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1

Chronic spinal subdural hematoma  

International Nuclear Information System (INIS)

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

2008-01-01

2

Chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] Recently much attention has been paid once again to etiology of chronic subdural hematoma since the appearance of computed tomography (CT). Authors examined 1824 head injury cases by CT from January 1977 to September 1979. Among them, there are 40 cases (they were all over 16 years old) whose CT showed frontal extracerebral low density area. The low density area which is considered to be so-called fluid collection could be classified into four types (type I to IV). In two cases of those 40 cases (5%), the low density area changed into high density area which seemed to be hemorrhage. The 2 cases were diagnosed to be chronic subdural hematoma and proved surgery. The change of density on CT developed only from type I (the brain surface looks smooth and sulci are not recognized beneath the low density area). The change of density, occurred in 2 cases among 24 cases of type I (8.3%), was recognized about 2 months after the head injury. This fact is compatible with the report by Yamada et al. (1979). Thus, when CT after the head injury shows frontal extracerebral low density area of type I, the case may develop to chronic subdural hematoma about 2 months after the head injury. Therefore, careful observation should be needed especially during this period after the head injury. (author)

1980-01-01

3

Pathogenesis of chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] Ten cases of chronic subdural hematoma that were followed by a sequential study with CT from an early posttraumatic period to evolution of chronic subdural hematoma were reported. In four of these 10 cases, the initial CT showed thin subdural collections of high density suggesting acute subdural hematoma. Two weeks later, the density of subdural collections reduced, but their volumes increased. Clinical symptoms such as headache and disorientation occurred three or four weeks later. Preoperative CT showed similar huge subdural collections of low density and marked mass effect. These cases underwent surgery from 24 to 44 days after injury, and development of neomenbranes was confirmed. In the remaining six cases, the initial CT showed thin subdural collections of low density suggesting subdural hygroma. In five of the six cases, the density of the subdural collections was slightly higher than that of cerebrospinal fluid, and in one case, an area of spotted high density was shown. It was suggested that these were mixtures with blood. Follow-up CT scans revealed that the subdural collections increased in size but remained at a uniformly low density for the first month after the head injury, and then the increase in density occurred. Operations were performed 55 to 76 days after injury, and operative findings were not different from those of common chronic subdural hematoma. From these investigations, it was suggested that there were two types of evolution of chronic subdural hematoma. One is the development from acute subdural hematomas, and the other from subdural hygromas. It is supposed that blood and cerebrospinal fluid are very important factors in the evolution of subdural collections into chronic subdural hematomas. (J.P.N.)

1982-01-01

4

Postoperative course of chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] 1) Fourty cases of chronic subdural hematoma were operated on by trephination, irrigation and external drainage. Postoperative neurological recovery and decrease of hematoma cavity on CT scan were followed. 2) Operation were effective for recovery of neurological grade in 28 cases, moderately effective in 7 cases and not effective in 5 cases. 3) Withinthe tenth postoperative day, more than half residual hematoma cavity existed in 53% of examined cases. After that, more than half residual cavity existed in only 17%. 4) Preoperative feature of neurologically unimproved cases were no definite history of head trauma and water like low density of hematoma cavity. Postoperative feature was persistence of more than three fourth of residual hematoma cavity on CT scan. 5) A group of unimproved cases described above are thought to have a feature of subdural hygroma rather than subdural hematoma. When possibility of subdural hygroma is high in preoperative differential diagnosis, indication of operation should be different from chronic subdural hematoma. (author)

1983-01-01

5

Postoperative course of chronic subdural hematoma  

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1) Fourty cases of chronic subdural hematoma were operated on by trephination, irrigation and external drainage. Postoperative neurological recovery and decrease of hematoma cavity on CT scan were followed. 2) Operations were effective for recovery of neurological grade in 28 cases, moderately effective in 7 cases and not effective in 5 cases. 3) Within the tenth postoperative day, more than half residual hematoma cavity existed in 53% of examined cases. After that, more than half residual cavity existed in only 17%. 4) Preoperative feature of neurologically unimproved cases were no definite history of head trauma and water like low density of hematoma cavity. Postoperative feature was persistence of more than three fourth of residual hematoma cavity on CT scan. 5) A group of unimproved cases described above are thought to have a feature of subdural hygroma rather than subdural hematoma. When possibility of subdural hygroma is high in preoperative differential diagnosis, indication of operation should be different from chronic subdural hematoma.

Takahashi, Toshiaki; Tsubone, Kyoji; Kyuma, Yoshikazu; Kuwabara, Takeo (Yokohama City Univ. (Japan). Faculty of Medicine)

1983-10-01

6

Chronic subdural hematoma secondary to traumatic subdural hygroma  

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Sometimes chronic subdural hematoma can be developed following posttraumatic subdural hygroma. The purpose of this study is to investigate its incidence, the duration required for their conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. We studied 8 patients with persistent posttraumatic subdural hygroma which consequently developed chronic subdural hamatoma. The patients were examined with CT initially and followed-up with CT in 3 and MR in 5. We analyzed the location of the lesion, the change of the density or signal intensity, the change of the size, and the degree of enhancement and mass effect. The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table with-out contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma in all cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were identical to those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hamatoma were higher. The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma.

Hong, Deok Hwa; Lim, Han Hyuk; Bae, Won Kyung; Kim, Pyo Nyun; Kim, Il Young; Lee, Byung Ho; Lee, Kyeong Seok [Soonchunhyang University Chonan Hospital, Cheonan (Korea, Republic of)

1994-02-15

7

Chronic subdural hematoma secondary to traumatic subdural hygroma  

International Nuclear Information System (INIS)

[en] Sometimes chronic subdural hematoma can be developed following posttraumatic subdural hygroma. The purpose of this study is to investigate its incidence, the duration required for their conversion, and characteristic CT and MR findings of subdural hygroma and chronic subdural hamatoma. We studied 8 patients with persistent posttraumatic subdural hygroma which consequently developed chronic subdural hamatoma. The patients were examined with CT initially and followed-up with CT in 3 and MR in 5. We analyzed the location of the lesion, the change of the density or signal intensity, the change of the size, and the degree of enhancement and mass effect. The duration required for the formation of hematoma was 48-166 days (mean, 76 days). The characteristic CT findings of subdural hygroma were a crescentric lesion with CSF density along the inner table with-out contrast enhancement. The mass effect was minimal. The CT findings of chronic subdural hematoma were higher density than that of hygroma in all cases, increase in thickness and size in 3 cases, and contrast enhancement along the inner membrane of the hematoma in 5 cases. The signal intensities of the subdural hygroma were identical to those of CSF on both T1 and T2 weighted images, whereas, those of chronic subdural hamatoma were higher. The increased signal intensity on T1 weighted MR images and increased attenuation or contrast enhancement of the lesion on CT may suggest the conversion of subdural hygroma into chronic subdural hematoma

1994-01-01

8

Computerized tomography in chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] In this report, the computerized tomography (CT) of chronic subdural hematoma was studied. Our experience was based on 22 patients with chronic subdural hematoma, verified by surgery. The results of the analysis of 16 cases excluded infant cases and post-operative cases. (1) In 8 cases, the locations of the hematoma were bilateral, and in 8 cases, unilateral. (2) The CT findings of the hematomas were classified into 4 types: low density (9 cases), iso-density (2 cases), mixed density (2 cases), and high density (3 cases). (3) Contrast enhancement in the capsule and the content of hematoma was indicated by the Marginal Curve. In infant cases (4), it is difficult to diagnose by the CT scan alone. We concluded, however, that CT was very useful in diagnosing chronic subdural hematoma. (author)

1979-01-01

9

Subdural hematoma  

Science.gov (United States)

Subdural hemorrhage ... Subdural hematomas are usually the result of a serious head injury. When one occurs in this way, it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest ...

10

Cortical enhancement in chronic subdural hematoma  

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In the CT findings of chronic subdural hematoma, brain enhancement adjacent to a subdural hematoma was seen occasionally after the injection of a contrast material. The authors called this finding ''cortical enhancement'', and 35 cases of chronic subdural hematoma were studied concerning cortical enhancement in relation to age, clinical signs and symptoms, hematoma density, and volume of the hematoma. Eight cases out of the 35 were subjected to measurements of the regional cerebral blood flow preoperatively by the method of the carotid injection of Xe-133. Cortical enhancement was apt to be seen in the cases which revealed intracranial hypertension or disturbance of consciousness, in isodensity or mixed-density hematomas, and in huge subdural hematomas. There was no specific correlation with age distribution. The pathogenesis of cortical enhancement seemed to be the result of cerebral compression with an increase in the contrast material per unit of volume and a prolonged venous outflow from the hemisphere, but no characteristic feature was detected in the average regional cerebral blood flow in our cases.

Taguchi, Y.; Sato, J.; Makita, T.; Hayashi, S. (Kanagawa Prefectural Hospital, Atsugi (Japan)); Nakamura, N.

1981-12-01

11

Cortical enhancement in chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] In the CT findings of chronic subdural hematoma, brain enhancement adjacent to a subdural hematoma was seen occasionally after the injection of a contrast material. The authors called this finding ''cortical enhancement'', and 35 cases of chronic subdural hematoma were studied concerning cortical enhancement in relation to age, clinical signs and symptoms, hematoma density, and volume of the hematoma. Eight cases out of the 35 were subjected to measurements of the regional cerebral blood flow preoperatively by the method of the carotid injection of Xe-133. Cortical enhancement was apt to be seen in the cases which revealed intracranial hypertension or disturbance of consciousness, in isodensity or mixed-density hematomas, and in huge subdural hematomas. There was no specific correlation with age distribution. The pathogenesis of cortical enhancement seemed to be the result of cerebral compression with an increase in the contrast material per unit of volume and a prolonged venous outflow from the hemisphere, but no characteristic feature was detected in the average regional cerebral blood flow in our cases. (author)

1981-01-01

12

Evaluation of subdural space after evacuation of chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] Subdural low density lesions of two cases were reexplored after evacuation of chronic subdural hematoma and thickening of the outer membrane was found in both cases. 1st case was a 88 year-old male, who had shown at least 7 months history of chronic subdural fluid accumulation. Reexploration of residual subdural low density space on CT after 14 days following the evacuation disclosed thickening of the outer membrane and none of fluid. 2nd case was a 71 year-old male who had a history of head injury 2 months before. Reexploration of residual low density lesion 14 days later disclosed a similar thickening of the outer membrane without fluid accumulation. The postoperative low density area in both cases was suspected to be a residual hematoma before reexploratin, but only thickening of the outer membrane of the hematoma was found. The outer membrane of 2nd case was histologically composed of layers of matured granulation, contiguous to the dura and a layer of immature granulation with microhemorrhage, facing the cavity. Thickening of the outer membrane seems to play an important role not only to develope, but to resolve the chronic subdural hematoma. It is neccessary to evaluate other factors than low density space per se to eliminate a needless reexploration. (author)

1988-01-01

13

Evaluation of subdural space after evacuation of chronic subdural hematoma  

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Subdural low density lesions of two cases were reexplored after evacuation of chronic subdural hematoma and thickening of the outer membrane was found in both cases. 1st case was a 88 year-old male, who had shown at least 7 months history of chronic subdural fluid accumulation. Reexploration of residual subdural low density space on CT after 14 days following the evacuation disclosed thickening of the outer membrane and none of fluid. 2nd case was a 71 year-old male who had a history of head injury 2 months before. Reexploration of residual low density lesion 14 days later disclosed a similar thickening of the outer membrane without fluid accumulation. The postoperative low density area in both cases was suspected to be a residual hematoma before reexploratin, but only thickening of the outer membrane of the hematoma was found. The outer membrane of 2nd case was histologically composed of layers of matured granulation, contiguous to the dura and a layer of immature granulation with microhemorrhage, facing the cavity. Thickening of the outer membrane seems to play an important role not only to develope, but to resolve the chronic subdural hematoma. It is neccessary to evaluate other factors than low density space per se to eliminate a needless reexploration.

Odake, Genya

1988-09-01

14

Intracranial Rhabdomyosarcoma Presented as Chronic Subdural Hematoma: A Case Report  

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Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion...

A. Mahdavi; Sh. Yazdani; Sh. Kazmi; F. Nejat; M. Mehdizadeh; M. Monajemzadeh

15

Cerebral perfusion changes in chronic subdural hematoma.  

Science.gov (United States)

Abstract Chronic subdural hematoma is a frequent disorder in the elderly. Although intensively investigated, numerous aspects, including the pathophysiology of clinical symptoms, remain unclear. Perfusion deficits are likely to induce the transient neurologic symptoms seen in chronic subdural hematoma (cSDH). The aim of the present study was to quantify cerebral perfusion impairment in cSDH. Before surgery, 34 patients were examined neurologically using the National Institutes of Health Stroke Scale (NIHSS) score and investigated by CT perfusion imaging. Hematoma volume, localization, and hematoma configuration were recorded. Clinical and radiological data were correlated. Mean hematoma volume was 91.8?cm(3) (16.2-241.6?cm(3), standard deviation [SD] 49.5). Whole brain mean transit time (MTT) was slightly elevated (mean 36.6?sec, SD 5.8). Hematoma volume and cerebral blood volume (CBV) in the underlying hemisphere correlated marginally but not significantly (p=0.067). Perfusion parameters determined in the area below the hematoma (ABH) and the corresponding contralateral cortex (MAC) were highly significantly different regarding cerebral blood flow (CBF) (mean 88.8 vs. 70.4, p<0.01) and CBV (mean 29.4 vs. 22.5, p<0.01). On the other hand, MTT and Tmax were almost equal between these areas (MTT means 35.0 vs. 34.8, (p)=0.914; tMax means 16.0 vs. 15.4, p=0.587). We conclude that local brain perfusion autoregulation is active in the cortical area below cSDH. CBV and CBF are significantly upregulated in the cortical area below cSDH indicating the effect of autoregulation in tissue at risk of ischemia. Cerebral autoregulation is intact in cSDH. Neurologic deficits are likely induced by borderline perfusion. PMID:23227943

Slotty, Philipp Jörg; Kamp, Marcel Alexander; Steiger, Steiger Hans-Jakob; Cornelius, Jan Frederick; Macht, Stephan; Stummer, Walter; Turowski, Bernd

2013-02-11

16

Postoperative CT appearance in chronic subdural hematomas  

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Postoperative CT appearances in 65 cases of chronic subdural hematomas were evaluated in terms of patient's age, preoperative neurological symptoms and CT findings, final outcomes, and so on. All of the cases were treated with trepanation and irrigation. CT appearances were divided into four different types as follows; Type Ia: No abnormal findings in the subdural sapce, Type Ib: The same as above except for a linear high density suggestive of thickened outer membrane, Type II: Persistence subdural fluid collection and widened cortical sulci which indicate underlining brain atrophy, Type III: Remaining hematoma and/or density changes during follow-up period. Although the mean age of the patients in type Ib was higher than those in type Ia and reexpansion of the brain appear to delay in type Ib and preoperative CT in type Ib tended to show mixed density, final outcome in both groups were excellent. Characteristics in type II were that most of cases were in the eighth decade, preceding head injury was unclear, preoperative psychiatric symptoms and disturbance of consciousness were common and postoperative improvement of the symptoms was not satisfactory compared to other types. Aged patients as in type Ib and type II and thick hematomas of over 2 cm depth with mixed or high density tended to show type III postoperatively. All of the nine patients who required reoperation were included in this type. The present study indicates that thick hematomas with sizable mass effect and mixed or high density in the aged must be carefully treated, such as with placement of the subdural drainage or keeping the patient in the Trendelenburg position, to facilitate postoperative reexpansion of the brain.

Kaneko, Takaaki; Nishikawa, Michio; Handa, Hajime; Iwaki, Kazuo; Sawai, Teruaki; Munaka, Masahiro

1988-05-01

17

Postoperative CT appearance in chronic subdural hematomas  

International Nuclear Information System (INIS)

[en] Postoperative CT appearances in 65 cases of chronic subdural hematomas were evaluated in terms of patient's age, preoperative neurological symptoms and CT findings, final outcomes, and so on. All of the cases were treated with trepanation and irrigation. CT appearances were divided into four different types as follows; Type Ia: No abnormal findings in the subdural sapce, Type Ib: The same as above except for a linear high density suggestive of thickened outer membrane, Type II: Persistence subdural fluid collection and widened cortical sulci which indicate underlining brain atrophy, Type III: Remaining hematoma and/or density changes during follow-up period. Although the mean age of the patients in type Ib was higher than those in type Ia and reexpansion of the brain appear to delay in type Ib and preoperative CT in type Ib tended to show mixed density, final outcome in both groups were excellent. Characteristics in type II were that most of cases were in the eighth decade, preceding head injury was unclear, preoperative psychiatric symptoms and disturbance of consciousness were common and postoperative improvement of the symptoms was not satisfactory compared to other types. Aged patients as in type Ib and type II and thick hematomas of over 2 cm depth with mixed or high density tended to show type III postoperatively. All of the nine patients who required reoperation were included in this type. The present study indicates that thick hematomas with sizable mass effect and mixed or high density in the aged must be carefully treated, such as with placement of the subdural drainage or keeping the patient in the Trendelenburg position, to facilitate postoperative reexpansion of the brain. (author)

1988-01-01

18

Pathogenesis of chronic subdural hematoma. Sequential study with computerized tomography  

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Ten cases of chronic subdural hematoma that were followed by a sequential study with CT from an early posttraumatic period to evolution of chronic subdural hematoma were reported. In four of these 10 cases, the initial CT showed thin subdural collections of high density suggesting acute subdural hematoma. Two weeks later, the density of subdural collections reduced, but their volumes increased. Clinical symptoms such as headache and disorientation occurred three or four weeks later. Preoperative CT showed similar huge subdural collections of low density and marked mass effect. These cases underwent surgery from 24 to 44 days after injury, and development of neomembranes was confirmed. In the remaining six cases, the initial CT showed thin subdural collections of low density suggesting subdural hygroma. In five of the six cases, the density of the subdural collections was slightly higher than that of cerebrospinal fluid, and in one case, an area of spotted high density was shown. It was suggested that these were mixtures with blood. Follow-up CT scans revealed that the subdural collections increased in size but remained at a uniformly low density for the first month after the head injury, and then the increase in density occurred. Operations were performed 55 to 76 days after injury, and operative findings were not different from those of common chronic subdural hematoma. From these investigations, it was suggested that there were two types of evolution of chronic subdural hematoma. One is the development from acute subdural hematomas, and the other from subdural hygromas. It is supposed that blood and cerebrospinal fluid are very important factors in the evolution of subdural collections into chronic subdural hematomas.

Taguchi, Y.; Nakamura, N.; Sato, J. (Jikei Univ., Tokyo (Japan). School of Medicine); Hasegawa, Y.

1982-04-01

19

Hematoma subdural crônico: análise de 35 casos/ Chronic subdural hematoma: analysis of 35 cases  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacient (more) es submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado. Abstract in english Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III (more) or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.

Araújo, João Flavio M.; Iafigliola, Maria Gracia; Balbo, Roque José

1996-03-01

20

Hematoma subdural crônico: análise de 35 casos Chronic subdural hematoma: analysis of 35 cases  

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Full Text Available Os autores relatam 35 casos com diagnóstico de hematoma subdural crônico, operados no período de janeiro-1988 a março-1995. A idade dos pacientes variou entre 19 e 80 anos. Foram eles agrupados retrospectivamente segundo a escala de Bender. Quanto ao tratamento cirúrgico, foram empregadas duas técnicas: craniotomia com membranectomia e dupla trepanação com instilação de solução salina na cavidade ocupada pelo hematoma. O índice de mortalidade entre os pacientes submetidos à craniotomia foi 16,6% e nos pacientes submetidos à trepanação foi nulo. Dentre os pacientes que faleceram, 80% encontravam-se em grau III ou IV na escala de Bender. O hematoma subdural crônico apresenta até os dias atuais alguns aspectos controversos, como quanto à sua fisiopatologia e ao tratamento cirúrgico adequado.Thirty five patients with chronic subdural hematoma were treated surgically between 1988 and 1995. The patients, aged 19 to 80 years, were graded retrospectively according to the Bender scale. The clots were removed via burr-holes with irrigation of the subdural space to ensure as complete an evacuation of subdural colletion, and craniotomy with membranectomy. The mortality rate was 16.6% with craniotomy and 0% with burr-hole. The patients who died, 80% were in grade III or IV. The pathogenesis and surgical treatment of chronic subdural hematoma has been controversial, and still remains obscure.

João Flavio M. Araújo; Maria Gracia Iafigliola; Roque José Balbo

1996-01-01

 
 
 
 
21

Chronic subdural hematoma. Brain computerized tomography in forty cases  

International Nuclear Information System (INIS)

[en] The natural history of the chronic subdural hematoma is reviewed in an attempt to determine the mechanisms usually implicated in the pathogenesis of delayed subdural hematoma. Indications for repeated computerized tomography in the follow-up of patients with head injury are detailed. (M.A.C.)

1988-01-01

22

Hematoma subdural crónico: Una enfermedad del adulto mayor/ Chronic subdural hematoma: a disease of elderly people  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. Aim: To report the experience of a Neurosurgical Service in chronic subdural hematoma. Patients and methods: One hundred patients (77 male, mean age 77±13 years) with chronic subdural hematoma were analyzed. Results: The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as (more) a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. Conclusions: Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome (Rev Méd Chile 2003; 131: 177-82)

Tagle M, Patricio; Mery M, Francisco; Torrealba M, Gonzalo; Del Villar PM, Sergio; Carmona V, Hans; Campos P, Manuel; Méndez S, Jorge; Chicharro C, Ada

2003-02-01

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Hematoma subdural crónico: Una enfermedad del adulto mayor Chronic subdural hematoma: a disease of elderly people  

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Full Text Available The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. Aim: To report the experience of a Neurosurgical Service in chronic subdural hematoma. Patients and methods: One hundred patients (77 male, mean age 77±13 years) with chronic subdural hematoma were analyzed. Results: The main clinical presentations were mental status changes (50%) and progressive focal neurological deficit (46%). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3%. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. Conclusions: Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome (Rev Méd Chile 2003; 131: 177-82)

Patricio Tagle M; Francisco Mery M; Gonzalo Torrealba M; Sergio Del Villar PM; Hans Carmona V; Manuel Campos P; Jorge Méndez S; Ada Chicharro C

2003-01-01

24

CT findings and the evaluation of chronic subdural hematoma, (1). Forecast of chromic subdural hematoma  

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CT examinations were performed in 621 cases of minor head injury within 3 days, and 26 cases (4%) exhibited hygroma-like CT findings. These 26 cases were divided into two patterns: Type A (12 cases) and Type B (14 cases). Type A showed smooth thin hygroma-like low density area beneath the skull with compression of the cerebral surface and cerebral sulci. Type B showed an irregular thin hygroma-like low density area beneath the skull with recognized cerebral sulci. Many of these cases changed into chronic subdural hematomas, i.e. Twelve cases (100%) of Type A and three cases (21%) of Type B changed into chronic subdural hematomas. It is highly possible to forecast the subsequent occurrence of the chronic subdural hematomas soon after a head injury.

Takahashi, Y.; Sato, H.; Inoue, Y.; Takeda, S.; Ohkawara, S. (Ohkawara Neurosurgical Hospital, Muroran, Hokkaido (Japan))

1981-05-01

25

Hematoma subdural crónico calcificado. Reporte de un caso/ Calcified chronic subdural hematoma. A case report  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 de (more) recha 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. Abstract in english The chronic subdural hematoma constitutes a frequent disease in daily neurosurgical practice. Currently its diagnosis of premature form is performed in the majority of patients, since the introduction of imaging's modern techniques. An 84 years old patient with history of cephalea, akinetic mutism and cuadriparesis, whose tomographic exam showed a right hemispheric supratentorial extraxial collection with massive calcification; the exeresis was performed by means of a cra (more) niotomy and the histopathological study confirmed the diagnosis of chronic subdural hematoma. It was concluded that, when constitute the massive calcification of the chronic subdural hematoma a rare form of imaging presentation at present, should contemplate another entities in the differential diagnostic like neoplasias and intracranial vascular malformations; In addition, increases the surgical complexity since it is essential the practice of a craniotomy for the evacuation of the lesion.

Varela Hernández, Ariel; Mosquera Betancourt, Gretel; Cardoso Núñez, Oscarlyns; Pardo Cardoso, Guillermo

2008-12-01

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[Chronic subdural hematoma and psychotic decompensation].  

UK PubMed Central (United Kingdom)

BACKGROUND: In Tunisia, with the remarkable progress in health, life expectancy has significantly increased these last decades. Indeed, in 2004, 9.3% of the population was aged over 60, and this rate is predicted to reach 17% in 2029 and about 29% by 2050. In the elderly, chronic subdural hematoma (HSDC) may be caused by even minimal trauma or occur spontaneously. The manifestations of this type of accumulation depend on the degree of cerebral compression and the localisation of the mass. They could be delirium, dementia, convulsions or psychiatric disorders (frontal location). CASE REPORT: When the psychiatric presentation predominates, the decision to hospitalise an elderly person in a psychiatric unit is difficult and often avoided. We report the case of an 81 year-old man without history of medical condition or personal or family psychiatric history, who, in 2000, began to exhibit behavioural disorders, delusions of persecution and jealousy, visual hallucinations and sexual disinhibition. This clinical picture that set in so insidiously and in moderate intensity was long tolerated by the family circle. The patient was admitted to a psychiatric hospital in January 2008 with the worsening of the symptoms. The clinical examination and investigations confirmed the diagnosis of chronic frontoparietal subdural hematoma without compression. The decision in neurosurgery was to refrain from surgical drainage and administer high doses of steroids under supervision (clinical and biological). The evolution was good with progressive resorption of the hematoma to complete recovery. Currently, the patient is symptom free and the last CT scan on 03/11/2010 confirms the total resorption of the hematoma. CONCLUSION: It appears from this case and review of the literature that various psychiatric manifestations may reveal an HSDC and that, in the elderly, neuroimaging should be systematic, even for minor symptoms. The total resorption led to the disappearance of psychiatric symptoms in most patients, but this remains a topic of discussion for patients who retain residual symptoms, even after resorption of the mass. Caution is required when faced with an elderly person suffering, and we should strive to explore all possible causes before jumping to the conclusion of the fatality of growing old.

Jomli R; Zgueb Y; Nacef F; Douki S

2012-09-01

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Moving the Blood and Transforming Stasis for Chronic Subdural Hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available A 44-year-old female fainted when she went to the bathroom at midnight. There was abruise over her right cheek when she regained consciousness. The patient had no headacheor neurological defects on physical examination. The computed tomographic (CT) scan ofthe brain showed a chronic subdural hematoma over the right fronto-parietal lobe 12 weeksafter the fainting episode. She took a modification of xu?e f?u zhú y¯u t¯ang ( , XZT,House of Blood Stasis-Expelling Decoction) for moving the blood and transforming stasis.The subdural hematoma disappeared 2 months after she began taking the formula. Themechanisms of XZT to treat chronic subdural hematoma might be (1) regulating the permeabilityof hematoma capsule to prevent recurrent bleeding, and (2) promoting the microcirculationaround the hematoma to accelerate resolution of subdural collection.

Liang-In Liu; Helen Chang; Lung Chan

2006-01-01

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Analysis of chronic subdural hematoma based on CT, (2)  

International Nuclear Information System (INIS)

[en] Twenty-three cases of chronic subdural hematoma were observed soon after head injury for the relationship between its CT findings and clinical symptoms. It has been found that the chronic subdural hematoma is a slowly growing and expanding intracranial disease that starts in an early period of head injury. Chronic subdural hematoma did not present any signs or symptoms initially, except for the gradual occurrence of headache, but finally it presented signs of intracranial hypertension and focal signs. Chronic subdural hematoma in the hygroma-like period did not show any signs and symptoms. In the capsulated period, when changes in CT density suggested intracapsular hemorrhage, a heavy sensation of the head was noted. It was recognized as an abnormal feeling or a full sensation of the head. When the bleeding continued in the cavity, headache became continuous and focal signs gradually appeared. (author)

1982-01-01

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[Presentation of chronic subdural hematoma in the elderly].  

UK PubMed Central (United Kingdom)

A 87-year old man was admitted to our hospital with decline in cognition and mobility and visual hallucinations. CT scanning revealed a bilateral chronic subdural hematoma. The hematoma was probably caused by a recent fall, while the patient was using acenocoumarol. Chronic subdural hematoma (CSDH) is a frequently occurring intracranial bleeding in the elderly. It usually occurs after a minor trauma and may present with a variety of symptoms. The differentiation between CSDH and other disorders like dementia can be difficult when the hematoma presents with cognitive decline and neuropsychiatic symptoms, such as hallucinations.

Jobse IC; Feitsma MT

2011-06-01

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Delayed contrast-enhanced CT findings in traumatic subdural hygromas and chronic subdural hematomas  

International Nuclear Information System (INIS)

[en] There have been some reports about chronic subdural hematomas occuring subsequent to traumatic subdural hygromas. The purpose of this report is to investigate the dynamic changes in subdural collections by means of DCECT (Delayed Contrast-enhanced CT). The clinical subjects were 30 cases of traumatic subdural hygromas and chronic subdural hematomas. DCECT examinations (plain CT, contrast-enhanced CT, and DCECT taken 3, 6, 24 hours after the injection of the contrast media) were performed in all cases. In 90% of the cases, the density of subdural collections increased 3 or 6 hours after the injection and decreased 24 hours after the injection. These findings suggest that the contrast media go in and come out of the subdural collections and that the balance of passage influences the progression and regression of subdural collections and the development of hematomas from hygromas. (author)

1982-01-01

31

Delayed contrast-enhanced CT findings in traumatic subdural hygromas and chronic subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

There have been some reports about chronic subdural hematomas occuring subsequent to traumatic subdural hygromas. The purpose of this report is to investigate the dynamic changes in subdural collections by means of DCECT (Delayed Contrast-enhanced CT). The clinical subjects were 30 cases of traumatic subdural hygromas and chronic subdural hematomas. DCECT examinations (plain CT, contrast-enhanced CT, and DCECT taken 3, 6, 24 hours after the injection of the contrast media) were performed in all cases. In 90% of the cases, the density of subdural collections increased 3 or 6 hours after the injection and decreased 24 hours after the injection. These findings suggest that the contrast media go in and come out of the subdural collections and that the balance of passage influences the progression and regression of subdural collections and the development of hematomas from hygromas.

Karasawa, Hideharu; Ohya, Shigeru; Ueno, Junji; Watanabe, Saburo; Mikabe, Toshio (Asahi General Hospital, Chiba (Japan))

1982-10-01

32

The use of reservoir shunt in chronic subdural hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available Recurrent chronic subdural hematomas (CSDH) can be a therapeutic challenge. We report the use of reservoir shunts for continuous irrigation and drainage of the subdural space for a prolonged period. This system appears to be more useful than an external drainage system.

Aydin M

2004-01-01

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Intracranial Rhabdomyosarcoma Presented as Chronic Subdural Hematoma: A Case Report  

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Full Text Available Intracranial rhabdomyosarcoma is a very rare disorder. Subdural rhabdomyosarcoma has not been reported yet. It can be misdiagnosed with chronic subdural hematoma in CT images. Herein, we presented a 2.5-year-old boy with intractable chronic subdural hematoma who were treated with burr hole insertion, needle aspiration and shunting for about 2 years with partial resolution of his symptoms after each procedure. The final pathologic evaluation after extensive bilateral craniotomy revealed rhabdomyosarcoma. The role of CT and MRI in early diagnosis and management of this rare situation is discussed.

A. Mahdavi; Sh. Yazdani; Sh. Kazmi; F. Nejat; M. Mehdizadeh; M. Monajemzadeh

2007-01-01

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[Rapid recurrence of chronic subdural hematoma by CSF entrapment].  

UK PubMed Central (United Kingdom)

A case of chronic subdural hematoma with multiple rapid recurrences is reported. A 41-year-old woman was admitted to hospital because of a traumatic subarachnoid hemorrhage and an intracerebral hematoma in the left frontal lobe. Both regions were conservatively treated, and she was discharged with no neurological deficit. Four months after this injury, she was readmitted to our clinic with complaints of severe headache and mild left hemiparesis. A CT scan showed a right chronic subdural hematoma. A burr hole and irrigation was performed, and the hematoma cavity disappeared on the following day. However, a deterioration of consciousness and left hemiparesis appeared ten days after the first operation. A second CT scan showed the recurrence of a left chronic subdural hematoma, so a second operation was performed. The patient showed a good postoperative course, and once again the hematoma cavity disappeared on the day following the operation. Nevertheless, a deterioration of consciousness and left hemiparesis appeared eight days after the second operation. A CT scan showed a second recurrence with low-density findings. Intraoperative findings during the third operation showed an almost water-like subdural fluid, and entrapment of cerebrospinal fluid by the inner membrane was suspected. A craniotomy and the removal of the outer and inner membranes were performed. Macroscopically, the inner membrane was intact and showed no signs of injury. No further recurrences occurred after the craniotomy. The suspected cause of the multiple subdural hematomas was the flow and entrapment of cerebrospinal fluid in some area of the inner membrane.

Kannuki SG; Shirakawa N; Toi H

2009-06-01

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Computerized tomography of chronic subdural hematoma extending to the tentorium  

Energy Technology Data Exchange (ETDEWEB)

A case of chronic subdural hematoma extending to the cerebellar tentorium is presented. The clinical feature of this case was gait disturbance with trankial ataxia. An axial CT scan showed only a diffuse high-density area in the cerebellar tentorium, but a coronal CT scan revealed a characteristic high-density lesion just on the cerebellar tentorium. The hematoma was evacuated by opening a burrhole at the convex; the gait disturbance disappeared after this operation. The value of a coronal CT scan in this case is stressed, and the mechanism of gait disturbance in a chronic subdural hematoma is discussed.

Kondoh, Takeshi; Kanazawa, Yasuhisa; Harada, Hideaki; Tamaki, Norihiko; Matsumoto, Satoshi

1987-06-01

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The risk factors for recurrence of chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

Chronic subdural hematoma (CSDH) is a common disease in the elderly, and the recurrence rate of CSDH is reported to range from 2.3 to 33%. We performed a retrospective review of a number of CSDH cases and the potential factors associated with CSDH recurrence. The patient population comprised 112 men and 65 women with a mean age of 74.7 years. We analyzed the following factors: age, sex, antiplatelet and anticoagulant use, hematoma laterality, hematoma thickness, degree of midline shift and internal architecture of the hematoma in the preoperative CT films, use of irrigation, direction of the drainage tube, width of the subdural space, and degree of midline shift and the presence of a massive subdural air collection in the postoperative CT films. Univariate analysis revealed that there was a trend for different rates of recurrence among the different types of hematomas. The presence of a postoperative massive subdural air collection tended to be associated with the recurrence of hematoma. Multivariate analysis revealed that separated hematomas were significantly associated with CSDH recurrence, whereas the presence of postoperative massive subdural air collection tended to be associated with hematoma recurrence. Neither univariate nor multivariate analysis could demonstrate an association between the direction of the drainage tube and the recurrence of CSDH.

Ohba S; Kinoshita Y; Nakagawa T; Murakami H

2013-01-01

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

International Nuclear Information System (INIS)

[en] Percutaneous subdural tapping for chronic subdural hematoma (CSDH) can measure initial hematoma pressure, which cannot be measured using burr-hole craniotomy. Initial hematoma pressure has not been discussed as a risk factor for recurrence. We evaluated the clinical features for recurrence, which included initial hematoma pressure. The study involved 71 unilateral CSDH cases whose initial hematoma pressure was measured using percutaneous subdural tapping. Clinical recurrence was identified in 19 cases (23%). Age, sex, neurological grading, alcohol consumption, presence of head injury, hypertension, diabetes mellitus, antiplatelet, anticoagulant medication, hematoma volume on computed tomography (CT) images, and initial hematoma pressure were compared between non-recurrence and recurrence groups. The initial hematoma pressure was 12.6±4.5 cmH2O in the non-recurrence group, and 15.5±6.2 cmH2O in the recurrence group (p

2012-01-01

38

Tratamiento médico de un hematoma subdural crónico Medical treatment of a chronic subdural hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available Se presenta una paciente portadora de un hematoma subdural crónico postraumático, que se trató médicamente y se logró su desaparición en el curso de varios meses, sin tratamiento quirúrgico y sin signos evolutivos de empeoramiento neurológico. La furosemida fue usada como medicamento básico en su tratamiento. Se adjuntan imágenes que confirman el valor de este punto de vista terapéutico.This is the case of a patient carrier of a post-traumatic chronic subdural hematoma clinically treated achieving its disappearance over some months without surgical treatment and evolutionary signs of neurologic worsening. The furosemide was used as basic drug in its treatment. The images confirming the value of this point of therapeutical view are enclosed.

Antonio Guevara Melcón; Ashley Obregón Marín

2012-01-01

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Tratamiento médico de un hematoma subdural crónico/ Medical treatment of a chronic subdural hematoma  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Se presenta una paciente portadora de un hematoma subdural crónico postraumático, que se trató médicamente y se logró su desaparición en el curso de varios meses, sin tratamiento quirúrgico y sin signos evolutivos de empeoramiento neurológico. La furosemida fue usada como medicamento básico en su tratamiento. Se adjuntan imágenes que confirman el valor de este punto de vista terapéutico. Abstract in english This is the case of a patient carrier of a post-traumatic chronic subdural hematoma clinically treated achieving its disappearance over some months without surgical treatment and evolutionary signs of neurologic worsening. The furosemide was used as basic drug in its treatment. The images confirming the value of this point of therapeutical view are enclosed.

Guevara Melcón, Antonio; Obregón Marín, Ashley

2012-03-01

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CT findings and the evaluation of chronic subdural hematoma, (1)  

International Nuclear Information System (INIS)

[en] CT examinations were performed in 621 cases of minor head injury within 3 days, and 26 cases (4%) exhibited hygroma-like CT findings. These 26 cases were divided into two patterns: Type A (12 cases) and Type B (14 cases). Type A showed smooth thin hygroma-like low density area beneath the skull with compression of the cerebral surface and cerebral sulci. Type B showed an irregular thin hygroma-like low density area beneath the skull with recognized cerebral sulci. Many of these cases changed into chronic subdural hematomas, i.e. Twelve cases (100%) of Type A and three cases (21%) of Type B changed into chronic subdural hematomas. It is highly possible to forecast the subsequent occurrence of the chronic subdural hematomas soon after a head injury. (author)

1981-01-01

 
 
 
 
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Metrizamide CT cisternography in cases of traumatic subdural hygroma and chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] Subdural fluid collection and some cases of chronic subdural hematoma are observed by means of a CT scan as marginal low-density areas (m-LDA) in head-injured patients. It is thought that the cerebro-spinal fluid dynamics may play an important role in the pathogenesis and clinical course of such subdural pathology. We applied metrizamide CT cisternography to these cases. According to the findings of this metrizamide CT cisternography (M-CTC), the examples of subdural pathology can be classified into four types: Type I: Metrizamide filling is seen in both the cortical subarachnoid space and the m-LDA. Type II: Metrizamide filling is seen only in the cortical subarachnoid space, not in the m-LDA. Type III: Metrizamide filling is very poor in both the cortical subarachnoid space and the m-LDA. Type IV: Metrizamide filling extends well into the m-LDA, but only partially into the cortical subarachnoid space. Many of these cases studied had been operated on and the subdural pathology had been ascertained. From a comparison between the M-CTC and subdural types of pathology, subdural pathology of Types I, II, and III can all be classified as cases of a subdural hygroma (subdural fluid collection or subdural effusion), while Type IV is a chronic subdural hematoma. The characteristics and choice of treatment of each type may be briefly shown as follows: For Type I conservative therapy is recommended because of its tendency to decrease rapidly. For Type II a subduro-peritoneal shunt is recommended, for the m-LDA is long-standing and a simple burrhole evacuation sometimes results in an aggravation of the subdural hygroma. For Type III a burrhole evacuation is recommended; also, care must be taken against the development of a chronic subdural hematoma. For Type IV a burrhole evacuation is recommended became such cases are all chronic subdural hematoma. (J.P.N.)

1987-01-01

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Metrizamide CT cisternography in cases of traumatic subdural hygroma and chronic subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

Subdural fluid collection and some cases of chronic subdural hematoma are observed by means of a CT scan as marginal low-density areas (m-LDA) in head-injured patients. It is thought that the cerebro-spinal fluid dynamics may play an important role in the pathogenesis and clinical course of such subdural pathology. We applied metrizamide CT cisternography to these cases. According to the findings of this metrizamide CT cisternography (M-CTC), the examples of subdural pathology can be classified into four types: Type I: Metrizamide filling is seen in both the cortical subarachnoid space and the m-LDA. Type II: Metrizamide filling is seen only in the cortical subarachnoid space, not in the m-LDA. Type III: Metrizamide filling is very poor in both the cortical subarachnoid space and the m-LDA. Type IV: Metrizamide filling extends well into the m-LDA, but only partially into the cortical subarachnoid space. Many of these cases studied had been operated on and the subdural pathology had been ascertained. From a comparison between the M-CTC and subdural types of pathology, subdural pathology of Types I, II, and III can all be classified as cases of a subdural hygroma (subdural fluid collection or subdural effusion), while Type IV is a chronic subdural hematoma. The characteristics and choice of treatment of each type may be briefly shown as follows: For Type I conservative therapy is recommended because of its tendency to decrease rapidly. For Type II a subduro-peritoneal shunt is recommended, for the m-LDA is long-standing and a simple burrhole evacuation sometimes results in an aggravation of the subdural hygroma. For Type III a burrhole evacuation is recommended; also, care must be taken against the development of a chronic subdural hematoma. For Type IV a burrhole evacuation is recommended became such cases are all chronic subdural hematoma. (J.P.N.).

Morimoto, Tetsuya; Takemura, Kiyoshi; Inui, Shoji; Hori, Yutaka; Sakaki, Toshisuke; Miyamoto, Seiji; Kyoi, Kikuo; Utsumi, Shozaburo

1987-06-01

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Chronic subdural hematoma fluid and its computerized tomographic density  

International Nuclear Information System (INIS)

[en] Laboratory and in vivo CT analysis were performed on 19 chronic subdural hematomas and five subdural hygromas. In these 25 hematoma samples, red blood cells (RBC), hematocrit, and hemoglobin (Hgb) varied greatly, though, these values correlated well with the CT densities. Plasma protein content was fairly constant with an average of 7.1+-0.8g/dl. There were four hematoma samples with RBC of less than 20x104?l or Hgb of less than 2.0g/dl. Their CT values ranged between 18 and 23 H.U., which were considered close to the in vivo serum level CT density. Five hygroma fluid showed no RBC and very little protein content of less than 0.4g/dl. CT density ranged between -2 and 13 H.U. The edge effect of the skull was experimentally studied using a phantom skull filled with water. This revealed a remarkable overshoot of the CT values within ten pixels from the inner wall of the skull. Visual observation of the original CT pictures revealed four low density hematomas and seven mixed density ones. When compared to the density of the ventricular cavity, all of the low density hematomas and the supernatant part of the mixed density ones were clearly higher in density. All five hygromas appeared CSF dense or lower. In conclusion, because of the edge effect by the skull, thin subdural fluids could not be diagnosed by CT alone. Thick subdural fluids could be differentiated as either hematoma or hygroma by their CT densities. Subdural hematomas had in vivo CT densities of at least serum level or approximately 20 H.U., while subdural hygromas had densities close to CSF. These characteristics were best appreciated by visual observation of the CT scan films. (J.P.N.)

1983-01-01

44

Chronic Subdural Hematoma - An Up-to-Date Concept.  

UK PubMed Central (United Kingdom)

Chronic subdural hematoma (CSDH) is prevalent among elderly populations worldwide, and its mysterious pathogenesis has been discussed in the literature for decades. The issues remaining to be solved in regard to CSDH include the initiating events; the bleeding into the subdural space and the formation of the outer and inner membranes, its development; increase and liquefaction of hematoma, the optimal treatments, and the natural history. The pathophysiology is becoming more clear due to recent findings from computed tomography studies and human models of CSDH. In this work, we review previous studies on CSDH and present a new integrated concept about the development of this common condition after head injuries.

Tanaka Y; Ohno K

2013-01-01

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Significance of delayed contrast-enhanced CT in chronic subdural hematomas. The entry of the contrast media into subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

The authors have, previously, reported their delayed contrast-enhanced CT (DCECT) findings in traumatic subdural hygromas and chronic subdural hematomas. The purpose of this report is to clarify the relationship between the contrast media within subdural hematomas and the delayed enhancement. The clinical subjects were 35 cases of traumatic subdural hematomas. DCECT examinations were performed in all cases. The concentrations of the contrast media within the hematoma were measured during the operations. DCECT showed that the density of the hematomas increased 3 to 6 hours after the injection of the contrast media. The contrast media were detected within the hematomas a few hours after the injection. The contrast media were still present 24 hours after the injection, but disappeared in 48 hours. These findings suggest that contrast media go in and then come out of the subdural hematomas and that the main factor related to delayed enhancement is the concentration of the contrast media within the hematomas. DCECT examination may be most helpful in evaluating the dynamic changes in subdural collections.

Karasawa, Hideharu; Ohya, Shigeru; Ueno, Junji; Watanabe, Saburo; Mikabe, Toshio

1983-08-01

46

Process of evolution to chronic subdural hematoma, (1)  

International Nuclear Information System (INIS)

[en] The process of evolution to chronic subdural hematoma (CSH) was discussed on the basis of MRI and CT findings. The materials were 22 sides of 15 cases in which CSH had been diagnosed by means of MRI, CT, and/or surgery. These cases were followed by CT with/without MRI after the initial head injury. Various findings were shown in the subdural space, such as subdural hygroma (40%), acute subdural hematoma (25%), normal state (20%), and traumatic subarachnoid hemorrhage (15%). Regardless of the conditions of the subdural space after the head injury, however, CSH was finally present in all cases after the formation of subdural hygroma and its enlargement. The duration of the formation of hygroma after head injury ranged from 0 to 12 days (mean: 2.7 days), and its final confirmation ranged from 11 to 61 days (mean: 33.4 days). The period from the final confirmation of hygroma to the first recognition of CSH was between 8 and 36 days (mean: 17.7 days), while the period from head injury to the formation of CSH was between 27 and 75 days (mean: 51.1 days). The process of evolution to CSH may be thought to be as follows: A normal subdural space changes into a subdural hygroma by the tearing of the arachnoid membrane due to head injury. Capsule formation follows the process lasting for more than three weeks. CSH develops in consequence of bleeding from the outer membrane. (author)

1989-01-01

47

Benefits of Artcereb on the irrigation of chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] 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

2011-01-01

48

Chronic subdural hematoma leading to fatal cavernous sinus thrombosis  

Directory of Open Access Journals (Sweden)

Full Text Available Presented is a case of cavernous sinus thrombosis in a young female with fatal outcome. There were not any septic focus, no history of head trauma, no relation with pregnancy. Computed tomography scan of brain showed chronic subdural hematoma. An attempt is made to correlate the aetiopathology with the clinical features of this rare case presentation.

Kumar Sunil; Jain A; Jain S; Kale S

2009-01-01

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Chronic subdural hematoma: a comparison of two drainage methods  

Digital Repository Infrastructure Vision for European Research (DRIVER)

"nBackground: Chronic Subdural Hematoma (CSDH) is one of the most common challenges of neurosurgeons. Most predominant among the elderly, the incidence increases incrementally with age and might lead to permanent severe complications. The aim of this study is to outline the symptoms and signs a...

Lotfinia; Shakere; Shimia; Mahbobee; Mashrabi

50

Chronic spinal subdural hematoma; Spinales chronisches subdurales Haematom  

Energy Technology Data Exchange (ETDEWEB)

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

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

2008-10-15

51

Intracerebral hemorrhage following evacuation of a chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

Burr hole drainage has been widely used to treat chronic subdural hematomas (SDH), and most of them are easily treated by simple trephination and drainage. However, various complications, such as, hematoma recurrence, infection, seizure, cerebral edema, tension pneumocephalus and failure of the brain to expand due to cerebro-cranial disproportion may develop after chronic SDH drainage. Among them, intracerebral hemorrhage after evacuation of a recurrent chronic SDH is very rare. Here, we report a fatal case of delayed intracerebral hemorrhage caused by coagulopathy following evacuation of a chronic SDH. Possible pathogenic mechanisms of this unfavorable complication are discussed and a review of pertinent literature is included.

Kim JK; Kim SW; Kim SH

2013-02-01

52

Acute-on-chronic subdural hematoma by spinal anesthesia in a patient with undiagnosed chronic subdural hematoma -A case report-  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Subdural hematoma is a serious but rare complication of spinal anesthesia. A 70-year-old woman patient underwent elective total knee replacement under spinal anesthesia. At 4 days postoperatively, the patient complained of headache and vomiting. Brain computed tomography revealed an acute-on-chronic...

Park, Il Bong; Moon, Soo Yeong; Kim, Yu Yil; Kwon, Young Eun; Lee, Jun Hak

53

Analysis of chronic subdural hematoma based on CT, 3  

International Nuclear Information System (INIS)

[en] Forty-nine cases of chronic subdural hematoma experienced during the past 5 years were analyzed as to the number of days elapsed following head injury, symptoms, and computerized tomography (CT) findings. As a result, the clinical course of chronic subdural hematoma was devided into the following 5 stages on the basis of the presumed pathologic processes. The initial stage corresponded to a period of about 2 weeks after the precipitating injury; symptoms were absent; plain CT showed low-density areas (LDA); and metrizamide CT revealed metrizamide penetration into the LDA. The premature stage corresponded to a period of 2-4 weeks after trauma; no symptoms were present; plain CT showed LDA; and metrizamide CT revealed that metrizamide penetrated into the LDA with difficulty. The mature stage corresponded to a period of 30-60 days after trauma; CT showed iso-density areas (IDA) or high-density areas (HDA) with occasional enhancement effect; metrizamide penetration was not detected; and symptoms such as headache may have been present. The progressive stage typified chronic subdural hematoma; headache and focal symptoms were present; plain CT showed relative LDA, IDA, HDA or mixed-density areas (MDA); and enhancement of the contents of hematoma was observed in roughly half of the cases. The resolving stage was the stage in which hematoma had disappeared; plain CT showed relative LDA or LDA without mass sign; and metrizamide penetration was not detected. This clinical staging was useful in evaluating the pathologic picture of the chronic subdural hematoma and in determining suitable treatment. (author)

1984-01-01

54

Magnetic resonance imaging in chronic subdural hematomas of early stages  

International Nuclear Information System (INIS)

[en] The characteristic findings to distinguish chronic subdural hematomas of early stages from subdural CSF collections or enlarged subarachnoid spaces, was assessed by magnetic resonance imagings (MRI). Three sets of MRI, pre- and post-contrast as well as delayed post-contrast T1-weighted coronal images were obtained in 20 cases, in which low intensity subdural spaces were observed in 6 on the right, in 5 on the left and 9 bilaterally. The characteristic findings observed were as follows: a low signal intensity band between low intensity subdural space and cerebral surface at the precontrast MRI; linear enhancement at the outer surface of low intensity space at postcontrast MRI; and enhancement of the low intensity space at the delayed MRI. A combination of more than 2 of the above-mentioned findings was noted in 24 out of 29 low intensity spaces, 7 of which were confirmed by surgery as chronic subdural hematomas with outer membranes. In the remaining 17, low intensity spaces spontaneously regressed in 10, and increased their intensity and/or changed their sizes in 7. This data was obtained from follow-up MRI's. Such a combination in the initial MRI's may indicate developing chronic subdural hematomas. In 5 out of 29 low intensity spaces, neither intensity nor size changed, nor did enhancement show in delayed imagings in the follow-up MRI's, which may strongly suggest either subdural CSF collections or enlarged subarachnoid spaces. In conclusion, the low intensity band is speculated to be subarachnoid space shown up secondarily by the relative increase of intensity in the low intensity space; the linear enhancement is thought to be outer membrane formation, and the delayed-enhancement of low intensity spaces may be extravasation of contrast media from the outer membrane. (author)

1990-01-01

55

Magnetic resonance imaging in chronic subdural hematomas of early stages  

Energy Technology Data Exchange (ETDEWEB)

The characteristic findings to distinguish chronic subdural hematomas of early stages from subdural CSF collections or enlarged subarachnoid spaces, was assessed by magnetic resonance imagings (MRI). Three sets of MRI, pre- and post-contrast as well as delayed post-contrast T{sub 1}-weighted coronal images were obtained in 20 cases, in which low intensity subdural spaces were observed in 6 on the right, in 5 on the left and 9 bilaterally. The characteristic findings observed were as follows: a low signal intensity band between low intensity subdural space and cerebral surface at the precontrast MRI; linear enhancement at the outer surface of low intensity space at postcontrast MRI; and enhancement of the low intensity space at the delayed MRI. A combination of more than 2 of the above-mentioned findings was noted in 24 out of 29 low intensity spaces, 7 of which were confirmed by surgery as chronic subdural hematomas with outer membranes. In the remaining 17, low intensity spaces spontaneously regressed in 10, and increased their intensity and/or changed their sizes in 7. This data was obtained from follow-up MRI's. Such a combination in the initial MRI's may indicate developing chronic subdural hematomas. In 5 out of 29 low intensity spaces, neither intensity nor size changed, nor did enhancement show in delayed imagings in the follow-up MRI's, which may strongly suggest either subdural CSF collections or enlarged subarachnoid spaces. In conclusion, the low intensity band is speculated to be subarachnoid space shown up secondarily by the relative increase of intensity in the low intensity space; the linear enhancement is thought to be outer membrane formation, and the delayed-enhancement of low intensity spaces may be extravasation of contrast media from the outer membrane. (author).

Tsuchiya, Naoto; Muraki, Masaaki; Ohishi, Haruyuki (Shinshiro Municipal Hospital, Aichi (Japan)); Ninchoji, Toshiaki; Uemura, Kenichi

1990-10-01

56

Prospects for conservative treatment of chronic subdural hematomas  

International Nuclear Information System (INIS)

[en] 111In-DTPA was injected into the hematoma cavity before and after hematoma evacuation and irrigation in 12 cases of chronic subdural hematoma with comparatively mild symptoms. The radioactivity in the head was measure with time using a scintillation counter and the attenuation rate was obtained. The value measured hourly were expressed as ratios of the 1st measured value. Because of the properties of 111In-DTPA, this attenuation rate was considered to be the absorption rate of the liqid components of the hematoma. In 8 of the preoperative cases, the average measured values, were 84.8 +- 12.6% after 3 hours, 77.3 +- 12.1% after six hours, 34.5 +- 13.8% after 24 hours and 13.3 +- 13.5% after 48 hours. In six of the postoperative cases, the values were 70.4 +- 14.3% after 3 hours, 47.8 +- 10.8% after 6 hours, 12.4 +- 6.7% after 24 hours and 3.6 +- 2.0% after 48 hours. In a comparison between the two, the postoperative cases showed clearly advanced absorption with a significant difference at a risk factor of 0.1% or less in each case. This is because the osmotic pressure is the same for the liquid in the hematoma, the blood and the cerebrospinal fluid and an explanation based on this alone is difficult; it is neccessary to consider colloid osmotic pressure. When the radioactivities in the liquid in the hematoma, blood and cerebrospinal fluid were measured, the values for the blood were always higher than those for the cerebrospinal fluid and most of the absorption of the hematoma is considered to originate in the vascular bed in the hematoma cavity (sinusoidal channel layer). Therefore, for the conservative treatment of chronic subdural hematomas, it is necessary to consider methods which promote absorption of the hematoma. (J.P.N.)

1982-01-01

57

[Chronic subdural hematoma in young patients].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. PATIENTS AND METHODS: This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011). RESULTS: Of the 42 cases analysed, 32 were males and 10 were females, and the mean age at diagnosis was 29.3±8.9 years (range: 4 to 39 years). The mean interval from trauma to appearance of clinical symptoms was 33.4±9.7 days (range: 19 to 95 days). The main symptoms were headache (59.5%) and seizures (21.4%), and the most frequent predisposing factors were ventriculoperitoneal shunting in 5 (11.9%) patients and haematological disorders in another 5 (11.9%) cases. CSDH was right-sided in 21 cases (50%), left-sided in 19 cases (45.3%) and bilateral in the remaining 2 patients (4.7%). Postoperative complications occurred in 2 patients (1 recurrence and 1 acute subdural haematoma). CONCLUSIONS: CSDH is a rare pathology during the first decades of life. It mainly affects males and headache is usually the first symptom. Prognosis is good in young patients, since postoperative complications and recurrences are less frequent at this age than in older populations.

Gelabert-González M; Frieiro-Dantas C; Serramito-García R; Díaz-Cabanas L; Aran-Echabe E; Rico-Cotelo M; García-Allut A

2013-03-01

58

Spontaneous chronic subdural hematoma in an adolescent girl.  

UK PubMed Central (United Kingdom)

In most cases, subdural hematoma (SDH) is regarded as a complication of head injury and nontraumatic causes are rare. Moreover, spontaneous chronic SDH in child or adolescent is very unusual. Here, we present the case of a healthy 14-year-old girl who was diagnosed as a spontaneous chronic SDH. The patient presented with severe headache following blurring of vision two weeks ago without any history of trivial head injury. Computed tomography and magnetic resonance imaging depicted a chronic SDH. The cause of the hematoma was not established. After performing burr hole drainage of the hematoma, the patient made an uneventful recovery. We explore the potential risk factors and pathophysiology implicated in this condition. Possible pathogenic mechanisms of this unique case are discussed and a review of the pertinent literature is included.

Wang HS; Kim SW; Kim SH

2013-03-01

59

Quantitative kinetic analysis of blood vessels in the outer membranes of chronic subdural hematomas  

International Nuclear Information System (INIS)

[en] Dynamic biologic modeling was used to calculate the transfer rate constant for gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) and capillary permeability in the outer membrane of chronic subdural hematomas and effusions. Following intravenous Gd-DTPA injection, Gd concentrations in the subdural fluid and in timed arterial blood samples were measured by ion-coupled plasma emission spectrometry in 53 chronic subdural hematomas and 18 chronic subdural effusions. The capillary surface area in outer membrane was assessed morphometrically. Transfer rate constants for subdural hematomas and subdural effusions were 12.4±1.0 and 20.6±1.7 (x 10-4)min-1, respectively. Capillary permeabilities for subdural hematomas and subdural effusions were 16±1.2 and 19±3.7 ml·min-1(mm2/mm3)-1, respectively. The capillary surface areas for subdural hematomas and subdural effusions were 48±3 and 77±10 mm2/mm3, respectively. The high degree of infiltration of Gd into subdural effusions reflects the high capillary surface area in the outer membrane rather than greater permeability of individual capillaries. The value of transfer rate constant was correlated inversely with the duration of the chronic subdural fluid collection. Immature outer membrane has a high transfer rate constant which allows extravasation of plasma components into the subdural space, resulting in increasing volume of the subdural effusion. Delayed magnetic resonance imaging following Gd administration may be clinically useful for estimating the age of chronic subdural fluid accumulations. (author)

1998-01-01

60

PATOBIOLOGÍA DEL HEMATOMA SUBDURAL CRÓNICO.  

Directory of Open Access Journals (Sweden)

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

Rubén Sabogal Barrios; Luís Rafael Moscote Salazar

2008-01-01

 
 
 
 
61

Clinical studies on cerebral blood flow in chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] 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)

1988-01-01

62

Clinical studies on cerebral blood flow in chronic subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

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 /sup 133/Xe 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.

Fukuda, Atsuhiro; Akagi, Katsuhito; Horibe, Kunio; Yamasaki, Mami; Yuguchi, Takamichi

1988-11-01

63

Subdural drainage versus subperiostal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas  

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BACKGROUND: Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial. OBJECT: The aim of this retrospective single-center study is to compare for the first tim...

Bellut, D; Woernle, C M; Burkhardt, J K; Kockro, R A; Bertalanffy, H; Krayenbühl, N

64

Computerized tomography in the diagnosis of chronic subdural hematomas in children  

International Nuclear Information System (INIS)

[en] Examples of clinical cases were described to show CT advantages in the diagnosis of chronic subdural hematomas in children, especially in a late period of a severe craniocerebral trauma complicated by the appalic syndrome. In some cases additional angiographic investigation was necessary to differentiate between chronic subdural hematoma and a tumor process in the absence of direct CT signs

1987-01-01

65

Multiple Densities of the Chronic Subdural Hematoma in CT Scans.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Density of the chronic subdural hematoma (cSDH) is variable. It often appears to be mixed density. Multiple densities of cSDH may result from multiple episodes of trauma. We investigated the frequency of mixed density and the causes of head injuries representing each density. METHODS: We could collect 242 cases of chronic SDH. The cSDHs were classified into four groups; hypodensity, homogeneous isodensity, layered type, and mixed type on the basis of CT scans. RESULTS: The density of cSDH was isodense in 115 patients, hypodense in 31 patients, mixed in 79 cases, and layered in 17 cases. The cSDH was on the left side in 115 patients, on the right side in 70 patients, and bilateral in 40 patients. The history of trauma was identifiable in 122 patients. The etiology could be identified in 67.7% of the hypodense hematomas, while it was obscure in 59.5% of the mixed hematomas. CONCLUSION: Mixed density of cSDH results from multiple episodes of trauma, usually in the aged. It is hard to remember all the trivial traumas for the patients with the mixed density cSDHs. Although there were membranes within the mixed density hematomas, burr-holes were usually enough to drain the hematomas.

Park HR; Lee KS; Shim JJ; Yoon SM; Bae HG; Doh JW

2013-07-01

66

Multiple Densities of the Chronic Subdural Hematoma in CT Scans  

Science.gov (United States)

Objective Density of the chronic subdural hematoma (cSDH) is variable. It often appears to be mixed density. Multiple densities of cSDH may result from multiple episodes of trauma. We investigated the frequency of mixed density and the causes of head injuries representing each density. Methods We could collect 242 cases of chronic SDH. The cSDHs were classified into four groups; hypodensity, homogeneous isodensity, layered type, and mixed type on the basis of CT scans. Results The density of cSDH was isodense in 115 patients, hypodense in 31 patients, mixed in 79 cases, and layered in 17 cases. The cSDH was on the left side in 115 patients, on the right side in 70 patients, and bilateral in 40 patients. The history of trauma was identifiable in 122 patients. The etiology could be identified in 67.7% of the hypodense hematomas, while it was obscure in 59.5% of the mixed hematomas. Conclusion Mixed density of cSDH results from multiple episodes of trauma, usually in the aged. It is hard to remember all the trivial traumas for the patients with the mixed density cSDHs. Although there were membranes within the mixed density hematomas, burr-holes were usually enough to drain the hematomas.

Park, Hye-Ran; Shim, Jae-Jun; Yoon, Seok-Mann; Bae, Hack-Gun; Doh, Jae-Won

2013-01-01

67

Nonsurgical treatment of chronic subdural hematoma with tranexamic acid.  

UK PubMed Central (United Kingdom)

OBJECT: Chronic subdural hematoma (CSDH) is a common condition after head trauma. It can often be successfully treated surgically by inserting a bur hole and draining the liquefied hematoma. However, to the best of the authors' knowledge, for nonemergency cases not requiring surgery, no reports have indicated the best approach for preventing hematoma enlargement or resolving it completely. The authors hypothesized that hyperfibrinolysis plays a major role in liquefaction of the hematoma. Therefore, they evaluated the ability of an antifibrinolytic drug, tranexamic acid, to completely resolve CSDH compared with bur hole surgery alone. METHODS: From 2007 to 2011, a total of 21 patients with CSDH seen consecutively at Kuki General Hospital, Japan, were given 750 mg of tranexamic acid orally every day. Patients were identified by a retrospective records review, which collected data on the volume of the hematoma (based on radiographic measurements) and any complications. Follow-up for each patient consisted of CT or MRI every 21 days from diagnosis to resolution of the CSDH. RESULTS: Of the 21 patients, 3 with early stages of CSDH were treated by bur hole surgery before receiving medical therapy. The median duration of clinical and radiographic follow-up was 58 days (range 28-137 days). Before tranexamic acid therapy was initiated, the median hematoma volume for the 21 patients was 58.5 ml (range 7.5-223.2 ml); for the 18 patients who had not undergone surgery, the median hematoma volume was 55.6 ml (range 7.5-140.5 ml). After therapy, the median volume for all 21 patients was 3.7 ml (range 0-22.1 ml). No hematomas recurred or progressed. CONCLUSIONS: Chronic subdural hematoma can be treated with tranexamic acid without concomitant surgery. Tranexamic acid might simultaneously inhibit the fibrinolytic and inflammatory (kinin-kallikrein) systems, which might consequently resolve CSDH. This medical therapy could prevent the early stages of CSDH that can occur after head trauma and the recurrence of CSDH after surgery.

Kageyama H; Toyooka T; Tsuzuki N; Oka K

2013-08-01

68

Subdural hyperintense band on diffusion-weighted imaging of chronic subdural hematoma indicates bleeding from the outer membrane  

International Nuclear Information System (INIS)

[en] The diffusion-weighted magnetic resonance (MR) imaging characteristics of chronic subdural hematoma and the correlation between hematoma liquidity and apparent diffusion coefficient (ADC) were investigated in 26 consecutive patients, 16 males and 10 females aged 42 to 92 years (mean±SD 73.3±13.1 years), with 31 chronic subdural hematomas. The chronic subdural hematomas were divided into homogeneous, separate, and trabecular types based on diffusion-weighted MR imaging findings. Almost all hematomas were low intensity on diffusion-weighted imaging, and the mean ADC value was 1.81±0.79 x 10-3 mm2/sec. The high intensity areas in the subdural hematomas consisted of several types: high intensity line along the dura mater (subdural hyperintense band), high intensity along the intrahematoma septum, and laminar shape along the inner membrane. The subdural hyperintense bands accounted for almost all high intensity areas in the subdural hematomas. The mean ADC value of the high intensity areas was 0.76±0.24 x 10-3 mm2/sec, close to that of the normal brain. The subdural hyperintense bands were considered to be intracellular and/or extracellular methemoglobin based on the T1- and T2-weighted imaging and intraoperative findings. The subdural hyperintense band is an important finding indicating relatively fresh bleeding from the outer membrane. Diffusion-weighted imaging shows liquid subdural hematoma as low intensity, and measurement of the ADC values can differentiate between liquid and solid components of the chronic subdural hematoma. (author)

2005-01-01

69

Quantitative estimation of hemorrhage in chronic subdural hematoma using the /sup 51/Cr erythrocyte labeling method  

Energy Technology Data Exchange (ETDEWEB)

Red cell survival studies using an infusion of chromium-51-labeled erythrocytes were performed to quantitatively estimate hemorrhage in the chronic subdural hematoma cavity of 50 patients. The amount of hemorrhage was determined during craniotomy. Between 6 and 24 hours after infusion of the labeled red cells, hemorrhage accounted for a mean of 6.7% of the hematoma content, indicating continuous or intermittent hemorrhage into the cavity. The clinical state of the patients and the density of the chronic subdural hematoma on computerized tomography scans were related to the amount of hemorrhage. Chronic subdural hematomas with a greater amount of hemorrhage frequently consisted of clots rather than fluid.

Ito, H.; Yamamoto, S.; Saito, K.; Ikeda, K.; Hisada, K.

1987-06-01

70

Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method  

International Nuclear Information System (INIS)

[en] Red cell survival studies using an infusion of chromium-51-labeled erythrocytes were performed to quantitatively estimate hemorrhage in the chronic subdural hematoma cavity of 50 patients. The amount of hemorrhage was determined during craniotomy. Between 6 and 24 hours after infusion of the labeled red cells, hemorrhage accounted for a mean of 6.7% of the hematoma content, indicating continuous or intermittent hemorrhage into the cavity. The clinical state of the patients and the density of the chronic subdural hematoma on computerized tomography scans were related to the amount of hemorrhage. Chronic subdural hematomas with a greater amount of hemorrhage frequently consisted of clots rather than fluid

1987-01-01

71

Giant unusual shaped chronic subdural hematoma in a patient with untreated congenital hydrocephalus  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Subdural hematoma is a well known complication of ventriculoperitoneal shunt insertion for hydrocephalus and usually spreads out over the cerebral convexity, and appears as a crescent shaped lesion on imaging. Chronic subdural hematoma in a case of untreated compensated congenital hydrocephalus has ...

Mishra, Arvind; Ojha, Bal. K.; Chandra, Anil; Srivastava, Chhitij; Singh, Sunil Kumar

72

Hematoma subdural crônico como complicação de derivações ventrículo-peritoneais Chronic subdural hematoma as complication of ventriculo-peritoneal shunts  

Directory of Open Access Journals (Sweden)

Full Text Available Os autores relatam sua experiência com 9 casos de derivação ventriculo-peritoneal que desenvolveram hematoma subdural crônico como complicação do procedimento. Três pacientes eram crianças, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia normobárica. Nos casos de hidrocefalia crônica, os hematomas foram drenados por orifício de trépano associado a oclusão temporária do catéter distal da derivação. Em dois pacientes, extremamente dependentes de válvula, optou-se por derivação subduro--peritoneal e manutenção da derivação ventrículo peritoneal original, observando-se gradual e completa reabsorção da lesão em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessário trocar o sistema de drenagem por outro de pressão mais elevada. Em um caso procedeu-se a craniotomia e exérese da cápsula do hematoma para tratar coleções recidivantes. Com exceção de um paciente falecido em decorrência de complicações infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma.Nine cases of chronic subdural hematoma occurring after the insertion of ventriculo-peritoneal shunts are described. Three patients were children, two were adults with stenosis of the Sylvian acqueduct, and the last four had normal pressure hydrocephalus. Patients with chronic hydrocephalus were initially treated with burr holes associated to transient occlusion of the distal catheter of the diversion in order to promote reexpansion of the compressed hemisphere. Two shunt-dependent patients were successfully treated with a concurrent subdural-peritoneal shunt. In two cases a higher pressure shunt was inserted, and in another craniotomy with membranectomy was required to treat persistent subdural fluid accumulation. One patient died due to infectious complications of multiple procedures.

J. Francisco Salomão; Renê Dottori Leibinger; Yara M. Serra Lima

1990-01-01

73

Hematoma subdural crônico como complicação de derivações ventrículo-peritoneais/ Chronic subdural hematoma as complication of ventriculo-peritoneal shunts  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Os autores relatam sua experiência com 9 casos de derivação ventriculo-peritoneal que desenvolveram hematoma subdural crônico como complicação do procedimento. Três pacientes eram crianças, dois eram adultos com estenose do aqueduto de Sylvius e quatro, com hidrocefalia normobárica. Nos casos de hidrocefalia crônica, os hematomas foram drenados por orifício de trépano associado a oclusão temporária do catéter distal da derivação. Em dois pacientes, extrem (more) amente dependentes de válvula, optou-se por derivação subduro--peritoneal e manutenção da derivação ventrículo peritoneal original, observando-se gradual e completa reabsorção da lesão em tomografias computadorizadas de crânio seriadas. Em dois casos foi necessário trocar o sistema de drenagem por outro de pressão mais elevada. Em um caso procedeu-se a craniotomia e exérese da cápsula do hematoma para tratar coleções recidivantes. Com exceção de um paciente falecido em decorrência de complicações infecciosas, todos retornaram ao estado anterior ao desenvolvimento do hematoma. Abstract in english Nine cases of chronic subdural hematoma occurring after the insertion of ventriculo-peritoneal shunts are described. Three patients were children, two were adults with stenosis of the Sylvian acqueduct, and the last four had normal pressure hydrocephalus. Patients with chronic hydrocephalus were initially treated with burr holes associated to transient occlusion of the distal catheter of the diversion in order to promote reexpansion of the compressed hemisphere. Two shunt (more) -dependent patients were successfully treated with a concurrent subdural-peritoneal shunt. In two cases a higher pressure shunt was inserted, and in another craniotomy with membranectomy was required to treat persistent subdural fluid accumulation. One patient died due to infectious complications of multiple procedures.

Salomão, J. Francisco; Leibinger, Renê Dottori; Lima, Yara M. Serra

1990-06-01

74

Quantitative kinetic analysis of blood vessels in the outer membranes of chronic subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

Dynamic biologic modeling was used to calculate the transfer rate constant for gadolinium-diethylenetriaminepenta-acetic acid (Gd-DTPA) and capillary permeability in the outer membrane of chronic subdural hematomas and effusions. Following intravenous Gd-DTPA injection, Gd concentrations in the subdural fluid and in timed arterial blood samples were measured by ion-coupled plasma emission spectrometry in 53 chronic subdural hematomas and 18 chronic subdural effusions. The capillary surface area in outer membrane was assessed morphometrically. Transfer rate constants for subdural hematomas and subdural effusions were 12.4{+-}1.0 and 20.6{+-}1.7 (x 10{sup -4})min{sup -1}, respectively. Capillary permeabilities for subdural hematomas and subdural effusions were 16{+-}1.2 and 19{+-}3.7 ml{center_dot}min{sup -1}(mm{sup 2}/mm{sup 3}){sup -1}, respectively. The capillary surface areas for subdural hematomas and subdural effusions were 48{+-}3 and 77{+-}10 mm{sup 2}/mm{sup 3}, respectively. The high degree of infiltration of Gd into subdural effusions reflects the high capillary surface area in the outer membrane rather than greater permeability of individual capillaries. The value of transfer rate constant was correlated inversely with the duration of the chronic subdural fluid collection. Immature outer membrane has a high transfer rate constant which allows extravasation of plasma components into the subdural space, resulting in increasing volume of the subdural effusion. Delayed magnetic resonance imaging following Gd administration may be clinically useful for estimating the age of chronic subdural fluid accumulations. (author)

Mori, Kentaro; Adachi, Keiji; Cho, Kajin; Ishimaru, Sumio; Maeda, Minoru [Juntendo Univ., Shizuoka (Japan). Izunagaoka Hospital

1998-11-01

75

Critical classification of craniostomy for chronic subdural hematoma; safer technique for hematoma aspiration.  

UK PubMed Central (United Kingdom)

Chronic subdural hematoma (CSDH) is generally treated by twist drill, and one and two burr-hole craniostomy. We proposed new classification of the intraoperative condition of CSDH, and present a safer technique for aspiration of CSDH in one burr-hole surgery. The intraoperative condition of CSDH was classified according to the connections between the hematoma cavity and the extracranial space as follows. The "closed condition" represents only a single route consisting of a tube inserted intraoperatively connecting the extracranial space to the hematoma cavity. The "open condition" includes another route or space, which can freely pass air, saline, or old hematoma fluid, in addition to the tube inserted intraoperatively. Twist drill craniostomy and two burr-hole craniostomy clearly involve the intraoperative closed and open conditions, respectively. One burr-hole craniostomy may involve either condition due to the operative procedure. Aspiration and irrigation of the hematoma is basically free and safe in the open condition, but risky in the closed condition. All of the hematoma can be aspirated through one burr hole under certain open conditions with temporary replacement of the hematoma cavity with air followed by replacement of air with saline. Twenty-seven patients with symptomatic CSDH underwent one burr-hole craniostomy by the above mentioned aspiration technique. There were no special complications. The recurrence rate was average. The substitution of saline after complete aspiration of hematoma carries little risk only under the "open condition," shortens the operation time, and achieves good irrigation of the hematoma.

Tosaka M; Sakamoto K; Watanabe S; Yodonawa M; Kunimine H; Aishima K; Fujii T; Yoshimoto Y

2013-01-01

76

Pressure changes within a chronic subdural hematoma during hemodialysis.  

UK PubMed Central (United Kingdom)

Spontaneous intracranial hemorrhage is not an infrequent complication of systemic anticoagulation, as occurs in hemodialysis. The neurological symptoms of subdural hematoma may be similar to those of dialysis disequilibrium. The pressure within a subdural fluid collection was monitored in a patient undergoing hemodialysis. The patient was known to become unresponsive during previous dialysis treatments. The initial pressure within the subdural cavity was measured to be -10.0 cm H2O prior to dialysis. The pressure within the collection decreased to a minimum value of -19.4 cm H2O during dialysis and stabilized at -16.4 cm H2O at the termination of dialysis. The neurological status changed subjectively during the procedure, with the patient becoming unresponsive to verbal stimuli as the intracranial pressure reached a minimum. These findings represent a syndrome similar to aliquorrhea, or low cerebrospinal fluid pressure within an otherwise asymptomatic subdural hematoma. Previously only increased intracranial pressure has been reported with hemodialysis.

Kopitnik TA Jr; de Andrade R Jr; Gold MA; Nugent GR

1989-10-01

77

Chronic subdural hematoma: a comparison of two drainage methods  

Directory of Open Access Journals (Sweden)

Full Text Available "nBackground: Chronic Subdural Hematoma (CSDH) is one of the most common challenges of neurosurgeons. Most predominant among the elderly, the incidence increases incrementally with age and might lead to permanent severe complications. The aim of this study is to outline the symptoms and signs and to compare the outcomes and complications among two groups of patients who underwent two different surgical procedures."n"nMethods: In a cross-sectional and descriptive-analytical study performed on 125 patients with CSDH from 2000 to 2005. Computed tomography scan was used for diagnostic imaging in all cases and magnetic resonance imaging was also obtained for six patients. In one center, group 1, which included 82 patients, underwent surgery with a single burr hole and closed drainage, and, at another center, group 2, which included 43 patients, was treated with a method using two burr holes and close drainage."n"nResults: Of the 125 patients, 102 were male and 23 were female. The mean age of patients was 65.79±16.41 years. The most common symptoms were weakness in extremities (78.4%), headache (72.8%) and decreased level of consciousness (24%), respectively. At presentation, 88 (70.4%) of the patients had several symptoms and 37 (29.6%) had only one symptom. A history of mild head trauma, such as falling, was observed in 83 (68%) of the patients. The interval between head trauma and the onset of symptoms ranged from 10 to 120 days (mean: 46 days). Hematoma recurred in five cases from group 1, whereas two cases from group 2 had recurrence of hematoma. Postoperative epidural hematoma developed in one case from group 2 and tension pneumocephalus also occurred in one group 2 patients."n"nConclusion: As a treatment for CSDH, the single burr hole method was significantly better than the two burr hole method.

Lotfinia; Shakere; Shimia; Mahbobee; Mashrabi

2008-01-01

78

Analysis of chronic subdural hematoma based on CT, (2). Symptoms and CT findings  

Energy Technology Data Exchange (ETDEWEB)

Twenty-three cases of chronic subdural hematoma were observed soon after head injury for the relationship between its CT findings and clinical symptoms. It has been found that the chronic subdural hematoma is a slowly growing and expanding intracranial disease that starts in an early period of head injury. Chronic subdural hematoma did not present any signs or symptoms initially, except for the gradual occurrence of headache, but finally it presented signs of intracranial hypertension and focal signs. Chronic subdural hematoma in the hygroma-like period did not show any signs and symptoms. In the capsulated period, when changes in CT density suggested intracapsular hemorrhage, a heavy sensation of the head was noted. It was recognized as an abnormal feeling or a full sensation of the head. When the bleeding continued in the cavity, headache became continuous and focal signs gradually appeared.

Takahashi, Y.; Mikami, J.; Sato, H.; Takeda, S.; Matsuoka, T. (Ohkawara Neurosurgical Hospital, Muroran, Hokkaido (Japan))

1982-05-01

79

Chronic subdural hematoma patients aged 90 years and older.  

UK PubMed Central (United Kingdom)

OBJECTIVES: The American population above 65 years of age will double by 2050, and more nonagenarians will present to neurosurgeons for treatment for subdural hematomas (SDH), common in the elderly. Healthcare providers, and patients' relatives, often choose treatment when there is little chance of recovery. Hospital mortality is 24% (n = 5) in chronic subdural hematoma (cSDH) patients over 65 years, but there are no studies on cSDH outcomes in patients aged over 90 years. This retrospective study evaluates outcomes in this population. METHODS: We reviewed all patients with cSDH between December 2005 and December 2011. We analyzed charts of patients aged 90 years and older. Patient demographics, Glagow Coma Scale (GCS) at presentation, medical co-morbidities, length of stay, disposition, treatment, and radiographic characteristics were abstracted. RESULTS: Twenty-one patients aged 90 or older with 24 admissions for cSDH were identified. Median age was 92 (SD = 2.5); 76% (n = 16) underwent surgery. Median presentation GCS was 14. Disposition to home, rehabilitation facility, nursing home, hospice, or death were not significantly different between conservative and operative groups (P = 0.10), nor was admission GCS (P = 0.59). The size of SDH was significantly (P = 0.02) larger in the operative group. Overall, only 24% (n = 5) of patients were discharged home. CONCLUSION: Clinical presentation with cSDH is a sentinel event for patients aged 90 years or older; 67% have surgical intervention. Disposition does not vary with surgical or non-surgical treatment. Only 24% of patients of this age group presenting with cSDH return home despite a good admission GCS.

Stippler M; Ramirez P; Berti A; Macindoe C; Villalobos N; Murray-Krezan C

2013-04-01

80

Treatment of recurrent chronic subdural hematoma in a patient with Arachnoid cyst  

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Full Text Available Introduction. Arachnoid cysts are congenital fluid-filled compartments within the cerebrospinal fluid cisterns and major cerebral fissure, between two layers of the arachnoid membrane. They can develop anywhere within the subarachnoid space, most frequently located within the Sylvian fissure in the middle fossa. In young patients with the arachnoid cyst and history od head trauma chronic subdural hemathoma is present up to 4.6%. Case report. This is a case report of a 21 year old male, with left temporal lobe arachnoid cyst. Three months after minor head injury the patient was admitted to our clinic with chronic subdural hematoma compressing the surrounding tissue. The scull burr-hole trepanation was performed and the hematoma was drained. The control CT scan showed a reduced size of the chronic subdural hematoma with the smaller subdural collection of the fresh blood. Three weeks after the intervention the new CT scan showed the recurrence of the chronic subdural hematoma. The second trepanation was performed and the hematoma was drained. After the second operation, the patient was with no neurological disorders and subjective complaints. Three months after the second intervention, the control CT scan visualized only the arachnoid cyst in the temporal lobe, without the presence of the subdural hematoma. Conclusion. We conclude that a chronic subdural hematoma and reccurrent chronic subdural hematoma in patients with the arachnoid cyst in the fossa media should be drained by applying the method of burr-hole trepanation. In the patient with no subjective complaints and neurological disorders, the operative treatment of the arachnoid cyst is not considered necessary.

?ilvesi ?ula; Vulekovi? Petar; Cigi? Tomislav; Kojadinovi? Željko; Horvat Igor; Karan Mladen

2009-01-01

 
 
 
 
81

Subdural sarcoma associated with chronic subdural hematoma. Report of two cases and review of the literature.  

Science.gov (United States)

The authors report the cases of two children who presented in the first months of life with progressive macrocrania related to chronic pericerebral fluid collection. This condition resolved spontaneously without treatment after a few months in the first case, whereas it required several aspirations of blood-stained fluid via the fontanel in the second case. Both patients developed normally without evidence of disease in the earliest years of life and presented at the ages of 3 1/2 and 4 1/2 years, respectively, with symptoms and signs of rapidly progressing intracranial hypertension. In both cases contrast-enhanced computerized tomography and magnetic resonance imaging revealed masses in the subdural space of the skull base and the cranial vault associated with significant subdural fluid collections. In the first case the lesion was misdiagnosed in the initial phase and treated, by means of multiple craniotomies, as an organized subdural hematoma. After a diagnosis of liposarcoma had been made, the patient was treated with chemotherapy, which resulted in a good resolution of the lesions at 3-month follow-up review. In the second case a biopsy allowed the diagnosis of fibrohistiocytic sarcoma and the patient was treated with chemotherapy. The authors review the literature of the few reported cases and discuss the possible pathophysiological association between pericerebral fluid collection and the subsequent development of a subdural sarcoma. PMID:9046316

Cinalli, G; Zerah, M; Carteret, M; Doz, F; Vinikoff, L; Lellouch-Tubiana, A; Husson, B; Pierre-Kahn, A

1997-03-01

82

Subdural sarcoma associated with chronic subdural hematoma. Report of two cases and review of the literature.  

UK PubMed Central (United Kingdom)

The authors report the cases of two children who presented in the first months of life with progressive macrocrania related to chronic pericerebral fluid collection. This condition resolved spontaneously without treatment after a few months in the first case, whereas it required several aspirations of blood-stained fluid via the fontanel in the second case. Both patients developed normally without evidence of disease in the earliest years of life and presented at the ages of 3 1/2 and 4 1/2 years, respectively, with symptoms and signs of rapidly progressing intracranial hypertension. In both cases contrast-enhanced computerized tomography and magnetic resonance imaging revealed masses in the subdural space of the skull base and the cranial vault associated with significant subdural fluid collections. In the first case the lesion was misdiagnosed in the initial phase and treated, by means of multiple craniotomies, as an organized subdural hematoma. After a diagnosis of liposarcoma had been made, the patient was treated with chemotherapy, which resulted in a good resolution of the lesions at 3-month follow-up review. In the second case a biopsy allowed the diagnosis of fibrohistiocytic sarcoma and the patient was treated with chemotherapy. The authors review the literature of the few reported cases and discuss the possible pathophysiological association between pericerebral fluid collection and the subsequent development of a subdural sarcoma.

Cinalli G; Zerah M; Carteret M; Doz F; Vinikoff L; Lellouch-Tubiana A; Husson B; Pierre-Kahn A

1997-03-01

83

The significance of delayed contrast-enhanced CT in chronic subdural hematomas  

International Nuclear Information System (INIS)

[en] We have previously, reported our delayed contrast-enhanced CT (DCECT) findings in traumatic subdural hygromas and chronic subdural hematomas. The purpose of this report is to clarify the relationship between the contrast media within subdural hematomas and the delayed enhancement. The clinical subjects were 35 cases of traumatic subdural hematomas. DCECT examinations were performed in all cases. The concentrations of the contrast media within the hematoma were measured during the operations. DCECT showed that the density of the hematomas increased 3 to 6 hours after the injection of the contrast media. The contrast media were detected within the hematomas a few hours after the injection. The contrast media were still present 24 hours after the injection, but disappeared in 48 hours. These findings suggest that contrast media go in and then come out of the subdural hematomas and that the main factor related to delayed enhancement is the concentration of the contrast media within the hematomas. DCECT examination may be most helpful in evaluating the dynamic changes in subdural collections. (author)

1983-01-01

84

Dural metastases from prostatic cancer or chronic subdural hematoma  

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Full Text Available Introduction: dural metastases of prostatic adenocarcinoma appear in advanced stagesof the disease and they can be the first manifestation of a prostatic carcinoma, evenwithout urological symptoms.Clinical case: a 71 year-old patient without previous diagnosis of prostatic carcinomawho presented progressive neurological deterioration. Axial computerized tomography(CT) allowed to see a suggestive image of subacute subdural hematoma. It was donea craniotomy to do drainage of the hematoma, but warty and bleeding lesions wereseen. An specimen of these lesions was taken and the study of pathological anatomydemonstrated prostatic adenocarcinoma metastases. Primary tumor in prostatic glandwas proved later.Conclusion: dural metastases of prostatic carcinoma are infrequent. When they occur,they can simulate a subdural hematoma or meningioma, between other lesions. Rev.cienc.biomed. 2012;3(2): 346-349RESUMEN:Introducción: las metástasis durales del adenocarcinoma prostático aparecen enetapas avanzadas de la enfermedad y pueden ser la primera manifestación de uncarcinoma prostático, aun sin síntomas urológicos.Caso clínico: paciente de 71 años de edad, sin diagnóstico previo de carcinoma prostáticoque presentó deterioro neurológico progresivo. Tomografía axial computarizada (TAC)permitió observar imagen sugestiva de hematoma subdural subagudo. Se realizócraneotomía para realizar drenaje del hematoma, pero se observaron en la duramadrelesiones verrugosas y sangrantes. Se tomó muestra de las lesiones y estudio de anatomíapatológica demostró metástasis de adenocarcinoma prostático. Tumor primario englándula prostática fue demostrado posteriormente.Conclusión: las metástasis durales de carcinoma prostático son infrecuentes. Cuandose suceden pueden simular hematoma subdural o meningioma, entre otras lesiones.Rev.cienc.biomed. 2012;3(2): 346-349

Taboada-Lora Luis Roberto; Bernal-Bernal David Alejandro; Navarro-Tovar Saúl

2012-01-01

85

Chronic subdural hematomas treated by burr-hole trepanationand subperiostal drainage system  

Digital Repository Infrastructure Vision for European Research (DRIVER)

OBJECTIVE: Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare th...

Zumofen, D; Regli, L; Levivier, M; Krayenbühl, N

86

Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings  

Directory of Open Access Journals (Sweden)

Full Text Available Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.

Costa Jr Leodante B.; Andrade Agustinho de; Valadão Gustavo Fonseca

2004-01-01

87

Chronic subdural hematoma associated with an arachnoid cyst in a juvenile taekwondo athlete: a case report and review of the literature.  

UK PubMed Central (United Kingdom)

Both chronic subdural hematoma and arachnoid cysts are common lesions in neurosurgical practice. Arachnoid cysts are a well-known predisposing factor for chronic subdural hematoma. Here, we present a 12-year-old taekwondo athlete with chronic subdural hematoma associated with arachnoid cysts. The chronic subdural hematoma was evacuated through 2 burr holes and the patient was discharged in good condition. To our knowledge, this is the first case of chronic subdural hematoma with associated arachnoid cysts in a taekwondo athlete. We also review the literature on sports-related chronic subdural hematomas associated with arachnoid cysts in children.

Kertmen H; Gürer B; Yilmaz ER; Sekerci Z

2012-01-01

88

Chronic subdural hematoma associated with an arachnoid cyst in a juvenile taekwondo athlete: a case report and review of the literature.  

Science.gov (United States)

Both chronic subdural hematoma and arachnoid cysts are common lesions in neurosurgical practice. Arachnoid cysts are a well-known predisposing factor for chronic subdural hematoma. Here, we present a 12-year-old taekwondo athlete with chronic subdural hematoma associated with arachnoid cysts. The chronic subdural hematoma was evacuated through 2 burr holes and the patient was discharged in good condition. To our knowledge, this is the first case of chronic subdural hematoma with associated arachnoid cysts in a taekwondo athlete. We also review the literature on sports-related chronic subdural hematomas associated with arachnoid cysts in children. PMID:22832284

Kertmen, Hayri; Gürer, Bora; Yilmaz, Erdal Resit; Sekerci, Zeki

2012-07-21

89

The low-field MRI and CT of chronic subdural hematomas  

International Nuclear Information System (INIS)

Magnetic resonance (MR) imaging was performed at a field strength of 0.2 T in 52 patients with 78 surgery-proven chronic subdural hematomas. Signal intensities of the lesions, which were obtained on T1- (n=74), T2- (n=73), and proton density-weighted (n=64) spin-echo sequences, were compared with concurrently available CT densities. Of 74 hematomas, 60, 10, and 4 had hyperintensities, isointensities, and hypointensities, respectively, on T1-weighted images. Of 22 hematomas having high density on CT, 17 were hyperintense and 5 were isointense on T1-weighted images. Similarly, 25 isodensity hematomas on CT consisted of 23 hyperintensities and two isointensities; and 27 low density hematomas consisted of 20 hyperintensities, 3 isointensities, and 4 hypointensities. Both T2- and proton density-weighted images revealed hyperintensity in all hematomas. Two spin-echo images, T1 and proton density, were useful in differentiating chronic subdural hematoma from edema. (N.K.)

1991-01-01

90

Can recurrence of chronic subdural hematoma be predicted? a retrospective analysis of 136 cases  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Objective: Chronic subdural hematoma is the most common intracranial hematoma effecting especially elderly population. There is a substantial recurrence rate after evacuation by burr-hole surgery. In this study, we aimed to determine predictors associated with recurrence. Methods: We retrospectively...

Bekir Tu?cu; Osman Tanr?verdi; Serhat Bayd?n; Ömür Günald?; Ender Ofluo?lu; Bülent T. Demirgil

91

PlGF and sVEGFR-1 in chronic subdural hematoma: implications for hematoma development.  

UK PubMed Central (United Kingdom)

OBJECT: A considerable body of evidence indicates that inflammation and angiogenesis play a significant role in the development and progression of chronic subdural hematoma (CSDH). While various experimental and clinical studies have implicated placental growth factor (PlGF) in the processes that underpin pathological angiogenesis, no study has thus far investigated its expression in CSDH. The actions of PlGF and its related proangiogenic vascular endothelial growth factor (VEGF) are antagonized by a high-affinity soluble receptor, namely soluble VEGF receptor-1 (sVEGFR-1), and thus the ratio between sVEGFR-1 and angiogenic factors provides an index of angiogenic capacity. METHODS: In the present study, using an automated electrochemiluminescence assay, levels of PlGF and sVEGFR-1 were quantified in serum and hematoma fluid obtained in 16 patients with CSDH. RESULTS: Levels of PlGF and sVEGFR-1 were significantly higher in hematoma fluid than in serum (p < 0.0001). In serum, levels of sVEGFR-1 were higher than those of PlGF (p < 0.0001), whereas in hematoma fluid this difference was not apparent. Furthermore, the ratio of sVEGFR-1 to PlGF was significantly lower in hematoma fluid than in serum (p < 0.0001). CONCLUSIONS: Given previous evidence indicating a role for PlGF in promoting angiogenesis, inflammatory cell chemotaxis, and stimulation, as well as its ability to amplify VEGF-driven signaling under conditions favoring pathological angiogenesis, enhanced expression of PlGF in hematoma fluid suggests the involvement of this factor in the mechanisms of inflammation and angiogenesis in CSDH. Furthermore, a reduced ratio of sVEGFR-1 to PlGF in hematoma fluid is consistent with the proangiogenic capacity of CSDH. Future studies are warranted to clarify the precise role of PlGF and sVEGFR-1 in CSDH.

Kalamatianos T; Stavrinou LC; Koutsarnakis C; Psachoulia C; Sakas DE; Stranjalis G

2013-02-01

92

Pressure changes within a chronic subdural hematoma during hemodialysis.  

Science.gov (United States)

Spontaneous intracranial hemorrhage is not an infrequent complication of systemic anticoagulation, as occurs in hemodialysis. The neurological symptoms of subdural hematoma may be similar to those of dialysis disequilibrium. The pressure within a subdural fluid collection was monitored in a patient undergoing hemodialysis. The patient was known to become unresponsive during previous dialysis treatments. The initial pressure within the subdural cavity was measured to be -10.0 cm H2O prior to dialysis. The pressure within the collection decreased to a minimum value of -19.4 cm H2O during dialysis and stabilized at -16.4 cm H2O at the termination of dialysis. The neurological status changed subjectively during the procedure, with the patient becoming unresponsive to verbal stimuli as the intracranial pressure reached a minimum. These findings represent a syndrome similar to aliquorrhea, or low cerebrospinal fluid pressure within an otherwise asymptomatic subdural hematoma. Previously only increased intracranial pressure has been reported with hemodialysis. PMID:2781460

Kopitnik, T A; de Andrade, R; Gold, M A; Nugent, G R

1989-10-01

93

Classification and clinical course of chronic subdural hematoma on CT scan  

Energy Technology Data Exchange (ETDEWEB)

Forty-five cases of chronic subdural hematoma were classified into four groups according to CT findings, mainly by x-ray attenuation, and the relations with clinical findings and physical examinations were studied. The following results were obtained. First group (13 cases): The hematoma shows low attenuated mass effects homogeneously in the subdural territory on CT scan. This type of hematoma was located on the bilateral convexity in about half of the cases. Second group (12 cases): The hematoma of this group revealed two different attenuations in same hematoma, for example, low density and high density, and this group was named the mixed type. Third group (14 cases): The hematoma of this group is difficult to diagnose because of its unclear border with the brain. This was named the iso-density type or brain density type. This type of hematoma was generally found in young adults and was huge. than other types. Fourth group (6 cases): The hematoma shows a high density x-ray attenuation of 25 or more Hounsfield units, and was named the high density type. The low density type and isodensity hematoma were thought to be primary stages in its development. The high density type is the terminal stage of the life cycle of chronic subdural hematoma.

Maegawa, M.; Fujita, T.; Hiramatsu, K.; Yokoyama, K.; Horiike, N. (Nara Medical Univ., Kashihara (Japan))

1981-06-01

94

The classification and clinical course of chronic subdural hematoma on CT scan  

International Nuclear Information System (INIS)

[en] Forty-five cases of chronic subdural hematoma were classified into four groups according to CT findings, mainly by x-ray attenuation, and the relations with clinical findings and physical examinations were studied. The following results were obtained. First group (13 cases): The hematoma shows low attenuated mass effects homogeneously in the subdural territory on CT scan. This type of hematoma was located on the bilateral convexity in about half of the cases. Second group (12 cases): The hematoma of this group revealed two different attenuations in same hematoma, for example, low density and high density, and this group was named the mixed type. Third group (14 cases): The hematoma of this group is difficult to diagnose because of its unclear border with the brain. This was named the iso density type or brain density type. This type of hematoma was generally found in young adults and was huge. than other types. Fourth group (6 cases): The hematoma shows a high density x-ray attenuation of 25 or more Hounsfield units, and was named the high density type. The low density type and isodensity hematoma were thought to be primary stages in its development. The high density type is the terminal stage of the life cycle of chronic subdural hematoma. (author)

1981-01-01

95

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)

Full Text Available Abstract in spanish 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 complicación 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 (more) 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 (more) 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.

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

2010-06-01

96

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

Directory of Open Access Journals (Sweden)

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 complicación 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.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.

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

2010-01-01

97

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

International Nuclear Information System (INIS)

[en] 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)

2002-01-01

98

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

Energy Technology Data Exchange (ETDEWEB)

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)

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

2002-09-01

99

Chronic calcified subdural hematoma: Case report and review of the literature.  

UK PubMed Central (United Kingdom)

BACKGROUND: Calcified chronic subdural hematoma is a rare but known entity, estimated to represent 0.3-2.7% of chronic subdural hematomas. Although surgical treatment is unanimous for chronic subdural hematomas, therein lies some doubt on it being applied to calcified chronic subdural hematomas. CASE DESCRIPTION: We report a case of a 73-year-old male, presenting with deterioration of motor function in his right limbs since 18 months, with computed tomography (CT) scans and magnetic resonance imaging (MRI) documenting a large subdural collection of the left hemisphere, with calcified inner membrane, which was successfully and completely removed, with progressive clinical and radiological improvement. CONCLUSIONS: We report a case where this type of rare lesion was removed with a progressive and complete resolution of the patient's symptoms, restoring his previous neurological condition. From the cases described in the literature and our own experience with this case, we think surgical treatment in these patients, when symptomatic, is necessary and viable, frequently resulting in the patient's improvement.

Pappamikail L; Rato R; Novais G; Bernardo E

2013-01-01

100

Can Recurrence of Chronic Subdural Hematoma Be Predicted? A Retrospective Analysis of 292 Cases.  

UK PubMed Central (United Kingdom)

Background?Chronic subdural hematomas are the most common type of intracranial hemorrhage among the elderly. There is a substantial recurrence rate after evacuation by burr-hole surgery. In this study, we aimed to determine the predictors of recurrence after single burr-hole evacuation of chronic subdural hematomas.Methods?We retrospectively analyzed 292 consecutive patients with chronic subdural hematoma. Clinical parameters, anamnesis, and previous anticoagulant drug use have been evaluated with univariate and multivariate analyses to determine predictors associated with recurrence.Results?At least a second surgery was needed in 43 of 292 (14.7%) patients. We showed that recurrence rate was significantly higher in patients with bilateral subdural hematoma, after univariate and multivariate analyses (23.1% versus 11.4%). We did not find any significant relationship between recurrence rate and age, gender, hypertension, and/or diabetes mellitus in anamnesis, preceding head trauma, and time interval between trauma and the operation, previous anticoagulant, and/or antiaggregant therapy.Conclusion?After analysis of all evaluated factors, only bilateral hematoma was found correlated with high recurrence rate (p?=?0.01), probably due to previous brain atrophy or existing coagulopathy.

Tugcu B; Tanriverdi O; Baydin S; Hergunsel B; Günald? O; Ofluoglu E; Alatas I; Demirgil B; Emel E

2013-01-01

 
 
 
 
101

Process of evolution to chronic subdural hematoma, (1); A study with MRI and CT  

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The process of evolution to chronic subdural hematoma (CSH) was discussed on the basis of MRI and CT findings. The materials were 22 sides of 15 cases in which CSH had been diagnosed by means of MRI, CT, and/or surgery. These cases were followed by CT with/without MRI after the initial head injury. Various findings were shown in the subdural space, such as subdural hygroma (40%), acute subdural hematoma (25%), normal state (20%), and traumatic subarachnoid hemorrhage (15%). Regardless of the conditions of the subdural space after the head injury, however, CSH was finally present in all cases after the formation of subdural hygroma and its enlargement. The duration of the formation of hygroma after head injury ranged from 0 to 12 days (mean: 2.7 days), and its final confirmation ranged from 11 to 61 days (mean: 33.4 days). The period from the final confirmation of hygroma to the first recognition of CSH was between 8 and 36 days (mean: 17.7 days), while the period from head injury to the formation of CSH was between 27 and 75 days (mean: 51.1 days). The process of evolution to CSH may be thought to be as follows: A normal subdural space changes into a subdural hygroma by the tearing of the arachnoid membrane due to head injury. Capsule formation follows the process lasting for more than three weeks. CSH develops in consequence of bleeding from the outer membrane. (author).

Kwak, Ryungchan; Takeuchi, Fumihiko; Yokoyama, Masato; Sasaki, Takashi (Kanazawa Medical Univ. Uchinada (Japan)); Mun, Jhongbu; Ohi, Masayoshi

1989-10-01

102

CT findings of subdural fluid collections and the histology of the organized neomembrane, (2). Process of evolution to chronic subdural hematoma  

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Recently it has been noticed that some cases of low-density subdural fluid collection within several weeks after a head injury later develop a chronic subdural hematoma. To make the pathogenesis clear, the authors investigated the following: (1) whether the neomembrane had already formed prior to the recent head injury or clinical onset of the hematoma, and (2) if the neomembrane was newly formed due to minor hemorrhage mixed with CSF, or whether it was due simply to the isolated CSF. As a result, it has definitely been shown that there are two different processes developing to typical chronic subdural hematoma from low-density subdural fluid collection. One is the intramembraneous rebleeding of the pre-existing resolving chronic subdural hematoma. The other is rebleeding from the newly formed neomembrane, which has been organized as a result of an undetectable minor hemorrhage mixed with CSF through an arachnoidal tear.

Shibata, Taichiro; Nagai, Hajime; Kashino, Susumu; Umemura, Satoshi; Wakabayashi, Shigeo (Nagoya City Univ. (Japan). Faculty of Medicine)

1983-02-01

103

The low-field MRI and CT of chronic subdural hematomas; An analysis of 52 cases with 78 hematomas  

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Magnetic resonance (MR) imaging was performed at a field strength of 0.2 T in 52 patients with 78 surgery-proven chronic subdural hematomas. Signal intensities of the lesions, which were obtained on T1- (n=74), T2- (n=73), and proton density-weighted (n=64) spin-echo sequences, were compared with concurrently available CT densities. Of 74 hematomas, 60, 10, and 4 had hyperintensities, isointensities, and hypointensities, respectively, on T1-weighted images. Of 22 hematomas having high density on CT, 17 were hyperintense and 5 were isointense on T1-weighted images. Similarly, 25 isodensity hematomas on CT consisted of 23 hyperintensities and two isointensities; and 27 low density hematomas consisted of 20 hyperintensities, 3 isointensities, and 4 hypointensities. Both T2- and proton density-weighted images revealed hyperintensity in all hematomas. Two spin-echo images, T{sub 1} and proton density, were useful in differentiating chronic subdural hematoma from edema. (N.K.).

Kawanishi, Masahiro; Kajikawa, Hiroshi; Tamura, Yoji; Hirota, Naoki; Takase, Takashi (Suisei-kai Kajikawa Hospital, Hiroshima (Japan))

1991-06-01

104

Resolution of Chronic Subdural Hematoma after Treatment with Tumor Necrosis Factor Alpha Inhibitor  

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Background and Importance: Chronic subdural hematomas (cSDH) are a common problem for which solutions remain imperfect. Surgery is effective, but not without risk. Recent data have suggested a role for inflammation in the genesis of cSDH and several reports have documented some benefit to steroid tr...

Donald Ross

105

Effect of Postoperative Administration of Saireito for Bilateral Chronic Subdural Hematomas  

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The aim of this retrospective study was to investigate the efficacy of saireito for bilateral chronic subdural hematomas (B-CSDH). Between April 2006 and March 2010, a total of 18 patients undergoing unilateral burr hole drainage for B-CSDH took part in a controlled clinical study. Postoperative sta...

Satoshi Utsuki; Hidehiro Oka; Chihiro Kijima; Madoka Inukai; Katsutoshi Abe; Kimitoshi Sato; Sachio Suzuki; Kiyotaka Fujii

106

A Modified Technique for Treatment of Chronic Subdural Hematoma with Intermittent Irrigation and Unilateral Drainage System  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Chronic Subdural Hematoma (CSDH) is the problem of infancy and elderly. There are many technique for operation of CSDH, but recurrent bleeding, pneumocephalous and cerebral swelling are the main complication of these techniques. A simple and easy technique is used with intermittent irrigation and un...

Saeed Abrishamkar; Hoshang Moin; M. Abedinzadeh M. Mirzaei; Masih Sabouri; Jafar Mehvari

107

MR Imaging of Shaken Baby Syndrome Manifested as Chronic Subdural Hematoma  

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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 most...

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

108

Acute subdural hematoma requiring surgery in the subacute or chronic stage.  

UK PubMed Central (United Kingdom)

The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate form of management for them. A total of 50 patients with ASDH were admitted to our institution during a 5-year period. Hematoma removal in the subacute or chronic stage was performed in 8 patients. The ASDH had been caused by a fall in 5 patients. Five patients had been treated with antiplatelet agents. Fluid-attenuated inversion recovery magnetic resonance (MR) imaging demonstrated an irregularly shaped hematoma with gyrus patterns in 4 of 5 patients. Diffusion-weighted MR imaging demonstrated a two-layered hematoma structure in 3 of 4 patients. The hematoma was removed via a craniotomy, a small craniotomy, and a burr hole in 1, 1, and 6 patients, respectively. At surgery in the craniotomy case, a solid clot was located beneath the dura, and a liquid hematoma was located close to the brain. After hematoma removal, no inner membrane was observed on the brain surface. One patient had typical chronic subdural hematoma in the subacute stage, and 2 patients had so-called subacute subdural hematoma (SASDH) in the chronic stage. Although the majority of such cases can be treated by burr-hole surgery, a small craniotomy or craniotomy ought to be considered as a further surgical option if SASDH is diagnosed on the basis of clinical and radiological data, especially diffusion-weighted MR imaging.

Izumihara A; Yamashita K; Murakami T

2013-01-01

109

Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma  

International Nuclear Information System (INIS)

[en] 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 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)

1994-01-01

110

Iatrogenic subdural hematoma mimicking acute epidural hematoma on computed tomography  

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Full Text Available Computed tomography images of the subdural and epiduralhematoma are well defined, crescent and lentiformshapes, respectively. However, it has been reported thatboth of them might mimic each other in rare instances. Literaturereveals seven reports subdural hematoma mimickingepidural. We are reporting a new case of subduralhematoma mimicking epidural hematoma radiologically,which occurred after evacuation of chronic subdural hematomawith burr-hole in a 75 years old man. J Clin ExpInvest 2013; 4 (3): 367-369Key words: Subdural hematoma, epidural hematoma,computed tomography, brain.

Hakan Ak; Sadiye Yolcu; Tugay Atalay; Naciye K??

2013-01-01

111

Computed tomographic findings and histological findings of an organized chronic subdural hematoma  

International Nuclear Information System (INIS)

[en] As chronic subdural hematoma can be readily diagnosed by computed tomography (CT) and can be treated, there are no reports in the literature describing the CT findings of an organized chronic subdural hematoma with a long clinical course. The present case was a 53-year-old male who experienced a series of remissions and aggravations of such symptoms as right hemiparesis and consciousness disturbance for about five years. CT showed a crescent lesion in the left frontoparietal region. In the margin, an uneven, high-density area could be observed running in ward, and in the interior, an iso ? low-density area could be seen, but no evident enhancement could be noted in either area. The patient died of liver cirrhosis, and an autopsy was performed. The hematoma was encapsulated with a very thick and hard membrane, and directly under the capsule the foci of fresh hemorrhage could be seen along the capsule. The interior of the hematoma was almost entirely organized. The clinical features of this case were considered to reflect the remissions and aggravations of symptoms due to repeated hemorrhages of the chronic subdural hematoma over an extended period. (author)

1987-01-01

112

Computed tomographic findings and histological findings of an organized chronic subdural hematoma. A case report  

Energy Technology Data Exchange (ETDEWEB)

As chronic subdural hematoma can be readily diagnosed by computed tomography (CT) and can be treated, there are no reports in the literature describing the CT findings of an organized chronic subdural hematoma with a long clinical course. The present case was a 53-year-old male who experienced a series of remissions and aggravations of such symptoms as right hemiparesis and consciousness disturbance for about five years. CT showed a crescent lesion in the left frontoparietal region. In the margin, an uneven, high-density area could be observed running in ward, and in the interior, an iso approx. low-density area could be seen, but no evident enhancement could be noted in either area. The patient died of liver cirrhosis, and an autopsy was performed. The hematoma was encapsulated with a very thick and hard membrane, and directly under the capsule the foci of fresh hemorrhage could be seen along the capsule. The interior of the hematoma was almost entirely organized. The clinical features of this case were considered to reflect the remissions and aggravations of symptoms due to repeated hemorrhages of the chronic subdural hematoma over an extended period.

Kamiya, Kazuko; Inagawa, Tetsuji; Nagasako, Ren

1987-08-01

113

Analysis of chronic subdural hematoma based on CT, 3. Clinical stage classification based on CT findings  

Energy Technology Data Exchange (ETDEWEB)

Forty-nine cases of chronic subdural hematoma experienced during the past 5 years were analyzed as to the number of days elapsed following head injury, symptoms, and computerized tomography (CT) findings. As a result, the clinical course of chronic subdural hematoma was divided into the following 5 stages on the basis of the presumed pathologic processes. The initial stage corresponded to a period of about 2 weeks after the precipitating injury; symptoms were absent; plain CT showed low-density areas (LDA); and metrizamide CT revealed metrizamide penetration into the LDA. The premature stage corresponded to a period of 2-4 weeks after trauma; no symptoms were present; plain CT showed LDA; and metrizamide CT revealed that metrizamide penetrated into the LDA with difficulty. The mature stage corresponded to a period of 30-60 days after trauma; CT showed iso-density areas (IDA) or high-density areas (HDA) with occasional enhancement effect; metrizamide penetration was not detected; and symptoms such as headache may have been present. The progressive stage typified chronic subdural hematoma; headache and focal symptoms were present; plain CT showed relative LDA, IDA, HDA or mixed-density areas (MDA); and enhancement of the contents of hematoma was observed in roughly half of the cases. The resolving stage was the stage in which hematoma had disappeared; plain CT showed relative LDA or LDA without mass sign; and metrizamide penetration was not detected. This clinical staging was useful in evaluating the pathologic picture of the chronic subdural hematoma and in determining suitable treatment.

Takahashi, Yoshio; Mikami, Junichi; Ueda, Mikiya; Ito, Kazunori; Sato, Hiroyuki (Ohkawara Neurosurgical Hospital, Muroran, Hokkaido (Japan))

1984-08-01

114

Can recurrence of chronic subdural hematoma be predicted? a retrospective analysis of 136 cases  

Directory of Open Access Journals (Sweden)

Full Text Available Objective: Chronic subdural hematoma is the most common intracranial hematoma effecting especially elderly population. There is a substantial recurrence rate after evacuation by burr-hole surgery. In this study, we aimed to determine predictors associated with recurrence. Methods: We retrospectively analyzed 136 consecutive patients with chronic subdural hematoma. Clinical parameters, anamnesis, previous anticoagulant drug use have been evaluated with univariate and multivariate analyses to determine predictors associated with recurrence Results: At least a second surgery was needed in 27 patients of 136. We showed that recurrence rate was significantly higher in patients with bilateral subdural hematoma, after univariate and multivariate analyses (37% versus 11%). We did not find any significant relationship between recurrence and age, gender, hypertension and/or diabetes mellitus in anamnesis, preceding head trauma and time interval, anticoagulant and/or antiaggregan therapy. Conclusion: After analysis of all evaluated factors, only bilateral hematoma was found correlated with high recurrence rate, probably due to previous brain atrophy or existing coagulopathy.

Bekir Tu?cu; Osman Tanr?verdi; Serhat Bayd?n; Ömür Günald?; Ender Ofluo?lu; Bülent T. Demirgil

2010-01-01

115

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

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Full Text Available Introduction. Neurosurgeons are familiar with chronic subdural haematoma (CSH), a well-known clinical entity, which is usually treated by some modality of trepanation. Despite the excellent outcomes obtained by surgery, complications may occur, some of which may be potentially severe or fatal. Furthermore, up to 25% recurrence rate is reported. The authors present a novel approach to the management of CSH based on the use of dexamethasone as the treatment of choice in the majority of cases. Patients and methods. Medical records of 122 CSH patients were retrospectively reviewed. At admission, symptomatic patients were classified according to the Markwalder Grading Score (MGS). Those scoring MGS 1-2 were assigned to the Dexamethasone protocol (4mg every 8h, re-evaluation after 48-72h, slow tapering), and those scoring MGS 3-4 were, in general, assigned to the Surgical protocol (single frontal twistdrill drainage to a closed system, without irrigation). Patients were followed in the Outpatient Office with neurological assessment and serial CT scans. Results. Between March 2001 and May 2006, 122 consecutive CSH patients (69% male, median aged of 78, range 25-97) were treated. Seventy-three percent of the patients exhibited some kind of neurological defect (MGS 2-3-4). Asymptomatic patients (MGS 0) were left untreated. Initial treatment assignment was: 101 dexamethasone, 15 subdural drain, 4 craneotomy and 2 untreated. Twenty-two patients on dexamethasone ultimately required surgical drain (21.8%). Favourable outcome (MGS 0-1-2) was obtained in 96% and 93.9% of those treated with dexamethasone and surgical drain, respectively. Median hospital stay was 6 days (range 141) for the dexamethasone group and the whole series, and 8 days (range 5-48) for the surgical group. Overall mortality rate was 0.8% and re-admissions related to the haematoma reached 14.7% (all maintained or improved their MGS). Medical complications occurred in 34 patients (27.8%), mainly mild hyperglycemic impairments. Median outpatient follow up was 25 weeks (range 8-90), and two patients were lost. Discussion. The rationale for the use of dexamethasone in CSH lies in its anti-angiogenic properties over the subdural clot membrane, as it is derived from experimental studies and the very few clinical observations published. Surgical evacuation of CSH is known to achieve excellent results but no well-designed trials compare medical versus surgical therapies. The experience obtained from this series lets us formulate some clinical considerations: dexamethasone is a feasible treatment that positively compares to surgical drain (and avoided two thirds of operations); the natural history of CSH allows a 48-72h dexamethasone trial without putting the patient at risk of irreversible deterioration; eliminates all morbidity related to surgery and recurrences; does not provoke significant morbidity itself; reduces hospital stay; does not preclude ulterior surgical procedures; it is well tolerated and understood by the patient and relatives and it probably reduces costs. The authors propose a protocol that does not intend to substitute surgery but to offer a safe and effective alternative. Conclusion. Data obtained from this large retrospective series suggests that dexamethasone is a feasible and safe option in the management of CSH. In the author's experience' dexamethasone was able to cure or improve two thirds of the patients. This fact should be confirmed by others in the future. The true effectiveness of the therapy as compared to surgical treatment could be ideally tested in a prospective randomized trial.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 complicaciones, algunas de las cuales son potencialmente graves o mortales. Además, la tasa de recidivas puede alcanzar el 25% de los casos. Presenta

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

2009-01-01

116

CT findings of subdural fluid collections and the histology of the organized neomembrane, (1). A case evolving into chronic subdural hematoma  

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Recently it has been reported that, among cases of subdural fluid collection with a low CT density with several weeks after injury, some of the cases developed a chronic subdural hematoma at the same location several months later. On its pathogenesis, it is assumed that the isolated fluid collection between the dura and arachnoid forms a neomembrane and then develops a chronic subdural hematoma. Based upon our 4 cases of subdural fluid collection, we pointed out that the following conditions of subdural low-density lesions are difficult to differentiate from subdural hydroma at the early stage of injury: (1) The existence of a very old chronic subdural hematoma that might have been formed before the recent injury. (2) The occurrence of a minor hemorrhage into the subdural-fluid collection at the time of injury, which is indistinguishable on the CT scan. Therefore, the present authors considered it necessary to investigate the histology of the hematoma membrane in order to make clear the formation process of neomembrane and to compare the relation between the aging of neomembrane and the time interval of injury and CT examination. We consider the histological study very useful to reveal the pathogenesis of a chronic subdural hematoma, for it will make clear the following points: (1) Whether the neomembrane had already been formed prior to the recent head injury, (2) Whether the neomembrane was formed newly due to minor hemorrhage into the subdural fluid collection, and (3) Whether the formation of the neomembrane is possible simply from subdural-fluid collection isolated from the CSF pathway.

Shibata, T.; Nitta, M.; Fukuoka, H.; Umemura, S.; Nagai, H. (Nagoya City Univ. (Japan). Faculty of Medicine)

1981-10-01

117

Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Chronic subdural hematoma (cSDH) is frequently seen by neurosurgeons. Treatment often includes evacuation of the subdural hematoma (SDH) through one or two burr holes and placement of a drain in the subdural space to further evacuate subdural fluid and prevent reaccumulation of blood during the immediate postoperative period. Complications associated with this type of drainage include fluid and blood reaccumulation, tension pneumocephalus, seizures and subdural empyema. PRESENTATION OF CASE: The author presents a case in which aggressive CSF overdrainage most likely led to acute severe intracranial hypotension, causing the collapse of the contralateral bridging veins and ultimately resulting in venous insufficiency and hemorrhagic infarction. The remote intracerebral hemorrhages were suspected to be due to CSF overdrainage through the subdural drain, so the drain was immediately removed. After drain removal, the patient's neurologic status improved and his hemiplegia disappeared within 4h. A follow-up head CT scan 1 month later revealed resolution of his subdural fluid collection and right-sided intraparenchymal hemorrhages. He returned to work 1 month later in good condition. DISCUSSION: Although many authors have examined factors affecting the success of cSDH drainage procedures, there are few reports about the risks of overdrainage and little information available about drainage volume. This report links excessive cSDH drainage of with a remote contralateral intraparenchymal hemorrhage, a complication that has been noted only twice previously, and neither report suggested the mechanism for occurrence of the hemorrhage, or specified the amount of drainage. CONCLUSION: Subdural drainage should be carefully monitored to avoid overdrainage.

Cohen-Gadol AA

2013-01-01

118

Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma  

Science.gov (United States)

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.

Moon, Wonjun; Chough, Jeongki; Park, Haekwan

2013-01-01

119

Spontaneous spinal subdural hematoma concurrent with cranial subdural hematoma.  

UK PubMed Central (United Kingdom)

A 39-year old female presented with chronic spinal subdural hematoma manifesting as low back pain and radiating pain from both legs. Magnetic resonance imaging (MRI) showed spinal subdural hematoma (SDH) extending from L4 to S2 leading to severe central spinal canal stenosis. One day after admission, she complained of nausea and severe headache. Computed tomography of the brain revealed chronic SDH associated with midline shift. Intracranial chronic SDH was evacuated through two burr holes. Back pain and radiating leg pain derived from the spinal SDH diminished about 2 weeks after admission and spinal SDH was completely resolved on MRI obtained 3 months after onset. Physicians should be aware of such a condition and check the possibility of concurrent cranial SDH in patients with spinal SDH, especially with non-traumatic origin.

Moon W; Joo W; Chough J; Park H

2013-07-01

120

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

International Nuclear Information System (INIS)

[en] Objective: To investigate the relationship between the neuron-specific enolase (NSE) contents of serum and drainage fluid in patients with chronic subdural hematoma (CSDH). Methods: Serum and drainage fluid NSE contents were determined with RIA right after and 24, 48, 72, 96, 120 hours after trephining in 28 patients with CSDH as well as 28 controls (once and serum only). Results: The serum contents of NSE in the patients were significantly higher than those in the controls (P

2008-01-01

 
 
 
 
121

Chronic subdural hematoma: Results of a homogeneous series of 159 patients operated on by residents  

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Full Text Available AIMS: A series of cases with chronic subdural hematoma operated upon by residents in neurosurgery is analysed. MATERIALS AND METHODS: 159 patients treated between 1998 and 2001 were included in the study. Mean age was 76.4 years and male/female ratio was 1.7/1. The patients were classified both on admission and at discharge according to the Markwalder scale. The standard operative procedure consisted of an enlarged single burr-hole, rinsing the subdural space with iso-osmotic saline solution and insertion of a subdural drain. CONCLUSION: In CSDH, operation by the residents is safe and the results are comparable to those of the major series of the literature as the surgical procedure is standardized.

Gastone Pansini; Fabrizia Cioffi; Homere Mouchaty; Francesco Cacciola; Alberto Maleci; Nicola Di

2004-01-01

122

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

UK PubMed Central (United Kingdom)

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

Song Y; Wang Z; Liu L; Wang D; Zhang J

2013-01-01

123

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in english OBJECTIVES: The onset of chronic subdural hematoma may be associated with direct or indirect minor injuries to the head or a poorly repaired vascular injury. Endothelial progenitor cells happen to be one of the key factors involved in hemostasis and vascular repair. This study was designed to observe the levels of endothelial progenitor cells, white blood cells, platelets, and other indicators in the peripheral blood of patients diagnosed with chronic subdural hematoma t (more) o 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.

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

2013-01-01

124

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

Science.gov (United States)

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

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

2013-01-01

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MR imaging of shaken baby syndrome manifested as chronic subdural hematoma  

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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-enhanced MRI revealed diffuse dural enhancement.

Lee, Yul; Lee, Kwan Seop; Hwang, Dae Hyun; Lee, In Jae; Kim, Hyun Beom; Lee, Jae Young [Hallym University College of Medicine, Anyang (Korea, Republic of)

2001-09-01

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MR imaging of shaken baby syndrome manifested as chronic subdural hematoma  

International Nuclear Information System (INIS)

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-enhanced MRI revealed diffuse dural enhancement.

2001-01-01

127

Chronic subdural hematoma with sedimentation level on CT: correlation with clinical and operative findings  

International Nuclear Information System (INIS)

[en] The purpose of this study is to correlate CT findings of the patients with chronic subdural hematoma(SDH) showing a sedimentation level with their clinical and operative findings. We selected 9 patients who showed a sedimentation level within the hematoma after reviewing the CT findings of 55 patients with SDH. We also analyzed their age, initial symptoms, cause of head injury, latent period, the level of consciousness on admission, CT findings, and operative findings. All of the 9 patients were aged persons(over 52 years). They had a history of acute exacerbation of neurologic symptoms. Five of them had an apparent history of head trauma more than one month before the exacerbation. The CT scans showed unilateral, crescent-shaped subdural fluid collection with a sedimentation level except a case of bilateral SDH and 2 cases of planoconvex-shaped SDH. The interface of the sedimentation level was sharp in 3 cases and indistinct in 6 cases. None had bleeding tendency and the hemoglobin level was slightly decreased in 2 patients. All patients revealed membrane of the hematoma during operation. The upper portion of the sedimentation was liquefied blood and the lower portion was fresh blood clots. We could observe fresh RBC's in the hematoma microscopically. A sedimentation level in chronic SDH was operatively proved to represent rebleeding, and was clinically manifested as an acute exacerbation of symptoms

1994-01-01

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Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM  

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Full Text Available Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paciente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar.

Leodante B. Costa Jr; Agustinho de Andrade; Gustavo Fonseca Valadão

2004-01-01

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Chronic subdural hematoma of the posterior fossa associated with cerebellar hemorrhage: report of rare disease with MRI findings/ Hematoma subdural crônico de fossa posterior associado a hemorragia cerebelar espontânea: relato de doença rara com achados de RNM  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Hematomas subdurais da fossa posterior são lesões raras, mais comumente relacionadas com traumas graves. A ocorrência de hematomas subdurais crônicos na fossa posterior é muito rara, sendo descritos 15 casos até o momento, boa parte relacionada ao uso de anticoagulantes. Em nossa revisão da literatura, não pudemos encontrar nenhum relato da associação entre hematoma subdural crônico da fossa posterior e hemorragia cerebelar espontânea. Relatamos o caso de paci (more) ente de 64 anos com hematoma intraparenquimatoso cerebelar tratado conservadoramente e hematoma subdural crônico, tratado cirurgicamente, cerca de 1 mês após o acidente vascular cerebelar. Abstract in english Chronic subdural hematoma of the posterior fossa is an uncommon entity, and spontaneous lesions are very rarely described, occurring mostly during anticoagulation therapy. The association of the posterior fossa chronic subdural hematoma with spontaneous parenchymal hemorrhage without anticoagulation therapy was never related in the literature, to our knowledge. We describe a case of a 64 year-old woman who suffered a spontaneous cerebellar hemorrhage, treated conservatively, and presented 1 month later with a chronic subdural posterior fossa hematoma.

Costa Jr, Leodante B.; Andrade, Agustinho de; Valadão, Gustavo Fonseca

2004-03-01

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

International Nuclear Information System (INIS)

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

1989-01-01

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Impact of Pre-Hospital Antithrombotic Medication on the Outcome of Chronic and Acute Subdural Hematoma.  

UK PubMed Central (United Kingdom)

Introduction Antithrombotic medication has proven efficacy in the treatment and prevention of cardiovascular and cerebrovascular diseases. A major disadvantage is the increased incidence of cerebral hemorrhages such as subdural hematomas (SDH). The impact of antithrombotic therapy on the outcome of subdural hematoma is not well characterized to date.Materials and Methods We retrospectively analyzed patients with subdural hematomas admitted to our hospital between 2005 and 2009. Antithrombotic medication, as well as other risk factors (age, sex, and preexisting diseases) were statistically analyzed in 476 consecutive patients for an independent association with inferior outcome, such as recurrent hematoma or in-hospital death. The patients had been evaluated and treated according to clinical standards for the management of severe head injury and were divided into groups with chronic SDH (cSDH) and acute SDH (aSDH), respectively.Results Of 312 patients with aSDH, 71 (22.8%) patients had at least one recurrence and 41 (13.1%) patients died in hospital. In the aSDH group, both the recurrence and the mortality were associated with anticoagulant therapy and with platelet aggregation inhibition. In the group of 163 patients with cSDH, 40 (24.5%) patients had a recurrence and 13 (7.9%) patients died within 9 weeks. Neither the application of platelet aggregation inhibitors nor the anticoagulant therapy were associated with recurrence or in-hospital mortality in this group.Conclusion Our results clearly indicate that prehospital antithrombotic therapy was independently associated with inferior outcome of patients with aSDH, while no association for patients with cSDH was observed.

Baraniskin A; Steffens C; Harders A; Schmiegel W; Schroers R; Spangenberg P

2013-02-01

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Imaging diagnosis--Neuronal ceroid lipofuscinosis with a chronic subdural hematoma.  

Science.gov (United States)

A subdural hematoma was found to accompany neuronal ceroid lipofuscinosis in an 11-month-old Dachshund. Results from clinical, magnetic resonance (MR) imaging, histopathologic, ultrastructural, and molecular assessments are described. The dog had a 3-month history of progressive neurologic signs. In MR images, there was severe asymmetric cerebral atrophy with a subdural hematoma. Histopathologically, there was autofluorescent, periodic acid-Schiff-positive lipopigment in neurons and transmission electron microscopy confirmed a typical curvilinear profile of the storage bodies. We hypothesize that rapid brain atrophy contributed to the subdural hematoma formation, a complication not described previously in dogs with neuronal lipofuscinosis. PMID:20402401

Asakawa, Midori Goto; MacKillop, Edward; Olby, Natasha J; Robertson, Ian D; Cullen, John M

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Imaging diagnosis--Neuronal ceroid lipofuscinosis with a chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

A subdural hematoma was found to accompany neuronal ceroid lipofuscinosis in an 11-month-old Dachshund. Results from clinical, magnetic resonance (MR) imaging, histopathologic, ultrastructural, and molecular assessments are described. The dog had a 3-month history of progressive neurologic signs. In MR images, there was severe asymmetric cerebral atrophy with a subdural hematoma. Histopathologically, there was autofluorescent, periodic acid-Schiff-positive lipopigment in neurons and transmission electron microscopy confirmed a typical curvilinear profile of the storage bodies. We hypothesize that rapid brain atrophy contributed to the subdural hematoma formation, a complication not described previously in dogs with neuronal lipofuscinosis.

Asakawa MG; MacKillop E; Olby NJ; Robertson ID; Cullen JM

2010-03-01

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Modified twist drill technique in the management of chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

AIM: Burr-hole craniostomy is the most efficient and safe choice for surgical drainage of chronic subdural hematoma (CSDH). Although the twist-drill drainage is also relatively safe and time-saving, it carries the risk of inadequate drainage, brain penetration and hematoma formation. Our modified technique helps in avoiding bleeding and brain penetration. MATERIAL and METHODS: The preferred sites for twist drill were the most curved parts on the cranium. Normal drilling at about 90 degree angle was done on the most curved surfaces while it was at about 60 degree angles on flat surface. This angled drilling and the curved guide wire (hooked in the distal blind end of infant feeding tube), helped to guide infant feeding tube in the hematoma cavity. Dura matter was coagulated using insulated wire. RESULTS: There was no procedure related hematoma, brain penetration and mortality in any of the 50 patients managed by the modified technique. Infant feeding tube was properly positioned in all the cases. Burr hole evacuation was done in 7 cases (14%) due to inadequate evacuation of the hematoma after TDC. CONCLUSION: Our modified technique of twist drill drainage is inexpensive, simple, safe and effective alternative technique in the treatment of CSDH.

Yadav YR; Yadav S; Parihar VS

2013-01-01

135

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)

Full Text Available Abstract in portuguese 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 relacionados à intensidade do comprometimento neurológico por ocasião da cirurgia. A idade avançada associada à presença de doenças sistêmicas também teve influ? (more) ?ncia 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 impai (more) rment, 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.

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

1990-03-01

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

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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 relacionados 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.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.

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

1990-01-01

137

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 complicaciones, algunas de las cuales son potencialmente graves o mortales. Además, la tasa de recidivas puede alcanzar el 25% de los casos. Presentamos una aproximación noved (more) osa 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, idealment

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

2009-08-01

138

One versus double burr holes for treating chronic subdural hematoma meta-analysis.  

UK PubMed Central (United Kingdom)

OBJECTIVE AND DESIGN: There is controversy among neurosurgeons regarding whether double burr hole craniostomy (DBHC) is better than single burr hole craniostomy (SBHC) in the treatment of chronic subdural hematoma (CSH), in terms of having a lower revision rate. In order to compare the revision rates after SBHC versus DBHC, we performed a meta-analysis of the available studies in the literature. MATERIALS AND METHODS: Multiple electronic health databases were searched to identify all the studies published between 1966 and December 2010 that compared SBHC and DBHC. Data were processed in Review Manager 5.0.18. Effect sizes were expressed in pooled odds ratio (OR) estimates, and due to heterogeneity between studies we used random effect of the inverse variance weighted method to perform the meta-analysis. RESULTS: Five observational retrospective cohort studies were identified: four published studies and one unpublished, describing the outcomes of 355 DBHC and 358 SBHC to evacuate 713 CSH in 631 patients. Meta-analysis showed that there was no significant difference in the revision rates between double burr hole craniostomy and single burr hole craniostomy when performed to evacuate CSH. Pooled odds ratio for all the studies was 0.62 (95% confidence interval 0.26 - 1.46). CONCLUSIONS: The results of this meta-analysis suggest that SBHC is as good as DBHC in evacuating chronic subdural hematoma and is not associated with a higher revision rate compared to DBHC.

Belkhair S; Pickett G

2013-01-01

139

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

International Nuclear Information System (INIS)

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

2000-01-01

140

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities  

Directory of Open Access Journals (Sweden)

Full Text Available O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (pThe chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas - SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth decade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p<0.001 and p=0.004 respectively). Patients with previous head injury history (76%) showed a lower mortality (p=0.044). The results stand out the importance of the pre-operative evaluation with coagulation studies in order to correct possible abnormalities.

Clarissa Lin Yasuda; Márcia Elisabete Morita; Fernanda Yoshi Nishimori; Agnes Meri Yasuda; Hélvio Leite Alves

2003-01-01

 
 
 
 
141

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma/ Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (in (more) ternational normalized ratio) superiores a 1,25 e/ou trombocitopenia (p Abstract in english The chronic subdural hematoma represents one of the most frequent types of intracranial hemorrhage. One hundred sixty one patients operated in the Clinical Hospital of State University of Campinas - SP (UNICAMP) from April 1994 to May 2000, were analyzed retrospectively in order to characterize the population and to study the importance of the pre-operative coagulation analysis in the outcome. The majority of the population was male (86%), white (85.1%) and in the fifth d (more) ecade (median age: 57 years). A high mortality index in the postoperative period was found in patients with INR (international normalized ratio) values greater than 1.25 and/or thrombocytopenia (p

Yasuda, Clarissa Lin; Morita, Márcia Elisabete; Nishimori, Fernanda Yoshi; Yasuda, Agnes Meri; Alves, Hélvio Leite

2003-12-01

142

Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas  

Science.gov (United States)

Background: Chronic subdural hematoma (CSDH) is generally treated by burr hole irrigation. However, sometimes repeated recurrence is observed, and treatment may consequently become difficult. We examined the efficacy of embolization of the middle meningeal artery (MMA) for such cases. Methods: We considered embolization of the MMA for three patients who had refractory CSDH with repeated recurrence and two CSDH patients who were at risk of recurrence and showed signs of recurrence after surgery. A microcatheter was advanced through the MMA as peripherally as possible, and embolization was performed with 15-20% n-butyl-2-cyanoacrylate or 200 ?m polyvinyl alcohol particles. Results: Embolization was performed in the three patients who had refractory CSDH with repeated recurrence: The procedure was performed after burr hole irrigation of the hematoma in two patients and before the irrigation in one patient. In the two CSDH patients at risk of recurrence, embolization was performed when signs of recurrence appeared. The timing of embolization differed for each patient. However, in all the patients, the hematoma tended to decrease in size, and no recurrence was observed. Conclusion: Embolization of the MMA is effective for refractory CSDH or CSDH patients with a risk of recurrence, and is considered an effective therapeutic method to stop hematoma enlargement and promote resolution.

Hashimoto, Takao; Ohashi, Tomoo; Watanabe, Daisuke; Koyama, Syunichi; Namatame, Hiroaki; Izawa, Hitoshi; Haraoka, Rei; Okada, Hirofumi; Ichimasu, Norio; Akimoto, Jiro; Haraoka, Jo

2013-01-01

143

Diplopia from Subacute Bilateral Subdural Hematoma after Spinal Anesthesia  

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Subdural hematoma (SDH) is a rare, but life-threatening complication of spinal anesthesia. Subdural hematoma resulting from this procedure could present with vague symptoms such as chronic headache and could easily be missed. Chronic headache is one of the symptoms of chronic SDH in postpartum women...

Hassen, Getaw Worku; Kalantari, Hossein

144

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

UK PubMed Central (United Kingdom)

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

Hirashima Y; Kuwayama N; Hamada H; Hayashi N; Endo S

2002-02-01

145

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

Science.gov (United States)

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

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

2002-02-01

146

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)

2009-01-01

147

Chronic subdural hematoma associated with the middle fossa arachnoid cyst: pathogenesis and review of its management.  

UK PubMed Central (United Kingdom)

BACKGROUND: The pathogenesis of chronic subdural hematoma (CSDH) associated with an arachnoid cyst (AC) is still not clear. We propose an origin of initial bleeding of CSDH in patients with AC based on our experience and discuss the management of this disease. MATERIALS AND METHODS: The total number of operations included in this study was 23. Eleven cases were indicated because of associated CSDH (group 1), and the other cases were due to different reasons (group 2). The relationship of the AC and dura was evaluated in patients who did not have CSDH (group 2) because patients with CSDH would have had structural changes of AC due to hematoma. RESULTS: In group 1, the age distribution was from 8 to 61 years (mean 23.0). The development of CSDH was not related with Galassi types. The hematomas were located outside of the outer cyst membrane in six patients and both inside and outside in three patients. In two patients, the location could not be reviewed. After suspicion of the outer cyst membrane as the origin of the bleeding site, we found small bridging vessels between the dura and outer cyst membrane in three of five consecutive patients in group 2. CONCLUSIONS: Based on our surgical experience of AC cyst, we found small bridging vessels between the dura and outer membrane of the AC. We suggested that these small vessels are the source of initial bleeding leading to CSDH in AC.

Kwak YS; Hwang SK; Park SH; Park JY

2013-01-01

148

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

International Nuclear Information System (INIS)

[en] 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)

1991-01-01

149

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

Energy Technology Data Exchange (ETDEWEB)

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).

Shinoura, Nobusada; Kondo, Tatsuya; Yamakawa, Kenta; Makiuchi, Tsuneo; Fujii, Kyoichi; Yoshioka, Masumi (National Medical Center of Hospital, Tokyo (Japan))

1991-06-01

150

Endoscopic burr hole evacuation of an acute subdural hematoma.  

UK PubMed Central (United Kingdom)

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed.

Codd PJ; Venteicher AS; Agarwalla PK; Kahle KT; Jho DH

2013-08-01

151

Superimposed Propionibacterium Acnes Subdural Empyema in a Patient with Chronic Subdural Hematoma  

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The authors present a case of subdural empyema in a macrocephalic patient. A 23-year-old male was admitted due to headache and fever. One month ago, he had mild head injury by his coworkers. Physical examination showed a macrocephaly and laboratory findings suggested purulent meningitis. Neuroimagin...

Kim, Jong Hun; Lee, Chul-Hee; Hwang, Soo Hyun; Kang, Dong Ho

152

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

International Nuclear Information System (INIS)

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

2000-01-01

153

Intracranial aneurysms causing spontaneous acute subdural hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available Acute subdural hematoma is an uncommon presentation of the rupture of an intracranial aneurysm. We report two cases of intracranial aneurysms causing spontaneous acute subdural hematoma.

Shenoy S; Kumar M; Raja A

2003-01-01

154

Subdural evacuating port system (SEPS)--minimally invasive approach to the management of chronic/subacute subdural hematomas.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The population suffering from chronic/subacute subdural hematomas (SDHs) generally includes elderly patients with co-morbidities; therefore the success of less invasive surgical techniques has been of long standing interest. The optimum treatment option for chronic/subacute SDH has not been well established. We report our retrospective outcomes of SDH drainage through a subdural evacuating port system (SEPS). PATIENTS AND METHODS: Fifty-two consecutive adult patients with chronic/subacute SDH treated with SEPS (total 64 procedures), over a period of 3 years (June 2006-June 2009), were included. 9/52 patients had SEPS performed for bilateral SDHs. Three patients had SEPS placed for recurrent SDH. This retrospective study was approved by the Institutional Review Board of SUNY Upstate Medical University and Crouse Hospital. RESULTS: Overall 38/52 patients (73%) showed clinical improvement, 10/52 patients (19%) did not show any clinical improvement and 4/52 (8%) patients became clinically worse after the SEPS placement during initial hospitalization. 41/52 patients, treated initially with SEPS were followed as outpatients. 32/41 patients improved, returning to baseline neurological status, 5/41 patients improved, but still had some residual symptoms. The remaining 4/41 patients, presented with recurrent symptoms and had recurrent SDH on CT scans. During the in-hospital post-SEPS period, 8 SDH had >75% decrease, 17 SDH had between 50 and 75% decrease, 23 SDH had between 25 and 50% decrease and 14 procedures had <25% decrease in maximal width of the SDH on postoperative scans. Outpatient follow up CT scans after SEPS placement were available for 46/64 procedures. At final outpatient follow up, 33/46 SDHs showed >75% decrease in maximal thickness, 4/46 SDH showed between 50 and 75% and 2/46 SDH showed between 25 and 50% decreases in maximal width of chronic SDH. However, in 7/46 patients, SDH re-accumulated (i.e. increased in thickness) as outpatients, after initial response to treatment on post-operative in-hospital CT scans. CONCLUSION: SEPS is an effective, relatively safe and convenient treatment strategy with low invasiveness; among management options of chronic/subacute SDH.

Singla A; Jacobsen WP; Yusupov IR; Carter DA

2013-04-01

155

A case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography  

International Nuclear Information System (INIS)

[en] One case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography is reported. A 44-year-old female slipped and hit her head without loss of consciousness, one month ago. Recently she complained of headaches and visited the department of Neurosurgery, Washokai Sadamoto Hospital on May 21, 1985. There were no physical and neurological signs on examination. Plain CT scans showed a crescent-shaped high density area in the left frontal region with a slight mass sign. She was diagnosed as having a possible chronic subdural hematoma and further examination was recommended. Biplane ultrafast overlapping cerebral computed angiotomograms clearly demonstrated a so-called avascular area delineated by enhanced superficial cerebral vessels with contrast medium. Furthermore, a marked high density mass measuring 8 mm x 10 mm x 6 mm in diameters was simultaneously demonstrated around the right anterior clinoid process on the same image, suggesting a cerebral aneurysm. Right carotid angiograms showed a right internal carotid-posterior communicating junction aneurysm. The irrigation of the left chronic subdural hematoma was carried out on May 24 and the neck clipping of the right IC-PC junction aneurysm was done two weeks later. During the operation, there were no findings suggesting a previous subarachnoid hemorrhage from the aneurysm, but a bleb was found on the aneurysm. The post-operative course was uneventful. (J.P.N.)

1986-01-01

156

Resolution of Chronic Subdural Hematoma after Treatment with Tumor Necrosis Factor Alpha Inhibitor  

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Full Text Available Background and Importance: Chronic subdural hematomas (cSDH) are a common problem for which solutions remain imperfect. Surgery is effective, but not without risk. Recent data have suggested a role for inflammation in the genesis of cSDH and several reports have documented some benefit to steroid treatment. In this report, a possible role for tumor necrosis factor alpha blockade in the resolution of a multiply recurrent cSDH is described. Clinical Presentation: An 86-year-old man with rheumatoid arthritis treated with infliximab presented with a large, symptomatic, multiloculated cSDH. Infliximab was withheld and craniotomy for evacuation was uncomplicated, but recurrent symptoms were noted and a recurrence was operated upon again several weeks later. Follow up CT showed a second recurrence. The patient requested to go back on his infliximab due to painful arthralgias. After a single dose of 10 mg/kg, follow up CT showed that the cSDH resolved and did not recur. Conclusion: Anti-TNF-alpha treatment with infliximab may have played a role in the resolution of this patient’s cSDH. Further investigation of this possible effect seems warranted.

Donald Ross

2011-01-01

157

[Chronic subdural hematoma (CSH) complicated by bilateral occipital lobe infarction: two case reports].  

UK PubMed Central (United Kingdom)

Chronic subdural hematoma (CSH) is a common disease that is treated with burr hole drainage by neurosurgeons. The outcome of CSH is mostly favorable. We treated 2 cases with bilateral occipital lobe infarction due to CSH. A 57-year-old woman was ambulatory when she visited a clinic for evaluation of headache. One hour after the CT was taken, she developed acute impairment of consciousness, so that she was referred to our hospital. The second patient was a 73-year-old woman with a history of depression who was involved in a traffic accident 5 weeks before admission to our hospital. She was at first admitted to a psychiatric hospital for evaluation of gait disturbance. Three weeks after she was admitted to the psychiatric hospital, she fell into a coma. She was referred to our hospital. Their brain CT on admission revealed compressed ambient and interpeduncular cistern and bilateral CSH. Although burr hole drainage surgery was performed, the 2 patients developed severe sequelae due to occipital lobe infarction caused by central transtentorial herniation.

Kudo K; Naraoka M; Shimamura N; Ohkuma H

2013-04-01

158

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

UK PubMed Central (United Kingdom)

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy. METHODS: We conducted a retrospective review of 239 patients undergoing surgery for CSDH over a period of six years (2006-2011). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, coagulation status, laterality, surgical method and recurrence. RESULTS: Seventy-two percent of the patients were male and the mean age was 71.8 years (range 28-97 years). Previous fall with head trauma was reported in 60% of the patients while 16% were certain of no previous head trauma. The majority of patients (63%) in the non-trauma group were receiving anticoagulants and/or antiplatelet agent therapy prior to CSDH presentation, compared to 42% in the trauma group. Twenty-four percent experienced recurrence of the CSDH. There was no association between recurrence and anticoagulant and/or antiplatelet agent therapy. CONCLUSION: Anticoagulant and/or antiplatelet aggregation agent therapy is more prevalent among non-traumatic CSDH patients but does not seem to influence the rate of CSDH recurrence.

Aspegren OP; Åstrand R; Lundgren MI; Romner B

2013-07-01

159

Subdural hematoma scans  

International Nuclear Information System (INIS)

[en] The correlation of radioisotopic brain scan findings with surgical or autopsy findings in 20 patients with proven subdural hematomata were studied. The radioisotopic brain scanning was either normal or falsely localizing in 3 of 13 patients with unilateral lesions. Six of the seven patients with bilateral lesions showed only unilateral abnormality; the scan was normal in one. Rapid sequential scintiphotography was performed in nine patients. It was normal in four. There was a slightly higher incidence of false-negative radioisotopic brain scans in patients with proven membrane formation. These findings emphasize the importance of strongly considering bilateral subdural lesions, despite unilateral abnormality on the brain scan

1976-01-01

160

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

International Nuclear Information System (INIS)

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

1995-01-01

 
 
 
 
161

A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation.  

UK PubMed Central (United Kingdom)

Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm(3) vs 112.6 cm(3), respectively; p = 0.25) or final SDH volume (31.9 cm(3) vs 28.2 cm(3), respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

Safain M; Roguski M; Antoniou A; Schirmer CM; Schirmer CS; Malek AM; Riesenburger R

2013-03-01

162

Hematoma subdural crónico: Análisis de 95 casos  

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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 evoluciónChronic 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

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

2012-01-01

163

Hematoma subdural crónico: Análisis de 95 casos  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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

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

2012-03-01

164

Histopathological features of the outer membrane of chronic subdural hematoma and correlation with clinical and radiological features.  

Science.gov (United States)

We compared the histopathological features of the outer membrane of a chronic subdural hematoma (CSH) with its clinico-radiological presentation in patients. One hundred and fifty-six patients undergoing surgery for CSH were prospectively included in this study. Histopathological specimens of the outer neomembrane obtained intraoperatively were studied. Histological features were classified into four types and analyzed in relation to the Glasgow Coma Scale (GCS) score at presentation and radiological features. On histopathological examination, there were no cases of type I, 42.3% cases of type II and 34.6% cases of type III and 23.1% cases of types IV CSH neomembranes. Patients presenting with a GCS subdural hemorrhage after drainage surgery. PMID:23916760

Gandhoke, Gurpreet S; Kaif, Mohammad; Choi, Lawrence; Williamson, Richard W; Nakaji, Peter

2013-07-31

165

Parkinsonism secondary to bilateral subdural hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available Subdural hematoma is a rare cause of secondary parkinsonism. In this study, we present a case of parkinsonian syndrome caused by a bilateral subdural haematoma. The patient’s parkinsonism symptoms completely disappeared following successful surgical removal of the hematoma without any anti-parkinson drug.

Adalet Ar?kano?lu; Remziye Hünkar; Kadir Ç?nar

2011-01-01

166

Computed tomography of isodense subdural hematomas  

International Nuclear Information System (INIS)

[en] Most subdural hematomas with significant differed attenuation from that of adjacent brain tissue can be accurately diagnosed by CT. Difficulty arises when the hematoma is isodense that is exhibited similar attenuation to that of brain. Unilateral isodense subdural hematoma can be identified by indirect sign such as mass effect. Occasionally, the use of intravenous contrast material to aid in identifying isodense subdural hematomas has met with variable success. Moreover, bilateral isodense subdural hematoma may be more difficult. We therefore considered it of interest to evaluate the diagnostic efficiency of CT in isodense subdural hematomas. We have analysed 13 cases surgically provened cases of isodense subdural hematoma examined at Korea General Hospital from October 1981 to April 1982. The results were as follows: 1. One hundred twenty seven cases of subdural hematomas were studied by CT, 13 cases (10.2%) of which were isodense. 2. The age distribution was from 29 years to 69 years and mean age was 52 years. The sex ratio was 11 male to 2 female. 3. Seven (53.8%) of 13 cases has a history of head trauma. 4. The time interval which subdural hematoma became isodense was from 1 week to 4 months and peak time interval was from 1 week to 3 weeks. 5. The precontrast CT scan of isodense subdural hematoma appeared shifting of midline structure, compression and deformity of the ventricles in all 13 cases, effacement of cerebral sulci in 10 cases (76.9%) and dilatation of contralateral ventricles in 4 cases (30.8%). 6. The postcontrast CT scan demonstrated enhancement of the medial margin of the lession in 4 (30.8%) of 13 cases and displacement of cortical vein away from the inner table of the skull in 3 (23.1%) of 13 cases. 7. Bilateral isodense subdural hematomas were 2 (15.4%) of 13 cases

1981-10-00

167

Computed tomography of isodense subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

Most subdural hematomas with significant differed attenuation from that of adjacent brain tissue can be accurately diagnosed by CT. Difficulty arises when the hematoma is isodense that is exhibited similar attenuation to that of brain. Unilateral isodense subdural hematoma can be identified by indirect sign such as mass effect. Occasionally, the use of intravenous contrast material to aid in identifying isodense subdural hematomas has met with variable success. Moreover, bilateral isodense subdural hematoma may be more difficult. We therefore considered it of interest to evaluate the diagnostic efficiency of CT in isodense subdural hematomas. We have analysed 13 cases surgically provened cases of isodense subdural hematoma examined at Korea General Hospital from October 1981 to April 1982. The results were as follows: 1. One hundred twenty seven cases of subdural hematomas were studied by CT, 13 cases (10.2%) of which were isodense. 2. The age distribution was from 29 years to 69 years and mean age was 52 years. The sex ratio was 11 male to 2 female. 3. Seven (53.8%) of 13 cases has a history of head trauma. 4. The time interval which subdural hematoma became isodense was from 1 week to 4 months and peak time interval was from 1 week to 3 weeks. 5. The precontrast CT scan of isodense subdural hematoma appeared shifting of midline structure, compression and deformity of the ventricles in all 13 cases, effacement of cerebral sulci in 10 cases (76.9%) and dilatation of contralateral ventricles in 4 cases (30.8%). 6. The postcontrast CT scan demonstrated enhancement of the medial margin of the lession in 4 (30.8%) of 13 cases and displacement of cortical vein away from the inner table of the skull in 3 (23.1%) of 13 cases. 7. Bilateral isodense subdural hematomas were 2 (15.4%) of 13 cases.

Youn, Eun Kyung; Kim, Jae Won; Kim, Ock Dong; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)

1983-03-15

168

Contralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation.  

UK PubMed Central (United Kingdom)

Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. Burr-hole craniotomy was performed before decompressive craniectomy, and the bleeding source was a cortex artery within the frontal lobe contusion. Despite supportive therapy with barbiturate and mild hypothermia he expired 3 days later of brain death. Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.

Shen J; Fan Z; Ji T; Pan J; Zhou Y; Zhan R

2013-01-01

169

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

Energy Technology Data Exchange (ETDEWEB)

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.

Tsui, Edmund Yik Kong. E-mail: yktsui@hongkong.com; Fai Ma, Ka; Cheung, Yu Keung; Chan, Jimmy Hon Mo; Yuen, Ming Keung

2000-10-01

170

Acute subdural hematoma in infancy and childhood.  

UK PubMed Central (United Kingdom)

27 cases of acute posttraumatic subdural hematomas diagnosed and treated by the authors from 1968 to 1972 are presented. Five were newborns, 18 were infants, and three were toddlers. The youngest patient was 38 h and the oldest 5 years old. The most common age was between 1 and 3 months. Falls were the most frequent cause of injury, parental or familial abuse was next. A correlative analysis of the different clinical pictures in each of these age groups is made. We stressed that the presence of hemorrhages in the fundi, and convulsions, in the infant who has suffered a head injury, are indications for contrast studies. A critical analysis of subdural taps, as a method of diagnosis and treatment, is made: we seriously doubt that subdural taps are of any real value in the clinical management of a child with acute head injury. Comparative analysis of the surgical treatment and results is made. Twelve patients were treated with repeated subdural taps, 15 with craniotomy. Of the former group, 41.6% developed a chronic subdural whereas only 13% of the latter group developed this complication. Five out of the 27 patients died. Comparative psychological evaluation of these two groups, surgical and nonsurgical, is presented. In the surgical group 72.7% had an IQ over 80 and in the nonsurgical group only 25% had an IQ over 80. A correlative analysis of the clinical picture, method of diagnosis, surgical result, and psychological tests are analyzed.

Gutierrez FA; Raimondi AJ

1975-01-01

171

Multiple tenting techniques improve dead space obliteration in the surgical treatment for patients with giant calcified chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Calcified chronic subdural hematoma (CCSDH), or "armored brain," is a rare disease entity. The optimal surgical procedure for CCSDH has not been established because it is hard to obtain brain re-expansion after surgery. In particular, a large CCSDH is difficult to completely extirpate, and the residual rigid inner and outer membranes facilitates dead space retention and hematoma recurrence. METHODS: We introduce the use a multiple suturing technique to tent the residual outer and inner membranes onto the dura matter so as to obliterate dead space after surgical treatment for CCSDH. Neuroimaging and surgical reports with illustrative images from two cases are shown. RESULTS: Two patients were admitted to our intensive care unit more than 10 years apart from their ventriculoperitoneal (V-P) shunt placements. The first patient presented with clinical signs of increased intracranial pressure. The second patient had a large CCSDH as a concomitant finding with ruptured aneurysmal subarachnoid hemorrhage. Computerized cranial tomography demonstrated large hematoma cavities with thick calcified inner membranes. After neurosurgical intervention by craniotomy and optimal resection of calcified membranes and muddy blood clot, we tented the residual calcified inner and outer membranes onto the dura matter by multiple sutures to reduce dead space accumulation. Postoperatively, the two patients had improved clinical symptoms along with much reduced hematoma cavity in imaging examinations. CONCLUSIONS: We reported an alternative technique using multiple tenting procedures to improve dead space obliteration after surgical treatment for patients with a large CCSDH presenting as a late complication after V-P shunting.

Juan WS; Tai SH; Hung YC; Lee EJ

2012-04-01

172

Two cases of subdural hematoma with niveau formation on CT  

International Nuclear Information System (INIS)

[en] The authors report a case of a bilateral chronic subdural hematoma with niveau formation and another rare case of an acute subdural hematoma with niveau formation on plain CT. The different mechanisms of the niveau formation in these cases are speculated about. The first case was a 75-year-old male who showed a drowsy state, urinary incontinence, and muscle weakness of the bilateral lower limbs. No definite history of head trauma could be found. A plain CT scan showed a bilateral-crescent type fluid collection with niveau formation, consisting of a low-density area in the upper part and a high-density area in the lower part. An operation showed bilateral, moderately encapsulated subdural hematomas; they were evacuated. The second case was a 61-year-old male with head trauma due to a fall from a ladder. On admission, neurological examination revealed a decerebrate posture, a deep coma, and anisocoria. A plain CT scan twenty hours after the onset showed a crescent-type fluid collection with niveau formation in the left fronto-parietal region. The operation showed an acute subdural hematoma containing xanthochromic fluid and coagulated blood. No capsule of hematoma could be seen. The incidence of niveau formation in chronic subdural hematomas is not low (5 - 20%); such niveau formation is thought to be caused by rebleeding into the hematoma and the spending of considerable time in the supine position. On the other hand, no case of an acute subdural hematoma with niveau formation has previously been reported. With regard to this mechanism of niveau formation, we speculate that the hematoma is mixed with cerebrospinal fluid from the arachnoidal tear caused by the head trauma; also, a considerable time in the supine position is necessary. (author)

1984-01-01

173

MRI findings of traumatic spinal subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

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

Jeong, Hyeon Jo; Baek, Jung Hwan; Kim, Yun Suk; Jeong, Sun Ok; Park, Hyun Joo; Jo, Jin Man [Dae rim St. Mary' s Hospital, Seoul (Korea, Republic of); Kim, Sung Tae [Inha General Hospital, Inchon (Korea, Republic of)

2000-04-01

174

MRI findings of traumatic spinal subdural hematoma  

International Nuclear Information System (INIS)

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

2000-01-01

175

Radiologic findings of acute spontaneous subdural hematomas  

International Nuclear Information System (INIS)

[en] To evaluate the characteristic CT and cerebral angiographic findings in patients with acute spontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome. Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presenting during the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determine the cause of bleedings, CT and angiographic findings were retrospectively analysed. Clinical history, laboratory and operative findings, and final clinical outcome were reviewed. Acute spontaneous subdural hematoma is a rare condition, and the mortality rate is high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid or intracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm and arteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus markedly reduce mortality, the causes of bleedings should be prompty determined by means of cerebral angiography. (author). 20 refs., 1 tab., 4 figs

1998-01-01

176

Radiologic findings of acute spontaneous subdural hematomas  

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To evaluate the characteristic CT and cerebral angiographic findings in patients with acute spontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome. Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presenting during the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determine the cause of bleedings, CT and angiographic findings were retrospectively analysed. Clinical history, laboratory and operative findings, and final clinical outcome were reviewed. Acute spontaneous subdural hematoma is a rare condition, and the mortality rate is high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid or intracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm and arteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus markedly reduce mortality, the causes of bleedings should be prompty determined by means of cerebral angiography. (author). 20 refs., 1 tab., 4 figs.

Kim, Hyun Jung; Bae, Won Kyong; Gyu, Cha Jang; Kim, Gun Woo; Cho, Won Su; Kim, Il Young; Lee, Kyung Suk [Soonchunhyang University, Chonan (Korea, Republic of). Chonan Hospital

1998-03-01

177

[A case of infected subdural hematoma accompanied by cerebral infarction].  

UK PubMed Central (United Kingdom)

Infected subdural hematoma(ISH)is a rare disease caused by hematogenous infection of a preexisting subdural hematoma. We report a rare case of ISH accompanied by cerebral infarction. A 76-year-old man who had suffered a closed head injury 3 months before presented fever, headache and left hemiparesis during the medical treatment of acute cholangitis and obstructive jaundice with pancreatic cancer at the department of surgical gastroenterology. At the consultation, computed tomography(CT)scan indicated right chronic subdural hematoma. We performed a burr hole opening surgery on the same day. Abscess and hematoma was aspirated from the subdural space, and methicillin-resistant Staphylococcus aureus(MRSA)was detected in this specimen. Thus the diagnosis of the infected subdural hematoma was confirmed. However, despite the antibiotics therapy, follow-up CT showed a low-density area close to the residual abscess, which suggested cerebral infarction. Cerebral angiography showed a vasospasm at the cortical segment of the right middle cerebral artery near the residual abscess. Eventually we carried out a small craniotomy to evacuate the abscess. Our case showed that prompt surgical treatment is required in case of ISH and the whole hematoma and abscess should be removed as soon as possible with an image diagnosis and an additional surgical operation.

Fujii N; Naito Y; Takanashi S; Ueno T; Nakagomi T

2013-05-01

178

Subdural hematoma associated with dural metastatic tumor  

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Two cases of subdural hematoma associated with dural metastasis are reported. The computed tomographic and angiographic features are presented. The possible pathogenetic mechanism is discussed. Our cases support the idea of obstruction of dural capillaries by neoplastic cells and subsequent subdural bleeding.

Vonofakos, D.; Marcu, H.; Zieger, A.

1980-12-01

179

Recovery of cerebral blood flow in unilateral chronic subdural hematoma. The correlation with cerebral re-expansion in elders  

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CT and SPECT were used to investigate the relationship between cerebral re-expansion and changes in cerebral blood flow underneath hematoma in elderly patients after surgery for chronic unilateral subdural hematoma. I studied 22 patients with mild hematoma, aged 43 to 82 years (mean 67 years). The patients were placed in either Group A (under 70 years) or Group B (70 years or over) to observe postoperative changes. CT and SPECT examinations were conducted before surgery and 1, 7 and 30 days after surgery, 4 times in total. Cerebral re-expansion was represented by the re-expansion rate (PER) comparing the pre- and postoperative thickness of the maximal hematoma in CT images. The rate of cerebral re-expansion was slowed in Group B (p<0.01). Cerebral re-expansion was characterized by biphasic, rapid or gradual re-expansion on postoperative day 1 with a significant difference between groups (p<0.01). Before surgery, cerebral blood flow on the affected side correlated with age (p<0.01), thougn blood flow was diminished in both groups. After surgery, cerebral blood flow on the affected side exceeded that on the unaffected side in Group A and transiently increased on postoperative day 1. Cerebral blood flow improved after surgery in both groups, with a significant difference in those changes over time (p<0.01). In both groups, cerebral re-expansion on postoperative days 7 and 30 correlated with cerebral blood flow on the affected side (p<0.05). The present results suggest that improvement in cerebral blood flow on the affected side is delayed in elderly patients, due to slower postoperative cerebral re-expansion. (author)

Nemoto, Akio [Toho Univ., Tokyo (Japan). School of Medicine

2003-01-01

180

Subdural Hematoma from a Cavernous Malformation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To present a case of a cavernous malformation presenting with a subdural hematoma. METHODS: A 27-year-old woman was admitted with progressive worse headache, vomiting, weakness, and difficulties in finding the correct words to speak 1 week after she was discharged from an outside hospital, where she was managed conservatively for a presumed traumatic subdural hematoma. Computed tomography revealed an enlarging subacute left hemispheric subdural hematoma for which she underwent drill craniostomy. Postprocedural magnetic resonance imaging showed a posterior left temporal lobe mass consistent with a cavernous malformation juxtaposed with the subdural hematoma. Craniotomy for resection of the lesion was performed. She had an uncomplicated postoperative course and experienced a good recovery. RESULTS: The signs and symptoms, diagnostic imaging, and intraoperative findings suggest that the subdural hematoma was caused by extralesional hemorrhage of the cavernous malformation, which is a rare finding associated with these malformations. CONCLUSION: The clinical course, radiologic, and intraoperative findings suggest that the subdural hemorrhage was caused by extralesional hemorrhage of the cavernous malformation.

Schmitt AJ; Mitha AP; Germain R; Eschbacher J; Spetzler RF

2013-01-01

 
 
 
 
181

[Effect of panax notoginseng powder on pathological features and expressions of VEGF and its receptors of chronic subdural hematoma rabbits: an experimental study].  

UK PubMed Central (United Kingdom)

OBJECTIVE: To observe the effect of Panax notoginseng (PN) on pathological features in chronic subdural hematoma (CSDH) rabbits and its mechanisms. METHODS: A stable pathological animal model similar to CSDH in humans could be established using subdural injections of small number of blood through a subdural pre-catheter in rabbits. After successful modeling, 18 rabbits were randomly divided into the model group, the low dose PN group (0.125 g/kg), and the high dose PN group (0.250 g/kg), 6 in each group. Normal saline was given to rabbits in the model group, while PN power was given to those in the PN groups by gastrogavage for 6 successive days. Pathologic features of the hematoma outer membrane were observed by HE staining. The activity of SOD and the content of MDA in the hematoma outer membrane were examined by the colorimetric method. Expressions of CD31, CD34, and VEGF in the hematoma outer membrane were observed by immunohistochemical assay. Expressions of VEGF in the peripheral blood and the subdural hematoma were detected by enzyme-linked immunosorbent assay (ELISA). Expressions of VEGFR-1 and VEGFR-2 in the hematoma outer membrane were detected by Western blot. RESULTS: Compared with the model group, the inflammatory reaction was comparatively lessen and the proliferation of the fibrous tissue was relatively mature in the low and high dose PN groups. The activity of SOD increased (P < 0.05); expressions of CD31 and CD34 were reduced (P < 0.01); VEGF expression in the residual hematoma fluid decreased (P < 0.05) in the high dose PN group. Expressions of VEGF and VEGFR-2 were all reduced in the high and low dose PN groups (P < 0. 05, P < 0.01). Compared with the low dose PN group, expressions of CD31 and CD34 were reduced (P < 0.01), and the VEGFR-2 expression was also reduced (P < 0.05) in the high dose PN group. CONCLUSIONS: PN could promote the fibrous repairing of subdural hematoma in CSDH rabbits. It also lessened inflammation and oxidative injury of the hematoma outer membrane and reduced expressions of VEGF. The pathological angiogenesis could be reduced through influencing VEGFR-2 receptor pathways, which might be an important mechanism.

Liu JH; Xing HT; Wang YF; Luan HY; Yang M

2013-07-01

182

Procollagen propeptides in chronic subdural hematoma reveal sustained dural collagen synthesis after head injury.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To study the hypothesis that concentrations of procollagen propeptides of type I and III collagens (PICP and PIIINP, respectively) and the carboxyterminal telopeptide of type I collagen (ICTP) in subdural haematoma increase in a time-dependent manner as a sign of dural collagen synthesis after head injury. METHODS: Thirty-six patients with subdural haematoma were operated. Subdural haematoma fluid samples were assayed for the concentrations of PICP, PIIINP and ICTP by specific radioimmunoassays. RESULTS: High concentrations of PICP, PIIINP and ICTP were found in subdural haematoma. The mean concentration of PICP in the 36 subdural haematoma samples was 11.8 (SD 9.27) mg/l, the concentration of PIIINP 590 (SD 302) microg/l and that of ICTP 32.0 (SD 12.1) microg/l. The time elapsed from the alleged head injury to operation could be defined in 30 patients. The concentrations of PICP, PIIINP and ICTP in subdural haematoma increased rapidly during the first two weeks after head injury and then stayed high for at least three months. CONCLUSIONS: High concentrations of procollagen propeptides were found in subdural haematoma samples of different haematoma age. Concentrations of these propeptides seem to follow a time-dependent course. The elevation of the concentrations of procollagen propeptides in subdural haematoma may be regarded as a sign of sustained dural collagen synthesis after head injury.

Heula AL; Sajanti J; Majamaa K

2009-01-01

183

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports  

International Nuclear Information System (INIS)

[en] 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

2009-01-01

184

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports  

Energy Technology Data Exchange (ETDEWEB)

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.

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

2009-02-15

185

Subdural hematoma in regularly hemodialyzed patients.  

UK PubMed Central (United Kingdom)

Thirteen of 394 (3.3%) regularly dialyzed patients of the Regional Kidney Disease Program developed subdural hematoma. The following factors contributed to formation of subdural hematoma: head trauma, ultrafiltration to control excessive accumulation of fluid and hypertension, anticoagulants, and frequent vascular access infection and clotting. Neurologic symptoms and signs, which may be similar to dialysis disequilibrium, aid only in signifying the presence, not the ultimate localization, of subdural hematoma. Our experience underscores the frequency of bilateral disease, irrespective of neurologic findings. Skull films, lumbar puncture, and electroencephalography were of little diagnostic help. Although valuable and safe, brain scanning was not as useful as desired due to occurrences of false-negative studies and failure to identify bilaterality of lesions. Cerebral angiography was always diagnostic. Surgical intervention yielded disappointing results, and only 2 patients (15%) survived. A review of 9 other patient reports is included.

Leonard A; Shapiro FL

1975-05-01

186

Subdural hematoma in regularly hemodialyzed patients.  

Science.gov (United States)

Thirteen of 394 (3.3%) regularly dialyzed patients of the Regional Kidney Disease Program developed subdural hematoma. The following factors contributed to formation of subdural hematoma: head trauma, ultrafiltration to control excessive accumulation of fluid and hypertension, anticoagulants, and frequent vascular access infection and clotting. Neurologic symptoms and signs, which may be similar to dialysis disequilibrium, aid only in signifying the presence, not the ultimate localization, of subdural hematoma. Our experience underscores the frequency of bilateral disease, irrespective of neurologic findings. Skull films, lumbar puncture, and electroencephalography were of little diagnostic help. Although valuable and safe, brain scanning was not as useful as desired due to occurrences of false-negative studies and failure to identify bilaterality of lesions. Cerebral angiography was always diagnostic. Surgical intervention yielded disappointing results, and only 2 patients (15%) survived. A review of 9 other patient reports is included. PMID:1094874

Leonard, A; Shapiro, F L

1975-05-01

187

Bilateral subdural hematomas after lumboperitoneal shunt placement.  

UK PubMed Central (United Kingdom)

BACKGROUND: Lumboperitoneal shunts are commonly placed as treatment for a variety of conditions, and complications can be significant. OBJECTIVES: We discuss a rare complication of these shunts, namely bilateral non-traumatic subdural hematoma formation. CASE REPORT: A patient with a normal neurologic examination but severe nausea, weight loss, and dehydration presented 2 weeks after lumboperitoneal shunt placement for cryptococcal meningitis, and was found to have bilateral subdural hematomas. CONCLUSIONS: Physicians should be aware of this potentially devastating complication of shunt placement so that prompt and appropriate treatment can be initiated.

Barash IA; Medak AJ

2013-08-01

188

Antiplatelet/Anticoagulant Agents and Chronic Subdural Hematoma in the Elderly  

Science.gov (United States)

Background and Purpose In the last decade there has been an increasing use of antiplatelet/anticoagulant agents in the elderly. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma-CSDH. Methods Single institution case-control study involving 138786 patients older than 60 years who visited our academic tertiary care Emergency Department from January 1st 2001 to December 31st 2010. 345 patients with CSDH (cases) were identified by review of ICD-9 codes 432.1 and 852.2x. Case and controls were matched with a 1?3 ratio for gender, age (±5 years), year of admission and recent trauma. A conditional logistic model was built. A stratified analysis was performed with respect to the presence (842 patients) or absence (536 patients) of recent trauma. Results There were 345 cases and 1035 controls. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 2.46 (CI 95% 1.66–3.64) and 1.42 (CI 95% 1.07–1.89), respectively. OR was 2.70 (CI 95% 1.75–4.15), 1.90 (CI 95% 1.13–3.20), and 1.37(CI 95% 0.99–1.90) for patients receiving oral anticoagulants, ADP-antagonists, or Cox-inhibitors, respectively. History of recent trauma was an effect modifier of the association between anticoagulants and CSDH, with an OR 1.71 (CI 95% 0.99–2.96) for patients with history of trauma and 4.30 (CI 95% 2.23–8.32) for patients without history of trauma. Conclusions Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association, for patients under anticoagulant therapy, appears even stronger in those patients who develop a CSDH in the absence of a recent trauma.

de Waure, Chiara; Sferrazza, Antonella; Volpe, Massimo; Pompucci, Angelo; Anile, Carmelo; Mangiola, Annunziato

2013-01-01

189

Treatment of irrigation through burr hole with siphonage drainage for chronic subdural hematoma: a report of 139 cases  

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Full Text Available Objective To investigate the effect of irrigation through burr hole with siphonage drainage on chronic subdural hematoma(CSDH).Methods The clinical data of 139 patients with CSDH(89 males and 50 females,aged from 48 to 87 with mean of 66.4 years) hospitalized from Jan.2006 to Dec.2010 were retrospectively reviewed.All the patients were finally diagnosed by radiology,and divided into 3 groups according to the operative method,i.e.parietal burr hole irrigation with drainage group(group A,n=47),parietal burr hole irrigation and aspiration group(group B,n=41),and frontal burr hole irrigation with siphonage drainage group(group C,n=51).All the patients were treated with closed drainage for 2-6 days.The activity of daily living(ADL) scores was measured before and 7 days after operation in all patients.The patients were followed-up for 12-36 months to observe the treatment results.Results No death occurred in the 3 groups during the follow-up period.The improvement of ADL was markedly better in group C than in group B(P 0.05).Conclusion The frontal burr hole irrigation with siphonage drainage has a definite treatment effect for CSDH with a low recurrence rate and less complications,and is appropriate to use in most of CSDH patients.

She-peng WEI; Ji-zong ZHAO; Fan-min ZHOU; Kan DING; Wei-feng ZHANG; Yan-fei ZHANG; Cheng YANG; Liang WEI; Kui-ming ZHANG; Zhi-yang SUN

2011-01-01

190

Diplopia from Subacute Bilateral Subdural Hematoma after Spinal Anesthesia  

Directory of Open Access Journals (Sweden)

Full Text Available Subdural hematoma (SDH) is a rare, but life-threatening complication of spinal anesthesia. Subdural hematoma resulting from this procedure could present with vague symptoms such as chronic headache and could easily be missed. Chronic headache is one of the symptoms of chronic SDH in postpartum women. Diplopia as the presenting complaint in SDH secondary to peripartum spinal anesthesia has not, to our knowledge, been previously reported. Here, we report a case of diplopia secondary to postpartum subacute bilateral SDHs with transtentorial herniation after spinal anesthesia in a healthy primagravid 25-year-old woman. SDH can expand gradually and the initial symptoms might be subtle as in our case, despite critically high intracranial pressure. [West J Emerg Med. 2012;13(1):108–110.

Getaw Worku Hassen; Hossein Kalantari

2012-01-01

191

Brain herniation induced by drainage of subdural hematoma in spontaneous intracranial hypotension.  

UK PubMed Central (United Kingdom)

Spontaneous intracranial hypotension (SIH), typically presents with orthostatic headache, low pressure on lumbar tapping, and diffuse pachymeningeal enhancement on magnetic resonance imaging. SIH is often accompanied by subdural fluid collections, which in most cases responds to conservative treatment or spinal epidural blood patch. Several authors advocate that large subdural hematoma with acute deterioration merits surgical drainage; however, few have reported complications following craniotomy. We describe a complicated case of SIH, which was initially diagnosed as acute subarachnoid hemorrhage with bilateral chronic subdural hematoma (SDH), due to unusual presentation. Burr hole drainage of subdural hematoma was performed due to progressive decrease of consciousness, which then resulted in a huge postoperative epidural hematoma collection. Prompt hematoma evacuation did not restore the patient's consciousness but aggravated downward brain herniation. Trendelenburg position and spinal epidural blood patch achieved a rapid improvement in patient's consciousness. This case indicates that the surgical drainage for chronic SDH in SIH can lead to serious complications and it should be cautiously considered.

Chotai S; Kim JH; Kim JH; Kwon TH

2013-04-01

192

A case with Parkinsonism secondary to bilateral subdural hematoma  

Directory of Open Access Journals (Sweden)

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.

Adalet Ar?kano?lu; Remziye Hünkar; Kadir Ç?nar

2011-01-01

193

A chronic subdural hematoma in a patient receiving combination therapy with pegylated interferon alfa-2b and ribavirin for chronic hepatitis C.  

UK PubMed Central (United Kingdom)

A 70-year-old man who suffered from chronic hepatitis C was infected with HCV genotype 1 and exhibited a high viral load. He had hypertension and had consumed the equivalent of 50 g of ethanol per day. He was treated with pegylated interferon and ribavirin. After 51 weeks, he developed an unsteady gait while walking and demonstrated Barre's sign on the right foot and a headache. Contrast computed tomography showed a subdural hematoma with a mass effect. The patient was treated with drainage and aspiration surgery via a burr hole. Following the drainage procedure, there were no neurological sequelae. Treatment with pegylated interferon and ribavirin was discontinued. Fortunately, a sustained virological response was achieved.

Goto T; Ohshima S; Miura K; Shibuya T; Sato W; Dohmen T; Kamada K; Kanata R; Sakai T; Chiba M; Sugimoto Y; Minami S; Ohnishi H

2013-01-01

194

CT findings in a case of neonatal acute subdural hematoma  

International Nuclear Information System (INIS)

[en] The CT findings in a case of neonatal accute subdural hematoma are presented. CT demonstrated a crescentic high density area in the subdural space over the left cerebral hemisphere and an oval high density area in the left occipital region. The latter was suspected of being an intracerebral hematoma. Emergency craniotomy revealed that the high density area was due to a subdural hematoma between the occipital lobe and the tentorium cerebelli. (orig.)

1981-01-01

195

CT findings in a case of neonatal acute subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

The CT findings in a case of neonatal acute subdural hematoma are presented. CT demonstrated a crescentic high density area in the subdural space over the left cerebral hemisphere and an oval high density area in the left occipital region. The latter was suspected of being an intracerebral hematoma. Emergency craniotomy revealed that the high density area was due to a subdural hematoma between the occipital lobe and the tentorium cerebelli.

Koshu, K.; Horie, Y.; Hirashima, Y.; Endo, S.; Takaku, A.

1981-06-01

196

Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage  

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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.

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

1984-06-01

197

Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage  

International Nuclear Information System (INIS)

[en] 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)

1984-01-01

198

[Postspinal subacut subdural hematoma: case report].  

UK PubMed Central (United Kingdom)

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

Do?anay F; Pirbudak L; Gül R; Alptekin M; Kaplan N

2013-07-01

199

Follow up study and interested cases in subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

Out of 67 patients ranging from 16 to 82 years old, 20 were followed up by CT scan after operation. Five patients presented hematoma on the both sides after operation, though they had suffered from the lesion of one side before operation. In four patients, hematoma was observed on the both sides before and after operation. Neither preoperative involved side changed nor hematoma apeared on the opposite side after operation in 11 patients. Follow-up examinations lasted almost three months. The maximum width of the subdural space was divided by the maximum intracranial width. These two factors were measured on horizontal CT scan. The calculated value was expressed in percentage and then the result was regarded as subdural Space (SDS) Index. Dividing a difference between the largest SDS Index (before operation) and the smallest by the number of days between the two points gave us a reduction rate of SDS Index. As a result, a reduction rate of 0.4 or less was obtained in all the patients less than 65 years old. There were three patients within the range from 0.7 to 1.0 of the rate. 76-year-old patients showed 2.6 and 5.7. Except the 76-old patients, mean duration of 35.5 days was calculated in Group I and SDS Index was 0, while Group II showed mean duration of 52.4 days, resulting in SDS Index of 0. 4. Specific progresses are shown below: 1) hemorrhage of the caudate nucleus after operation; 2) subdural effusion of the both sides; 3) appearance of abscess; 4) subtentrial hemorrhage after operation; 5) postoperative epidural hematoma; and 6) traumatic intracerebral hemorrhage, resulting in chronic subdural hematoma six months afterward.

Kano, Mitsumasa; Goh, Jyunto; Koomura, Eiji; Nakao, Kazutami (Osaka Rosai Byoin, Sakai (Japan))

1983-01-01

200

Follow up study and interested cases in subdural hematoma  

International Nuclear Information System (INIS)

[en] 1. Out of 67 patients ranging from 16 to 82 years old, 20 were followed up by CT scan after operation. 2. Five patients presented hematoma on the both sides after operation, though they had suffered from the lesion of one side before operation. In four patients, hematoma was observed on the both sides before and after operation. Neither preoperative involved side changed nor hematoma appeared on the opposite side after operation in 11 patients. Follow-up examinations lasted up almost three months. 3. The maximum width of the subdural space was divided by the maximum intracranial width. These two factors were measured on horizontal CT scan. The calculated value was expressed in percentage and then, the result was regarded as Subdural Space (SDS) Index. Dividing a difference between the largest SDS Index (before operation) and the smallest by the number of days between the two points gave us a reduction rate of SDS Index. As a result, a reduction rate of 0.4 or less was obtained in all the patients less than 65 years old. There were three patients within the range from 0.7 to 1.0 of the rate. 76-year-old patients showed 2.6 and 5.7. Except the 76-old patients, mean duration of 35.5 days was calculated in Group I and SDS Index was 0, while Group II showed mean duration of 52.4 days, resulting in SDS Index of 0. 4. Specific progresses are shown below: 1) Hemorrhage of the caudate nucleus after operation 2) Subdural effusion of the both sides 3) Appearance of abscess 4) Subtentrial hemorrhage after operation 5) Postoperative epidural hematoma 6) Traumatic intracerebral hemorrhage, resulting in chronic subdural hematoma six months afterward (author)

1983-01-01

 
 
 
 
201

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

Science.gov (United States)

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

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

2005-12-01

202

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

UK PubMed Central (United Kingdom)

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

Hirashima Y; Kurimoto M; Nagai S; Hori E; Origasa H; Endo S

2005-12-01

203

Acute subdural hematoma caused by clopidrogel  

Directory of Open Access Journals (Sweden)

Full Text Available Clopidogrel, is a potent oral antiplatelet agent often used in the treatment of coronary artery disease, peripheral vascular disease, and cerebrovascular disease. Clopidrogel a thienopyridine deritivate, selectively inhibits the binding to adenosine diphosphate, thereby inhibiting platelet aggregation. It thus reduces the formation of arterial and venous thrombi. Reported side effects of clopidrogel include gastrointestinal symptoms of nausea, stomach ache, diarrhea, and constipation. Serious side effects consist of an increased risk of bleeding, intracranial hemorrhage, and severe neutropenia. A 75-year-old man with syncope was admitted to cardiology clinic. The patient had undergone two vessel angioplasty 15 years earlier. Furthermore, the patient had undergone placement of coronary artery stent 3 months earlier. His daily prescription contained clopidrogel 75 mg for the past 3 years. Fourteen hours after admittance to the cardiology clinic, the patient experienced a blackout. A computed tomography of the brain revealed acute subdural hematoma of the right frontoparietal region with 1.5 cm midline shift. The patient subsequently underwent right frontoparietal craniotomy with drainage of the subdural hematoma. Unfortunately, the patient died on the postoperative eleventh day.

Nail OZDEMIR; Murat YILDIRIM; Kaan ALTINKAYA

2010-01-01

204

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 e (more) stado 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 prosthesis under warfarin treat­ment, presenting severe and progressive headache associated with altered level of consciousness and seizures. Laboratory studies revealed a hig (more) h 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.

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

2011-06-01

205

The outcome of the acute subdural hematoma  

International Nuclear Information System (INIS)

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

1984-01-01

206

Dynamic CT in the acute subdural hematoma  

International Nuclear Information System (INIS)

[en] Dynamic computed tomography (CT) was performed on thirteen patients with acute sudbural hematoma with and without diffuse cerebral swelling. The cause of the diffuse cerebral swelling accompanying the acute subdural hematoma is discussed in this paper. Patients were classified into two groups according to the Glasgow Coma Scale (GCS). Eight patients with a severe neurological state were judged to have GCS values of approximately 3-6 and to have diffuse cerebral swelling on the initial CT scan. All 8 patients had been rendered unconsciousness at the moment of injury and remained so until death. Five patients were judged to have moderate neurological states (GCS 9-13), and only two of these patients had mild cerebral swelling. The diagnosis of the diffuse cerebral swelling was made by means of the CT scan. The criteria are a marked increase in brain volume and a marked reduction in the size of the ventricular shadow and the basal cistern, or their absence. The dynamic CT of the brain consists of performing eight rapid serial scans after the bolus intravenous injection of 50 ml of a contrast material. The data from these scans were analyzed by means of the time-density curves of various brain regions. In 7 out of the 8 patients with diffuse cerebral swelling, the time-density curves of the cerebral hemisphere of the lesional side were always lower than those on the opposite side, and in 3 of these patients, the time-density curves of the lesional side were flat. However, in 1 patient with diffuse cerebral swelling and in 5 patients without diffuse cerebral swelling, the time-density curves of the cerebral hemisphere had obvious peaks and the curve of the lesional side was nearly identical with that of the opposite side. In 5 patients out of the 8 with severe acute subdural hematoma with diffuse cerebral swelling, the peak of the gray matter of the lesional side was not observed. (J.P.N.)

1983-01-01

207

[Intracranial granuloma as a late complication of subdural hematoma  

UK PubMed Central (United Kingdom)

Complications during subdural hematoma treatment are rare and usually occur soon after its evacuation. We present the clinicopathological and radiological findings of a granuloma that happened as late effect of the drainage of a subdural hematoma (1 year after). The presence of bone wax around the tumor and the finding of empty spaces intracytoplasmatic and extracellular surrounded by inflammatory cells suggest that the bone wax was the cause of the granulomatous process.

Lainez JM; Fontana F; del Rosario Martín M; Sancho J; Barcia C

1989-03-01

208

Wegener's granulomatosis with subdural hematoma as the initial manifestation  

Science.gov (United States)

Wegener's granulomatosis (WG) is a systemic vasculitis, which can involve any organ system in the body; however, involvement of central nervous system at presentation is very uncommon. Dural involvement in WG has been infrequently reported; however, presentation with subdural hematoma as the initial manifestation is extremely rare. We present a case of WG presenting as subdural hematoma, which resolved on cytotoxic therapy without surgical evacuation.

Kalra, Sarathi; Yadav, Anil; Agarwal, Sunil; Kumar, Sunil

2013-01-01

209

Relations among traumatic subdural lesions.  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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...

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

210

Hematoma subdural crónico: Modalidades de tratamiento revisión del tema. Propuestas de manejo  

Directory of Open Access Journals (Sweden)

Full Text Available El hematoma subdural crónico constituye una entidad nosológica frecuente en la práctica neuroquirúrgica, existiendo múltiples modalidades de tratamiento propuestas con resultados muy diversos. Se hizo una revisión de varios de los aspectos del tratamiento de estos pacientes para intentar formular recomendaciones generales de manejo de acuerdo a los trabajos científicos publicados y a la experiencia de los autores. Se plantea un tratamiento basado en la fisiopatología del hematoma subdural crónico y su correspondiente traducción imagenológica.Chronic Subdural Haematoma is a frequent neurosurgical con-dition, with multple treatment modalities and diverse results. The authors have made a review of various aspects of treatment in these patients aiming to establish general recommendations, based on the scientific publications and their own experience. The proposed treatment is based on the physiopatology of the Chronic Subdural Haematoma and the images pattern.

Marcelo Algorta; Edgardo Spagnuolo

2010-01-01

211

Hematoma subdural crónico: Modalidades de tratamiento revisión del tema. Propuestas de manejo  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El hematoma subdural crónico constituye una entidad nosológica frecuente en la práctica neuroquirúrgica, existiendo múltiples modalidades de tratamiento propuestas con resultados muy diversos. Se hizo una revisión de varios de los aspectos del tratamiento de estos pacientes para intentar formular recomendaciones generales de manejo de acuerdo a los trabajos científicos publicados y a la experiencia de los autores. Se plantea un tratamiento basado en la fisiopatología del hematoma subdural crónico y su correspondiente traducción imagenológica. Abstract in english Chronic Subdural Haematoma is a frequent neurosurgical con-dition, with multple treatment modalities and diverse results. The authors have made a review of various aspects of treatment in these patients aiming to establish general recommendations, based on the scientific publications and their own experience. The proposed treatment is based on the physiopatology of the Chronic Subdural Haematoma and the images pattern.

Algorta, Marcelo; Spagnuolo, Edgardo

2010-12-01

212

Interhemispheric subdural hematoma: An uncommon sequel of trauma  

Directory of Open Access Journals (Sweden)

Full Text Available Interhemispheric subdural hematomas are relatively uncommon and usually seen in patients with bleeding disorders. They may present with signs of the falx syndrome or seizures. The management options range from craniotomy and evacuation to conservative management. We report such a case in a patient with normal bleeding parameters, which was managed with a twist drill craniostomy and drainage of the hematoma.

Shankar A; Joseph M; Chandy M

2003-01-01

213

Spontaneous subdural hematoma in a young adult with hemophilia  

Directory of Open Access Journals (Sweden)

Full Text Available We report a case of spontaneous acute subdural hematoma in a 30-year-old man, who was diagnosed with hemophilia during his hospital stay. He developed an extradural hematoma following evacuation of the acute SDH, which was also evacuated. He had a good outcome. Management of such a patient is discussed.

Agrawal D; Mahapatra A

2003-01-01

214

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies  

International Nuclear Information System (INIS)

[en] CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Ot the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hermorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully. (orig.)

1996-01-01

215

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies  

Energy Technology Data Exchange (ETDEWEB)

CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Ot the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hermorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully. (orig.)

Ochi, M. [Dept. of Radiology, Nagasaki Univ. School of Medicine, (Japan); Morikawa, M. [Dept. of Radiology, Nagasaki Univ. School of Medicine, (Japan)]|[Dept. of Radiology, National Nagasaki Chuo Hospital, Ohmura (Japan); Ogino, A. [Dept. of Radiology, Nagasaki Univ. School of Medicine, (Japan); Nagaoki, K. [Dept. of Radiology, Nagasaki Univ. School of Medicine, (Japan)]|[Dept. of Radiology, Isahaya General Hospital (Japan); Hayashi, K. [Dept. of Radiology, Nagasaki Univ. School of Medicine, (Japan)

1996-10-01

216

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 en 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.

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

2005-08-01

217

Slippery platelet syndromes in subdural hematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: This study investigates platelet dysfunction in patients with subdural hematomas (SDH) using platelet function analysis (PFA). METHODS: PFA using the PFA-100 (Dade International Inc., Miami, FL) was performed at admission using the collagen-epinephrine and collagen-ADP assays in 58 SDH patients. Clinical and radiologic information was collected. RESULTS: Normal PFA results were present in 36 patients (62%; PFA collagen:epinephrine assay (s) 118 ave; PFA collagen:adenosine diphosphate assay (s) ave 75) and abnormal platelet function in 22 patients (38%; PFA collagen:epinephrine assay (s) 231 average; PFA collagen:adenosine diphosphate assay (s) 124 average). Compared to patients with normal PFA results, patients with abnormal PFA results were more likely to have hypertension (22 vs. 55%; P = 0.01), take clopidogrel (3 vs. 32%; P = 0.001), and use anti-platelet medications and non-steroidal anti-inflammatory agents (22 vs. 59%; P = 0.004). Measurements of baseline CT for midline shift, maximum thickness, presence of blood/fluid levels in the hematoma, and presence of additional sites of intracranial bleeding did not reveal significant differences based on PFA testing. Platelet dysfunction improved after platelet transfusions (PFA collagen:epinephrine assay: baseline 270 s, CI 61 s; after transfusion 124 s, CI 50 s, P < 0.001). CONCLUSION: Platelet dysfunction was found in 38% of SDH patients. This finding adds to our understanding of the pathophysiology of SDH. Since platelet transfusions are indicated for platelet dysfunction accompanied by major bleeding or need for surgery, these results impact peri-operative management.

Akins PT; Guppy KH; Sahrakar K; Hawk MW

2010-06-01

218

Rapid spontaneous resolution of an acute subdural hematoma: Case report  

Energy Technology Data Exchange (ETDEWEB)

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.

Bae, Won Kyong; Kim, Pyo Nyun; Kim, Il Young; Lee, Byoung Ho; Lee, Kyeong Seok; Bae, Hack Gun; Yun, Il Gyu [Soonchunhyang University, Chonan Hospital, Chonan (Korea, Republic of)

1989-10-15

219

Rapid spontaneous resolution of an acute subdural hematoma: Case report  

International Nuclear Information System (INIS)

[en] 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

1989-01-01

220

An Atropa belladonna L. poisoning with acute subdural hematoma.  

Science.gov (United States)

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

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

2011-05-03

 
 
 
 
221

Magnetic resonance maging of epidural and subdural spinal hematomas  

International Nuclear Information System (INIS)

[en] Epidural und subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MR) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD-and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n=2), thoracic spine (n=6) and lumbar spine (n=2). They were epidural in five patients and subdural in four. Blinded reading correctly indentified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas ([de] Epidurale und subdurale spinale Haematome sind neurochirurgische Notfaelle, deren Diagnose bisher vorwiegend mittels Myelographie und Computertomographie gestellt wurde. Wir berichten ueber 9 Patienten, die primaer magnetresonanztomographisch diagnostiziert wurden. Bei allen Patienten wurden T1, Spindichte und T2-gewichtete Bilder erzeugt. Zusaetzlich wurden T2*-gewichtete Gradientenechosequenzen angewendet. Die Magnetresonanztomographien wurden mit dem intraoperativen Situs korreliert. Computertomographische Befunde waren bei 4 und myelographische Befunde waren bei 2 Patienten vorhanden. Die Haematome komprimierten in 2 Faellen das Zervikalmark, bei 6 Patienten das Thorakalmark und bei 2 Patienten Konus und Cauda. Die Magnetresonanztomographie ergab 6 epidurale und 3 subdurale Haematome, operativ handelte es sich um 5 epidural und 4 subdurale Blutungen. In einem Fall konnte die Kernspintomographie nicht zwischen epi- und subduraler Lokalisation unterscheiden. Perakute Haematome (

1994-01-01

222

Contralateral acute subdural hematoma after surgical evacuation of the initial hematoma: two case reports and review of the literature.  

UK PubMed Central (United Kingdom)

Remote intracranial hemorrhages after craniotomy or craniectomy may rarely develop. As the sparse literature on this phenomenon has focused on contralateral intraparenchymal and epidural clots, only seven cases of postoperative contralateral acute subdural hematomas have been reported in the literature. We presented two patients who developed contralateral acute subdural hematomas after surgical evacuation of their initial hematomas. Case 1: A 19-year-old male fell from a height. CT scan revealed a left parietal acute epidural hematoma. A left craniotomy and epidural hematoma evacuation were performed; however, the brain expanded towards the craniotomy site. Dural incision revealed a thick subdural hematoma. Evacuation of the subdural hematoma was performed. The bone flap was not replaced. An emergency CT scan revealed a right acute subdural hematoma, and a right decompressive craniectomy and hematoma evacuation were performed. Case 2: A 7-year-old boy was hit by a motor vehicle. CT scan revealed a right frontotemporal acute subdural hematoma. A right decompressive craniectomy and subdural hematoma evacuation were performed; however, the brain expanded towards the craniectomy site. An emergency CT scan revealed a left acute subdural hematoma. We also reviewed the literature and discussed about these characteristics.

Takeuchi S; Takasato Y

2013-01-01

223

[An operated case of a meningioma causing acute subdural hematoma].  

Science.gov (United States)

We report a rare case of a meningioma causing acute hematoma. A 67-year-old woman presented with sudden headache. No evidence of trauma was seen. CT demonstrated a subdural hematoma in the convexity of the fronto-temporal lobe. Magnetic resonance imaging showed marked signal heterogeneity in the convexity of the frontal lobe. One week later, the patient underwent hematoma evacuation and tumor resection including the attached dura mater. The histological diagnosis was meningothelial meningioma. The clot was connected directly to the tumor and the origin of the subdural hematoma was identified as the meningioma. Postoperative course was uneventful, and the headache improved. Meningiomas have a relatively benign course but rarely present with hemorrhage. Surgical exploration is the effective and recommended treatment. PMID:23459521

Chonan, Masashi; Niizuma, Kuniyasu; Koyama, Shinya; Kon, Hiroyuki; Sannohe, Seiya; Kurotaki, Hidekachi; Midorikawa, Hiroshi; Sasaki, Tatsuya; Nishijima, Michiharu

2013-03-01

224

Subdural Hematoma in Grave’s Disease Induced Thrombocytopenia.  

Directory of Open Access Journals (Sweden)

Full Text Available Subdural hematoma (SDH) usually occurs secondary to trauma, in bleeding disorders it may occur spontaneously. It is a rare complication of immune thrombocytopenia. Here we report a case of 45 years female presenting with presenting with complaints of headache, palpitation and menorrhagia and later diagnosed to be a case of Grave's disease with thrombocytopenia with sub dural hematoma. No such case reports are available in literature.

Sunil Kumar; Sanjay Diwan; Shailee Chandek; Pratik Nitey; Anand Kakani

2013-01-01

225

Hematoma subdural crónico: Resultados quirúrgicos en 2 años de trabajo  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Disminuir al máximo la mortalidad por hematoma subdural crónico (HSDC), es un reto que se debe alcanzar en todo centro neuroquirúrgico, en el que pueden influir el diagnóstico precoz y la adecuada selección del proceder quirúrgico. Se presentan 20 pacientes, 16 masculinos (80 %) y 4 femeninos (20 %), con una edad promedio para el grupo de 66,55 años, tratados quirúrgicamente por medio de la trepanación múltiple con lavado de la cavidad y drenaje cerrado al exter (more) ior. La angiografía carotídea constituyó el examen más utilizado para el diagnóstico 14 (70 %), seguida por la tomografía axial computadorizada (TAC) 8 (40 %). La escala de Bender se empleó para clasificar a los enfermos según el estado neurológico al ingreso, y se halló que el 80 % estaba en los grados I y II. Los resultados se evaluaron según la escala de resultados de Glasgow, y presentaron 17 (85 %), una buena recuperación Abstract in english To reduce as much as possible mortality from chronic subdural hematoma (CSDH) is a goal that should be attained by every neurosurgical center. An early diagnosis and an adequate selection of the surgical procedure may influence on it. 20 patients, 16 males (80 %) and 4 females (20 %) with an average age by group of 66.55 years of age were surgically treated by multiple trephining with lavage of the cavity and closed drainage. The carotid angiography was the most used test (more) for the diagnosis with 14 (70 %), followed by computerized axial tomography (CAT) with 8 (40 %). Bender´s scale was utilized to classify the patients according to the neurological state at the time of admission . 80 % of them corresponded to degrees I and II. The results were evaluated by using the Glasgow´s scale. 17 (85 %) had a good recovery

Lacerda Gallardo, Ángel Jesús; Estenoz Esquivel, Juan Carlos; Borroto Pacheco, Rigoberto

1999-04-01

226

Hematoma subdural crónico: Resultados quirúrgicos en 2 años de trabajo  

Directory of Open Access Journals (Sweden)

Full Text Available Disminuir al máximo la mortalidad por hematoma subdural crónico (HSDC), es un reto que se debe alcanzar en todo centro neuroquirúrgico, en el que pueden influir el diagnóstico precoz y la adecuada selección del proceder quirúrgico. Se presentan 20 pacientes, 16 masculinos (80 %) y 4 femeninos (20 %), con una edad promedio para el grupo de 66,55 años, tratados quirúrgicamente por medio de la trepanación múltiple con lavado de la cavidad y drenaje cerrado al exterior. La angiografía carotídea constituyó el examen más utilizado para el diagnóstico 14 (70 %), seguida por la tomografía axial computadorizada (TAC) 8 (40 %). La escala de Bender se empleó para clasificar a los enfermos según el estado neurológico al ingreso, y se halló que el 80 % estaba en los grados I y II. Los resultados se evaluaron según la escala de resultados de Glasgow, y presentaron 17 (85 %), una buena recuperaciónTo reduce as much as possible mortality from chronic subdural hematoma (CSDH) is a goal that should be attained by every neurosurgical center. An early diagnosis and an adequate selection of the surgical procedure may influence on it. 20 patients, 16 males (80 %) and 4 females (20 %) with an average age by group of 66.55 years of age were surgically treated by multiple trephining with lavage of the cavity and closed drainage. The carotid angiography was the most used test for the diagnosis with 14 (70 %), followed by computerized axial tomography (CAT) with 8 (40 %). Bender´s scale was utilized to classify the patients according to the neurological state at the time of admission . 80 % of them corresponded to degrees I and II. The results were evaluated by using the Glasgow´s scale. 17 (85 %) had a good recovery

Ángel Jesús Lacerda Gallardo; Juan Carlos Estenoz Esquivel; Rigoberto Borroto Pacheco

1999-01-01

227

Pupillary sparing oculomotor palsy from acute subdural hematoma.  

Science.gov (United States)

An acute subdural hematoma presented as a partial third nerve palsy with complete pupillary sparing. The patient was alert and oriented, and except for a subtle hemisensory hypalgesia, there were no other neurologic signs. Preoperative diagnosis was made by CT scan and cerebral angiography. The patient underwent successful craniotomy and within six weeks after surgery, her third nerve palsy had completely resolved. PMID:6721349

Kavieff, R D; Miller, J A; Klepach, G L

1984-04-01

228

Pupillary sparing oculomotor palsy from acute subdural hematoma.  

UK PubMed Central (United Kingdom)

An acute subdural hematoma presented as a partial third nerve palsy with complete pupillary sparing. The patient was alert and oriented, and except for a subtle hemisensory hypalgesia, there were no other neurologic signs. Preoperative diagnosis was made by CT scan and cerebral angiography. The patient underwent successful craniotomy and within six weeks after surgery, her third nerve palsy had completely resolved.

Kavieff RD; Miller JA; Klepach GL

1984-04-01

229

Two cases of subdural hematoma with niveau formation on CT. A study of the cause of niveau formation  

Energy Technology Data Exchange (ETDEWEB)

The authors report a case of a bilateral chronic subdural hematoma with niveau formation and another rare case of an acute subdural hematoma with niveau formation on plain CT. The different mechanisms of the niveau formation in these cases are speculated about. The first case was a 75-year-old male who showed a drowsy state, urinary incontinence, and muscle weakness of the bilateral lower limbs. No definite history of head trauma could be found. A plain CT scan showed a bilateral-crescent type fluid collection with niveau formation, consisting of a low-density area in the upper part and a high-density area in the lower part. An operation showed bilateral, moderately encapsulated subdural hematomas; they were evacuated. The second case was a 61-year-old male with head trauma due to a fall from a ladder. On admission, neurological examination revealed a decerebrate posture, a deep coma, and anisocoria. A plain CT scan twenty hours after the onset showed a crescent-type fluid collection with niveau formation in the left fronto-parietal region. The operation showed an acute subdural hematoma containing xanthochromic fluid and coagulated blood. No capsule of hematoma could be seen. The incidence of niveau formation in chronic subdural hematomas is not low (5 - 20%); such niveau formation is thought to be caused by rebleeding into the hematoma and the spending of considerable time in the supine position. On the other hand, no case of an acute subdural hematoma with niveau formation has previously been reported. With regard to this mechanism of niveau formation, we speculate that the hematoma is mixed with cerebrospinal fluid from the arachnoidal tear caused by the head trauma; also, a considerable time in the supine position is necessary.

Shimizu, Satoshi; Fukuda, Atsuhiro; Sato, Masaharu; Kohama, Akitsugu (Kawasaki Medical School, Kurashiki, Okayama (Japan))

1984-04-01

230

Chronic subdural haematoma preceded by persistent traumatic subdural fluid collection.  

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The role of traumatic subdural fluid collections in the development of chronic subdural haematomas was studied in 43 of 715 patients who underwent a CT scan because of a recent head injury. Twenty of the 43 patients subsequently developed a chronic subdural haematoma, and this occurred especially in...

Ohno, K; Suzuki, R; Masaoka, H; Matsushima, Y; Inaba, Y; Monma, S

231

Spinal subdural hematoma as a complication of spinal surgery: can it happen without dural tear?  

UK PubMed Central (United Kingdom)

Post spinal surgery subdural hematoma is a rare entity. This is a report of a case of acute post-operative spinal subdural hematoma, without any dural injury. The case was managed expectantly and went on to complete resolution of the hematoma and full clinical recovery.

Gakhar H; Bommireddy R; Klezl Z; Calthorpe D

2013-05-01

232

[Acute subdural hematoma of the posterior fossa in the child. Case report  

UK PubMed Central (United Kingdom)

Acute subdural hematoma (ASDH) of the posterior fossa is very rare in childhood. It represent 0.52% of all subdural hematomas. We report a case of post-traumatic acute subdural hematoma of the posterior fossa in a 4-year-old child who was drowsy, without a neurologic defect. The CT scan revealed a simple ASDH, with a good recovery after surgical treatment. The literature is reviewed, clinical and therapeutic aspects are discussed.

Hilmani S; Bertal A; El Malki M; Sami A; Achouri M; Ouboukhlik A; El Kamar A; El Azhari A

2003-03-01

233

[Acute subdural hematoma of the posterior fossa in the child. Case report].  

Science.gov (United States)

Acute subdural hematoma (ASDH) of the posterior fossa is very rare in childhood. It represent 0.52% of all subdural hematomas. We report a case of post-traumatic acute subdural hematoma of the posterior fossa in a 4-year-old child who was drowsy, without a neurologic defect. The CT scan revealed a simple ASDH, with a good recovery after surgical treatment. The literature is reviewed, clinical and therapeutic aspects are discussed. PMID:12736580

Hilmani, S; Bertal, A; El Malki, M; Sami, A; Achouri, M; Ouboukhlik, A; El Kamar, A; El Azhari, A

2003-03-01

234

Magnetic resonance maging of epidural and subdural spinal hematomas; Magnetresonanztomographie bei epiduralen und subduralen spinalen Haematomen  

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Epidural und subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MR) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD- and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n=2), thoracic spine (n=6) and lumbar spine (n=2). They were epidural in five patients and subdural in four. Blinded reading correctly indentified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas (<24 h) in three patients appeared isointense or slightly hyperintense on T1-weighted images and had mixed signal intensity on T2- and T2*-weighted images. Acute hematomas (1-3 days) in four patients were also isointense on T1-weighted images but were more hypointense on T2- and T2*-weighted images. Chronic heamatomas in two patients (7 days and 14 days) were hyperintense on all sequences. Differentiation between epi- and subdural hematomas required transverse T2*-weighted gradient echo sequences. Our results underline that MRI at 1 and 1.5 T is capable of identifying epidural and subdural spinal hematoma in the acute and peracute stage. MRI is superior to CT and myelography for the delineation of the craniocaudal extension in epidural and subdural spinal hematomas and should be the primary preoperative diagnostic method. (orig.) [Deutsch] Epidurale und subdurale spinale Haematome sind neurochirurgische Notfaelle, deren Diagnose bisher vorwiegend mittels Myelographie und Computertomographie gestellt wurde. Wir berichten ueber 9 Patienten, die primaer magnetresonanztomographisch diagnostiziert wurden. Bei allen Patienten wurden T1, Spindichte und T2-gewichtete Bilder erzeugt. Zusaetzlich wurden T2*-gewichtete Gradientenechosequenzen angewendet. Die Magnetresonanztomographien wurden mit dem intraoperativen Situs korreliert. Computertomographische Befunde waren bei 4 und myelographische Befunde waren bei 2 Patienten vorhanden. Die Haematome komprimierten in 2 Faellen das Zervikalmark, bei 6 Patienten das Thorakalmark und bei 2 Patienten Konus und Cauda. Die Magnetresonanztomographie ergab 6 epidurale und 3 subdurale Haematome, operativ handelte es sich um 5 epidural und 4 subdurale Blutungen. In einem Fall konnte die Kernspintomographie nicht zwischen epi- und subduraler Lokalisation unterscheiden. Perakute Haematome (<24 h) waren isointens auf T1-gewichteten Bildern und hatten gemischte Signalintensitaet auf T2- und T*-gewichteten Bildern (n=3). Akute Blutungen (24 h bis 3 Tage) waren ebenfalls isointens auf T1 aber hypointens auf T- und T2*-gewichteten Bildern (n=4). Erst nach 7 Tagen fand sich die methaemoglobintypische Hyperintensitaet auf T1- und T2-gewichteten Bildern (n=2). Diese Ergebnisse unterstreichen, dass die Magnetresonanztomographie perakute und akute spinale Blutungen adaequat diagnostizieren kann. Die exakte Beurteilung der kraniokaudalen Ausdehnung verbessert die Operationsplanung. (orig.)

Felber, S. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie; Langmaier, J. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Judmaier, W. [Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz]|[Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Dessl, A. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Radiologie; Ortler, M. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurochirurgie; Birbamer, G. [Universitaetskliniken Innsbruck (Austria). Klinik fuer Neurologie]|[Universitaetskliniken Innsbruck (Austria). Inst. fuer Magnetresonanz; Piepgras, U. [Universitaetskliniken des Saarlandes, Homburg/Saar (Germany). Inst. fuer Neuroradiologie

1994-11-01

235

Computed tomographic diagnosis of traumatic fetal subdural hematoma.  

UK PubMed Central (United Kingdom)

Intrauterine subdural hematoma (SDH) is a rare event; maternal trauma, especially during the last trimester of pregnancy, is the best documented cause of fetal SDH. We report an extremely rare case of fetal SDH due to maternal trauma diagnosed by multidetector computed tomography. We also discuss the clinical and imaging features of fetal SDH which can be used to assist in diagnosis with emphasis on CT criteria.

Zeina AR; Kessel B; Mahamid A; Gazmawi J; Shrim A; Nachtigal A; Alfici R

2013-04-01

236

Spontaneous disappearance of acute subdural hematoma on CT scan  

International Nuclear Information System (INIS)

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

1986-01-01

237

Analysis of infantile subdural hematoma caused by abuse  

International Nuclear Information System (INIS)

[en] 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)

2010-01-01

238

Bilateral subdural hematoma after inadvertent dural puncture during epidural analgesia.  

UK PubMed Central (United Kingdom)

BACKGROUND: Post-dural puncture headache (PDPH) is typically a benign complication of dural puncture that is clinically diagnosed. It commonly presents as a throbbing and positional headache that occurs 24-48 h after dural puncture. Subdural hematomas, if unrecognized, may occur as a rare and life-threatening complication of dural puncture. OBJECTIVES: We aim to describe the clinical features and sequelae of a rare complication that may result as a consequence of inadvertent dural puncture that, if unrecognized, has the potential to become a life-threatening complication from a common procedure. CASE REPORT: We report the case of a previously healthy 17-year-old primigravida female who initially presented 4 days postpartum with clinical features and imaging studies consistent with PDPH. The patient's symptoms were unremitting, and within 4 weeks, she developed bilateral subdural hematoma. With prompt recognition and diagnosis, she was treated with conservative medical management and subsequently improved on follow-up. CONCLUSION: Patients with unremitting PDPH should prompt the clinician to suspect the development of subdural hematoma as a potential life-threatening complication of an otherwise benign condition.

Nepomuceno R; Herd A

2013-02-01

239

High altitude induced bilateral non-traumatic subdural hematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Minor clinical complaints such as headache and drowsiness after a disco party with alcohol abuse may be an unlikely cause for neurological consultation, but, rarely, they may hide a challenging diagnosis. CASE REPORT: A young male patient admitted to our Neurosurgical Department for progressive headache showed a sudden clinical deterioration of consciousness; head CT scan was promptly obtained and thick bilateral subdural hematomas requiring urgent craniotomies and drainage were detected. While his anamnesis was surprisingly negative for head trauma, coagulopathies, or other common causes of subdural hematoma, he reported a curious history of 10-d onset of symptoms after a farewell disco party on a high-altitude location, almost 9000 ft (>2700 m) above mean sea level, followed by an intercontinental flight back to his seaside hometown. Following surgery the patient eventually experienced a rapid recovery from this frightening experience. DISCUSSION: Due to its uniqueness, the case is reported and the influence of possible provoking causes relevant in the pathogenesis of subdural hematomas is carefully outlined.

Ganau L; Prisco L; Ganau M

2012-09-01

240

Unoperated subdural hematomas. Long-term follow-up study by brain scan and electroencephalography  

International Nuclear Information System (INIS)

[en] The authors report nine patients selected from over 100 patients with subdural hematomas successfully treated without surgery. These patients were followed for as long as 5 years. All had angiographically demonstrated subdural hematomas. Electroencephalograms (EEG) documented well the clinical improvement of the patient, but were poor guides to the true size of the hematoma, since EEG returns to normal early in the patient's course. Static scans are a better guide to the presence of a subdural hematoma, but they lag behind clinical improvement and usually remain abnormal for considerable periods of time after a major portion of the hematoma has been reabsorbed, and the patient is asymptomatic

1976-01-01

 
 
 
 
241

[Subdural hematoma after dural puncture: fateful complication of epidural anesthesia].  

UK PubMed Central (United Kingdom)

Subdural hematoma may occur as rare, although intervention- specific complications of accidental dural puncture by neuroaxial block. Bleeding may be caused by rapid cerebrospinal fluid loss related to traction on fragile intracranial bridging veins. This article reports a case of postdural puncture headache in a 43-year-old woman after accidental dural puncture during attempted placement of an epidural catheter for induction of abortion. Bed rest, analgesics, theophylline and hydration were to no avail and only a blood patch improved the headaches. The patient presented 7 weeks later with headache and left-sided hemiplegia. Magnetic resonance imaging showed a right frontoparietal subdural intracranial hematoma which had to be surgically evacuated. The patient recovered completely. Intracranial hematoma is a rare but serious complication of central neuroaxial block. According to current German jurisdiction this risk must be addressed when informed consent is obtained. Intracranial hematoma should be considered in the differential diagnosis of atypical headache and neurological signs (e.g. focal motor and sensory deficits and seizures) following neuroaxial block and adequate image diagnostics should be carried out without delay.

Schott M; Gehrke A; Gaab M; Jantzen JP

2013-05-01

242

Aspirin therapy and risk of subdural hematoma: meta-analysis of randomized clinical trials.  

UK PubMed Central (United Kingdom)

BACKGROUND: Subdural hematomas are an important bleeding complication of antithrombotic therapies. We sought to characterize the risk of subdural hematoma associated with antiplatelet therapy. METHODS: Trials were gathered from the Cochrane Central Register of Controlled Trials and from recent meta-analyses of trials regarding antiplatelet therapy for the primary prevention of stroke. Randomized trials published since 1980 comparing antiplatelet therapy with placebo or control and reporting subdural hematoma were included in the analysis. For recent large trials that did not report subdural hematomas, unpublished results were sought. Two reviewers independently extracted data on study design and subdural hematomas, with differences resolved by joint review and consensus. RESULTS: Four published trials were identified that compared aspirin with placebo/control involving 6565 participants (mean age 66 years) with 8 total subdural hematomas. Unpublished data from 5 aspirin trials with 90,689 participants reported 18 total subdural hematomas. The incidence of subdural hematomas varied from 0.02 per 1000 patient-years for primary prevention trials of middle-aged health professionals to 1 to 2 per 1000 patient-years for older patients with atrial fibrillation. Pooled data from all 9 trials revealed an odds ratio of 1.6 (95% confidence interval 0.8-3.5; heterogeneity P = .8; I(2) index 0%) for antiplatelet therapy and risk of subdural hematoma. CONCLUSIONS: Based on the limited available data, it is uncertain whether aspirin therapy increases the risk of subdural hematoma: the observed 1.6-fold increased risk was not statistically significant. The incidence of subdural hematoma during aspirin therapy is low but varies widely depending upon the age of the patient population.

Connolly BJ; Pearce LA; Kurth T; Kase CS; Hart RG

2013-05-01

243

Subdural hematoma caused by epithelioid angiosarcoma originating from the skull.  

UK PubMed Central (United Kingdom)

Cancers metastatic to the skull or dura may cause subdural hematoma (SDH). However, the frequency is low, and the presence of underlying cancers has almost always been known in such situations. We report a case of skull angiosarcoma manifesting as SDH, posing a diagnostic challenge to physicians. A 75-year-old man visited our clinic with sensorimotor disturbance of gradual onset approximately 1 month after a minor head trauma. He was diagnosed with SDH after imaging studies, and underwent surgery to evacuate the hematoma. Because the hematoma was organized, surgery was switched from burr-hole drainage to craniotomy. The bone flap as well as the dura over the hematoma had grossly normal appearance, and only the hematoma itself was submitted for histological examination. Although postoperative recovery was uneventful, the patient experienced recurrence of the SDH 2 months after surgery. At the second surgery, the bone flap and dura were intermingled with tumor tissue, and histological examination revealed that an epithelioid angiosarcoma originating from the skull was responsible for the SDH. Timely diagnosis of angiosarcoma manifesting as SDH is difficult because of its rarity. In retrospect, however, the diagnosis might have been established earlier if the bone flap and/or the dura had been biopsied at the time of the first surgery. The present case gives us a lesson that SDH may be an unusual manifestation of malignant tumors of skull or dural origin, and histological examination of not only hematoma capsule but also of the surrounding tissues may provide important diagnostic clues.

Yamada Y; Inamasu J; Moriya S; Oguri D; Hasegawa M; Abe M; Hirose Y

2013-06-01

244

Arterial origin subdural hematoma and associated pial pseudoaneurysm following minor head trauma.  

UK PubMed Central (United Kingdom)

The vast majority of primary acute subdural hematomas following trauma are venous in origin. We report a very rare case of a primary acute subdural hematoma following minor head trauma that was arterial in origin and was associated with a pial cortical branch pseudoaneurysm. The patient was managed conservatively, and follow-up imaging demonstrated complete resolution of both lesions.

Dharsono F; Phatouros CC

2013-07-01

245

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 pre...

Gulsen, Salih; Sonmez, Erkin; Yilmaz, Cem; Altinors, Nur

246

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Spinal subdural hematoma is a rare disorder and can be caused by abnormalities of coagulation, blood dyscrasias, lumbar puncture, trauma, underlying neoplasm, and arteriovenous malformation. We discuss an unusual case of an elderly woman who presented with spontaneous spinal subdural hematoma and de...

Cincu Rafael; Lorente Francisco de Asis; Rivero David; Eiras Jose; Ara Jose

247

Enhancement of isodense subdural hematoma on delayed-high-dose contrast computed tomography  

International Nuclear Information System (INIS)

A case is presented in which bilateral, isodense subdural hematomas, not readily apparent on immediate rapid-high-dose computed tomography, became enhanced and clearly visible on delayed scans. If difficulty is encountered in interpreting the immediate scan of a patient suspected of having isodense subdural hematoma, further scans after a one-hour delay may resolve the dilemma

1983-01-01

248

Enhancement of isodense subdural hematoma on delayed-high-dose contrast computed tomography  

Energy Technology Data Exchange (ETDEWEB)

A case is presented in which bilateral, isodense subdural hematomas, not readily apparent on immediate rapid-high-dose computed tomography, became enhanced and clearly visible on delayed scans. If difficulty is encountered in interpreting the immediate scan of a patient suspected of having isodense subdural hematoma, further scans after a one-hour delay may resolve the dilemma.

Miller, D.L.; Hinck, V.C.

1983-02-01

249

Non-surgical management of intracranial subdural hematoma complicating spinal anesthesia/ Manejo no quirúrgico de hematoma subdural intracraneal tras anestesia espinal complicada  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El hematoma subdural (SDH) es una complicación evolutiva rara, documentada y de riesgo vital en los cuadros de cefalea post punción subdural (PDPH). Presentamos un caso de esta rara complicación resuelto con un parche de sangre autóloga epidural y tratamiento conservador, sin precisar evacuación quirúrgica. Abstract in english We report the case of a 29 year-old woman who presented a symptomatic intracranial subdural hematoma developing shortly after spinal anesthesia. The patient was fully conscious at clinical onset, and thus we treated her conservatively with an epidural autologous blood patch and close neurological observation. Given the clinical improvement the possibility of surgery was discauded in agreement with the neurosurgical team. Most cases of subdural hematoma appearing after spi (more) nal anesthesia are treated with surgery. In the present case the subdural hemorrhage was detected at our hospital 20 days after the anesthetic procedure, and given the excellent state of consciousness, we choosed a conservative management.

Verdú, M.T.; Martínez-Lage, J.F.; Alonso, B.; Sánchez-Ortega, J.L.; Garcia-Candel, A.

2007-02-01

250

Non-surgical management of intracranial subdural hematoma complicating spinal anesthesia Manejo no quirúrgico de hematoma subdural intracraneal tras anestesia espinal complicada  

Directory of Open Access Journals (Sweden)

Full Text Available We report the case of a 29 year-old woman who presented a symptomatic intracranial subdural hematoma developing shortly after spinal anesthesia. The patient was fully conscious at clinical onset, and thus we treated her conservatively with an epidural autologous blood patch and close neurological observation. Given the clinical improvement the possibility of surgery was discauded in agreement with the neurosurgical team. Most cases of subdural hematoma appearing after spinal anesthesia are treated with surgery. In the present case the subdural hemorrhage was detected at our hospital 20 days after the anesthetic procedure, and given the excellent state of consciousness, we choosed a conservative management.El hematoma subdural (SDH) es una complicación evolutiva rara, documentada y de riesgo vital en los cuadros de cefalea post punción subdural (PDPH). Presentamos un caso de esta rara complicación resuelto con un parche de sangre autóloga epidural y tratamiento conservador, sin precisar evacuación quirúrgica.

M.T. Verdú; J.F. Martínez-Lage; B. Alonso; J.L. Sánchez-Ortega; A. Garcia-Candel

2007-01-01

251

Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma caused by rupture of a posterior communicating artery aneurysm: case report and review of the literature.  

UK PubMed Central (United Kingdom)

BACKGROUND: Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma is rare. CASE REPORT: We report on a 47-year-old women without previous trauma who presented with an acute subdural hematoma without subarachnoid hemorrhage. The hematoma was evacuated immediately. Further evaluation with a cerebral four-vessel angiography revealed a left-sided posterior communicating artery aneurysm that was occluded by endovascular embolization. The patient recovered without neurological deficit. CONCLUSIONS: Ruptured intracranial aneurysm should be considered as a cause of nontraumatic subdural hematoma. Immediate subdural hematoma removal after aneurysm coiling can be performed in such patients, even those in poor neurological condition.

Mrfka M; Pistracher K; Augustin M; Kurschel-Lackner S; Mokry M

2013-06-01

252

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)

Full Text Available Abstract in portuguese 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 (more) 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 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 (more) 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 relationshi (more) p is inverted in the group of younger patients (

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

2010-12-01

253

Chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.  

UK PubMed Central (United Kingdom)

BACKGROUND: Enlargement of intracerebral hematoma without rebleeding in chronic phase is a rare but well-known clinical condition, and is well-described as chronic expanding intracerebral hematoma. However, chronic enlargement of pituitary hematoma without rebleeding after pituitary apoplexy is extremely rare. CASE DESCRIPTION: We report a case of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy. A 29-year-old male presented with sudden onset of headache and vomiting. Magnetic resonance imaging (MRI) demonstrated a pituitary mass lesion with hematoma, consistent with pituitary apoplexy. Neuro-ophthalmological examination revealed no visual field defect, and endocrinological evaluations showed an elevated prolactin level. Pituitary apoplexy due to a prolactinoma was the most likely diagnosis. He was conservatively treated because he exhibited no visual disturbance. Three weeks after the onset, he gradually began to complain of blurred vision and neuro-ophthalamological examination revealed bitemporal upper quadrant hemianopsia. MRI showed enlargement of the pituitary hematoma without any finding suggestive of rebleeding. This enlarged mass lesion compressed the chiasm. The patient was operated on via transsphenoidal approach. After dural opening, xanthochromic fluid spouted out, but no fresh clot could be detected within the cyst. After the operation, the visual field disturbance resolved completely. The possible mechanism of hematoma enlargement is considered to be expansion due to the serum exudation from capillaries of the hematoma capsule. This pathogenetic mechanism is common in enlargement of chronic subdural hematoma. CONCLUSIONS: This case is the first report of chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.

Hojo M; Goto M; Miyamoto S

2013-01-01

254

Positron emission tomography in the evaluation of subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

Fifteen patients with 21 subdural effusions were investigated both with transmission computer assisted tomography (CAT) and positron emission tomography (PET). The tracer in the emission studies was /sup 68/Ga-EDTA. Twelve lesions were visualized both with CAT and PET. Five lesions that were negative or doubtful on CAT were visualized with PET, whereas four lesions negative or doubtful on PET were demonstrated by CAT. The two methods complement each other due to the fact that they are based on different mechanisms: CAT mainly on attenuation of the fluid collection. PET on isotope accumulation, particularly in the hematoma membranes.

Ericson, K.; Bergstroem, M.; Eriksson, L.

1980-12-01

255

Positron emission tomography in the evaluation of subdural hematomas  

International Nuclear Information System (INIS)

[en] Fifteen patients with 21 subdural effusions were investigated both with transmission computer assisted tomography (CAT) and positron emission tomography (PET). The tracer in the emission studies was 68Ga-EDTA. Twelve lesions were visualized both with CAT and PET. Five lesions that were negative or doubtful on CAT were visualized with PET, whereas four lesions negative or doubtful on PET were demonstrated by CAT. The two methods complement each other due to the fact that they are based on different mechanisms: CAT mainly on attenuation of the fluid collection. PET on isotope accumulation, particularly in the hematoma membranes

1980-01-01

256

Spontaneous acute subdural hematoma contralateral to an arachnoid cyst Hematoma subdural agudo espontâneo contralateral a cisto aracnóideo  

Directory of Open Access Journals (Sweden)

Full Text Available Arachnoid cysts (AC) are extra-cerebral cerebrospinal fluid collections of unknown origin. They correspond to 1% of all intracranial nontraumatic space-occupying lesions and appear more frequently in the middle fossa (50%). More than 25% of these cysts are incidental findings and the majority of patients are asymptomatic. Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. AC rupture and bleeding are rare, usually occurring in young adults and associated with trauma. The risk of hemorrhage does not exceed 0.04% / year. We describe the case of a ten-year-old boy who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma, contralateral to an AC of the middle fossa. Three factors were significant in this case: signs and symptoms occurred spontaneously; the presence of an acute subdural hematoma exclusively contralateral to the AC; successful outcome of the conservative treatment.Os cistos aracnóideos (CA) são coleções liquóricas extra-cerebrais e intra-aracnóideas de origem desconhecida. Correspondem a 1% de todas as lesões expansivas intracranianas não traumáticas e têm nítido predomínio na fossa média (50%). Até 25% destes cistos são achados incidentais sendo que a maioria dos pacientes é assintomática. Crises epilépticas, sinais de hipertensão intracraniana, déficits neurológicos focais, macrocrania, atraso no desenvolvimento e abaulamento da calota craniana são os principais sinais e sintomas da lesão. A ruptura dos CA, assim como seu sangramento, são situações raras, geralmente associadas a traumas e acometem adultos jovens. O risco de hemorragia em pacientes com CA não excede 0,04% ao ano. É descrito caso de paciente de dez anos de idade que subitamente apresentou sinais de hipertensão intracraniana secundários a hematoma subdural agudo espontâneo, contralateral a volumoso CA de fossa média. Três fatores foram de relevância neste paciente: a ocorrência de sinais e sintomas espontaneamente, especialmente em um menino; presença de hematoma subdural agudo exclusivamente contralateral ao CA; e a boa evolução com o tratamento conservador.

José Gilberto de Brito Henriques; Geraldo Pianetti Filho; Karina Santos Wandeck Henriques; Luiz Fernando Fonseca; Renato Pacheco de Melo; Márcia Cristina da Silva; José Augusto Malheiros

2007-01-01

257

Spontaneous acute subdural hematoma contralateral to an arachnoid cyst/ Hematoma subdural agudo espontâneo contralateral a cisto aracnóideo  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Os cistos aracnóideos (CA) são coleções liquóricas extra-cerebrais e intra-aracnóideas de origem desconhecida. Correspondem a 1% de todas as lesões expansivas intracranianas não traumáticas e têm nítido predomínio na fossa média (50%). Até 25% destes cistos são achados incidentais sendo que a maioria dos pacientes é assintomática. Crises epilépticas, sinais de hipertensão intracraniana, déficits neurológicos focais, macrocrania, atraso no desenvolvime (more) nto e abaulamento da calota craniana são os principais sinais e sintomas da lesão. A ruptura dos CA, assim como seu sangramento, são situações raras, geralmente associadas a traumas e acometem adultos jovens. O risco de hemorragia em pacientes com CA não excede 0,04% ao ano. É descrito caso de paciente de dez anos de idade que subitamente apresentou sinais de hipertensão intracraniana secundários a hematoma subdural agudo espontâneo, contralateral a volumoso CA de fossa média. Três fatores foram de relevância neste paciente: a ocorrência de sinais e sintomas espontaneamente, especialmente em um menino; presença de hematoma subdural agudo exclusivamente contralateral ao CA; e a boa evolução com o tratamento conservador. Abstract in english Arachnoid cysts (AC) are extra-cerebral cerebrospinal fluid collections of unknown origin. They correspond to 1% of all intracranial nontraumatic space-occupying lesions and appear more frequently in the middle fossa (50%). More than 25% of these cysts are incidental findings and the majority of patients are asymptomatic. Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and sympt (more) oms of the lesion. AC rupture and bleeding are rare, usually occurring in young adults and associated with trauma. The risk of hemorrhage does not exceed 0.04% / year. We describe the case of a ten-year-old boy who presented with acute signs of intracranial hypertension secondary to a spontaneous acute subdural hematoma, contralateral to an AC of the middle fossa. Three factors were significant in this case: signs and symptoms occurred spontaneously; the presence of an acute subdural hematoma exclusively contralateral to the AC; successful outcome of the conservative treatment.

Henriques, José Gilberto de Brito; Pianetti Filho, Geraldo; Henriques, Karina Santos Wandeck; Fonseca, Luiz Fernando; Melo, Renato Pacheco de; Silva, Márcia Cristina da; Malheiros, José Augusto

2007-12-01

258

[A case of intracranial subdural hematoma after thoracic epidural anesthesia].  

UK PubMed Central (United Kingdom)

Intracranial subdural hematoma (SDH) occurred in a 58-year-old female after laparoscopy-assisted distal gastrectomy under general and thoracic epidural anesthesia. On postoperative day 2, she complained of headache in sitting position, but there were no remarkable neurological defect and nausea. On postoperative day 5, her headache subsided and she could walk by herself. But on postoperative day 10, she felt heavy-headed again, and complained sensory abnormality of her right leg. Magnetic resonance imaging of the head showed small acute subdural hematoma in bilateral parietal regions with no mass effect. She was managed conservatively with bed rest and intravenous fluids. Her condition improved and was discharged on postoperative day 17 without subsequent complications. SDH after epidural anesthesia is rare, but diagnosis in early stage has a decisive influence on its prognosis. It is crucial to exclude the possibility of SDH and observe closely if the patient complains of severe headache or another unexplained symptom only with postdural puncture headache.

Tanabe Y; Fujinaka W; Takatori M; Tada K

2013-03-01

259

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Traumatic retroclival hematomas are uncommon lesions usually associated with significant trauma. Majority of the reported hematomas are epidural; and in the pediatric population. Retroclival acute subdural hematomas (RSDH) are very rare, with only two previous cases reported in English literature. A...

Sridhar Krishnamurthy; Venkateswara Prasanna; Ramakrishnaiah Sridhar; Iyer Vijay

260

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)

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

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

2012-01-01

 
 
 
 
261

Computed tomography(CT) of the spontaneous resolution of traumatic epidural and subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

During the period of four years and three months from January 1985 to March 1989, 29 cases in 27 patients with traumatic epidural and subdural hematomas which resolved spontaneously on sequential CT examinations, at the Hanyang University Hospital, show the following results. 1. Of 29 hematomas, there are 20 epidural hematomas including 9 cases (45%) in parietal area, and 4 cases (20%) in frontal area, and 9 subdural hematomas including 6 cases (66%) in temporal area. 2. The thickness of all hematomas in less than 2 cm. The thickness of hematoma is 1.0{approx}2.0 cm in 10 epidural hematomas (50%), and less than 0.5 cm in 5 subdural hematomas (56%). 3. The size decrease and complete resolution of hematomas within 4 weeks show 24 of 29 hematomas (83%), of which 18 hematomas (62%) show that between 2 and 4 weeks. 4. No difference between absorption rates of hematomas as the degrees of type or size of hematomas is present.

Hahm, Chang Kok; Lee, Seung Ro; Park, Dong Woo; Joo, Kyung Bin; Lee, Sang Gil [Hanyang University School of Medicine, Seoul (Korea, Republic of)

1989-08-15

262

Computed tomography(CT) of the spontaneous resolution of traumatic epidural and subdural hematomas  

International Nuclear Information System (INIS)

[en] During the period of four years and three months from January 1985 to March 1989, 29 cases in 27 patients with traumatic epidural and subdural hematomas which resolved spontaneously on sequential CT examinations, at the Hanyang University Hospital, show the following results. 1. Of 29 hematomas, there are 20 epidural hematomas including 9 cases (45%) in parietal area, and 4 cases (20%) in frontal area, and 9 subdural hematomas including 6 cases (66%) in temporal area. 2. The thickness of all hematomas in less than 2 cm. The thickness of hematoma is 1.0?2.0 cm in 10 epidural hematomas (50%), and less than 0.5 cm in 5 subdural hematomas (56%). 3. The size decrease and complete resolution of hematomas within 4 weeks show 24 of 29 hematomas (83%), of which 18 hematomas (62%) show that between 2 and 4 weeks. 4. No difference between absorption rates of hematomas as the degrees of type or size of hematomas is present

1989-01-01

263

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)

Full Text Available Abstract in portuguese 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 cir (more) urgia 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 d (more) e 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 d

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

2012-02-01

264

Dynamic CT in the acute subdural hematoma. The cause of diffuse cerebral swelling accompanied by acute subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

Dynamic computed tomography (CT) was performed on thirteen patients with acute sudbural hematoma with and without diffuse cerebral swelling. The cause of the diffuse cerebral swelling accompanying the acute subdural hematoma is discussed in this paper. Patients were classified into two groups according to the Glasgow Coma Scale (GCS). Eight patients with a severe neurological state were judged to have GCS values of approximately 3-6 and to have diffuse cerebral swelling on the initial CT scan. All 8 patients had been rendered unconsciousness at the moment of injury and remained so until death. Five patients were judged to have moderate neurological states (GCS 9-13), and only two of these patients had mild cerebral swelling. The diagnosis of the diffuse cerebral swelling was made by means of the CT scan. The criteria are a marked increase in brain volume and a marked reduction in the size of the ventricular shadow and the basal cistern, or their absence. The dynamic CT of the brain consists of performing eight rapid serial scans after the bolus intravenous injection of 50 ml of a contrast material. The data from these scans were analyzed by means of the time-density curves of various brain regions. In 7 out of the 8 patients with diffuse cerebral swelling, the time-density curves of the cerebral hemisphere of the lesional side were always lower than those on the opposite side, and in 3 of these patients, the time-density curves of the lesional side were flat. However, in 1 patient with diffuse cerebral swelling and in 5 patients without diffuse cerebral swelling, the time-density curves of the cerebral hemisphere had obvious peaks and the curve of the lesional side was nearly identical with that of the opposite side. In 5 patients out of the 8 with severe acute subdural hematoma with diffuse cerebral swelling, the peak of the gray matter of the lesional side was not observed.

Yoshino, Eiji; Yamaki, Tarumi; Higuchi, Toshihiro (Saisei-Kai Shiga-Ken Hospital, Shiga (Japan)); Horikawa, Yoshiharu; Hirakawa, Kimiyoshi

1983-02-01

265

Teaching NeuroImages: Burkitt dural lymphoma mimicking a subacute subdural hematoma.  

Science.gov (United States)

A 59-year-old woman with no history of trauma presented with severe headaches and right-sided weakness. A CT scan showed a left hemispheric isodense subdural collection thought consistent with a subacute subdural hematoma (figure 1A). The patient underwent a single parietal burr hole for evacuation, but the neurosurgeon found subdural fleshy tissue and performed a biopsy. Immediate postoperative MRI showed a homogeneous hypercellular subdural mass (figure 1, B-F).(1) Pathology was consistent with Burkitt lymphoma (figure 2). Retrospectively, the homogeneous density of the collection argued against hematoma. In nonemergent situations, an atypical radiologic appearance of a subdural hematoma may suggest the need for further radiologic investigations before surgical evacuation.(2.) PMID:24145887

Mathon, Bertrand; Nouet, Aurélien; Villa, Chiara; Mokhtari, Karima; Alshehhi, Hussa; Faillot, Matthieu; Dormont, Didier; Cornu, Philippe; Leclercq, Delphine

2013-10-22

266

Scintigraphic demonstration of intracranial communication between arachnoid cyst and associated subdural hematoma  

International Nuclear Information System (INIS)

[en] An arachnoid cyst found to have a communication to an associated subdural hematoma was demonstrated with the Tc-99m DTPA brain scintigraphy. Although arachnoid cysts are known to be silent, when a patient with an arachnoid cyst develops signs of increased intracranial pressure or neurological deficits, the presence of a complication, including subdural hematoma, intracystic hemorrhage or subdural hygroma, is highly suspected. In the present case, the patient with an arachnoid cyst had a subdural hematoma following minor head injury. Tc-99m DTPA brain scintigraphy showed abnormal accumulation of the tracer not only in the hematoma but in the arachnoid cyst. This observation suggested communication of the two lesions, which was confirmed at surgery

1989-01-01

267

Subdural hematoma occurrence: comparison between ethanol and cocaine use at death.  

UK PubMed Central (United Kingdom)

OBJECTIVE: The objective of this study was to show that, in a medical examiner population, ethanol intoxication is associated with an increase in the occurrence of subdural hematoma (SDH), whereas the presence of cocaine is not associated with an increase in the occurrence of SDH. DESIGN: This was a retrospective evaluation of 967 SDH including the investigative information, autopsy, and toxicological findings derived from 18,314 medical examiner cases over 8 years. RESULTS: Subdural hematoma is found in 7% to 9% of cases with either no ethanol or less than 100 mg/dL of ethanol. Subdural hematoma is found in 18% of cases with ethanol levels of greater than 100 mg/dL. Subdural hematoma is found in 11% of cases negative for cocaine, whereas SDH is found in 9% of cases with any form of cocaine present at death.

Heninger M

2013-09-01

268

Scintigraphic demonstration of intracranial communication between arachnoid cyst and associated subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

An arachnoid cyst found to have a communication to an associated subdural hematoma was demonstrated with the Tc-99m DTPA brain scintigraphy. Although arachnoid cysts are known to be silent, when a patient with an arachnoid cyst develops signs of increased intracranial pressure or neurological deficits, the presence of a complication, including subdural hematoma, intracystic hemorrhage or subdural hygroma, is highly suspected. In the present case, the patient with an arachnoid cyst had a subdural hematoma following minor head injury. Tc-99m DTPA brain scintigraphy showed abnormal accumulation of the tracer not only in the hematoma but in the arachnoid cyst. This observation suggested communication of the two lesions, which was confirmed at surgery.

Yokoyama, K.; Tonami, N.; Kimura, M.; Kinoshita, A.; Aburano, T.; Hisada, K.

1989-05-01

269

Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American.  

Science.gov (United States)

A 57-year-old black woman with an atraumatic subdural hematoma was treated for congestive heart failure and was found to have moyamoya disease. The association of these two lesions is rare and has never been described in an African-American. High cerebral venous pressures and changes in cerebral perfusion caused by congestive heart failure and the loss of cerebrovascular autoregulation in moyamoya disease may explain the spontaneous occurrence of a subdural hematoma. Recommendations for management are discussed. PMID:1812845

Oppenheim, J S; Gennuso, R; Sacher, M; Hollis, P

1991-04-01

270

Acute atraumatic subdural hematoma associated with moyamoya disease in an African-American.  

UK PubMed Central (United Kingdom)

A 57-year-old black woman with an atraumatic subdural hematoma was treated for congestive heart failure and was found to have moyamoya disease. The association of these two lesions is rare and has never been described in an African-American. High cerebral venous pressures and changes in cerebral perfusion caused by congestive heart failure and the loss of cerebrovascular autoregulation in moyamoya disease may explain the spontaneous occurrence of a subdural hematoma. Recommendations for management are discussed.

Oppenheim JS; Gennuso R; Sacher M; Hollis P

1991-04-01

271

Middle fossa arachnoid cyst with temporal lobe agenesis accompanying isodense subdural hematoma -a case report-  

Energy Technology Data Exchange (ETDEWEB)

Cysts overlying the temporal lobes have been well described in literature. These are often associated with agenesis of the temporal lobes, and of major neurosurgical interest due to their frequent association with subdural hematoma, a combination that is rarely seen with cysts in other regions. Full features of plain, angiographic, and CT findings of arachnoid cyst with temporal lobe agenesis accompanying isodense subdural hematoma are presented, being very rare in radiologic literature.

Lee, Kyung Soo; Choi, Hyung Sik; Kim, Myung Joon; Yang, Seoung Oh; Kim, Chang Jin [Capital Armed Forces General Hospital, Seongnam (Korea, Republic of)

1987-12-15

272

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

Directory of Open Access Journals (Sweden)

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

JiEun Park; SooMi Lim; Jeong Hyun Yoo

2011-01-01

273

Treatment of Spontaneous Cervical Spinal Subdural Hematoma with Methylprednisolone Pulse Therapy  

Digital Repository Infrastructure Vision for European Research (DRIVER)

We report herein a case of hyperacute onset of spontaneous cervical spinal subdural hematoma treated with methylprednisolone pulse therapy that showed good results. A 57-year-old man was admitted for posterior neck pain and paraparesis which occurred an hour ago. MRI revealed a ventral subdural hema...

Song, Tae-Jin; Lee, Jun-Bum; Choi, Young-Chul; Lee, Kyung-Yul; Kim, Won-Joo

274

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

Directory of Open Access Journals (Sweden)

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.

Liu Jinping; Wu Bo; Feng Hailong; You Chao

2011-01-01

275

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed  

Directory of Open Access Journals (Sweden)

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

Cincu Rafael; Lorente Francisco de Asis; Rivero David; Eiras Jose; Ara Jose

2009-01-01

276

Migration of traumatic intracranial subdural hematoma to lumbar spine causing radiculopathy.  

UK PubMed Central (United Kingdom)

BACKGROUND: There have been rare reports of intracranial subdural hematoma (SDH) that migrated into the spine. All previous cases have been surgically managed and in this case report, we describe the first case of conservatively managed spinal hematoma secondary to migratory intracranial SDH. CASE DESCRIPTION: A 26-year-old male presented with a left tentorial SDH after blunt trauma. He was conservatively managed and discharged home. He presented 8 days later with worsening lower back pain that was found to be secondary to a spinal SDH. CONCLUSION: Spinal hematomas can be a serious sequelae of migrated intracranial hematomas. Tentorial and other caudally located intracranial hematomas may be more prone to this phenomenon.

Li CH; Yew AY; Lu DC

2013-01-01

277

Intracranial subdural hematoma: a rare complication following spinal anesthesia: case report.  

UK PubMed Central (United Kingdom)

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 after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spinal anesthesia was performed with 27G Quincke needle and single puncture. There was no unexpected event in the surgery and the patient was discharged. After 48 hours of spinal puncture, the patient reported sudden, strong headache, affecting especially the orbital region, but also the temporal region, with important improvement in dorsal decubitus and followed by two vomiting episodes. A cranial tomography was requested and revealed the presence of an acute left frontotemporoparietal subdural hematoma. A conservative treatment with analgesics, dexamethasone and hydantoin was indicated. After 17 days, the patient had intense headache, followed by dormancy and paresis of right upper limb and speech and behavior disorders. The hematoma was surgically drained. The patient evolved well and without sequelae. CONCLUSIONS: Headache is the most frequent complication after spinal anesthesia and it is considered of benign evolution. In many cases however, it leads to the late or absent diagnosis of potentially fatal conditions, like subdural hematoma. This case describes a rare case of an acute subdural hematoma following spinal anesthesia with fine-gauge needle in a patient without risk factors for bleeding.

Bisinotto FM; Dezena RA; Fabri DC; Abud TM; Canno LH

2012-01-01

278

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

International Nuclear Information System (INIS)

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

1984-01-01

279

Hematoma subdural após punção inadvertida da dura-máter: relato de caso/ Subdural hematoma after inadvertent dura mater puncture: case report/ Hematoma subdural después de la punción inadvertida de la duramadre: relato de caso  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é complicação bastante conhecida das anestesias subaracnóidea e peridural, e o tratamento mais difundido é o tampão sangüíneo. O tampão sangüíneo alivia totalmente a cefaléia na grande maioria dos pacientes, e nos demais não há melhora ou, apenas, melhora parcial. Nesses casos, é prudente buscar diagnósticos diferenciais, como o hematoma subdural ou pneumoencéfalo. Os métodos de imagem s (more) ão extremamente úteis nessas situações. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano após punção inadvertida da dura-máter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado físico ASA II, foi admitido para realização de dermolipectomia abdominal, após ter-se submetido à gastroplastia redutora. Durante anestesia peridural, houve perfuração acidental da dura-máter. O paciente evoluiu com sintomas de cefaléia pós-punção da dura-máter que foram tratados com tampão sangüíneo, com melhora parcial. Houve, posteriormente, piora da cefaléia, e a ressonância nuclear magnética de encéfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperação total após 30 dias. CONCLUSÕES: A ocorrência de hematoma subdural é complicação rara, mas grave da perfuração de dura-máter. O diagnóstico é difícil e deve ser sempre cogitado quando a cefaléia pós-punção da dura-máter não se resolve com o tampão sangüíneo ou piora com sua realização. No esclarecimento diagnóstico é fundamental o auxílio de um método de imagem. Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: La cefalea pos punción de la duramadre es una complicación bastante conocida de las anestesias subaracnoidea y epidural, siendo que el tratamiento más difundido es el tapón sanguíneo. El tapón sanguíneo alivia totalmente la cefalea en la gran mayoría de los pacientes, y en los demás no hay mejorías o apenas se ve una mejoría parcial. En esos casos, es prudente buscar diagnósticos diferenciales, como el hematoma subdural o neumoencéf (more) alo. Los métodos de imagen son extremadamente útiles en esas situaciones. El objetivo de este relato fue el de presentar el caso de un paciente que debutó con hematoma subdural intracraneal después de la punción inadvertida de la duramadre en anestesia epidural. RELATO DEL CASO: Paciente del sexo masculino, 47 años, 147 kg, 1,90 m, estado físico ASA II, fue admitido para la realización de dermolipectomía abdominal, después de haberse sometido a la gastroplastía reductora. Durante la anestesia epidural, hubo perforación accidental de la duramadre. El paciente evolucionó con síntomas de cefalea pospunción de la duramadre que fueron tratados con tapón sanguíneo, obteniéndose una mejora parcial. Hubo posteriormente, un empeoramiento de la cefalea y la resonancia nuclear magnética de encéfalo mostró un hematoma subdural intracraneal, que se trató clínicamente. Hubo una mejoría progresiva, con recuperación total después de 30 días. CONCLUSIONES: La aparición de hematoma subdural es una complicación rara, pero grave de la perforación de la duramadre. El diagnóstico es difícil y debe ser siempre pensado, cuando la cefalea pospunción de la duramadre no se resuelva con el tapón sanguíneo o tampoco se resuelva su empeoramiento. En la aclaración del diagnóstico es fundamental la ayuda de un método de imagen. Abstract in english BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In th

Duarte, Wallace Lage; Araújo, Fabiano de Souza; Almeida, Marcelo Figueiredo; Geber, Débora Grimberg; Castro, Carlos Henrique Viana de

2008-08-01

280

Hematoma subdural após punção inadvertida da dura-máter: relato de caso Hematoma subdural después de la punción inadvertida de la duramadre: relato de caso Subdural hematoma after inadvertent dura mater puncture: case report  

Directory of Open Access Journals (Sweden)

Full Text Available JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é complicação bastante conhecida das anestesias subaracnóidea e peridural, e o tratamento mais difundido é o tampão sangüíneo. O tampão sangüíneo alivia totalmente a cefaléia na grande maioria dos pacientes, e nos demais não há melhora ou, apenas, melhora parcial. Nesses casos, é prudente buscar diagnósticos diferenciais, como o hematoma subdural ou pneumoencéfalo. Os métodos de imagem são extremamente úteis nessas situações. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano após punção inadvertida da dura-máter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado físico ASA II, foi admitido para realização de dermolipectomia abdominal, após ter-se submetido à gastroplastia redutora. Durante anestesia peridural, houve perfuração acidental da dura-máter. O paciente evoluiu com sintomas de cefaléia pós-punção da dura-máter que foram tratados com tampão sangüíneo, com melhora parcial. Houve, posteriormente, piora da cefaléia, e a ressonância nuclear magnética de encéfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperação total após 30 dias. CONCLUSÕES: A ocorrência de hematoma subdural é complicação rara, mas grave da perfuração de dura-máter. O diagnóstico é difícil e deve ser sempre cogitado quando a cefaléia pós-punção da dura-máter não se resolve com o tampão sangüíneo ou piora com sua realização. No esclarecimento diagnóstico é fundamental o auxílio de um método de imagem.JUSTIFICATIVA Y OBJETIVOS: La cefalea pos punción de la duramadre es una complicación bastante conocida de las anestesias subaracnoidea y epidural, siendo que el tratamiento más difundido es el tapón sanguíneo. El tapón sanguíneo alivia totalmente la cefalea en la gran mayoría de los pacientes, y en los demás no hay mejorías o apenas se ve una mejoría parcial. En esos casos, es prudente buscar diagnósticos diferenciales, como el hematoma subdural o neumoencéfalo. Los métodos de imagen son extremadamente útiles en esas situaciones. El objetivo de este relato fue el de presentar el caso de un paciente que debutó con hematoma subdural intracraneal después de la punción inadvertida de la duramadre en anestesia epidural. RELATO DEL CASO: Paciente del sexo masculino, 47 años, 147 kg, 1,90 m, estado físico ASA II, fue admitido para la realización de dermolipectomía abdominal, después de haberse sometido a la gastroplastía reductora. Durante la anestesia epidural, hubo perforación accidental de la duramadre. El paciente evolucionó con síntomas de cefalea pospunción de la duramadre que fueron tratados con tapón sanguíneo, obteniéndose una mejora parcial. Hubo posteriormente, un empeoramiento de la cefalea y la resonancia nuclear magnética de encéfalo mostró un hematoma subdural intracraneal, que se trató clínicamente. Hubo una mejoría progresiva, con recuperación total después de 30 días. CONCLUSIONES: La aparición de hematoma subdural es una complicación rara, pero grave de la perforación de la duramadre. El diagnóstico es difícil y debe ser siempre pensado, cuando la cefalea pospunción de la duramadre no se resuelva con el tapón sanguíneo o tampoco se resuelva su empeoramiento. En la aclaración del diagnóstico es fundamental la ayuda de un método de imagen.BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In those situations, imaging exams are extremely useful. The objective of this report

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

2008-01-01

 
 
 
 
281

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

Directory of Open Access Journals (Sweden)

Full Text Available 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 hemorrhage was reviewed for physical child abuse, which has been a medical and social issue in many developed countries and has recently become an issue in Turkey.

Volkan ETUS; Savas CEYLAN

2003-01-01

282

Recovery after delayed surgery in a case of spinal subdural hematoma.  

UK PubMed Central (United Kingdom)

Spinal chronic subdural hematoma (SCSH) is a rare pathology usually associated with trauma or hematological alterations or is due to iatrogenic causes; rarely SCSH can be spontaneous. We report a case of a 79-year-old female who underwent a surgical evacuation of a spontaneous SCSH one year after diagnosis. She presented with a severe paraparesis and showed a considerable improvement in sensory-motor performances after surgery. The treatment of spontaneous SCSH is not well defined and universally accepted. Early surgery is mandatory in cases presenting with severe deficits. To the best of our knowledge, this is the first case showing a good outcome in a case of SCSH following a delayed surgery. In our opinion, an aggressive approach should be considered as a viable option in cases of spontaneous SCSH even after a lasting spinal cord compression.

Panciani PP; Cornali C; Agnoletti A; Esposito G; Ronchetti G; Fontanella M

2013-01-01

283

Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI  

International Nuclear Information System (INIS)

[en] Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed. (orig.)

1999-01-01

284

Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI  

Energy Technology Data Exchange (ETDEWEB)

Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed. (orig.) With 2 figs., 14 refs.

Tillich, M.; Kammerhuber, F.; Reittner, P.; Szolar, D.H. [Department of Radiology, Karl-Franzens Medical School and University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz (Austria); Leber, K.A. [Department of Neurosurgery, Karl-Franzens Medical School and University Hospital Graz, Auenbruggerplatz 9, A-8036 Graz (Austria)

1999-02-01

285

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

Directory of Open Access Journals (Sweden)

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.

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

2009-01-01

286

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 ad (more) mitida 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 Glasg (more) ow 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%

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

1996-06-01

287

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

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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%

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

1996-01-01

288

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

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

Sridhar Krishnamurthy; Venkateswara Prasanna; Ramakrishnaiah Sridhar; Iyer Vijay

2010-01-01

289

Rapid resolution of acute subdural hematoma in child with severe head injury: a case report.  

UK PubMed Central (United Kingdom)

INTRODUCTION: Rapid spontaneous resolution of traumatic acute subdural hematoma is an infrequent phenomenon and mainly develops in a case of simple acute subdural hematoma without parenchymal contusion. However, it has been rarely reported in a pediatric case with severe initial head injury. CASE PRESENTATION: A 7-year-old Asian girl with traumatic acute subdural hematoma was transferred to our hospital for an emergency operation based on the results of an initial computed tomography scan and neurological examination. However, a repeat computed tomography scan two hours after trauma disclosed considerable reduction of the hematoma and midline shift with neurological improvements. Serial follow-up imaging studies demonstrated apparent redistribution of the hematoma over the cerebellar tentorium, posterior interhemispheric fissure and subarachnoid space. The patient was discharged with mild confusion 40 days after the admission. CONCLUSION: A follow-up computed tomography scan is strongly recommended before surgery when a child with a severe head injury presents with any sign of neurological improvement, especially with a mixed density hematoma on the initial computed tomography scan.

Park JY; Moon KS; Lee JK; Jeung KW

2013-01-01

290

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

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Spontaneous spinal subdural hematoma is a rare disease. Several predisposing factors are reported including impaired clotting due to therapeutic anti-coagulation or hematologic disorder, vascular anom-aly, intraspinal tumor, and iatrogenic causes such as lumbar puncture or spinal anesthesia.We repor...

JiEun Park; SooMi Lim; Jeong Hyun Yoo

291

Acute spontaneous subdural hematoma of arterial origin: A report of four cases and review of literature  

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Acute spontaneous subdural hematoma of arterial origin, a neurosurgical emergency resulting from rupture of the perisylvian cortical artery, is a rare occurrence. We report four such patients who presented with progressive neurological deterioration. All the patients were operated and perisylvian co...

Chhiber Sarbjit; Singh J

292

Spinal subdural hematoma revealing hemophilia A in a child: A case report  

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Abstract Background Intraspinal bleeding especially in the form of subdural hematoma is rare in hemophiliacs. In the present case, we report a neglected hemophilic A child with such a problem and discuss its management options. Case Presentation A 9-year old hemophili...

Eftekhar Behzad; Ghodsi Mohammad; Ketabchi Ebrahim; Bakhtiari Abbas; Mostajabi Pardis

293

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

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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 dow...

Liu Jinping; Wu Bo; Feng Hailong; You Chao

294

Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome  

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Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to...

Gabaeff, Steven C.

295

Spinal subdural hematoma revealing hemophilia A in a child: A case report  

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Full Text Available Abstract Background Intraspinal bleeding especially in the form of subdural hematoma is rare in hemophiliacs. In the present case, we report a neglected hemophilic A child with such a problem and discuss its management options. Case Presentation A 9-year old hemophilic A boy presented with quadriparesis, confusion and meningismus after a fall 4 days previously. There was no sign of direct trauma to his back. His CT Scan and MRI showed spinal extramedullary hematoma extended from C5 to L2. We corrected the factor VIII level, but two days later, the patient's lower limbs weakened to 1/5 proximally as well as distally. We performed a laminectomy from T11 to L2, according to the level of the maximal neurological deficit and recent deterioration course. The subdural hematoma was evacuated. The hematoma in other spinal levels was managed conservatively. In the week following the operation, the patient's neurological status approached normal. Conclusion This case calls attention to the clinical manifestation, radiological features and management options of the rarely reported intraspinal hematoma in hemophilic children. Although this case has been managed operatively for its hematoma in the thoracolumbar region, at the same time it can be considered a successful case of conservative management of intraspinal hematoma in the cervicothoracic region. Both conservative and surgical management could be an option in managing these patients considering their neurological course.

Eftekhar Behzad; Ghodsi Mohammad; Ketabchi Ebrahim; Bakhtiari Abbas; Mostajabi Pardis

2003-01-01

296

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  

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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.

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

2010-01-01

297

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

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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.

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

2012-01-01

298

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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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.

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

1984-04-01

299

Spectrophotometry of cerebrospinal fluid in subacute and chronic subdural haematomas  

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Spectrophotometric examinations were performed on cerebrospinal and subdural fluids in subacute (five patients) and chronic (20 patients) subdural haematomas, with special reference to the diagnostic aid of CSF spectrophotometry. Spectrophotometric xanthochromia of haemorrhagic origin was found in a...

Kjellin, K. G.; Steiner, L.

300

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

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

Rocque Brandon G; Ba?kaya Mustafa K

2008-01-01

 
 
 
 
301

Acute intracranial hematoma formation following excision of a cervical subdural tumor: a report of two cases and literature review.  

UK PubMed Central (United Kingdom)

An intracranial hematoma is a rare, yet significant, complication following spinal surgery. The authors describe two cases with acute intracranial hematoma formation after excision of a cervical subdural schwannoma. One was a 14-year-old girl who developed bilateral intracranial extradural hematomas immediately following excision of the C4 subdural schwannoma. The other was a 59-year-old woman who had an acute cerebellar hematoma after removal of the C2-C5 subdural schwannoma. During the surgeries of both cases, spinal dura was partially removed together with the tumor and the dural sac could not be repaired, resulting in large amounts of intraoperative CSF loss and persistent postoperative CSF leakage. Both patients failed to regain consciousness from anesthesia after surgery, and a cranial CT scan identified large intracranial hematomas. Urgent hematoma evacuation was ultimately performed to save the patients. Based on the authors' experience and literature review, a conclusion was drawn that considerable CSF leakage and a sharp decrease of CSF pressure are common features during the excision of a spinal subdural tumor, which may lead to acute intracranial hematomas. Continual postoperative monitoring in patients with this condition should be of a very high priority. A CT or MRI should be immediately investigated to exclude intracranial hematomas for any patient with delayed emergence from anesthesia following spinal surgery. Hematoma evacuation is indispensable once an intracranial hematoma is identified in the patient who fails to regain consciousness from anesthesia post surgery. Furthermore, the possible pathophysiological mechanisms responsible for the formation of an intracranial hematoma after spinal procedures, particularly after manipulations of a cervical subdural tumor, are discussed.

Ma X; Zhang Y; Wang T; Li G; Zhang G; Khan H; Xiang H; Chen B

2013-07-01

302

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

International Nuclear Information System (INIS)

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

2006-01-01

303

[BNP elevation due to a subdural hematoma - misled by a biomarker].  

Science.gov (United States)

History and admission findings: A 73-year-old man with a mechanical aortic valve and a history of congestive heart failure was admitted to our hospital with an unspecifically reduced general condition. Physical examination was normal according to age apart from mechanic valve closure tones and a 2/6 sytolic murmur at Erb's point.Investigations: Inflammation markers were elevated (leukocytosis 22 100/?l, CRP 22 mg/dl ), there was mild anemia (hemoglobin 9.7 mg/dl) and digitoxin blood level was increased to 56 ?g/l (therapeutic range 10-30 ?g/l). Because NT-proBNP was highly elevated, further diagnostics focused on cardiac causes of BNP elevation despite missing clinical symptoms. Transesophageal echocardiography was inconspicuous and blood cultures were negative. Therefore an infection of unknown origin or an emerging endocarditis were presumed.Treatment and course: Pragmatic treatment with antibiotics and diuretics as well as discontinuation of digitoxin led to normalization of leukocytes, CRP and digitoxin levels. But the patient's general condition deteriorated further, NT-proBNP rose to 37731 pg/ml and the patient became disoriented. On thorough questioning the patient's relatives stated that he had fallen 6 weeks previously. Computed tomography then revealed a large chronic subdural hematoma which had caused the NT-proBNP elevation. The patient was operated successful.Conclusion: In patients with elevated BNP and atypical symptoms neurological causes should be considered. PMID:24065415

Härle, T; Elsässer, A

2013-09-24

304

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

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Full Text Available Abstract Introduction Intracranial arachnoid cysts are considered to be congenital malformations with a predilection for the temporal fossa. They are often asymptomatic but can sometimes be symptomatic due to enlargement or hemorrhage. There are multiple case reports of arachnoid cysts becoming symptomatic with hemorrhagic complications following head trauma. In such cases, the bleeding is often confined to the side ipsilateral to the arachnoid cyst. Occurrence of contralateral subdural hematomas in patients with temporal fossa arachnoid cysts has rarely been observed and is reported less frequently in the medical literature. Case presentation We report two cases of people (a 23-year-old man and a 41-year-old man) with temporal fossa arachnoid cysts complicated by a subdural hematoma following head injury. Both patients developed a subdural hematoma contralateral to the side of a temporal fossa arachnoid cyst. It is likely that lack of adequate intracranial cushioning in the presence of an intracranial arachnoid cyst may result in injury not only to ipsilateral but also to contralateral bridging veins, following head trauma. Conclusion It is important to identify and report such rare complications with intracranial arachnoid cysts, so that asymptomatic patients with an intracranial arachnoid cyst can be counseled about such possibilities following head trauma.

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

2009-01-01

305

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

International Nuclear Information System (INIS)

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

2010-01-01

306

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)  

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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.

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

2009-01-01

307

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)

Full Text Available Abstract in portuguese 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 2 (more) 4 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). Tr (more) as 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 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 (more) 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.

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

2009-01-01

308

Chronic intradiploic hematoma in patients with coagulopathy.  

UK PubMed Central (United Kingdom)

Intradiploic hematomas occur rarely. They have been reported in patients with and without coagulation disorders. The presentation of intradiploic hematomas varies depending on their location and the severity of the coagulopathy. We describe a patient with a huge hemicranial chronic intradiploic hematoma. Surgery involved opening the thinned outer table and evacuation of a jelly-like material and an organized clot, leaving behind the inner table. The rarity of this disease, possible pathogenesis and related surgical aspects are discussed.

Dange N; Mahore A; Avinash KM; Joshi V; Kawale J; Goel A

2010-08-01

309

Chronic intradiploic hematoma in patients with coagulopathy.  

Science.gov (United States)

Intradiploic hematomas occur rarely. They have been reported in patients with and without coagulation disorders. The presentation of intradiploic hematomas varies depending on their location and the severity of the coagulopathy. We describe a patient with a huge hemicranial chronic intradiploic hematoma. Surgery involved opening the thinned outer table and evacuation of a jelly-like material and an organized clot, leaving behind the inner table. The rarity of this disease, possible pathogenesis and related surgical aspects are discussed. PMID:20537896

Dange, Nitin; Mahore, Amit; Avinash, K M; Joshi, Vijay; Kawale, Juhi; Goel, Atul

2010-05-26

310

Rapid resolution of an acute subdural hematoma by increasing the shunt valve pressure in a 63-year-old man with normal-pressure hydrocephalus with a ventriculoperitoneal shunt: a case report and literature review  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Abstract Introduction Symptomatic subdural hematoma development is a constant concern for patients who have undergone cerebrospinal fluid shunting procedures to relieve symptoms related to normal-pressure hydrocephalus. Acute subdural hematomas are of particular concern in these pat...

Hayes Jackson; Roguski Marie; Riesenburger Ron I

311

Safe implementation of mechanical thrombectomy in acute stroke patients with major arterial occlusion and concomitant subdural hematoma.  

Science.gov (United States)

Mechanical thrombectomy (MT) alone in cases of large-vessel acute ischemic stroke (AIS) with a concomitant subdural hematoma (SDH) seems feasible and safe, but there's still a lack of evidence in the clinical literature. We report three cases of AIS with SDH, of which MT was performed with successful recanalization and no major changes in SDH: two elderly men with acute traumatic SDH and one man with incidental chronic SDH. (1) A 67-year-old man with acute traumatic SDH in the right side developed right middle cerebral artery (MCA) stroke, (2) a 72-year-old man with chronic SDH in the left side developed right MCA stroke, and (3) a 76-year-old-man with acute traumatic SDH in the right side developed top-of-basilar artery syndrome. As for AIS patients with a SDH, MT may be the only feasible and safe treatment option. PMID:24024077

Kim, Yong-Won; Kang, Dong-Hun; Hwang, Yang-Ha; Kim, Yong-Sun; Park, Sung-Pa

2013-08-29

312

Safe Implementation of Mechanical Thrombectomy in Acute Stroke Patients with Major Arterial Occlusion and Concomitant Subdural Hematoma  

Science.gov (United States)

Mechanical thrombectomy (MT) alone in cases of large-vessel acute ischemic stroke (AIS) with a concomitant subdural hematoma (SDH) seems feasible and safe, but there's still a lack of evidence in the clinical literature. We report three cases of AIS with SDH, of which MT was performed with successful recanalization and no major changes in SDH: two elderly men with acute traumatic SDH and one man with incidental chronic SDH. (1) A 67-year-old man with acute traumatic SDH in the right side developed right middle cerebral artery (MCA) stroke, (2) a 72-year-old man with chronic SDH in the left side developed right MCA stroke, and (3) a 76-year-old-man with acute traumatic SDH in the right side developed top-of-basilar artery syndrome. As for AIS patients with a SDH, MT may be the only feasible and safe treatment option.

Kim, Yong-Won; Kang, Dong-Hun; Kim, Yong-Sun; Park, Sung-Pa

2013-01-01

313

A case of acute traumatic subdural hematoma in a child with previous bilateral encephaloduroarteriosynangiosis.  

UK PubMed Central (United Kingdom)

The authors report the case of a 5-year-old female with right-sided hemiparesis and aphasia secondary to moyamoya disease, who had previously undergone staged bilateral encephaloduroarteriosynangiosis procedures. A subsequent ground-level fall caused an acute traumatic subdural hematoma with mass effect and neurological decline. She underwent emergency hematoma evacuation and decompressive craniectomy, which required interruption of the superficial temporal artery that had been used for indirect bypass, followed later by autologous cranioplasty. There were no acute or long-term ischemic events related to the occurrence or treatment of the traumatic hematoma. Follow-up angiography revealed extensive spontaneous vascular collateralization in the field of the decompressive craniectomy and cranioplasty. The patient returned to her pre-injury neurological baseline.

Curry M; Whitney N; Roundy N; Selden NR

2013-10-01

314

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)

Full Text Available Abstract in portuguese 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, vômit (more) os 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 case 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 jau (more) ndice 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.

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

2013-06-01

315

Anesthetic management of a patient with hemophilia A with spontaneous acute subdural hematoma.  

UK PubMed Central (United Kingdom)

Intracranial hemorrhage in patients with hemophilia is associated with high mortality and sequelae. We report the case of 50-year-old man with Hemophilia A, who presented with spontaneous acute subdural hematoma and underwent craniotomy for clot evacuation. The patient received Factor VIII infusions perioperatively along with other measures to decrease blood loss. The patient presented with signs of high intracranial tension and received 3% saline intraoperatively and postoperatively to prevent brain edema. Recommendations for perioperative preparation and management of hemophilia, especially in the setting of emergency major surgery are reviewed.

Gyanesh P; Dhiraaj S

2013-01-01

316

Recombinant factor Vlla therapy in a patient on long term anticoagulant treatment with a bleeding and acute subdural hematoma  

Directory of Open Access Journals (Sweden)

Full Text Available In this paper we report on the successful correction of a coagulopathy with activated recombinant factor seven (rFVIIa) therapy which enabled surgical removal of a life threatening subdural hematoma. The severe coagulopathy developed due to long term warfarin therapy, which followed heart valvular reconstruction and replacement. The coagulopathy failed to improve following fresh frozen plasma and vitamin K therapy. Activated recombinant factor VII therapy became the treatment of choice, which enabled the life saving surgical removal of the subdural hematoma.

Natasa Kovac; Aleksandar Gopcevic; Josip Kovac; Petar Gacina; Mladen Novkoski

2007-01-01

317

Subdural Hematoma in Plasmodium falciparum and P. vivax Mixed Infection Presenting Multiple Clinical Complications: A Case Report.  

UK PubMed Central (United Kingdom)

A 40-year-old man was admitted to the hospital with a 5-day history of fever, restlessness, and altered sensorium. The peripheral blood smear showed Plasmodium vivax and P. falciparum mixed infection as revealed by the presence of rings, schizonts and gametocyte forms of parasites. The patient soon became unconscious due to subdural hematoma associated with disseminated intravascular coagulation and thrombocytopenia. Immediate intervention with right fronto-parieto temporal craniectomy, evacuation of subdural hematoma and intravenous quinine administration resulted in the complete recovery in 8 days of admission and the patient was discharged in good clinical condition.

Devaraju PB; Padukone S; Veerabhadraiah SR; Ramachandrappa VS; Panji N; Chandrappagowda PB; Rudrappa MB; Gowda CD; Achur RN

2013-08-01

318

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  

Directory of Open Access Journals (Sweden)

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 bicicleta 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.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.

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

2011-01-01

319

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)

Full Text Available Abstract in spanish 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 bicicleta 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 (more) 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 b (more) y 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.

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

2011-08-01

320

Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome.  

Science.gov (United States)

Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse. PMID:21691518

Gabaeff, Steven C

2011-05-01

 
 
 
 
321

Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome.  

UK PubMed Central (United Kingdom)

Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse.

Gabaeff SC

2011-05-01

322

Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome  

Directory of Open Access Journals (Sweden)

Full Text Available Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse. [West J Emerg Med. 2011;12(2):144-158.

Gabaeff, Steven C

2011-01-01

323

Intrasphenoidal encephalocele associated with cerebrospinal fluid fistula and subdural hematomas: technical case report.  

UK PubMed Central (United Kingdom)

OBJECTIVE AND IMPORTANCE: Intrasphenoidal encephalocele is a rare clinical entity that is often complicated by rhinorrhea, recurrent meningitis, and headache, but in no case has the association of rhinorrhea with subdural hematomas been described. A surgical procedure to stop persistent cerebrospinal fluid leakage is reported. CLINICAL PRESENTATION: A 59-year-old man sought care for intractable rhinoliquorrhea of 6 months' duration. Cranial computed tomographic and magnetic resonance imaging scans revealed a basal posterior frontal bony defect and an evocative image suggesting intrasphenoidal encephalocele. INTERVENTION: A transnasal transsphenoidal surgical procedure was performed; the encephalocele was removed, and the sphenoid sinus was filled with an inflatable pouch made of synthetic dura mater containing abdominal fat. Postoperative reduction of the rhinoliquorrhea, but not its total disappearance, was observed. Total disappearance was achieved only after endonasal, transmucosal inflation of the pouch with human fibrin glue. One of the subdural hematomas disappeared spontaneously, and the other was treated by a surgical procedure. CONCLUSION: The possible role of the presented technique in the treatment of cerebrospinal fluid leakage is discussed.

Fraioli B; Conti C; Lunardi P; Liccardo G; Fraioli MF; Pastore FS

2003-06-01

324

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

Spinal subdural hematoma (SDH) is a rare condition and can be caused by several factors. Concomitant cranial and spinal SDH is even much less common. We present a 77-year-old male patient with lower back pain, paraparesis, and urinary retention following a sudden onset headache. Imaging revealed con...

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

325

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

International Nuclear Information System (INIS)

[en] A case of diffuse hemispheric gyral high density area following acute subdural hematoma was reported. A 2 - 10/12 year-old male was admitted to our hospital in comatous state after head injury by fall. Neurological examination revealed deep coma with anisocoria (R

1986-01-01

326

Blood constituents trigger brain swelling, tissue death, and reduction of glucose metabolism early after acute subdural hematoma in rats  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Outcome from acute subdural hematoma is often worse than would be expected from the pure increase of intracranial volume by bleeding. The aim was to test whether volume-independent pathomechanisms aggravate damage by comparing the effects of blood infusion with those of an inert fluid, paraffin oil,...

Baechli, Heidi; Behzad, Melika; Schreckenberger, Matthias; Buchholz, Hans-Georg; Heimann, Axel; Kempski, Oliver

327

Chronic subdural haematoma, an unusual injury from playing basketball  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Although the literature records instances of acute epidural haematoma and acute subdural haematoma related to playing basketball, there has not been a report of chronic subdural haematoma as a basketball injury. With the burgeoning interest in this sport in the United Kingdom and Europe, the po...

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

328

Erythropoietin neuroprotection is enhanced by direct cortical application following subdural blood evacuation in a rat model of acute subdural hematoma.  

UK PubMed Central (United Kingdom)

Recombinant human erythropoietin (EPO) has been successfully tested as neuroprotectant in brain injury models. The first large clinical trial with stroke patients, however, revealed negative results. Reasons are manifold and may include side-effects such as thrombotic complications or interactions with other medication, EPO concentration, penetration of the blood-brain-barrier and/or route of application. The latter is restricted to systemic application. Here we hypothesize that EPO is neuroprotective in a rat model of acute subdural hemorrhage (ASDH) and that direct cortical application is a feasible route of application in this injury type. The subdural hematoma was surgically evacuated and EPO was applied directly onto the surface of the brain. We injected NaCl, 200, 2000 or 20,000IU EPO per rat i.v. at 15min post-ASDH (400?l autologous venous blood) or NaCl, 0.02, 0.2 or 2IU per rat onto the cortical surface after removal of the subdurally infused blood t at 70min post-ASDH. Arterial blood pressure (MAP), blood chemistry, intracranial pressure (ICP), cerebral blood flow (CBF) and brain tissue oxygen (ptiO2) were assessed during the first hour and lesion volume at 2days after ASDH. EPO 20,000IU/rat (i.v.) elevated ICP significantly. EPO at 200 and 2000IU reduced lesion volume from 38.2±0.6mm(3) (NaCl-treated group) to 28.5±0.9 and 22.2±1.3mm(3) (all p<0.05 vs. NaCl). Cortical application of 0.02IU EPO after ASDH evacuation reduced injury from 36.0±5.2 to 11.2±2.1mm(3) (p=0.007), whereas 0.2IU had no effect (38.0±9.0mm(3)). The highest dose of both application routes (i.v. 20,000IU; cortical 2IU) enlarged the ASDH-induced damage significantly to 46.5±1.7 and 67.9±10.4mm(3) (all p<0.05 vs. NaCl). In order to test whether Tween-20, a solvent of EPO formulation 'NeoRecomon®' was responsible for adverse effects two groups were treated with NaCl or Tween-20 after the evacuation of ASDH, but no difference in lesion volume was detected. In conclusion, EPO is neuroprotective in a model of ASDH in rats and was most efficacious at a very low dose in combination with subdural blood removal. High systemic and topically applied concentrations caused adverse effects on lesion size which were partially due to increased ICP. Thus, patients with traumatic ASDH could be treated with cortically applied EPO but with caution concerning concentration.

Rahimi Nedjat M; Wähmann M; Bächli H; Güresir E; Vatter H; Raabe A; Heimann A; Kempski O; Alessandri B

2013-05-01

329

Erythropoietin neuroprotection is enhanced by direct cortical application following subdural blood evacuation in a rat model of acute subdural hematoma.  

Science.gov (United States)

Recombinant human erythropoietin (EPO) has been successfully tested as neuroprotectant in brain injury models. The first large clinical trial with stroke patients, however, revealed negative results. Reasons are manifold and may include side-effects such as thrombotic complications or interactions with other medication, EPO concentration, penetration of the blood-brain-barrier and/or route of application. The latter is restricted to systemic application. Here we hypothesize that EPO is neuroprotective in a rat model of acute subdural hemorrhage (ASDH) and that direct cortical application is a feasible route of application in this injury type. The subdural hematoma was surgically evacuated and EPO was applied directly onto the surface of the brain. We injected NaCl, 200, 2000 or 20,000IU EPO per rat i.v. at 15min post-ASDH (400?l autologous venous blood) or NaCl, 0.02, 0.2 or 2IU per rat onto the cortical surface after removal of the subdurally infused blood t at 70min post-ASDH. Arterial blood pressure (MAP), blood chemistry, intracranial pressure (ICP), cerebral blood flow (CBF) and brain tissue oxygen (ptiO2) were assessed during the first hour and lesion volume at 2days after ASDH. EPO 20,000IU/rat (i.v.) elevated ICP significantly. EPO at 200 and 2000IU reduced lesion volume from 38.2±0.6mm(3) (NaCl-treated group) to 28.5±0.9 and 22.2±1.3mm(3) (all p<0.05 vs. NaCl). Cortical application of 0.02IU EPO after ASDH evacuation reduced injury from 36.0±5.2 to 11.2±2.1mm(3) (p=0.007), whereas 0.2IU had no effect (38.0±9.0mm(3)). The highest dose of both application routes (i.v. 20,000IU; cortical 2IU) enlarged the ASDH-induced damage significantly to 46.5±1.7 and 67.9±10.4mm(3) (all p<0.05 vs. NaCl). In order to test whether Tween-20, a solvent of EPO formulation 'NeoRecomon®' was responsible for adverse effects two groups were treated with NaCl or Tween-20 after the evacuation of ASDH, but no difference in lesion volume was detected. In conclusion, EPO is neuroprotective in a model of ASDH in rats and was most efficacious at a very low dose in combination with subdural blood removal. High systemic and topically applied concentrations caused adverse effects on lesion size which were partially due to increased ICP. Thus, patients with traumatic ASDH could be treated with cortically applied EPO but with caution concerning concentration. PMID:23415790

Rahimi Nedjat, M; Wähmann, M; Bächli, H; Güresir, E; Vatter, H; Raabe, A; Heimann, A; Kempski, O; Alessandri, B

2013-02-13

330

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma  

Directory of Open Access Journals (Sweden)

Full Text Available O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3%), da cor branca (85,1%) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente) e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76%) (p=0,044). Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações.

Yasuda Clarissa Lin; Morita Márcia Elisabete; Nishimori Fernanda Yoshi; Yasuda Agnes Meri; Alves Hélvio Leite

2003-01-01

331

Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy.  

UK PubMed Central (United Kingdom)

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 case 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.

Wayhs SY; Wottrich J; Uggeri DP; Dias FS

2013-04-01

332

Post-traumatic epidural and subdural hematomas of the spinal cord in MR imaging; Pourazowe nadoponowe i podoponowe krwiaki rdzenia kregowego w obrazie MR  

Energy Technology Data Exchange (ETDEWEB)

Diagnostics of epi- and subdural hematomas of the spinal cord is discussed on the basis of 1992 records of Konstancin Rehabilitation Center. 54 patients with symptoms of partial or complete cord injury were submitted to MR imaging. In 4 cases (7.5%) epi- and subdural hematoma was found to contribute to neurological condition of the patient. MRI determines indications for surgical intervention. (author). 6 refs, 6 figs.

Bronarski, J.; Wozniak, E.; Kiwerski, J. [Stoleczne Centrum Rehabilitacji, Konstancin (Poland)]|[Inst. Psychiatrii i Neurologii, Warsaw (Poland)

1993-12-31

333

RI cisternography and CT cisternography in chronic subdural effusion in infancy  

International Nuclear Information System (INIS)

[en] Differential diagnosis has been made more accurately between subdural and subarachnoid effusions in infancy since the introduction of the CT scan. We have four cases where In-DTPA (lmCi) and Metrizamide (5 ml x 170 mgl/dl) were given intrathecally at the same time. These dynamics were followed at intervals of 3, 6, 24, and 48 hours, and the diagnosis of chronic subdural effusion (or hematoma) was made at the time of surgery. The findings of both cisternographies were analyzed in these 4 cases. The dynamics of the two materials in the CSF space were almost the same. Comparing the two materials, CT cisternography delineates the anatomical structures of CSF pathways more clearly and accurately. Cerebral sulci and sylvian fissures were well defined with metrizamide at 3 and/or 6 h, but the subdural space was nonfilling. The diagnosis of the CSF block is significant in determining operative indications. RI cisternography seems to be the better method of detecting abnormal findings regarding convexity flow, especially the asymmetry of cerebral convexity. However, the asymmetrical convexity flow as determining by RI at 24 and/or 48 h corresponds quite closely to asymmetrical sylvian-fissure filling by metrizamide at 3 and/or 6 h. It has been concluded that metrizamide CT cisternography can replace some parts of RI cisternography in studying chronic subdural effusion in infancy. (author)

1980-01-01

334

RI cisternography and CT cisternography in chronic subdural effusion in infancy  

Energy Technology Data Exchange (ETDEWEB)

Differential diagnosis has been made more accurately between subdural and subarachnoid effusions in infancy since the introduction of the CT scan. We have four cases where In-DTPA (lmCi) and Metrizamide (5 ml x 170 mgl/dl) were given intrathecally at the same time. These dynamics were followed at intervals of 3, 6, 24, and 48 hours, and the diagnosis of chronic subdural effusion (or hematoma) was made at the time of surgery. The findings of both cisternographies were analyzed in these 4 cases. The dynamics of the two materials in the CSF space were almost the same. Comparing the two materials, CT cisternography delineates the anatomical structures of CSF pathways more clearly and accurately. Cerebral sulci and sylvian fissures were well defined with metrizamide at 3 and/or 6 h, but the subdural space was nonfilling. The diagnosis of the CSF block is significant in determining operative indications. RI cisternography seems to be the better method of detecting abnormal findings regarding convexity flow, especially the asymmetry of cerebral convexity. However, the asymmetrical convexity flow as determining by RI at 24 and/or 48 h corresponds quite closely to asymmetrical sylvian-fissure filling by metrizamide at 3 and/or 6 h. It has been concluded that metrizamide CT cisternography can replace some parts of RI cisternography in studying chronic subdural effusion in infancy.

Fujiwara, K.; Hayakawa, I. (Bokuto Municipal Hospital of Metropolitan, Tokyo (Japan))

1980-10-01

335

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

DEFF Research Database (Denmark)

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 

Nielsen, Troels Halfeld; Engell, Susanne I

2011-01-01

336

CT manifestation of diffuse brain injury in cases of serious acute subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

Eighty-two adult cases of serious acute subdural hematoma (SDH) of Glasgow Coma Scale 9 or more severe (50 operated-on and 32 non-operated-on cases) were selected in order to study the relation between CT findings at the acute stage and the prognosis of SDH. The CT findings were analyzed in the following respects: size of SDH, midline shift, manifestation of perimesencephalic cisterns, and presence or absence of diffuse hemispheric swelling, diffuse cerebral swelling, subarachnoid hemorrhage, intraventricular hemorrhage, epidural hematoma, hemorrhagic contusion, and dilatation of the contralateral temporal horn. As a result, the most important prognostic signs were found to be: (1) diffuse hemispheric swelling, (2) diffuse cerebral swelling, (3) subarachnoid hemorrhage of the basal-cistern type, (4) intraventricular hemorrhage, (5) deep-seated contusion, (6) complete effacement of the perimesencephalic cisterns, and (7) dilatation of the contralateral temporal horn. These findings, except for the last item, which indicates the final phase of tentorial herniation, were regarded as various patterns of the CT manifestation of diffuse brain injury; the positively associated diffuse brain injury seemed to determine the prognosis of SDH.

Nikaido, Yuji; Shimomura, Takahide; Fujita, Toyohisa; Hirabayashi, Hidehiro; Utsumi, Shozaburo

1987-04-01

337

Automated detection of extradural and subdural hematoma for contrast-enhanced CT images in emergency medical care  

Science.gov (United States)

We have been developing the CAD scheme for head and abdominal injuries for emergency medical care. In this work, we have developed an automated method to detect typical head injuries, rupture or strokes of brain. Extradural and subdural hematoma region were detected by comparing technique after the brain areas were registered using warping. We employ 5 normal and 15 stroke cases to estimate the performance after creating the brain model with 50 normal cases. Some of the hematoma regions were detected correctly in all of the stroke cases with no false positive findings on normal cases.

Hara, Takeshi; Matoba, Naoto; Zhou, Xiangrong; Yokoi, Shinya; Aizawa, Hiroaki; Fujita, Hiroshi; Sakashita, Keiji; Matsuoka, Tetsuya

2007-03-01

338

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

International Nuclear Information System (INIS)

[en] 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 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)

2012-01-01

339

Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature  

Science.gov (United States)

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2?mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.

Utku, Ufuk; Guler, Sibel; Yaln?z, Erol; Unlu, Ercument

2013-01-01

340

Acute infratentorial traumatic subdural hematoma associated with a torn tentorium cerebelli in a one-year-old boy  

International Nuclear Information System (INIS)

The case of a 1-year-old boy with an acute infratentorial subdural hematoma is presented. Surgical intervention revealed a bleeding vein at the edge of a right-sided tentorial tear. Traumatic tentorial tearing has been demonstrated previously only in neonates. Although computed tomography is the most effective method for recognition of this lesion, vertebral angiography may be mandatory for more accurate localization. (orig.)

1982-01-01

 
 
 
 
341

Acute infratentorial traumatic subdural hematoma associated with a torn tentorium cerebelli in a one-year-old boy  

Energy Technology Data Exchange (ETDEWEB)

The case of a 1-year-old boy with an acute infratentorial subdural hematoma is presented. Surgical intervention revealed a bleeding vein at the edge of a right-sided tentorial tear. Traumatic tentorial tearing has been demonstrated previously only in neonates. Although computed tomography is the most effective method for recognition of this lesion, vertebral angiography may be mandatory for more accurate localization.

Vielvoye, G.J.; Peters, A.C.B.; van Dulken, H.

1982-01-01

342

Armoured brain due to chronic subdural collections masking underlying hydrocephalus.  

UK PubMed Central (United Kingdom)

Calcified chronic subdural collection (armoured brain) is a known long-standing complication of shunt overdrainage. We report a young male who became symptomatic eleven years after a shunt surgery. Radiology showed bilateral calcified subdural collections. Drainage of these collections did not help, but shunt revision did. Patients with armoured brain syndrome who suddenly become symptomatic should possibly undergo shunt revision before the more extensive and morbid procedure of drilling the membranes.

Salunke P; Aggarwal A; Madhivanan K; Futane S

2013-02-01

343

Chronic Expanding Hematoma of Thorax Extended to the Neck.  

Science.gov (United States)

We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fl uid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck. PMID:23411837

Ueda, Hitoshi; Baba, Hiromitsu; Ondo, Kaoru

2013-02-15

344

Chronic Expanding Hematoma of Thorax Extended to the Neck.  

UK PubMed Central (United Kingdom)

We report a rare case of chronic expanding hematoma of thorax extended to the neck. An 83-year-old man with a history of Lucite ball plombage and thoracoplasty of bilateral thorax was admitted with numbness of left upper extremity. In 6 months, left supraclavicular fossa was gradually bulged like tumor. The lesion was diagnosed as chronic expanding hematoma. Surgically, Lucite balls were removed with surrounding hematoma debris and fl uid, and neck hematoma, which was slightly communicated to the thorax, was extirpated. We discussed the genesis of this hematoma and its extension to the neck.

Ueda H; Baba H; Ondo K

2013-02-01

345

Postoperative anticoagulation in patients with mechanical heart valves following surgical treatment of subdural hematomas.  

UK PubMed Central (United Kingdom)

BACKGROUND: Thromboembolic events and anticoagulation-associated bleeding events represent frequent complications following cardiac mechanical valve replacement. Management guidelines regarding the timing for resuming anticoagulation therapy following a surgically treated subdural hematoma (SDH) in patients with mechanical valves remains to be determined. OBJECTIVE: To determine optimal anticoagulation management in patients with mechanical heart valves following treatment of SDH. METHODS: Outcomes were retrospectively reviewed for 12 patients on anticoagulation therapy for thromboembolic prophylaxis for mechanical cardiac valves who underwent surgical intervention for a SDH at the Johns Hopkins Hospital between 1995 and 2010. RESULTS: The mean age at admission was 71 years. All patients had St. Jude's mechanical heart valves and were receiving anticoagulation therapy. All patients had their anticoagulation reversed with vitamin K and fresh frozen plasma and underwent surgical evacuation. Anticoagulation was withheld for a mean of 14 days upon admission and a mean of 9 days postoperatively. The average length of stay was 19 days. No deaths or thromboembolic events occurred during the hospitalization. Average follow-up time was 50 months, during which two patients had a recurrent SDH. No other associated morbidities occurred during follow-up. CONCLUSION: Interruptions in anticoagulation therapy for up to 3 weeks pose minimal thromboembolic risk in patients with mechanical heart valves. Close follow-up after discharge is highly recommended, as recurrent hemorrhages can occur several weeks after the resumption of anticoagulation.

Amin AG; Ng J; Hsu W; Pradilla G; Raza S; Quinones-Hinojosa A; Lim M

2013-08-01

346

Imaging CT findings in cases of subdural hematoma after cardiovascular surgery  

International Nuclear Information System (INIS)

A characteristic initial sign of CT findings, as seen in cases of subdural hematoma (SDH) after cardiovascular surgery, was reported. Central-nervous-system (CNS) complications after cardiovascular surgery have been thought to be due mainly to the ischemic brain damage caused by both reduced cerebral perfusion pressure and microembolism during extracorporeal circulation. However, we observed 8 cases of SDH in 39 patients suffering from major CNS complications after cardiovascular surgery. In view of these experiences, SDH was thought to be one of the most significant factors causing CNS complications after cardiovascular surgery. In the sequential CT scans of 8 cases of SDH, four exhibited a typical, small, spotty high-density area in the early period of SDH. The clinical courses of these four patients were relatively acute or subacute, and the initial small high-density area progressed to definite SDH findings in that region in the follow-up CT. These initial findings of CT scans were regarded as ''initial signs of SDH-ISS-''. Although there have been many reports concerning the sequential CT changes in SDH, there has been no report describing the above-mentioned finding. It was emphasized that ''ISS'' is of great importance in the early management for SDH. (author).

1987-01-01

347

Computed tomography of acute subdural hematomas from intracranial aneurysmal ruptures, as seen in relation to angiographic and clinical findings  

International Nuclear Information System (INIS)

[en] Nine cases of acute subdural hematomas, as demonstrated by CT, resulting from cerebral aneurysmal ruptures were reviewed in a series of 450 cases of ruptured aneurysms between January, 1977, and December, 1985. They consisted of two males and seven females ranging in age from 36 to 66 years. Their CT examinations were performed from within 20 minutes to 17 hours from the onset. 1) From CT, cerebral angiographical, surgical, and/or autopsy findings, four of these cases were found to have ruptured aneurysms on the internal carotid artery, two on the middle cerebral artery, and three on the anterior cerebral artery. 2) Seven (78 %) of the cases showed a large aneurysm. 3) In addition to subdural hematomas with variable degrees of thickness and extension, intracerebral hemorrhage was present in all nine cases (100 %), ruptured intraventricular hemorrhage, in two (22 %), and subarachnoid hemorrhage, in six (67 %). 4) On admission, six cases (67 %) were in Grade IV and three (33 %) in Grade V, according to the classification of Hunt and Kosnik. Eight (89 %) had anisocoria, four (44 %) had decerebrate posture, and six (67 %) had fundal hemorrhage. 5) As to the outcome, six (67 %) of these cases died, while three (33 %) are still alive. Two of the survivors are in ADL 5, and one, in ADL 2. All of the fatalities and none of the survivors presented fundal hemorrhage. 6) Therefore, in the case of an acute subdural hematoma from an aneurysmal rupture it may be suggested that the evaluation of the primary brain damage, for which other, accompanying intracranial hemorrhages are also responsible, is important for prognosis and management. (author)

1986-01-01

348

Hematomas na fossa craniana posterior Haematomata in the posterior fossa  

Directory of Open Access Journals (Sweden)

Full Text Available São relatados 6 casos de hematomas sub-tentorias (um de hematoma subdural crônico, quatro de hematomas intra-cerebelares, um de hematoma extra-dural). Salientando a pequena freqüência dos hematomas da fossa craniana posterior, o autor mostra a necessidade de vários exames complementares para o diagnóstico exato, indispensável para a aplicação de terapêutica cirúrgica adequada.Six cases of sub-tentorial haematomata (one chronic sub-dural, four intra-cerebellar, one extra-dural) are reported. Emphasizing the relative rarity of haematomata in the posterior cranial fossa, the author claims the necessity of complementary examinations for proper diagnosis, indispensable for adequate surgical treatment.

Mário S. Cademartori

1969-01-01

349

Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review.  

UK PubMed Central (United Kingdom)

BACKGROUND: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). CASE DESCRIPTION: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature. CONCLUSION: This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.

Akins PT; Axelrod YK; Ji C; Ciporen JN; Arshad ST; Hawk MW; Guppy KH

2013-01-01

350

Cerebral venous sinus thrombosis complicated by subdural hematomas: Case series and literature review  

Science.gov (United States)

Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to the neurointensive care unit. A 38-year-old woman had both SDH and a hemorrhagic venous infarct associated with a transverse sinus thrombosis. She was managed conservatively with long-term anticoagulation. A 68-year-old woman presented with an acute SDH requiring craniotomy and a thrombosed cortical vein was noted intraoperatively. Computed tomography venography showed thrombosis of the superior sagittal sinus. She had polycythemia vera with the V617 Jak2 gene mutation and was managed with aspirin and hydroxyurea. A 60-year-old male had recurrence of a spontaneous convexity SDH requiring reoperation. Neuroimaging identified ipsilateral transverse sinus thrombosis with retrograde flow into the opposite sinus. Manometry demonstrated elevated venous pressures and these normalized after thrombectomy. Angiography performed after endovascular treatment demonstrated a normal venous drainage pattern. There have been limited reports of SDH complicating CVST in the literature. Conclusion: This case series and literature review demonstrates that CVST can also present with spontaneous SDH with or without associated venous infarctions. Treatment must be individualized. This is the first published description of endovascular thrombectomy for recurrent symptomatic SDH due to CVST.

Akins, Paul T; Axelrod, Yekaterina K; Ji, Cheng; Ciporen, Jeremy N.; Arshad, Syed T.; Hawk, Mark W.; Guppy, Kern H.

2013-01-01

351

Rapid resolution of an acute subdural hematoma by increasing the shunt valve pressure in a 63-year-old man with normal-pressure hydrocephalus with a ventriculoperitoneal shunt: a case report and literature review  

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Full Text Available Abstract Introduction Symptomatic subdural hematoma development is a constant concern for patients who have undergone cerebrospinal fluid shunting procedures to relieve symptoms related to normal-pressure hydrocephalus. Acute subdural hematomas are of particular concern in these patients as even minor head trauma may result in subdural hematoma formation. The presence of a ventricular shunt facilitates further expansion of the subdural hematoma and often necessitates surgical treatment, including subdural hematoma evacuation and shunt ligation. Case presentation We present the case of a 63-year-old North American Caucasian man with normal-pressure hydrocephalus with an adjustable valve ventriculoperitoneal shunt who developed an acute subdural hematoma after sustaining head trauma. Conservative treatment was favored over operative evacuation because our patient was neurologically intact, but simple observation was considered to be too high risk in the setting of a low-pressure ventriculoperitoneal shunt. Thus, the valve setting on the ventriculoperitoneal shunt was increased to its maximum pressure setting in order to reduce flow through the shunt and to mildly increase intracranial pressure in an attempt to tamponade any active bleeding and limit hematoma expansion. A repeat computed tomography scan of the head six days after the valve adjustment revealed complete resolution of the acute subdural hematoma. At this time, the valve pressure was reduced to its original setting to treat symptoms of normal-pressure hydrocephalus. Conclusions Programmable shunt valves afford the option for non-operative management of acute subdural hematoma in patients with ventricular shunts for normal-pressure hydrocephalus. As illustrated in this case report, increasing the shunt valve pressure may result in rapid resolution of the acute subdural hematoma in some patients.

Hayes Jackson; Roguski Marie; Riesenburger Ron I

2012-01-01

352

In vivo imaging of twist drill drainage for subdural hematoma: a clinical feasibility study on electrical impedance tomography for measuring intracranial bleeding in humans.  

UK PubMed Central (United Kingdom)

Intracranial bleeding is one of the most severe medical emergencies in neurosurgery. Early detection or diagnosis would largely reduce the rate of disability and mortality, and improve the prognosis of the patients. Electrical Impedance Tomography (EIT) can non-invasively image the internal resistivity distribution within a human body using a ring of external electrodes, and is thus a promising technique to promptly detect the occurrence of intracranial bleedings because blood differs from other brain tissues in resistivity. However, so far there is no experimental study that has determined whether the intracranial resistivity changes in humans could be repeatedly detected and imaged by EIT. Hence, we for the first time attempt to clinically validate this by in vivo imaging the influx and efflux of irrigating fluid (5% dextrose in water, D5W) during the twist-drill drainage operation for the patients with subdural hematoma (SDH). In this study, six patients (four male, two female) with subacute or chronic SDH received the surgical operation in order to evacuate the hematoma around subdural region, and EIT measurements were performed simultaneously on each patient's head. The results showed that the resistivity significantly increased on the corresponding position of EIT images during the influx of D5W and gradually decreased back to baseline during the efflux. In the quantitative analysis, the average resistivity values demonstrated the similar results and had highly linear correlation (R(2) = 0.93 ± 0.06) with the injected D5W volumes, as well as the area of the resistivity gain(R(2) = 0.94 ± 0.05). In conclusion, it was clinically validated that intracranial resistivity changes in humans were detectable and quantifiable by the EIT method. After further technical improvements, EIT has the great potential of being a routine neuroimaging tool for early detection of intracranial bleedings.

Dai M; Li B; Hu S; Xu C; Yang B; Li J; Fu F; Fei Z; Dong X

2013-01-01

353

CT findings of subdural fluid collections and the histology of the organized neomembrane, (2)  

International Nuclear Information System (INIS)

[en] Recently it has been noticed that some cases of low-density subdural fluid collection within several weeks after a head injury later develop a chronic subdural hematoma. To make the pathogenesis clear, the authors investigated the following: (1) whether the neomembrane had already formed prior to the recent head injury or clinical onset of the hematoma, and (2) if the neomembrane was newly formed due to minor hemorrhage mixed with CSF, or whether it was due simply to the isolated CSF. As a result, it has definitely been shown that there are two different processes developing to typical chronic subdural hematoma from low-density subdural fluid collection. One is the intramembraneous rebleeding of the pre-existing resolving chronic subdural hematoma. The other is rebleeding from the newly formed neomembrane, which has been organized as a result of an undetectable minor hemorrhage mixed with CSF through an arachnoidal tear. (author)

1983-01-01

354

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

UK PubMed Central (United Kingdom)

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.

Sano R; Hirasawa S; Awata S; Kobayashi S; Shimada T; Takei H; Takahashi Y; Kominato Y

2013-01-01

355

[Cardiac failure caused by intrapericardial chronic expanding hematoma 18 years after CABG].  

UK PubMed Central (United Kingdom)

Chronic expanding hematoma(CEH)was first recognized by Reid in 1980. It begins to expand chronically more than 1 month after surgery or trauma, which is considered the possible cause of bleeding. It resembles chronic subdural hematoma. Most of the reports on CEH are those in the thoracic cavity or muscles, and few are in the pericardial cavity after open heart surgery. Our case was a 64-year-old male, who had undergone coronary artery bypass grafting (CABG) 18 years before. He presented with symptoms of heart failure such as exertional dyspnea, general fatigue and appetite loss. Computed tomography( CT) scan showed severe compression of the left ventricle by a large mass, and he was diagnosed with intrapericardial CEH. Resection of the severely calcified epicardium as well as removal of the hematoma in the pericardial cavity was performed, and the symptoms of heart failure improved. No recurrence has been noted for 1 year since the operation. A long-term follow-up will be necessary.

Ono H; Abe H; Sakurai Y; Endou H; Chiba K; Oono M; Kitanaka Y; Makuuchi H

2012-09-01

356

Conservative management of subdural hematoma in idiopathic thrombocytopenic purpura: Report of two cases and review of literature  

Directory of Open Access Journals (Sweden)

Full Text Available Intracranial hemorrhage (ICH) is the most serious complication of idiopathic thrombocytopenic purpura (ITP) and is potentially fatal. It is rare, affecting 1% or less of patients and is usually subarachnoid or intracerebral. Isolated subdural hematoma (SDH) is rare and only few cases have been reported. Two cases of acute SDH (ASDH) are reported which resolved with conservative management. One of the patients later developed intracerebral hematoma also. In ITP, contrary to traumatic ASDH, the brain parenchyma is well preserved and hence conservative management may be safe in selected patients. However, only a prospective randomized control study will give the final answer. Both the patients developed the hematoma consequent to low platelet count, which was not detected earlier due to inadequate follow-up. In a developing country, where proper follow-up is often lacking these problems are likely to be more common and are probably underreported. Increased awareness is therefore important to ensure proper follow-up and early intervention.

Sunitha R; Mathew Robert; Thomas Mathew

2007-01-01

357

Chronic spinal subdural abscess mimicking an intradural-extramedullary tumor.  

UK PubMed Central (United Kingdom)

Spinal subdural abscesses (SSA) are very rare disease. The etiologies of SSA are hematogenous spread, iatrogenic contamination, and local extension. Elevated WBC counts, ESR, and C-reactive protein are usually found in laboratory tests. But they are not sensitive indicators of SSA, especially chronic abscesses patient tend to have a less specific characteristic. We report the case of a healthy man with chronic subdural abscess referred to our hospital as an intradural-extramedullary (IDEM) tumor. The patient presented with voiding difficulty and pain in the back and left leg. In a contrast MRI scan, a rim-enhanced mass-like lesion was seen at the L5/S1 level. But adjacent ill-defined epidural fat enhancement that are unusual imaging manifestation for IDEM tumors was seen. He had no fever and normal WBC, ESR, and CRP. In addition, the patient had no previous infection history or other disease, but he did have an epidural block for back pain at another hospital 2 years previously. So, we repeated the MRI with a high-resolution 3-T scanner. The newly taken MR images in our hospital revealed a clear enlargement of lesion size compared to the previous MRI taken 1 week before in other hospital. We suspected a chronic spinal subdural abscess with recent aggravation and immediately performed surgical evacuation. In the surgical field, tensed dura was observed and pus was identified after opening the abscess capsule. Because chronic spinal subdural abscesses are difficult to diagnose, we could differentiate with IDEM tumor exactly and an exact history taking, contrast MRI are required.

Lim HY; Choi HJ; Kim S; Kuh SU

2013-05-01

358

Computerized tomography findings of acute traumatic epidural hematoma  

Energy Technology Data Exchange (ETDEWEB)

During four year period from April, 1977 to March, 1981, 53 cases with acute traumatic epidural hematoma had been encountered out of 430 acute head injured patients examined by computerized tomography (CT) within 24 hours after incurring the trauma. Besides the initial CT, the authors performed contrast enhanced CT (41 cases) and serial CT scanning (31 cases). There were 49 cases of epidural hematoma existing in the supratentorial region, Two cases infratentorial region and 2 cases in the both regions. Two cases of vertex epidural hematoma had been encountered, one of them required vertical scan technique. In 22 (41%) of the 53 patients, the initial CT showed evidence of other cerebral lesions. The most frequent lesion was pneumocephalus (11 cases), 3 cases of them existed in the epidural hematoma. There were also intracerebral hematoma (6 cases), subdural hematoma (4 cases), cerebral contusion (2 cases), intraventricular hemorrhage (2 cases) and 2 cases of them demonstrated ''diffuse traumatic cerebral injury''. During contrast enhanced CT, 11 cases out of 41 cases indicated several enhancement pattern. There were total enhancement of epidural hematoma (2 cases), partial enhancement of hematoma (2 cases) and enhancement of internal margin of hematoma (2 cases). Serial CT scans was performed in 36 out of the 53 patients. Common findings on the serial CT scans were decreased density collection in the subdural space such as subdural effusions or chronic subdural hematomas (8 cases) and enlargement of small epidural hematomas (3 cases). After evacuation of epidural hematoma, there were some cases showing the so-called ''delayed traumatic intracerebral hematoma'' (4 cases), appearance of other epidural hematoma (1 case) and development of small cerebral infarction in the basal ganglia. There was one case indicating appearance of a new epidural hematoma contra lateral to the side of evacuation of subdural hematoma. (J.P.N.).

Kobayashi, Shiro; Nakazawa, Shozo; Yokota, Hiroyuki; Yajima, Kouzo; Yano, Masami; Otsuka, Toshibumi

1984-12-01

359

Refractory diabetes insipidus following drainage of chronic subdural haematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Post-traumatic diabetes insipidus (DI) is a relatively common complication after head injury. The authors report a fatal case of refractory DI, which developed in a patient with chronic subdural haematoma. CASE HISTORY: A 38-year-old woman presented to the emergency room with a headache for over a week. She was alert and neurological examination demonstrated no significant deficits or external wounds in her head. Brain computed tomography (CT) scans revealed a small amount of chronic subdural haematoma bilaterally. She was treated conservatively and her hospital course was uneventful until she developed a convulsive seizure and mental change on the 3rd day after admission. Immediate follow-up CT scans showed no significant change in the amount of haemorrhage except effacement of gyral marking. Bilateral trephination and drainage of the haematoma were performed immediately. Post-operatively, she developed a refractory DI and was managed in the intensive care unit. However, she died on the 6th day after the operation ultimately. CONCLUSION: The authors emphasize the importance of timely drainage of chronic subdural haematoma to prevent a fatal endocrinologic complication after head injury. This study also discusses the possible mechanism of DI after head injury, management and review of the pertinent literatures.

Won YD; Kim CH; Cheong JH; Kim JM

2013-01-01

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Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. OBJECTIVES: To assess the effects of prophylactic anticonvulsants in patients with chronic subdural haematoma, in both the pre- and post-operative periods. SEARCH METHODS: We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), PubMed, LILACS, and the databases clinicaltrials.gov, the WHO International Clinical Trials Reg