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Sample records for chronic subdural hematoma

  1. Chronic subdural hematoma

    Science.gov (United States)

    Subdural hemorrhage - chronic; Subdural hematoma - chronic; Subdural hygroma ... The goal of treatment is to control symptoms and reduce or prevent permanent damage to the brain. Anticonvulsant medications such as carbamazepine, lamotrigine ...

  2. Pathogenesis of chronic subdural hematoma

    International Nuclear Information System (INIS)

    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.)

  3. Postoperative course of chronic subdural hematoma

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

    1983-10-01

    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.

  4. Postoperative course of chronic subdural hematoma

    International Nuclear Information System (INIS)

    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)

  5. Chronic subdural hematoma secondary to traumatic subdural hygroma

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    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

    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.

  6. Chronic subdural hematoma secondary to traumatic subdural hygroma

    International Nuclear Information System (INIS)

    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

  7. Chronic subdural hematoma following electro convulsive therapy

    Directory of Open Access Journals (Sweden)

    Debasish Saha

    2012-01-01

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

  8. Pathogenesis of chronic subdural hematoma

    International Nuclear Information System (INIS)

    In a retrospective examination, the developmental process of chronic subdural haematomas (CSDH) was investigated by means of sequential CT studies. All CSDHs were found to arise from subdural hygromas by means of encapsulation and bleeding into the hygroma content: hypodense, isodense and 'mixed' hyper/hypodense CSDHs were shown to develop due to this mechanism. It is suggested that low intracranial pressure represents the main factor for membrane formation and the development of CSDH of traumatic as well as non-traumatic origin. It is hypothesised that CSDHs are space-filling rather than space-occupying and represent some sort of adaption process to intracranial hypotension. The developmental process described is well suited to explain specific features of CSDH, including membrane formation and the latent interval. (orig.)

  9. Pathogenesis of chronic subdural hematoma. Sequential study with computerized tomography

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-04-01

    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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1981-05-01

    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.

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

    International Nuclear Information System (INIS)

    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)

  12. Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

    OpenAIRE

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

    2015-01-01

    We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemis...

  13. Intracranial Rhabdomyosarcoma Presented as Chronic Subdural Hematoma: A Case Report

    Directory of Open Access Journals (Sweden)

    A. Mahdavi

    2007-10-01

    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.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Antonio Guevara Melcón

    2012-03-01

    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.

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

    International Nuclear Information System (INIS)

    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)

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

    International Nuclear Information System (INIS)

    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.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1987-06-01

    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.).

  20. Chronic subdural hematoma fluid and its computerized tomographic density

    International Nuclear Information System (INIS)

    Laboratory and in vivo CT analysis were performed on 19 chronic subdural hematomas and five subdural hygromas. In these 25 hematoma samples, red blood cells (RBC), hematocrit, and hemoglobin (Hgb) varied greatly, though, these values correlated well with the CT densities. Plasma protein content was fairly constant with an average of 7.1+-0.8g/dl. There were four hematoma samples with RBC of less than 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.)

  1. Process of evolution to chronic subdural hematoma, (1)

    International Nuclear Information System (INIS)

    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)

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

    International Nuclear Information System (INIS)

    Percutaneous subdural tapping for chronic subdural hematoma (CSDH) can measure initial hematoma pressure, which cannot be measured using burr-hole craniotomy. Initial hematoma pressure has not been discussed as a risk factor for recurrence. We evaluated the clinical features for recurrence, which included initial hematoma pressure. The study involved 71 unilateral CSDH cases whose initial hematoma pressure was measured using percutaneous subdural tapping. Clinical recurrence was identified in 19 cases (23%). Age, sex, neurological grading, alcohol consumption, presence of head injury, hypertension, diabetes mellitus, antiplatelet, anticoagulant medication, hematoma volume on computed tomography (CT) images, and initial hematoma pressure were compared between non-recurrence and recurrence groups. The initial hematoma pressure was 12.6±4.5 cmH2O in the non-recurrence group, and 15.5±6.2 cmH2O in the recurrence group (p<0.05). The other factors did not differ significantly except hematoma volume on CT images (92±45 ml in the non-recurrence group and 123±43 ml in the recurrence group, p<0.05). Cases with high initial hematoma pressure should be closely observed. (author)

  3. Recent Changes in Risk Factors of Chronic Subdural Hematoma

    OpenAIRE

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

    2012-01-01

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

  4. Chronic Subdural Hematomas Associated with Arachnoid Cysts: Significance in Young Patients with Chronic Subdural Hematomas

    Science.gov (United States)

    TAKIZAWA, Ken; SORIMACHI, Takatoshi; HONDA, Yumie; ISHIZAKA, Hideo; BABA, Tanefumi; OSADA, Takahiro; NISHIYAMA, Jun; INOUE, Go; MATSUMAE, Mitsunori

    2015-01-01

    Although arachnoid cysts (ACs) are associated with chronic subdural hematomas (CSDHs), especially in young patients, the detailed features of CSDHs associated with ACs remain poorly understood. The objective of this study was to clarify the relationship between the location of CSDHs and ACs and the significance of ACs in young patients with CSDHs. We retrospectively assessed 605 consecutive patients 7 years of age and older who were diagnosed with a CSDH between 2002 and 2014. Twelve patients (2%) had ACs, and 10 of the 12 patients were 7–40 years of age. Patients with ACs as a complication of CSDHs were significantly younger than those without ACs (p < 0.05). Three different relationships between the location of CSDHs and ACs were found: a CSDH contacting an AC, an ipsilateral CSDH apart from an AC, and a CSDH contralateral to an AC. In 21 patients with CSDHs who were 7–40 years of age, 10 (47.6%) had ACs (AC group) and 7 (33.3%) had no associated illnesses (non-AC group). All 10 young patients with ACs showed ipsilateral CSDHs including a CSDH apart from an AC. All 17 patients in both the AC and non-AC groups showed headache but no paresis at admission. The pathogenesis of CSDHs associated with ACs may be different among the three types of locations. The clinical characteristics of patients with a combination of a CSDH and an AC including headache as a major symptom may be attributed to young age in the majority of patients with ACs. PMID:26345665

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1982-05-01

    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.

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

    DEFF Research Database (Denmark)

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

    2013-01-01

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

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

    Czech Academy of Sciences Publication Activity Database

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

    2012-01-01

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

  8. [A case of calcified chronic subdural hematoma wherein MRI was useful for decision of the treatment strategy].

    Science.gov (United States)

    Ito, Miiko; Saito, Shinjiro; Kondo, Rei; Nagahata, Morio; Kayama, Takamasa

    2014-08-01

    Calcified chronic subdural hematoma is a rare condition, representing 0.4-2.6% of all chronic subdural hematomas. It is often difficult to remove the hematoma without damaging the brain, owing to the adhesion between hematoma capsule and brain. Therefore, surgical intervention in managing calcified chronic subdural hematoma cases is still considered controversial. We report a case of calcified chronic subdural hematoma, which was successfully performed under microscopic guidance. A 72-year-old man complained of progressive left hemiparesis of 6-month duration. A CT scan revealed a calcified chronic subdural hematoma, 10 cm long and 4.5 cm thick, in the right convexity. On MRI, T2-weighted images showed a thin layer of cerebrospinal fluid intensity between the hematoma capsule and brain. There was no brain edema adjacent to the chronic subdural hematoma. Based on these MRI observations, we believed that adhesion between the hematoma capsule and brain would be mild. We then planned and succeeded in total removal of the calcified chronic subdural hematoma mass under microscopic guidance. The left hemiparesis disappeared after surgery. The patient was discharged without any neurological deficit. While considering surgical management in calcified chronic subdural hematoma cases, it should be important to evaluate adhesion between the hematoma capsule and brain with MRI. PMID:25087759

  9. Predictors of functional outcomes and recurrence of chronic subdural hematomas.

    Science.gov (United States)

    Leroy, Henri-Arthur; Aboukaïs, Rabih; Reyns, Nicolas; Bourgeois, Philippe; Labreuche, Julien; Duhamel, Alain; Lejeune, Jean-Paul

    2015-12-01

    We aimed to evaluate the functional outcome and risk factors of recurrence in patients operated on for a chronic subdural hematoma (CSH), and discuss systematic early postoperative CT scans. CSH is a very common disease in neurosurgical practice, especially in elderly patients who are treated with anticoagulation. The challenge is to rapidly restore the independence of these patients. We retrospectively analyzed data from 164 consecutive surgical procedures performed on 140 CSH patients, including recurrent surgery, at our institution from June 2011 to June 2012. Pre- and postoperative CT scans, and medical records, were systematically reviewed using the institutional computing database. A poor functional outcome was defined by a modified Rankin scale (mRS) score>2 at 3months. Among the 140 patients (mean age 76years; 64% men), a single burr hole craniostomy was performed in 122 patients, and a craniotomy in 18. A poor functional outcome was recorded in 39 patients (28%; 95% confidence interval [CI] 20-35%). In multivariate analyses, an increased risk of poor functional outcome was associated with age >75years (odds ratio [OR] 5.88; 95% CI 1.96-17.63), residual hematoma thickness >14mm (OR 3.79; 95% CI 1.47-9.77), and GCSCT scan (OR 5.61; 95% CI 1.52-20.66). Three months after surgical treatment, more than one quarter of the CSH patients had a mRS?3. The loss of independence was associated with older age, initial GCS<15, and residual hematoma thickness postoperatively. Anticoagulant therapy and persistence of postoperative mass effect heightened the risk of recurrence. PMID:26260114

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-10-01

    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).

  13. Chronic subdural hematoma associated with moyamoya phenomenon after radiotherapy for medulloblastoma; A case report

    Energy Technology Data Exchange (ETDEWEB)

    Fuse, Takahisa; Takagi, Takuji; Fukushima, Tsuneyuki; Mizuno, Shiroh; Hashimoto, Nobukazu; Suzuki, Osamu (Nagoya City Higashi General Hospital (Japan))

    1994-04-01

    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).

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

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

  15. Intrahemispheric subdural hematoma complicated with chronic neurologic diseases

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

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

  18. MR imaging of shaken baby syndrome manifested as chronic subdural hematoma

    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

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

    Scientific Electronic Library Online (English)

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

    2009-08-01

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

  20. A rat model of chronic subdural hematoma: Insight into mechanisms of revascularization and inflammation.

    Science.gov (United States)

    Quan, Wei; Zhang, Zhifei; Tian, Qilong; Wen, Xiaolong; Yu, Peng; Wang, Dong; Cui, Weiyun; Zhou, Lei; Park, Eugene; Baker, Andrew J; Zhang, Jianning; Jiang, Rongcai

    2015-11-01

    Chronic subdural hematoma (CSDH) is a common neurological occurrence in the elderly population with significant impact on the quality of life and work. Studies have attempted to determine the risk factors and pathophysiological mechanisms of CSDH using models in numerous mammalian species. To date, these animal models have only been able to reproduce limited durations of hematoma which does not accurately reflect the chronic state of CSDH. To address some of these challenges we modified a rat model of CSDH using two consecutive injections of autologous blood resulting in a hematoma of more than three weeks. We observed inflammatory and angiogenic changes related to the development and recovery of CSDH. In this study the technique for producing a CSDH in a small animal model had a success rate of 78.13%. The hematoma was sustainable up to 24 days. Hematoma resolution was associated with a gradual decrease in local pro-inflammatory factors and gradual increase in anti-inflammatory factors as well as proliferation and subsequent maturation of newly formed vessels. These events were also associated with improved behavioral outcome. Expression of anti-inflammatory cytokines also paralleled reabsorption of the hematoma. Reduction in hematoma size was also associated with neurological recovery. These data suggest that vessel maturation and anti-inflammatory pathways may contribute to the resolution of CSDH and neurological recovery. The regulation of the two mechanisms is a potential target for the treatment of CSDH. The modified model of rat CSDH demonstrated a high level of reproducibility in our hands and may be useful in future CSDH studies. PMID:26315377

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2009-01-01

    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. Neuroimaging studies revealed a huge size of epidural space-occupying lesion. Under the impression of epidural abscess, operation was performed. Eventually, the lesion was located at subdural space and was pr...

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

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

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

  4. 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)

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

    Science.gov (United States)

    TAKAHASHI, Koichi; MIMA, Tatsuo; AKIBA, Yoichi

    2016-01-01

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

  6. Intracranial Chronic Subdural Hematoma Presenting with Intractable Headache after Cervical Epidural Steroid Injection

    Science.gov (United States)

    Kim, Myungsoo

    2015-01-01

    Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma. PMID:26361532

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1991-06-01

    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).

  9. Diffuse dural gadolinium MRI enhancement associated with bilateral chronic subdural hematomas.

    Science.gov (United States)

    Blitshteyn, Svetlana; Mechtler, Laszlo L; Bakshi, Rohit

    2004-01-01

    Chronic subdural hematomas (CSDHs) typically present with cognitive dysfunction and a history of trauma. Localized dural enhancement on postcontrast MRI scans associated with the surrounding membrane has been described in CSDH. We present an 83-year-old man with rapidly progressing cognitive dysfunction 4 weeks after head trauma related to a fall. MRI showed CSDHs, which in addition to localized dural gadolinium enhancement, showed a marked diffuse, symmetric, contiguous pachymeningeal enhancement of the supratentorial and infratentorial intracranial dural mater. Meningeal biopsy failed to disclose an infectious or neoplastic cause of the enhancement and instead showed fibrocollagenous change. We conclude that diffuse dural enhancement on MRI scans associated with CSDH cause does not necessarily indicate a superimposed process such as infection or malignancy. CSDH should be considered in the differential diagnosis of diffuse dural enhancement, especially when supported by appropriate clinical findings. PMID:15050219

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

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

    1984-06-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1995-02-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  16. Case report: Extreme levels of serum S-100B in a patient with chronic subdural hematoma

    OpenAIRE

    EricPeterThelin; MalinElisabetPersson

    2012-01-01

    The protein S-100B is a biomarker increasingly used within neurosurgery and neurointensive care. As a relatively sensitive, yet unspecific, indicator of CNS pathology, potential sources of error must be clearly understood when interpreting serum S-100B levels. This case report studied the course of a 46-year-old gentleman with a chronic subdural haemorrhage, serum S-100B levels of 22 ?g/L and a history of malignant melanoma. Both intra- and extra-cranial sources of S-100B are evaluated and im...

  17. Case Report: Extreme Levels of Serum S-100B in a Patient with Chronic Subdural Hematoma

    OpenAIRE

    Persson, Malin Elisabet; Thelin, Eric Peter; Bellander, Bo-Michael

    2012-01-01

    The protein S-100B is a biomarker increasingly used within neurosurgery and neurointensive care. As a relatively sensitive, yet unspecific, indicator of CNS pathology, potential sources of error must be clearly understood when interpreting serum S-100B levels. This case report studied the course of a 46-year-old gentleman with a chronic subdural hemorrhage, serum S-100B levels of 22??g/l, and a history of malignant melanoma. Both intra- and extra-cranial sources of S-100B are evaluated and im...

  18. MRI findings of traumatic spinal subdural hematoma

    International Nuclear Information System (INIS)

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

  19. Subdural hematoma associated with dural metastatic tumor

    International Nuclear Information System (INIS)

    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. (orig.)

  20. Case Report: Extreme Levels of Serum S-100B in a Patient with Chronic Subdural Hematoma.

    Science.gov (United States)

    Persson, Malin Elisabet; Thelin, Eric Peter; Bellander, Bo-Michael

    2012-01-01

    The protein S-100B is a biomarker increasingly used within neurosurgery and neurointensive care. As a relatively sensitive, yet unspecific, indicator of CNS pathology, potential sources of error must be clearly understood when interpreting serum S-100B levels. This case report studied the course of a 46-year-old gentleman with a chronic subdural hemorrhage, serum S-100B levels of 22??g/l, and a history of malignant melanoma. Both intra- and extra-cranial sources of S-100B are evaluated and imply an unclear contribution of several sources to the total serum concentration. Potential sources of error when interpreting serum concentrations of S-100B are discussed. PMID:23227020

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-02-15

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2016-01-01

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

  4. Subdural hematoma after an epidural blood patch.

    Science.gov (United States)

    Verduzco, L A; Atlas, S W; Riley, E T

    2012-04-01

    We report the case of a 37-year-old postpartum patient who developed a contained subacute spinal subdural hematoma causing mass effect on the cauda equina and severe spinal stenosis after undergoing an epidural blood patch for postdural puncture headache. Recovery occurred following administration of oral steroids. PMID:22317890

  5. Comparison of Burr Hole Irrigation and Closed System Drainage Methods After Burr Hole Irrigation in The Treatment of Chronic Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Murat GÜNAL

    2012-06-01

    Full Text Available Objective: Comparison of evacuation of hematoma through burr hole irrigation (BHI and closed system drainage (CSD after burr hole irrigation in the treatment of chronic subdural hematoma (CSDH in terms of relapse.Materials and Methods: 32 patients who were operated with CSDH diagnosis between 2001 and 2008 were retrospectively evaluated with respect to clinical features, etiologic factors, surgical technique and recurrence. Of the 5 recurrent cases in BHI group, 2 (20% received tap and 3 received excision of hematoma via craniotomy. No pathology requiring additional surgery was detected in the follow-up of the patients who underwent BHI-CSD.Conclusion: Closed system drainage through burr hole irrigation in CSDH cases is a simple and reliable method which reduces the risk for recurrence and reoperation and enables evacuation of anticoagulants such as plasminogen and thrombomodulin, products of impaired coagulation- anticoagulation balance.

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

    Science.gov (United States)

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

    2014-08-01

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

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

    Science.gov (United States)

    Meshkini, Ali; Meshkini, Mohammad

    2012-01-01

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

  8. Multiple subdural hematomas associated with breakdancing.

    Science.gov (United States)

    McNeil, S L; Spruill, W A; Langley, R L; Shuping, J R; Leonard, J R

    1987-01-01

    A 17-year-old, previously healthy, male breakdancer presented with a three-month history of crescendo headache and newly identified papilledema. The patient was found to have four separate, unilateral extracranial collections. At surgery, three were subdural hematomas, and one was a probable arachnoid cyst containing a hematoma. These were removed, and the patient made an uneventful recovery with no neurosurgical sequelae. The possibility of serious head injury must be considered when evaluating headache in youngsters who engage in this new and apparently popular dance form. PMID:3800063

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

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2012-01-01

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

  10. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

    OpenAIRE

    Kon, Hiroyuki; Saito, Atsushi; Uchida, Hiroki; Inoue, Mizuho; Sasaki, Tatsuya; Nishijima, Michiharu

    2014-01-01

    Traumatic acute subdural hematoma (ASDH) is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering he...

  11. Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-06-01

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

  12. Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage

    International Nuclear Information System (INIS)

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

  13. MR imaging evaluation of subdural hematomas in child abuse

    International Nuclear Information System (INIS)

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

  14. Dilated pericerebellar fluid space and subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Matsumura, Yasumasa; Kurose, Yoshiko; Tanaka, Masahiro (Kobe Central Municipal Hospital, Kobe (Japan))

    1983-10-01

    It is not uncommon to observe the dilatation of the pericerebellar fluid space (PCFS) on CT images in patients with subdural hematomas. CT scans of 67 patients with supratentorial subdural hematomas (SDH) proven by surgery were reviewed with respect to the dilatation of the PCFS. The dilatation of the PCFS was seen in 31 patients out of the 67 (46%). In 50 patients without SDH (control group), the dilatation of the PCFS was noted in only 6 (12%). Intrathecal metrizamide CT in 4 patients demonstrated that the PCFS was the cerebrospinal fluid (CSF) space. Twelve patients were followed with CT 1 to 12 months after the evacuation of the SDH. The dilatation of the PCFS had disappeared in 4, had slightly increased in volume in 2, and remained unchanged in 6. Although the mechanism of the dilatation of the PCFS in the patients with SDH is not clear, it can be postulated that the mechanism is caused by a CSF flow disturbance, compression, or adhesion of the subarachnoid space due to the SDH. We would like to emphasize that the recognition of PCFS dilatation is a clue to make a CT diagnosis of a SDH, particularly a bilateral isodense SDH.

  15. Dilated pericerebellar fluid space and subdural hematoma

    International Nuclear Information System (INIS)

    It is not uncommon to observe the dilatation of the pericerebellar fluid space (PCFS) on CT images in patients with subdural hematomas. CT scans of 67 patients with supratentorial subdural hematomas (SDH) proven by surgery were reviewed with respect to the dilatation of the PCFS. The dilatation of the PCFS was seen in 31 patients out of the 67 (46%). In 50 patients without SDH (control group), the dilatation of the PCFS was noted in only 6 (12%). Intrathecal metrizamide CT in 4 patients demonstrated that the PCFS was the cerebrospinal fluid (CSF) space. Twelve patients were followed with CT 1 to 12 months after the evacuation of the SDH. The dilatation of the PCFS had disappeared in 4, had slightly increased in volume in 2, and remained unchanged in 6. Although the mechanism of the dilatation of the PCFS in the patients with SDH is not clear, it can be postulated that the mechanism is caused by a CSF flow disturbance, compression, or adhesion of the subarachnoid space due to the SDH. We would like to emphasize that the recognition of PCFS dilatation is a clue to make a CT diagnosis of a SDH, particularly a bilateral isodense SDH. (author)

  16. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Osama Shukir Muhammed Amin

    2014-02-01

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

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

    Science.gov (United States)

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

    2005-12-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2011-06-01

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

  20. The outcome of the acute subdural hematoma

    International Nuclear Information System (INIS)

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

  1. Dynamic CT in the acute subdural hematoma

    International Nuclear Information System (INIS)

    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.)

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

    Scientific Electronic Library Online (English)

    Fernando, Martínez.

    2007-06-01

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

  3. Cerebral Subdural Hematoma Following Spinal Anesthesia: Report of Two Cases

    OpenAIRE

    Karim Nesseri; Fariba Farhadifar; Shoaleh Shami; Mehrdad Moradi

    2012-01-01

    Postdural puncture headache and cerebral subdural hematoma are among complications of spinal anesthesia with some common characteristics; however misdiagnosis of these two could result in a catastrophic outcome or prevent unwanted results by urgent interventions. With the purpose of increasing awareness of such complications and a speedy diagnosis, we report two cases of postspinal anesthesia headache that was timely diagnosed as cerebral subdural hematoma and prevented the likelihood of a di...

  4. Cerebral subdural hematoma following spinal anesthesia: report of two cases.

    Science.gov (United States)

    Moradi, Mehrdad; Shami, Shoaleh; Farhadifar, Fariba; Nesseri, Karim

    2012-01-01

    Postdural puncture headache and cerebral subdural hematoma are among complications of spinal anesthesia with some common characteristics; however misdiagnosis of these two could result in a catastrophic outcome or prevent unwanted results by urgent interventions. With the purpose of increasing awareness of such complications and a speedy diagnosis, we report two cases of postspinal anesthesia headache that was timely diagnosed as cerebral subdural hematoma and prevented the likelihood of a disastrous outcome. PMID:22536262

  5. A Rare Complication of Spinal Anesthesia: Subdural Hematoma

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    Fuldem Y?ld?r?m Dönmez

    2014-03-01

    Full Text Available The most common complication of spinal anesthesia is postdural puncture headache. Any injury of the dura may cause headache. After the injury of the dura, CSF leakage may occur and due to the tension of the veins between the cortex and the dural sinuses, subdural hematoma may be seen. Herein, we present a patient with persistent headache after the spinal anesthesia given during delivery of her baby, and emphasize a rare complication of spinal anesthesia which is subdural hematoma.

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2005-08-01

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

  8. Chronic subdural haematoma.

    Science.gov (United States)

    Luxon, L M; Harrison, M J

    1979-01-01

    A retrospective case note survey of chronic subdural haematomata was carried out in an attempt to throw some light on the difficulties encountered in clinical diagnosis. The combination of raised intracranial pressure headache, fluctuating drowsiness and mild hemiparesis, although highly suggestive of subdural haematoma, is not always encountered, and epilepsy, aphasia, hemianopia and dense hemiplegia can all occur contrary to 'text book' descriptions. Head injury or other aetiological factors are commonly absent. The presentation may mimic tumour, dementia, cerebrovascular accident or subarachnoid haemorrhage. Non-invasive investigations may yield false negative results, although in the case of radionucleide scanning and computerized axial tomography the reliability is approaching 90 per cent. The diagnosis will, however, remain an unexpected finding at angiography in a percentage of cases. PMID:482590

  9. Analysis of infantile subdural hematoma caused by abuse

    International Nuclear Information System (INIS)

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

  10. Hematoma subdural crónico calcificado. Reporte de un caso

    Directory of Open Access Journals (Sweden)

    Ariel Varela Hernández

    2008-01-01

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

  11. Remote Postoperative Epidural Hematoma after Subdural Hygroma Drainage

    OpenAIRE

    Manoel Jacobsen Teixeira; Roger Schmidt Brock; Wellingson Silva Paiva; Arthur Maynart Pereira Oliveira; Almir Ferreira Andrade

    2010-01-01

    Objective. Subdural hygroma is reported to occur in 5%–20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass eff...

  12. Acute Spinal Subdural Hematoma Presenting with Spontaneously Resolving Hemiplegia

    OpenAIRE

    Oh, Seung-Hun; Han, In-Bo; Koo, Young-Ho; Kim, Ok-Joon

    2009-01-01

    Although prompt diagnosis and emergent surgical intervention are important in acute spinal subdural hematoma (SSDH), some cases with spontaneous remission of symptom and hematoma without surgery have been reported. We present a case of acute nontraumatic SSDH presenting with transient left hemiplegia for 4 hours. A magnetic resonance imaging study of cervical spine confirmed SSDH with C3-6 cervical cord compression at the left side. The patient had conservative management without recurrence. ...

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

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    Agon Y Mekaj

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Patrick Mulligan

    2013-01-01

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

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

    OpenAIRE

    Andrew Ng; Victor Romo; Dajie Wang

    2014-01-01

    Intrathecal drug delivery systems are commonly used in the management of chronic pain, cancer pain and neuromuscular disorders with muscle spasticity. The complications associated with in-trathecal pump placement include persistent cerebrospinal fluid (CSF) leak, hygroma, meningitis, and granuloma formation. A severe persistent CSF leak may cause postdural puncture headache along with acute intracranial subdural hematoma, which can be potentially life threatening. Surgical exploration with du...

  16. Spontaneous disappearance of acute subdural hematoma on CT scan

    International Nuclear Information System (INIS)

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

  17. Remote postoperative epidural hematoma after subdural hygroma drainage.

    Science.gov (United States)

    Paiva, Wellingson Silva; Oliveira, Arthur Maynart Pereira; de Andrade, Almir Ferreira; Brock, Roger Schmidt; Teixeira, Manoel Jacobsen

    2010-01-01

    Objective. Subdural hygroma is reported to occur in 5%-20% of all patients with closed head trauma, the treatment is controversial and in symptomatic cases surgical drainage is need. We report on a new case with remote acute epidural hematoma (AEH) after subdural hygroma drainage. Case Presentation. A 38-year-old man suffered blunt head trauma and had diffuse axonal injury grade III in CT scan. A CT scan that was late performed showed an increasing subdural fluid collection with mild mass effect and some effacement of the left lateral ventricle. We perform a trepanation with drainage of a hypertensive subdural collection with citrine aspect. Postoperative tomography demonstrated a large left AEH. Craniotomy and evacuation of the hematoma were performed. Conclusion. The mechanism of remote postoperative AEH formation is unclear. Complete reliance on neurologic monitoring, trust in an early CT scan, and a relative complacency after an apparently successful initial surgery for hygroma drainage may delay the diagnosis of this postoperative AEH. PMID:20671987

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

    Science.gov (United States)

    Schott, M; Gehrke, A; Gaab, M; Jantzen, J-P

    2013-05-01

    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. PMID:23558719

  19. 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

    OpenAIRE

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

    2012-01-01

    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 uri...

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

    OpenAIRE

    JiEun Park; SooMi Lim; Jeong Hyun Yoo

    2011-01-01

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

  1. Postdural puncture subdural hematoma or postdural puncture headache?: two cases report.

    Science.gov (United States)

    Kale, Aydemir; Emmez, Hakan; Pi?kin, Özcan; Durda?, Emre

    2015-10-01

    Spinal anesthesia is widely used for many obstetric, gynecological, orthopedic, and urological operations. Subdural hematomas may occur after trauma and are associated with high morbidity and mortality rates. Postdural puncture headache (PDPH) is a benign condition and the most frequent complication of spinal anesthesia. The high rate of headache after spinal anesthesia may mask or delay the diagnosis of subdural hematoma. The true incidence of postdural puncture subdural hematoma (PDPSH) is unknown because most affected patients are probably managed without investigation. Therefore, the true incidence of PDPSH may be greater than suggested by previous reports. The differentiation of headache associated with subdural hematoma from PDPH is crucial. We herein report two cases of bilateral subdural hematoma after epidural anesthesia and emphasize the importance of suspicion for PDPSH and careful evaluation of patients with headache after spinal anesthesia. PMID:26495064

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

    Scientific Electronic Library Online (English)

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

    2010-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Hematoma subdural intracraniano é uma complicação rara pós-anestesia subaracnóidea. Relatamos dois casos de mulheres que desenvolveram hematoma subdural crônico pós-anestesia subaracnóidea, diagnosticados após a evolução clínica prolongada de cefaleia pós-punção dural (CPP [...] D) e analisamos outros 33 casos encontrados em revisão da literatura. RELATO DOS CASOS: Nos 35 pacientes (idade entre 20-88 anos, 19 homens), 14 tinham mais de 60 anos (40%) sendo 12 (86%) homens. A relação se inverte no grupo de pacientes mais jovens ( Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara postanestesia subaracnoidea. Relatamos aquí dos casos de mujeres que desarrollaron hematoma subdural crónico postanestesia Subaracnoidea, diagnosticados posteriormente a la evolución clínica prolongada de cefalea p [...] ostpunción dural (CPPD), y analizamos otros 33 casos encontrados en una revisión de la literatura. RELATO DE LOS CASOS: En los 35 pacientes (edad entre 20 y 88 años, 19 hombres), 14 tenían más de 60 años (40%) siendo 12 (86%) hombres. La relación se invierte en el grupo de pacientes más jóvenes ( Abstract in english BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication of spinal anesthesia. We report two cases of women who developed chronic subdural hematoma post-spinal anesthesia diagnosed after prolonged clinical evolution of post-dural puncture headache (PDPH) and we analyze other [...] 33 cases found on literature review. CASE REPORTS: In 35 patients (ages 20-88 years, 19 males), 14 were older than 60 years (40%), of which 12 (86%) were males. The relationship is inverted in the group of younger patients (

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

    Science.gov (United States)

    Tanabe, Yuko; Fujinaka, Waso; Takatori, Makoto; Tada, Keiichi

    2013-03-01

    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. PMID:23544334

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

    Scientific Electronic Library Online (English)

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

    2012-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: O hematoma subdural intracraniano é uma complicação rara após raquianestesia. O diagnóstico é muitas vezes difícil porque os sintomas iniciais são os mesmos da cefaleia pós-punção da dura-máter. O objetivo é relatar o caso de um hematoma subdural diag nosticado precocement [...] e, após uma raquianestesia realizada com agulha de calibre fino e punção única. RELATO DO CASO: Paciente de 48 anos, ASA I, submetida a raquianestesia para cirurgia de correção de incontinência urinária. Foi realizada a raquianestesia com agulha 27G Quincke e punção única. A cirurgia foi sem intercorrências, e a paciente recebeu alta hospitalar. Após 48 horas da punção raquidiana, a paciente relatou cefaleia de início súbito, de forte intensidade, acometendo principalmente a região orbitária, mas também a região temporal, com melhora importante no decúbito dorsal e acompanhada de dois episódios de vômitos. Foi solicitada tomografia de crânio que revelou a presença de um hematoma subdural agudo frontotemporoparietal esquerdo. Foi indicado tratamento conservador com analgésicos, dexametasoma e hidantoína. Após 17 dias, apresentou quadro de cefaleia intensa, acompanhada de dormência e paresia do membro superior direito, e distúrbio da fala e comportamento. O hematoma foi drenado cirurgicamente. A paciente evoluiu bem sem sequelas. CONCLUSÕES: A cefaleia é a complicação mais frequente após raquianestesia e é considerada de evolução benigna. Faz com que diagnósticos potencialmente fatais, como o hematoma subdural, não sejam feitos em muitos casos, ou sejam tardios. Este caso descreve uma ocorrência rara, um hematoma subdural agudo após uma raquianestesia com agulha fina em uma paciente sem fatores de risco para sangramento Abstract in spanish JUSTIFICATIVA Y OBJETIVOS: El hematoma subdural intracraneal es una complicación rara posterior a la raquianestesia. El diagnóstico es en muchas ocasiones difícil, porque los síntomas iniciales son los mismos de la cefalea postpunción de la duramadre. El objetivo de este estudio, es relatar el caso [...] de un hematoma subdural diagnosticado rápidamente, y posterior a una raquianestesia realizada con una aguja de calibre fino y punción única. RELATO DEL CASO: Paciente de 48 años, ASA I, sometida a la raquianestesia para la cirugía de corrección de incontinencia urinaria. Fue realizada la raquianestesia con una aguja 27G Quincke y una punción única. La cirugía transcurrió sin problemas, y la paciente recibió alta. Después de 48 horas de efectuada la punción raquídea, la paciente relató cefalea de inicio súbito, de fuerte intensidad, afectando principalmente la región orbitaria, pero también la región temporal, con una mejoría importante en el decúbito dorsal, y acompañada de dos episodios de vómitos. Se le solicitó la tomografía de cráneo que arrojó un hematoma subdural agudo frontotemporoparietal izquierdo. Fue indicado un tratamiento conservador con analgésicos, dexametasoma e hidantoína. Después de 17 días, debutó con un cuadro de cefalea intensa, seguida de adormecimiento y paresia del miembro superior derecho, y un disturbio del habla y del comportamiento. El hematoma fue drenado quirúrgicamente. La paciente evolucionó bien y sin secuelas. CONCLUSIONES: La cefalea es la complicación más frecuente después de la raquianestesia y se le considera de evolución benigna. Ella logra que diagnósticos potencialmente fatales, como el hematoma subdural, se eviten en muchos casos o se hagan más tarde. Este caso describe una aparición rara, un hematoma subdural agudo posterior a una raquianestesia con una aguja fina en una paciente sin factores de riesgo para el sangramiento Abstract in english BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma

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

    Science.gov (United States)

    Mori, Sayano; Kanai, Akifumi; Hoka, Sumio

    2005-04-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-05-01

    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.

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

    International Nuclear Information System (INIS)

    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

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

    OpenAIRE

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

    2009-01-01

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

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

    OpenAIRE

    Chotai, Silky; KIM, JONG-HYUN; Kim, Joo-Han; Kwon, Taek-Hyun

    2013-01-01

    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 cranio...

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

    Directory of Open Access Journals (Sweden)

    Jinping Liu

    2011-01-01

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

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

    Science.gov (United States)

    Cincu, Rafael; de Asis Lorente, Francisco; Rivero, David; Eiras, José; Ara, José Ramón

    2009-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Cincu Rafael

    2009-01-01

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

  13. 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)

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

    2008-08-01

    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 o [...] u, 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. 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 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. 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 those situations, imag

  14. Diagnosis of isodense subdural hematomas by computed tomography

    International Nuclear Information System (INIS)

    Fifteen cases of surgically proved isodense subdural hematoma on CT were studied in the Hanyang University Hospital from Feb. 1979 to Aug. 1981. The medical records and CT films were reviewed. The results were as follows: 1. The age distribution is broad from 12 years to 73 years old. The peak age incidence is in the 6th decade. The most of the cases were male. 2. 12 out of 15 cases were conscious at the time of CT examination, and the rest of them were stuporous or unconscious. 3. 10 out of 15 cases had historys of head injury. In 6 cases the intervals between head injury and CT examination were more than 3 weeks. 4. Skull radiograms showed a fracture in the right frontal bone in 1 case. 5. In computed tomograms shifting of mid-line structures were observed in 14 out of 15 cases, compression and local deformities of the lpsilateral lateral ventricles in 14 cases, dilatation of the contralateral lateral ventricles in 14 cases, unilateral effacement of the cortical sulci in 14 cases

  15. 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

    OpenAIRE

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

    2008-01-01

    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 ob...

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

    Science.gov (United States)

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Sehara, Yoshihide; Hayashi, Yuka; Mimuro, Jun

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

    Background: Persistent/recurrent extra-axial hemorrhage may occur after decompression of a subdural hematoma (SDH) followed by an immediate replacement of bone flap. A fenestration of the bone flap may encourage extra-axial fluid absorption; however, the literature has not explored this technique. Methods: Forty-four consecutive patients who underwent surgical decompression of SDH with immediate replacement of bone flap were divided into two groups: Fenestration (F), n = 33, and no fenestration (NF), n = 11. Fenestration involves placement of twist drill holes 1–2 cm apart throughout the bone flap. Clinical data (age, sex, history of antiplatelet/anticoagulation [AA], and presence of drains) were collected. The size of bone flap, postoperative volume, and midline shift (MLS) were measured. A univariate analysis was performed for continuous variables; Fisher's exact test was performed for categorical variables. Results: For postoperative volume, NF group exhibited 94.4 ± 15.5 cm3, while F group exhibited 47.3 ± 15.5 cm3 (P = 0.04); no AA exhibited 62.9 ± 12.3 cm3, while AA exhibited 100.5 ± 19.0 cm3 (P = 0.07); no drains exhibited 110.1 ± 29.6 cm3, while drains exhibited 63.0 ± 9.1 cm3 (P = 0.14). For postoperative MLS, NF group exhibited 4.8 ± 1.1 mm, while F group exhibited 2.5 ± 1.1 mm (P = 0.16); no AA exhibited 2.3 ± 1.0 mm, while AA exhibited 5.8 ± 1.4 mm (P = 0.048); no drains exhibited 4.6 ± 2.2 mm, while drains exhibited 3.8 ± 0.7 mm (P = 0.70). Accounting for fenestration status and AA status: For F group, AA status did not correlate with postoperative volume or MLS significantly; for NF group, history of AA exhibited higher postoperative value 129.2 ± 26.5 cm3, compared to no history of AA at 59.5 ± 16.2 cm3 (P = 0.03). Conclusion: Our results suggest that fenestration prior to the immediate replacement of bone flap after surgical decompression of SDH has the potential to reduce extra-axial fluid accumulation.

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    V. Umamaheswara Reddy

    2015-03-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

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

    OpenAIRE

    Enny Harliany Alwi

    2009-01-01

    Subdural hematoma (SDH) is a common condition in infancy and young children with a poor prognostic. The more studies related SDH with nonaccidental injury. With the aim to identify the characteristics of SDH in infants below 1 year, a retrospective study of infants below 1 year diagnosed as subdural hematoma who were admitted to PICU Hasan Sadikin General Hospital from Januari 2000 to Desember 2003 has been conducted. Infants less than 1 month and SDH developed after neurosurgery intervention...

  4. 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

    OpenAIRE

    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

    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. ...

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

    Directory of Open Access Journals (Sweden)

    Carlos Fernando Lozano-Tangua

    2009-01-01

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

  6. Misdiagnosed spontaneous intracranial hypotension complicated by subdural hematoma following lumbar puncture

    OpenAIRE

    Louhab N; Adali N; Laghmari M; El Hymer W; Ait Ben Ali S; Kissani N

    2014-01-01

    Nissrine Louhab,1 Nawal Adali,1 Mehdi Laghmari,2 Wafae El Hymer,2 Said Ait Ben Ali,2 Najib Kissani11Neurology Department, 2Neurosurgery Department, University Hospital of Mohammed the VIth, Cadi Ayyad University, Marrakech, MoroccoIntroduction: Spontaneous intracranial hypotension is an infrequent cause of secondary headache due to cerebrospinal fluid (CSF) hypovolemia.Objective: To describe a case of headache revealing spontaneous intracranial hypotension complicated by subdural hematoma fol...

  7. Delayed Onset of Spinal Subdural Hematoma after Vertebroplasty for Compression Fracture: A Case Report

    OpenAIRE

    Lee, Keong Duk; Sim, Hong Bo; Lyo, In Uk; Kwon, Soon Chan; Park, Jun Bum

    2012-01-01

    Vertebroplasty (VP) is a well-known therapeutic modality used to treat pain associated with vertebral compression fractures. Major complications such as cord or root compression, epidural and subdural hematomas (SDH) and pulmonary emboli, occur in less than 1% of patients who undergo VP after compression fracture. Spinal SDH is an extremely rare complication that usually happens a few hours after the procedure. We report a case of spinal SDH that developed at two weeks after a successful VP. ...

  8. Hematoma subdural após punção inadvertida da dura-máter: relato de caso

    Directory of Open Access Journals (Sweden)

    Wallace Lage Duarte

    2008-08-01

    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.

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

    OpenAIRE

    KRISHNAN, Prasad; Jena, Manaranjan; Kartikueyan, Rajaraman

    2015-01-01

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

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

    Scientific Electronic Library Online (English)

    José, Zaclis; Rolando A., Tenuto.

    1955-12-01

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

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

    Science.gov (United States)

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

    1996-06-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-06-01

    Full Text Available Pré-eclâmpsia, síndrome HELLP (hemólise, elevação de enzimas hepáticas e plaquetopenia) e fígado gorduroso agudo da gestação são as principais causas de microangiopatia trombótica e disfunção hepática grave durante a gestação, representando um spectrum do mesmo processo patológico. Relatou-se aqui o [...] caso de uma gestante com 35 semanas internada em unidade de terapia intensiva no pós-operatório imediato de cesariana por morte fetal, com náuseas, vômitos e icterícia. Diagnosticaram-se pré-eclâmpsia pós-parto e fígado gorduroso agudo da gestação. Houve evolução tardia com hematoma subdural agudo e hemorragia intracerebral, sendo realizado tratamento neurocirúrgico. A paciente foi a óbito por anemia hemolítica refratária, com sangramento espontâneo em múltiplos órgãos. Pré-eclâmpsia, síndrome HELLP e fígado gorduroso agudo da gestação são processos patológicos que podem se sobrepor e se associar a complicações potencialmente fatais, como a hemorragia intracraniana aqui descrita. Sua detecção e diagnóstico precoces são fundamentais para a instituição de manejo adequado e sucesso do tratamento. Abstract in english Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The c [...] ase of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    OpenAIRE

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

    2003-01-01

    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) supe...

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

    Science.gov (United States)

    Yamashima, T; Yamamoto, S

    1984-07-01

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

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

    Scientific Electronic Library Online (English)

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

    2011-08-01

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

  17. Dynamic/statis brain scintigraphy: an effective screening test for subdural hematoma

    International Nuclear Information System (INIS)

    Dynamic /sup 99m/Tc-pertechnetate perfusion scintigraphy of the brain was coupled with the delayed static scan in 5,853 studies as a screening test for neurological disease. Of approximately 1,000 patients referred for investigation for possible subdural hematoma (SDH), 23 proved to have SDH at surgery. Their scintigraphic abnormalities were analyzed and classified. When neither study indicates abnormality, angiography is not required, as SDH is unlikely. When the scintigraphic appearance is characteristic of SDH, angiography or surgical exploration is mandatory, since SDH is probably present. When the scintigraphic findings are consistent with but not typical of SDH, the study remains useful as a screening procedure, but the decision to proceed with angiography is based primarily on the neurological course. (auth)

  18. Armoured brain due to chronic subdural collections masking underlying hydrocephalus.

    Science.gov (United States)

    Salunke, P; Aggarwal, A; Madhivanan, K; Futane, S

    2013-08-01

    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. PMID:23421586

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

    OpenAIRE

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

    1998-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-07-15

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

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

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    Enny Harliany Alwi

    2009-09-01

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

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

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    Niteen D Karnik

    2014-01-01

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

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

    Science.gov (United States)

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

    2010-01-01

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

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

    International Nuclear Information System (INIS)

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

  8. Computed tomography of the adult traumatic subdural effusion

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2016-03-01

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

  11. Chronic subdural empyema and cranial vault osteomyelitis due to Salmonella paratyphi A

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    Bhooshan P

    2010-01-01

    Full Text Available Intracranial infections, especially subdural empyema, due to salmonella are rare. Subdural empyema caused by Salmonella paratyphi A has been documented only once earlier in the literature. Hence, we report a case of subdural empyema and osteomyelitis of cranial vault due to S. paratyphi A. A 42- year-old male presented with headache and purulent discharge from right parietal burr hole wound site. Patient gave a history of head injury two years ago. He underwent burr hole evacuation of chronic subdural haematoma, excision of outer membrane and right parietal craniectomy. The cultures grew S. paratyphi A. Recovery was uneventful following surgical intervention and antibiotic therapy.

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

    LENUS (Irish Health Repository)

    Kaliaperumal, Chandrasekaran

    2012-11-01

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

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

    Science.gov (United States)

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

    2016-03-01

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

  14. Traumatic subdural hygroma: five cases with changed density and spontaneous resolution / Higroma subdural traumático: a propósito de cinco casos com modificação de densidade e resolução espontânea

    Scientific Electronic Library Online (English)

    Marco Antonio, Zanini; Luiz Antonio de Lima, Resende; Carlos Clayton Macedo de, Freitas; Seizo, Yamashita.

    2007-03-01

    Full Text Available Analisamos 34 pacientes adultos com higroma subdural traumático quanto à evolução clínica, tomografias seriadas e ressonância magnética. Observou-se aumento da densidade do higroma subdural em cinco dos pacientes durante período que variou de 11 dias a 6 meses após o trauma. Nestes cinco pacientes, [...] a evolução clínica foi favorável e os higromas apresentaram resolução espontânea. Há vários relatos na literatura de modificação da densidade dos higromas subdurais tramáticos, transformando-se em hematoma subdural crônico. Esta casuística apresenta outra possibilidade, ou seja, modificação da densidade, que pode ser apresentada como hematoma subdural pelas imagens de tomografia ou ressonância magnética, mas com resultado final das condições clínicas e de imagem retornando ao normal. Abstract in english Thirty-four consecutive adult patients with subdural traumatic hygroma were analysed for clinical evolution, serial computed tomography scan (CT), and magnetic resonance imaging (MRI) over a period of several months. Five of the patients presented CT scan and MRI evolution data showing increasing de [...] nsity over a period of 11 days to 6 months post trauma. In these five patients, final clinical and CT scan data were benign, with complete spontaneous resolution. Descriptions in literature of evolving traumatic subdural hygroma have presented CT scan density modifications changing into chronic subdural hematoma. Our patients show another possibility, density transformation, which sometimes show as subdural hematoma in CT scan and MRI, but with final evolution where clinical condition and CT scan return to normal.

  15. Traumatic subdural hygroma: five cases with changed density and spontaneous resolution Higroma subdural traumático: a propósito de cinco casos com modificação de densidade e resolução espontânea

    Directory of Open Access Journals (Sweden)

    Marco Antonio Zanini

    2007-03-01

    Full Text Available Thirty-four consecutive adult patients with subdural traumatic hygroma were analysed for clinical evolution, serial computed tomography scan (CT, and magnetic resonance imaging (MRI over a period of several months. Five of the patients presented CT scan and MRI evolution data showing increasing density over a period of 11 days to 6 months post trauma. In these five patients, final clinical and CT scan data were benign, with complete spontaneous resolution. Descriptions in literature of evolving traumatic subdural hygroma have presented CT scan density modifications changing into chronic subdural hematoma. Our patients show another possibility, density transformation, which sometimes show as subdural hematoma in CT scan and MRI, but with final evolution where clinical condition and CT scan return to normal.Analisamos 34 pacientes adultos com higroma subdural traumático quanto à evolução clínica, tomografias seriadas e ressonância magnética. Observou-se aumento da densidade do higroma subdural em cinco dos pacientes durante período que variou de 11 dias a 6 meses após o trauma. Nestes cinco pacientes, a evolução clínica foi favorável e os higromas apresentaram resolução espontânea. Há vários relatos na literatura de modificação da densidade dos higromas subdurais tramáticos, transformando-se em hematoma subdural crônico. Esta casuística apresenta outra possibilidade, ou seja, modificação da densidade, que pode ser apresentada como hematoma subdural pelas imagens de tomografia ou ressonância magnética, mas com resultado final das condições clínicas e de imagem retornando ao normal.

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

    Science.gov (United States)

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

    2012-01-01

    Intracranial hemorrhage is a rare devastating complication of idiopathic thrombocytopenic purpura (ITP), mostly presenting as intraparenchymal or subarachnoid haemorrhage. Isolated chronic subdural haematoma (SDH) is still very rare and the optimal management is unsettled. Spontaneous resolution of chronic SDH in patients with idiopathic thrombocytopenic purpura is possible. We report a case of spontaneous chronic SDH in a patient with ITP with hemiparesis where the haematoma significantly decreased in size with complete resolution of hemiparesis as a result of platelet transfusions and continuing therapy with steroids. Surgical treatment of subdural haematoma with consequent bleeding complications can be avoided in this scenario. PMID:23741595

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-10-01

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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

    Kocaeli, H; Korfali, E

    2008-04-01

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

  20. Shunt site chronic calcified extradural hematoma: An avoidable complication.

    Science.gov (United States)

    Mishra, Sudhansu Sekhar; Satapathy, Mani Charan; Senapati, Satya Bhusan

    2014-05-01

    Extradural hematoma (EDH) after ventriculoperitoneal (VP) shunt procedure is a rare, dangerous but easily avoidable and manageable complication. It is more common in children and young adults presumably due to relatively lax adhesion of dura to calvarium. We report a case of an 18-year-old male with acqueductal stenosis who underwent VP shunt procedure. Three months later, a computed tomography (CT) scan was done for the complaints of intractable headache and altered sensorium which showed chronic calcified EDH near shunt site. The ventricular catheter was in position and the ventricles were decompressed. After surgical decompression of EDH his symptoms improved. We discuss the factors leading to formation of EDH, with stress on proper technique to prevent or minimize such an avoidable complication. PMID:25250078

  1. Post-traumatic subdural hygroma

    International Nuclear Information System (INIS)

    Full text: Introduction: Post-traumatic subdural hygroma (PSH) refers to a relatively common complication of blunt head trauma that consists in cerebrospinal fluid accumulation in the subdural space. Objectives and tasks: The aim of this case presentation is to briefly outline the clinical and imaging signs, the natural history and clinical significance of PSH. Material and methods: An 85-year-old, female patient was admitted to the emergency department with loss of consciousness after falling on the ground. The patient underwent an emergency head CT scan that didn't show any haemorrhagic findings or fractures and the woman was transferred to the Internal Medicine Department with the assumed diagnosis of an ischaemic cerebral stroke. Results: A new CT scan, 3 days later,confirmed the above diagnosis showing a low-density lesion in the area of left basal ganglia. The presence of an ipsilateral subdural parietal fluid accumulation with a density near to cerebrospinal fluid was also noticed. This new finding was compatible with PSH. Conclusion: PSH frequently appears as a late post-traumatic complication missing clinical attention. In most cases, it's treated conservatively because it's usually self-limited.Very rarely, PSH may be large enough to cause mass effect and may require surgical decompression. The entity should be differentiated from chronic subdural hematoma and cerebral atrophy with dilation of the subarachnoid spaces

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

    Scientific Electronic Library Online (English)

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

    2011-06-01

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

  3. Hematoma cerebeloso a distancia

    Scientific Electronic Library Online (English)

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

    2010-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Sebastião Nataniel Silva Gusmão

    2003-09-01

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

  5. Subdural tuberculous abscess of the lumbar spine in a patient with chronic low back pain

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    Miki? Dragan

    2012-01-01

    Full Text Available Introduction. Despite modern imaging methods, tuberculous abscess in the subdural space of the spine can lead to misdiagnosis and to neurogical complications development, even more up to paraplegia. We presented an extremely rare case of subdural tuberculous abscess of the lumbar (L spine and paraparesis in imunocompetent a 49-year-old patient. Case report. A patient with chronic L syndrome and a history of intervertebral (IV disc L3 and L5 operations got severe back pain late in July 2007. At the same time the patient had a purulent collection in the left knee, and was treated with high doses of corticosteroids and antibiotics. Then, the patient got a high fever, the amplification of pain in the L spine and the development of paraparesis. Erythrocyte sedimentation rate was 108 mm/1 h, Creactive protein 106.0 mg/L, white blood cell (WBC 38.4 x 09/L with a left turn. Magnetic resonance imaging (MRI of the spine was registered expansive formation in the spinal canal, from the level of the IV disc L2 to the mid-L4 vertebral body. This finding is a “spoke” in favor of the extrusion and sequestration of IV disc L3 with the cranial and caudal migration. The patient underwent an emergency neurosurgical operation. The diagnosis of subdural staphylococcal abscess of L spine was made. According to the antibiogram antibiotic therapy was applied but without effect on the course of the disease. Control MRI of the L spine showed spondylodiscitis L3/L4, abscess collection in the spinal canal and paravertebral muscle abscess. Late in September 2007 the patient underwent needle biopsy of the L3 vertebral body guided by computed tomography and the acid-fast bacilli (AFB were found. Tuberculostatics were introduced in the therapy. Two years later the patient was without significant personal difficulties, and with normal clinical, laboratory and morphological findings. Conclusion. Subdural tuberculous abscess of the spine is extremely rare manifestation of spine tuberculosis. The exact and early diagnosis and adequate treatment of atypical form of spine tuberculosis are key factors of good prognosis.

  6. Shunt site chronic calcified extradural hematoma: An avoidable complication

    OpenAIRE

    Mishra, Sudhansu Sekhar; Satapathy, Mani Charan; Senapati, Satya Bhusan

    2014-01-01

    Extradural hematoma (EDH) after ventriculoperitoneal (VP) shunt procedure is a rare, dangerous but easily avoidable and manageable complication. It is more common in children and young adults presumably due to relatively lax adhesion of dura to calvarium. We report a case of an 18-year-old male with acqueductal stenosis who underwent VP shunt procedure. Three months later, a computed tomography (CT) scan was done for the complaints of intractable headache and altered sensorium which showed ch...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-12-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

  9. Differentiation of subdural effusions

    International Nuclear Information System (INIS)

    Although X-ray computerized tomography facilitates the diagnosis of intracranial disorders, differentiation of the lesions like extracerebral effusions is often unsatisfactory. Epidural and acute subdural haematoma shown as hyperdensity in CT requires an emergency neurosurgical operation, so that differentiation of these hyperdense effusions may not be required. But the discrimination of the effusions shown as hypodensity in CT (chronic subdural haematoma, subdural hygroma, subdural empyema as well as arachnoid cysts) is urgent because of the different treatment of these effusions. The clinical differentiation is hampered by unspecific neurologic symptoms and the lack of adequate laboratory tests. Some aspects facilitating the diagnostic decision are presented. Recent magnetic resonance (MR) studies promise further progress in differentiating between subdural effusions. (orig.)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2013-04-15

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

  11. No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma.

    Science.gov (United States)

    Phang, I; Sivakumaran, R; Papadopoulos, M C

    2015-11-01

    Introduction Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. Methods All CSDH cases performed at St George's Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. Results A total of 239 patients (median age: 79 years, range: 33-98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1-161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13-6.10, poperation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. Conclusions CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence. PMID:26492904

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2012-06-15

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

  13. Subdural effusion

    Science.gov (United States)

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

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

    Science.gov (United States)

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

    2012-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Erdevi?ki Ljiljana

    2012-01-01

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

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

    Science.gov (United States)

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

    2010-09-01

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

  17. Epidural and subdural stimulation.

    Science.gov (United States)

    Tronnier, V; Rasche, D

    2013-01-01

    Cortical stimulation, either transcranial or by means of electrodes implanted epidurally or subdurally, is used increasingly to treat neuropsychiatric diseases. In cases where transcranial stimulation gives only short-term success, implanted electrodes can yield results that are similar but long-term. Epidural stimulation is used widely to treat chronic neuropathic pain, whereas newer fields are in movement disorders, tinnitus, depression, and functional rehabilitation after stroke. For epidural stimulation, computational models explain the geometry of stimulation parameters (anodal, cathodal, and bifocal) and are used for targeting to yield the best clinical results. Nevertheless, the role of the cerebrospinal fluid layer also has to be taken into consideration. Subdural or intrasulcal stimulation allows a more focused stimulation with lower current intensities. This advantage, however, is counterbalanced by a higher complication rate with regard to epileptic seizures, subdural or intracerebral hemorrhages, and wound infections. PMID:24112907

  18. Hematoma espinal Spinal hematoma

    Directory of Open Access Journals (Sweden)

    Antonio Javier García Medina

    2013-04-01

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

  19. Hematoma espinal / Spinal hematoma

    Scientific Electronic Library Online (English)

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

    2013-04-01

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

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

    International Nuclear Information System (INIS)

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

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

    LENUS (Irish Health Repository)

    Kamel, M H

    2012-02-03

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

  2. Suprarrenal hematoma Hematoma suprarrenal

    Directory of Open Access Journals (Sweden)

    Concepción Guardo B.

    1996-04-01

    Full Text Available Neonatal asymptomatic suprarrenal hemorrhage is relatively frequent; sometimes it is detected only after resolution when a calcification is found; symptomatic forms are rare; most times hemorrhage and hematoma are due to an obstetric trauma and are related to macrosomia, breech presentation, maternal diabetes and neonatal hypoxia. Clinical picture is characterized by abdominal mass and anemia; diagnosis is confirmed by imagenology. Two patients with suprarrenal hematoma from the University Hospital at Cartagena, Colombia, are presented. Both were related with traumatic delivery and cephalohematoma; one of them had oral and gastric bleeding and the othersuffered hematoma infection; diagnosis was done with abdominal ecography and CAT. Both patients recovered with medical treatment. La hemorragia suprarrenal asintomática del neonato es relativamente frecuente y muchas veces se detecta como una calcificación local después de que se resuelve el hematoma. La forma sintomática es rara y, a menudo, se debe a un trauma obstétrico relacionado con la macrosomía fetal, la presentación podálica, la diabetes materna o la hipoxia perinatal. Las manifestaciones clínicas son, principalmente, una masa abdominal y anemia importante; el diagnóstico se confirma con la imaginología. Se presentan dos casos de hematoma suprarrenal derecho tratados en el Hospital Universitario de Cartagena, ambos relacionados con un parto traumático y acompañados de cefalohematomas; uno de ellos presentó sangrado gastrointestinal alto y el otro infección del hematoma suprarrenal. El diagnóstico se comprobó con la ecografía abdominal y se verificó con la tomografía. El tratamiento fue médico y no se requirió cirugía a pesar de la anemia severa que presentó uno de los pacientes.

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

    Science.gov (United States)

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

    2014-04-01

    BACKGROUND. Chronic subdural haematoma (CSDH) is a common condition that increases in incidence with rising age. Evacuation of a CSDH is one of the commonest neurosurgical procedures; however the optimal peri-operative management, surgical technique, post-operative care and the role of adjuvant therapies remain controversial. AIM. We propose a prospective multi-centre audit in order to establish current practices, outcomes and national benchmarks for future studies. METHODS. Neurosurgical units (NSU) in the United Kingdom and Ireland will be invited to enrol patients to this audit. All adult patients aged 16 years and over with a primary or recurrent CSDH will be eligible for inclusion. OUTCOME MEASURES AND ANALYSIS. The proposed outcome measures are (1) clinical recurrence requiring re-operation within 60 days; (2) modified Rankin scale (mRS) score at discharge from NSU; (3) morbidity and mortality in the NSU; (4) destination at discharge from NSU and (5) length of stay in the NSU. Audit standards have been derived from published systematic reviews and a recent randomised trial. The proposed standards are clinical recurrence rate < 20%; unfavourable mRS (4-6) at discharge from NSU < 30%; mortality rate in NSU < 5%; morbidity rate in NSU < 10%. Data will be submitted directly into a secure online database and analysed by the study's management group. CONCLUSIONS. The audit will determine the contemporary management and outcomes of patients with CSDH in the United Kingdom and Ireland. It will inform national guidelines, clinical practice and future studies in order to improve the outcome of patients with CSDH. PMID:24053314

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

    Science.gov (United States)

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

    2015-01-01

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

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

    OpenAIRE

    Akyüz, Mehmet; Çal??kan, Selahattin; Kaya, Cevdet

    2012-01-01

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

  6. Direct subdural scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

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

    1980-06-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

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

    International Nuclear Information System (INIS)

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

  9. Subdural abscess in infant and child

    International Nuclear Information System (INIS)

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

  10. Spinal subdural metastasis

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2015-01-01

    Objectives To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients. Methods The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 1996–2011. Information on potential predictors was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR) were estimated using Poisson regression. Results Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43–1.80), older age (>70 years compared to 20–49 years; RR 1.41, 95% CI: 1.21–1.65), alcohol addiction (RR 1.20, 95% CI:1.04–1.37), surgical treatment (RR 1.76, 95% CI:1.58–1.96), trauma diagnoses (RR 1.14, 95% CI:1.03–1.27), and diabetes mellitus (RR 1.40, 95% CI:1.11–1.74). Out of a selected combination of risk factors, the highest cumulative 1-year recurrence risks for subdural hematoma of 25% (compared to 14% for all patients) was found in surgically treated males with diabetes mellitus. Conclusions The recurrence risk of subdural hematoma is largely limited to the first year. Patient characteristics including co-morbidities greatly influence the recurrence risk of SDH, suggesting that individualized prognostic guidance and follow-up is needed. PMID:26465602

  12. Traumatic rupture of arachnoid cyst with subdural hygroma

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    A Rajesh

    2012-01-01

    Full Text Available Intracranial arachnoid cysts developing in relation to the cerebral hemispheres and middle cranial fossa are usually incidental or asymptomatic. However, most of the clinically active cysts present with seizures because of chronic compression. Presentation as raised intracranial pressure due to cyst rupture into the subdural space is a rare clinical entity. We herein present a case of an asymptomatic arachnoid cyst with rupture into the subdural space bilaterally and presenting as raised intracranial pressure.

  13. Subdural effusion following purulent meningitis

    International Nuclear Information System (INIS)

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

  14. Idiopathic Hypertrophic Cranial Pachymeningitis Misdiagnosed as Acute Subtentorial Hematoma

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    Park, Ik-Seong; Kim, Hoon; Chung, Eun Yong; Cho, Kwang Wook

    2010-01-01

    A case of idiopathic hypertrophic cranial pachymeningitis (IHCP) misdiagnosed as an acute subdural hematoma is reported. A 37-year-old male patient presented with headache following head trauma 2 weeks earlier. Computerized tomography showed a diffuse high-density lesion along the left tentorium and falx cerebri. Initial chest X-rays revealed a small mass in the right upper lobe with right lower pleural thickening, which suggested lung cancer, such as an adenoma or mediastinal metastasis. Dur...

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

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    Cengiz Kaplan

    2015-02-01

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

  16. Arachnoid cyst of the middle fossa and subdural hygroma: an uncommon association

    International Nuclear Information System (INIS)

    The middle fossa is the most common site for arachnoid cysts and the presence of subdural hematomas has been well-established. Occasionally, as a consequence of mild cranial trauma, or even spontaneously, the capsule of the cyst can be damaged, allowing part of the contents to empty into the extra cerebral compartment. We present two cases of congenital arachnoid cysts of middle fossa media complicated by subdural hygroma and intracranial hypertension, and we discuss the possible mechanisms involved in this uncommon association. 9 refs

  17. Rotura de quiste aracnoideo tras traumatismo craneoencefálico leve: Exposición de un caso y revisión de la literatura / Traumatic rupture of arachnoid cyst resulting in acute subdural haematoma: Case report and literature review

    Scientific Electronic Library Online (English)

    F., Moreno Cantero; MP., Suárez Mier; L., Abad Ortiz.

    2005-01-01

    Full Text Available La presencia de un hematoma subdural (HSD) en personas ancianas no constituye un hallazgo inusual, aunque puede ser objeto de complejas consideraciones medicolegales cuando se produce el fallecimiento tras un traumatismo leve reciente. Presentamos el caso de una mujer adulta añosa (87 años) que es a [...] sistida en un servicio de urgencia hospitalario tras sufrir traumatismo craneoencefálico (TCE) por caída en una residencia de la tercera edad, al presentar deterioro progresivo del nivel de conciencia y anisocoria transcurridas varias horas desde el trauma. Se practica tomografía axial computerizada (TAC) craneal sin contraste donde se aprecian lesiones compatibles con HSD crónico con resangrado. El estudio neuropatológico pone de manifiesto la existencia de un HSD agudo sobre quiste aracnoideo roto, hipertensión intracraneal, enclavamiento y hemorragias compatibles con daño axonal difuso grado III. Abstract in english The presence of a subdural hematoma (SDH) in aging people is not uncommon, although it can be the cause of complex medicolegal deliberations when death occurs after a recent head trauma. We present the case of an old woman (87 years old) who is attended in a hospital emergency service after sufferin [...] g a fall with closed head injury, because of progressive stupor and anisocoria several hours later. A chronic SDH with new hemorrhage was diagnosed in a cranial computerized tomography (CT) without contrast. The neuropathological examination showed an acute SDH, arachnoid cyst elements, raised intracraneal pressure lesions with Duret hemorrhage and hemorrhages characteristic of grade III diffuse axonal injury.

  18. Epidural hematomas of posterior fossa

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    Radulovi? Danilo

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

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

  20. Acute subdural empyema

    International Nuclear Information System (INIS)

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

  1. Cerebral venous sinus thrombosis presenting as subdural haematoma

    International Nuclear Information System (INIS)

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

  2. Hematoma epidural subagudo / Subacute epidural hematoma

    Scientific Electronic Library Online (English)

    Yvei, González Orlandi; Luis, Elizondo Barrier; Reinel, Junco Martín; Jorge, Rojas Manresa; Víctor, Duboy Limonta; Alberto, Pérez Villafuerte.

    2011-03-01

    Full Text Available Se presenta el caso de un paciente con hematoma epidural subagudo, temporoparietal derecho, secundario a una agresión física. En el cuadro clínico, a las 24 h, predominó la cefalea de intensidad moderada, con somnolencia y agitación psicomotora ligera. Las radiografías simples de cráneo no mostraron [...] alteraciones. Los síntomas se mantuvieron a pesar del tratamiento médico, por lo que se realizó una tomografía axial simple de cráneo que mostró la presencia de un hematoma epidural subagudo temporoparietal derecho, con desplazamiento de estructuras de la línea media. Se realizó una craneotomía temporoparietal derecha para la evacuación del hematoma posterior. El paciente evolucionó satisfactoriamente y se recuperó por completo, tanto clínica como imaginológicamente. Abstract in english This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographie [...] s didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging.

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

    Scientific Electronic Library Online (English)

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

    2011-10-01

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

  4. Hematoma traumático del psoas

    Scientific Electronic Library Online (English)

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

    2006-12-01

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

  5. Subacute epidural hematoma

    International Nuclear Information System (INIS)

    This is the case of a patient presenting with right temporoparietal subacute hematoma secondary to a physical act of aggression. In clinical picture at 24 hours there was predominance of headache of moderate intensity with drowsiness and slight psychomotor restlessness. The skull single radiographies didn't show alterations. Symptoms remained despite the medical treatment, thus a single skull axial tomography was carried out showing the presence of a right temporoparietal subacute epidural hematoma with displacement from the middle line structures. A right temporoparietal craniotomy was carried out to evacuation of the posterior hematoma. Patient evolved satisfactorily with a total recovery as much clinical as imaging. (author)

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Masuzawa, T.; Sato, F.; Kumagai, M.

    1984-05-01

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

  8. Hematoma intramural esofágico

    Directory of Open Access Journals (Sweden)

    Julián D Martínez M

    Full Text Available El hematoma intramural esofágico es una patología poco frecuente, que puede ser ocasionada por barotrauma de la pared esofágica secundaria a náuseas, vómitos, por cuerpos extraños, por manipulación endoscópica o por condiciones predisponentes como la terapia anticoagulante. En muchos pacientes no existen estos antecedentes y entonces se denomina “espontáneo”. Informamos nueve casos atendidos en nuestra institución.Intramural esophagic hematoma is a rare pathology, which could be caused by barotrauma secondary to nausea, vomiting, foreign bodies, endoscopy, or predisponent conditions such as anticoagulant therapy. In many patients there are not such antecedents so the condition is named “spontaneous”. We report nine cases seen in our institution.

  9. Hematoma intramural esofágico

    Scientific Electronic Library Online (English)

    Julián D, Martínez M; Mario H, Rey T; Juan C, Marulanda G; Martín A, Garzón O; Juan C, Molano V.

    2005-03-30

    Full Text Available El hematoma intramural esofágico es una patología poco frecuente, que puede ser ocasionada por barotrauma de la pared esofágica secundaria a náuseas, vómitos, por cuerpos extraños, por manipulación endoscópica o por condiciones predisponentes como la terapia anticoagulante. En muchos pacientes no ex [...] isten estos antecedentes y entonces se denomina “espontáneo”. Informamos nueve casos atendidos en nuestra institución. Abstract in english Intramural esophagic hematoma is a rare pathology, which could be caused by barotrauma secondary to nausea, vomiting, foreign bodies, endoscopy, or predisponent conditions such as anticoagulant therapy. In many patients there are not such antecedents so the condition is named “spontaneous”. We repor [...] t nine cases seen in our institution.

  10. Rectus sheath hematoma

    OpenAIRE

    Osinbowale, Olusegun; Bartholomew, John R

    2008-01-01

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

  11. Arachnoid cysts with intracystic and subdural haematoma

    International Nuclear Information System (INIS)

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

  12. Arachnoid cysts with intracystic and subdural haematoma.

    Science.gov (United States)

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

    1989-05-01

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

  13. Arachnoid cysts with intracystic and subdural haematoma

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-05-01

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

  14. Sinusitis-induced subdural empyema.

    OpenAIRE

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

    1992-01-01

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

  15. Acute epidural hematoma in children

    International Nuclear Information System (INIS)

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

  16. Spontaneous Rectus Sheath Hematoma

    OpenAIRE

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

    2010-01-01

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

  17. Akinetic mutism and parkinsonism due to subdural and intraventricular tension pneumocephalus.

    Science.gov (United States)

    Lütjens, Götz; Capelle, H Holger; Krauss, Joachim K

    2013-12-01

    Pneumocephalus may occur after intracranial surgery and is most often asymptomatic. It is usually associated with posterior fossa surgery. Here, we present a 56-year-old man who developed akinetic mutism and parkinsonism caused by subdural and intraventricular tension pneumocephalus associated with decompression of a chronic subdural hygroma. As an emergency treatment, air was exchanged with saline via the drainage, which then was removed and a subduro-peritoneal shunt was implanted. The condition described here requires immediate attention and appropriate treatment. PMID:23322598

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

    Scientific Electronic Library Online (English)

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

    2011-06-01

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

  19. Co-presentation of a subdural empyema and an infected ventriculoperitoneal shunt in an adult patient: A rare complication with review of literature

    Science.gov (United States)

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

    2015-01-01

    Background: The occurrence of a subdural empyema as a complication of a ventriculoperitoneal (VP) shunt infection is rare. Only three articles have been published on this topic. Moreover, the available literature only involves pediatric patients. Case Description: The authors present a 38-year-old male with a preexisting right frontal subdural hygroma that developed into a subdural empyema in the presence of an infected right occipital VP shunt. A brief literature review is provided, and the pathogenesis is discussed. Conclusion: This is the first known report regarding an adult patient with a subdural empyema and a VP shunt infection. Although a magnetic resonance imaging (MRI) brain is not typically ordered during diagnosis of a shunt infection, the authors advocate a low threshold to employ MRI brain to evaluate for other sources of infection, especially in an immunocompromised patient or in a patient with a history of a subdural hematoma or hygroma that can be easily overlook as being stable on computed tomography of head. PMID:26539321

  20. Tracer accumulation in a subdural hygroma: case report

    International Nuclear Information System (INIS)

    A surgically proven case of traumatic subdural hygroma gave a ''positive'' image during 111In-DTPA cisternography. This was probably secondary to a communication between the subdural and subarachnoid spaces

  1. A Lethal Complication of Endoscopic Therapy: Duodenal Intramural Hematoma

    Science.gov (United States)

    Calhan, Turan; Kahraman, Resul; Soyda?, Bar??; Tosun, Ali; Cebeci, Egemen

    2015-01-01

    Duodenal intramural hematoma (DIH) usually occurs in childhood and young adults following blunt abdominal trauma. It may also develop in the presence of coagulation disorders and may rarely be an iatrogenic outcome of endoscopic procedures. Management of DIH is usually a conservative approach. A case of intramural duodenal hematoma that developed following endoscopic epinephrine sclerotherapy and/or argon plasma coagulation and that was nonresponsive to conservative therapy in a patient with chronic renal failure who died from sepsis is being discussed in this report. Clinicians should be aware of such possible complications after endoscopic hemostasis in patients with coagulation disorders. PMID:26697240

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

    Science.gov (United States)

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

    2004-10-01

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

  3. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

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

  4. Hepatostomy for central hepatic hematomas

    International Nuclear Information System (INIS)

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

  5. Prevention of Hematomas and Seromas

    OpenAIRE

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

    2006-01-01

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

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

    Science.gov (United States)

    Shah, Nirav H.

    2016-01-01

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

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

    Science.gov (United States)

    Shah, Nirav H; Adams, David

    2016-01-01

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

  8. Coleção subdural na criança: fisiopatologia e tratamento Subdural effusions in children: pathophysiology and treatment

    Directory of Open Access Journals (Sweden)

    Sebastião Gusmão

    1997-06-01

    Full Text Available Nove crianças portadoras de coleção subdural (CSD foram tratadas por meio de derivação subduro-peritoneal. Todas foram submetidas a controle com tomografia computadorizada do encéfalo. O tamanho da coleção subdural foi avaliado por medida de sua área no corte tomográfico por meio de morfologia quantitativa com planímetro. Ocorreu regressão completa ou quase completa da CSD em oito pacientes. Os resultados funcionais foram excelentes em quatro pacientes, bons em três e maus em dois. Foi feita uma revisão da fisiopatologia e do tratamento da CSD na criança.Nine children harboring subdural effusions were treated by subduro peritoneal shunt. These patients were followed-up by CT scans. The area of the subdural effusions was measured by quantitative morphology with a planimeter. With the surgical treatment, the subdural effusion disappeared completely or near completely in 8 patients. The patient's functional state were excellent in 4, good in 3 and bad in 2 in the postoperative follow-up. We aldo reviewed the literature as far as the pathophysiology and the treatment of the subdural effusions are concerned.

  9. Acquired Factor XI Inhibitor Presenting as Spontaneous Bilateral Subdural Hematoma in an Elderly Patient

    OpenAIRE

    Natale Vazzana; Luca Scarti; Chiara Beltrame; Antonella Picchi; Gianni Taccetti; Alberto Fortini

    2014-01-01

    Development of autoantibodies against coagulation factors is an uncommon bleeding disorder associated with cancer, autoimmune conditions, pregnancy, or no apparent disease. Spontaneous FVIII inhibitors are the most frequently encountered; those against FXI have been only anecdotally reported. We report a case of acquired FXI inhibitor presenting as fatal intracranial spontaneous bleeding in an elderly patient with history of cancer and previous transfusions. Few cases of acquired FXI inhibito...

  10. Optimal management of hemophilic arthropathy and hematomas

    Directory of Open Access Journals (Sweden)

    Lobet S

    2014-10-01

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

  11. Is human fracture hematoma inherently angiogenic?

    LENUS (Irish Health Repository)

    Street, J

    2012-02-03

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-02-11

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

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

    OpenAIRE

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

    1999-01-01

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

  14. Bilateral subdural haematoma demonstrated at scintigraphy of the brain

    International Nuclear Information System (INIS)

    Bilateral subdural haematoma is not a rare disorder, but only a few cases diagnosed at brain scintigraphy have been reported. Bilateral subdural haematoma was demonstrated at scintigraphy in a 66-year-old man. Subsequent computerized-tomography scanning of the brain also demonstrated the lesion. After bilateral burr-hole aspiration, the patient made a good recovery. (orig.)

  15. Intracranial subdural hygroma after Le Fort I osteotomy.

    Science.gov (United States)

    Thompson, William L; Lee, Michael; MacIntosh, Robert Bruce

    2015-04-01

    Various intra- and postoperative complications have been well-documented after Le Fort I osteotomies; however, an intracranial subdural hygroma has not yet been reported in oral and maxillofacial studies. We report a unique case of an intracranial subdural hygroma requiring neurosurgical intervention after Le Fort I advancement. PMID:25631863

  16. [Subgaleal hematoma in 2 neonates].

    Science.gov (United States)

    Boumahni, B; Ghazouani, J; Bey, K J; Carbonnier, M; Staquet, P

    2010-10-01

    Subgaleal hematoma in the newborn infant is rare, occurs early, and often bears serious consequences. We report on 2 subacute cases of bruising of the scalp that occurred following the use of a suction cup. Emergency treatment consisted of a transfusion of packed red blood cells and fresh frozen plasma. Children born by use of vacuum extractor or forceps require careful monitoring by the nursing staff throughout their stay in the maternity unit. PMID:20851581

  17. Interventricular septum hematoma during cineventriculography

    Directory of Open Access Journals (Sweden)

    Melzer Christoph

    2008-01-01

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

  18. Late unilateral hematoma after breast augmentation

    OpenAIRE

    Peters, Walter; Fornasier, Victor; HOWARTH, David

    2014-01-01

    Incidence data regarding late hematoma following breast augmentation do not exist, nor has its etiology been elucidated. Hematomas have been reported to develop months to decades after augmentation with various types of implants, even in the absence of trauma. This study reviewed the occurrence of late hematoma in five patients who received smooth, round silicone gel implants in a single-surgeon practice over a 30-year period. All patients presented with progressive enlargement of the involve...

  19. Subungual frictional hematoma due to overriding toe

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-07-01

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

  20. Spontaneous spinal epidural hematoma diagnosed by CT scan

    International Nuclear Information System (INIS)

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

  1. MR imaging of hyperacute intracranial hematomas

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais são realizadas amplamente no nosso meio. A anestesia subdural acidental após punção peridural é uma complicação rara. O objetivo deste relato é descrever dois casos de injeção subdural que coincidentemente ocorreram de forma consecutiva realizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado físico ASA I, a realizar procedimento cirúrgico de retirada de cálculo renal. Optou-se por...

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

    Directory of Open Access Journals (Sweden)

    B Vijayakumar

    2012-01-01

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

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

    Scientific Electronic Library Online (English)

    Isael, Olazábal Armas.

    2011-02-01

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

  5. Hematoma hepático subcapsular por fasciola

    Scientific Electronic Library Online (English)

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

    2003-04-01

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

  6. Intra-uterine hematoma in pregnancy

    DEFF Research Database (Denmark)

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

    1991-01-01

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

  7. Spontaneous extracranial decompression of epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-03-15

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

  8. Multiple cerebral hematoma and viral encephalitis

    Energy Technology Data Exchange (ETDEWEB)

    Zegers de Beyl, D.; Noterman, J.; Martelart, A.; Baleriaux, D.; Flament-Durand, J.

    1980-08-01

    A patient with the clinical diagnosis of brain abcess presented with a CT brain scan showing an intracerebral hematoma. Subsequently bilateral spontaneous hyperdense lesions appeared. Autopsy showed the typical findings of viral encephalitis probably due to herpes simplex. It is stressed that the differential diagnosis of intracerebral hematoma includes viral encephalitis in the proper clinical setting.

  9. The Association Between Arachnoid Cysts and Subdural Hygroma and Spontaneous Resolution of Subdural Higroma

    Directory of Open Access Journals (Sweden)

    Hikmet Turan SUSLU

    2005-12-01

    Full Text Available The association between arachnoid cyst and subdural hygroma (SH is rare. We report a case, presenting of left middle cranial fossa arachnoid cyst with traumatic SH and spontaneous resolution of SH. The patient was totally asymtomatic prior to the injury and his arachnoid cyst was detected incidentally during investigations following minor head trauma. Our case with normal neurological examination was treated symptomatically without surgical intervention and SH was resolved spontaneously.

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

    International Nuclear Information System (INIS)

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

  11. Anestesia subdural após punção peridural: relato de dois casos

    OpenAIRE

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

    2003-01-01

    JUSTIFICATIVA E OBJETIVOS: Anestesias condutivas peridurais são realizadas amplamente no nosso meio. A anestesia subdural acidental após punção peridural é uma complicação rara. O objetivo deste relato é descrever dois casos de injeção subdural que coincidentemente ocorreram de forma consecutiva realizadas pelo mesmo anestesiologista. RELATO DOS CASOS: Caso 1: Paciente do sexo masculino, 41 anos, estado físico ASA I, a realizar procedimento cirúrgico de retirada de cálculo renal. Optou-se por...

  12. Age determination of soft tissue hematomas.

    Science.gov (United States)

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

    2014-11-01

    In clinical forensic medicine, the estimation of the age of injuries such as externally visible subcutaneous hematomas is important for the reconstruction of violent events, particularly to include or exclude potential suspects. Since the estimation of the time of origin based on external inspection is unreliable, the aim of this study was to use contrast in MRI to develop an easy-to-use model for hematoma age estimation. In a longitudinal study, artificially created subcutaneous hematomas were repetitively imaged using MRI over a period of two weeks. The hemorrhages were created by injecting autologous blood into the subcutaneous tissue of the thigh in 20 healthy volunteers. For MRI, standard commercially available sequences, namely proton-density-weighted, T2 -weighted and inversion recovery sequences, were used. The hematomas' MRI data were analyzed regarding their contrast behavior using the most suitable sequences to derive a model allowing an objective estimation of the age of soft tissue hematomas. The Michelson contrast between hematoma and muscle in the proton-density-weighted sequence showed an exponentially decreasing behavior with a dynamic range of 0.6 and a maximum standard deviation of 0.1. The contrast of the inversion recovery sequences showed increasing characteristics and was hypointense for TI = 200ms and hyperintense for TI =1000ms. These sequences were used to create a contrast model. The cross-validation of the model finally yielded limits of agreement for hematoma age determination (corresponding to ±1.96 SD) of ±38.7h during the first three days and ±54 h for the entire investigation period. The developed model provides lookup tables which allow for the estimation of a hematoma's age given a single contrast measurement applicable by a radiologist or a forensic physician. This is a first step towards an accurate and objective dating method for subcutaneous hematomas, which will be particularly useful in child abuse. PMID:25208978

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

    Scientific Electronic Library Online (English)

    Jacinto Barbosa Lay, Chaves; Marcus Sabry Azar, Batista; Ronie Leo, Piske; Kaile de Araújo, Cunha; Kelson James Silva, Almeida.

    2007-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Jacinto Barbosa Lay Chaves

    2007-08-01

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

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

    OpenAIRE

    Jacinto Barbosa Lay Chaves; Marcus Sabry Azar Batista; Ronie Leo Piske; Kaile de Araújo Cunha; Kelson James Silva de Almeida

    2007-01-01

    Descrevemos um paciente de 16 anos que após traumatismo crânio-encefálico leve evoluiu com dor ocular, hematoma palpebral unilateral e proptose do olho esquerdo. Tomografia computadorizada de órbitas evidenciou hematoma subperiosteal em órbita esquerda. Foi realizada drenagem cirúrgica da coleção. O hematoma subperiosteal de órbita, apesar de raro, deve ser incluído como etiologia de proptose ocular e seu diagnóstico deve ser precoce a fim de evitar a morbidade associada.We describe a sixteen...

  16. Cervical Ligamentum Flavum Hematoma: A Case Report.

    Science.gov (United States)

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

    2016-02-01

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

  17. Delayed extradural hematoma : a case report.

    Directory of Open Access Journals (Sweden)

    Alappat J

    2002-07-01

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

  18. Rectus sheath hematoma: three case reports

    OpenAIRE

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlos Escobar Vásquez

    2003-04-01

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

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

    Scientific Electronic Library Online (English)

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

    2003-04-01

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

  1. Serial computed tomographies in subdural effusions following purulent meningitis

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

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

    2004-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Adhemar Pettri Filho

    2006-12-01

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

  4. Nontraumatic spinal epidural hematomas. MR features

    Energy Technology Data Exchange (ETDEWEB)

    Loevblad, K.O. [Dept. of Neuroradiology, Inselspital, Univ. Bern (Switzerland); Baumgartner, R.W. [Dept. of Neurology, Inselspital, Univ. Bern (Switzerland); Zambaz, B.D. [Dept. of Neurosurgery, Inselspital, Univ. Bern (Switzerland); Remonda, L. [Dept. of Neuroradiology, Inselspital, Univ. Bern (Switzerland); Ozdoba, C. [Dept. of Neuroradiology, Inselspital, Univ. Bern (Switzerland); Schroth, G. [Dept. of Neuroradiology, Inselspital, Univ. Bern (Switzerland)

    1997-01-01

    Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images. Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas. (orig.).

  5. Nontraumatic spinal epidural hematomas. MR features

    International Nuclear Information System (INIS)

    Purpose: Spinal epidural hematoma (SEH) is a rare clinical entity with a bleak outcome. The aim of our study was to establish the value of MR findings in the diagnosis of nontraumatic SEH. Material and Methods: Seven patients with nontraumatic SEH were examined by MR at 1.5 T. Two patients were under anticoagulation therapy with heparin, and 2 others were taking salicylic acid. One patient had lupus erythematodes with a marked thrombocytopenia. One patient had a spinal arteriovenous malformation. Results: MR imaging permitted the accurate localization of extradural intraspinal expansive lesions which exhibited the characteristic signal intensities of blood. Five patients underwent laminectomy and evacuation of the hematoma. In the acute phase, the hematomas appeared isointense when compared with the spinal cord on T1-weighted images and hyperintense on T2-weighted images. Later the hematomas were hyperintense on T1-weighted images and showed signals identical to those of cerebrospinal fluid (CSF) on T2-weighted images. Conclusion: MR imaging established the exact diagnosis and localization of SEH in all cases. MR also can provide useful information about the age of the hematomas. (orig.)

  6. Evaluation of Risk Factors for Rectus Sheath Hematoma.

    Science.gov (United States)

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

    2016-04-01

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

  7. Computer tomography of intracranial tumours and hematomas

    International Nuclear Information System (INIS)

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

  8. Delayed epidural hematoma after mild head injury

    Directory of Open Access Journals (Sweden)

    Radulovi? Danilo

    2005-01-01

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

  9. Burrhole simulation for an intracranial hematoma simulator.

    Science.gov (United States)

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

    2007-01-01

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

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

    Scientific Electronic Library Online (English)

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

    2005-04-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-12-01

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

  12. Spontaneous rectus sheath hematoma during rivaroxaban therapy

    OpenAIRE

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

    2014-01-01

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

  13. Concurrent Intracranial and Spinal Subdural Hematoma in a Teenage Athlete: A Case Report of This Rare Entity

    OpenAIRE

    Treister, Daniel S.; Sara E. Kingston; Gabriel Zada; Manu Singh; Jones, Jesse G. A.; Jena N. Mills; Alexander Lerner; Orest B. Boyko; Meng Law; Anandh Rajamohan; Shiroishi, Mark S.

    2014-01-01

    A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical statu...

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Min; Bom, Hee Seung; Song, Ho Chun; Min, Jung Jun; Jeong, Hwan Jeong; Kim, Ji Yeul [Chonnam National Univ. College of Medicine, Kwangju (Korea, Republic of)

    2000-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Hannah Pitanga Lukashok

    2009-12-01

    Full Text Available CONTEXT: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. Risk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. Methods - This is a retrospective observational study made at the "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. RESULTS: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%. Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. CONCLUSION: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal mucosa after previous esophageal variceal sclerotherapy sessions. Impaired coagulation, although not essential, could contribute to hematoma formation and extension through esophageal submucosa.CONTEXTO: Apesar do fato de que a escleroterapia endoscópica de varizes esofágicas vem sendo largamente substituída pela técnica de ligadura elástica, a escleroterapia é ainda rotineiramente utilizada em muitas instituições, especialmente em países em desenvolvimento. O hematoma intramural esofágico é uma complicação rara da escleroterapia e os fatores de risco para seu desenvolvimento ainda não estão completamente estabelecidos. OBJETIVO - Demonstrar a incidência do hematoma intramural esofágico pós-escleroterapia no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, e discutir os possíveis fatores envolvidos. MÉTODOS: Este é um estudo retrospectivo observacional realizado no Hospital Universitário Clementino Fraga Filho, através da revisão dos prontuários médicos de todos os pacientes submetidos a escleroterapia endoscópica de varizes esofágicas entre abril de 2000 e novembro de 2005. Uma avaliação das características clínicas, laboratoriais e endoscópicas desses pacientes e dos descritos na literatura foi realizada. A revisão da literatura foi feita através de pesquisa no MEDLINE. RESULTADOS: Foram realizados 1.433 procedimentos de escleroterapia endoscópica de varizes esofágicas em 397 pacientes, com incidência de hematoma intramural esofágico de 4 casos (0,28%. Três dos quatro pacientes desenvolveram complicações adicionais e um falecimento foi consequência direta do hematoma intramural esofágico. Dezenove casos bem documentados de hematoma intramural esofágico foram descritos na literatura. Na maioria dos casos o hematoma intramural esofágico ocorreu a partir da quarta sessão de escleroterapia endoscópica de varizes esofágicas e distúrbios de coagulação estavam presentes. CONCLUSÃO: O hematoma intramural esofágico é complicação rara da escleroterapia e a incidência no hospital onde foi realizada esta pesquisa foi similar à observada na literatura. Este estudo sugere que essa complicação resulta de mucosa fragilizada por sessões previa de escleroterapia endoscópica de varizes esofágicas.

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

    Scientific Electronic Library Online (English)

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

    2009-12-01

    Full Text Available CONTEXTO: Apesar do fato de que a escleroterapia endoscópica de varizes esofágicas vem sendo largamente substituída pela técnica de ligadura elástica, a escleroterapia é ainda rotineiramente utilizada em muitas instituições, especialmente em países em desenvolvimento. O hematoma intramural esofágico [...] é uma complicação rara da escleroterapia e os fatores de risco para seu desenvolvimento ainda não estão completamente estabelecidos. OBJETIVO - Demonstrar a incidência do hematoma intramural esofágico pós-escleroterapia no Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, RJ, e discutir os possíveis fatores envolvidos. MÉTODOS: Este é um estudo retrospectivo observacional realizado no Hospital Universitário Clementino Fraga Filho, através da revisão dos prontuários médicos de todos os pacientes submetidos a escleroterapia endoscópica de varizes esofágicas entre abril de 2000 e novembro de 2005. Uma avaliação das características clínicas, laboratoriais e endoscópicas desses pacientes e dos descritos na literatura foi realizada. A revisão da literatura foi feita através de pesquisa no MEDLINE. RESULTADOS: Foram realizados 1.433 procedimentos de escleroterapia endoscópica de varizes esofágicas em 397 pacientes, com incidência de hematoma intramural esofágico de 4 casos (0,28%). Três dos quatro pacientes desenvolveram complicações adicionais e um falecimento foi consequência direta do hematoma intramural esofágico. Dezenove casos bem documentados de hematoma intramural esofágico foram descritos na literatura. Na maioria dos casos o hematoma intramural esofágico ocorreu a partir da quarta sessão de escleroterapia endoscópica de varizes esofágicas e distúrbios de coagulação estavam presentes. CONCLUSÃO: O hematoma intramural esofágico é complicação rara da escleroterapia e a incidência no hospital onde foi realizada esta pesquisa foi similar à observada na literatura. Este estudo sugere que essa complicação resulta de mucosa fragilizada por sessões previa de escleroterapia endoscópica de varizes esofágicas. Distúrbios da coagulação, apesar de não serem essenciais, podem contribuir para a formação e extensão do hematoma através da submucosa esofágica. Abstract in english CONTEXT: Although endoscopic esophageal variceal sclerotherapy has been largely supplanted by variceal band ligation, it is still performed routinely in many institutions, especially in developing countries. Intramural esophageal hematoma has been described as a rare complication of sclerotherapy. R [...] isk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the possible factors involved. Methods - This is a retrospective observational study made at the "Hospital Universitário Clementino Fraga Filho", Rio de Janeiro, RJ, Brazil, reviewing the medical records of all esophageal variceal sclerotherapy procedures performed from April 2000 to November 2005. The evaluation of the clinical, laboratorial and endoscopic features in our patients and those reported in the literature was also done. Review of literature was performed through MEDLINE search. RESULTS: A total of 1,433 esophageal variceal sclerotherapy procedures were performed in 397 patients, with an intramural esophageal hematoma incidence of 4 cases (0.28%). Three of our patients developed additional complications, and one death was a direct consequence of a rupture of the hematoma. Nineteen well described cases were reported in the literature. Intramural esophageal hematoma occurred mostly after the forth esophageal variceal sclerotherapy session. Coagulation disturbances were present in the majority of cases. CONCLUSION: Intramural esophageal hematoma is a rare complication of esophageal variceal sclerotherapy and its incidence in our institution was similar to those observed in the literature. Our study suggests that this complication occurs as a result of a fragile esophageal muco

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

    Directory of Open Access Journals (Sweden)

    Salam MT

    2014-12-01

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

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

    International Nuclear Information System (INIS)

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

  20. A Hybrid PDMS-Parylene Subdural Multi-Electrode Array

    OpenAIRE

    Ochoa, Manuel; Wei, Pinghung; Wolley, Andrew; Otto, Kevin J.; Ziaie, Babak

    2013-01-01

    In this paper, we report on a cost effective and simple method for fabricating a flexible multi-electrode array for subdural neural recording. The electrode was fabricated using a PDMS-Parylene bilayer to combine the major advantages of both materials. Mechanical and electrical characterizations were performed to confirm functionality of a 16-site electrode array under various flexed/bent conditions. The electrode array was helically wound around a 3 mm diameter cylindrical tube and laid over...

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

    OpenAIRE

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

    2004-01-01

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

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

    OpenAIRE

    Usoltseva, Natalia; Medina-Flores, Rafael; Rehman, Ateeq; Samji, Swetha; D’Costa, Matthew

    2014-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  4. Spontaneous intraneural hematoma of the sural nerve.

    Science.gov (United States)

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

    2015-04-01

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

  5. Spontaneous bilateral extrapleural hematoma: a case report

    OpenAIRE

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

    2015-01-01

    Extrapleural hematoma (EPH) is a rare condition characterized by the accumulation of blood in the extrapleural space. EPH is generally identified by computed tomography (CT), which shows an inward displacement of extrapleural fat due to intrathoracic peripheral fluid accumulation (Ann Ital Chir 75(83): 5, 2004; J Korean Radiol Soc 49: 89–97, 2003; Monaldi Arch Chest Dis 63(3): 166–169, 2005). EPH has been reported to be associated with chest trauma and injuries. However, the correlation betwe...

  6. Hematoma extradural intrarraquidiano espontâneo: relato de caso

    OpenAIRE

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

    1999-01-01

    Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C4. Foi diagnosticado, por ressonância magnética, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontra-se em acompanhamento fisioterápico e evolui com melhora da motricidade e s...

  7. Hematoma extradural intrarraquidiano espontâneo: relato de caso

    Directory of Open Access Journals (Sweden)

    TANURI FABIANO DA CUNHA

    1999-01-01

    Full Text Available Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C4. Foi diagnosticado, por ressonância magnética, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontra-se em acompanhamento fisioterápico e evolui com melhora da motricidade e sensibilidade.

  8. MR imaging of epidural hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-12-01

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

  9. MR imaging of epidural hematoma in the lumbar spine

    International Nuclear Information System (INIS)

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

  10. An obscure case of hepatic subcapsular hematoma.

    Science.gov (United States)

    Ndzengue, Albert; Hammoudeh, Fadi; Brutus, Pierre; Ajah, Ofem; Purcell, Roland; Leadon, Joseph; Rafal, Richard B; Balmir, Simon; Enriquez, Danilo A; Posner, Gerald L; Jaffe, Eric A; Chandra, Pradeep

    2011-01-01

    Spontaneous liver bleeding is often reported in preeclampsia. It is otherwise rare and has been linked to gross anatomical lesions and coagulopathy. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy. A 41-year-old male, paraplegic for 16 years, presented to the emergency department 3 days after sudden onset of right upper quadrant and shoulder pain. He had been on vitamins and 5,000 units subcutaneous heparin 12-hourly at the nursing home for the last month. He was in no distress, afebrile, with stable vitals. Physical examination showed a diverting colostomy, tender hepatomegaly and sacral decubiti. A fecal occult blood test was negative. There was spastic paraplegia below the level of T12. Two days after admission, the patient was afebrile and hemodynamically stable. PTT, PT, liver profile, BUN and creatinine were all normal, however his hemoglobin had dropped from 11.3 to 7.6 g/dl. An abdominal CT scan revealed an isolated 9.0 × 1.8 cm subcapsular hematoma. The patient received blood transfusion in the intensive care unit and was discharged 7 days later. In conclusion, spontaneous liver hemorrhage occurs in the nonobstetrical population in the setting of gross anatomical lesions or coagulopathy. This is the first report of an isolated subcapsular liver hematoma. PMID:21552450

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

    Science.gov (United States)

    Xiaoyu, Wang; Guoping, Li

    2013-01-01

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

  12. Cisto aracnoideo intracraniano associado com higroma subdural: registro de um caso Intracranial arachnoid cyst with subdural hygroma: a case report

    OpenAIRE

    Aloisio C. Tortelly-Costa; Marcos R.G. de Freitas; Roberto Mauro S. de Sá; Benjamim F. Silva

    1985-01-01

    Relata-se o caso de um menino de 10 anos com um cisto aracnóideo congênito na fossa média direita. Os sintomas foram precipitados por traumatismo crânio-encefálico de moderada intensidade ocorrido alguns dias antes do inicio do quadro clínico. A tomografia axial computadorizada demonstrou a presença de higroma subdural fronto-parietal direito, responsável pela síndrome de hipertensão intracraniana. A influência do cisto na formação do higroma é sugerida. Os mecanismos de crescimento, a etiolo...

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

    Scientific Electronic Library Online (English)

    Rodrigo, Mendonça; Telmo T.F., Lima; Leandro I., Dini; Cláudio L.L., Krebs.

    2005-09-01

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

  14. An Obscure Case of Hepatic Subcapsular Hematoma

    OpenAIRE

    Ndzengue, Albert; Hammoudeh, Fadi; Brutus, Pierre; Ajah, Ofem; Purcell, Roland; Leadon, Joseph; Rafal, Richard B.; Balmir, Simon; Enriquez, Danilo A.; Posner, Gerald L.; Jaffe, Eric A.; Chandra, Pradeep

    2011-01-01

    Spontaneous liver bleeding is often reported in preeclampsia. It is otherwise rare and has been linked to gross anatomical lesions and coagulopathy. We report a case of subcapsular hematoma of the liver without any apparent lesion and in the absence of coagulopathy. A 41-year-old male, paraplegic for 16 years, presented to the emergency department 3 days after sudden onset of right upper quadrant and shoulder pain. He had been on vitamins and 5,000 units subcutaneous heparin 12-hourly at the ...

  15. Idiopathic Adrenal Hematoma Masquerading as Neoplasm

    OpenAIRE

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

    2012-01-01

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

  16. Spontaneous Spinal Epidural Hematoma; a Case Report

    Directory of Open Access Journals (Sweden)

    Maryam Motamedi

    2014-09-01

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

  17. Spontaneous Spinal Epidural Hematoma; a Case Report.

    Science.gov (United States)

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

    2014-01-01

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

  18. Bilateral occipital extradural hematoma in a child

    Science.gov (United States)

    Pandey, Sharad; Sharma, Vivek; Shinde, Neeraj; Sharma, Mukesh

    2015-01-01

    Extradural hematoma (EDH) occurs in approximately 2% of all patients with head injuries. Bilateral EDHs account for 2–10% of all acute EDHs in adults but are exceedingly rare in children. Posterior fossa EDHs occurs in 5% of all cases of EDHs. EDHs in children are more frequently venous (from tears of a dural sinus or diploic veins) and consequently have a better prognosis than EDHs in adults. Once the diagnosis of BEH is confirmed, urgent surgical treatment should be considered. We are reporting such rare form of injury as bilateral occipital EDH with supratentorial extension in 12 years child following road traffic accident.

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

    International Nuclear Information System (INIS)

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

  20. Subcapsular liver hematoma causing cardiac tamponade in HELLP syndrome.

    Science.gov (United States)

    Kinthala, S; Fakoory, M; Greaves, T; Kandamaran, L; Thomas, H; Moe, S

    2012-07-01

    HELLP (hemolysis, elevated liver enzymes and low platelets) syndrome is an obstetric complication with heterogeneous presentation, multisystem involvement and variable prognosis, but which usually resolves after delivery. We report a case of HELLP syndrome with subcapsular hematoma of the liver causing extrapericardial cardiac tamponade. The subcapsular hematoma and cardiac tamponade were managed conservatively. PMID:22658970

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-07-15

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2009-06-15

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Fahri Halit Besir

    2011-01-01

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

  5. Bilateral subdural hygromas following administration of intrathecal methotrexate chemotherapy.

    Science.gov (United States)

    Lewis, Heledd; Mahdi, Ali Jassem; Rowntree, Clare

    2015-01-01

    We report the case of a previously well 58-year-old man who presented with headache and confusion 4?days postadministration of intrathecal methotrexate. He was undergoing intensive chemotherapy (CODOX-M/IVAC, cyclophosphamide, doxorubicin, vincristine, methotrexate, etoposide, ifosfamide, cytarabine) for the treatment of leukaemic phase CD20 negative diffuse large B-cell lymphoma. A CT of the head demonstrated the presence of bilateral subdural hygromas complicated by haemorrhage resulting from coexisting chemotherapy induced thrombocytopenia. Surgical drainage of the hygroma was undertaken but the patient died of overwhelming sepsis. In patients with high-risk lymphoma, directed central nervous system (CNS) therapy is administered either systemically or intrathecally. It is thought that subdural hygromas result from cerebrospinal fluid (CSF) accumulation in the inner dural layers of the cerebral convexities from CSF leak and reduction in CSF pressure post-lumbar puncture. We describe a rare but potentially fatal complication of intrathecal chemotherapy that haemato-oncologists need to be mindful of. PMID:26002663

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

    Directory of Open Access Journals (Sweden)

    Viviana de la Caridad Sáez Cantero

    2010-12-01

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

  7. Hematoma extradural intrarraquidiano espontâneo: relato de caso / Spontaneous extradural spinal hematoma: case report

    Scientific Electronic Library Online (English)

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

    1999-09-01

    Full Text Available Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C4. Foi diagnosticado, por ressonância magnética, he [...] matoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontra-se em acompanhamento fisioterápico e evolui com melhora da motricidade e sensibilidade. Abstract in english We report a case of a 55-year-old woman, that has a mild hypertension, in use of a betablocker drugs, who had a sudden spinal cord compression syndrome with intense cervical pain, tetraplegia and sensitivity level in C4. Extradural spinal hematoma of the cervical spine was diagnosed by magnetic reso [...] nance. The patient underwent a laminectomy and aspiration of the hematoma. The patient is on physiotherapy and presents progressive motor and sensivity improvement.

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

    Directory of Open Access Journals (Sweden)

    Sudhir M Naik

    2015-10-01

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

  9. [Cerebral venous thrombosis and subdural haematoma: complications of spontaneous intracranial hypotension].

    Science.gov (United States)

    Fabricius, J; Klotz, J M; Hofmann, E; Behr, R; Neumann-Haefelin, T

    2012-10-01

    We report on the case of a spontaneous intracranial hypotension with subdural hygroma, as well as cerebral venous thrombosis (CVT), both known complications of intracranial hypotension. The 45-year-old patient was subsequently treated - according to current guidelines for CVT - with anticoagulation, but developed subdural haematoma (SDH), which required neurosurgical treatment. Our case highlights the complex pathophysiological sequelae of intracranial hypotension, as well as the occasionally difficult treatment decisions. Subdural hygroma probably predisposes patients to SDH during anticoagulation. Thus, the potential benefit of anticoagulation needs to be weighed against the risk of SDH on an individual basis. PMID:23033205

  10. Hematoma extradural intrarraquidiano espontâneo: relato de caso Spontaneous extradural spinal hematoma: case report

    OpenAIRE

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

    1999-01-01

    Relatamos o caso de uma mulher de 55 anos, hipertensa leve, em uso de beta bloqueador, que apresentou quadro súbito de síndrome de compressão medular, caracterizado por dor cervical intensa, evoluindo para tetraplegia com nível de sensibilidade em C4. Foi diagnosticado, por ressonância magnética, hematoma intrarraquidiano extradural cervical , que foi aspirado cirurgicamente através de laminectomia. A paciente encontra-se em acompanhamento fisioterápico e evolui com melhora da motricidade e s...

  11. Cisto aracnoideo intracraniano associado com higroma subdural: registro de um caso / Intracranial arachnoid cyst with subdural hygroma: a case report

    Scientific Electronic Library Online (English)

    Aloisio C., Tortelly-Costa; Marcos R. G. de, Freitas; Roberto Mauro S. de, Sá; Benjamim F., Silva.

    1985-03-01

    Full Text Available Relata-se o caso de um menino de 10 anos com um cisto aracnóideo congênito na fossa média direita. Os sintomas foram precipitados por traumatismo crânio-encefálico de moderada intensidade ocorrido alguns dias antes do inicio do quadro clínico. A tomografia axial computadorizada demonstrou a presença [...] de higroma subdural fronto-parietal direito, responsável pela síndrome de hipertensão intracraniana. A influência do cisto na formação do higroma é sugerida. Os mecanismos de crescimento, a etiologia, aspectos clínicos, o diagnóstico e o tratamento cirúrgico dos cistos aracnóideos são discutidos. Abstract in english A case of a 10-year-old boy with a congenital arachnoid cyst in the right middle cranial fossa is reported. The symptoms were precipitated by head injury of moderate intensity, occurred some days before the beginning of the clinical picture. The computerized tomography has demonstrated the existence [...] of a simultaneous right fronto-parietal subdural hygroma that was responsible for the intracranial hypertension syndrome. The influence of the cyst in the hygroma formation has been suggested. The mechanisms of growth, the etiology, clinical aspects, the diagnostics and the surgical treatment of the arachnoid cysts are discussed.

  12. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-15

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

  13. First report of hepatic hematoma after presumed Bothrops envenomation

    Directory of Open Access Journals (Sweden)

    Fernanda Cristina Cunha

    2015-10-01

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

  14. Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Eun Ju; Lee, Ki Nam [Dong-A University College of Medicine, Busan (Korea, Republic of); Kim, In; Chane, Jong Min; Kim, Gun Jik; Yang, Dong Heon; Lee, Jong Min [Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2012-07-15

    A 65-year-old woman visited our hospital with a complaint of acute onset dyspnea and radiological manifestations of pulmonary thromboembolism. The patient underwent an exploratory surgery to find a whitish-blue colored mass occupying almost the whole lumen of the main pulmonary arteries. Based on the pathological and radiological findings, the patient was diagnosed to have a pulmonary arterial intramural hematoma. Intramural hematomas are usually observed in the walls of the aorta, and we believe that an isolated intramural hematoma in the pulmonary artery has not been described previously.

  15. Dabigatran-related Intracerebral Hemorrhage Resulting in Hematoma Expansion

    DEFF Research Database (Denmark)

    Simonsen, Claus Z; Steiner, Thorsten

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

  17. Intramural aortic hematoma: no flap no warning?

    Science.gov (United States)

    Citro, Rodolfo; Panza, Antonello; Masiello, Paolo; Ravera, Amelia; Tedesco, Lucia; Leone, Rocco; Mirra, Marco; Giudice, Roberta; Iesu, Severino; Silvestri, Francesco; Di Benedetto, Giuseppe; Bossone, Eduardo

    2011-03-01

    We report a case of type A intramural aortic hematoma (IMH) occurred in a 78 years old female. The clinical scenario (medical history of hypertension, severe substernal chest pain, early diastolic decrescendo murmur as for aortic insufficiency), the laboratory results (no significant troponin level), ECG and transthoracic echocardiography findings (no signs of myocardial ischemia) shifted the initial diagnostic suspicion from acute coronary syndrome to the acute aortic syndrome (AAS) and triggered further imaging tests. Computed tomography revealed an aneurismatic dilatation with thickening of the wall of the ascending aorta without intimal flap. No particular "warning message" for evidence of AAS was sent to the clinician on call. Subsequently, due to the persisting high clinical suspicion transesophageal echocardiography (TEE) was performed. TEE confirmed the aneurysm of the ascending aorta and highlighted an extended and marked aortic wall thickness, consisting with the diagnosis of type A IMH. Patient underwent urgent cardiac surgery that confirmed the diagnosis. PMID:21751738

  18. Computed tomographic investigations on intraventricular hematomas

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1992-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Aslihan KOSEOGLU

    2010-12-01

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

  1. Idiopathic intraparenchymal hematoma of the liver in a neonate

    International Nuclear Information System (INIS)

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

  2. Idiopathic intraparenchymal hematoma of the liver in a neonate

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1975-04-01

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

  4. Hand-held instrument should relieve hematoma pressure

    Science.gov (United States)

    Raggio, L. J.; Robertson, T. L.

    1967-01-01

    Portable instrument relieves hematomas beneath fingernails and toenails without surgery. This device simplifies the operative procedure with an instant variable heating tip, adjustable depth settings and interchangeable tip sizes for cauterizing small areas and relieving pressurized clots.

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

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-10-15

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

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2011-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Mitra S

    2001-04-01

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

  10. Subdural collections associated with pediatric bacterial meningitis MR imaging

    International Nuclear Information System (INIS)

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-09-15

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

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

    2009-09-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

  16. Sonographically Diagnosed Vault Hematomas Following Vaginal Hysterectomy and Its Correlation with Postoperative Morbidity

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    Cem Dane

    2007-02-01

    Full Text Available Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. Results. The incidence of vault hematoma was found 19.4% in present study. In these patients, 40% (8/20 had fever while only 2.4% (2/83 of cases without vault hematoma suffered from fever. Out of all women having vault hematoma, 70% (14/20 had small-sized hematoma and 30% (6/20 had large-sized hematoma. Fifty percent of patients (3/6 with large-sized hematoma, as compared to only 35% (5/14 with small-sized hematoma, suffered from febrile morbidity. Large-sized hematomas drained by vaginally, while all small-sized pelvic hematomas managed by watchful expectancy successfully. The significant difference was found mean hemoglobin drop and postoperative stay in the hematoma group or without hematoma group. Conclusion. Sonographic detection of vaginal vault fluid collection is common after hysterectomy, but such a finding rarely indicates additional treatment. Though febrile morbidity was more in cases with vault hematoma, the number of such patients was too small to be significant. Vaginal ultrasound examination should not be performed routinely after hysterectomy.

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

    International Nuclear Information System (INIS)

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

  18. Spontaneous bacterial seeding of a biceps hematoma.

    Science.gov (United States)

    Frye, Benjamin; Prud'homme, Joseph; Daney, Blake

    2010-11-01

    A 19-year-old male construction worker presented with an injury to his left upper arm after lifting a heavy pipe. He reported an acute onset of sharp pain followed by swelling, warmth, and weakness with elbow flexion. The diagnosis of a distal biceps tendon rupture was made and elective repair was scheduled. Seventy-two hours later, the patient presented with a spontaneous draining wound on his anterior distal humerus. The wound was draining thick purulent material. The patient underwent surgery for irrigation and debridement of his abscess. Nearly 500 cc of hematoma and purulent fluid were evacuated. A large tear of both the biceps and brachialis muscle bellies were found. Cultures were obtained that revealed the infecting organism to be Streptococcus intermedius. Human immunodeficiency virus and hepatitis-C virus testing were negative, and no history, signs, or symptoms of any cause of underlying immunodeficiency were detected. No signs or history of drug use were present. He was discharged home on culture-specific oral antibiotics. At 4-month postoperative follow-up, the patient reported no pain or limitations. He has returned to full duty at his job. Elbow range of motion was measured from 7° to 150° of flexion. Strength of elbow flexion and extension was symmetric to the uninjured side. Pronation and supination of the forearm was symmetric on both sides. He has been released from scheduled follow-up and will be seen again on an as-needed basis. PMID:21053873

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

    Directory of Open Access Journals (Sweden)

    JUAN L MORALES G

    2009-02-01

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

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

    Scientific Electronic Library Online (English)

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

    2009-02-01

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

  1. Hematoma esofágico intramural: de la disección a la perforación / Intramural esophageal hematoma: Dissection of the perforation

    Scientific Electronic Library Online (English)

    Martin, Gómez Zuleta; Álvaro, Rodríguez Gómez; Amaranto, Siado.

    2012-06-30

    Full Text Available El hematoma esofágico intramural es una entidad infrecuente, con pocos casos registrados en la literatura. Existen factores de riesgo que favorecen la aparición de esta condición como las náuseas y el vómito. Su presentación clínica más frecuente es la tríada de hematemesis, disfagia y dolor torácic [...] o. El tratamiento es conservador en la mayoría de los casos. En este trabajo presentamos nuestra experiencia en 7 casos recolectados durante los últimos 8 años, en los cuales se puede apreciar todo el espectro de la enfermedad desde la disección submucosa hasta la perforación del esófago Abstract in english Intramural esophageal hematomas are rare with few cases reported in the literature. Risk factors that affect the incidence of this condition include nausea and vomiting, but its most common clinical presentation is the triad of hematemesis, dysphagia and chest pain. Conservative treatment is best in [...] most cases. We present our experience in 7 cases collected during the last 8 years in which you can see the entire spectrum of the disease from submucosal dissection to perforation of the esophagus

  2. Hematoma esofágico intramural: de la disección a la perforación Intramural esophageal hematoma: Dissection of the perforation

    Directory of Open Access Journals (Sweden)

    Martin Gómez Zuleta

    Full Text Available El hematoma esofágico intramural es una entidad infrecuente, con pocos casos registrados en la literatura. Existen factores de riesgo que favorecen la aparición de esta condición como las náuseas y el vómito. Su presentación clínica más frecuente es la tríada de hematemesis, disfagia y dolor torácico. El tratamiento es conservador en la mayoría de los casos. En este trabajo presentamos nuestra experiencia en 7 casos recolectados durante los últimos 8 años, en los cuales se puede apreciar todo el espectro de la enfermedad desde la disección submucosa hasta la perforación del esófagoIntramural esophageal hematomas are rare with few cases reported in the literature. Risk factors that affect the incidence of this condition include nausea and vomiting, but its most common clinical presentation is the triad of hematemesis, dysphagia and chest pain. Conservative treatment is best in most cases. We present our experience in 7 cases collected during the last 8 years in which you can see the entire spectrum of the disease from submucosal dissection to perforation of the esophagus

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

    Directory of Open Access Journals (Sweden)

    Zhi JIANG

    2015-08-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

    M., Bermejo; E., Castañón; P., Fervienza; F., Cosío; M., Carpintero; M. L., Díaz-Fernández.

    2004-11-01

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

  6. Post meningitis subdural hygroma: Anatomical and functional evaluation with 99mTc-ehylene cysteine dimer single photon emission tomography/computed tomography

    OpenAIRE

    Sharma, Punit; Mishra, Ajiv; Arora, Geetanjali; Tripathi, Madhavi; Bal, Chandrasekhar; Kumar, Rakesh

    2013-01-01

    Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. 99mTc-ehylene cysteine dimer (99mTc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cereb...

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

    Science.gov (United States)

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

    1990-03-01

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

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

    Directory of Open Access Journals (Sweden)

    GUILHERME BORGES

    2000-09-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.Paciente de 74 anos acordou à noite sentindo fortes dores na região da nuca acompanhadas de ansiedade e desconforto torácico e respiratório. A internação emergencial em clinica cardiológica não demonstrou problemas cardíacos. Com a progressão do quadro neurológico traduzida por quadriplegia severa foi realizada uma punção lombar para afastar hipótese de meningite, sendo retirados cerca de 20 ml de liquor. Trinta minutos imediatamente após a punção lombar foi observada completa remissão do déficit neurológico. Transferido para um hospital geral a tomografia computadorizada demonstrou extenso hematoma epidural espinal em nivel C4/C5 com extensão a C7/Th1, bem como hemangioma do sexto corpo vertebral (C6. A ressonância magnética demonstrou as mesmas lesões. Observando-se os parâmetros clínicos e neurológicos, optou-se por tratamento conservador. Dezoito meses após este episódio o paciente se apresenta normal, sem deficit residual. Neste artigo, relatamos um caso de completa recuperação de déficit neurológico devido a hematoma epidural espinal, após forma não usual de descompressão medular.

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

    Scientific Electronic Library Online (English)

    GUILHERME, BORGES; LEONARDO, BONILHA; MARCOS VINICIUS CALFAT, MALDAUM; JOSÉ RIBEIRO, MENEZES; VERÔNICA, ZANARDI.

    2000-09-01

    Full Text Available Paciente de 74 anos acordou à noite sentindo fortes dores na região da nuca acompanhadas de ansiedade e desconforto torácico e respiratório. A internação emergencial em clinica cardiológica não demonstrou problemas cardíacos. Com a progressão do quadro neurológico traduzida por quadriplegia severa f [...] oi realizada uma punção lombar para afastar hipótese de meningite, sendo retirados cerca de 20 ml de liquor. Trinta minutos imediatamente após a punção lombar foi observada completa remissão do déficit neurológico. Transferido para um hospital geral a tomografia computadorizada demonstrou extenso hematoma epidural espinal em nivel C4/C5 com extensão a C7/Th1, bem como hemangioma do sexto corpo vertebral (C6). A ressonância magnética demonstrou as mesmas lesões. Observando-se os parâmetros clínicos e neurológicos, optou-se por tratamento conservador. Dezoito meses após este episódio o paciente se apresenta normal, sem deficit residual. Neste artigo, relatamos um caso de completa recuperação de déficit neurológico devido a hematoma epidural espinal, após forma não usual de descompressão medular. Abstract in english A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous syst [...] em infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT) scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH) is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.

  10. The treatment of brain abscess and subdural empyema

    International Nuclear Information System (INIS)

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

  11. Intracranial Subdural Empyema: A 10-Year Case Series

    Science.gov (United States)

    French, Heath; Schaefer, Nathan; Keijzers, Gerben; Barison, David; Olson, Sarah

    2014-01-01

    Background Intracranial subdural empyema (ISDE) is a pyogenic infection located in the space between the dura and arachnoid mater. Early diagnosis, prompt initiation of antimicrobial therapy, and surgical drainage are essential to reduce morbidity and mortality. This case series analyzes the presentation and management of ISDE in Queensland, Australia, over a 10-year period. Methods Thirty-six patients with ISDE were treated at Gold Coast University Hospital, Princess Alexandra Hospital, Townsville Hospital, and Royal Brisbane Hospital. The patients' medical records were analyzed to ascertain patient demographics, etiology, presentation, and management. Results A slight male preponderance occurred in the cohort of 36 patients with ISDE. The most common source of infection was a neurosurgical procedure, followed by sinusitis and otogenic sources. Headache, fever, and altered sensorium were the most common clinical triad of symptoms, present in 19 (53%) patients. Craniotomy was performed as the initial surgical procedure in 28 (88%) of the 32 patients who required surgery. Seizure prophylaxis was given to 25 (69%) patients, with 8 (32%) of those patients having seizures during their hospitalizations despite this therapy. Five (14%) patients required readmission and a second craniotomy because of failed resolution of the ISDE. Conclusion Altered sensorium, fever, vomiting, and headache should alert the clinician to the possibility of ISDE. A history of neurosurgery, sinusitis, otitis media, or skull trauma increases the likelihood of this differential. Management includes sensitive antibiotic therapy and surgical drainage. Compared with burr hole, craniotomy is associated with less recurrence of ISDE. PMID:24940128

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

    Scientific Electronic Library Online (English)

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

    2011-12-01

    Full Text Available Presentamos el caso de un varón de 9 años derivado al servicio de Urgencias por proptosis ocular derecha y cefalea progresiva en el contexto de una sinusitis, diagnosticado dos días antes por clínica y radiología compatible y en tratamiento con amoxicilina-clavulánico. A la exploración física destac [...] a proptosis derecha con ligera limitación para la mirada conjugada. Con la sospecha de una posible complicación neurológica de la sinusitis, se realiza tomografía axial computarizada (TAC) craneal, observando empiema subdural frontal derecho. Ingresa para tratamiento antibiótico endovenoso con cefotaxima, vancomicina y metronidazol. Es valorado por los servicios de Neurocirugía, Cirugía Maxilofacial y Otorrinolaringología (ORL) infantil, decidiéndose únicamente drenaje del foco primario, con actitud neuroquirúrgica expectante. El paciente evoluciona favorablemente con progresiva desaparición de los síntomas. Se realizan resonancias magnéticas periódicas, que muestran clara mejoría hasta resolución completa del empiema. Tras 4 semanas de antibioterapia iv., y tras la normalización clínica y radiológica, el paciente es dado de alta. Abstract in english We present the case of 9 year old male referred to the A and E service with right ocular proptosis and progressive migraine in the context of a sinusitis diagnosed two days earlier by compatible clinical and radiological tests, and receiving treatment with amoxicillin-clavulanic acid. Physcial explo [...] ration revealed right ocular proptosis with a slight limitation for conjugate gaze. Facing the suspicion of a possible neurological complication of the sinusitis, cranial computer aided tomography (CAT) was carried out, with right frontal subdural empyema observed. He was admitted for intravenous antibiotic treatment with cefotaxime, vancomicin and metronidazole. He was evaluated by child Neurosurgery, Maxillofacial Surgery and Otorhinolaryngology (ORL) services; the decision was taken to only drain the primary focus, while an expectant neurosurgical attitude was maintained. The patient evolved favourably with a progressive disappearance of the symptoms. Periodical magnetic resonances were carried out, which showed a clear improvement up until the complete resolution of the empyema. Following four weeks of antibiotherapy iv., and after clinical and radiological normalization, the patient was discharged.

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Sagar Bhargava

    2014-01-01

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

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

    OpenAIRE

    ÜNLÜ, Ebru; Ulu, Sena; Özdinç, ?erife; Baki, Elif Dogan; Kaçar, Emre; Beker Acay, Mehtap; Karavelio?lu, Ergün; Y?lmaz, Emel; Uzel Tas, Hanife

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2011-05-15

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

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

    International Nuclear Information System (INIS)

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

  18. Delayed Occurrence of Escherichia coli Subdural Empyema Following Head Injury in an Elderly Patient: A Case Report and Literature Review.

    Science.gov (United States)

    Munusamy, Thangaraj; Dinesh, Shree Kumar

    2015-07-01

    Subdural empyema is a rare but serious intracranial infection that warrants prompt management to reduce morbidity and avoid mortality. However, clinical and radiologic features may be subtle or ambivalent. Thus a diagnosis of subdural empyema should not be discounted, especially in a patient with a history of head trauma. Treatment consists of surgery to establish bacteriologic identification and subsequently guide antibiotic therapy. Here we present a case of delayed Escherichia coli subdural empyema following a head injury in an elderly patient without significant risk factors. Computed tomography imaging was equivocal for subdural empyema. The patient underwent surgery and was treated with intravenous antibiotic therapy. Although initial improvement in the patient's clinical condition was observed, he eventually succumbed to nosocomial pneumonia. In this article, we discuss the presentation, diagnostic tools, and treatment options for subdural empyema with an emphasis on the challenges. The management conundrum that follows prompted us subsequently to review the literature. PMID:26251817

  19. Two rare cases of intrahepatic subcapsular hematoma after laparoscopic cholecystectomy.

    Science.gov (United States)

    Minaya Bravo, Ana María; González González, Enrique; Ortíz Aguilar, Manuel; Larrañaga Barrera, Eduardo

    2010-12-01

    The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy (LC) is an infrequent complication and seldom studied. Some cases have been connected to ketorolac given during surgery and after surgery. Other described causes are : hemangiomas or small iatrogenic lesions that could be aggravated by administration of ketorolac. Coagulation dysfunction like circulating heparin as seen in hemathological diseases is cause of bleeding after aggressive procedures. We describe two cases of subcapsular liver hematoma after LC, both of them have been given intravenous ketorolac and one of them had multiple myeloma. We discuss the causes and treatment of it. PMID:22131659

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

    Directory of Open Access Journals (Sweden)

    Ji Seon Cheon

    2013-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-02-15

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

  2. Sickle cell disease with orbital infarction and epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Naran, A.D.; Fontana, L. [Dept. of Diagnostic Radiology, New York Methodist Hospital, Brooklyn, NY (United States)

    2001-04-01

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

  3. Giant splenic hematoma can be a hidden condition

    DEFF Research Database (Denmark)

    Jensen, Kristian Kiim; Hangaard, Stine

    2014-01-01

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

  4. Sickle cell disease with orbital infarction and epidural hematoma

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    M. Bermejo

    2004-11-01

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

  6. Acute spontaneous subdural hemorrhage by cerebral aneurysmal rupture : report of two cases

    International Nuclear Information System (INIS)

    Two cases of acute spontaneous subdural hemorrhage caused by cerebral aneurysmal rupture are presented. The patients' chief complaints were sudden bursting headache and comatose mentality. There was no history of trauma or proclivity for spontaneous bleeding, and CT scans of the brain indicated subdural hemorrhage without remarkable subarachnoid hemorrhage. In case 1, an aneurysm at the distal segment of the right anterior cerebral artery was identified by CT angiography ; the subdural hemorrhage was evacuated and the aneurysm surgically clipped. In case 2, an aneurysm at the junction of the anterior communicating artery and the right anterior cerebral artery was revealed by CT angiography and digital subtraction angiography, and Guglielmi detachable coil amortization of the aneurysm was performed

  7. Subdural effusions and lack of early pontocerebellar hypoplasia in siblings with RARS2 mutations.

    Science.gov (United States)

    Kastrissianakis, Katherina; Anand, Geetha; Quaghebeur, Gerardine; Price, Sue; Prabhakar, Prab; Marinova, Jasmina; Brown, Garry; McShane, Tony

    2013-12-01

    Mutations in the recently described RARS2 gene encoding for mitochondrial arginyl-transfer RNA synthetase give rise to a disorder characterised by early onset seizures, progressive microcephaly and developmental delay. The disorder was named pontocerebellar hypoplasia type 6 (PCH6) based on the corresponding radiological findings observed in the original cases. We report two siblings with the RARS2 mutation who displayed typical clinical features of PCH6, but who had distinct neuroimaging features. Early scans showed marked supratentorial, rather than infratentorial, atrophy, and the pons remained preserved throughout. One sibling also had bilateral subdural effusions at presentation. The deceleration in head growth pointed to an evolving genetic/metabolic process giving rise to cerebral atrophy and secondary subdural effusions. RARS2 mutations should be considered in infants presenting with seizures, subdural effusions, decelerating head growth and evidence of cerebral atrophy even in the absence of pontocerebellar hypoplasia on imaging. PMID:24047924

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

    OpenAIRE

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

    2010-01-01

    A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica,...

  9. Diagnosis of subcapsular hematoma of the liver by scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Beauchamp, J.M.; Belanger, M.A.; Neitzschman, H.R.

    1976-12-01

    The diagnosis of subcapsular hematoma of the liver following blunt abdominal trauma has assumed clinical importance with recent reports of improved mortality with conservative management. There is increasing use of hepatic scintigraphy in evaluation of upper abdominal trauma. Two recently observed cases are used to illustrate the typical findings in this entity.

  10. Diagnosis of subcapsular hematoma of the liver by scintigraphy

    International Nuclear Information System (INIS)

    The diagnosis of subcapsular hematoma of the liver following blunt abdominal trauma has assumed clinical importance with recent reports of improved mortality with conservative management. There is increasing use of hepatic scintigraphy in evaluation of upper abdominal trauma. Two recently observed cases are used to illustrate the typical findings in this entity

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

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-04-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2000-01-01

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

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

    Science.gov (United States)

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

    2012-10-01

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

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

    Directory of Open Access Journals (Sweden)

    McCarthy Danielle

    2010-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Gabriel Zago

    2010-01-01

    Full Text Available A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramento retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais.La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrencia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales.Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

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

    Scientific Electronic Library Online (English)

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

    2010-01-01

    Full Text Available A varfarina é droga amplamente utilizada na prevenção de fenômenos tromboembólicos e o conhecimento de seus efeitos adversos faz-se necessário para o acompanhamento dos pacientes. Embora o desenvolvimento de discrasias sanguíneas seja complicação potencial nesses pacientes, a ocorrência de sangramen [...] to retroperitoneal é rara. Este artigo discute o caso de um paciente que evoluiu com hematoma do músculo iliopsoas durante tratamento com a referida droga, pós-implante de prótese aórtica metálica, com quadro clínico envolvendo importantes diagnósticos diferenciais. Abstract in spanish La warfarina es un fármaco ampliamente utilizado en la prevención de fenómenos tromboembólicos, y el conocimiento de sus efectos adversos se hace necesario para el seguimiento de los pacientes. Aunque el desarrollo de discrasias sanguíneas es la complicación potencial en estos pacientes, la ocurrenc [...] ia de sangrado retroperitoneal es rara. Este artículo discute el caso de un paciente que evolucionó con hematoma del músculo ileopsoas durante tratamiento con el referido fármaco en el postimplante de prótesis mitral metálica, con cuadro clínico implicando importantes diagnósticos diferenciales. Abstract in english Warfarin is a widely used drug for the prevention of thromboembolic events. Knowledge of its adverse effects is necessary for patient follow-up. Although the development of blood dyscrasias is a potential complication in these patients, retroperitoneal bleeding is rare. This article reports the case [...] of a patient who developed iliopsoas muscle hematoma during treatment with warfarin after implantation of a metallic prosthetic aortic valve. The clinical manifestations involved important differential diagnoses.

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

    International Nuclear Information System (INIS)

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

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

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2007-04-01

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

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

    Science.gov (United States)

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

    2008-09-01

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

  1. Recurrent subdural hygromas after foramen magnum decompression for Chiari Type I malformation.

    Science.gov (United States)

    Pereira, Erlick A C; Steele, Louise F; Magdum, Shailendra A

    2014-06-01

    A paediatric case of foramen magnum decompression for Chiari Type I malformation complicated by recurrent subdural hygromas (SH) and raised intracranial pressure without ventriculomegaly is described. SH pathogenesis is discussed, with consideration given to arachnoid fenestration. We summarise possibilities for treatment and avoidance of this unusual consequence of foramen magnum decompression. PMID:23952134

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

    Scientific Electronic Library Online (English)

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

    2014-10-01

    Full Text Available Objetivo: avaliar o uso perioperatório do atenolol na redução da incidência de hematoma pós-ritidoplastia. Métodos: entre janeiro de 2007 e fevereiro de 2013 foram randomizados 80 pacientes em dois grupos: Grupo A (n=26) recebeu atenolol perioperatório com objetivo de manter frequência de puls [...] o (FP) ± 60 por minuto, Grupo B (n=54) não recebeu atenolol. Ambos os grupos foram submetidos à mesma técnica anestésico-cirúrgica. A pressão arterial (PA) e FP, formação de hematoma e a necessidade de drenagem foram monitorizados. Houve seguimento até o 90º dia de pós-operatório. As variáveis foram analisadas entre os dois grupos utilizando-se o teste de ANOVA. As variáveis contínuas foram apresentadas como média (± Desvio-padrão) e as diferenças foram comparadas utilizando-se o t de Student. Foram considerados significantes os valores p Abstract in english Objective: To evaluate the perioperative use of atenolol in reducing the incidence of hematoma after rhytidoplasty. Methods: Between January 2007 and February 2013, 80 patients were randomized into two groups: Group A (n = 26) received perioperative atenolol in order to maintain heart rate (PR [...] ) around 60 per minute; Group B (n = 54) did not receive atenolol. Both groups underwent the same anesthetic and surgical technique. We monitored blood pressure (BP), HR, hematoma formation and the need for drainage. Patients were followed-up until the 90th postoperative day. The variables were compared between the groups using the ANOVA test. Continuous variables were presented as mean ± standard deviation and the differences were compared with the Student's t test. Values of p d" 0.05 were considered significant. Results: In group A the mean BP (110-70mmHg ± 7.07) and HR (64 / min ± 5) were lower (p d" 0.05) than in group B (135-90mmHg ± 10.6) and (76 / min ± 7.5), respectively. There were four cases of expansive hematoma in group B, all requiring reoperation for drainage, and none in group A (p d" 0,001). Conclusion: The perioperative use of atenolol caused a decrease in blood pressure and heart rate and decreased the incidence of expanding hematoma after rhytidectomy.

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

    Scientific Electronic Library Online (English)

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

    2013-12-01

    Full Text Available Descrevemos o caso de um paciente com hematoma intramural e trombo flutuante após ressuscitação cardiopulmonar. Esse homem, de 92 anos de idade, teve uma parada cardíaca causada por fibrilação atrial e testemunhas iniciaram imediatamente manobras manuais de ressuscitação cardiopulmonar. Ao ser admit [...] ido no hospital, o paciente apresentava-se em choque cardiogênico, sendo, então, imediatamente submetido a ecocardiografia transesofágica. Além de uma parede anterior acinética, o exame da aorta torácica descendente mostrou um hematoma intramural e um trombo intra-aórtico flutuante a uma distância de 40cm do arco dental. Não havia dissecção da aorta. O trombo foi atribuído à compressão aórtica durante a ressuscitação cardiopulmonar. Embora o trombo aórtico e o hematoma intramural não tenham se associado a qualquer complicação nesse paciente, a inserção de um balão intra-aórtico poderia ter levado a uma ruptura da aorta ou a eventos embólicos. Recomenda-se a realização de ecocardiografia transesofágica, quando disponível, antes da inserção de um balão intra-aórtico de contrapulsação em pacientes submetidos à ressuscitação cardiopulmonar. Abstract in english We describe the case of a patient with an intramural hematoma and floating thrombus after cardiopulmonary resuscitation. The 92-year old man had a cardiac arrest due to ventricular fibrillation and witnesses immediately initiated manual cardiopulmonary resuscitation. Transesophageal echocardiography [...] was performed immediately on hospital admission because the patient was in cardiogenic shock. In addition to an akinetic anterior wall, examination of the descending thoracic aorta demonstrated an intramural hematoma and a floating intra-aortic thrombus at a distance of 40cm from the dental arch. There was no aortic dissection. The thrombus was attributed to aortic compression during cardiopulmonary resuscitation. Although the aortic thrombus and intramural hematoma were not associated with any complications in this patient, insertion of an intra-aortic balloon may have led to aortic rupture or embolic events. Transesophageal echocardiography should be performed, when available, prior to insertion of an intra-aortic balloon for counterpulsation in patients who have undergone cardiopulmonary resuscitation.

  4. Hepatic subcapsular hematoma: two neonates with disparate presentations.

    Science.gov (United States)

    Anjay, Maliyackel Aiyappanpillai; Sasidharan, Chaniyil Krishnan; Anoop, Parameswaran

    2012-04-01

    Subcapsular hematoma of the liver rarely occurs in neonates and the diagnosis is often missed or delayed. We report two babies who had this uncommon condition in the early neonatal period. In the first baby, the hematoma was associated with ventouse delivery and presented with abdominal distension and worsening jaundice. In contrast, the other baby was relatively well, with progressive pallor as the only clinical finding. The former had no other identifiable risk factors, whereas the latter was confirmed as having classical hemophilia. The literature is briefly reviewed with regards to incidence, etiology, diagnosis and management. Awareness of this unusual entity coupled with a high index of suspicion is essential for early identification and stabilization of such babies. PMID:22503263

  5. Postpartum spontaneous subcapsular hepatic hematoma related to preeclampsia.

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Halim Tariq

    2008-01-01

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

  7. A rare cause of duodenal obstruction: Intramural hematoma

    Directory of Open Access Journals (Sweden)

    Gokcen Coban

    2014-06-01

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

  8. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-08-15

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

  9. Neuroimaging of nonaccidental head trauma: pitfalls and controversies

    International Nuclear Information System (INIS)

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

  10. Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

    OpenAIRE

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

    2014-01-01

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

  11. Two Rare Cases of Intrahepatic Subcapsular Hematoma After Laparoscopic Cholecystectomy

    OpenAIRE

    Minaya Bravo, Ana María; González González, Enrique; Ortíz Aguilar, Manuel; Larrañaga Barrera, Eduardo

    2010-01-01

    The appearance of subcapsular liver hematoma after a laparoscopic cholecystectomy (LC) is an infrequent complication and seldom studied. Some cases have been connected to ketorolac given during surgery and after surgery. Other described causes are : hemangiomas or small iatrogenic lesions that could be aggravated by administration of ketorolac. Coagulation dysfunction like circulating heparin as seen in hemathological diseases is cause of bleeding after aggressive procedures. We describe two ...

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

    Ji Seon Cheon; Bin Na Seo; Jeong Yeol Yang; Kyung Min Son

    2013-01-01

    Retrobulbar hemorrhage, especially when associated with visual loss, is a rare but significant complication after facial bone reconstruction. In this article, two cases of retrobulbar hematoma after surgical repair of blow-out fracture are reported. In one patient, permanent loss of vision was involved, but with the other patient, we were able to prevent this by performing immediate decompression after definite diagnosis. We present our clinical experience with regard to the treatment process...

  14. Intramural esophagic hematoma secondary to coumarinic anticoagulation: a case report

    OpenAIRE

    Quintero, Álvaro M; Gaviria, María E; Balparda, Jon K; Cuervo, Héctor R

    2009-01-01

    Esophagic Intramural Hematoma is an uncommon clinical condition, with a prognosis which is essentially benign. On most cases, a predisposing or precipitating factor may be seen, with the most common ones being the history of esophagic instrumentation, food impactations and thrombocytopenia. In the following manuscript, the authors present the case of a 54-years-old male with history of valve replacement surgery, who was treated at the Clinica Cardiovascular (Medellin, Colombia), with a clinic...

  15. Hematoma of Rectus Sheath Following Subcutaneous Enoxaparin Injection

    Directory of Open Access Journals (Sweden)

    Shahram Firoozbakhsh

    2013-05-01

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

  16. Rectus Sheath Hematoma: A Simplified Emergency Surgical Approach

    OpenAIRE

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

    2011-01-01

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

  17. Intramuscular Hematomas Caused by Anticoagulant Therapy: Is Advanced

    Directory of Open Access Journals (Sweden)

    Nilgün ÇINAR

    2010-09-01

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

  18. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

    Directory of Open Access Journals (Sweden)

    Emine Rabia Koç

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.

  19. Symptomatic posterior fossa and supratentorial subdural hygromas as a rare complication following foramen magnum decompression for Chiari malformation Type I.

    Science.gov (United States)

    Bahuleyan, Biji; Menon, Girish; Hariharan, Easwer; Sharma, Mridul; Nair, Suresh

    2011-02-01

    Symptomatic subdural hygroma due to foramen magnum decompression for Chiari malformation Type I is extremely rare. The authors present their experience with 2 patients harboring such lesions and discuss treatment issues. They conclude that the possibility of subdural hygromas should be considered in all patients presenting with increased intracranial tension following foramen magnum decompression for Chiari malformation Type I. Immediate neuroimaging and appropriate surgical intervention provides a good outcome. PMID:20849216

  20. Computed Tomography Angiography for Detection of Middle Meningeal Artery Lesions Associated with Acute Epidural Hematomas

    OpenAIRE

    Wellingson Silva Paiva; Almir Ferreira Andrade; Robson Luis Oliveira de Amorim; Edson Bor-Seng-Shu; Gabriel Gattas; Iuri Santana Neville; Jose Guilherme Caldas; Eberval Gadelha Figueiredo; Manoel Jacobsen Teixeira

    2014-01-01

    Background. The natural history of traumatic aneurysms of the middle meningeal artery (MMA) is not well known, but patients with these lesions are more likely to have delayed bleeds. In this paper, we described a series of patients with epidural hematoma who underwent angiotomography (CTA) for MMA vascular lesion diagnosis. Methods. Eleven patients admitted to our emergency unit with small acute epidural hematoma were prospectively studied. All patients with temporal acute epidural hematomas...

  1. Resolution of epidural hematoma related to osteoporotic fracture after percutaneous vertebroplasty

    OpenAIRE

    Hidenari Hirata; Akio Hiwatashi; Takashi Yoshiura; Osamu Togao; Koji Yamashita; Hironori Kamano; Kazufumi Kikuchi; Hiroshi Honda

    2013-01-01

    We are the first to report a case that showed spontaneous resolution of epidural hematoma which was related to a steroid-induced osteoporotic compression fracture. The patient had a painful fracture with an intravertebral cleft at L1 accompanying an epidural hematoma posteriorly. Immediate pain relief was achieved after percutaneous vertebroplasty. Complete resolution of hematoma was noted three months after procedure. We theorized that intravertebral stability after treatment might have play...

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

    Directory of Open Access Journals (Sweden)

    Kouhei Iwashita

    2014-07-01

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

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

    Scientific Electronic Library Online (English)

    ANTONIO CARLOS DE PÁDUA, MILAGRES; FLÁVIO, ALÓE; JOÃO CARLOS PAPATERRA, LIMONGI.

    1998-03-01

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

  4. Clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma

    International Nuclear Information System (INIS)

    Objective: To evaluate the clinical application of CT-controlled stereotactic aspiration for intracerebral hematoma. Methods: CT-guided stereotactic system was installed on the CT bed, and checked against a standard of the coordinate. According to controlled CT scan, the target can be adjusted at any time in the operation. 860 patients with cerebral hematoma underwent CT-controlled stereotactic aspiration. Of the 860 cases, basal ganglion hematoma was present in 408, thalamus and posterior limb of internal capsule hematoma in 136, cerebral lobe hematoma in 261, cerebellar hematoma in 5, ventricular hemorrhage in 10, midbrain and pons hemorrhage in 37, and medulla hemorrhage in 3. Results: Easy drainage of hematoma by aspiration was achieved in 586 cases, stickiness of hematoma with clearing away more than 50% was performed in 202 and less than 50% in 68. The operation duration ranged from 25 to 120 minutes (average 45 minutes). 693 cases survived and 167 cases died. According to the evaluation by active day life (ADL) after 3 months in survivors, ADL 1-2, ADL 3, ADL 4 and ADL 5 results were achieved in 378 cases, 166 cases, 107 cases, and 28 cases, respectively. In addition, 14 cases were lost beyond recall. Conclusion: CT-controlled stereotactic aspiration for intracerebral hematoma is a handy, less invasive, and safe procedure with high accuracy and curative effect, it is worth while popularizing the procedure

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

    Science.gov (United States)

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

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

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

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

    OpenAIRE

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

    2013-01-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    LENUS (Irish Health Repository)

    Hanif, S

    2009-09-01

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

  11. Hematoma de fosa posterior no traumático: consideraciones clínicas y terapéuticas / Non-traumatic Posterior Fossa Hematomas: Clinical and Therapeutical issues

    Scientific Electronic Library Online (English)

    Patricio, Tagle; Luis Carlos, Vintimilla; Sergio, Del Villar; Gonzalo, Torrealba; Pablo, Villanueva; Jorge, Méndez; Sergio, Rey.

    2002-04-01

    Full Text Available Se analizan 52 pacientes portadores de hematoma de fosa posterior no traumático. Correspondieron a 28 hombres y 24 mujeres, con una media de edad de 60 años. Diez (19,2%) fueron secundarios a malformación arteriovenosa (5), cavernomas (3), angioma venoso (1) y hemangioblastoma (1). Cuarenta y dos (8 [...] 0,7%) fueron catalogados como primarios, encontrándose el antecedente de hipertensión arterial en 31, trastornos de coagulación en 5 y en 6 no se demostró un factor predisponente. Hipertensión intracraneana fue el cuadro clínico de presentación en la mayoría (84%). La Tomografía Computarizada demostró el hematoma en todos los casos. Cuatro de ellos medían menos de 2 cm., 24 entre 2 y 3 cm. y 24 eran mayores de 3 cm. Hidrocefalia estuvo presente en 22 casos (42,3%). Angiografía digital se realizó en 12 pacientes, siendo positiva en 7 (5 malformaciones arteriovenosas, 1 angioma venoso y 1 hemangioblastoma). Resonancia Magnética fue practicada en 2 enfermos, demostrando en uno angioma cavernoso. Treinta y un pacientes fueron operados realizándose vaciamiento del hematoma en 24, 14 de ellos con drenaje de LCR. En los restantes solo se trató la hidrocefalia. Se observó buenos resultados en el 67,3% y la mortalidad global fue de 9,6%. La mortalidad quirúrgica fue de 12,5%. Incide en los resultados el estado de conciencia inicial y el tamaño. Las cisternas troncales no fueron evaluadas en nuestra casuística. Sin embargo, creemos que el tratamiento debiera ser evaluado en cada caso en particular, ya que ningún factor influyen en forma absoluta en la evolución Abstract in english Fifty two patients (28 male and 24 female) with non-traumatic posterior fossa hematomas were analyzed. Average age of the patients was 60 years old. In ten cases (19.2%), the hematomas were secondary to arteriovenous malformations (5), cavernomas (3), venous angiomas (1) and hemangioblastoma (1). Fo [...] rty two (80.7%) were considered primary, with a history of high blood pressure in 31 patients and coagulation disorders in 5. Six cases had no predisposing factors. Most subjects also had intercraneal hypertension (84%). Computerized tomography showed hematomas in all cases, of which four were under 2 cm in size, 24 were between 2 and 3 cm, and 24 were larger than 3 cm. Hydrocephalus was present in 22 cases (42.3%). Twelve patients underwent digital angiography, with favorable results in seven (5 arteriovenous malformations, 1 venous angioma and 1 hemangioblastoma). Magnetic resonance imaging was done with two patients, and showed one cavernous angioma. Thirty-one patients underwent surgery; the hematoma was drained in 24 cases, 14 of which involved LCR draining. The remaining cases were treated for hydrocephalus only. Favorable results were seen in 67.3% of the cases, and the overall mortality rate was 9.6%. Surgical mortality was 12.5%. The initial state of consciousness and size had a bearing on results. We believe that treatment must be evaluated on a case-by-case basis, since no single factor has an absolute effect on a patient's outcome

  12. Hematoma intraneural experimental em ratos: avaliação da recuperação funcional e histomorfometria neural Experimental intraneural hematoma model in rats: evaluation of functional recovery and neural histomorphometry

    Directory of Open Access Journals (Sweden)

    Gean Paulo Scopel

    2007-01-01

    Full Text Available A formação do hematoma intraneural com comprometimento de nervos periféricos pode ocorrer após trauma ou coagulopatias. O tratamento expectante ou abordagem cirúrgica descompressiva ainda não estão definidos. Foram estudados 40 ratos da raça Wistar divididos em 4 grupos. No grupo A realizou-se injeção intraneural de 0,2 ml de sangue autógeno no nervo ciático direito. No grupo B, após produção do hematoma, fez-se descompressão imediata com epineurotomia longitudinal. No grupo D realizamos liberação imediata do hematoma com neurólise interfascicular. No grupo C (CONTROLE apenas realizou-se a exposição do nervo ciático sem formação de hematoma. A avaliação da função nervosa foi feita com o Índice de Função Ciática de Bain-Mackinnon-Hunter (IFC. O grupo A apresentou IFC inicial de -28,43, com recuperação funcional no 5º dia. A drenagem imediata desse hematoma através de uma epineurotomia longitudinal (B determinou retorno da função ciática normal desde o 1º dia (IFC= -14,42. Tratando o hematoma através da neurólise interfascicular observamos um IFC inicial de -23,69 e retorno da função ciática normal no 3º dia. Os parâmetros histomorfométricos apontaram melhora dos parâmetros de isquemia após os 2 tipos de intervenção cirúrgica aplicadas neste estudo. Não houve diferença entre os tipos de intervenções aplicadas.Emergence of intraneural hematoma with involvement of peripheral nerves can occur after trauma or coagulation disorders. The decision for expectant management or decompressive surgical techniques is still controversial. Forty male Wistar rats were divided into 4 groups. In group A, an intraneural injection of autologous blood was provided at the right sciatic nerve. In group B, after the hematoma creation, a longitudinal epineurotomy was performed. In the group C (sham-operated, the sciatic nerve was exposed without hematoma. In group D. immediately after the hematoma creation, an interfascicular neurolysis was performed. Nerve function recovery was assessed using the Bain-Mackinnon-Hunter Sciatic Function Index (SFI. At the end of the study, the animals were sacrificed and a specimen of the sciatic nerve at compression midpoint was removed for morphometric analysis. Group A displayed an initial SFI of -28.43, with full functional recovery on the fifth day. Immediate drainage of the hematoma by longitudinal epineurotomy (group B promoted recovery of normal sciatic function on the first day (SFI -14.42. Addressing the hematoma via interfascicular neurolysis resulted in an initial SFI of -23.69 and recovery of normal sciatic function on the third day. The morphometric variables indicated an improvement of ischemic parameters following both types of surgical intervention.

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

    OpenAIRE

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

    2007-01-01

    JUSTIFICATIVA E OBJETIVOS: Durante a realização de anestesia espinal existe o risco de ocorrer sangramentos. A compressão do tecido nervoso, secundária à formação de hematoma, pode determinar o surgimento de lesão neurológica que se não for diagnosticada e tratada a tempo pode ser permanente. A identificação dos fatores de risco, o diagnóstico e o tratamento precoce da compressão são importantes para o prognóstico do paciente. O objetivo deste trabalho foi descrever um caso de hematoma após r...

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

    Directory of Open Access Journals (Sweden)

    CUKIERT ARTHUR

    2000-01-01

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

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

    Science.gov (United States)

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

    2014-03-01

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

  16. Anesthetic management of a case of armored brain

    OpenAIRE

    Gupta, Surender Kumar; Pandia, Mihir Prakash

    2015-01-01

    Armored brain is condition, which occurs due to calcification in a chronic subdural hematoma (SDH). Here, we are reporting a case of armored brain due to chronic SDH as a complication of vetriculoperitoneal shunt (VP shunt). Patient had undergone major surgery for removal of calcified hematoma. VP shunt is a simple surgery, but can lead to catastrophic complications like this. In this report, we had described this condition and its aspects.

  17. Anesthetic management of a case of armored brain.

    Science.gov (United States)

    Gupta, Surender Kumar; Pandia, Mihir Prakash

    2015-01-01

    Armored brain is condition, which occurs due to calcification in a chronic subdural hematoma (SDH). Here, we are reporting a case of armored brain due to chronic SDH as a complication of vetriculoperitoneal shunt (VP shunt). Patient had undergone major surgery for removal of calcified hematoma. VP shunt is a simple surgery, but can lead to catastrophic complications like this. In this report, we had described this condition and its aspects. PMID:25558206

  18. Remote Postoperative Epidural Hematoma after Brain Tumor Surgery

    Science.gov (United States)

    Chung, Ho-Jung; Park, Jae-Sung; Jeun, Sin-Soo

    2015-01-01

    A postoperative epidural hematoma (EDH) is a serious and embarrassing complication, which usually occurs at the site of operation after intracranial surgery. However, remote EDH is relatively rare. We report three cases of remote EDH after brain tumor surgery. All three cases seemed to have different causes of remote postoperative EDH; however, all patients were managed promptly and showed excellent outcomes. Although the exact mechanism of remote postoperative EDH is unknown, surgeons should be cautious of the speed of lowering intracranial pressure and implement basic procedures to prevent this hazardous complication of brain tumor surgery. PMID:26605271

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

    Science.gov (United States)

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

    2014-04-01

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

  20. Iliopsoas Muscle Hematoma Secondary to Alcoholic Liver Cirrhosis

    OpenAIRE

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

    2012-01-01

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

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

    International Nuclear Information System (INIS)

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

  2. Hematoma subcapsular esplénico en paciente portador de rasgo falciforme

    Directory of Open Access Journals (Sweden)

    Diego Ugalde

    2011-09-01

    Full Text Available Drepanocytic anemia is an uncommon hereditary disease in Chile. The heterozygous state of drepanocytic anemia or "sickle trait" has a frequency of 8% among Afro-Americans. A small number of patients carrying hemoglobin S are homozygous, with clinical manifestations of hemolytic anemia and thrombotic disease. Sickle trait is usually asymptomatic. We report a 59-year-old male who presented an acute abdominal pain and dyspnea while staying at high altitude. Six days later, an angio CAT scan showed the presence of a subcapsular splenic hematoma that was managed conservatively. Sickle cell induction with sodium metabisulphite was positive. Hemoglobin electrophoresis confirmed the sickle trait.

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

    Directory of Open Access Journals (Sweden)

    MILAGRES ANTONIO CARLOS DE PÁDUA

    1998-01-01

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

  4. An alarming but self-limited case of isolated large spontaneous liver hematoma in pregnancy

    OpenAIRE

    Shakya, Vikal Chandra; Regmi, Mohan Chandra; Sah, Pannalal; Khaniya, Sudeep; Adhikary, Shailesh

    2013-01-01

    Spontaneous subcapsular liver hematoma is rare but potentially life-threatening complication of pregnancy usually associated with severe preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). We present here a case of such a large spontaneous liver hematoma presenting in pregnancy, but without other known associated abnormalities, which has not been described before and it resolved on itself without any intervention.

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

    International Nuclear Information System (INIS)

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

  6. Intrahepatic hematoma: hepatic lesion in a newborn with high {alpha}-fetoprotein level

    Energy Technology Data Exchange (ETDEWEB)

    Lam, Chiu Ying Flora; Chan, Kui Fai; Fan, Tsz Wo; Kwok, Chong Hei Philip; Chan, Chi Hum Susan; Tsang, Tsz Kan [Queen Elizabeth Hospital, Department of Radiology and Imaging, Hong Kong (China)

    2005-11-01

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

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

    Science.gov (United States)

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

    1999-07-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

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

    International Nuclear Information System (INIS)

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

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

    Scientific Electronic Library Online (English)

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

    2009-03-01

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

  11. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator Fibrinólise com infusão de rtPA e drenagem estereotáxica de hematoma intracerebral espontâneo profundo

    OpenAIRE

    José Augusto Nasser; Asdrubal Falavigna; Márcio Bezerra; Victor Martinez; Gabriel Freitas; Armando Alaminos; Antônio Bonatelli; Fernando Ferraz

    2002-01-01

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

  12. Armoured brain of unknown etiology

    OpenAIRE

    Goyal, Puneet Kumar; Singh, Daljit; Singh, Hukum; Dubey, Jaya; Tandon, Monica

    2013-01-01

    Armoured brain is a rare condition where dense calcification occurs over the brain. It can result in mass effect and raised intracranial pressure. Most often, it happens due to trauma, subdural effusion, infection, or after VP shunt. There is controversy in its treatment. Most published literature does not support removing the calcification. We describe a rare case of idiopathic chronic calcified subdural hematoma with relatively short history which was successfully treated by microsurgical r...

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

    Directory of Open Access Journals (Sweden)

    John Baliah

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Bansal Ujjwal

    2010-01-01

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

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

    International Nuclear Information System (INIS)

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

  16. Tratamiento con malla de poliglactina del hematoma subcapsular hepático roto Treatment of subcapsular liver hematoma using a polyglactine mesh

    Directory of Open Access Journals (Sweden)

    JEAN MICHEL BUTTE B

    2006-10-01

    Full Text Available En la mayoría de los enfermos el traumatismo hepático tiene un tratamiento médico. Esto se ve favorecido por el desarrollo de UCI y por el seguimiento estricto de las lesiones con estudios imagenológicos, fundamentalmente con TAC. El tratamiento quirúrgico se realiza en los pacientes con compromiso hemodinámico o cuando existen otras lesiones que ameritan una operación. Clásicamente, las lesiones hepáticas han sido tratadas con empaquetamiento del hígado con compresas. La malla de poliglactina cumple el mismo rol, pero tiene el beneficio de no necesitar ser retirada, lo que disminuiría la morbimortalidad. Presentamos 4 pacientes tratadas con malla de poliglactina luego de un traumatismo hepático, su evolución inmediata y alejada. Además se discuten aspectos de este tratamientoMost patients with subcapsular liver hematomas can be managed conservatively with a good hemodynamic and imaging monitoring. Surgery is reserved for patients with hemodynamic instability or when there are other lesions requiring surgical exploration. During surgery, liver lesions are usually wrapped with compresses. Polyglactine mesh has the same function, but does not require to be withdrawn, decreasing the risk for complications. We report four female patients with a ruptured subcapsular liver hematoma treated with polyglactine mesh wrapping. One patient was aged four days and had multiple malformations, one was aged 29 and had a HELLP syndrome, one was aged 34 years and had a lupus hepatitis and one aged 82 years and was in anticoagulant treatment. There was a mean of 2.3 surgical interventions in each patients and mean hospital stay was 17 days. One patient had to be admitted again due to a progression of the hematoma and was managed with selective arterial embolization. The newborn patient died of a respiratory infection, one month after discharge

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

    Directory of Open Access Journals (Sweden)

    Daniel Álvarez G

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

  19. Tratamiento con malla de poliglactina del hematoma subcapsular hepático roto / Treatment of subcapsular liver hematoma using a polyglactine mesh

    Scientific Electronic Library Online (English)

    JEAN MICHEL, BUTTE B; NICOLÁS, JARUFE C; FERNANDO, VULETIN S; JORGE, MARTÍNEZ C.

    2006-10-01

    Full Text Available En la mayoría de los enfermos el traumatismo hepático tiene un tratamiento médico. Esto se ve favorecido por el desarrollo de UCI y por el seguimiento estricto de las lesiones con estudios imagenológicos, fundamentalmente con TAC. El tratamiento quirúrgico se realiza en los pacientes con compromiso [...] hemodinámico o cuando existen otras lesiones que ameritan una operación. Clásicamente, las lesiones hepáticas han sido tratadas con empaquetamiento del hígado con compresas. La malla de poliglactina cumple el mismo rol, pero tiene el beneficio de no necesitar ser retirada, lo que disminuiría la morbimortalidad. Presentamos 4 pacientes tratadas con malla de poliglactina luego de un traumatismo hepático, su evolución inmediata y alejada. Además se discuten aspectos de este tratamiento Abstract in english Most patients with subcapsular liver hematomas can be managed conservatively with a good hemodynamic and imaging monitoring. Surgery is reserved for patients with hemodynamic instability or when there are other lesions requiring surgical exploration. During surgery, liver lesions are usually wrapped [...] with compresses. Polyglactine mesh has the same function, but does not require to be withdrawn, decreasing the risk for complications. We report four female patients with a ruptured subcapsular liver hematoma treated with polyglactine mesh wrapping. One patient was aged four days and had multiple malformations, one was aged 29 and had a HELLP syndrome, one was aged 34 years and had a lupus hepatitis and one aged 82 years and was in anticoagulant treatment. There was a mean of 2.3 surgical interventions in each patients and mean hospital stay was 17 days. One patient had to be admitted again due to a progression of the hematoma and was managed with selective arterial embolization. The newborn patient died of a respiratory infection, one month after discharge

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

    Scientific Electronic Library Online (English)

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

    Full Text Available El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. H [...] abitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt. Abstract in english The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along w [...] ith some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

  1. MRI study for CT-guided stereotactic aspiration of intracerebral hematoma

    International Nuclear Information System (INIS)

    Twenty-five patients with acute hypertensive intracerebral hematomas, diagnosed by computed tomography (CT), underwent CT-guided stereotactic aspiration. Magnetic resonance (MR) images were obtained immediately before aspiration, using T1-weighted (TR=500 msec, TE=15 msec) and T2-weighted (TR=2500 msec, TE=120 msec) sequences and a 0.5 Tesla MR system. On the basis of the MR images the hematomas were divided into peripheral, central, and core segments. The signal intensities were divided into seven grades based on the comparison with white matter. The sequential changes in each segment on the MR images were evaluated, and the ratio of hematoma removal vs. size of residual hematoma was assessed by preoperative MR imaging and pre-and post-operative CT. The hematomas were located in the putamen in 13 cases, the thalamus in 8, combined in 2, and subcortex in 2. The hematomas, targeted in their centers, were evacuated by the aspiration procedure alone, 1 to 12 days after onset (day 0=day of onset). The results were as follows : 1) The proportion of hematomas removed was high after day 4. 2) Sequential T1-weighted images showed that the peripheral segments gradually increased in signal intensity, appearing as high-intensity rings that gradually filled and could be easily aspirated. 3) In those cases in which sequential T2-weighted images showed the central segments gradually increasing in signal intensity, the hematomas were easily aspirated if the signal was either iso-intense or hyper-intense. 4) Several hematomas had a core that appeared as a high intensity signal on T1-weighted images and as a low intensity signal on T2-weighted images; these hematomas could not be aspirated. (author)

  2. Hematoma renal subcapsular espontáneo secundario al empleo de antiagregantes plaquetarios

    Directory of Open Access Journals (Sweden)

    Tomás Lázaro Rodríguez Collar

    2014-06-01

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

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

    Scientific Electronic Library Online (English)

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

    2013-03-01

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

  4. Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Hee Seok; Lee, Yong Seok; Lim, Ji Hyon; Kim, Kyung Soo; Yoon, Yup [Dongguk University College of Medicine, Goyang (Korea, Republic of); Hwang, Jae Cheol [Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (Korea, Republic of)

    2007-08-15

    Hemorrhagic fever with renal syndrome (HFRS) is an acute viral disease characterized by fever, hemorrhage and renal failure. Among the various hemorrhagic complications of HFRS, spontaneous rupture of the kidney and perirenal hematoma are very rare findings. We report here on a case of HFRS complicated by massive perirenal hematoma, and this was treated with transcatheter arterial embolization. Hemorrhagic fever with renal syndrome (HFRS) is an acute infectious disease caused by hantavirus. HFRS is clinically characterized by fever, renal failure and hemorrhage in organs such as lung, kidney, spleen and the pituitary gland. Renal medullary hemorrhage is a well-known complication in the kidney, but spontaneous rupture of the kidney and perirenal hematoma in HFRS is rare, and patients showing continuous bleeding and massive perirenal hematoma have often been surgically treated. We report here on a case of HFRS complicated by massive perirenal hematoma, and the patient was treated with transcatheter arterial embolization. In summary, spontaneous rupture of the kidney and perirenal hematoma is a rare complication of HFRS. We report here on a case of HFRS that caused massive perirenal hematoma, and this was treated with superselective renal artery embolization.

  5. Chronic hematic cyst of the temporomandibular joint.

    OpenAIRE

    Kaan Orhan; Hideyoshi Nishiyama; Kishino Mitsunobu; Souhei Furukawa; Cagri Delilbasi

    2005-01-01

    ABSTRACT Hematic cyst refers to accumulation of blood or blood breakdown products in a non epithelium-lined fibrous tissue capsule. Hepatic cyst is a term often used for deeply placed, incompletely resorbed hematoma hemorrhagic cyst, which may remain unchanged and unidentified for long periods of time. Trauma is the major causative factor, although it is often vague or totally uncalled by the patient. Chronic hematic cysts are uncommon lesions those can present diagnostic challenge. In thi...

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

    Science.gov (United States)

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

    2013-12-01

    A 40-year-old man was admitted to hospital with a 5 day history of fever, restlessness and altered sensorium. Peripheral blood smears showed a Plasmodium vivax and Plasmodium falciparum mixed infection as revealed by the presence of rings, schizonts and gametocyte forms of the parasites. The patient soon became unconscious due to subdural haematoma (SDH) associated with disseminated intravascular coagulation and thrombocytopenia. Immediate intervention with a right fronto-parieto temporal craniectomy, evacuation of the SDH and intravenous quinine administration resulted in the patient's complete recovery within 8 days of admission, and he was discharged in good clinical condition. PMID:23988631

  7. Spectrum of intracranial subdural empyemas in a series of 45 patients: Current surgical options and outcome

    OpenAIRE

    Tewari Manoj; Sharma Rewati; Shiv Vinod; Lad Santosh

    2004-01-01

    Background: The subject of subdural empyema (SDE) is reviewed on the basis of experience with 45 cases. Methods: Records of 45 patients with SDE were analyzed. There were 35 males and 10 females in the series. The majority of the patients were either infants (22.2%) or in their second and third decade of life (37.8%). For supratentorial SDE, craniotomy was done in 5 cases (11.1%). In six cases (13.3%) two burr-holes and in the rest of the cases multiple burrholes ...

  8. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  9. Bilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery.

    Science.gov (United States)

    Li, Zhao-Jian; Sun, Peng; Dou, Yi-He; Lan, Xiao-Lei; Xu, Jian; Zhang, Chun-Yong; Wang, Jian-Peng

    2012-01-01

    A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication. PMID:23006878

  10. Neuropatía femoral y hematoma bilateral de músculos psoas-iliaco asociados a tratamiento con warfarina

    Directory of Open Access Journals (Sweden)

    Rolando Rodríguez Fernández

    2012-06-01

    Full Text Available Se presentó un hombre de 70 años que sufrió un hematoma bilateral de los músculos psoas-iliacos como consecuencia del tratamiento con warfarina. Después de 6 d de tratamiento analgésico, valores de índice internacional normalizado inferiores a 1,5 y control del sangrado, se indicó la warfarina para continuar la profilaxis por la prótesis valvular mecánica. Fue egresado con secuelas motoras por la neuropatía femoral y se ha mantenido con tratamiento fisioterapéutico. Se diagnosticó neuropatía por compresión del nervio femoral, por hematoma de los músculos psoas-ilíacos. Los casos de hematomas retroperitoneales son escasos en la literatura médica, en Cuba no encontramos casos publicados.

  11. Unusual Presentation of Pulmonary Hematoma after Blunt Chest Wall Trauma

    Directory of Open Access Journals (Sweden)

    Reza Bagheri

    2014-02-01

    Full Text Available A 25-year-old man was admitted in hospital due to right side hemopneumothorax secondary to car accident. A chest tube was inserted. During the hospitalization days, chest CT scan revealed a 3cmx3 cm oval-shaped density located in the right upper lobe. Since he was in a good general condition, he was discharged from hospital after removal of chest tube and a follow-up chest CT-scan was recommended. In the chest CT scan that was performed 3 months later (Figure 1, the oval-shaped density was increased in size. There was no endobronchial lesion in bronchoscopic evaluation. Surgery was recommended He was underwent thoracotomy and the lesion was resected (Figure 2. It was post-traumatic pulmonary hematoma (Figure 3.

  12. Importance of computerized tomography for surgical treatment of intracranial hematomas

    International Nuclear Information System (INIS)

    The improved treatment by using computerized tomography (CT) located operating theater and intensive care unit is reported in comparison of 3,382 patients with severe head injuries. By preoperative use of CT the frequency of diagnosed hermatomas was about the same (29.5% before CT; 27.0% with CT) but the preoperative diagnosed multiple hematomas were much more frequent (14.0% resp. 27.0%). The most important advantage however is the saving of time by CT in this localisation by which the chance of survival has increased from 54% to 69%. Without any doubt everywhere in neurotraumatology the CT should be situated as near as possible to the intensive care unit and to the operating theater and should be available 24 hours a day. (Author)

  13. Imaging management of spontaneous giant esophageal intramural hematoma

    Energy Technology Data Exchange (ETDEWEB)

    Hagel, J. [Univ. of British Columbia, Dept. of Radiology, Vancouver, British Columbia (Canada); Bicknell, S.G.; Haniak, W. [Lions Gate Hospital, Dept. of Radiology, Vancouver, British Columbia (Canada)]. E-mail: sbicknel@interchg.ubc.ca

    2007-04-15

    A woman, aged 84 years, presented to our emergency department with posteriorly radiating chest pain that began following dinner. She reported no change in bowel habits, hematochezia, or melena. She had previous peptic ulcer disease and a long-standing history of gastroesophageal reflux disease. Her medications included acetylsalicylic acid and rabeprazole. Electrocardiogram and troponin analyses were negative for ischemic heart disease. The emergency physician suspected an aortic dissection, and computed tomography (CT) chest and abdomen scans were performed with and without IV and oral contrast. The aorta was normal and the noncontrast images demonstrated a hyperdense mass (not shown) that did not enhance consistent with a large intramural hematoma extending from the upper esophagus (level of T2 vertebral body) to the fundus of the stomach (Figures 1A and B). (author)

  14. Cervical spine intradural-extramedullary hematoma presenting as ipsilateral hemiparesis

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    Chih Ming Lin

    2011-08-01

    Full Text Available A 75-year-old Taiwanese man suffered from acute onset of right-sided extremity weakness while talking to his neighbors. He was transferred to the hospital within three-hour time after symptom onset. Initial acute ischemic cerebral infarct was diagnosed based on his symptom and cerebral computed tomography. Thrombolytic therapy was held after his symptom improved promptly and could not excluded other etiology. Thorough history taking unraveled previous Chinese medicine clinic visit because of neck sore. However, he received limited improvement after several times of massage treatment. Magnetic resnance imaging (MRI of the cervical spine demonstrated hematoma compressing right side intradural-extramedullary space at the C2/C3 level. Through his clinical course, muscle weakness was the sole neurological finding with sparing of sensory defects. Given the close anatomy relationship between sensory and motor lamina distribution in the cervical spinal cord, our patient presented a rare manifestation. Cases of cervical spine intradural-extramedullary hematoma are not often seen and only sporadic in the documented literature. We wish, through the report of this article, to inform the first- line physicians with the following information. Among the elderly, neck sore is a common symptom. Over- stretching or overt local massage is not suggested due to relatively fragile musculature. In the clinical diagnosis and localization of lesion, cerebral or cervical spine lesion could mimic with each other and manifest hemiparesis as their first symptom. Meticulous history taking, neurological/ physical examination and pertinent laboratory work-up should be done before initiation of intravenous thrombolytic therapy as it could cause catastrophic consequences if not used properly.

  15. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    Science.gov (United States)

    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  16. Spectrum of intracranial subdural empyemas in a series of 45 patients: Current surgical options and outcome

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    Tewari Manoj

    2004-07-01

    Full Text Available Background: The subject of subdural empyema (SDE is reviewed on the basis of experience with 45 cases. Methods: Records of 45 patients with SDE were analyzed. There were 35 males and 10 females in the series. The majority of the patients were either infants (22.2% or in their second and third decade of life (37.8%. For supratentorial SDE, craniotomy was done in 5 cases (11.1%. In six cases (13.3% two burr-holes and in the rest of the cases multiple burrholes were done to evacuate the empyema. Craniectomy was done in three cases (6.7%, of which two had posterior fossa SDE. All patients received appropriate preoperative and postoperative broad-spectrum antibiotics. Results: There was good recovery in 35 (77.8% patients, six patients (13.3% had moderate disability, two patients (4.4% had severe disability, and two (4.4% died. Three patients who developed recollection at operation site required evacuation of residual SDE. Median follow-up was 3½ years (range 4 months to 3½ years. Conclusion: Emergent evacuation of SDE using multiple burr-holes and irrigation of the subdural cavity with saline for 24 hours results in a satisfactory outcome in cases with SDE.

  17. Acute subdural empyema. With special reference to CT findings and surgical treatment; case report

    Energy Technology Data Exchange (ETDEWEB)

    Sasahira, Masahiro; Takagi, Kenichi; Hashimoto, Kazumasa; Inou, Satoshi; Arai, Toshimoto (Dokkyo Univ., School of Medicine, Tochigi (Japan))

    1983-05-01

    The patient, a 19-year-old male, began suffering from severe headache, vomiting, and high fever. Two days later the patient was admitted in a semicomatose state and with left hemiplegia. Nuchal rigidity and choked disc were not noticed. WBC count was 12,500/mm/sup 3/. CT scan disclosed marked swelling of the right cerebral hemisphere with midline shift. Except for a small lucent space in the parafalcial region, no extracerebral collection was noted in either pre- or post-contrast scans. Plain craniograms showed clouding of the left frontal, ethmoidal, and sphenoidal sinuses. Carotid angiography revealed prolongation of the circulation time and stenosis of the supraclinoidal portion of the right carotid artery. Right fronto-parietal decompressive craniectomy was performed. Subdural empyema was found and evacuated. Curettage and drainage of the empyema in the paranasal sinuses were also done. A bone defect 4 mm in diameter was detected on the medial-upper wall of the left frontal sinus. The causative organism was confirmed as ..cap alpha..-Streptococcus. Both systemic and local antibiotics were administered and the patient recovered well and was discharged without any neurological deficit. The authors emphasized that cerebral angiography is necessary for its accurate diagnosis of subdural empyema in its acute stage and that emergency intracranial and rhino-otological operations should be concomitantly performed.

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

    Directory of Open Access Journals (Sweden)

    Ciceri David P

    2007-03-01

    Full Text Available Abstract Background We report a case of severe upper airway obstruction due to a retropharyngeal hematoma that presented nearly one day after a precipitating traumatic injury. Retropharyngeal hematomas are rare, but may cause life-threatening airway compromise. Case presentation A 50 year-old man developed severe dyspnea with oropharyngeal airway compression due to retropharyngeal hematoma 20 hours after presenting to the emergency department. The patient also had a fractured first cervical vertebra and was diagnosed with a left brachial plexopathy. The patient underwent emergent awake fiberoptic endotracheal intubation to provide a definitive airway. Conclusion Retropharyngeal hematoma with life-threatening airway compromise can develop hours or days after a precipitating injury. Clinicians should be alert to the potential for this delayed airway collapse, and should also be prepared to rapidly secure the airway in this patient population likely to have concomitant cervical spinal or head injuries.

  19. Diagnosis of epidural hematoma by brain scan and perfusion study: case report

    International Nuclear Information System (INIS)

    By using the arterial and venous phases of an anterior cerebral perfusion study, which showed downward displacement of the sagittal sinus, and the finding of a rim on the delayed scans, the specific diagnosis of epidural hematoma was established

  20. [An intramural hematoma of the small intestine, during anticoagulant therapy: radiological course. Concerning one case].

    Science.gov (United States)

    Schutz, J F; Baumann, R; Constantinesco, A; Kerschen, A; Kempf, F; Weill, J P

    1977-03-01

    The authors present a case of intramural hematoma of the small intestines during anticoagulant treatment. With reference to this case, they study the frequency, etiopathogenesis and anatomy of this hematoma and particularly look at the radiological manifestations. In this respect they distinguish three stages in the evolution. The first, when the straight X-ray of the abdomen and barium followthrough demonstrate an axial stenosis of the small intestines with dilation of the proximal loops; the second (between the 7th and 20th days) when the loop affected by the hematoma takes on a characteristic "palissade" or "spring" -like sausage appearance; finally the third (after the 3rd week), when only thickening of the haustrations persists with progressive return to normal. The radiological diagnosis is discussed, not only with intramural hematomas of the small intestines of other etiologies (traumatic, during pancreatitis, during disorders in hemostatis), but also with conditions giving rise to similar radiological pictures: malabsorption, inflammatory conditions, etc. PMID:300805

  1. Spontaneous cervical epidural hematoma: a case report and review of the literature; Hematoma epidural cervical espontaneo: a proposito de un caso y revision de la bibligrafia

    Energy Technology Data Exchange (ETDEWEB)

    Aparici, F.; Mas, F.; Solera, M. C.; Moro, G. [Hospital Universitario La Fe. Valencia (Spain)

    2002-07-01

    We present the case of a 78-year-old woman with a spontaneous spinal epidural hematoma that presented with sudden interscapular pain accompanied by left hemiparesis and a significant improvement 15 minutes later. Initially diagnosed as angina, the persistence of pain in dorsal cervical spine suggested the need to perform magnetic resonance imaging (MRI). The images demonstrated a lesion in the epidural spinal canal at level C3-D2 that presented a heterogeneous signal intensity, with hyperintense areas in T1-weighted sequences and hypointense areas in gradient-echo sequences, with no sign of compression myelopathy. A diagnosis of epidural hematoma was established and, given the favorable clinical course, conservative treatment was indicated. The second MRI study showed the complete resorption of the epidural hematoma. (Author) 12 refs.

  2. CO2 Demonstration of Multiple Extravasations into a Subcapsular Hematoma of the Liver

    International Nuclear Information System (INIS)

    In a case of esophageal cancer with liver metastases, rupture of a liver metastasis resulted in subcapsular hematoma of the liver. Digital subtraction angiography with carbon dioxide showed multiple extravasations at the surface of the liver suggesting multiple ruptures of the penetrating hepatic capsular arteries. It was suggested that these findings are not rare in cases of subcapsular hematoma; however, they have received little attention

  3. An alarming but self-limited case of isolated large spontaneous liver hematoma in pregnancy.

    Science.gov (United States)

    Shakya, Vikal Chandra; Regmi, Mohan Chandra; Sah, Pannalal; Khaniya, Sudeep; Adhikary, Shailesh

    2013-01-01

    Spontaneous subcapsular liver hematoma is rare but potentially life-threatening complication of pregnancy usually associated with severe preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets). We present here a case of such a large spontaneous liver hematoma presenting in pregnancy, but without other known associated abnormalities, which has not been described before and it resolved on itself without any intervention. PMID:23560119

  4. Late Intrahepatic Hematoma Complicating Transjugular Intrahepatic Portosystemic Shunt for Budd-Chiari Syndrome

    International Nuclear Information System (INIS)

    Late intrahepatic hematoma is a rare complication of the transjugular intrahepatic portosystemic shunt (TIPS) procedure. We describe a patient with Budd-Chiari syndrome (BCS), who presented with a large inrahepatic hematoma 13 days after TIPS. Review of the literature reveals only two previous cases, both occurring in patients with BCS and presenting after a similar time interval. This potentially serious complication appears to be specific for TIPS in BCS

  5. Sonographically Diagnosed Vault Hematomas Following Vaginal Hysterectomy and Its Correlation with Postoperative Morbidity

    OpenAIRE

    Cem Dane; Banu Dane; Ahmet Cetin; Murat Yayla

    2007-01-01

    Objective. Our aim is to investigate sonographically detectable vault hematomas after vaginal hysterectomy and its relation to postoperative morbidity. Methods. We studied a group of 103 women who had undergone vaginal hysterectomy for benign causes apart from uterovaginal prolapse. Transabdominal ultrasound examinations were carried out 24 to 72 hours after surgery to assess the presence of vault hematomas. Ultrasound findings were correlated with clinical data and postoperative morbidity. R...

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

    OpenAIRE

    Bansal Ujjwal; Sawant Ajit; Dhabalia Jayesh

    2010-01-01

    Renal subcapsular hematoma is not an uncommon complication after extracorporeal short wave lithotripsy, trauma, renal angiographic procedures and spontaneously in patients of malignancy and in patients on anticoagulation. We present a patient who developed renal subcapsular hematoma after ureterorenoscopy, which has not been mentioned in literature ever. Clinical spectrum varies from spontaneous resolution through acute renal failure to Page kidney. Page kidney is the external compression of ...

  7. Conservative vs. Surgical Management of Post-Traumatic Epidural Hematoma: A Case and Review of Literature.

    Science.gov (United States)

    Maugeri, Rosario; Anderson, David Greg; Graziano, Francesca; Meccio, Flavia; Visocchi, Massimiliano; Iacopino, Domenico Gerardo

    2015-01-01

    BACKGROUND Trauma is the leading cause of death in people younger than 45 years and head injury is the main cause of trauma mortality. Although epidural hematomas are relatively uncommon (less than 1% of all patients with head injuries and fewer than 10% of those who are comatose), they should always be considered in evaluation of a serious head injury. Patients with epidural hematomas who meet surgical criteria and receive prompt surgical intervention can have an excellent prognosis, presumably owing to limited underlying primary brain damage from the traumatic event. The decision to perform a surgery in a patient with a traumatic extraaxial hematoma is dependent on several factors (neurological status, size of hematoma, age of patients, CT findings) but also may depend on the judgement of the treating neurosurgeon. CASE REPORT A 30-year old man arrived at our Emergency Department after a traumatic brain injury. General examination revealed severe headache, no motor or sensory disturbances, and no clinical signs of intracranial hypertension. A CT scan documented a significant left fronto-parietal epidural hematoma, which was considered suitable for surgical evacuation. The patient refused surgery. Following CT scan revealed a minimal increase in the size of the hematoma and of midline shift. The neurologic examination maintained stable and the patient continued to refuse the surgical treatment. Next follow up CT scans demonstrated a progressive resorption of hematoma. CONCLUSIONS We report an unusual case of a remarkable epidural hematoma managed conservatively with a favorable clinical outcome. This case report is intended to rather add to the growing knowledge regarding the best management for this serious and acute pathology. PMID:26567227

  8. Self-Inflicted Intraoral Hematoma in a Cardiac Patient Receiving Oral Anticoagulant Therapy- A Case Report

    OpenAIRE

    Shantala Arunkumar; Preethi A. Poonja; Shyam Amur; Sattur, Atul P.; Burde, Krishna N.; Venkatesh S Anehosur

    2015-01-01

    Intraoral hematoma secondary to systemic anticoagulant therapy is rare, but it is a potentially fatal condition requiring immediate medical management. Case report: Here we report a case of self-inflicted hematoma in the anterior maxillary gingival region in a 65year old female cardiac patient who was on systemic anticoagulant therapy with a poor periodontal condition, manifesting as a periodontal swelling for a period of one week. Oral anticoagulant therapy is cons...

  9. Management of Intramural Hematoma of the Ascending Aorta and Aortic Arch: The Risks of Limited Surgery

    OpenAIRE

    Saborio, David V.; Sadeghi, Alireza; Burack, Joshua H; Lowery, Robert C.; Genovesi, Mark H.; Brevetti, Gregory R.

    2003-01-01

    We present the case of a 57-year-old woman who had an intramural hematoma of the ascending aorta and aortic arch. After initial blood pressure control and imaging studies, the patient underwent limited surgical repair that consisted of ascending aortic replacement. One week postoperatively, the aortic arch hematoma progressed to a full dissection that extended into the proximal descending aorta. Emergent aortic arch replacement was required.

  10. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator

    OpenAIRE

    Nasser José Augusto; Falavigna Asdrubal; Bezerra Márcio; Martinez Victor; Freitas Gabriel; Alaminos Armando; Bonatelli Antônio; Ferraz Fernando

    2002-01-01

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

  11. Delayed duodenal obstruction after intramural hematoma in a patient with paroxysmal nocturnal hemoglobinuria: A case report

    OpenAIRE

    Tugan Tezcaner; Yahya Ekici; Mahir K?rnap; Feride Kural; Gökhan Moray

    2014-01-01

    INTRODUCTION: Paroxysmal nocturnal hemoglobinuria (PNH) is a clonal stem cell disorder of hematopoietic cells. Gastrointestinal complications of PNH are rare and mostly related with intravascular thrombosis or intramural hematoma. PRESENTATION OF CASE: We describe a case of a man with PNH complicated by intramural duodenal hematoma initially treated with supportive care. Three months after his first admission; he was admitted to the emergency department with abdominal pain, nausea and vomi...

  12. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator / Fibrinólise com infusão de rtPA e drenagem estereotáxica de hematoma intracerebral espontâneo profundo

    Scientific Electronic Library Online (English)

    José Augusto, Nasser; Asdrubal, Falavigna; Márcio, Bezerra; Victor, Martinez; Gabriel, Freitas; Armando, Alaminos; Antônio, Bonatelli; Fernando, Ferraz.

    2002-06-01

    Full Text Available OBJETIVO: Estudo prospectivo em 10 pacientes com infusão de trombolítico (rtPA) dentro do hematoma cerebral profundo supratentorial e drenagem estereotáxica. MÉTODO: Entre 1999 e 2000 10 pacientes com hematomas de profundidade foram selecionados para infusão de rtPA e drenagem do coágulo espontânea. [...] RESULTADO: Todos os casos obtiveram 80% de redução do volume do hematoma medidos por TC no terceiro dia. A pressão intracraniana estava normalizada no terceiro dia. Não houve complicações locais ou sistêmicas relacionadas com o uso deste trombolítico. Os resultados comparados foram mostrados pela Escala de Prognóstico de Glasgow com 6 pacientes em GrauV, 3 pacientes em Grau IV e 1 paciente em Grau III após três meses. CONCLUSÃO: Tratamento precoce e drenagem com técnica neurocirúrgica minimamente invasiva pode fazer estes pacientes terem uma recuperação da consciência mais rápida e assim serem reabilitados mais precocemente evitando complicações secundárias. Abstract in english PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA) intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA a [...] nd spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.

  13. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator Fibrinólise com infusão de rtPA e drenagem estereotáxica de hematoma intracerebral espontâneo profundo

    Directory of Open Access Journals (Sweden)

    José Augusto Nasser

    2002-06-01

    Full Text Available PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.OBJETIVO: Estudo prospectivo em 10 pacientes com infusão de trombolítico (rtPA dentro do hematoma cerebral profundo supratentorial e drenagem estereotáxica. MÉTODO: Entre 1999 e 2000 10 pacientes com hematomas de profundidade foram selecionados para infusão de rtPA e drenagem do coágulo espontânea. RESULTADO: Todos os casos obtiveram 80% de redução do volume do hematoma medidos por TC no terceiro dia. A pressão intracraniana estava normalizada no terceiro dia. Não houve complicações locais ou sistêmicas relacionadas com o uso deste trombolítico. Os resultados comparados foram mostrados pela Escala de Prognóstico de Glasgow com 6 pacientes em GrauV, 3 pacientes em Grau IV e 1 paciente em Grau III após três meses. CONCLUSÃO: Tratamento precoce e drenagem com técnica neurocirúrgica minimamente invasiva pode fazer estes pacientes terem uma recuperação da consciência mais rápida e assim serem reabilitados mais precocemente evitando complicações secundárias.

  14. Development of a renal subcapsular hematoma during angiography for diagnosis and subsequent treatment of hepatocellular carcinoma.

    Science.gov (United States)

    Hirao, Akihiro; Tomonari, Testu; Tanaka, Hironori; Tanaka, Kumiko; Kagawa, Miwako; Tanaka, Takahiro; Taniguchi, Tatsuya; Harada, Rie; Sato, Momoko; Muguruma, Naoki; Takayama, Tetsuji

    2014-04-01

    A renal subcapsular hematoma rarely occurs without a history of trauma. It has been reported as a complication of urological interventions and also reported to occur spontaneously in patients with renal malignancies. However, there are no previous reports of renal subcapsular hematomas occurring in connection with abdominal angiography. We report here a case of a renal subcapsular hematoma that developed and was recognized during abdominal angiography for treatment of hepatocellular carcinoma (HCC). An 80-year-old male was referred to our hospital for transarterial embolization for multiple HCCs. His past medical history included hypertension. His laboratory data showed slightly decreased number of platelets and hepaplastin test due to liver cirrhosis. When computed tomography angiography was performed, a 7-cm subcapsular hematoma developed and was recognized over the right kidney during the procedure. He was successfully managed supportively with blood transfusion, tranexamic acid and antibiotics. Since thrombocytopenia and hypertension are reportedly risk factors for hematoma formation, careful manipulation is required during angiography in HCC patients with liver cirrhosis and hypertension. It must be kept in mind that rare complications, such as a renal subcapsular hematoma, can happen during abdominal angiography for diagnostic and interventional treatment of HCC. PMID:26183639

  15. Nasalseptal hematoma/abscess: management and outcome in a tertiary hospital of a developing country

    Directory of Open Access Journals (Sweden)

    Nwosu JN

    2015-07-01

    Full Text Available Jones N Nwosu, Peter C NnadedeDepartment of Otolaryngology, University of Nigeria Teaching Hospital, Enugu, NigeriaBackground: Nasal hematoma/abscess is an uncommon entity, but capable of leading to serious consequences if not handled meticulously, and with urgency.Objective: To present the management, and outcome of nasal septal hematoma/abscess in a Nigerian tertiary institution.Method: Consecutive patients diagnosed with nasal septal hematoma/abscess over a 10-year period, treated at the University of Nigeria Teaching Hospital, Enugu, Nigeria, were prospectively studied. The processes leading to diagnosis, treatment, and outcome were sequentially evaluated.Results: Fifty-three patients (37 males and 16 females, age 5–65 years (with mean age of 23.10 years, were included. Surgical drainage of the hematoma/abscess, intranasal packing with insertion of drain was performed with total resolution of problem in all the cases.Conclusion: Incision and drainage, and intranasal packing with insertion of drain was effective in treating nasal septal hematoma/abscess.Keywords: septal hematoma, abscess, facial deformity

  16. Clinical appraisal of stereotactic hematoma aspiration surgery for hypertensive thalamic hemorrhage

    International Nuclear Information System (INIS)

    Three hundred and four patients with hypertensive thalamic hemorrhage were managed by medical treatment, ventricular drainage, or CT-controlled stereotactic aspiration surgery (AS). The therapeutic results of the 6-month outcome were analyzed and correlated with the volume of the hematoma. A hematoma volume of 20 ml was thought to be the critical size in determining whether the outcome would be favorable or unfavorable. Indications for AS are suggested as follows. In patients with a small-sized hematoma having a volume of less than 10 ml use of AS should be restricted to patients with severe paralysis or other neurological complications and the elderly (aged 70 years or older). For patients with a medium-sized hematoma having a volume between 10 ml and 20 ml, AS is indicated for patients having severe paralysis and disturbances of consciousness. For patients with a large-sized hematoma having a volume of 20 ml or more, AS increases not only the survival rate of patients but also reduces the number of bedridden patients. We conclude that AS opens up a new avenue of surgical treatment for hypertensive thalamic hemorrhage, which has been no indication for hematoma evacuation by conventional craniotomy. (author)

  17. Vertex extradural hematoma in association with Paget?s disease of the skull

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    Ramesh V

    2005-01-01

    Full Text Available Paget?s disease of skull usually causes neurological complications such as basilar invagination, cranial neuropathies, etc. Occurrence of extradural hematoma in association with Paget?s disease of skull is rare. A 48 year old man presented with headache and right upper limb weakness, two days after a fall from scooter. CT Scan of brain showed a large extradural hematoma at the vertex with the cranial vault showing features of Paget?s disease. At surgery, no skull fracture or injury to the superior sagittal sinus was evident. There was diffuse oozing from the inner table of the skull, which showed features of Paget?s disease. The extradural hematoma was evacuated and the patient made good recovery.He deteriorated a few hours after surgery. Follow up CT Scan showed diffuse brain swelling with minimal recollection of hematoma. Re-exploration showed a small recollection which was evacuated and the part of the oozing diseased skull was excised. The patient recovered completely. This is the first reported case of vertex extradural hematoma in association with the Paget?s disease of skull. The unusual features are the absence of skull fracture and injury to the superior sagittal sinus. The increased vascularity of the skull due to Paget?s disease has caused the hematoma by diffuse oozing from the inner table.

  18. An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report

    Directory of Open Access Journals (Sweden)

    Shimodaira Masanori

    2013-01-01

    Full Text Available Abstract Background Abdominal wall hematomas are an uncommon cause of acute abdominal pain and are often misdiagnosed. They are more common in elderly individuals, particularly in those under anticoagulant therapy. Most abdominal wall hematomas occur in the rectus sheath, and hematomas within the oblique muscle are very rare and are poorly described in the literature. Here we report the case of an oblique muscle hematoma in a middle-aged patient who was not under anticoagulant therapy. Case presentation A 42-year-old Japanese man presented with a painful, enlarging, lateral abdominal wall mass, which appeared after playing baseball. Abdominal computed tomography and ultrasonography showed a large soft tissue mass located in the patient’s left internal oblique muscle. A diagnosis of a lateral oblique muscle hematoma was made and the patient was treated conservatively. Conclusion Physicians should consider an oblique muscle hematoma during the initial differential diagnosis of pain in the lateral abdominal wall even in the absence of anticoagulant therapy or trauma.

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

    Scientific Electronic Library Online (English)

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

    2012-03-01

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

  20. Chronic hematic cyst of the temporomandibular joint

    International Nuclear Information System (INIS)

    Hematic cyst refers to accumulation of blood or blood breakdown products in a non epithelium-lined fibrous tissue capsule. Hepatic cyst is a term often used for deeply placed, incompletely resorbed hematoma hemorrhagic cyst, which may remain unchanged and unidentified for long periods of time. Trauma is the major causative factor, although it is often vague or totally uncalled by the patient. Chronic hematic cysts are uncommon lesions those can present diagnostic challenge. In this article we report a first case of a chronic hematic cyst of the temporomandibular joint TMJ. (author)

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

    Scientific Electronic Library Online (English)

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

    2014-03-01

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

  2. Pregnancy Outcomes in Pregnant Women with Subchorionic Hematoma

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    Victoria V. Barinova

    2015-09-01

    Full Text Available Background: The role of subchorionic hematoma (SCH in the first trimester of pregnancy remains open for discussion. Some authors claim that SCH does not affect the pregnancy; others have found that it is a serious risk factor for adverse pregnancy outcome. The objective of the present study was to explore the outcomes of pregnancy in patients with SCH diagnosed in the first trimester. Methods and Results: The study involved 194 pregnant women who were in terms of 6 to12 weeks: 115 women with SCH (Group 1 and 79 apparently healthy pregnant women (Group 2. A missed miscarriage was observed in 27/23% women of Group 1 and in 4/5% of Group 2 (P<0.05, recurrent threat of miscarriage in 27/23% and in 4/5%, recurrent bleeding in 14/12% and 2/3%, and the short cervix syndrome in 22/19% and 5/6% women, respectively. Conclusion: The results of our study show that the presence of SCH adversely affects the first half of pregnancy, leading to recurrent threatened abortion, recurrent threat of miscarriage, missed miscarriage until 12 weeks of gestation, and the short cervix syndrome.

  3. Post meningitis subdural hygroma: anatomical and functional evaluation with 99mTc-ethylene cysteine dimer single photon emission tomography/computed tomography

    International Nuclear Information System (INIS)

    Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. 99mTc-ethylene cysteine dimer (99mTc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If 99mTc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management. (author)

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

    Scientific Electronic Library Online (English)

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

    2011-03-01

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

  5. Hemophilia and child abuse as possible causes of epidural hematoma: case report Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso

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    Fernando Campos Gomes Pinto

    2003-12-01

    Full Text Available INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.INTRODUÇÃO: Traumatismo crânio-encefálico é importante conseqüência de abuso infantil. Mecanismos fisiopatológicos específicos do abuso infantil são responsáveis pela ''whiplash shaken-baby syndrome'', o que favoreceria o aparecimento de hemorragias intracranianas. RELATO DE CASO: Relatamos o caso de uma criança que desenvolveu hematoma extradural após trauma de pequena intensidade. Foi feito diagnóstico inicial de abuso infantil, mas investigações subseqüentes levaram ao diagnóstico de hemofilia A. CONCLUSÃO: Embora o hematoma extradural não esteja intimamente relacionado com abuso infantil, esta etiologia deve ser sempre considerada quando o mecanismo de trauma relatado estiver fora de proporção com as lesões encontradas.

  6. Hemophilia and child abuse as possible causes of epidural hematoma: case report / Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso

    Scientific Electronic Library Online (English)

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

    2003-12-01

    Full Text Available INTRODUÇÃO: Traumatismo crânio-encefálico é importante conseqüência de abuso infantil. Mecanismos fisiopatológicos específicos do abuso infantil são responsáveis pela ''whiplash shaken-baby syndrome'', o que favoreceria o aparecimento de hemorragias intracranianas. RELATO DE CASO: Relatamos o caso d [...] e uma criança que desenvolveu hematoma extradural após trauma de pequena intensidade. Foi feito diagnóstico inicial de abuso infantil, mas investigações subseqüentes levaram ao diagnóstico de hemofilia A. CONCLUSÃO: Embora o hematoma extradural não esteja intimamente relacionado com abuso infantil, esta etiologia deve ser sempre considerada quando o mecanismo de trauma relatado estiver fora de proporção com as lesões encontradas. Abstract in english INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who develop [...] ed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.

  7. Hematoma aórtico intramural tipo B: imágenes de una entidad con diferentes caminos evolutivos / Aortic intramural hematoma type B: images of an entity with different evolution pathways

    Scientific Electronic Library Online (English)

    Gabriel, Pérez-Baztarrica; Flavio, Salvaggio; Sebastián, Villecco; Rafael, Porcile.

    2012-03-01

    Full Text Available El progreso en técnicas no invasivas de imagen para patología aórtica, como son la tomografía computarizada (TC), resonancia magnética (RM) y la ecocardiografía transesofágica (ETE), han facilitado el diagnóstico y seguimiento de pacientes con hematoma intramural aórtico (HIA). A pesar de la compren [...] sión incompleta de su historia natural, se sabe que no hubo diferencia significativa, entre el HIA y la disección aórtica clásica (DAC), en la incidencia de complicaciones mayores o muerte. En nuestro artículo, presentamos imágenes de pacientes con diagnóstico de hematoma aórtico tipo B y los diferentes resultados, en su evolución natural. Abstract in english The progress in noninvasive imaging techniques for aortic pathology, such as computed tomography (CT), magnetic resonance (MRI) and transesophageal echocardiography (TEE) have facilitated the diagnosis and management of patients with aortic intramural hematoma (IMH). Despite incomplete understanding [...] of their natural history, it is known there is no significant difference between the IMH and classic aortic dissection (AD) on the incidence of major complication or death. In this article, we present images of patient with type B aortic hematoma and different outcomes in their natural evolution.

  8. Ligamentum flavum hematoma: a case report and literature review / Hematoma del ligamento amarillo: caso clínico y revisión de la literatura / Hematoma de ligamento amarelo: relato de caso e revisão da literatura

    Scientific Electronic Library Online (English)

    Ericson, Sfreddo; Marcelo Teodoro Ezequiel, Guerra.

    Full Text Available O objetivo é apresentar um caso raro de hematoma do ligamento amarelo na região lombar, discutir sua fisiopatologia e tratamento e revisar a literatura. Uma mulher de 68 anos apresentou-se com claudicação neurogênica devido à doença degenerativa lombar e espondilolistese que evoluiu para uma piora s [...] úbita com a síndrome da cauda equina. A imagem por ressonância magnética (IRM) mostrou sinais de degeneração da coluna lombar, com um canal vertebral estreito de L2 a S1, ântero-listese de L4 L5 e, posteriormente no nível da L1-L2, um processo expansivo arredondado e hiperintenso em T1 e com bordas hipointensas em T2 ponderada, compatível com hematoma na topografia do ligamento amarelo. A paciente foi submetida a laminectomia e fixação lombar. Sua evolução foi boa no período pós-operatório e, aos 18 meses de follow-up andou sozinha, apesar da dor que é controlada com medicamentos simples. Mesmo sendo raro, parece que o hematoma do ligamento amarelo tem uma relação com a degeneração e ruptura de pequenos vasos associadas a microtraumas na coluna vertebral. Sua fisiopatologia ainda não é bem definida e o tratamento é semelhante ao de outros processos de compressão da coluna vertebral. Abstract in spanish El objetivo es presentar un caso raro de un hematoma ligamento flavum en la región lumbar, discutir su fisiopatología y el tratamiento y revisión de la literatura. Una mujer de 68 años presentó claudicación neurogénica debido a la espondilolistesis lumbar degenerativa y que se convirtió en un repent [...] ino empeoramiento con el síndrome de cauda equina. Una imagen de resonancia magnética (RM) mostró signos de degeneración de la columna lumbar, con canal espinal estrecho de L2 a S1, anterolistesis L4 L5 y en la L1-L2, un proceso expansivo redondeado e hiperintenso en T1 y hipointenso en los bordes en T2, compatible con hematoma en la topografía del ligamento amarillo. La paciente fue sometida a laminectomía y fijación lumbar. Su evolución fue buena en el postoperatorio y, a los 18 meses de seguimiento caminaba sola, a pesar del dolor que se controla con medicamentos simples. Aunque raro, parece que el hematoma del ligamento amarillo tiene relación con la degeneración y la ruptura de pequeños vasos asociadas a micro-traumas en la columna vertebral. Su fisiopatología no está bien definida y el tratamiento es similar a otros procesos de compresión de la columna vertebral. Abstract in english The aim is to present a rare case of ligamentum flavum hematoma in the lumbar region, discuss its physiopathology and treatment and review the literature. A woman aged 68 presented with neurogenic claudication due to degenerative lumbar spondylolisthesis that evolved into a sudden worsening with cau [...] da equina syndrome. The magnetic resonance imagining (MRI) showed signs of degeneration of the lumbar spine, with a narrow spinal canal from L2 to S1, anterolisthesis L4 L5 and an expansive lesion hyperintense on T1-weighted and hypointense on T2-weighted images considered compatible with hematoma in the topography of the yellow ligament in L1-L2. The patient underwent laminectomy and lumbar fixation. Her evolution was good in the postoperative period and at 18 months of follow-up hse walked alone, despite the pain that is controlled with simple medications. Even though rare, it seems that ligamentum flavum hematoma has a relationship with the degeneration and rupture of small vessels associated with micro trauma to the spine. Its physiopathology is not well defined and treatment is similar to other spine compression processes.

  9. Combined spinal subdural tuberculous empyema and intramedullary tuberculoma in an HIV-positive patient

    International Nuclear Information System (INIS)

    Tuberculous involvement of the spinal subdural and intramedullary compartments is extremely uncommon. Simultaneous involvement of both compartments has never been reported, to our knowledge. We present an HIV-positive patient with such kind of combined involvement. Diagnosis was made on the basis of a prior history of pulmonary tuberculous infection and a positive therapeutic response to antituberculous chemotherapy. Magnetic resonance imaging is the diagnostic procedure of choice in order to determine the exact level, site, and size of the disease. Tuberculosis of the spine should always be considered in the differential diagnosis of spinal cord compression if the patient lives in or comes from a region where tuberculosis is endemic or if the patient is immunocompromised. (orig.)

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

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    Aradhna Sharma

    2016-02-01

    Full Text Available Scrub typhus is a common infectious disease with a self-limiting course but may potentially cause a fatal outcome in some cases. We here present a case report of a patient diagnosed with scrub typhus and was given effective antibiotic therapy. Initially, the patient improved significantly but had sudden clinical deterioration on day five and presented with subdural hemorrhage. Orientia tsutsugamushi the causative agent of scrub typhus may be considered as a causal or provoking factor for cerebrovascular accidents in regions where scrub typhus is endemic. Patients should be followed strictly during convalescence in such cases especially in those who have received delayed treatment. [Int J Basic Clin Pharmacol 2016; 5(1.000: 223-224

  11. Subdural and depth electrode placement in the brain for validation of MEG in partial epilepsy

    Science.gov (United States)

    Siadat, Mohammad-Reza; Elisevich, Kost; Soltanian-Zadeh, Hamid; Jafari-Khouzani, Kourosh; Bowyer, Susan

    2006-03-01

    Localization of epileptogenic zones in extratemporal epilepsy is a challenging problem. We speculate that using all modalities of data in an optimal way can facilitate the localization of these zones. In this paper, we propose the following steps to transfer all modalities of data in a single reference coordinate system: 1) Segmentation of subdural and depth electrodes, and cortical surface. 2) Building 3D models of the segmented objects. 3) Registration of preoperative MRI and postoperative CT, and magnetoencephalography (MEG). The above steps result in fusion of all modalities of data, objects of interests (electrodes and cortical surface), MEG analysis results and brain mapping findings. This approach offers a means by which an accurate appreciation of the zone of epileptogenicity may be established through optimal visualization and further quantitative analyses of the fused data. It also provides a ground for validation of less expensive and noninvasive procedures, e.g., scalp EEG, MEG.

  12. Spontaneous Rupture of the Middle Fossa Arachnoid Cyst into the Subdural Space: Case Report

    Science.gov (United States)

    Bora, Ayd?n; Yoku?, Adem; Batur, Abdussamet; Bulut, Mehmet Deniz; Yavuz, Alpaslan; Gül?en, ?smail; Özgökçe, Mesut; Arslan, Mehmet

    2015-01-01

    Summary Background Arachnoid cysts are congenital, benign and intra-arachnoidal lesions. A great majority of arachnoid cysts are congenital. However, to a lesser extent, they are known to develop after head trauma and brain inflammatory diseases. Arachnoid cysts are mostly asymptomatic and they can develop anywhere in the brain along the arachnoid membrane. Case Report Arachnoid cysts form 1% of the non-traumatic lesions which occupy a place and it is thought to be a congenital lesion developed as a result of meningeal development abnormalities or a lesion acquired after trauma and infection. There is a male dominance at a rate of 3/1 in arachnoid cysts which locate mostly in the middle fossa. Our patient was a 2-years-old boy. Conclusions As a conclusion, spontaneous subdural hygroma is a rare complication of the arachnoid cysts. Surgical intervention could be required in acute cases. PMID:26150904

  13. Comparison of clinical outcomes of intraventricular hematoma between neuroendoscopic removal and extraventricular drainage

    International Nuclear Information System (INIS)

    The efficacy of treatment for intraventricular hematoma by neuroendoscopic surgery and extraventricular drainage was compared in 10 patients with intraventricular hematoma and hydrocephalus who underwent neuroendoscopic surgery (endoscopic group), and eight patients with intraventricular hematoma and hydrocephalus treated with extraventricular drainage (EVD group). The outcomes in each group were assessed retrospectively using the Graeb scores on the pre- and postoperative computed tomography (CT), duration of extraventricular drainage, requirement for a shunt operation, and modified Rankin scale score at 12 months. The Graeb scores on the preoperative CT were not significantly different between the two groups, but the duration of catheter placement was significantly shorter (69.3%) in the endoscopic group (2.7 days) than in the EVD group (8.8 days). None of the patients in either group required a shunt procedure for communicating hydrocephalus 12 months after surgery. Neuroendoscopic removal is a safe and effective procedure for intraventricular hematoma. Advantages include rapid removal of hematoma in the ventricular systems and reliable improvement of non-communicating hydrocephalus in the acute phase. The procedure resulted in faster removal of the catheter in the postoperative period and earlier patient ambulation. (author)

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

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    Satomi Jyunichiro

    2009-11-01

    Full Text Available Abstract Abdominal wall hematoma is a rare and life-threatening complication after carotid artery stenting (CAS, but it can occur when activated clotting time is prolonged. We report a right lateral abdominal wall hematoma caused by rupture of the superficial circumflex iliac artery after CAS in a 72-year-old man with severe stenosis of the origin of the right internal carotid artery. We performed CAS for the targeted lesion while activated clotting time exceeded 300 seconds. After 2 hours, he complained of right lateral abdominal pain. Abdominal computed tomography revealed an extensive hematoma in the right lateral abdominal wall. Activated clotting time was 180 seconds at this point. Seven hours later, he developed hypotension and hemoglobin level dropped to 11.3 g/dl. Subsequent computed tomography showed enlargement of the hematoma. Emergent selective angiography of the external iliac artery revealed active bleeding from the right superficial circumflex iliac artery. Transcatheter arterial embolization with Gelfoam and microcoils was performed successfully. With more CAS procedures being performed, it is important for endovascular surgeons and radiologists to consider the possibility of abdominal wall hematoma in this situation.

  15. Delayed angiography in the investigation of intracerebral hematomas caused by small arteriovenous malformations

    Energy Technology Data Exchange (ETDEWEB)

    Willinsky, R.A. (Dept. of Radiology, Toronto Hospital, Western Div., Toronto, ON (Canada) Univ. of Toronto, Brain Vascular Malformation Study Group, ON (Canada)); Fitzgerald, M. (Dept. of Radiology, Toronto Hospital, Western Div., Toronto, ON (Canada)); TerBrugge, K. (Dept. of Radiology, Toronto Hospital, Western Div., Toronto, ON (Canada) Univ. of Toronto, Brain Vascular Malformation Study Group, ON (Canada)); Montanera, W. (Dept. of Radiology, Toronto Hospital, Western Div., Toronto, ON (Canada)); Wallace, M. (Div. of Neurosurgery, Dept. of Surgery, Toronto Hospital, Western Div., ON (Canada) Univ. of Toronto, Brain Vascular Malformation Study Group, ON (Canada))

    1993-04-01

    We reviewed the clinical and radiological features of ten patients with small arteriovenous malformations that caused intracerebral hematomas. In six patients, angiography showed a small nidus (less than 1 cm in diameter) with a shunt at the site of the hematoma, and in four only an early-filling vein was evident. Six patients had only delayed angiography (4 weeks or more after the ictus). In three, angiography within 2 days of the ictus failed to reveal the cause of the bleed, but repeat angiography showed an early-filling vein in two, and a nidus with shunting in one. In only one patient did early angiography reveal the malformation. MRI was obtained in eight patients, and in two prominent vessels were evident in the wall of the hematoma cavity. In investigation of an unexplained intracerebral hematoma, MRI may be useful to exclude a neoplasm or cavernoma, although the latter may be not be evident in the presence of a recent hematoma. We suggest early MRI and angiography for investigation of an unexplained, nonhypertensive intracerebral bleed, with follow-up MRI and dealyed angiography if the initial studies fail to reveal the cause. (orig.)

  16. Thickening of the pulmonary artery wall in acute intramural hematoma of the ascending aorta

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    Lardani Héctor

    2007-01-01

    Full Text Available Abstract Background The occurrence of pulmonary artery obstruction in the course of acute aortic dissection is an unusual complication. The mechanism implicated is the rupture of the outer layer of the aorta and the subsequent hemorrhage into the adventitia of the pulmonary artery that causes its wall thickening and, at times, produces extrinsic obstruction of the vessel. There are no reports of this complication in acute intramural hematoma. Case presentation An 87-year-old woman was admitted to the hospital in shock after having had severe chest pain followed by syncope. An urgent transesophageal echocardiogram revealed the presence of acute intramural hematoma, no evidence of aortic dissection, severe pericardial effusion with cardiac tamponade, and periaortic hematoma that involved the pulmonary artery generating circumferential wall thickening of its trunk and right branch with no evidence of flow obstruction. Urgent surgery was performed but the patient died in the operating room. The post mortem examination, in the operating room, confirmed that there was an extensive hematoma around the aorta and beneath the adventitial layer of the pulmonary artery, with no evidence of flow obstruction. Conclusion This is the first time that this rare complication is reported in the scenario of acute intramural hematoma and with the transesophageal echocardiogram as the diagnostic tool.

  17. Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Tatsuya; Sakai, Toshinori; Sairyo, Koichi; Katoh, Shinsuke; Yasui, Natsuo [The University of Tokushima Graduate School, Department of Orthopedics, Institute of Health Biosciences, Tokushima (Japan); Takao, Shoichiro [The University of Tokushima Graduate School, Department of Radiology, Institute of Health Biosciences, Tokushima (Japan); Kagawa, Seiko [The University of Tokushima Graduate School, Department of Human Pathology, Institute of Health Biosciences, Tokushima (Japan)

    2010-03-15

    Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma. (orig.)

  18. Retroperitoneal hematoma following rofecoxib and enoxaparin coadministration in a patient with atrial fibrillation

    International Nuclear Information System (INIS)

    There are very few published reports implicating enoxaparin as a factor in retroperitoneal hematoma. We report a patient who developed a retroperitoneal hematoma after using enoxaparin for paroxysmal atrial fibrillation. A 72 year old man was admitted with a history of low back pain, radiating beyond the back to the buttocks. His medical history was positive for bilateral knee osteoarthritis. On his physical examination his vital signs were: temperature 36.8, blood pressure 100/70 mm Hg, pulse 72/min, respiratory rate 16/min. X-ray of both the knees showed bilateral osteoarthritic changes. Computerized tomography scan of the spine showed lumbar spinal stenosis and he was referred to a Neurosurgeon, who finds the patient not fit surgical intervention. ECG showed atrial fibrillation. He was given enoxaparin one mg/kg every 12 hour and digoxin. Abdominal computed tomography revealed a right retroperitoneal hematoma and no aortic aneurysm was noted and enoxaparin and rofecoxib were discontinued. His general condition improved. The factors that increase the risk of bleeding in patients receiving enoxaparin are use of high doses of enxaparin, advanced stage, renal impairment, and the concomitant use of drugs affecting hemostasis. Retroperotoneal hematoma should be considered in the different diagnosis in patients receiving enoxaparin and experiencing unexplained decreases in hemoglobin and hematocrit. In the order of precedence of radiologic diagnostic procedures for fast diagnosis of a retroperitoneal hematoma, abdominal CT-scan is the preferred method

  19. Hematoma epidural cervical yatrogénico: Presentación de un caso clínico y revisión de la literatura / Iatrogenic cervical epidural hematoma: case report and review of the literature

    Scientific Electronic Library Online (English)

    I., Jusué-Torres; J.M., Ortega-Zufiria; M., Tamarit-Degenhardt; R., Navarro Torres; R., López-Serrano; J., Riqué-Dormido; P., Aragonés-Cabrerizo; J.C., Gómez-Angulo; P., Poveda-Nuñez; P., Jerez-Fernández; J. M. del, Pozo-García.

    2011-08-01

    Full Text Available Introducción: En la literatura se recogen alrededor de 600 casos de hematomas epidurales espinales. En varios estudios, se afirma que la incidencia de paraparesia secundaria a anestesia epidural oscila entre 0,0005-0,02%. Se han descrito numerosas etiologías, incluyendo cirugía, traumatismos, antico [...] agulación, malformaciones arteriovenosas, embarazo, procesos hematológicos y punción lumbar. Los procedimientos anestésicos raquídeos y epidurales representan la décima causa más frecuente. Pero en combinación con el tratamiento anticoagulante, dichos procedimientos aumentan su incidencia hasta alcanzar la quinta causa. Publicamos un caso clínico de hematoma epidural cervical yatrogénico en el adulto y el buen resultado obtenido con tratamiento conservador. Caso clínico: Paciente varón de 80 años, que a las 2 horas de tratamiento analgésico de cervicoartrosis mediante infiltración epidural cervical desarrolla intensa cervicalgia y pérdida de fuerza en extremidades inferiores, mostrando paraplejia completa con arreflexia. En RM cervical se evidencia hematoma epidural entre los niveles C4 y T1. Es trasladado a nuestro centro para cirugía pero ante la rápida recuperación se decide tratamiento médico conservador. Al mes de seguimiento, la situación clínica es similar a la previa, sin secuelas con completa reabsorción del hematoma en RM control. Conclusión: Actualmente, la tendencia general es realizar cirugía en pacientes con hematoma espinal y empeoramiento neurológico importante durante las primeras horas. Sin embargo, se pueden obtener buenos resultados neurológicos con tratamiento conservador, en pacientes bien seleccionados con déficit parcial, incompleto y no progresivo. En el presente, no estamos en condiciones de decir qué tratamiento es el mejor para cada caso concreto. Abstract in english Background: Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous m [...] alformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. Case report: 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI. Conclusions: Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict wich is the best treatment for each case.

  20. Ruptured hepatic subcapsular hematoma following laparoscopic cholecystectomy: report of a case.

    Science.gov (United States)

    Shibuya, Kentaro; Midorikawa, Yutaka; Mushiake, Hiroyuki; Watanabe, Masato; Yamakawa, Tatsuo; Sugiyama, Yasuyuki

    2010-12-01

    Laparoscopic cholecystectomy is now a standard procedure for cholecystolithiasis because of its minimally invasive nature compared to the conventional method. However, severe complications that have never been seen for open surgery have also been reported. Here, we report the case of a 28-year-old woman who underwent laparoscopic cholecystectomy and then developed a ruptured subcapsular hematoma. On postoperative day 1, she developed shock, and postoperative bleeding was suspected. During re-operation, a ruptured subcapsular hematoma of the whole right lobe of the liver with active bleeding was found, and hemostasis was achieved. In this case, it was assumed that the rupture of the subcapsular hematoma was due to compression of the liver by the clamp for retrieving the spilled gallstones during the first operation and perioperative administration of nonsteroidal anti-inflammatory drugs. PMID:21248436