en los antiagregados (66.7 [IQR 42-110] vs 27 [4.4-64.6] cm³, p=0.03), independientemente de si fueron intervenidos o no. Además, el volumen del hematoma creció en más de un 33% en los antiagregados (69 vs 33%, p=0,002) y el TAG fue el único predictor significativo del crecimiento del hematoma. Los pacientes antiagregados también presentaron una mayor mortalidad durante su estancia en la UCI (78 vs 45%, p Abstract in english Objective: Antiplatelet therapy (AT) is increasingly used for treating or preventing vascular diseases, especially as a consequence of population aging. However, the risks may sometimes outweigh the benefits, mostly in relation to intracranial hemorrhage (ICH). Our aim was to determine whether AT is [...] associated with hematoma enlargement and increased mortality in ICH. Design: A prospective, observational cohort study. Setting: The Intensive Care Unit (ICU) of Arrixaca University Hospital (Murcia, Spain). Patients: We studied 156 patients admitted with non-traumatic ICH between January 2006 and August 2008. Interventions: None. Main variables: Demographic data, medical history and clinical and laboratory parameters were recorded, along with hematoma volume upon admission and after 24h, and mortality. Results: A total of 37 patients (24%) received AT. These subjects were older (69±11 vs. 60±15 years, p=0.001) and more frequently diabetic (38% vs. 15%, p=0.003) than those without AT. We detected no difference in hematoma volume upon admission between the two groups, though the volume was significantly greater after 24h in the AT group (66.7 [IQR 42-110] vs. 27 [4.4-64.6]cm³, p=0.03), irrespective of surgical intervention. Moreover, hematoma volume increased by more than a third in AT-users (69% vs. 33%, p=0.002), and AT was the only significant predictor of hematoma enlargement. Patients on AT also had higher mortality during their ICU stay (78% vs. 45%, p

  19. Comparative Effectiveness of Family Problem-Solving Therapy (F-PST) for Adolescent TBI

    Science.gov (United States)

    2015-02-16

    Tbi; Intracranial Edema; Brain Edema; Craniocerebral Trauma; Head Injury; Brain Hemorrhage, Traumatic; Subdural Hematoma; Brain Concussion; Head Injuries, Closed; Epidural Hematoma; Cortical Contusion; Wounds and Injuries; Disorders of Environmental Origin; Trauma, Nervous System; Brain Injuries

  20. Aortic dissection presenting with secondary pulmonary hypertension caused by compression of the pulmonary artery by dissecting hematoma: a case report

    International Nuclear Information System (INIS)

    The rupture of an acute dissection of the ascending aorta into the space surrounding the pulmonary artery is an uncommon occurrence. No previous cases of transient pulmonary hypertension caused by a hematoma surrounding the pulmonary artery have been documented in the literature. Herein, we report a case of acute aortic dissection presenting as secondary pulmonary hypertension

  1. The Relationship of Hematoma Size and Mortality in Non-Traumatic Intra-Cerebral Hemorrhages in Basal Ganglia

    Directory of Open Access Journals (Sweden)

    P. Ahmadi

    2006-04-01

    Full Text Available Introduction & Objective: Among all of the neurologic diseases in adult life, the cerebrovascular disease (CVD is the most common and important ones. Intracerebral hemorrhage (ICH in basal ganglia (BG is one of the common and major types of CVD. The relations between clot size and mortality rate, in different parts of the brain, has been addressed by several researchers. It is unclear whether such a relationship is in BG. Therefore this study was designed to find a formula that predicts outcome of hemorrhage based on clot size in BG.Materials & Methods: This descriptive-comparative study that was carried out prospectively, conducted on all 63 patients who admitted to the hospital during one year, with definite diagnosis of ICH in BG. After urgent CT scanning, the size of hematoma was determined by scan images. Routine treatment was uniform for all patients. Focal signs and consciousness state were assessed in the first and last days of admission. The data were analyzed using descriptive statistics, frequency tables and chi-square and T- test. Results: 33% of patients died. Hematoma size in 70% of them was larger than 5cm and in other 30% smaller. None of the hematoma with less than 4cm size was fatal. In patients with clots of 5cm or larger, the mortality was 100%. Conclusion: The results indicated that, there was meaningful relationship between hematoma size and mortality, in BG hemorrhages. So the clot size can be used as a factor in predicting hemorrhage outcome in BG.

  2. Vascular lesions of the lumbar epidural space: magnetic resonance imaging features of epidural cavernous hemangioma and epidural hematoma

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    Basile Júnior Roberto

    1999-01-01

    Full Text Available The authors report the magnetic resonance imaging diagnostic features in two cases with respectively lumbar epidural hematoma and cavernous hemangioma of the lumbar epidural space. Enhanced MRI T1-weighted scans show a hyperintense signal rim surrounding the vascular lesion. Non-enhanced T2-weighted scans showed hyperintense signal.

  3. Axillary artery injury combined with delayed brachial plexus palsy due to compressive hematoma in a young patient: a case report

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    Yajima Hiroshi

    2008-03-01

    Full Text Available Abstract Introduction Axillary artery injury in the shoulder region following blunt trauma without association with either shoulder dislocation or fracture of the humeral neck has been previously reported. Axillary artery injury might also be accompanied with brachial plexus injury. However, delayed onset of brachial plexus palsy caused by a compressive hematoma associated with axillary injury after blunt trauma in the shoulder region has been rarely reported. In previous reports, this condition only occurred in old patients with sclerotic vessels. We present a case of a young patient who suffered axillary artery injury associated with brachial plexus palsy that occurred tardily due to compressive hematoma after blunt trauma in the shoulder region without association of either shoulder dislocation or humeral neck fracture. Case presentation A 16-year-old male injured his right shoulder in a motorbike accident. On initial physical evaluation, the pulses on the radial and ulnar arteries in the affected arm were palpable. Paralysis developed later from 2 days after the injury. Functions in the right arm became significantly impaired. Angiography showed complete occlusion of the axillary artery. Magnetic resonance imaging demonstrated a mass measuring 4 × 5 cm that was suspected to be a hematoma compressing the brachial plexus in a space between the subscapular muscle and the pectoralis minor muscle. Surgery was performed on the third day after injury. In intraoperative observations, the axillary artery was occluded with thrombus along 5 cm; a subscapular artery was ruptured; the brachial plexus was compressed by the hematoma. After evacuation of the hematoma, neurolysis of the brachial plexus, and revascularization of the axillary artery, the patient had an excellent functional recovery of the affected upper limb, postoperatively. Conclusion Surgeons should be aware that axillary artery injuries may even occur in young people after severe blunt trauma in the shoulder region and can be associated with secondary brachial plexus injury due to a hematoma. For treatment in cases with progressive nervous deficit after trauma, not only reconstruction of the injured artery but also immediate evacuation of the hematoma, and exploration of the brachial plexus are necessary to avoid irreversible neurological damage.

  4. Chronic sorrow

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    Ivka Blaževi?

    2011-11-01

    Full Text Available Chronic grief is a normal response to lost, and can be persistant in parents of sick children, or acute when a dear person is lost. In this paper, the theoretical model of chronic grief is presented, a model that gives an alternative way to observe and react to experience of pain (grief and sorrow. While treating the medical condition of the patients, it is important to pay attention to his emotional condition, too. The concept of loneliness is connected to the theory oft he chronic grief, because the key component oft he loneliness and chronic grief is a lost. The theory of the chronic grief gives the guidelines to understanding and work with individuals who survived the important loss. Situation and circumstances that cause chronic grief and loneliness are identified and methods of management of chronic grief, considered as useful are described in this paper. The research on chronic grief includes qualitative methods, such as interviews face-to-face, or by phone, Burke/NCRCS questionnaire on chronic gried, instrument for evaluation of chronic grief by Kendall (Kendall Chronic Sorrow Instrument, KCSI, which has 18 parts and is designed to observe and measure the experience of chronic grief. The results have demonstrated that KCSI is valid and reliable, and adds to quantitative research on chronic grief. Empirical dana give means to ensure measurability of the defined atributes of loneliness.Modernization of society, technical and biomedical achievements, faster life style, loss of communication lead to loneliness and alienation. Future research should be focused on finding efficient internal methods of chronic grief management.

  5. Three select subungual pathologies: subungual exostosis, subungual osteochondroma, and subungual hematoma.

    Science.gov (United States)

    Grisafi, P J; Lombardi, C M; Sciarrino, A L; Rainer, G F; Buffone, W F

    1989-04-01

    Special attention has been given to the differences between subungual exostosis and subungual osteochondroma. Once a diagnosis has been made and symptoms persist, complete excision of the lesion with curettage of the base is the treatment of choice for both conditions. Subungual hematoma is an exquisitely painful condition that usually results from trauma, but may also be caused by systemic pathology, medication and drug reactions, and aging. Prompt decompression will significantly reduce pain and further damage to the nail bed and matrix. Radiographs must be taken because of the high incidence of associated distal phalangeal fracture. Patients must be warned that onycholysis, transient and permanent nail deformity, and infection are possible complications, even with the best treatment. PMID:2650846

  6. Achalasia combined with esophageal intramural hematoma: Case report and literature review

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    Yin-Yi Chu, Kai-Feng Sung, Soh-Ching Ng, Hao-Tsai Cheng, Cheng-Tang Chiu

    2010-11-01

    Full Text Available A 62-year-old male patient was admitted to our hospital due to severe chest pain, odynophagia, and hematemesis. Chest computed tomography showed an esophageal submucosal tumor. Esophagogastroduodenoscopy (EGD revealed a longitudinal purplish bulging tumor of the esophagus. Endoscopic ultrasound (EUS showed a mixed echoic tumor with partial liquefaction from the submucosal layer. The patient was diagnosed with esophageal intramural hematoma as well as achalasia by upper gastrointestinal endoscopy, esophagography and esophageal manometry. The patient was managed conservatively with intravenous nutrition, and oral feeding was discontinued. Follow-up EGD and EUS showed complete recovery of the esophageal wall, and finally, the patient underwent endoscopic dilatation for achalasia. The patient was symptom free at the time when we wrote this manuscript.

  7. Isolated Crural Hematoma Mimicking Retroperitoneal Lymphadenopathy, A Unique Sign of Traumatic Diaphragmatic Rupture: A Case Report

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    Abhishek Jha

    2014-09-01

    Full Text Available Diaphragmatic injury following blunt thoracoabdominal trauma is rare and is usually associated with key radiological features like dependent viscera sign, collar sign, diaphragmatic thickening and defects. It may also be associated with secondary signs like intrathoracic herniation of abdominal viscera. Diaphragmatic crura, which are attached to the upper lumbar vertebra represent prominently thickened folds along the posterior diaphragm, are usually inconspicuous on routine Computed Tomography (CT scans. We present a case of a young patient who sustained a motor vehicle accident and developed difficulty in breathing. CT scan of the patient revealed bilateral crural hematomas, with splenic and renal lacerations and no other sign of diaphragmatic injury. The patient was operated and blunt diaphragmatic rupture was confirmed at surgery.

  8. CT imaging of aortic intramural hematoma: Report of two cases, and review of literature

    International Nuclear Information System (INIS)

    Aortic intramural hematoma (IMH) is a relatively rare, but potentially fatal pathology, which is most commonly diagnosed under emergency conditions with computed tomography angiography (CTA). We present two cases of IMH examined with different CTA protocols, which resulted in diverse diagnoses. In the first patient, contrast-enhanced CTA revealed dilatation of thoracic aorta and polymorphic wall thickening. It was misdiagnosed as being a mural thrombus and was complicated by acute dissection. In the second patient, non-enhanced CT revealed hyperdense aortic wall thickening. The patient was diagnosed as having type B IMH but he died due to aortic rupture. In our opinion, CT examination of the aorta in emergency cases should always include non enhanced scanning. Any delay in proper diagnosis and treatment of IMH may result in serious complications. (authors)

  9. CT imaging of aortic intramural hematoma: Report of two cases, and review of literature.

    Science.gov (United States)

    Serafin, Zbigniew; Laskowska, Katarzyna; Marzec, Ma?gorzata; Lasek, W?adys?aw

    2011-01-01

    Aortic intramural hematoma (IMH) is a relatively rare, but potentially fatal pathology, which is most commonly diagnosed under emergency conditions with computed tomography angiography (CTA). We present two cases of IMH examined with different CTA protocols, which resulted in diverse diagnoses.In the first patient, contrast-enhanced CTA revealed dilatation of thoracic aorta and polymorphic wall thickening. It was misdiagnosed as being a mural thrombus and was complicated by acute dissection. In the second patient, non-enhanced CT revealed hyperdense aortic wall thickening. The patient was diagnosed as having type B IMH but he died due to aortic rupture.In our opinion, CT examination of the aorta in emergency cases should always include non-enhanced scanning. Any delay in proper diagnosis and treatment of IMH may result in serious complications. PMID:22802822

  10. Dynamic MRI study for hematoma and hemangioma with inversion recovery snapshot FLASH method

    International Nuclear Information System (INIS)

    We studied 38 patients with liver tumor using inversion recovery snapshot FLASH (turbo-FLASH) (16 hepatomas, 7 hemangiomas) and FLASH (12 hepatomas, 3 hemangiomas) on dynamic MRI study. Hematomas showed central enhancement on early phase, and their maximum intensities were recorded on early phase by turbo-FLASH (12/12, 100%) and FLASH (7/12, 58.3%) respectively. Hemangiomas showed peripheral enhancement on early and mid phases, and their maximum intensities were recorded on mid or late phase by turbo-FLASH (6/7, 85.7%) and FLASH (3/3, 100%) respectively. Turbo-FLASH dynamic MRI study is useful for differentiation between hepatoma and hemangioma. (author)

  11. Experience with contrast-enhanced CT in delayed traumatic intracerebral hematoma

    International Nuclear Information System (INIS)

    During the four-and-a-half-year period from April, 1976, to September, 1980, out of 257 patients with severe head injuries graded 8 or less by the Glasgow Coma Scale in the Department of Neurosurgery and Critical Care Medicine of the Nippon Medical School, Tokyo, Japan, 33 cases showed the development of delayed traumatic intracerebral hematoma (DTICH) upon the serial computerized tomography (CT). Contrast-enhanced CT was performed in 20 cases of the 33 patients demonstrating DTICH. Among these, 8 cases (40%) indicated the development of DTICH in the lesions of cerebral contusion (a salt-and-pepper appearance in the initial plain CT) which showed a remarkable enhancement, sustaining the extravasation of the contrast medium into the contused brain tissue. The authors discuss the pathogenesis of DTICH and suggest that vasoparalysis in the cerebral contusion might be a factor in the development of DTICH in patients with servere head injuries. (author)

  12. Monitoreo de presión intracraneana: infección y otras complicaciones con el uso de K-30® subdural y fibra óptica intraparenquimatosa

    Scientific Electronic Library Online (English)

    Javier L., Gardella; Martín, Guevara; Cynthia, Purves; Carolina, Moughty Cueto.

    2006-12-01

    Full Text Available Objetivo. Evaluar las complicaciones en la utilización de trasductores de presión intracraneana (PIC) K-30® subdurales (KS) y fibrasópticas intraparenquimatosas (FO). Método. En un estudio estadístico descriptivo y retrospectivo se revisaron las historias clínicas de los pacientes que ingresaron a T [...] erapia Intensiva del Hospital "Juan A Fernández" (junio 1993 - febrero 2003) y requirieron monitoreo de PIC. Los datos fueron procesados con el programa STATA 6.0. Resultados. Se efectuaron 252 monitoreos en 191 pacientes; 71 monitores fueron FO y 181 fueron SK; 188 fueron catéteres únicos y 64 recambios. Los motivos de recambio fueron: arrancamiento, error de lectura, deterioro neurológico y colocación > 5 días. El arrancamiento ocurrió en 13 casos (12 KS y 1 FO); error de lectura o falla técnica en 33 casos (20 KS y 13 FO); fístula de LCR en 9 casos (7 KS y 2 FO). Sólo en un caso de los que presentaron fístula se constató cultivo de LCR positivo. (En 6 casos el recambio se debió a deterioro neurológico. Recambio por monitoreo > 5 días ocurrió en 12). Período de monitorización: 1-15 días. La permanencia del monitor en pacientes con catéteres sin infección fue de 3,62 días y en pacientes con infección: 4,67 días. En 29 casos se comprobó infección (10 FO y 19 KS). No fue significativa la diferencia entre edad, sexo, Glasgow al ingreso y cirugía a cielo abierto cuando se lo relacionó con infección y tipo de monitor. Fue significativa la incidencia de infección en los pacientes reoperados. Conclusión. Técnicamente el monitoreo PIC con KS subdural demostró ser un método confiable. La incidencia de complicaciones, en particular la infecciosa, con sistema KS fue similar a las observadas con FO. Abstract in english Objective: To evaluate the complications between to types of intracranial pressure monitoring devices: subdural K-30® (SK) and intraparenchymal fiber optic (FO). Method: In this descriptive retrospective study we reviewed the clinical records of those patients who were admitted to the Intensive Care [...] Unit of the Hospital "Juan A. Fernández" (June 1993-February 2003) and required intracranial pressure monitoring. We processed the data with the STATA 6.0 programme. Results: We inserted 252 monitors in 191 patients: 71 FO and 181 SK; 188 were primary and 64 were secondary procedures. The causes of removal were: dislocation of the device, technical failure, neurological deterioration and permanence longer than 5 days. Dislocation occurred in 13 cases (12 SK, 1 FO), technical failure was observed in 33 cases (20 SK, 13 FO). We observed cerebrospinal fluid fistula (CSF) in 9 cases (7 SK , 2 FO). Only 1 case that presented with fistula had a positive CSF culture with a non typified germen. In 6 cases the change of the catheter was due to neurological deterioration. Changing due to permanence longer than 5 days occurred in 12 cases. The period of monitorization was 1-15 days (median: 3 days). The permanence of the catheter in non infected patients was 3.62±3.22 days and on infected patients was 4.67±2.30 days. On 29 cases we observed infection, 10 FO and 19 SK (NS p). It was not significant the difference between age, sex, Glasgow and surgery when related to infection and type of device. It was significant the rate of infection in patients that had to be reoperated. Conclusion: From a technical point of view monitorization of the intracranial pressure using SK proved to be reliable. In our experience the rate of complications between the SK was similar to those observed with FO.

  13. Chronic inflammatory polyneuropathy

    Science.gov (United States)

    Polyneuropathy - chronic inflammatory; CIDP; Chronic inflammatory demyelinating polyneuropathy ... usually affects both sides of the body equally. Chronic inflammatory demyelinating polyneuropathy (CIDP) is the most common chronic neuropathy caused ...

  14. Acute pancreatitis and subdural haematoma in a patient with severe falciparum malaria: Case report and review of literature

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    Sathyendra Sowmya

    2008-05-01

    Full Text Available Abstract Plasmodium falciparum infection is known to be associated with a spectrum of systemic complications ranging from mild and self-limiting to life-threatening. This case report illustrates a patient who had a protracted course in hospital due to several rare complications of falciparum malaria. A 21-year old man presented with a five-day history of high-grade fever, jaundice and abdominal pain and a two-day history of altered conscious state. A diagnosis of severe falciparum malaria was made based on the clinical presentation and a positive blood smear with parasitaemia of 45%. Despite adequate anti-malarial therapy with artesunate, the patient had persistent and worsening abdominal pain. Investigations suggested a diagnosis of acute pancreatitis, a rare association with falciparum malaria. However, in spite of supportive therapy for acute pancreatitis and a 10-day course of intravenous artesunate and oral doxycycline at recommended doses, he continued to be febrile with peripheral blood smear showing persistence of ring forms. Antimalarial therapy was, therefore, changed to quinine on the suspicion of possible artesunate resistance. On the 17th day of stay in hospital, the patient developed generalized tonic-clonic seizures. Computerized tomography of the brain showed bilateral fronto-parietal subdural haematomas that were surgically drained. His fever persisted beyond 30-days despite broad-spectrum antibiotics, quinine therapy and negative malarial smears. A possibility of drug fever was considered and all drugs were ceased. He subsequently became afebrile and was discharged on the 38th hospital admission day. Recognition of complications and appropriate management at each stage facilitated successful outcome. This report has been presented to highlight the occurrence of several rare complications of falciparum malaria in the same patient.

  15. The clinical efficacy of small-window craniotomy on non-progressive trans-sinus epidural hematoma

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    Lian-shui HU

    2015-03-01

    Full Text Available Objective To investigate the clinical efficacy of two surgical approaches, trans-sinus small-window craniotomy (TSSWCT and combined supratentorial-infratentorial craniotomy (CSITCT, on non-progressive trans-sinus epidural hematoma.  Methods There were 67 patients with non-progressive trans-sinus epidural hematoma who underwent TSSWCT or CSITCT. The postoperative residual hematoma, postoperative alteration of intracranial pressure (ICP, recanalization of affected cerebral venous sinuses, length of hospitalization, and 6-month Glasgow Outcome Scale (GOS score of patients were retrospectively compared.  Results Compared with patients in the CSITCT group (N = 35, those in the TSSWCT group (N = 32 had significantly reduced postoperative residual hematoma near the venous sinus [(1.40 ± 1.60 ml vs (3.50 ± 2.10 ml, P = 0.000], length of hospitalization [(13.40 ± 5.70 d vs (17.30 ± 7.00 d, P = 0.015], markedly down-regulated levels of intracranial pressure (ICP at indicated postoperative time points [1 d: (164.40 ± 33.30 mm H2O vs (198.60 ± 49.30 mm H2O, P = 0.002; 3 d: (185.90 ± 47.80 mm H2O vs (226.30 ± 81.60 mm H2O, P = 0.017; 7 d: (154.70 ± 52.50 mm H2O vs (198.30 ± 84.20 mm H2O, P = 0.014], and distinctly improved recanalization of affected cerebral venous sinuses (87.50% vs 65.70% , P = 0.037. Moreover, the 6-month GOS scores were not statistically different between patients in 2 groups (Z = -0.114, P = 0.909.  Conclusions Compared with CSITCT, TSSWCT is a reliable surgical approach in the treatment of non-progressive trans-sinus epidural hematoma which has strengthened capability of evacuating hematoma underlying affected venous sinuses, relieving the compressed venous sinus and attenuating the intracranial hypertension. DOI: 10.3969/j.issn.1672-6731.2015.02.011

  16. Unexpected limited chronic dissection of the ascending aorta

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    Asta Angiolino

    2008-07-01

    Full Text Available Abstract We report a rare case of a limited chronic dissection of the ascending aorta that was accidentally discovered at operation performed for severe aortic stenosis and moderate to severe dilatation of the ascending aorta. Preoperative investigations such as transoesophageal echocardiography and cardiac catheterization missed the diagnosis of dissection. Intraoperative findings included a 3.5 cm eccentric bulge of the ascending aorta and a 5 mm circular shaped intimal tear comunicating with a limited hematoma or small dissection of the media layer. (The rarety of the report is that the chronic dissection is limited to a small area (approximatively 3.5 × 2.5 cm of the ascending aorta.

  17. Hematomas renales postlitotricia extracorpórea en 324 sesiones consecutivas con el litotritor DOLI - S: incidencia, características, análisis multifactorial y revisión / Renal hematoma after extracorporeal shockwave lithotripsy in a series of 324 consecutive sessions with the DOLI-S lithotripter: incidents, characteristics, multifactorial analysis and review

    Scientific Electronic Library Online (English)

    Rodolfo, Orozco Fariñas; José Ignacio, Iglesias Prieto; Jorge, Massarrah Halabi; José Mª, Mancebo Gómez; Enrique, Perez-Castro Ellendt.

    2008-10-01

    Full Text Available Objetivo: Determinar la prevalencia de los hematomas renales postlitotricia en nuestra unidad, la incidencia de los sintomáticos y/o progresivos, el comportamiento clínico, el manejo de los mismos, así como los factores potencialmente influyentes sobre dichos aspectos. Método: Estudio observacional [...] prospectivo en el que analizamos diversos parámetros integrados en nuestra base de datos a partir de hojas recopilatorias confeccionadas en 314 pacientes sometidos a litotricia sobre 324 unidades renales en igual número de sesiones. Para el análisis estadístico se utilizó el paquete SPSS 15.0 con la asesoría de especialistas en bioestadística. Para el diagnóstico de los hematomas se utilizaron datos clínicos (interrogatorio y exploración física), hematológicos y ecográficos, estos últimos en casos aislados complementados con TAC, se realizó seguimiento mediante contacto telefónico con los pacientes durante un periodo de tiempo comprendido entre los 7 y los 19 meses después de la litotricia. Resultados: La prevalencia de hematomas fue del 13% pero sólo el 6,2 % fueron sintomáticos, la incidencia acumulada de hematomas de evolución progresiva fue de el 2,16 % y en el 0,92 % de las litotricias se requirió transfusión sanguínea a causa de los hematomas, lo que representó el 7,14% de estos. Los factores estadísticamente asociados a la incidencia de hematomas fueron el número de onda (superior a 2300), la energía total (a partir de 150J), el KV (a partir de 17,5), la microhematuria preoperatoria, la hipertensión perioperatoria, la litiasis de cistina, el hidrocáliz, la localización calicial del cálculo, (principalmente inferior), la asociación de cardiopatía isquémica con hipertensión arterial, (HTA) o hepatopatías, las hepatopatías crónicas "per se", la elevación de transaminasas, el uso habitual de antiagregantes plaquetarios y AINEs (sobre todo con pauta previa de heparina fraccionada para la progresión de los hematomas) y la combinación de estos con HTA pre-operatoria (para los hematomas síntomáticos), así como la presencia de litiasis múltiple tratadas en la misma sesión, encontrándose grados de asociación diferentes para los distintos subgrupos de hematomas establecidos. Se observó diferencias en el comportamiento clínico de los tipos de hematomas (subcapsular y perirrenal) y el 12 % de los pacientes con hematomas permanecieron sintomáticos entre 2 y 6 meses después. Conclusiones: El hematoma renal postlitotricia es mas frecuente de lo que creemos; su magnitud y evolución variables dependen de múltiples factores, algunos de los cuales tienen mayor peso específico (hepatopatías, comportamiento de la tensión arterial perioperatoria y uso habitual de fármacos antiagregantes con necesidad de heparina fraccionada perioperatoria), lo que dió lugar a pacientes con mayor riesgo de presentar hematomas cuando concurrieron 3 o mas de los factores relacionados encontrados en la presente serie. Los hematomas subcapsulares y los perirrenales difieren en su comportamiento clínico. Los hematomas con diámetros ecográficos iniciales igual o mayores de 4 cm fueron mas propensos a la progresión. El riesgo de expresión sintomática o de progresión de un hematoma se evidenció en los primeros cinco días postlitotricia aún cuando permanecieran asintomáticos o estables clínica e imagenológicamente en las primeras 24 hrs., todo lo cual aconseja un seguimiento cuidadoso y reposo físico relativo durante la primera semana en los pacientes con mayor riesgo, y considerar el reposo al menos cinco días en todos los pacientes tratados, entre otras medidas. El dolor lumbar puede persistir hasta seis meses en algunos pacientes después de padecer un hematoma postlitotricia clínicamente significativo. Abstract in english Objectives: The objective is to know the prevalence of renal hematoma after lithotripsy in our unit, as well as the incidence of symptomatic and/or progressive hematomas, their clinical behavior and management, and also the factors potentially

  18. [Chronic leukemia].

    Science.gov (United States)

    Shibata, A; Narita, M

    1989-05-01

    As compared with advances in the treatment of acute leukemia, we have made little progress in chronic leukemia. Recently we have attempted some new treatments for chronic phase of CML, and confirmed those effectiveness. But for blastic crisis, we still grope in the dark. In this paper, we review the chemotherapy of CML and CLL including new treatments except bone marrow transplantation. PMID:2658837

  19. Chronic pancreatitis

    OpenAIRE

    Kocher, Hemant M.; Froeling, Fieke Em

    2008-01-01

    Chronic pancreatitis is characterised by long-standing inflammation of the pancreas owing to a wide variety of causes, including recurrent acute attacks of pancreatitis. Chronic pancreatitis affects 3–9 people in 100,000; 70% of cases are alcohol-induced.

  20. Chronic pancreatitis

    OpenAIRE

    Kocher, Hemant M.; Kadaba, Raghu

    2011-01-01

    Chronic pancreatitis is characterised by long-standing inflammation of the pancreas due to a wide variety of causes, including recurrent acute attacks of pancreatitis. Chronic pancreatitis affects between 3 and 9 people in 100,000; 70% of cases are alcohol-induced.

  1. Ocorrência de hematoma peridural após anestesia geral associada à analgesia pós-operatória com cateter peridural em paciente em uso de heparina de baixo peso molecular: relato de caso / Epidural hematoma after general anesthesia associated with postoperative analgesia with epidural catheter in patient using low molecular weight heparin: case report / Ocurrencia de hematoma postanestesia general asociada a analgesia postoperatoria con cateter peridural en paciente que usa heparina de bajo peso molecular: relato de caso

    Scientific Electronic Library Online (English)

    Ranger Cavalcante da, Silva; André, Morais e Silva; Fernando Santos, Laffitte; Gilbert, Jamus.

    2006-04-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Apresentar um caso de paciente com hematoma peridural, na vigência do uso de cateter peridural e heparina de baixo peso molecular, seu quadro clínico e tratamento. RELATO DO CASO: Paciente do sexo feminino, 75 anos, submetida à fixação de coluna lombar por via anterior, qu [...] e desenvolveu no pós-operatório quadro clínico de paralisia progressiva nos membros inferiores, com perda de sensibilidade, sem apresentar dor radicular intensa. O tratamento foi descompressão medular imediata, com drenagem e limpeza cirúrgica de hematoma peridural, que se estendia da quinta até a décima vértebra torácica. Após a drenagem do hematoma a paciente recuperou gradualmente a força nos membros inferiores, recebeu alta em 10 dias com quadro de disfunção esfincteriana. Após três meses o quadro regrediu e não houve seqüela neurológica definitiva. CONCLUSÕES: O rápido diagnóstico com intervenção cirúrgica precoce é o tratamento mais eficaz para redução de lesão neurológica, em pacientes que desenvolvem hematoma peridural no pós-operatório. A utilização de heparina de baixo peso molecular, na vigência do uso de cateter peridural, exige a adesão estrita a protocolos estabelecidos, para que se reduzam os riscos do desenvolvimento de hematoma peridural. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: presentar el caso de una paciente con hematoma peridural, con uso actual de catéter peridural y heparina de bajo peso molecular, su cuadro clínico y tratamiento. RELATO DEL CASO: Paciente de 75 años, sometida a la fijación de columna lumbar por vía anterior, que desarrolló [...] en el postoperatorio un cuadro clínico de parálisis progresiva en los miembros inferiores, con pérdida de la sensibilidad, sin presentar dolor radicular intenso. El tratamiento fue descompresión medular inmediata, con drenaje y limpieza quirúrgica de un hematoma peridural, que se extendía desde la quinta hasta la décima vértebra toráxica. Después del drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural. Abstract in english BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who [...] , in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be reduced.

  2. Chronic contained rupture of abdominal aortic aneurysm (CCR-AAA) with massive vertebral bone erosion. Computed tomography (CT), magnetic resonance imaging (MRI) and fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) findings

    International Nuclear Information System (INIS)

    A 62-year-old male presented with sudden onset of low back and right leg pain. Contrast-enhanced computed tomography demonstrated an abdominal aortic aneurysm (AAA), along with a large mass lesion causing vertebral body erosion. Magnetic resonance imaging (MRI) suggested that the mass lesion consisted of a chronic hematoma. Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) demonstrated increased uptake around the mass lesion, but not around the AAA. Surgical intervention was performed, and the subsequent histological diagnosis was chronic contained rupture of AAA. The mass lesion consisted of chronic hematoma and necrosis with inflammatory cell infiltration and hemosiderin deposition. This condition mimics some neoplastic diseases, but MRI and FDG-PET findings may help establish the correct diagnosis. (author)

  3. Lack of evidence for a causal relationship between hypoxic-ischemic encephalopathy and subdural hemorrhage in fetal life, infancy, and early childhood

    DEFF Research Database (Denmark)

    Byard, Roger W; Blumbergs, Peter

    2013-01-01

    It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to cause injury in certain cases of inflicted head injury in infancy, clarification is required. A retrospective study of 82 fetuses, infants, and toddlers with proven HIE and no trauma was undertaken from forensic institutes in Australia, the United Kingdom, Germany, Denmark, and the United States. The age range was 35 weeks gestation to 3 years, with a male to female ratio of 2:1. All cases had histologically confirmed HIE. Causes of the hypoxic episodes were temporarily resuscitated sudden infant death syndrome with delayed death (N = 30), drowning (N = 12), accidental asphyxia (N = 10), intrauterine/delivery asphyxia (N = 8), congenital disease (N = 6), aspiration of food/gastric contents (N = 4), inflicted asphyxia (N = 3), epilepsy (N = 1), dehydration (N = 1), drug toxicity (N = 1), complications of prematurity (N = 1), and complications of anesthesia (N = 1). The initiating event was not determined in 4 instances. In no case was there macroscopic evidence of subdural hemorrhage. In this study no support could be given to the hypothesis that HIE in the young in the absence of trauma causes subdural hemorrhage.

  4. Life-Threatening Complication after Extracorporeal Shock Wave Lithotripsy for a Renal Stone: A Hepatic Subcapsular Hematoma

    OpenAIRE

    Kim, Tae-Beom; Park, Ho-Ki; Lee, Kwang-Yeom; Kim, Khae-Hawn; Jung, Han; Yoon, Sang-Jin

    2010-01-01

    Extracorporeal shock wave lithotripsy (ESWL) has revolutionized the management of urolithiasis since it was first introduced in 1980. ESWL is a well-established, safe and effective therapeutic alternative to surgical treatment for urolithiasis. Complications of ESWL do occur in a small number of patients, and when they do, they typically involve the kidney. We present a case of a young female patient who developed a huge hepatic subcapsular hematoma accompanied by hypovolemic shock after ESWL...

  5. Clinical features of the head injury caused by child abuse in infants

    International Nuclear Information System (INIS)

    The diagnosis and managements of the head injury in battered children are greatly complicated by medical history and the mechanisms of injury. In the present study, we evaluated the clinical features of the head injury in battered children. Clinical signs and symptoms, the mechanisms of injury, intracranial pathology, and prognosis of 25 battered children with head injury treated between 1984 and 2003 were retrospectively analyzed. The age of 25 children was between 1 month and 2 years old. The average of the ages was 7 months old. In 68% of 25 patients, the age was 6 months or less. The medical history of head injury was unclear in 16 children. The chief complains were disturbance of consciousness, convulsion, vomiting and hypothermia. Retinal hemorrhages were recognized in 88% of the patients and these were bilateral in 68%. Acute subdural hematomas (19 cases) and chronic subdural hematomas (6 cases) were shown on CTs or MRIs. In four cases, cerebral contusions were complicated as intracranial pathology. In 44% of the patients, the hypoxic-ischemic injury was confirmed on CTs or MRIs. Fractures of limbs and ribs were recognized on skeletal survey in 40% of the patients. 71% of 17 survival cases had moderate or severe psychomotor disabilities at the end of follow-up periods. In children under 2 years of age with subdural hematomas, clinical investigations other than CT and MRI, included ophthalmoscopy by ophthalmologist and skeletal survey, are crucial and mandatory keletal survey, are crucial and mandatory for early diagnosis of the child abuse. (author)

  6. Paradigms for subdural grids' implantation in patients with refractory epilepsy Paradigmas para implante de placas subdurais em pacientes com epilepsia refratária

    Directory of Open Access Journals (Sweden)

    ARTHUR CUKIERT

    2000-09-01

    Full Text Available RATIONALE: The need for invasive monitoring in patients with refractory epilepsy has been greatly reduced by the introduction of new technologies such as PET, SPECT and MRI in the clinical practice. On the other hand, 10 to 30% of the patients with refractory epilepsy have non-localizatory non-invasive preoperative work-up results. This paper reports on the paradigms for subdural electrodes implantation in patients with different refractory epileptic syndromes. METHODS: Twenty-nine adult refractory epileptic patients were studied. Patients were divided into five different epileptic syndromes that represented the majority of the patients who needed invasive recordings: bitemporal (Group I; n=16 , bi-frontal-mesial (Group II, n=5, hemispheric (Group III; n=2, anterior quadrant (Group IV; n=3 and posterior quadrant (Group V; n=3. All of them were submitted to extensive subdural electrodes' implantation (from 64 to 160 contacts covering all the cortical surface potentially involved in epileptogenesis under general anesthesia. Results: All patients tolerated well the procedure. There was no sign or symptom of intracranial hypertension except for headache in 22 patients. In all except one Group II patient, prolonged electrocorticographic monitoring using the described subdural cortical coverage patterns was able to define a focal area amenable for resection. In all Groups II-V patients cortical stimulation was able to adequately map the rolandic and speach areas as necessary. CONCLUSION: Despite recent technological advances invasive neurophysiological studies are still necessary in some patients with refractory epilepsy. The standardization of the paradigms for subdural implantation coupled to the study of homogeneous patients' populations as defined by MRI will certainly lead to a better understanding of the pathophysiology involved in such cases and an improved surgical outcome.INTRODUÇÃO: O advento de novas tecnologias de imagem tais como o PET, SPECT e RM diminuíram em muito a necessidade da utilização de eletrodos invasivos na investigação pré-operatória de pacientes epilépticos. No entanto, 10 a 30% dos pacientes com epilepsias refratárias ainda possuem investigação não-invasiva inconclusiva. Este estudo relata nossos paradigmas para o implante de eletrodos subdurais nesta população de epilépticos refratários. MÉTODOS: Vinte e nove pacientes portadores de epilepsias refratárias foram estudados. Eles foram divididos em 5 grupos de síndromes epilépticas que incluíam a maioria dos pacientes submetidos a implantes: bitemporais (grupo I; n=16, bifrontomesiais (grupo II; n=5, hemisféricos (grupo III; n=2, quadrante anterior (grupo IV; n=3 e quadrante posterior (grupo V; n=3. Todos foram submetidos a extensos implantes subdurais (de 64 a 160 contatos cobrindo todo o córtex potencialmente epileptogênico, sob anestesia geral. RESULTADOS: Todos pacientes toleraram bem o procedimento. Vinte e dois pacientes referiram cefaléia. Não houve outro sinal ou sintoma sugestivo de hipertensão intracraniana. Com exceção de um paciente do grupo II, a monitorização eletrocorticográfica crônica foi capaz de definir uma área focal própria para a ressecção cortical. A estimulação cortical foi capaz de mapear as áreas eloquentes necessárias em todos os pacientes dos grupos II a V. CONCLUSÃO: Alguns pacientes com epilepsia refratária ainda necessitam de avaliação invasiva apesar dos avanços nos métodos diagnósticos pré-operatórios. A padronização dos paradigmas para implante subdural destes pacientes bem como o estudo de populações homogêneas de pacientes definidas por RM levará a melhor compreensão da fisiopatologia envolvida nestes casos bem como a melhores resultados cirúrgicos.

  7. Paradigms for subdural grids' implantation in patients with refractory epilepsy / Paradigmas para implante de placas subdurais em pacientes com epilepsia refratária

    Scientific Electronic Library Online (English)

    ARTHUR, CUKIERT; ALCIONE, SOUSA; ELCIO, MACHADO; JOSE AUGUSTO, BURATINI; JOAQUIM, VIEIRA; VIVIANE, FERREIRA; CASSIO, FORSTER; MEIRE, ARGENTONI; LEILA, FRAYMAN.

    2000-09-01

    Full Text Available INTRODUÇÃO: O advento de novas tecnologias de imagem tais como o PET, SPECT e RM diminuíram em muito a necessidade da utilização de eletrodos invasivos na investigação pré-operatória de pacientes epilépticos. No entanto, 10 a 30% dos pacientes com epilepsias refratárias ainda possuem investigação nã [...] o-invasiva inconclusiva. Este estudo relata nossos paradigmas para o implante de eletrodos subdurais nesta população de epilépticos refratários. MÉTODOS: Vinte e nove pacientes portadores de epilepsias refratárias foram estudados. Eles foram divididos em 5 grupos de síndromes epilépticas que incluíam a maioria dos pacientes submetidos a implantes: bitemporais (grupo I; n=16), bifrontomesiais (grupo II; n=5), hemisféricos (grupo III; n=2), quadrante anterior (grupo IV; n=3) e quadrante posterior (grupo V; n=3). Todos foram submetidos a extensos implantes subdurais (de 64 a 160 contatos) cobrindo todo o córtex potencialmente epileptogênico, sob anestesia geral. RESULTADOS: Todos pacientes toleraram bem o procedimento. Vinte e dois pacientes referiram cefaléia. Não houve outro sinal ou sintoma sugestivo de hipertensão intracraniana. Com exceção de um paciente do grupo II, a monitorização eletrocorticográfica crônica foi capaz de definir uma área focal própria para a ressecção cortical. A estimulação cortical foi capaz de mapear as áreas eloquentes necessárias em todos os pacientes dos grupos II a V. CONCLUSÃO: Alguns pacientes com epilepsia refratária ainda necessitam de avaliação invasiva apesar dos avanços nos métodos diagnósticos pré-operatórios. A padronização dos paradigmas para implante subdural destes pacientes bem como o estudo de populações homogêneas de pacientes definidas por RM levará a melhor compreensão da fisiopatologia envolvida nestes casos bem como a melhores resultados cirúrgicos. Abstract in english RATIONALE: The need for invasive monitoring in patients with refractory epilepsy has been greatly reduced by the introduction of new technologies such as PET, SPECT and MRI in the clinical practice. On the other hand, 10 to 30% of the patients with refractory epilepsy have non-localizatory non-invas [...] ive preoperative work-up results. This paper reports on the paradigms for subdural electrodes implantation in patients with different refractory epileptic syndromes. METHODS: Twenty-nine adult refractory epileptic patients were studied. Patients were divided into five different epileptic syndromes that represented the majority of the patients who needed invasive recordings: bitemporal (Group I; n=16 ), bi-frontal-mesial (Group II, n=5), hemispheric (Group III; n=2), anterior quadrant (Group IV; n=3) and posterior quadrant (Group V; n=3). All of them were submitted to extensive subdural electrodes' implantation (from 64 to 160 contacts) covering all the cortical surface potentially involved in epileptogenesis under general anesthesia. Results: All patients tolerated well the procedure. There was no sign or symptom of intracranial hypertension except for headache in 22 patients. In all except one Group II patient, prolonged electrocorticographic monitoring using the described subdural cortical coverage patterns was able to define a focal area amenable for resection. In all Groups II-V patients cortical stimulation was able to adequately map the rolandic and speach areas as necessary. CONCLUSION: Despite recent technological advances invasive neurophysiological studies are still necessary in some patients with refractory epilepsy. The standardization of the paradigms for subdural implantation coupled to the study of homogeneous patients' populations as defined by MRI will certainly lead to a better understanding of the pathophysiology involved in such cases and an improved surgical outcome.

  8. Performance of fixed-pressure valve with antisiphon device SPHERA® in hydrocephalus treatment and overdrainage prevention Desempenho da válvula de pressão fixa com antissifão SPHERA® no tratamento da hidrocefalia e na prevenção da ocorrência de hiperdrenagem

    Directory of Open Access Journals (Sweden)

    Fernando Campos Gomes Pinto

    2012-09-01

    Full Text Available Patients with hydrocephalus and risk factors for overdrainage may be submitted to ventricular shunt (VS implant with antisiphon device. The objective of this study was to prospectively evaluate for two years the clinical and tomographic results of the implant of fixed-pressure valves with antisiphon device SPHERA® in 35 adult patients, with hydrocephalus and risk factors for overdrainage. Of these, 3 had congenital hydrocephalus in adult patients with very dilated ventricles (Evans index >50%, 3 had symptomatic overdrainage after previous VS implant (subdural hematoma, hygroma or slit ventricle syndrome, 1 had previous chronic subdural hematoma, 15 had normal pressure hydrocephalus with final lumbar pressure Pacientes com hidrocefalia e fatores de risco para hiperdrenagem podem ser submetidos ao implante de derivação ventricular (VS com mecanismo antissifão. O objetivo deste trabalho foi avaliar prospectivamente os resultados clínicos e tomográficos do implante de válvulas de pressão fixa com antissifão SPHERA® em 35 pacientes adultos, com hidrocefalia e risco de hiperdrenagem, acompanhados por dois anos. Destes, 3 apresentavam hidrocefalia congênita em adulto, com ventrículos muito dilatados (índice de Evans >50%; 3 tinham hiperdrenagem sintomática pós-derivação ventricular prévia (hematoma subdural, higroma ou síndrome dos ventrículos colabados; 1 apresentava hematoma subdural crônico pregresso; 15 apresentavam hidrocefalia de pressão normal com pressão lombar final <5 cm H2O após tap test (40 mL; 6 apresentavam pseudotumor cerebral; e 7, devido a outras causas. A melhoria clínica foi detectada e sustentada em 94,3% dos pacientes no período de dois anos, sem indícios tomográficos de hipo ou hiperdrenagem e sem complicações significativas imediatas, precoces ou tardias.

  9. Massive retroperitoneal hematoma as a complication of anticoagulation therapy in a patient treated in a pulmonary intensive care unit

    Directory of Open Access Journals (Sweden)

    Stjepanovi? Mihailo

    2015-01-01

    Full Text Available Introduction. Retroperitoneal hematoma may occur as a result of trauma, but also from rupture of arterial aneurysms (aortic or iliac, surgical complications, tumors or anticoagulation therapy. Case report. We presented a patient on permanent anticoagulation therapy. On the day of admission to our institution, the patient had the value of his INR 5.57 which required immediate suspension of the therapy. The main symptom in this patient was pain in the right inguinal canal with propagation along the right leg, which was indicated in clinical picture of spontaneous retroperitoneal haematoma. After three days the fall of hemoglobin occurred, so the additonal diagnostics was done. A computed tomography of the abdomen was performed showing well limited, large retroperitoneal hematoma (213 x 79 x 91 mm. Transfusion of concentrated red blood cells was performed twice with satisfactory correction of hemoglobin level, and four units of fresh frozen plasma. The patient was hemodynamically stabilized and discharged after a two-month long intensive care unit treatment, with the advice to use low-molecular weight heparin 2 x 0.4 mg subcutaneusly, due to persistent arrhythmia. Conclusion. In patients on anti-coagulation therapy regular monitoring of the anticoagulant status is extremely important, because of the possibility of fatal complications development, such as retroperitoneal hematoma.

  10. Low back pain - chronic

    Science.gov (United States)

    Nonspecific back pain; Backache - chronic; Lumbar pain - chronic; Pain - back - chronic; Chronic back pain - low ... waist, leads to pain. Many people with chronic back pain have arthritis. Or they may have extra wear ...

  11. Subdural spread of injected local anesthetic in a selective transforaminal cervical nerve root block: a case report

    Directory of Open Access Journals (Sweden)

    Tofuku Katsuhiro

    2012-06-01

    Full Text Available Abstract Introduction Although uncommon, selective cervical nerve root blocks can have serious complications. The most serious complications that have been reported include cerebral infarction, spinal cord infarction, transient quadriplegia and death. Case presentation A 40-year-old Japanese woman with a history of severe right-sided cervical radicular pain was scheduled to undergo a right-sided C6 selective cervical nerve root block using a transforaminal approach under fluoroscopic guidance. An anterior oblique view of the C5-C6 intervertebral foramen was obtained, and a 23-gauge spinal needle, connected to the normal extension tube with a syringe filled with contrast medium, was introduced into the posterior-caudal aspect of the C5-C6 intervertebral foramen on the right side. In the anteroposterior view, the placement of the needle was considered satisfactory when it was placed no more medial than halfway across the width of the articular pillar. Although the spread of the contrast medium along the C6 nerve root was observed with right-sided C6 radiculography, the subdural flow of the contrast medium was not observed with real-time fluoroscopy. The extension tube used for the radiculography was removed from the spinal needle and a normal extension tube with a syringe filled with lidocaine connected in its place. We performed a negative aspiration test and then injected 1.5?mL of 1.0% lidocaine slowly around the C6 nerve root. Immediately after the injection of the local anesthetic, our patient developed acute flaccid paralysis, complained of breathing difficulties and became unresponsive; her respiratory pattern was uncoordinated. After 20 minutes, she regained consciousness and became alert, and her muscle strength in all four limbs returned to normal without any sensory deficits after receiving emergent cardiorespiratory support. Conclusions We believe that confirming maintenance of the appropriate needle position in the anteroposterior view by injecting local anesthetic is important for preventing central needle movement. Because the potential risk of serious complications cannot be completely eliminated during the use of any established selective cervical nerve root block procedure, preparation for an emergency airway, ventilation and cardiovascular support is indispensable in cases of high spinal cord anesthesia.

  12. Chronic Pericarditis

    Science.gov (United States)

    ... is unknown. However, it may be caused by cancer, tuberculosis, or an underactive thyroid gland (hypothyroidism). Usually, the ... are viral infections and radiation therapy for breast cancer or lymphoma in the ... tuberculosis was the most common cause of chronic pericarditis ...

  13. Comparison between transsylvian-transinsular and transcortical-transtemporal approach for evacuation of intracerebral hematoma

    Directory of Open Access Journals (Sweden)

    Xuhui Wang

    2013-02-01

    Full Text Available PURPOSE: Hypertensive cerebral hemorrhage in the basal ganglia is a potentially life-threatening cerebrovascular disease with high mortality. Surgical evacuation is an important treatment for intracerebral hemorrhage. However, little is reported about the comparison on the efficacy of various approaches on the prognosis. METHODS: Clinical data of 80 cases of intracerebral hemorrhage which surgically treated via transsylvian-transinsular approach or transcortical-transtemporal approach were collected. The proportion of post-surgery tracheostomy, incidence of digestive tract hemorrhage, revision surgery, the average length of hospital stay, and the six-month efficacy (defined by an ADL score rate between these two groups were compared. RESULTS: The six-month efficacy rates were 75% and 50% in patients receiving transsylvian-transinsular and transcortical-transtemporal surgery, respectively (p<0.05. Compared to the transcortical-transtemporal group, the proportion of revision surgery was statistically significantly lower in the transsylvian-transinsular group, (p<0.05. The proportion of post-surgery tracheostomy, the incidence of digestive tract hemorrhage, and the average length of hospital stay were lower in the transsylvian-transinsular group, compared to the transcortical-transtemporal group, but no statistically significant differences were noted in them between the two groups. CONCLUSION: The transsylvian-transinsular approach for evacuation of intracerebral hematoma demonstrates limited complications, shorter length of hospital stay, and improved long-term efficacy and prognosis. These findings suggest this operative approach has potential for wider application.

  14. Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance

    International Nuclear Information System (INIS)

    The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs

  15. Acute intramural hematoma of ascending aorta. CT findings and clinical outcome

    International Nuclear Information System (INIS)

    The purpose of this study was to describe the CT findings and clinical outcomes of nineteen patients with acute intramural hematoma (IMH) of the ascending aorta. Six patients underwent surgery on the emergency basis (3 patients) due to cardiac tamponade (n=2) and dilated aorta (n=1), and on the elective basis (3 patients) due to patent and enlarging false lumen. Among the 13 patients with medical management, four patients died from complications of IMH during the follow-up period (2 days-2.5 years). Transition to aortic dissection or enlargement of an intimal tear was noted in 5 patients (31%) in 1 to 6 weeks after onset. Three patients died of causes not related to IMH. Six patients had been alive 2 to 9 years after onset. Retrospective review revealed 10 patients (53%) as possible surgical candidates, and the other 9 patients as medically treated patients in the long-term follow-up. The surgical group showed cardiac tamponade or shock in 6 patients on admission and had pericardial effusion in all the patients on the initial CT scan. In the patients with acute IMH of the ascending aorta, surgery should be considered for severe clinical symptoms, pericardial effusion and large size of the ascending aorta (more than 4 cm) on CT scan, and for converting to a typical type A aortic dissection. CT scan had a major role in making an early diagnosis, in depicting a dangerous sign, and in monitoring its progression or resolution of IMH. (author)H. (author)

  16. Successful Hemostasis with Recombinant Activated Factor VII in a Patient with Massive Hepatic Subcapsular Hematoma

    Science.gov (United States)

    Lee, Ju-Hee; Chae, Hee Bok; Seo, Eui-Keun; Jeon, Won Joong; Jeong, Hye Won; Shin, Yoon Mi; Bae, Jang Whan; Kwon, Soon Kil; Bae, Il Hun; Shim, Woo Sub; Shin, Dong Ick; Sung, Rohyun; Kim, Ji Yoon

    2009-01-01

    Recombinant activated coagulation factor VII (rFVIIa) is known to be effective in the management of acquired deficiencies of factor VII and platelet function defects. But recently, rFVIIa has been successfully used to treat ongoing bleeding in disseminated intravascular coagulopathy (DIC) condition. The patient reported here was suspected to be suffering from toxic hepatitis on admission. After percutaneous liver biopsy, bleeding occurred and did not stop even after right hepatic artery embolization. The patient developed a severe hemorrhage that resulted in hypovolemic shock, hemoperitoneum, and a massive subcapsular hematoma. The patient then developed DIC due to massive transfusion, as well as acute liver necrosis. The patient was given 400 ?g/kg of rFVIIa. Recombinant factor VIIa was administered in an attempt to control the bleeding. This stabilized the hemoglobin levels of the patient. The patient gradually recovered in 4 months. In conclusion, this case suggests that rFVIIa can be successfully used for the hemostasis of uncontrolled bleeding in DIC. PMID:20651958

  17. Results of surgery in patients with bilateral independent temporal lobe spiking (BITLS) with normal MRI or bilateral mesial temporal sclerosis (MTS) investigated with bilateral subdural grids / Resultados cirúrgicos em pacientes com descargas bilaterais independentes do lobo temporal (DBILT) e ressonância magnética normal ou com esclerose mesial bilateral investigados com implante bilateral de grades subdurais

    Scientific Electronic Library Online (English)

    ARTHUR, CUKIERT; ALCIONE, SOUSA; ELCIO, MACHADO; JOSE AUGUSTO, BURATINI; CASSIO, FORSTER; MEIRE, ARGENTONI.

    1009-10-01

    Full Text Available INTRODUÇÃO: A introdução de novas tecnologias na prática clínica tem diminuído em muito a necessidade do estudo com eletrodos invasivos em pacientes epilépticos refratários. Por outro lado, alguns pacientes com epilepsia do lobo temporal ainda possuem exames de imagem normais ou com lesões potencial [...] mente epileptogênicas bilaterais. Este estudo relata os resultados da neurofisiologia invasiva e da cirurgia neste grupo de pacientes. MÉTODOS: Dezesseis pacientes foram estudados. Onze possuíam RM normal (grupo I) e 5 esclerose mesial bilateral (grupo II). Todos possuíam DBILT e crises não-localizatórias após vídeo-monitorização. Todos foram implantados bilateralmente com placas subdurais de 32 contatos cada. Eles foram submetidos a córtico-amigdalo-hipocampectomia do lado definido pela neurofisiologia invasiva. RESULTADO: No grupo I, as crises originaram-se em somente um lado em 9 pacientes. Em 9 pacientes, as crises iniciavam-se em um lado, espraiando-se para os contatos ipsilaterais e a seguir contralateralmente. Por outro lado, em 2 pacientes do grupo I, as crises iniciavam-se na superfície mesial de um lado e espraiava-se inicialmente para a superfície mesial e neocórtex contralaterais, antes de invadir outros contatos ipsilaterais. Todos os pacientes do grupo II possuíam crises iniciando-se na região mesial. Oito pacientes do grupo I estão sem crises e 3 encontram-se na classificação de Engel II. Oitenta por cento dos pacientes do grupo II estão sem crises após a cirurgia e um paciente encontra-se em Engel II. CONCLUSÃO: Bons resultados cirúrgicos podem ser obtidos em pacientes com DBILT. Pacientes com RM normal parecem ter prognóstico pior quando comparados com aqueles com esclerose mesial unilateral ou mesmo bilateral. Extensa cobertura subdural é necessária para o estudo invasivo de pacientes com RM normal. Abstract in english PURPOSE: The introduction of new technologies in the clinical practice have greatly decreased the number of patients submitted to invasive recordings. On the other hand, some patients with refractory temporal lobe epilepsy have normal MR scans or bilateral potentially epileptogenic lesions. This pap [...] er reports the results of invasive neurophysiology and surgical outcome in such patients. METHOD: Sixteen patients were studied. Eleven had normal MRI (Group I) and five had bilateral mesial temporal sclerosis (Group II). All patients had BITLS and non-localizatory seizures on video-EEG monitoring. All patients were implanted bilaterally with 32-contacts subdural grids. They were submitted to a cortico-amygdalo-total hippocampectomy at the side defined by chronic electrocorticography (ECoG). RESULTS: In Group I, seizures came from a single side in nine patients. In nine patients, seizures started at one side, spread to the ipsolateral contacts and contralaterally afterwards. On the other hand, in two Group I patients seizures started in one mesial region and spread to the contralateral parahippocampus and neocortex before spreading to ipsolateral contacts. All patients in Group II had seizures starting unilaterally with focal EcoG onset in the mesial regions. Eight Group I patients are seizure-free and three are in Engel's class II. Eighty percent of Group II patients are seizure-free after surgery and one patient is in Engel's class II. CONCLUSION: Good surgical results can be obtained in patients with BITLS. Patients with normal MRI seem to have a worse prognosis when compared to patients with unilateral or even bilateral MTS. Extensive subdural coverage is essential in patients with normal MRI.

  18. [Chronic hepatitis].

    Science.gov (United States)

    Figueroa Barrios, R

    1995-01-01

    Medical literature about chronic hepatitis is reviewed. This unresolving disease caused by viruses, drugs or unknown factors may progress to in cirrhosis and hepatocarcinoma. A classification based on liver biopsy histology into chronic persistent and chronic active types has been largely abandoned and emphasis is placed on recognizing the etiology of the various types. One is associated with continuing hepatitis B virus infection; another is related to chronic hepatitis C virus infection and the third is termed autoinmune, because of the association with positive serum autoantibodies. A fourth type with similar clinical functional and morphologic features is found with some drug reactions. Long term corticoesteroid therapy is usually successful in autoinmune type. Associations between antibodies to liver-kidney microsomes and the hepatitis C virus can cause diagnostic difficulties. Antiviral treatment of chronic hepatitis B and C with interpheron alfa is employed, controlling symptoms and abnormal biochemistry and the progression to cirrhosis and liver cancer in 30 to 40% patients. Alternative therapies or combinations with interpheron are being evaluated waiting for final results. PMID:8520023

  19. Chronic myelogenous leukemia (CML)

    Science.gov (United States)

    CML; Chronic myeloid leukemia; Chronic granulocytic leukemia; Leukemia - chronic granulocytic ... nuclear disaster. It takes many years to develop leukemia from radiation exposure. Most people treated for cancer ...

  20. Seizure's outcome after cortical resections including the face and tongue rolandic areas in patients with refractory epilepsy and normal MRI submitted to subdural grids' implantation

    Directory of Open Access Journals (Sweden)

    Cukiert Arthur

    2001-01-01

    Full Text Available PURPOSE: To study the seizure's outcome in patients with refractory epilepsy and normal MRI submitted to resections including the rolandic cortex. METHODS: Four adult patients were studied. All patients had motor or somatosensory simple partial seizures and normal MRI and were submitted to subdural grids' implantation with extensive coverage of the cortical convexity (1 in the non-dominant and 3 in the dominant hemisphere. RESULTS: ECoG was able to define focal areas of seizures' onset in every patient. All patients were submitted to resection of the face and tongue motor and sensitive cortex; two patients had resections including the perirolandic cortex and 2 had additional cortical removals. Three patients are seizures' free and one had a greater then 90% reduction in seizure frequency. CONCLUSION: Resections including the face and tongue rolandic cortex can be safely performed even within the dominant hemisphere.

  1. Hematoma retroesofágico com grave disfagia após estreptoquinase para tratamento da trombose venosa axilo-subclávia Severe dysfagia due to retroesophageal hematoma after thrombolytic therapy for right axillosubclavian vein thrombosis

    Directory of Open Access Journals (Sweden)

    Antonio Claudio do Amaral Baruzzi

    1997-08-01

    Full Text Available Homem de 72 anos, portador de neoplasia de próstata estádio IV, submetido à osteossíntese da coluna cervical para descompressão metastática da raiz nervosa, responsável por dor intensa no membro superior direito. Após três meses da internação, apresentou trombose total da veia axilo-subclávia direita, complicação da cateterização prolongada da veia subclávia direita para controle de septicemia secundária a pneumonia hospitalar. Foi submetido a terapia trombolítica com estreptoquinase por via venosa, no membro superior contra-lateral, na dose de 250.000UI em 15min, seguida de 100.000UI/h durante cinco dias, com total recanalização do trombo e redução do edema. Após 24h do término da trombólise, apresentou disfagia a líquidos e o esofagograma mostrou extensa compressão extrínseca do esôfago, por provável hematoma retroesofágico. Necessitou de nutrição enteral durante três meses, quando ocorreu normalização da deglutição, reabsorção do hematoma retroesofágico e passagem adequada do contraste pelo esôfago. No seguimento evolutivo não apresentou seqüelas da trombose venosa profunda, não tem disfagia e permaneceu em uso profilático de meias elásticas e heparina de baixo peso molecular.We report the case of a 72 year-old man with advanced, stage IV, prostate cancer who underwent osteosynthesis of the cervical spine for nerve root decompression due to metastasis which was causing severe pain in his right upper limb. After three months in the hospital, he developed occlusive thrombosis of the right axillosubclavian vein as a complication of prolonged catheterization of the right subclavian vein for treatment of septicemia secondary to a hospital acquired pneumonia. The patient received thrombolytic therapy with IV streptokinase in the contralateral arm in the following dosage: 250,000 units in 15 minutes followed by 100,000 units per hour during five days. This led to total recanalization of the thrombus, with significant reduction of the arm edema. Twenty-four hours after the end of the thrombolytic therapy, the patient started to complain of dysfagia to solids and liquids and a contrasted esophagogram revealed extensive extrinsic compression of the esophagus due to a probable retroesophageal hematoma. The patient required enteral nutrition via nasoenteral tube during three months after which swallowing returned to normal and a repeat upper GI series confirmed that the hematoma had been reabsorbed, with normal passage of contrast through the esophagus. On late follow-up, the patient did not show evidence of any sequelae of deep venous thrombosis nor any residual dysfagia and is currently in use of elastic stockings and low molecular weight heparin.

  2. Hematoma retroesofágico com grave disfagia após estreptoquinase para tratamento da trombose venosa axilo-subclávia / Severe dysfagia due to retroesophageal hematoma after thrombolytic therapy for right axillosubclavian vein thrombosis

    Scientific Electronic Library Online (English)

    Antonio Claudio do Amaral, Baruzzi; Maria Emília Cardoso, Gadelha; Claudio, Cirenza; Elias, Knobel.

    1997-08-01

    Full Text Available Homem de 72 anos, portador de neoplasia de próstata estádio IV, submetido à osteossíntese da coluna cervical para descompressão metastática da raiz nervosa, responsável por dor intensa no membro superior direito. Após três meses da internação, apresentou trombose total da veia axilo-subclávia direit [...] a, complicação da cateterização prolongada da veia subclávia direita para controle de septicemia secundária a pneumonia hospitalar. Foi submetido a terapia trombolítica com estreptoquinase por via venosa, no membro superior contra-lateral, na dose de 250.000UI em 15min, seguida de 100.000UI/h durante cinco dias, com total recanalização do trombo e redução do edema. Após 24h do término da trombólise, apresentou disfagia a líquidos e o esofagograma mostrou extensa compressão extrínseca do esôfago, por provável hematoma retroesofágico. Necessitou de nutrição enteral durante três meses, quando ocorreu normalização da deglutição, reabsorção do hematoma retroesofágico e passagem adequada do contraste pelo esôfago. No seguimento evolutivo não apresentou seqüelas da trombose venosa profunda, não tem disfagia e permaneceu em uso profilático de meias elásticas e heparina de baixo peso molecular. Abstract in english We report the case of a 72 year-old man with advanced, stage IV, prostate cancer who underwent osteosynthesis of the cervical spine for nerve root decompression due to metastasis which was causing severe pain in his right upper limb. After three months in the hospital, he developed occlusive thrombo [...] sis of the right axillosubclavian vein as a complication of prolonged catheterization of the right subclavian vein for treatment of septicemia secondary to a hospital acquired pneumonia. The patient received thrombolytic therapy with IV streptokinase in the contralateral arm in the following dosage: 250,000 units in 15 minutes followed by 100,000 units per hour during five days. This led to total recanalization of the thrombus, with significant reduction of the arm edema. Twenty-four hours after the end of the thrombolytic therapy, the patient started to complain of dysfagia to solids and liquids and a contrasted esophagogram revealed extensive extrinsic compression of the esophagus due to a probable retroesophageal hematoma. The patient required enteral nutrition via nasoenteral tube during three months after which swallowing returned to normal and a repeat upper GI series confirmed that the hematoma had been reabsorbed, with normal passage of contrast through the esophagus. On late follow-up, the patient did not show evidence of any sequelae of deep venous thrombosis nor any residual dysfagia and is currently in use of elastic stockings and low molecular weight heparin.

  3. Radiological image interpretation for hematoma and small tumors simulated in a head and neck phantom

    International Nuclear Information System (INIS)

    Subarachnoidal hemorrhages (HSA) are caused by aneurysms and their symptom usually becomes evident after a rupture. Nevertheless, there are situations in which the aneurysms compress a nerve or produce a bleed before the rupture happens, as consequence one alert signal like headache occurs. It, often occurs after minutes or weeks previous the major rupture. The main goal is to prevent a massive hemorrhage. Thus the Computer Tomography (CT) scan of skull provides a basic and specific function: to reveal the position where the hemorrhage was produced, guiding to a additional medical procedures. On the other hand, CT does not prevent the cerebral tumor development, but precise diagnostic for some symptoms such as vomits, nauseas, epileptic attacks, weakness in arms or legs, require this image protocol. CT has its fundamental importance to tumor detection. Indeed CT reveals its importance in the tumor early diagnosis. Specialized training in CT analysis shall be done. Ahead of a precise diagnosis to manager an early intervention, a CT diagnostic training is suitable for a favorable prognostic. In this context, focusing on propose of radiological inquires; a head and neck phantom will be used to simulate hematomas and cerebral tumors. Images of CT of skull will be used to identify these lesions physically implanted in phantom. The radiological response will be analyzed with the purpose of validation of the skull's CT diagnosis, for a double blind test. The diagnostic with non contrast CT shows only higher 5mm diameter subjects (tumors) identified by the double blind test. Hemorrhage is identified by only the administrator (single-blind test). As conclusion, the author's launches the hypothesis that this object simulator shall provide assistance for specialized training on pathology interpretation on radiological images. (author)

  4. Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

    International Nuclear Information System (INIS)

    To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean ± standard deviation age 66.1 ± 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 ± 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 ± 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 ± 9.5 months (range 12–42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic brancck pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

  5. Aortic Branch Artery Pseudoaneurysms Associated with Intramural Hematoma: When and How to Do Endovascular Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Ferro, Carlo; Rossi, Umberto G., E-mail: urossi76@hotmail.com; Seitun, Sara [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Radiology and Interventional Radiology (Italy); Scarano, Flavio; Passerone, Giancarlo [IRCCS San Martino University Hospital, IST, National Institute for Cancer Research, Department of Cardiac Surgery (Italy); Williams, David M. [University of Michigan Medical Center, Department of Radiology, Division of Vascular and Interventional Radiology (United States)

    2013-04-15

    To describe when and how to perform endovascular embolization of aortic branch artery pseudoaneurysms associated with type A and type B intramural hematoma (IMH) involving the descending thoracic and abdominal aorta (DeBakey I and III) that increased significantly in size during follow-up. Sixty-one patients (39 men; mean {+-} standard deviation age 66.1 {+-} 11.2 years) with acute IMH undergoing at least two multidetector computed tomographic examinations during follow-up for 12 months or longer were enrolled. Overall, 48 patients (31 men, age 65.9 {+-} 11.5) had type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III). Among the 48 patients, 26 (54 %; 17 men, aged 64.3 {+-} 11.4 years) had 71 aortic branch artery pseudoaneurysms. Overall, during a mean follow-up of 22.1 {+-} 9.5 months (range 12-42 months), 31 (44 %) pseudoaneurysms disappeared; 22 (31 %) decreased in size; two (3 %) remained stable; and 16 (22 %) increased in size. Among the 16 pseudoaneurysms with increasing size, five of these (three intercostal arteries, one combined intercostobronchial/intercostal arteries, one renal artery), present in five symptomatic patients, had a significant increase in size (thickness >10 mm; width and length >20 mm). These five patients underwent endovascular embolization with coils and/or Amplatzer Vascular Plug. In all patients, complete thrombosis and exclusion of aortic pseudoaneurysm and relief of back pain were achieved. Aortic branch artery pseudoaneurysms associated with type A and type B IMH involving the descending thoracic and abdominal aorta (DeBakey I and III) may be considered relatively benign lesions. However, a small number may grow in size or extend longitudinally with clinical symptoms during follow-up, and in these cases, endovascular embolization can be an effective and safe procedure.

  6. Technetium 99mTc Pertechnetate Brain Scanning

    International Nuclear Information System (INIS)

    Technetium 99mTc pertechnetate brain scanning were performed in 3 cases of head injury (2 chronic subdural hematomas and 1 acute epidural hematoma), 2 cases of brain abscess and 1 case of intracerebral hematoma associated with arteriovenous anomaly. In all the cases brain scintigrams showed 'hot areas.' Literatures on radioisotope scanning of intracranial lesions were briefly reviewed. With the improvement of radioisotope scanner and development of new radiopharmaceuticals brain scanning became a safe and useful screening test for diagnosis of intracranial lesions. Brain scanning can be easily performed even to a moribund patient without any discomfort and risk to the patient which are associated with cerebral angiography or pneumoencephalography. Brain scanning has been useful in diagnosis of brain tumor, brain abscess, subdural hematoma, and cerebral vascular diseases. In 80 to 90% of brain tumors positive scintigrams can be expected. Early studies were done with 203 Hg-Neohydrin or 131I-serum albumin. With these agents, however, patients receive rather much radiation to the whole body and kidneys. In 1965 Harper introduced 99mTc to reduce radiation dose to the patient and improve statistical variation in isotope scanning.

  7. The retro placental hematoma and fetal death in utero: About 49 cases and review of the literature

    Directory of Open Access Journals (Sweden)

    Saida Mezane

    2013-06-01

    Full Text Available The Retro Placental Hematoma (RPH or placental abruption untimely normally inserted paroxysmal is an accident that threatens maternal and fetal prognosis. It is a major emergency obstetric pathology and remains the second leading cause of maternal mortality after postpartum haemorrhage. It is actually very difficult to have an accurate evaluation the frequency of the HRP because it requires a complete table including Pathologists; or simple macroscopic or microscopic findings; or purely clinical diagnosis for some. Its occurrence requires appropriate resuscitation and adapted care to improve the prognosis. We report our study of 49 cases the HRP hospitalized in Obstetrics and Gynecology of Instruction Military Hospital Mohamed V in Rabat, diagnosed on a suggestive clinical picture and the presence of hematoma after examining the issue. This is a descriptive and comparative retrospective study over a period of one year. This study compared two groups: with HRP feotale death in utero and HRP without fetal death in utero. This study aims to evaluate neonatal mortality and maternal morbidity related to RPH and therapeutic modalities. This pathology formerly known pathology multiparous tends to reach more and more heifer. The important blood loss and delay the expulsion worse prognosis causing severe maternal morbidity hence the need to expand the indications for cesarean of retro placental hematoma regardless of the fetal state. Our study aims to contribute to reduce mortality and morbidity Fetomaternal by improving our work is stepping up efforts for a rapid decision-making, and we must educate what especially pregnant women of the risk factors to see from the beginning of symptoms. The pregnancy monitoring, early diagnosis of RPH, an obstetrical treatment adequate, and a resuscitation well driving can improve the prognosis of this disease.

  8. Chronic gastritis.

    Science.gov (United States)

    Sipponen, Pentti; Maaroos, Heidi-Ingrid

    2015-06-01

    Prevalence of chronic gastritis has markedly declined in developed populations during the past decades. However, chronic gastritis is still one of the most common serious pandemic infections with such severe killing sequelae as peptic ulcer or gastric cancer. Globally, on average, even more than half of people may have a chronic gastritis at present. Helicobacter pylori infection in childhood is the main cause of chronic gastritis, which microbial origin is the key for the understanding of the bizarre epidemiology and course of the disease. A life-long and aggressive inflammation in gastritis results in destruction (atrophic gastritis) of stomach mucosa with time (years and decades). The progressive worsening of atrophic gastritis results subsequently in dysfunctions of stomach mucosa. Atrophic gastritis will finally end up in a permanently acid-free stomach in the most extreme cases. Severe atrophic gastritis and acid-free stomach are the highest independent risk conditions for gastric cancer known so far. In addition to the risks of malignancy and peptic ulcer, acid-free stomach and severe forms of atrophic gastritis may associate with failures in absorption of essential vitamins, like vitamin B12, micronutrients (like iron, calcium, magnesium and zinc), diet and medicines. PMID:25901896

  9. Midbrain hematoma presenting with isolated bilateral palsy of the third cranial nerve in a Moroccan man: a case report

    Directory of Open Access Journals (Sweden)

    El Ouali Ouarda

    2012-07-01

    Full Text Available Abstract Introduction Bilateral third nerve palsy secondary to a hemorrhagic stroke is exceptional. To the best of our knowledge, no similar case has been reported in the literature. Case presentation We describe the case of a 69-year-old Moroccan man who presented with isolated sudden bilateral third nerve palsy. Computed tomography (CT of the brain revealed a midbrain hematoma. The oculomotor function gradually and completely improved over eight months of follow-up. Conclusion Stroke should be included in the differential diagnosis of sudden isolated oculomotor paralysis even when it is bilateral because of the severity of the underlying disease and the importance of its therape