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1

Intracranial aneurysms causing spontaneous acute subdural hematoma  

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

Shenoy S; Kumar M; Raja A

2003-01-01

2

Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.  

Science.gov (United States)

Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal. PMID:23020171

Derrey, Stéphane; Lebas, Axel; Parain, Dominique; Baray, Marie Gilles; Marguet, Christophe; Freger, Pierre; Proust, François

2012-09-28

3

Delayed intracranial hematoma following stereoelectroencephalography for intractable epilepsy: case report.  

UK PubMed Central (United Kingdom)

Intracranial bleeding following stereoelectroencephalography (sEEG) is rare and commonly occurs early after electrode implantation. The authors report the case of a delayed intracranial hematoma following sEEG. This 10-year-old boy was referred to the authors' department to undergo an sEEG study for intractable epilepsy, with the hypothesis of a single localized epileptic zone in the left precentral region. To perform the exploration, 14 depth electrodes were implanted under stereotactic conditions. The results of a postoperative CT scan performed routinely at the end of the surgical procedure were normal. Eight days later, following an epileptic seizure, the child's condition worsened. The neurological examination revealed a left hemiparesis, agitation, and coma due to a right subdural hematoma with intraparenchymal bleeding. Despite a surgical evacuation followed by a decompressive craniectomy, the curative treatments were stopped 1 week later due to severe diffuse ischemic lesions found on MRI studies. This is the first observation of a delayed hematoma following an sEEG procedure. The mechanism underlying this complication remains unclear, but the rupture of a growing pseudoaneurysm caused by the electrode's implantation or the tearing of a neighboring vessel by an electrode were suspected. In consequence, physicians must remain vigilant during the entire sEEG recording period and probably also several days after electrode removal.

Derrey S; Lebas A; Parain D; Baray MG; Marguet C; Freger P; Proust F

2012-12-01

4

Asphyxial death caused by postextraction hematoma.  

UK PubMed Central (United Kingdom)

A 71-year-old man was admitted to an emergency room because of postextraction hemorrhage and died of asphyxia caused by airway obstruction. About 40 days earlier, he had had 11 carious teeth removed without postextraction bleeding. At autopsy, liver cirrhosis was found, but examination of his previous extractions and postmortem external findings did not show a general hemorrhagic tendency. The surgical incision in the gingiva had been sutured, and no damage to the bony socket or large vasculature was found. We could not determine the etiologic source of the decedent's rapidly increasing hematoma. Postextraction hemorrhage or hematoma is a common complication in routine dental extraction, but marked hematoma formation around the airway may cause critical respiratory problems in the short run. In such cases, the maintenance of the airway, including control of hemorrhage, is necessary at an early stage.

Funayama M; Kumagai T; Saito K; Watanabe T

1994-03-01

5

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

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

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

1983-08-01

6

Subcapsular liver hematoma causing cardiac tamponade in HELLP syndrome.  

UK PubMed Central (United Kingdom)

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.

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

2012-07-01

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

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

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

2012-01-01

8

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

International Nuclear Information System (INIS)

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

1983-01-01

9

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1983-02-01

10

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

Science.gov (United States)

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

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

2013-03-01

11

Subdural hematoma caused by epithelioid angiosarcoma originating from the skull.  

UK PubMed Central (United Kingdom)

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

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

2013-06-01

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Acute subdural hematoma caused by clopidrogel  

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

Nail OZDEMIR; Murat YILDIRIM; Kaan ALTINKAYA

2010-01-01

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

International Nuclear Information System (INIS)

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

1983-01-01

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

UK PubMed Central (United Kingdom)

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

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

2013-06-01

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

UK PubMed Central (United Kingdom)

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

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

2013-01-01

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Traumatic subarachnoid hemorrhage, basal ganglia hematoma and ischemic stroke caused by a torn lenticulostriate artery.  

UK PubMed Central (United Kingdom)

Subarachnoid hemorrhage (SAH), basal ganglia hematoma (BGH) and ischemic stroke are common diseases with diverging therapies. The simultaneous occurrence of these diseases is rare and complicates the therapy. We report the case of a 30-year-old man with a ruptured lenticulostriate artery after traumatic brain injury that caused the combination of SAH, BGH and ischemic stroke and subsequent cerebral vasospasm. This rupture mimicked the pathophysiology and imaging appearance of aneurysmal SAH. The site of rupture was not secured by any treatment; however, hyperdynamic therapy and percutaneous transluminal angioplasty were feasible in this setting to prevent additional delayed neurological deficit.

Fung C; Z'Graggen WJ; Beck J; Gralla J; Jakob SM; Schucht P; Raabe A

2012-01-01

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Analysis of infantile subdural hematoma caused by abuse  

International Nuclear Information System (INIS)

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

2010-01-01

18

Contralateral delayed hematoma secondary to anticoagulant treatment-related intracerebral hemorrhage.  

UK PubMed Central (United Kingdom)

The incidence of anticoagulant treatment (AT)-related intracerebral hemorrhage (AT-ICH) is increasing in consequence of the increased incidence of ischemic stroke due to an aging population. AT-ICH is associated with a risk of ongoing bleeding, death, or disability. Cerebral amyloid angiopathy (CAA), a common pathological finding among the elderly that is associated with macro- and microscopic hematoma development, might increase the risk of ICH. We report a rare case of contralateral delayed hematoma in the context of CAA secondary to acute ICH after AT for intracerebral ischemic stroke.

Sun L; Gao Y; Fu C; Li F; Fang X; Zhao C

2013-01-01

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

International Nuclear Information System (INIS)

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

1982-01-01

20

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1982-10-01

 
 
 
 
21

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

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

Murata Keiichi; Maeda Manabu; Yoshida Atsushi; Yajima Hiroshi; Okuchi Kazuo

2008-01-01

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An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report.  

UK PubMed Central (United Kingdom)

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.

Shimodaira M; Kitano T; Kibata M; Shirahata K

2013-01-01

23

A case of submucosal hematoma of the esophagus and stomach, possibly caused by fish bone ingestion.  

UK PubMed Central (United Kingdom)

Submucosal hematoma of the esophagus is a rare disorder. We encountered a 70-year-old woman with an extremely large submucosal hematoma of the esophagus that extended from the cervical esophagus to the gastric angle. It was likely that her hematoma was caused by accidental ingestion of a fish bone, and her condition improved with conservative treatment alone. In this article, we summarize the reported cases of submucosal hematoma of the esophagus in Japan, and discuss the case with a review of the literature.

Koike J; Matsushima M; Teraoka H; Igarashi M; Deguchi R; Suzuki T; Shirai T; Mine T

2010-04-01

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A case of submucosal hematoma of the esophagus and stomach, possibly caused by fish bone ingestion.  

Science.gov (United States)

Submucosal hematoma of the esophagus is a rare disorder. We encountered a 70-year-old woman with an extremely large submucosal hematoma of the esophagus that extended from the cervical esophagus to the gastric angle. It was likely that her hematoma was caused by accidental ingestion of a fish bone, and her condition improved with conservative treatment alone. In this article, we summarize the reported cases of submucosal hematoma of the esophagus in Japan, and discuss the case with a review of the literature. PMID:21319026

Koike, Jun; Matsushima, Masashi; Teraoka, Hiromichi; Igarashi, Muneki; Deguchi, Ryuzou; Suzuki, Takayoshi; Shirai, Takayuki; Mine, Tetsuya

2010-04-20

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MRI of intracerebral hematoma: value of vasogenic edema ratio for predicting the cause  

Energy Technology Data Exchange (ETDEWEB)

We evaluated a method for quantifying vasogenic edema (VE) on MRI to identify brain hematomas caused by neoplasms. We performed a blinded review of 68 acute and subacute hematomas caused by neoplasms (22), hypertension or presumed amyloid angiopathy (27), or vascular malformations (19). The extent of vasogenic edema was quantified on an axial T2-weighted image using the VE ratio: the maximum width of high signal surrounding a hematoma and the mean diameter of the hematoma. Hematomas caused by neoplasm were associated with more vasogenic edema (mean VE ratio 104%{+-}15%; mean VE width 2.4{+-}0.7 cm) than non-neoplastic hematomas (mean VE ratio 37%{+-}5%; P =0.001). When the width of VE was equal to or more half the diameter the hematoma (VE ratio 50%), the positive predictive value for tumor was 66%; when it was equal to or more than the diameter, the positive predictive value was 71%. All six hematomas with VE ratios {>=}150% were caused by neoplasm. (orig.)

Tung, G.A.; Julius, B.D.; Rogg, J.M. [Department of Diagnostic Imaging, Brown Medical School and Rhode Island Hospital, 593 Eddy Street, 02903, Providence, RI (United States)

2003-06-01

26

Acute myocardial infarction caused by spontaneous coronary intramural hematoma.  

Science.gov (United States)

A 49-year-old male presented to our emergency department with sudden anterior chest pain. His electrocardiogram revealed ST-segment elevations in leads II, III and aVF. An inferior acute myocardial infarction was suspected. Emergent coronary angiography (CAG) showed there was a long lesion in the right coronary artery (RCA), which continued from the proximal to the distal part of RCA with 50% stenosis and narrowed further to 99% stenosis at the distal end. Intravascular ultrasound (IVUS) examination demonstrated a diffuse intramural hematoma raging from the proximal to the distal part of the RCA. No visualization of the intimal flap was identified by IVUS, indicating coronary artery dissection as a pathogenesis of this hematoma formation. After intracoronary injection of isosorbide dinitrate, the 99% stenosis regressed to 50% spontaneously. Neither balloon angioplasty nor stenting was performed. He was discharged home free from symptoms 9 days after the procedure. Thirty-day follow-up CAG revealed an almost normal finding of the RCA and IVUS delineated a complete restoration of the intramural hematoma. PMID:23220989

Ikegami, Ryutaro; Tsuchida, Keiichi; Oda, Hirotaka

2012-12-01

27

Acute myocardial infarction caused by spontaneous coronary intramural hematoma.  

UK PubMed Central (United Kingdom)

A 49-year-old male presented to our emergency department with sudden anterior chest pain. His electrocardiogram revealed ST-segment elevations in leads II, III and aVF. An inferior acute myocardial infarction was suspected. Emergent coronary angiography (CAG) showed there was a long lesion in the right coronary artery (RCA), which continued from the proximal to the distal part of RCA with 50% stenosis and narrowed further to 99% stenosis at the distal end. Intravascular ultrasound (IVUS) examination demonstrated a diffuse intramural hematoma raging from the proximal to the distal part of the RCA. No visualization of the intimal flap was identified by IVUS, indicating coronary artery dissection as a pathogenesis of this hematoma formation. After intracoronary injection of isosorbide dinitrate, the 99% stenosis regressed to 50% spontaneously. Neither balloon angioplasty nor stenting was performed. He was discharged home free from symptoms 9 days after the procedure. Thirty-day follow-up CAG revealed an almost normal finding of the RCA and IVUS delineated a complete restoration of the intramural hematoma.

Ikegami R; Tsuchida K; Oda H

2012-12-01

28

Intramuscular Hematomas Caused by Anticoagulant Therapy: Is Advanced  

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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)

Nilgün ÇINAR; ?evki ?ahin; Alper KARAO?LAN; Sibel KAR?IDA?

2010-01-01

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

Scientific Electronic Library Online (English)

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

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

2012-01-01

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

International Nuclear Information System (INIS)

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

1991-01-01

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1991-06-01

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[The relationship between delayed traumatic intracerebral hematoma and coagulopathy in patients diagnosed with a traumatic subarachnoid hemorrhage  

UK PubMed Central (United Kingdom)

It has long been recognized that a traumatic insult to brain tissue may result in substantive coagulation abnormalities. The present study was carried out in an attempt to find out the association of coagulopathy and the development of delayed traumatic intracerebral hematoma (DTICH) in patients diagnosed with a traumatic subarachnoid hemorrhage (TSAH). Sixty-three patients were diagnosed as having TSAH from the initial CT scans obtained within 2 hours after trauma. On admission, peripheral blood samples for coagulation studies were taken within 6 hours after injury. All patients had subsequent CT scans performed within 24 hours of admission. Thirty (47.6%) of 63 patients exhibited radiological evidence of DTICH on their subsequent CT scans. There was a significant correlation between the increased value of serum fibrinogen degradation product (FDP > 40 micrograms/ml) and the development of DTICH. We observed that the origin of the hematoma might be caused by those radiographically unidentifiable parenchymal lesions often found with TSAH on the initial CT scan. We conclude that a clotting study at the time of admission is of value in predicting the occurrence of DTICH associated with TSAH.

Sawauchi S; Yuhki K; Abe T

2001-02-01

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1983-02-01

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An oblique muscle hematoma as a rare cause of severe abdominal pain: a case report  

Directory of Open Access Journals (Sweden)

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.

Shimodaira Masanori; Kitano Tomohiro; Kibata Minoru; Shirahata Kumiko

2013-01-01

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Post lumbar puncture spinal subarachnoid hematoma causing paraplegia : a short report.  

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Full Text Available A 53 year old male underwent total excision of a large sphenoidal wing meningioma. Patient was treated with cephalosporins and phenytoin for postoperative meningitis. Three weeks after surgery, a follow up lumbar puncture was done. The patient became paraplegic over a few hours. Imaging of the dorsolumbar spine and other investigations demonstrated a large intraspinal hematoma caused by thrombocytopenia which was probably drug induced. After normalising the platelet count surgical evacuation of the spinal subarachnoid hematoma was done. Relevant literature is reviewed.

Pai S; Krishna K; Chandrashekar S

2002-01-01

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

International Nuclear Information System (INIS)

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

2012-01-01

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

International Nuclear Information System (INIS)

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

2006-01-01

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[Dissecting intramural hematoma of the esophagus: a rare cause of chest pain].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Dissecting intramural hematoma of the esophagus is a rare cause of chest pain that can be misinterpreted as a myocardial infarction. The use of anticoagulants in this case may lead to hemorrhagic complications. CASE: A 51-year-old patient, with coronary artery disease, diabetes, hypertension and dependent on both alcohol and tobacco, was admitted for chest pain and an elevated troponin T plasma level. He was treated with anticoagulants. He developed hematemesis on the third day and was transferred to intensive care. Esophageal endoscopy revealed a hematoma with active bleeding, covered by esophageal mucosa from the middle to the lower third of the esophagus (for 13 cm). Computed tomography allowed us to rule out an aortoesophageal fistula. Symptomatic treatment consisted of withdrawing the anticoagulant, mechanical ventilation, intravenous sedation, and blood transfusion. The patient recovered, after a long stay in ICU. DISCUSSION: Intramural dissecting hematoma of the esophagus is not always easy to diagnose. Administration of anticoagulant treatment after a misdiagnosis of acute coronary syndrome can have serious hemorrhagic consequences. Prognosis is excellent with conservative treatment.

Kimmoun A; Abboud G; Steinbach G; Tellaroli JC; Bemer M

2008-03-01

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

UK PubMed Central (United Kingdom)

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

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

2012-09-01

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1984-04-01

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

UK PubMed Central (United Kingdom)

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

Li CH; Yew AY; Lu DC

2013-01-01

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Spontaneous umbilical cord hematoma: an unusual cause of fetal mortality: a report of 3 cases and review of the literature.  

UK PubMed Central (United Kingdom)

Spontaneous hematoma of the umbilical cord represents a rare cause of fetal morbidity and mortality and the outcome is poor in half of the cases. There are many risk factors, such as infections, morphologic anomalies, alterations of the vessel walls, prolapses, twisting and traction of the cord, but in many cases the causes remain unknown. We present 3 cases of umbilical cord hematoma which took place at the end of the pregnancy and were followed by perinatal death of the fetus. In the 3 cases, which were autopsied including macroscopical and histopathologic examination of the placenta and the umbilical cord, a cordonal pathology was present; in all cases, there were alterations of the vascular wall, and in the third case inflammatory vasculopathy was found. In all 3 cases, the cause of death was attributed to acute anoxia due to the cordonal hematoma.

Gualandri G; Rivasi F; Santunione AL; Silingardi E

2008-06-01

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Spine surgery may cause more spinal epidural hematomas than spinal puncture.  

UK PubMed Central (United Kingdom)

BACKGROUND: Spinal epidural hematoma (SEH) is a rare but acute and possibly devastating clinical event. The purpose of this study is to assess the multiple etiologies of SEH seen in an academic medical center over a 15-year span. We have examined the etiologies of SEH occurring in a single institution, the University of Pittsburgh Medical Center (UPMC) over the last fifteen years using an electronic record keeping system and database: the Medical Archive Retrieval System (MARS). METHODS: We screened MARS from 1986 - 2001 using key words: epidural, hematoma and spinal. All potential SEH cases were reviewed and only those confirmed by surgical intervention were identified as positive SEH and reported in this study. RESULTS: There were 17 cases of confirmed SEH. Among them, seven cases were from spontaneous bleeding, seven cases following spinal surgery, and three cases from traumatic spinal fracture. There were no findings of SEH that were related to spinal or epidural anesthesia. Among the seven patients with spontaneous SEH; two were receiving anti-coagulants for deep venous thrombosis (DVT) and had elevated prothrombin time (PT) and activated partial thromboplastine time (APTT), one had hemophilia (type B), four had hypertension, and three out of seven had chronic renal or liver disease. Among postoperative SEH patients, two of the seven patients were receiving chemotherapy and radiation therapy and one had ongoing hemodialysis for renal failure. Among three patients with traumatic SEH, two had ankylosing spondylitis. Six patients had a history of alcohol abuse. CONCLUSIONS: Spontaneous bleeding is by far the leading cause of SEH with spinal surgery being the second leading cause. Patients with multiple co-morbidities that result in coagulopathy from a variety of causes include liver or renal disease, alcohol abuse, radiation therapy, or chemotherapy. Neuraxial anesthesia is an extremely rare cause of SEH.

An JX; Fang QW; Sullivan EA; Williams JP

2013-01-01

44

Spontaneous Rectus Sheath Hematoma  

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Full Text Available 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 among primary and emergency physicians about considering RSH in the initial differential diagnoses of abdominal pain. [West J Emerg Med. 2010; 11(1):76-79].

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

2010-01-01

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

Energy Technology Data Exchange (ETDEWEB)

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

Kim, Dong Hun [Soonchunhyang University Hospital, Seoul (Korea, Republic of); Ryu, Sang Wan; Choi, Yong Sun; Ahn, Byoung Hee [Chonnam National University Hospital, Gwangju (Korea, Republic of)

2004-06-15

46

Subdural hematoma  

Science.gov (United States)

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

47

Hematoma espinal Spinal hematoma  

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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.

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

2013-01-01

48

Hematoma espinal/ Spinal hematoma  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 consideracio (more) nes 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.

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

2013-04-01

49

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

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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.

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

2003-01-01

50

Delayed chromosomal instability caused by large deletion  

International Nuclear Information System (INIS)

[en] Full text: There is accumulating evidence that genomic instability, manifested by the expression of delayed phenotypes, is induced by X-irradiation but not by ultraviolet (UV) light. It is well known that ionizing radiation, such as X-rays, induces DNA double strand breaks, but UV-light mainly causes base damage like pyrimidine dimers and (6-4) photoproducts. Although the mechanism of radiation-induced genomic instability has not been thoroughly explained, it is suggested that DNA double strand breaks contribute the induction of genomic instability. We examined here whether X-ray induced gene deletion at the hprt locus induces delayed instability in chromosome X. SV40-immortalized normal human fibroblasts, GM638, were irradiated with X-rays (3, 6 Gy), and the hprt mutants were isolated in the presence of 6-thioguanine (6-TG). A 2-fold and a 60-fold increase in mutation frequency were found by 3 Gy and 6 Gy irradiation, respectively. The molecular structure of the hprt mutations was determined by multiplex polymerase chain reaction of nine exons. Approximately 60% of 3 Gy mutants lost a part or the entire hprt gene, and the other mutants showed point mutations like spontaneous mutants. All 6 Gy mutants show total gene deletion. The chromosomes of the hprt mutants were analyzed by Whole Human Chromosome X Paint FISH or Xq telomere FISH. None of the point or partial gene deletion mutants showed aberrations of X-chromosome, however total gene deletion mutants induced translocations and dicentrics involving chromosome X. These results suggest that large deletion caused by DNA double strand breaks destabilizes chromosome structure, which may be involved in an induction of radiation-induced genomic instability

2003-01-01

51

Retenção urinária aguda por extenso hematoma pelvico após herniorrafia inguinal Acute urinary retention caused by an extensive pelvic hematoma after inguinal herniorraphy  

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Full Text Available The authors report a rare case of a patient with urinary retention following an inguinal herniorraphy, due to extrinsic compression of the bladder by an extensive pelvic hematoma, diagnosed by cystourethrogram and pelvic computadorized tomography. A medical treatment was provided by vesical catheterization for seven days. After this period of time, the hematoma had disappeared and the patient recovered to spontaneous miction.

Roberto Vaz Juliano; Alexandre Cruz Henriques; Antonio Corrêa Lopes Neto; Renata Matsumoto; Milton Borelli; Eric Roger Wroclawski

1999-01-01

52

Retenção urinária aguda por extenso hematoma pelvico após herniorrafia inguinal/ Acute urinary retention caused by an extensive pelvic hematoma after inguinal herniorraphy  

Scientific Electronic Library Online (English)

Full Text Available Abstract in english The authors report a rare case of a patient with urinary retention following an inguinal herniorraphy, due to extrinsic compression of the bladder by an extensive pelvic hematoma, diagnosed by cystourethrogram and pelvic computadorized tomography. A medical treatment was provided by vesical catheterization for seven days. After this period of time, the hematoma had disappeared and the patient recovered to spontaneous miction.

Juliano, Roberto Vaz; Henriques, Alexandre Cruz; Lopes Neto, Antonio Corrêa; Matsumoto, Renata; Borelli, Milton; Wroclawski, Eric Roger

1999-04-01

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An improved approach to evacuation of subungual hematoma.  

Science.gov (United States)

An improved approach to subungual hematoma evacuation has been presented. Hand-held cautery is a cost-effective, precise method of treatment of subungual hematoma. Its use decreases the likelihood of unnecessary delay in the regrowth of the nail plate and secondary dystrophy that might result from pressure on the matrix caused by accumulated blood under the nail. The high temperature and fine tip make the cautery an excellent instrument to precisely and painlessly burn a small hole in the nail plate, allowing for evacuation of subungual hematoma. PMID:2607424

Palamarchuk, H J; Kerzner, M

1989-11-01

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An improved approach to evacuation of subungual hematoma.  

UK PubMed Central (United Kingdom)

An improved approach to subungual hematoma evacuation has been presented. Hand-held cautery is a cost-effective, precise method of treatment of subungual hematoma. Its use decreases the likelihood of unnecessary delay in the regrowth of the nail plate and secondary dystrophy that might result from pressure on the matrix caused by accumulated blood under the nail. The high temperature and fine tip make the cautery an excellent instrument to precisely and painlessly burn a small hole in the nail plate, allowing for evacuation of subungual hematoma.

Palamarchuk HJ; Kerzner M

1989-11-01

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Hemophilia and child abuse as possible causes of epidural hematoma: case report Hemofilia e abuso infantil como possíveis causas de hematoma extradural: relato de caso  

Directory of Open Access Journals (Sweden)

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.

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

2003-01-01

56

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)

Full Text Available Abstract in portuguese 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 subseq? (more) ?entes 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 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. CONCLU (more) SION: 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.

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

2003-12-01

57

Hematoma traumático del psoas  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 músculo 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 ili (more) opsoas 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 paralysis 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 gen (more) erally 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.

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

2006-12-01

58

[Compression of the trachea by a hematoma caused by an internal jugular vein catheter  

UK PubMed Central (United Kingdom)

In a patient with thrombocytopenia, respiratory obstruction because of a hematoma occurred following internal jugular vein cannulation. This patient recovered completely after surgical intervention. With the following precautions in mind, puncture of the internal jugular vein in patients with coagulopathies has a high success rate and does not result in severe complications: Internal jugular vein cannulation by an experienced physician; optimal conditions for puncture by increasing venous pressure and diameter with slight Trendelenburg position and Valsalva maneuver in patients with spontaneous breathing, or positive end-expiratory pressure in patients with artificial ventilation; catheter insertion by the Seldinger technique; manual compression of the puncture site for 10-15 min; and vein puncture with ultrasonographic aid if possible.

Janda A

1990-07-01

59

[Postoperative nocardiosis caused by Nocardia otitidiscaviarum: pitfalls and delayed diagnosis].  

Science.gov (United States)

Nocardiosis is an uncommon infection, which is exceptionally present as a postoperative event. A case of postoperative pulmonary and cerebro-meningeal infection caused by Nocardia otitidiscaviarum after a leg amputation in a diabetic patient is reported. Diagnosis has been delayed and the clinical, radiological and microbiological causes of this delay are assessed from a quality of care management point of view. Recommendations are proposed regarding physicians' role and optimized microbiological procedures for recognition of slowly growing nocardial strains. PMID:17572044

Bonnet, F; Donay, J-L; Fieux, F; Marie, O; de Kerviler, E; Jacob, L

2007-06-14

60

[Postoperative nocardiosis caused by Nocardia otitidiscaviarum: pitfalls and delayed diagnosis  

UK PubMed Central (United Kingdom)

Nocardiosis is an uncommon infection, which is exceptionally present as a postoperative event. A case of postoperative pulmonary and cerebro-meningeal infection caused by Nocardia otitidiscaviarum after a leg amputation in a diabetic patient is reported. Diagnosis has been delayed and the clinical, radiological and microbiological causes of this delay are assessed from a quality of care management point of view. Recommendations are proposed regarding physicians' role and optimized microbiological procedures for recognition of slowly growing nocardial strains.

Bonnet F; Donay JL; Fieux F; Marie O; de Kerviler E; Jacob L

2007-07-01

 
 
 
 
61

[Blunt force injuries due to martial arts in children--a diagnostic problem? Delayed diagnosis of an infected hematoma].  

UK PubMed Central (United Kingdom)

INTRODUCTION: Blunt force injuries in martial arts occur frequently but isolated hematoma of muscles in the extremities is rare. Even minor trauma of the lower extremities due to throwing techniques in judo and other forms of Asian martial arts can lead to major pathologies. METHODS: A 9-year-old girl presented with an unclear swelling and soreness of the calf muscle. The patient could not remember an obvious traumatic event. She was admitted 4 days later because of increased swelling, pain and erythema. The parents reported a minor trauma at judo training 1 week ago. Further investigation was performed with MRI and confirmed a massive hematoma much greater than previously shown by sonography. RESULTS: Histologic and microbiologic evaluation demonstrated florid inflammation and proof of Staphylococcus aureus was found intra-operatively. DISCUSSION: The diagnosis of blunt force injuries due to martial arts is difficult in childhood because often children do not remember a traumatic event. Therefore, it is important to obtain a thorough history from caregivers. Because sonography depends highly on the experience of the investigator MRI is considered to be a better diagnostic modality to diagnose and guide treatment in this age group.

Kruppa C; Goericke SL; Matheney T; Ozokyay L; Schildhauer TA; Muhr G; Dudda M

2010-10-01

62

PATOBIOLOGÍA DEL HEMATOMA SUBDURAL CRÓNICO.  

Directory of Open Access Journals (Sweden)

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

Rubén Sabogal Barrios; Luís Rafael Moscote Salazar

2008-01-01

63

An Unreported Cause of Buccal Mucosal Hematoma: A Rare Complication After Heparin Therapy in a Patient with Chronic Renal Failure  

Directory of Open Access Journals (Sweden)

Full Text Available Patients receiving anti-coagulants such as heparin can suffer from significant complications of these medications. Herein, we report a buccal mucosal hematoma in a heparinized patient with chronic renal failure.

Mustafa Y?ld?z; Hasan Kaya; Mehmet Ali Astarc?o?lu; Tayyar Gökdeniz; Ahmet Ça?r? Aykan; Banu ?ahin Y?ld?z; Mehmet Özkan

2013-01-01

64

Intracerebral hemorrhage following evacuation of a chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

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

Kim JK; Kim SW; Kim SH

2013-02-01

65

Spontaneous intracerebral hematomas  

International Nuclear Information System (INIS)

Thirty-six cases of so-called spontaneous intracerebral hematoma were analyzed with special reference to clinical signs and symptoms, computerized tomography (CT) scan findings and postoperative courses. Hematomas due to cerebral aneurysms, arterio-venous malformations, blood dyscrasias as well as traumatic and hypertensive intracerebral hematomas were excluded from this series. The patients varied in age from 7 months to 74 years with the mean age of 40 years. Caution must be paid to the fact that the age group of more than 50 years occupied 37% of the whole cases. The lesions were located predominantly in the parietal lobe (52%) and 36% were in the frontal or temporal lobe which had been said the most prevalent site of the lesion. There were 4 hematomas which located in the occipital lobe and all of them were the cases in CT era. CT scan was very useful for the diagnosis of small hematomas, particularly in such regions as parietal or occipital lobe, where arteriography offered insufficient evidence to substantiate the diagnosis of intracerebral hematoma in pre-CT era. However, arteriography should not be neglected in order to detect aneurysms or arteriovenous malformations which could not be visualized by CT scan. Small angiomatous malformations as a cause of hematoma were found in only 7 cases by either arteriography or pathologic examination. In all except 2 patients, craniotomy was carried out and 52% of them returned to their prevenous occupations. In contrast, only 4 of 14 patients of more than 50 years could get full social recovery and the postoperative improvement depended on the age of the patient. (author)

1979-01-01

66

Experimental epidural hematoma causes cerebral infarction and activates neocortical glial and neuronal genesis in adult guinea pigs.  

UK PubMed Central (United Kingdom)

Epidural hematoma (EDH) is a type of life-threatening traumatic brain injury. Little is known about the extent to which EDH may cause neural damage and regenerative response in the cerebral cortex. Here we attempted to explore these issues by using guinea pigs as an experimental model. Unilateral EDH was induced by injection of 0.1 ml autologous blood into the extradural space, with experimental effects examined at 7, 14, 30, and 60 days postlesion. An infarct developed in the cortex deep to the EDH largely after 7 days postlesion, with neuronal death occurred from layers I to V in the central infarct region, as evidenced by loss of immunoreactivity (IR) for neuron-specific nuclear antigen (NeuN). Glial fibrillary acidic protein (GFAP) IR appeared as a cellular band surrounding the infarct and extending into the periinfarct cortex along the pia. Doublecortin (DCX) IR emerged in these same areas, with labeled cells appearing as astrocytic and neuronal profiles. DCX/GFAP colocalization was found in these regions commonly at 7 and 14 days postlesion, whereas DCX/NeuN-colabeled neurons were detectable at 30 and 60 days postlesion. Subpopulations of GFAP-, DCX-, or NeuN-immunoreactive cells colocalized with the endogenous proliferative marker Ki-67 or bromodeoxyuridine (BrdU) after pulse-chase with this birth-dating marker. The results suggest that experimental EDH can cause severe neuronal loss, induce significant glial activation, and promote a certain degree of local neuronal genesis in adult guinea pig neocortex. These findings point to potential therapeutic targets for improving neuronal recovery in clinical management of EDH.

Pan A; Li M; Gao JY; Xue ZQ; Li Z; Yuan XY; Luo DW; Luo XG; Yan XX

2013-02-01

67

Optical signal path delay fluctuations caused by atmospheric turbulence.  

UK PubMed Central (United Kingdom)

We report the first direct measurements, to our knowledge, of optical signal path delay fluctuations caused by optical turbulence in the atmosphere. The experiments were based on satellite laser ranging. Our initial motivation was to identify all the random error contributors in satellite laser ranging. We measured and identified the random path fluctuations caused by the atmosphere in the range of units of picoseconds. An appropriate fluctuation model was developed.

Kral L; Prochazka I; Hamal K

2005-07-01

68

Transcatheter Embolization for Delayed Hemorrhage Caused by Blunt Splenic Trauma  

International Nuclear Information System (INIS)

Although the exact benefit of adjunctive splenic artery embolization (SAE) in the nonoperative management (NOM) of patients with blunt splenic trauma has been debated, the role of transcatheter embolization in delayed splenic hemorrhage is rarely addressed. The purpose of this study was to evaluate the effectiveness of SAE in the management of patients who presented at least 3 days after initial splenic trauma with delayed hemorrhage. During a 24-month period 4 patients (all male; ages 19-49 years) presented with acute onset of pain 5-70 days after blunt trauma to the left upper quadrant. Two had known splenic injuries that had been managed nonoperatively. All had computed axial tomography evidence of active splenic hemorrhage or false aneurysm on representation. All underwent successful SAE. Follow-up ranged from 28 to 370 days. These cases and a review of the literature indicate that SAE is safe and effective for NOM failure caused by delayed manifestations of splenic arterial injury.

2010-01-01

69

A parametric model for time delay common-cause failures  

International Nuclear Information System (INIS)

The significance of dependent failures in risk and reliability analysis has been demonstrated in almost all probabilistic risk assessments of nuclear power plants as well as in reports of reactor operating experiences. Among the different types of dependent failures, common cause failure (CCF), which is the failure of several redundant components due to the same shared cause, other than functional causes, has been shown to make a major contribution to the risk of nuclear power plant accidents. Although different studies resulted in introducing different methods for CCF analysis, a wide accepted method for analysis of certain classes of CCFs is still lacking. One of the main reasons is that existing methods for the treatment of CCFs do not distinguish between the different types of CCF events and, therefore, in some instances do not properly represent the data. Recognizing the need for more realistic models, this study has been performed to introduce a new method for estimating system unavailability due to a specific class of CCFs. Operating experience has shown that there is, certainly, a class of CCF that has the characteristics of time delay CCF. Therefore, in order to obtain more realistic estimates for unavailability of redundant systems, comparable models should be applied to the data. Application of the proposed model based on some specific set of assumed time delay data illustrates the inconsistencies of some of the existing models when applied to time delay CCF data and the significance of the proposed model.

1990-01-01

70

Subperiosteal hematoma in multiple settings.  

UK PubMed Central (United Kingdom)

Most reports of orbital hemorrhage do not distinguish among intraconal, extraconal, and subperiosteal hemorrhages, although several reports describe isolated subperiosteal hematomas as a separate entity. We report 3 cases of subperiosteal hematoma with different etiologies but similar progression of signs and symptoms. Each patient presented with spontaneous proptosis, rarely caused by orbital subperiosteal hematoma, measuring approximately 5 mm. Over the course of 4-10 days their conditions worsened and warranted intervention. All 3 cases were treated with anterior orbitotomy, and visual acuity returned to baseline following surgery in all.

Crawford C; Mazzoli R

2013-01-01

71

Parkinsonism secondary to bilateral subdural hematoma  

Directory of Open Access Journals (Sweden)

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

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

2011-01-01

72

A case with Parkinsonism secondary to bilateral subdural hematoma  

Directory of Open Access Journals (Sweden)

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

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

2011-01-01

73

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

UK PubMed Central (United Kingdom)

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

Schott M; Gehrke A; Gaab M; Jantzen JP

2013-05-01

74

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

Directory of Open Access Journals (Sweden)

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

Mikami Taro; Maegawa Jiro; Kuroda Mayu; Yamamoto Yasushi; Yasumura Kazunori

2012-01-01

75

Computerized tomography findings of acute traumatic epidural hematoma  

Energy Technology Data Exchange (ETDEWEB)

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

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

1984-12-01

76

Phlebography in crural hematoma  

International Nuclear Information System (INIS)

Fifteen cases of crural hematoma in which phlebography had been performed were revised. A phlebography was often normal in an early stage of hematoma. In major crural hematoma compression, displacement and occlusion of the deep venous system occurred. Non-filling of deep veins occurred in 6 cases, and venous thrombosis should therefore only be diagnosed on the basis of constant filling defects. (Auth.)

1980-01-01

77

An unusual cause of delayed puberty: Berardinelli- Seip syndrome.  

UK PubMed Central (United Kingdom)

Berardinelli- Seip syndrome is an autosomal recessive disorder characterized by generalized lipoatrophy, extreme insulin resistance with dyslipidemia in childhood and development of diabetes in adolescence. Menstrual irregularities are commonly seen as a result of secondary polycystic ovarian syndrome. Delayed puberty as a manifestation of these abnormalities in girls has rarely been described earlier. We report one such case patient who had delayed puberty and portal hypertension as unique features amongst the characteristic phenotypes of this syndrome.

Upreti V; Dhull P; Patnaik SK; Kumar KV

2012-01-01

78

A fatal stab wound causing selective injury to the left anterior descending coronary artery, myocardial infarction and delayed cardiac tamponade.  

UK PubMed Central (United Kingdom)

We describe an unusual case of delayed cardiac tamponade that led to death 9 days after a penetrating stab wound. The injury consisted of a longitudinal tear in the LAD coronary artery, with an occlusive thrombus and the rupture of the coronary wall into a pseudo-aneurysmatic peri-coronary hematoma. As imaging evidence of pericardial effusion and ischemic electrocardiographic changes were lacking, the diagnosis was only made during post-mortem examination.

Bartoloni G; Trio F; Bartoloni A; Giorlandino A; Pucci A

2013-06-01

79

Impact of early surgical evacuation of sylvian hematoma on clinical course and outcome after subarachnoid hemorrhage  

International Nuclear Information System (INIS)

The present study aimed to evaluate the impact of early surgical evacuation of sylvian hematoma caused by ruptured middle cerebral artery (MCA) aneurysm on clinical outcome after subarachnoid hemorrhage. Hospital records and computed tomography scans for 26 patients with MCA aneurysm who underwent surgical clipping between June 2001 and January 2008 were retrospectively reviewed. All patients presented with sylvian hematoma associated with subarachnoid hemorrhage and received surgery at 7.9±3.6 (mean±standard deviation) hours of ictus. They were divided postoperatively into two groups, achievement (n=16) and non-achievement (n=10) of extensive hematoma evacuation, and their clinical course and functional outcomes were compared. The frequencies of delayed ischemic neurological deficit and vasospasm-related cerebral infarction were significantly less (p

2008-01-00

80

Postoperative extradural hematomas.  

UK PubMed Central (United Kingdom)

Postoperative extradural hematoma (POEH) is a possible complication after head surgery, often neglected in the literature. In a single surgeon experience we found 13 cases of POEH (0.8%). We distinguished two subtypes: (1) larger hematomas (>40 cc) with typical features and overt clinical picture that always needed evacuation, and (2) smaller hematomas (<40 cc) with insidious clinical onset and different radiological features compared with traumatic and spontaneous extradural hematomas. On the basis of our experience, we propose that clinical picture and radiologic appearance lead the decision between conservative or interventional treatment of type II hematomas.

Pichierri A; Ruggeri A; Donnarumma P; Delfini R

2013-01-01

 
 
 
 
81

Chronic subdural hematoma. Brain computerized tomography in forty cases  

International Nuclear Information System (INIS)

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

1988-01-01

82

Spontaneous cervical epidural hematoma: case report.  

Science.gov (United States)

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of acute nontraumatic myelopathy. We report a 14 year-old boy who had tetraplegia on awakening. Diagnosis of spinal epidural hematoma was made by magnetic resonance imaging. Despite spinal cord decompression within 9 h from onset, he remained tetraplegic. No cause for the bleeding was found. The pathogenic hypotheses of SSEH are discussed and the importance of rapid diagnosis and treatment is emphasized. PMID:9471143

Awada, A; Russell, N; al Fayez, N; Naufal, R; al Kohlani, H

1998-01-01

83

Spontaneous cervical epidural hematoma: case report.  

UK PubMed Central (United Kingdom)

Spontaneous spinal epidural hematoma (SSEH) is an uncommon cause of acute nontraumatic myelopathy. We report a 14 year-old boy who had tetraplegia on awakening. Diagnosis of spinal epidural hematoma was made by magnetic resonance imaging. Despite spinal cord decompression within 9 h from onset, he remained tetraplegic. No cause for the bleeding was found. The pathogenic hypotheses of SSEH are discussed and the importance of rapid diagnosis and treatment is emphasized.

Awada A; Russell N; al Fayez N; Naufal R; al Kohlani H

1998-01-01

84

Radiologic findings of acute spontaneous subdural hematomas  

International Nuclear Information System (INIS)

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

1998-01-01

85

Radiologic findings of acute spontaneous subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

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

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

1998-03-01

86

Computed tomographic demonstration of a spontaneous subcapsular hematoma due to a small renal cell carcinoma  

Energy Technology Data Exchange (ETDEWEB)

Computed tomography (CT) was able to demonstrate a small renal cell carcinoma as the cause of a spontaneous subcapsular hematoma. Angiographic and pathologic correlation were obtained. A review of the causes for nontraumatic renal subcapsular hematoma is included.

Hilton, S.; Bosniak, M.A.; Megibow, A.J.; Ambos, M.A.

1981-12-01

87

Hematoma epidural subagudo Subacute epidural hematoma  

Directory of Open Access Journals (Sweden)

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.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.

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

2011-01-01

88

Hematoma epidural subagudo/ Subacute epidural hematoma  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 u (more) n 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 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 (more) 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.

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

2011-03-01

89

[Orbital subperiotal hematoma associated with extradural hematoma: one case report].  

Science.gov (United States)

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering. PMID:21899862

Compaoré, P; Ibahioin, K; Naja, A; Ouboukhlik, A; El Kamar, A; El Azhari, A

2011-09-06

90

[Orbital subperiotal hematoma associated with extradural hematoma: one case report].  

UK PubMed Central (United Kingdom)

Subperiotal hematoma of the orbit associated with extradural hematoma has been rarely reported in the literature. We report a case of an 8-year-old girl who presented after traumatism, a subperiotal hematoma of the orbit with two extradural hematomas. During the first clinical examination realized while the patient was unconscious, left exophthalmia was found, but after conscious improvement, we discovered ophtalmoplegia and a grade I papilla edema. The CT scan showed two extradural hematomas and a left intraorbital hematoma. The intraorbital hematoma was drained by surgical way but the extradural hematomas were not surgical. The outcome has been marked by the neurological improvement and the oculomotricity recovering.

Compaoré P; Ibahioin K; Naja A; Ouboukhlik A; El Kamar A; El Azhari A

2011-07-01

91

Obstructive uropathy secondary to rectus sheath hematoma.  

UK PubMed Central (United Kingdom)

Rectus sheath hematoma (RSH) is uncommon and is often reported in the setting of anticoagulation or trauma. Typically RSH presents with localized or diffuse abdominal pain and a fixed abdominal wall mass, however, various presentations and complications have been reported depending on the setting and extent of the hematoma. We report a case of a rapidly expanding RSH causing obstructive anuria and hydronephrosis in addition to a review of literature on this rare presentation of RSH.

Dangle PP; Patel MB; Terán M; Chehval MJ

2013-03-01

92

Posterior fossa epidural hematoma  

International Nuclear Information System (INIS)

[en] CT demonstrated posterior fossa epidural hematoma in three patients with head trauma in whom this diagnosis was not clinically apparent. No patient was in stupor or coma and no patient experienced a lucid interval. Only one patient had signs referable to the posterior fossa. Two patients had occipital skull fracture disclosed by plain radiographs. CT revealed a unilateral biconvex hematoma in two cases, and a bilateral hematoma with supratentorial extension in the third. All patients underwent suboccipital craniectomy and recovered. Therapeutic success in these cases was facilitated by early CT and the rapid disclosure of the unsuspected posterior fossa lesions. CT showing contiguous hematoma below and above the tentorium cerebelli after posterior head trauma is highly suggestive of epidural hematoma arising from the posterior fossa. (orig.)

1983-01-01

93

Delayed epithelial ingrowth caused by viral conjunctivitis after LASIK.  

Science.gov (United States)

To report a patient who presented with epithelial ingrowth caused by viral keratoconjunctivitis 3 months after LASIK surgery. A 41-year-old man presented with decreased visual acuity in the right eye, which had developed about 3 weeks before. He had undergone LASIK surgery 3 months prior without complications. Two months after the surgery, he was treated for viral conjunctivitis. During the treatment period, filamentary keratitis developed, and a therapeutic bandage contact lens was applied for 2 weeks. Upon presentation, examination revealed a corrected visual acuity of 20/100 and irregular epithelial sheets under the edematous flap. The flap was lifted, and the in-grown epithelium was removed. The flap was repositioned with double continuous 10-0 nylon sutures. Post-operatively, the patient developed a mild diffuse lamellar keratitis that resolved rapidly with topical corticosteroid treatment. At 2 months, the corrected visual acuity was 20/20 without interface opacities. As the patient showed no complications prior to viral conjunctivitis, we suspect that the viral infection caused edema of the corneal flap, which caused epithelial ingrowth under the flap. Patients who have viral conjunctivitis after LASIK surgery should be examined carefully and managed with consideration of flap complications. PMID:18729311

Jun, Roo Min; Suh, Wool; Kim, Eung Kweon

2008-08-30

94

Hematoma intramural esofágico/ Esophageal intramural hematoma  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El hematoma intramural esofágico es infrecuente, existiendo pocos casos registrados en la literatura. Generalmente se presenta posterior a un trauma, por ejemplo asociado a procedimientos endoscópicos (escleroterapia), o en forma espontánea. La presentación clínica más frecuente es la tríada de dolor torácico, odinofagia/disfagia y/o hematemesis. Generalmente el tratamiento consiste en un manejo expectante con medidas de soporte habitual. Se exponen 2 casos clínicos presentados en nuestro centro durante el año 2009 y se realiza una revisión de la literatura. Abstract in english The most common presentation of esophageal hematoma is pain, dysphagia and hematemesis. We report two patients with the condition. A 77 years old female presenting with retrosternal pain and odynophagia after ingesting a pig bone. An upper gastrointestinal endoscopy showed a lineal hematoma, protruding to the lumen in the upper portion of the esophagus. The patient was managed with nil per os (NPO) and parenteral hydration and discharged 72 hours later. An 87 years old ma (more) le presenting with two episodes of hematemesis and weight loss, an upper gastrointestinal endoscopy showed a dissecting hematoma involving the entire esophageal wall. The patient was managed with NPO and hydration and discharged in good conditions 11 days after admission.

Lombardi A, Juan J; González M, Ignacio; Valdivieso A, Javiera; Correa L, Ismael; Heredia P, Carolina

2012-02-01

95

Construction delays causing risks on time and cost - a critical review  

Directory of Open Access Journals (Sweden)

Full Text Available There is an increase in the number of construction projects experiencing extensive delays leading to exceeding initial time and cost budget.  This paper reviews 41 studies around the world which surveyed the delay factors and classified them into Groups.  The main purpose of this paper is to review literature, each of which have categorized the causes that are responsible for time delays and cost overrun in projects. The collected list has 113 causes for delays categorized in to 18 different groups.  Most of the researches have analysed the responses from the Questionnaire survey.    The collected data are used to rank the problem.  The data are further used to investigate and analyse Important Index, Frequency Index, Severity Index, Relative Important Index, Relative Importance Weight, Weighted Average, Mean, Standard Deviation and Variance.  The collective comparison has revealed that the ranking given by all the researchers is not the same.  Further each and every study has different rank ratings for the different group of the delays.  This review paper attempts to provide an updated compilation of the earlier studies on ranking of the delay causers, which are never similar and constant for universal projects.  It is concluded that a separate study is required for identifying the factors causing delay for projects operated in Sabah, East Malaysia.

Chidambaram Ramanathan; S P Narayanan; Arazi B Idrus

2012-01-01

96

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)

2011-01-01

97

Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage  

Energy Technology Data Exchange (ETDEWEB)

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

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

1984-06-01

98

Calcified subdural hematoma associated with hypertensive intracerebral hemorrhage  

International Nuclear Information System (INIS)

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

1984-01-01

99

[Presentation of chronic subdural hematoma in the elderly].  

UK PubMed Central (United Kingdom)

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

Jobse IC; Feitsma MT

2011-06-01

100

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

Energy Technology Data Exchange (ETDEWEB)

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.

Seo, Kwang Won; Kim, Kyung Rak; Lee, Hyeok; Kim, Young Hwa; Cho, Won Soo; Kim, Il Young [Soonchunhyang Univ. Chonan Hospital, Chonan (Korea, Republic of)

1997-05-01

 
 
 
 
101

[Hepatic hematoma in HELLP syndrome].  

UK PubMed Central (United Kingdom)

OBJECTIVE: The purpose of this study was to review our experience with patients having hepatic rupture or hematoma caused by HELLP syndrome. MATERIALS AND METHODS: Descriptive simple cross sectional retrospective study. A review was performed of medical records of all patients admitted at our Hospital's intensive care unit having HELLP syndrome during pregnancy or puerperium between February 1999 and February 2010. Patients complicated with hematoma or hepatic rupture were included. RESULTS: Three cases were identified. The average maternal age was 35 years old and the average gestational age at delivery was 33 weeks. The most frequent signs and symptoms were sudden onset of abdominal pain and shock. A distinctive laboratory finding was anemia. Surgical treatment was omental patching in one of the patients and it was conservative with drainages in the other two cases. Maternal and perinatal mortality were 33 %. CONCLUSION: Based on our experience and the literature review, we can conclude that hepatic hematoma and rupture associated with HELLP syndrome represent a life-threatening complication in which early detection is very important to achieve a proper diagnosis and treatment. Patients should be treated by a multidisciplinary team in reference centers being carefully followed with adequate hemodynamic support and regular images to improve the survival maternal rate.

Alassia M; Buteler MM; Caffaratti C; Bollatti H; Caratti MM

2011-01-01

102

Rectus sheath hematoma  

Digital Repository Infrastructure Vision for European Research (DRIVER)

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 ...

103

Postraumatic delayed loss of vision  

International Nuclear Information System (INIS)

The imaging studies and clinical findings in 10 patients who suffered delayed vision loss beginning 1 day to 13 years after head trauma have been reviewed. Two different primary lesions could be identified: pseudoaneurysm of the internal carotid artery and carotid cavernous fistula. The pathologic changes associated with pseudoaneurysm included compression of the optic nerves and/or chiasm by arterial aneurysm and intracranial hematoma. Carotid cavernous fistula caused delayed vision loss by compression of the optic nerves and chiasm by saccular dilatation of the cavernous sinus and by abnormal orbital venous drainage with retinal venous stasis, retinal edema, and glaucoma

1989-12-01

104

Chronic spinal subdural hematoma  

International Nuclear Information System (INIS)

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

2008-01-01

105

Warfarin Overdose Induced Intramural Small-Bowel Hematoma (Case Report)  

Directory of Open Access Journals (Sweden)

Full Text Available Uncontrolled use of anticoagulants may cause bleeding. Warfarin- dependent spontaneous intramural hematoma of the small intestine is a rare complication. Although warfarin using patients with abdominal pain were usually treated medically, surgical interventions should be considered in selected cases with intestinal intramural hematoma. Here we present a patient who was treated surgically to bring to mind this rare condition.

?brahim Yetim; Ersan Semerci; Orhan Veli Özkan; Muyittin Temiz; Ahmet Aslan

2011-01-01

106

Systemic 5-fluorouracil treatment causes a syndrome of delayed myelin destruction in the central nervous system  

Directory of Open Access Journals (Sweden)

Full Text Available Abstract Background Cancer treatment with a variety of chemotherapeutic agents often is associated with delayed adverse neurological consequences. Despite their clinical importance, almost nothing is known about the basis for such effects. It is not even known whether the occurrence of delayed adverse effects requires exposure to multiple chemotherapeutic agents, the presence of both chemotherapeutic agents and the body's own response to cancer, prolonged damage to the blood-brain barrier, inflammation or other such changes. Nor are there any animal models that could enable the study of this important problem. Results We found that clinically relevant concentrations of 5-fluorouracil (5-FU; a widely used chemotherapeutic agent) were toxic for both central nervous system (CNS) progenitor cells and non-dividing oligodendrocytes in vitro and in vivo. Short-term systemic administration of 5-FU caused both acute CNS damage and a syndrome of progressively worsening delayed damage to myelinated tracts of the CNS associated with altered transcriptional regulation in oligodendrocytes and extensive myelin pathology. Functional analysis also provided the first demonstration of delayed effects of chemotherapy on the latency of impulse conduction in the auditory system, offering the possibility of non-invasive analysis of myelin damage associated with cancer treatment. Conclusions Our studies demonstrate that systemic treatment with a single chemotherapeutic agent, 5-FU, is sufficient to cause a syndrome of delayed CNS damage and provide the first animal model of delayed damage to white-matter tracts of individuals treated with systemic chemotherapy. Unlike that caused by local irradiation, the degeneration caused by 5-FU treatment did not correlate with either chronic inflammation or extensive vascular damage and appears to represent a new class of delayed degenerative damage in the CNS.

Han Ruolan; Yang Yin M; Dietrich Joerg; Luebke Anne; Mayer-Pröschel Margot; Noble Mark

2008-01-01

107

Hematoma cerebeloso a distancia  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish 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 2009. 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 (more) 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 Hospital. 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 (more) 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.

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

2010-09-01

108

Subdural Hematoma from a Cavernous Malformation.  

UK PubMed Central (United Kingdom)

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

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

2013-01-01

109

RGS9 knockout causes a short delay in light responses of ON-bipolar cells.  

UK PubMed Central (United Kingdom)

RGS9 and R9AP are components of the photoreceptor-specific GTPase activating complex responsible for rapid inactivation of the G protein, transducin, in the course of photoresponse recovery from excitation. The amount of this complex in photoreceptors is strictly dependent on the expression level of R9AP; consequently, the knockouts of either RGS9 or R9AP cause comparable delays in photoresponse recovery. While RGS9 is believed to be present only in rods and cones, R9AP is also expressed in dendritic tips of ON-bipolar cells, which receive synaptic inputs from photoreceptors. Recent studies demonstrated that knockouts of R9AP and its binding partner in ON-bipolar cells, RGS11, cause a small delay in ON-bipolar cell light responses manifested as a delayed onset of electroretinography b-waves. This led the authors to suggest that R9AP and RGS11 participate in regulating the kinetics of light responses in these cells. Here we report the surprising finding that a nearly identical b-wave delay is observed in RGS9 knockout mice. Given the exclusive localization of RGS9 in photoreceptors, this result argues for a presynaptic origin of the b-wave delay in this case and perhaps in the case of the R9AP knockout as well, since R9AP is expressed in both photoreceptors and ON-bipolar cells. We also conducted a detailed analysis of the b-wave rising phase kinetics in both knockout animal types and found that, despite a delayed b-wave onset, the slope of the light response is unaffected or increased, dependent on the light stimulus intensity. This result is inconsistent with a slowdown of response propagation in ON-bipolar cells caused by the R9AP knockout, further arguing against the postsynaptic nature of the delayed b-wave phenotype in RGS9 and R9AP knockout mice.

Herrmann R; Lee B; Arshavsky VY

2011-01-01

110

Causes and remedial measures for construction delays: a case study of pakistan  

International Nuclear Information System (INIS)

[en] Delays are the most common event that influence the time performance and increase the cost of projects. This paper analyze causes of various delays experienced by three large construction projects in public sector and subsequently to recommend the corrective actions necessitated to safeguard future construction projects from suffering these delays, which result in enormous cost and time over-runs, undermining projects economic viability. The case-study approach has been employed as research method, to analyze construction delays, followed by categorizing them in view of their source. The method employed to collect data included interviews, questionnaire surveys, and analysis of project documents including monthly progress reports, minutes of meeting, and details of correspondence held between the project participants. The data collected was minutely analyzed to identify different delays, and their underlying causes encountered during execution of projects. The analysis reveals serious lapses on part of projects planners, for their failure to take care of the inevitable contingencies (unexpected situations), while conceptualizing projects by resorting to proactive planning at the very outset, incorporating adequate buffers in the projects budgeted costs, and timeframes, to ensure projects economic viability in any eventuality. The failure of owners to establish key performance indicators, followed by their inability in tracking down the indicators, worsened the situation, resulting in projects execution lagging far behind original schedules of construction activities with their estimated costs. (author)

2009-01-01

111

Nontraumatic intracranial epidural hematoma: a case report.  

UK PubMed Central (United Kingdom)

An outwardly mummified and inwardly badly decomposed body was found in a garage. At autopsy, no injuries were detected. Apart from coronary heart disease, with an old myocardial scar and a hepatic steatosis, the most striking finding was a large intracranial epidural hemorrhage situated at the left frontal lobe. As a relevant traumatic genesis could be ruled out, we deemed this a nontraumatic epidural hematoma. This finding is extremely rare. Several underlying disorders have been discussed as causes of spontaneous epidural hematomas. In this presented case, the authors discuss possible etiological factors.

Bolliger SA; Thali MJ; Zollinger U

2007-09-01

112

Pulsative hematoma: A penile fracture complication  

Directory of Open Access Journals (Sweden)

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

Nale ?or?e; Mi?i? Sava

2007-01-01

113

Rectus sheath hematoma: three case reports  

Directory of Open Access Journals (Sweden)

Full Text Available 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 abdomen and diagnosed by computerized tomography. The patients recovered uneventfully after bed rest, intravenous fluid replacement, blood transfusion and analgesic treatment. Conclusion Rectus sheath hematoma is a rarely seen pathology often misdiagnosed as acute abdomen that may lead to unnecessary laparotomies. Computerized tomography must be chosen for definitive diagnosis since ultrasonography is subject to error due to misinterpretation of the images. Main therapy is conservative management.

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

2008-01-01

114

Warfarin Overdose Induced Intramural Small-Bowel Hematoma (Case Report)  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Uncontrolled use of anticoagulants may cause bleeding. Warfarin- dependent spontaneous intramural hematoma of the small intestine is a rare complication. Although warfarin using patients with abdominal pain were usually treated medically, surgical interventions should be considered in selected cases...

?brahim Yetim; Ersan Semerci; Orhan Veli Özkan; Muyittin Temiz; Ahmet Aslan

115

Root cause analysis reports help identify common factors in delayed diagnosis and treatment of outpatients.  

UK PubMed Central (United Kingdom)

Delays in diagnosis and treatment are widely considered to be threats to outpatient safety. However, few studies have identified and described what factors contribute to delays that might result in patient harm in the outpatient setting. We analyzed 111 root cause analysis reports that investigated such delays and were submitted to the Veterans Affairs National Center for Patient Safety in the period 2005-12. The most common contributing factors noted in the reports included coordination problems resulting from inadequate follow-up planning, delayed scheduling for unspecified reasons, inadequate tracking of test results, and the absence of a system to track patients in need of short-term follow-up. Other contributing factors were team-level decision-making problems resulting from miscommunication of urgency between providers and providers' lack of awareness of or knowledge about a patient's situation; and communication failures among providers, patients, and other health care team members. Our findings suggest that to support care goals in the Affordable Care Act and the National Quality Strategy, even relatively sophisticated electronic health record systems will require enhancements. At the same time, policy initiatives should support programs to implement, and perhaps reward the use of, more rigorous interprofessional teamwork principles to improve outpatient communication and coordination.

Davis Giardina T; King BJ; Ignaczak AP; Paull DE; Hoeksema L; Mills PD; Neily J; Hemphill RR; Singh H

2013-08-01

116

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

Scientific Electronic Library Online (English)

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

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

1990-03-01

117

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

Directory of Open Access Journals (Sweden)

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

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

1990-01-01

118

Temporal muscle haematoma as a cause of suboptimal haemicraniectomy: case report Hematoma de músculo temporal como causa de inadequada descompressão após hemicraniectomia descompressiva: relato de caso  

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Full Text Available OBJECTIVE: To call attention to an unusual complication of decompressive haemicraniectomy in the treatment of malignant haemispheric infarction. METHOD: We describe a case in which partial decompression occurred despite large craniectomy. Complete decompression followed resection of the temporal muscle. Pertinent literature is briefly reviewed. CASE DESCRIPTION: A 55-year old woman developed massive right middle cerebral artery infarction evolving to cerebral haerniation in 40 hours. Decompressive haemicraniectomy without cortical excision was unable to revert coma and decerebrate posturing because of a massive temporal muscle haemorrhage with persistent contralateral deviation of midline structures. Muscle resection was followed by adequate external haerniation of the affected haemisphere and fast recovery. Cranioplasty was succesfully performed 22 days later, following gradual regression of cerebral oedema. CONCLUSION: There is an increasing perception of the need to operate patients with massive middle cerebral or internal carotid artery territory infarctions before the development of coma and cerebral haerniation. The most common factor leading to inadequate surgical decompression is small size craniectomy. The case reported calls attention to temporal muscle bleeding as an additional complication of craniectomy.OBJETIVO: Alertar para o risco de descompressão cirúrgica subótima após hemicraniectomia descompressiva. MÉTODO: Revisão da literatura pertinente após descrição de caso clínico exemplificador. RESULTADOS - DESCRIÇÃO DO CASO: Mulher de 55 anos, com instalação rápida de infarto cerebral no território da artéria cerebral média à direita. Evolução em 40 horas para coma e síndrome de herniação uncal. Tratada com salina hipertônica, hiperventilação e hemicraniectomia descompressiva (sem excisão de tecido cerebral), mantendo, porém, coma e decerebração persistentes. Exame de controle demonstrando volumoso hematoma de músculo temporal, levando a persistente desvio contralateral do segmento anterior do hemisfério afetado. Reoperação após 72 horas (exérese de músculo temporal), com rápida recuperação do nível de consciência e extubação. Controles neurorradiológicos mostrando adequada herniação externa do hemisfério, seguida de lenta regressão do edema cerebral, permitindo cranioplastia após 22 dias da primeira cirurgia. CONCLUSÃO: Progressivamente torna-se clara a importância potencial da cirurgia descompressiva. Estudos recentes sugerem maior benefício em casos de cirurgia precoce (de preferência antes da instalação de herniação cerebral) e de grandes craniectomias com descompressão completa para a evolução favorável de pacientes com infarto cerebral maciço. Hematoma de músculo temporal pode constituir causa não rara de descompressão incompleta.

Charles André; Marco de O. Py; Paulo Niemeyer-Filho

2003-01-01

119

Temporal muscle haematoma as a cause of suboptimal haemicraniectomy: case report/ Hematoma de músculo temporal como causa de inadequada descompressão após hemicraniectomia descompressiva: relato de caso  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese OBJETIVO: Alertar para o risco de descompressão cirúrgica subótima após hemicraniectomia descompressiva. MÉTODO: Revisão da literatura pertinente após descrição de caso clínico exemplificador. RESULTADOS - DESCRIÇÃO DO CASO: Mulher de 55 anos, com instalação rápida de infarto cerebral no território da artéria cerebral média à direita. Evolução em 40 horas para coma e síndrome de herniação uncal. Tratada com salina hipertônica, hiperventilação e (more) hemicraniectomia descompressiva (sem excisão de tecido cerebral), mantendo, porém, coma e decerebração persistentes. Exame de controle demonstrando volumoso hematoma de músculo temporal, levando a persistente desvio contralateral do segmento anterior do hemisfério afetado. Reoperação após 72 horas (exérese de músculo temporal), com rápida recuperação do nível de consciência e extubação. Controles neurorradiológicos mostrando adequada herniação externa do hemisfério, seguida de lenta regressão do edema cerebral, permitindo cranioplastia após 22 dias da primeira cirurgia. CONCLUSÃO: Progressivamente torna-se clara a importância potencial da cirurgia descompressiva. Estudos recentes sugerem maior benefício em casos de cirurgia precoce (de preferência antes da instalação de herniação cerebral) e de grandes craniectomias com descompressão completa para a evolução favorável de pacientes com infarto cerebral maciço. Hematoma de músculo temporal pode constituir causa não rara de descompressão incompleta. Abstract in english OBJECTIVE: To call attention to an unusual complication of decompressive haemicraniectomy in the treatment of malignant haemispheric infarction. METHOD: We describe a case in which partial decompression occurred despite large craniectomy. Complete decompression followed resection of the temporal muscle. Pertinent literature is briefly reviewed. CASE DESCRIPTION: A 55-year old woman developed massive right middle cerebral artery infarction evolving to cerebral haerniation (more) in 40 hours. Decompressive haemicraniectomy without cortical excision was unable to revert coma and decerebrate posturing because of a massive temporal muscle haemorrhage with persistent contralateral deviation of midline structures. Muscle resection was followed by adequate external haerniation of the affected haemisphere and fast recovery. Cranioplasty was succesfully performed 22 days later, following gradual regression of cerebral oedema. CONCLUSION: There is an increasing perception of the need to operate patients with massive middle cerebral or internal carotid artery territory infarctions before the development of coma and cerebral haerniation. The most common factor leading to inadequate surgical decompression is small size craniectomy. The case reported calls attention to temporal muscle bleeding as an additional complication of craniectomy.

André, Charles; Py, Marco de O.; Niemeyer-Filho, Paulo

2003-09-01

120

Iatrogenic subdural hematoma mimicking acute epidural hematoma on computed tomography  

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

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

2013-01-01

 
 
 
 
121

Two cases of subdural hematoma with niveau formation on CT  

International Nuclear Information System (INIS)

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

1984-01-01

122

Chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1980-01-01

123

Microwave hematoma detector  

Energy Technology Data Exchange (ETDEWEB)

The Microwave Hematoma Detector is a non-invasive device designed to detect and localize blood pooling and clots near the outer surface of the body. While being geared towards finding sub-dural and epi-dural hematomas, the device can be used to detect blood pooling anywhere near the surface of the body. Modified versions of the device can also detect pneumothorax, organ hemorrhage, atherosclerotic plaque in the carotid arteries, evaluate perfusion (blood flow) at or near the body surface, body tissue damage at or near the surface (especially for burn assessment) and be used in a number of NDE applications. The device is based on low power pulsed microwave technology combined with a specialized antenna, signal processing/recognition algorithms and a disposable cap worn by the patient which will facilitate accurate mapping of the brain and proper function of the instrument. The invention may be used for rapid, non-invasive detection of sub-dural or epi-dural hematoma in human or animal patients, detection of hemorrhage within approximately 5 cm of the outer surface anywhere on a patient's body.

Haddad, Waleed S. (Dublin, CA); Trebes, James E. (Livermore, CA); Matthews, Dennis L. (Moss Beach, CA)

2001-01-01

124

Chronic encapsulated expanding hematoma in nonfunctioning pituitary adenoma.  

UK PubMed Central (United Kingdom)

The diagnosis and treatment of pituitary macroadenomas with entire hematoma fluid accumulation are problematic. Such lesions are often difficult to completely resect, and recurrence is not uncommon. We present five cases of pituitary macroadenomas entirely composed of hematoma fluid and investigated their histopathology to clarify the mechanism of the hematoma fluid accumulation. Five patients with pituitary adenoma and significant intra-tumor hematoma underwent transsphenoidal resection and were retrospectively reviewed for their clinical status, findings on magnetic resonance imaging (MRI), intraoperative findings, and histopathology. The specific surgical techniques used to address these cases were also reviewed. All patients were diagnosed with nonfunctioning pituitary adenomas by histopathological examination. MRI showed all tumors extended to the cavernous sinus. Histopathology showed tumor tissues were located between the thick granulation tissue and the pseudocapsule of the tumor. The thick granulation tissues were composed of collagenous layers, neovascular vessels, and necrotic red blood cells, indicating repeat hemorrhage from the granulation tissues. The boundary between adenoma and normal pituitary gland was identified during surgical removal in four patients and was not identified in the other patient who showed a recurrence 2 years later. Clinical and histopathological findings indicate hematoma fluid accumulation in the present cases is caused by repeat hemorrhage from the reactive granulation tissues and can be regarded as a chronic encapsulated expanding hematoma. In these cases, the boundary between adenoma and normal pituitary gland should be identified before puncturing the hematoma fluid to minimize the risk of tumor recurrence.

Sugawara T; Aoyagi M; Tanaka Y; Tamaki M; Kobayashi D; Ohno K

2013-07-01

125

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

UK PubMed Central (United Kingdom)

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

Kannuki SG; Shirakawa N; Toi H

2009-06-01

126

Chronic exposure to fluoxetine (Prozac) causes developmental delays in Rana pipiens larvae.  

UK PubMed Central (United Kingdom)

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are among the many pharmaceuticals detected in aquatic ecosystems. Although the acute effects of SSRIs on select organisms have been reported, little is understood about the chronic effects of these drugs on amphibians, which are particularly sensitive to environmental pollutants. Serotonin plays important roles in many physiological functions, including a wide array of developmental processes. Exposure to SSRIs during development may cause developmental complications in a variety of organisms, but little is known about the degree of exposure necessary to cause deleterious effects. Here, we sought to gain a better understanding of the effects of SSRIs on amphibian development by use of a combined laboratory and outdoor mesocosm study. Tadpoles in a laboratory setting were exposed to a low (0.029 µg/L) and a high (0.29 µg/L) concentration of the common SSRI fluoxetine from stages 21 and 22 through completion of metamorphosis. Tadpoles in outdoor mesocosms were exposed to fluoxetine concentrations ranging from 0.1 to 0.3 µg/L. Exposed tadpoles in the laboratory showed delayed development compared with controls when stage was assessed throughout the experiment. Control tadpoles also gained weight faster than treatment tadpoles, which may be explained by reduced food intake. Mesocosm tadpoles exhibited similar trends, but no significant differences were detected. These results indicate that ecologically relevant levels of fluoxetine may cause developmental delays in amphibians.

Foster HR; Burton GA; Basu N; Werner EE

2010-12-01

127

Chronic exposure to fluoxetine (Prozac) causes developmental delays in Rana pipiens larvae.  

Science.gov (United States)

Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine, are among the many pharmaceuticals detected in aquatic ecosystems. Although the acute effects of SSRIs on select organisms have been reported, little is understood about the chronic effects of these drugs on amphibians, which are particularly sensitive to environmental pollutants. Serotonin plays important roles in many physiological functions, including a wide array of developmental processes. Exposure to SSRIs during development may cause developmental complications in a variety of organisms, but little is known about the degree of exposure necessary to cause deleterious effects. Here, we sought to gain a better understanding of the effects of SSRIs on amphibian development by use of a combined laboratory and outdoor mesocosm study. Tadpoles in a laboratory setting were exposed to a low (0.029 µg/L) and a high (0.29 µg/L) concentration of the common SSRI fluoxetine from stages 21 and 22 through completion of metamorphosis. Tadpoles in outdoor mesocosms were exposed to fluoxetine concentrations ranging from 0.1 to 0.3 µg/L. Exposed tadpoles in the laboratory showed delayed development compared with controls when stage was assessed throughout the experiment. Control tadpoles also gained weight faster than treatment tadpoles, which may be explained by reduced food intake. Mesocosm tadpoles exhibited similar trends, but no significant differences were detected. These results indicate that ecologically relevant levels of fluoxetine may cause developmental delays in amphibians. PMID:20836066

Foster, Hannah R; Burton, G Allen; Basu, Niladri; Werner, Earl E

2010-10-15

128

[Epidural hematoma. Myth and reality, based on 3 exemplary cases].  

Science.gov (United States)

The acute epidural hematoma is a real surgical emergency with a good outcome if the operation is performed in reasonable delays. In 1994, too many young patients eventually died or were left with major disabilities, because of an unacceptable and almost always avoidable loss of time. We do emphasize some rules which have to be followed to avoid catastrophic events. PMID:7738121

Guy, G; Fournier, H D; Mercier, P; Menei, P; Alhayek, G

1994-12-01

129

[Epidural hematoma. Myth and reality, based on 3 exemplary cases  

UK PubMed Central (United Kingdom)

The acute epidural hematoma is a real surgical emergency with a good outcome if the operation is performed in reasonable delays. In 1994, too many young patients eventually died or were left with major disabilities, because of an unacceptable and almost always avoidable loss of time. We do emphasize some rules which have to be followed to avoid catastrophic events.

Guy G; Fournier HD; Mercier P; Menei P; Alhayek G

1994-12-01

130

Spontaneous intracranial extradural hematoma: Case report and literature review  

Directory of Open Access Journals (Sweden)

Full Text Available Spontaneous extradural hematoma (EDH) is an uncommon form of intracranial hematoma and is caused by the adjacent sinus and otic infections, dural vascular malformations and disorders of blood coagulation. We report spontaneous EDH in a 54-year old women with chronic kidney disease (CKD) on intermittent hemodialysis. She was successfully managed by conservative treatment. The EDH in her was probably related to the coagulation abnormalities associated with CKD, hemodialysis or heparin use during the dialysis.

Zheng Fan; Chao You

2009-01-01

131

[Intracranial granuloma as a late complication of subdural hematoma  

UK PubMed Central (United Kingdom)

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

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

1989-03-01

132

Postoperative CT appearance in chronic subdural hematomas  

Energy Technology Data Exchange (ETDEWEB)

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

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

1988-05-01

133

Postoperative CT appearance in chronic subdural hematomas  

International Nuclear Information System (INIS)

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

1988-01-01

134

Recurrent spinal epidural hematoma: case report.  

Science.gov (United States)

We report the case of a man of 65 who, at 20 and 37 days from surgery of C6 corpectomy, experienced two epidural hematomas at C7-D1. We assume that the pathogenic cause of this rare disease was an overlap between three main factors: the surgical aggression of the internal anterior epidural venous plexus; a possible increase of intra-thoracic pressure due to chronic obstructive pulmonary disease; and double antiplatelet drug therapy. PMID:23351908

Caruso, R; Pesce, A; Wierzbicki, V; Marrocco, L

2013-01-23

135

Intradural nerve root hematoma in the lumbar spine. A case report.  

Science.gov (United States)

Intradural nerve root hematoma of the lumbar spine is extremely rare and can cause compression of the cauda equina. This case, which presented with low back pain and radiation to both lower extremities, diagnosed as an intradural hematoma of nerve root by magnetic resonance imaging (MRI) and was totally removed successfully. Intradural nerve root hematoma can present with or without a history of trauma or blood dyscrasia, where MRI is the best imaging modality, and can be well treated by surgery. PMID:17965895

Taghipour, M; Javadi, S; Attaran, Y; Bagheri, M H

2007-10-27

136

Cranial metastasis of hepatocellular carcinoma associated with chronic epidural hematoma--case report.  

UK PubMed Central (United Kingdom)

A case of cranial metastasis of hepatocellular carcinoma associated with epidural hematoma in a 58-year-old male is presented. The epidural hematoma demonstrated an unusual chronic clinical course and computed tomographic appearance. Associated bleeding from either the diploic marrow or emissary veins might be a cause of the slowly expanding hematoma, and the outward displacement of the artificial bone-flap implanted previously may also have contributed to the chronic course.

Nakao N; Kubo K; Moriwaki H

1992-02-01

137

Causes of Delay in Patient Triage in the Emergency Departments of Tabriz Hospitals  

Directory of Open Access Journals (Sweden)

Full Text Available Objectives: Organized triage has been useful method in immediate classification of large number of patients. Urgent intervention and evaluation of patients in Emergency Department result in shorter patient waiting time and, therefore, intensifying the quality of supervision. This study aimed at determining the causes of delays in patient triage in Emergency Departments (EDs) in the city of Tabriz.Methods: This descriptive study was conducted in 18 hospitals of Tabriz, Iran. A questionnaire developed for this study was the only tool used in data collection. They were filled in by selected sample of ED staff, consisting 22 physicians and 135 nurses. The data was analyzed using the SPSS v.15.0 statistical software and descriptive analyses were used. Results: Findings of this study indicate that 75% of the survey was conducted in public and 25% in private hospitals. Based on the study results, major reasons of delay in patients priority processing include shortage of nursing staff (65%), large number of patients (50.3%), shortage of medical staff (38.2%), shortage of hospital resources (31.2%), shortage of medical equipment (26.8%), patients evaluation (13.4%), diagnostic tests (12.1%), advanced age of patients (5.7%), early age of patients (5.1%). Conclusions: Results of the study indicate that some of the major reasons of delay in priority processing of patients include shortage of nursing staff and large number of patients. Therefore, increasing staff number can be an efficient way to effectively manage the patient population in Emergency Department.

Abbas DADASHZADEH; Farahnaz ABDOLLAHZADEH; Samad Shams VAHDATI; Mozhgan LOTFI; Morteza GHOJAZADEH; Simindokht Bagheri MEHMANDOUSTI

2011-01-01

138

Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery.  

UK PubMed Central (United Kingdom)

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery.

Bhardwaj A; Dharmavaram S; Wadhawan S; Sethi A; Bhadoria P

2011-04-01

139

Donepezil: A cause of inadequate muscle relaxation and delayed neuromuscular recovery.  

Science.gov (United States)

A 74-year-old female with diabetes mellitus type II and Alzheimer's disease, taking donepezil for 4 months was operated for right modified radical mastectomy under general anesthesia. During the procedure a higher dose of non-depolarizing muscle relaxant was required than those recommended for her age yet the muscle relaxation was inadequate intra-operatively. Residual neuromuscular blockade persisted postoperatively, due to the cumulative effect of large doses of non-depolarizing muscle relaxant, needing post-operative ventilatory assistance. After ruling out other causes of resistance to non-depolarizing muscle relaxants, we concluded that acetylcholinesterase inhibitor donepezil was primarily responsible for inadequate muscle relaxation and delayed post-operative neuromuscular recovery. PMID:21772691

Bhardwaj, Alka; Dharmavaram, Sudhindra; Wadhawan, Sonia; Sethi, Anjali; Bhadoria, Poonam

2011-04-01

140

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture.  

UK PubMed Central (United Kingdom)

We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

Takamatsu R; Takahashi H; Yokoyama Y; Terajima F; Inoue Y; Fukutake K; Wada A

2013-01-01

 
 
 
 
141

A Case of Delayed Myelopathy Caused by Atlantoaxial Subluxation without Fracture  

Science.gov (United States)

We report a case of delayed myelopathy caused by atlantoaxial subluxation without fracture. The patient was a 38-year-old male who became aware of weakness in extremities. The patient had a history of hitting his head severely while diving into a swimming pool at the age of 14 years old. At that time, cervical spine plain X-ray images showed no fracture, and the cervical pain disappeared after use of a collar for several weeks. At his first visit to our department, X-ray images showed an unstable atlantoaxial joint. After surgery, weakness of the extremities gradually improved. At 6 months after surgery, bone union was completed and the symptoms disappeared. This case shows that atlantoaxial ligament injuries are difficult to diagnose and may easily be missed. A high level of suspicion is important in such cases, since neurological compromise or deterioration may occur many years after the injury.

Takamatsu, Ryo; Takahashi, Hiroshi; Yokoyama, Yuichiro; Terajima, Fumiaki; Inoue, Yasuhiro; Fukutake, Katsunori; Wada, Akihito

2013-01-01

142

Muscle hematoma: A critically important complication of alcoholic liver cirrhosis  

Directory of Open Access Journals (Sweden)

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.

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

2009-01-01

143

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

UK PubMed Central (United Kingdom)

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

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

2013-05-01

144

Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor  

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Full Text Available Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica.

A. J. Lucendo Villarín; G. Carrión Alonso; A. Kassem; R. Pajares Villarroya; N. Manceñido Marcos; R. Rey Sanz

2005-01-01

145

Bruising of the esophagus as a cause of gastrointestinal bleeding in a case of heatstroke/ Hematomas esofágicos como causa de hemorragia digestiva en un caso de golpe de calor  

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish Las alteraciones de la coagulación son una complicación frecuente en el golpe de calor grave, y pueden ser causa de hemorragia digestiva. Presentamos el caso de un varón de 26 años que fue admitido en nuestro hospital por un cuadro de hipertermia, asociado con encefalopatía y coagulación intravascular diseminada tras exposición solar prolongada. Presentó hematemesis por la que fue diagnosticado de múltiples hematomas esofágicos que ocupaban los tercios superior (more) e inferior del órgano, en ausencia de otras lesiones en estómago y duodeno. Tras el tratamiento de soporte y la resolución de la patología subyacente, desaparecieron las lesiones endoscópicas, normalizándose la mucosa esofágica. Abstract in english Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower th (more) irds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.

Lucendo Villarín, A. J.; Carrión Alonso, G.; Kassem, A.; Pajares Villarroya, R.; Manceñido Marcos, N.; Rey Sanz, R.

2005-08-01

146

Delay of transfer from the intensive care unit: A prospective observational study of incidence, causes and financial impact.  

UK PubMed Central (United Kingdom)

INTRODUCTION: A paucity of literature exists regarding delays in transfer out of the intensive care unit. We sought to analyze the incidence, causes and costs of delayed transfer from a surgical intensive care unit (SICU). METHODS: An institutional review board -approved prospective observational study was conducted from 1/24/2010 to 7/31/2010 of all 731 patients transferred from a 20-bed SICU at a large tertiary-care academic medical center. Data were collected on patients who were medically ready for transfer to the floor who remained in the SICU for at least one extra day. Reasons for delay were examined and extra costs associated were estimated. RESULTS: Transfer to the floor was delayed in 22% (n=160) of the 731 patients transferred from the SICU. Delays ranged from 1 to 6 days (mean 1.5 days, median 2 days). The extra costs associated with delays were estimated to be $581,790 during the study period, or $21,547 per week. The most common reasons for delay in transfer were: lack of available surgical floor bed [71% (114/160)], lack of room appropriate for infectious contact precautions [18% (28/160)], change of primary service (Surgery to Medicine) [7% (11/160)], and lack of available patient attendant ("sitter" for mildly delirious patients) [3% (5/160)]. There was a positive association between the daily hospital census and the daily number of SICU beds occupied by patients delayed in transfer (Spearman's rho=0.27, p<0.0001). CONCLUSIONS: Delay in transfer from the SICU is common and costly. The most common reason for delay is insufficient availability of surgical floor beds. Delay in transfer is associated with high hospital census. Further study of this problem is necessary.

Johnson DW; Schmidt U; Bittner EA; Christensen B; Levi R; Pino RM

2013-07-01

147

[Spontaneous spinal epidural hematoma: case report  

UK PubMed Central (United Kingdom)

We report a case of spontaneous spinal epidural hematoma (SSEH) at the upper thoracic level which accompanied an epidural vascular lesion demonstrated by histological examination. A 62-year-old male was referred to our department, because of sudden onslaught of back pain, progressive paraparesis, and sensory disturbance below the dermatome of Th8. He had no history of a tendency to bleed, anticoagulant therapy, or trauma. There was no abnormality in the laboratory data. MRI revealed that an epidural mass at the level of dorsal T1 and T2 was compressing the spinal cord. Multilevel spondylotic change and thickened yellow ligament were also noted. Sixteen hours after the onset, we performed laminectomy at T1 and T2 and evacuated the epidural hematoma. An unusual vascular-net like tissue was found on the dura mater after removal of the hematoma. Postoperatively, neurological symptoms disappeared within three weeks. Histological appearance of the vascular tissue was a cluster of vessels containing a dilated vein with partially thin wall due to lack of elastic and collagen fibers. In reviewing the literature, there are several reports describing vascular lesions, such as cavernous angioma and AVM, as possible etiologies of SSEH. In the present case, long lasting compression of the posterior epidural venous plexus by the thick yellow ligament might have resulted in formation of an abnormal vein which ultimately caused bleeding.

Nakamura H; Tominaga T; Satoh S; Kousyu K; Yoshimoto T

1997-04-01

148

[Spontaneous spinal epidural hematoma: case report].  

Science.gov (United States)

We report a case of spontaneous spinal epidural hematoma (SSEH) at the upper thoracic level which accompanied an epidural vascular lesion demonstrated by histological examination. A 62-year-old male was referred to our department, because of sudden onslaught of back pain, progressive paraparesis, and sensory disturbance below the dermatome of Th8. He had no history of a tendency to bleed, anticoagulant therapy, or trauma. There was no abnormality in the laboratory data. MRI revealed that an epidural mass at the level of dorsal T1 and T2 was compressing the spinal cord. Multilevel spondylotic change and thickened yellow ligament were also noted. Sixteen hours after the onset, we performed laminectomy at T1 and T2 and evacuated the epidural hematoma. An unusual vascular-net like tissue was found on the dura mater after removal of the hematoma. Postoperatively, neurological symptoms disappeared within three weeks. Histological appearance of the vascular tissue was a cluster of vessels containing a dilated vein with partially thin wall due to lack of elastic and collagen fibers. In reviewing the literature, there are several reports describing vascular lesions, such as cavernous angioma and AVM, as possible etiologies of SSEH. In the present case, long lasting compression of the posterior epidural venous plexus by the thick yellow ligament might have resulted in formation of an abnormal vein which ultimately caused bleeding. PMID:9125724

Nakamura, H; Tominaga, T; Satoh, S; Kousyu, K; Yoshimoto, T

1997-04-01

149

Surgical management of posttraumatic intraorbital hematoma.  

UK PubMed Central (United Kingdom)

Retrobulbar hematoma is a rare condition but represents a diagnostic and therapeutic emergency. It occurs in between 0.3% and 3.5% of facial traumas and can be caused by direct or indirect injury of the orbit; they can be classified into intraorbital and subperiosteal hematoma. We describe 4 different cases of posttraumatic retrobulbar hematoma treated at the Unit of Maxillofacial Surgery of the Novara Major Hospital between January 2005 and December 2009, each different from the others for morphologic aspects, and we discuss its diagnosis and management. Surgery decompression of the orbit is recommended when visual deficit arises and when there is no response to pharmacologic therapy. Several techniques for orbital decompression have been proposed. The lateral canthotomy and/or the inferior cantholysis are the 2 techniques most practiced. Anterior-chamber paracentesis is effective, but it is rarely indicated for frequent complications such as cataract formation, herniation of the iris, infection, and trauma to the canal of Schlemm. Other procedures including transantral ethmoidectomy, transantral sphenoidectomy, and transfrontal craniotomy are described.

Brucoli M; Arcuri F; Giarda M; Benech R; Benech A

2012-01-01

150

Surgical management of posttraumatic intraorbital hematoma.  

Science.gov (United States)

Retrobulbar hematoma is a rare condition but represents a diagnostic and therapeutic emergency. It occurs in between 0.3% and 3.5% of facial traumas and can be caused by direct or indirect injury of the orbit; they can be classified into intraorbital and subperiosteal hematoma. We describe 4 different cases of posttraumatic retrobulbar hematoma treated at the Unit of Maxillofacial Surgery of the Novara Major Hospital between January 2005 and December 2009, each different from the others for morphologic aspects, and we discuss its diagnosis and management. Surgery decompression of the orbit is recommended when visual deficit arises and when there is no response to pharmacologic therapy. Several techniques for orbital decompression have been proposed. The lateral canthotomy and/or the inferior cantholysis are the 2 techniques most practiced. Anterior-chamber paracentesis is effective, but it is rarely indicated for frequent complications such as cataract formation, herniation of the iris, infection, and trauma to the canal of Schlemm. Other procedures including transantral ethmoidectomy, transantral sphenoidectomy, and transfrontal craniotomy are described. PMID:22337467

Brucoli, Matteo; Arcuri, Francesco; Giarda, Mariangela; Benech, Rodolfo; Benech, Arnaldo

2012-01-01

151

[Postspinal subacut subdural hematoma: case report].  

UK PubMed Central (United Kingdom)

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

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

2013-07-01

152

Fuzzy Assessment of Causes of Time Overrun (Delays) in Iran`s Dam Construction Projects  

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Full Text Available On-time completion and conformity with assigned costs of every project or plan is one of the most important factors in success of that project or plan. No completion or overrun cost leads to not meeting the employer`s requirements need or goals of the plan or the project. This issue is of greater importance in large and national projects in which the period of execution is long even in normal conditions and takes more than 6 years averagely. Dam construction projects are of especial importance regarding on-time completion and assigned funds because of their importance in operation size, great investment, complicated nature and many uncertainties in them like underground conditions, natural disasters and high cost of construction. So, inspection, identification and evaluation of causes of cost and time overrun and representations of solutions for obviating them have great benefits for economy of the country. Besides in most cases precise and sufficient information is not available for this purpose and opinions of experts and professionals in this project (in fuzzy theory framework) should be used. In this study, in addition to brief review of studies related to the issue of delays, fuzzy theory and method of using it is explained and real value of cost and time overrun in some dams of Iran is calculated and subsequently, fuzzy identification and evaluation of causes and cost and time overrun in these projects are dealt with.

P. Ghoddosi; M. P. Jalal; M. Hosseinalipour

2008-01-01

153

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed  

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

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

154

Bilateral supratentorial epidural hematomas: a rare complication in adolescent spine surgery.  

UK PubMed Central (United Kingdom)

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.

Li ZJ; Sun P; Dou YH; Lan XL; Xu J; Zhang CY; Wang JP

2012-01-01

155

Multiple organ dysfunction: a delayed envenomation syndrome caused by tentacle extract from the jellyfish Cyanea capillata.  

Science.gov (United States)

The delayed jellyfish envenomation syndrome (DJES) with serious multiple organ dysfunction or systemic damages, generally developed 2 h after jellyfish stings, deserves special attention for it is very meaningful to the clinical interventions. To set up a DJES model as well as to obtain more details about its process, an integrative approach, including clinical chemistry, pathology and immunohistochemistry, was conducted to simultaneously monitor the effects of tentacle extract (TE) from the jellyfish Cyanea capillata on the vital target organs (heart, lung, liver and kidney). Our results showed that the TE from C. capillata could induce diverse toxic effects on these organs, among which the liver and kidney injuries seemed to be more serious than cardiopulmonary injuries and might be the leading causes of death in rats with DJES. In summary, we have established a DJES model with multiple organ dysfunction, which could facilitate the research on its underlying mechanism as well as the development of specific prevention or therapy strategies against jellyfish envenomation. The application of this model suggested that the possible mechanism of DJES might be attributed to the synergy of cytotoxicity, vasoconstriction effect and other specific target organ toxicities of jellyfish venom. PMID:23151380

Wang, Beilei; Zhang, Lin; Zheng, Jiemin; Wang, Qianqian; Wang, Tao; Lu, Jia; Wen, Xiaojuan; Zhang, Bo; Liu, Guoyan; Zhang, Wei; Xiao, Liang; Zhang, Liming

2012-11-11

156

Multiple organ dysfunction: a delayed envenomation syndrome caused by tentacle extract from the jellyfish Cyanea capillata.  

UK PubMed Central (United Kingdom)

The delayed jellyfish envenomation syndrome (DJES) with serious multiple organ dysfunction or systemic damages, generally developed 2 h after jellyfish stings, deserves special attention for it is very meaningful to the clinical interventions. To set up a DJES model as well as to obtain more details about its process, an integrative approach, including clinical chemistry, pathology and immunohistochemistry, was conducted to simultaneously monitor the effects of tentacle extract (TE) from the jellyfish Cyanea capillata on the vital target organs (heart, lung, liver and kidney). Our results showed that the TE from C. capillata could induce diverse toxic effects on these organs, among which the liver and kidney injuries seemed to be more serious than cardiopulmonary injuries and might be the leading causes of death in rats with DJES. In summary, we have established a DJES model with multiple organ dysfunction, which could facilitate the research on its underlying mechanism as well as the development of specific prevention or therapy strategies against jellyfish envenomation. The application of this model suggested that the possible mechanism of DJES might be attributed to the synergy of cytotoxicity, vasoconstriction effect and other specific target organ toxicities of jellyfish venom.

Wang B; Zhang L; Zheng J; Wang Q; Wang T; Lu J; Wen X; Zhang B; Liu G; Zhang W; Xiao L; Zhang L

2013-01-01

157

Determination of damages of photosynthetic metabolism caused by herbicides using a delayed fluorescence technique  

Science.gov (United States)

The structure and function of chloroplast in plant can be affected by herbicide, resulting in the decrease in photosynthetic capacity. The photosystem II (PSII) in plants is considered to be the primary site where light-induced delayed fluorescence (DF) is produced. In this study, a simple analytical model of DF has been developed to diagnose the damages of photosynthesis caused by herbicides based on the charge recombination theory. Using a home-made portable DF detection system, we have studied the effects of two different kinds of herbicides on decay kinetics of DF in soybean (Glycine max (L.), Jinghuang No. 3). Current investigations have demonstrated that the analytic equation of DF decay dynamics we proposed here can accurately determine the extent of damage of herbicides to photosynthetic metabolism and truly reflect the mechanism and site about which herbicides inhibit photosynthetic electron transport chain. Therefore, the decay kinetics of DF with proper calibration may provide a promisingly new and practical means for pharmacological analysis of herbicides and damage-diagnosis of photosynthetic metabolism. The DF technique could be potentially useful for detecting the effects of herbicide on plant performance in vivo and screening new generation of promising herbicides with low toxicity and superhigh efficiency.

Zhang, Lingrui; Xing, Da; Zhou, Xiaoming; Li, Qiang

2007-11-01

158

In utero protein restriction causes growth delay and alters sperm parameters in adult male rats  

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Full Text Available Abstract Background Recent studies have supported the concept of "fetal programming" which suggests that during the intrauterine development the fetus may be programmed to develop diseases in adulthood. The possible effects of in utero protein restriction on sexual development of rat male offspring were evaluated in the present study. Methods Pregnant Wistar rats were divided into two experimental groups: one group treated with standard chow (SC, n = 8, 17% protein) and the other group treated with hypoproteic chow (HC, n = 10, 6% protein) throughout gestation. After gestation the two experimental groups received standard chow. To evaluate the possible late reproductive effects of in utero protein restriction, the male offspring of both groups were assessed at different phases of sexual development: prepubertal (30 days old); peripubertal (60 days old); adult (90 days old). Student's t-test and Mann-Whitney test were utilized. Differences were considered significant when p Results We found that in utero protein restriction reduced the body weight of male pups on the first postnatal day and during the different sexual development phases (prepubertal, peripubertal and adult). During adulthood, Sertoli cell number, sperm motility and sperm counts in the testis and epididymal cauda were also reduced in HC. Furthermore, the numbers of sperm presenting morphological abnormalities and cytoplasmic drop retention were higher in HC. Conclusions In conclusion, in utero protein restriction, under these experimental conditions, causes growth delay and alters male reproductive-system programming in rats, suggesting impairment of sperm quality in adulthood.

Toledo Fabíola C; Perobelli Juliana E; Pedrosa Flávia PC; Anselmo-Franci Janete A; Kempinas Wilma DG

2011-01-01

159

Antiangiogenesis therapy using a novel angiogenesis inhibitor, anginex, following radiation causes tumor growth delay  

International Nuclear Information System (INIS)

The present study investigated whether treatment with anginex, a novel antiangiogenic peptide, could block re-vascularization after radiation treatment. A squamous cell (SCCVII) xenograft tumor mouse model was employed to assess the effects of anginex given post-radiation on tumor growth, microvessel density (MVD), and oxygen levels. The oxygen status was determined by the partial pressure of O2. Tumors in untreated mice increased threefold in 7.0 days, anginex-treated tumors (10 mg/kg intraperitoneal, twice) required 7.3±0.9 days, and tumors exposed to 8-Gy radiation increased threefold over 11 days. Combination treatment of anginex and radiation caused the tumors to grow threefold in 16.1±1.6 days, a delay which was significant and deemed supra-additive. Oxygen levels in tumors treated by stand-alone or combination therapies were significantly reduced; for example from 19.5±4.9 mmHg in controls to 9.7±1.9 mmHg in combination-treated, size-matched tumors. In addition, immunohistochemistry showed a decrease in MVD in the tumors treated with anginex, radiation, or the combination. These results suggest that a combination of anginex and radiation can greatly affect the amount of functional vasculature in tumors and prolong radiation-induced tumor regression. Antiangiogenesis therapy with anginex, in addition to radiotherapy, will be useful by blocking angiogenesis-dependent regrowth of vessels. (author)

2007-01-01

160

Spontaneous chronic subdural hematoma in an adolescent girl.  

UK PubMed Central (United Kingdom)

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

Wang HS; Kim SW; Kim SH

2013-03-01

 
 
 
 
161

Pathogenesis of chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1982-01-01

162

Systemic 5-fluorouracil Treatment Causes a Syndrome of Delayed Myelin Destruction in the Central Nervous System  

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Background: Cancer treatment with a variety of chemotherapeutic agents often is associated with delayed adverse neurological consequences. Despite their clinical importance, almost nothing is known about the basis for such effects. It is not even known whether the occurrence of delayed adverse effec...

Han, Ruolan; Luebke, Anne; Mayer-Pröschel, Margot; Noble, Mark; Yang, Yin Miranda; Dietrich, Jorg

163

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

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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.

Bansal Ujjwal; Sawant Ajit; Dhabalia Jayesh

2010-01-01

164

Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels.  

UK PubMed Central (United Kingdom)

ABSTRACTObjective:Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non-ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.Methods:We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.Results:From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65-120); for blood collection from the time the collection was ordered for was 0 minutes (IQR -12-0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2-19); laboratory process duration was 44 minutes (IQR 39-52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15-52).Conclusions:For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay.

James Owen J; Worster A; Marie Waines B; Ward J; Kavsak P; Hill S

2013-01-01

165

Root cause analysis of delays to discharge for patients held for serial cardiac troponin levels.  

Science.gov (United States)

ABSTRACTObjective:Emergency department (ED) patients with symptoms of cardiac ischemia often require a second cardiac troponin (cTn) measurement to rule out non-ST elevation myocardial infarction. We measured the total turnaround time and the component event times following the ordering of the second cTn level to ED discharge to identify root causes of delays.Methods:We reviewed a random sample of ED discharges following a second normal cTn measurement and recorded associated event times. The central tendency of time intervals is reported as median and mean number of minutes with interquartile ranges (IQRs) and 95% confidence intervals, respectively.Results:From 9,656 eligible cases, we randomly selected 226 for data collection. The median number of minutes for each event are as follows: from ordering the second cTn measurement to the time of ED discharge was 90 minutes (IQR 65-120); for blood collection from the time the collection was ordered for was 0 minutes (IQR -12-0); from blood collection to the time the blood was transported to the laboratory was 9 minutes (IQR 2-19); laboratory process duration was 44 minutes (IQR 39-52); from when the results were available to the time the patient was discharged was 30 minutes (IQR 15-52).Conclusions:For ED patients discharged following two normal cTn levels, the laboratory processing time and time from the result being available to the time of ED discharge represent the longest modifiable time periods to reduce ED length of stay. PMID:23816272

James Owen, Julian; Worster, Andrew; Marie Waines, Barbara; Ward, James; Kavsak, Peter; Hill, Stephen

2013-01-01

166

Inactivation of IL11 signaling causes craniosynostosis, delayed tooth eruption, and supernumerary teeth  

DEFF Research Database (Denmark)

Craniosynostosis and supernumerary teeth most often occur as isolated developmental anomalies, but they are also separately manifested in several malformation syndromes. Here, we describe a human syndrome featuring craniosynostosis, maxillary hypoplasia, delayed tooth eruption, and supernumerary teeth. We performed homozygosity mapping in three unrelated consanguineous Pakistani families and localized the syndrome to a region in chromosome 9. Mutational analysis of candidate genes in the region revealed that all affected children harbored homozygous missense mutations (c.662C>G [p.Pro221Arg], c.734C>G [p.Ser245Cys], or c.886C>T [p.Arg296Trp]) in IL11RA (encoding interleukin 11 receptor, alpha) on chromosome 9p13.3. In addition, a homozygous nonsense mutation, c.475C>T (p.Gln159X), and a homozygous duplication, c.916_924dup (p.Thr306_Ser308dup), were observed in two north European families. In cell-transfection experiments, the p.Arg296Trp mutation rendered the receptor unable to mediate the IL11 signal, indicating that the mutation causes loss of IL11RA function. We also observed disturbed cranial growth and suture activity in the Il11ra null mutant mice, in which reduced size and remodeling of limb bones has been previously described. We conclude that IL11 signaling is essential for the normal development of craniofacial bones and teeth and that its function is to restrict suture fusion and tooth number. The results open up the possibility of modulation of IL11 signaling for the treatment of craniosynostosis.

Nieminen, Pekka; Morgan, Neil V

2011-01-01

167

Inactivation of IL11 signaling causes craniosynostosis, delayed tooth eruption, and supernumerary teeth.  

UK PubMed Central (United Kingdom)

Craniosynostosis and supernumerary teeth most often occur as isolated developmental anomalies, but they are also separately manifested in several malformation syndromes. Here, we describe a human syndrome featuring craniosynostosis, maxillary hypoplasia, delayed tooth eruption, and supernumerary teeth. We performed homozygosity mapping in three unrelated consanguineous Pakistani families and localized the syndrome to a region in chromosome 9. Mutational analysis of candidate genes in the region revealed that all affected children harbored homozygous missense mutations (c.662C>G [p.Pro221Arg], c.734C>G [p.Ser245Cys], or c.886C>T [p.Arg296Trp]) in IL11RA (encoding interleukin 11 receptor, alpha) on chromosome 9p13.3. In addition, a homozygous nonsense mutation, c.475C>T (p.Gln159X), and a homozygous duplication, c.916_924dup (p.Thr306_Ser308dup), were observed in two north European families. In cell-transfection experiments, the p.Arg296Trp mutation rendered the receptor unable to mediate the IL11 signal, indicating that the mutation causes loss of IL11RA function. We also observed disturbed cranial growth and suture activity in the Il11ra null mutant mice, in which reduced size and remodeling of limb bones has been previously described. We conclude that IL11 signaling is essential for the normal development of craniofacial bones and teeth and that its function is to restrict suture fusion and tooth number. The results open up the possibility of modulation of IL11 signaling for the treatment of craniosynostosis.

Nieminen P; Morgan NV; Fenwick AL; Parmanen S; Veistinen L; Mikkola ML; van der Spek PJ; Giraud A; Judd L; Arte S; Brueton LA; Wall SA; Mathijssen IM; Maher ER; Wilkie AO; Kreiborg S; Thesleff I

2011-07-01

168

Multiple Densities of the Chronic Subdural Hematoma in CT Scans.  

UK PubMed Central (United Kingdom)

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

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

2013-07-01

169

Multiple Densities of the Chronic Subdural Hematoma in CT Scans  

Science.gov (United States)

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

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

2013-01-01

170

An Atropa belladonna L. poisoning with acute subdural hematoma.  

Science.gov (United States)

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

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

2011-05-03

171

[Evaluation of the technique of subcutaneous administration of heparin in the development of hematomas].  

Science.gov (United States)

This study identified and evaluated the presence and extent of hematomas, pain and other complications after the administration of low-dose subcutaneous heparin. It compared applications using the conventional technique and applications with modified techniques in 60 patients hospitalized in an University Hospital in the interior of São Paulo State-Brazil. Each patient received four heparin injections, that is, two injections of each of the techniques mentioned. The site was observed after 24 hours. Results showed that hematomas were observed after the application of 83.7% of the injections. The thigh was the site with the highest incidence of hematomas, followed by the arm and the abdomen. There were no significant differences in the formation of hematomas caused by the two techniques. It was concluded that the techniques used for heparin application were probably not related to the formation of hematomas. PMID:12514832

da Silva, Aline Aparecida Leite; Cassiani, Silvia Helena De Bortoli; Optiz, Simone Perufo

172

[Evaluation of the technique of subcutaneous administration of heparin in the development of hematomas].  

UK PubMed Central (United Kingdom)

This study identified and evaluated the presence and extent of hematomas, pain and other complications after the administration of low-dose subcutaneous heparin. It compared applications using the conventional technique and applications with modified techniques in 60 patients hospitalized in an University Hospital in the interior of São Paulo State-Brazil. Each patient received four heparin injections, that is, two injections of each of the techniques mentioned. The site was observed after 24 hours. Results showed that hematomas were observed after the application of 83.7% of the injections. The thigh was the site with the highest incidence of hematomas, followed by the arm and the abdomen. There were no significant differences in the formation of hematomas caused by the two techniques. It was concluded that the techniques used for heparin application were probably not related to the formation of hematomas.

da Silva AA; Cassiani SH; Optiz SP

2002-03-01

173

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

UK PubMed Central (United Kingdom)

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

Kafarnik C; Donaldson D; Payne R; Holloway A

2013-08-01

174

[Chronic subdural hematoma and psychotic decompensation].  

UK PubMed Central (United Kingdom)

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

Jomli R; Zgueb Y; Nacef F; Douki S

2012-09-01

175

Causes of Delay in Diagnosis of Smear-Positive Pulmonary Tuberculosis Patients Referred to the Tuberculosis Center of Zahedan  

Directory of Open Access Journals (Sweden)

Full Text Available Background: Tuberculosis is now the major cause of mortality in the world. This study has tried to identify the factors affecting the diagnosis of this disease by determining the relationship between delay in diagnosis and factors associated with patient and health system.Materials and Methods: This research was a cross-sectional study conducted on smear positive pulmonary tuberculosis patients referred to the tuberculosis center in the first half of 2008. Required information was completed through patient records and patient interviews.Results: A total 98 patients were studied including 42 males and 56 females. Average age of patients was 51.6±19.57. Average delay in diagnosis was 2.8±1.78 months. The average delay of patients and health system was respectively 2.6±1.76 months and 6±4.27days. Data analysis showed that there is no relationship between the delay in diagnosis and individual variables such as age, gender, occupation, etc., and examination of sputum smears at the first visit. However, there is a significant relationship between patient delay with different factors such as education (p=0.03), marital status (p=0.03), existence of hospital or medical centers in the residence (p=0.02), distance to the medical center (p=0.02) and between health system delay and residence in the city (p=0.01), distance to this medical center (p=0.03) and obtaining chest X-ray (CXR) in the first visit (p=0.003).Conclusion: The results showed that with the increase of literacy, the establishment of new hospitals and health centers in remote areas and suburbs as well as chest X-ray in the first visit, the amount of delay in diagnosis can be reduced.

Mosayeb Shahriyar; Abasali Niazi; Reza Karimian; Elham Naroii; Masoud Pishjoo; Mahdi Nikoseresht; Iraj Shahramian

2012-01-01

176

Cylinder syringe suction: a simple and efficient technique for the evacuation of subcutaneous hematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Subcutaneous hematoma is commonly caused by trauma or surgery. Proper treatment of the condition is needed to avoid severe complications. The present paper introduces a simple technique of hematoma evacuation, called cylinder syringe suction (CSS). Experiments were also performed to determine the detailed mechanism underlying its effectiveness. METHODS: The CSS procedure was performed as follows. A cylindrical plastic cylinder syringe was used. Either a few stitches were removed or a very small incision was made on the site of the hematoma. The edge of the syringe was compressed to the skin, which was covered by a thin hydrocolloid dressing. Vacuum aspiration was enforced at the site of the wound or incision, and the hematoma was gradually aspirated.For the experiment, house rabbits were used. Hematoma evacuation was performed in 4 different ways, including needle aspiration alone (group 1), needle puncture followed by CSS (group 2), and creation of a small wound (5 mm) followed by needle aspiration (group 3) or CSS (group 4). The amount of evacuated hematoma and the suction pressure created by each of the 4 methods were compared. RESULTS: Group 4 showed the highest suction pressure and the greatest evacuated amount of hematoma. High suction pressure was also obtained in group 1; however, the amount of evacuated hematoma was small as the other 2 groups. CONCLUSION: The CSS technique becomes effective mainly by creating high suction pressure, and the opening of a small wound enables the viscous coagula to pass through the skin.

Hayashi A; Matsuda N; Horiguchi M; Matsumura T; Komoto M; Natori Y; Komuro Y; Mizuno H

2013-05-01

177

Ogura-CMS in Chinese cabbage (Brassica rapa ssp. pekinensis) causes delayed expression of many nuclear genes.  

UK PubMed Central (United Kingdom)

We investigated the mechanism regulating cytoplasmic male sterility (CMS) in Brassica rapa ssp. pekinensis using floral bud transcriptome analyses of Ogura-CMS Chinese cabbage and its maintainer line in B. rapa 300-K oligomeric probe (Br300K) microarrays. Ogura-CMS Chinese cabbage produced few and infertile pollen grains on indehiscent anthers. Compared to the maintainer line, CMS plants had shorter filaments and plant growth, and delayed flowering and pollen development. In microarray analysis, 4646 genes showed different expression, depending on floral bud size, between Ogura-CMS and its maintainer line. We found 108 and 62 genes specifically expressed in Ogura-CMS and its maintainer line, respectively. Ogura-CMS line-specific genes included stress-related, redox-related, and B. rapa novel genes. In the maintainer line, genes related to pollen coat and germination were specifically expressed in floral buds longer than 3mm, suggesting insufficient expression of these genes in Ogura-CMS is directly related to dysfunctional pollen. In addition, many nuclear genes associated with auxin response, ATP synthesis, pollen development and stress response had delayed expression in Ogura-CMS plants compared to the maintainer line, which is consistent with the delay in growth and development of Ogura-CMS plants. Delayed expression may reduce pollen grain production and/or cause sterility, implying that mitochondrial, retrograde signaling delays nuclear gene expression.

Dong X; Kim WK; Lim YP; Kim YK; Hur Y

2013-02-01

178

Dynamic CT in the acute subdural hematoma  

International Nuclear Information System (INIS)

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

1983-01-01

179

HEMATOMA OF THE PROXIMAL NAIL FOLD. REPORT OF 41 CASES  

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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.

Chang Patricia; Rodas Diaz Cecilia

2011-01-01

180

Neonatal Infected Subgaleal Hematoma: An Unusual Complication of Early-onset E. coli Sepsis.  

UK PubMed Central (United Kingdom)

Subgaleal hematoma (SGH) is an uncommon but potentially lethal medical emergency in newborns. Delay in diagnosis may lead to mortality and morbidity. Infection of an SGH is extremely rare. We report an infected SGH with abscess formation as a complication of early-onset Escherichia coli sepsis in a term neonate. The patient was discovered to have SGH soon after birth. Early-onset E. coli sepsis developed on Day 3 of life. The SGH became infected, with abscess formation 1 week later. The infected SGH was probably due to direct hematogenous spreading of sepsis. The patient was successfully treated without complications. Clinicians should be aware that SGH is a potential site of infection and infection may be caused either by direct hematogenous extension or from traumatic scalp lesions. Appropriate antibiotic treatment and surgical debridement are necessary when an infected SGH occurs.

Chang HY; Cheng KS; Liu YP; Hung HF; Fu HW

2013-04-01

 
 
 
 
181

Prevention of Hematomas and Seromas  

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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 considerabl...

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

182

Postoperative course of chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1983-01-01

183

Postoperative course of chronic subdural hematoma  

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

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

1983-10-01

184

Delayed rupture of traumatic intracranial pseudoaneurysm in a child following gunshot wound to the head.  

UK PubMed Central (United Kingdom)

BACKGROUND AND OBJECTIVES: Traumatic intracranial aneurysms (TICAs) are highly unstable lesions that may rupture within minutes after formation or remain quiescent for several weeks and manifest with delayed hemorrhage and neurologic deterioration. Mortality following a rupture may be 30% to 40%. Among all cerebral aneurysms, the incidence of TICAs is less than 1%; 20% to 30% of TICAs occur in children. METHODS AND MATERIALS: A child with a low-caliber craniocerebral gunshot wound deteriorated neurologically 12 days after the initial injury and emergency evacuation of an intracranial hematoma. A new massive left frontal hematoma was discovered, caused by the rupture of an unsuspected left pericallosal artery pseudoaneurysm. The new hematoma was evacuated, and the aneurysm was trapped using microsurgical techniques. RESULTS AND/OR CONCLUSIONS: A high index of suspicion should be maintained for delayed pseudoaneurysm genesis and rupture. A cerebral arteriogram should be obtained when significant subarachnoid hemorrhage or intraparenchymal hematomas are present, when missiles traverse major arteries, or when the pterional or cranioorbitofacial regions are violated. Treatment should be prompt.

Alvarez JA; Bambakidis N; Takaoka Y

1999-01-01

185

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

Directory of Open Access Journals (Sweden)

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

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

1997-01-01

186

Complete nonsurgical resolution of a spontaneous spinal epidural hematoma.  

UK PubMed Central (United Kingdom)

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

Silber SH

1996-07-01

187

Spontaneous Subperiosteal Hematoma Precipitated by Anxiety Attack.  

UK PubMed Central (United Kingdom)

Abstract A 60-year-old woman presented with diplopia and left periorbital edema and pressure, which developed during an anxiety attack the previous day. Examination revealed left inferotemporal globe dystopia, periorbital edema, ecchymosis, and limitation in supraduction. Orbital MRI confirmed the diagnosis of a superior subperiosteal orbital hematoma. The patient's signs and symptoms rapidly resolved with administration of oral corticosteroids. The patient remains asymptomatic with complete resolution of orbital signs at 3-month follow-up. Subperiosteal orbital hematoma (SOH) is a rare condition in which blood accumulates between the bony orbit and separated periosteum, and is often due to blunt head trauma. Non-traumatic SOH (NTSOH) is exceedingly rare and usually associated with known coagulopathies or tendency to bleed. However, few cases of spontaneous NTSOH have been reported without any such predisposition and are thought to be caused by sudden elevations in intrathoracic and intracranial venous pressure such as vomiting, coughing, SCUBA diving, weight lifting and labor. We herein describe the presentation, radiography and outcome of a unique case of spontaneous NTSOH following an anxiety attack.

Swanenberg IM; Rizzuti AE; Shinder R

2013-09-01

188

[Aortic intramural hematoma: aspects with spiral computerized tomography  

UK PubMed Central (United Kingdom)

PURPOSE: To evaluate the signs of aortic intramural hematoma with helical CT and the diagnostic role of this technique in patients with this condition. MATERIAL AND METHODS: We reviewed the CT findings of 396 patients submitted to emergency examinations for suspected aortic dissection from 1995 to 1999. Only 18 patients (6 women and 12 men) had CT signs of aortic intramural hematoma. Helical CT studies were carried out with the following parameters: slice thickness 10 mm, reconstruction index 10, feed 1.5 mm, conventional algorithm with minimum values of 130 kV and 125 mA. All patients were examined with dynamic contrast-enhanced CT, before and after a power injection of 130 mL ionic contrast material. We studied: hematoma localization and longitudinal extension; thickness and density of aortic wall; presence and location of intimal calcifications; integrity of intimal wall; hemomediastinum and/or hemothorax. RESULTS: Aortic wall thickening appeared as a high density crescent-shaped area at baseline CT and had low density on enhanced images in all patients. Thickening was eccentric in 14/18 patients and concentric in 4/18 only; it always exceeded 4 mm. We found some intimal calcifications in 8 patients and hemothorax and/or hemomediastinum in 9 patients. A patient with type A hematoma died of cardiac tamponade a few hours after CT diagnosis. Six patients (5 type B and 1 type A) underwent anti-hypertensive treatment and radiological follow-up. Eleven patients (6 type A and 5 type B) underwent prosthesis replacement and 5 of them (3 type A and 2 type B) died of postoperative complications. In the 5 type B patients surgery was performed because of treatment-resistant pain and of the onset of ischemic complications to abdominal organs caused by involvement of the main collateral branches of the aorta. One patient with type A hematoma was submitted to drug treatment because it was judged unresectable. DISCUSSION AND CONCLUSIONS: Intramural hematoma of the aorta is a distinct pathological entity, which should not be confused with aortic dissection. The imaging techniques (TEE, CT, MRI) have an important role in the final diagnosis of aortic hematoma. Presently Helical CT and MR angiography are the main tools in the early diagnosis of this condition before the development of complications. In our experience helical CT, before and after the administration of contrast material, was accurate in identifying the hematoma localization and extension.

Midiri M; Strada A; Stabile Ianora AA; Scialpi M; D'Agostino D; De Luca Tupputi Schinosa L; Angelelli G; Rotondo A

2000-09-01

189

Stream of dark matter as a possible cause of the opera clocks' synchronization signals delay  

CERN Document Server

A stream of weakly interacting massive particles (WIMPs) gravitationally scattered outwards within the Earth yields a delay, \\delta t \\simeq 60 ns, in good agreement with the results of the OPERA experiment. Conversely, the OPERA experiment may be seen as the unveiling of the first hint of a dark matter particle probed with the photons of the GPS communication signals and using the neutrino beam of the CNGS as a velocity standard. Our analysis yields the true neutrino velocity, V_{\

Mbelek, Jean Paul

2012-01-01

190

Contralateral acute subdural hematoma following traumatic acute subdural hematoma evacuation.  

UK PubMed Central (United Kingdom)

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

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

2013-01-01

191

Spontaneous Spinal Subdural Hematoma Concurrent with Cranial Subdural Hematoma  

Science.gov (United States)

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

Moon, Wonjun; Chough, Jeongki; Park, Haekwan

2013-01-01

192

Spontaneous spinal subdural hematoma concurrent with cranial subdural hematoma.  

UK PubMed Central (United Kingdom)

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

Moon W; Joo W; Chough J; Park H

2013-07-01

193

Antiplatelet antibody may cause delayed transfusion-related acute lung injury  

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Full Text Available Yoshitaro Torii1, Toshiki Shimizu1, Takashi Yokoi1, Hiroyuki Sugimoto1, Yuichi Katashiba1, Ryotaro Ozasa1, Shinya Fujita1, Yasushi Adachi2, Masahiko Maki3, Shosaku Nomura11The First Department of Internal Medicine, Kansai Medical University, Osaka, 2Department of Clinical Pathology, Toyooka Hospital, Hyogo, 3First Department of Pathology, Kansai Medical University, Osaka, JapanAbstract: A 61-year-old woman with lung cancer developed delayed transfusion-related acute lung injury (TRALI) syndrome after transfusion of plasma- and leukoreduced red blood cells (RBCs) for gastrointestinal bleeding due to intestinal metastasis. Acute lung injury (ALI) recurred 31 days after the first ALI episode. Both ALI episodes occurred 48 hours after transfusion. Laboratory examinations revealed the presence of various antileukocyte antibodies including antiplatelet antibody in the recipient's serum but not in the donors' serum. The authors speculate that antiplatelet antibodies can have an inhibitory effect in the recipient, which can modulate the bona fide procedure of ALI and lead to a delay in the onset of ALI. This case illustrates the crucial role of a recipient's platelets in the development of TRALI.Keywords: delayed TRALI syndrome, recurrence, anti-platelet antibody

Torii Y; Shimizu T; Yokoi T; Sugimoto H; Katashiba Y; Ozasa R; Fujita S; Adachi Y; Maki M; Nomura S

2011-01-01

194

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

UK PubMed Central (United Kingdom)

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

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

2013-07-01

195

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report  

Energy Technology Data Exchange (ETDEWEB)

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.

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

196

Renal Artery Embolization of Perirenal Hematoma in Hemorrhagic Fever with Renal Syndrome: A Case Report  

International Nuclear Information System (INIS)

[en] 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

2007-01-01

197

Magnetic resonance imaging in chronic subdural hematomas of early stages  

International Nuclear Information System (INIS)

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

1990-01-01

198

Magnetic resonance imaging in chronic subdural hematomas of early stages  

Energy Technology Data Exchange (ETDEWEB)

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

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

1990-10-01

199

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed  

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

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

2009-01-01

200

Cocaine Withdrawal Causes Delayed Dysregulation of Stress Genes in the Hippocampus  

Science.gov (United States)

Relapse, even following an extended period of withdrawal, is a major challenge in substance abuse management. Delayed neurobiological effects of the drug during prolonged withdrawal likely contribute to sustained vulnerability to relapse. Stress is a major trigger of relapse, and the hippocampus regulates the magnitude and duration of stress responses. Recent work has implicated hippocampal plasticity in various aspects of substance abuse. We asked whether changes in stress regulatory mechanisms in the hippocampus may participate in the neuroadaptations that occur during prolonged withdrawal. We therefore examined changes in the rat stress system during the course of withdrawal from extended daily access (5-hours) of cocaine self-administration, an animal model of addiction. Tissue was collected at 1, 14 and 28 days of withdrawal. Plasma corticosterone levels were determined and corticosteroid receptors (GR, MR, MR/GR mRNA ratios) and expression of other stress-related molecules (HSP90AA1 and HSP90AB1 mRNA) were measured in hippocampal subfields using in situ hybridization. Results showed a delayed emergence of dysregulation of stress genes in the posterior hippocampus following 28 days of cocaine withdrawal. This included increased GR mRNA in DG and CA3, increased MR and HSP90AA1 mRNA in DG, and decreased MR/GR mRNA ratio in DG and CA1. Corticosterone levels progressively decreased during the course of withdrawal, were normalized following 28 days of withdrawal, and were correlated negatively with GR and positively with MR/GR mRNA ratio in DG. These results suggest a role for the posterior hippocampus in the neuroadaptations that occur during prolonged withdrawal, and point to a signaling partner of GR, HSP90AA1, as a novel dysregulated target during cocaine withdrawal. These delayed neurobiological effects of extended cocaine exposure likely contribute to sustained vulnerability to relapse.

Garcia-Fuster, M. Julia; Flagel, Shelly B.; Mahmood, S. Taha; Watson, Stanley J.; Akil, Huda

2012-01-01

 
 
 
 
201

Interventricular septum hematoma during cineventriculography  

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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.

Grohmann Andrea; Elgeti Thomas; Eddicks Stephan; Knebel Fabian; Rutsch Wolfgang; Melzer Christoph; Baumann Gert; Borges Adrian C

2008-01-01

202

Computerized tomography in chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1979-01-01

203

Delay in diagnosis of adrenal insufficiency is a frequent cause of adrenal crisis.  

UK PubMed Central (United Kingdom)

Delay of diagnosis of primary adrenal insufficiency (PAI) leads to adrenal crisis which is potentially lethal complication. The objective of our work was an assessment whether the establishment of diagnosis of adrenocortical insufficiency in Poland is so much delayed as assessed in the past. We have analysed data from 60 patients with diagnosis of PAI established in our department during the past 12 years and who are still under our care. We found that the time to diagnosis of primary adrenal insufficiency in Poland exceeds 3 months in every patient and 6 months in patients admitted with symptoms of adrenal crisis. Forty-four percent of patients were diagnosed only just after the hospitalisation due to crisis, despite the evident signs and symptoms of PAI. Lack of appetite and loss of body weight occurred in all patients and for that reason a diagnosis of chronic gastric and duodenal ulcer disease was the most often incorrect diagnosis. After the proper diagnosis and treatment, in the course of 1-11 years of observation, there was only 6 imminent adrenal crises in 5 patients. Our results indicated that training of primary care physicians in the field of recognising and treatment of adrenal insufficiency is still essential.

Papierska L; Rabijewski M

2013-01-01

204

Chronic intradiploic hematoma in patients with coagulopathy.  

UK PubMed Central (United Kingdom)

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

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

2010-08-01

205

Chronic intradiploic hematoma in patients with coagulopathy.  

Science.gov (United States)

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

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

2010-05-26

206

Endoscopic drainage for duodenal hematoma following endoscopic retrograde cholangiopancreatography: a case report.  

UK PubMed Central (United Kingdom)

Intramural duodenal hematoma (IDH) is a rare complication following endoscopic retrograde cholangiopancreatography (ERCP). Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH. Surgical treatment of isolated duodenal hematoma after blunt trauma is traditionally reserved for rare cases of perforation or persistent symptoms despite conservative management. Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy. Duodenal hematoma is mainly treated by drainage, which includes open surgery drainage and percutaneous transhepatic cholangial drainage, both causing great trauma. Here we present a case of massive IDH following ERCP, which was successfully managed by minimally invasive management: intranasal hematoma aspiration combined with needle knife opening under a duodenoscope.

Pan YM; Wang TT; Wu J; Hu B

2013-04-01

207

Endoscopic drainage for duodenal hematoma following endoscopic retrograde cholangiopancreatography: A case report  

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Full Text Available Intramural duodenal hematoma (IDH) is a rare complication following endoscopic retrograde cholangiopancreatography (ERCP). Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH. Surgical treatment of isolated duodenal hematoma after blunt trauma is traditionally reserved for rare cases of perforation or persistent symptoms despite conservative management. Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy. Duodenal hematoma is mainly treated by drainage, which includes open surgery drainage and percutaneous transhepatic cholangial drainage, both causing great trauma. Here we present a case of massive IDH following ERCP, which was successfully managed by minimally invasive management: intranasal hematoma aspiration combined with needle knife opening under a duodenoscope.

Ya-Min Pan; Tian-Tian Wang; Jun Wu; Bing Hu

2013-01-01

208

Endoscopic drainage for duodenal hematoma following endoscopic retrograde cholangiopancreatography: a case report.  

Science.gov (United States)

Intramural duodenal hematoma (IDH) is a rare complication following endoscopic retrograde cholangiopancreatography (ERCP). Blunt damage caused by the endoscope or an accessory has been suggested as the main reason for IDH. Surgical treatment of isolated duodenal hematoma after blunt trauma is traditionally reserved for rare cases of perforation or persistent symptoms despite conservative management. Typical clinical symptoms of IDH include abdominal pain and vomiting. Diagnosis of IDH can be confirmed by imaging techniques, such as magnetic resonance imaging or computed tomography and upper gastrointestinal endoscopy. Duodenal hematoma is mainly treated by drainage, which includes open surgery drainage and percutaneous transhepatic cholangial drainage, both causing great trauma. Here we present a case of massive IDH following ERCP, which was successfully managed by minimally invasive management: intranasal hematoma aspiration combined with needle knife opening under a duodenoscope. PMID:23599635

Pan, Ya-Min; Wang, Tian-Tian; Wu, Jun; Hu, Bing

2013-04-01

209

Intra-uterine hematoma in pregnancy.  

DEFF Research Database (Denmark)

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 detection was found. A subplacentar localization of the hematoma was associated with a higher, but not statistically significant, incidence of spontaneous abortion than a subchorionic localization. Spontaneous abortion most often occurred in the first weeks after the formation of the hematoma. Udgivelsesdato: 1991-Jun-5

Glavind, K; NØhr, S

1991-01-01

210

The retro placental hematoma and fetal death in utero: About 49 cases and review of the literature  

Directory of Open Access Journals (Sweden)

Full Text Available The Retro Placental Hematoma (RPH) or placental abruption untimely normally inserted paroxysmal is an accident that threatens maternal and fetal prognosis. It is a major emergency obstetric pathology and remains the second leading cause of maternal mortality after postpartum haemorrhage. It is actually very difficult to have an accurate evaluation the frequency of the HRP because it requires a complete table including Pathologists; or simple macroscopic or microscopic findings; or purely clinical diagnosis for some. Its occurrence requires appropriate resuscitation and adapted care to improve the prognosis. We report our study of 49 cases the HRP hospitalized in Obstetrics and Gynecology of Instruction Military Hospital Mohamed V in Rabat, diagnosed on a suggestive clinical picture and the presence of hematoma after examining the issue. This is a descriptive and comparative retrospective study over a period of one year. This study compared two groups: with HRP feotale death in utero and HRP without fetal death in utero. This study aims to evaluate neonatal mortality and maternal morbidity related to RPH and therapeutic modalities. This pathology formerly known pathology multiparous tends to reach more and more heifer. The important blood loss and delay the expulsion worse prognosis causing severe maternal morbidity hence the need to expand the indications for cesarean of retro placental hematoma regardless of the fetal state. Our study aims to contribute to reduce mortality and morbidity Fetomaternal by improving our work is stepping up efforts for a rapid decision-making, and we must educate what especially pregnant women of the risk factors to see from the beginning of symptoms. The pregnancy monitoring, early diagnosis of RPH, an obstetrical treatment adequate, and a resuscitation well driving can improve the prognosis of this disease.

Saida Mezane; M. Achnani; M. Ziyadi; A. Babahabib; R. Hafidi; D. Moussaoui; M. Dehayni

2013-01-01

211

Pulmonary embolism caused by delayed heparin-induced thrombocytopenia in a patient who received prophylactic LMWH.  

UK PubMed Central (United Kingdom)

BACKGROUND: Heparin induced thrombocytopenia (HIT) is a serious complication associated with heparin use. HIT usually develops between 5-14 days after starting heparin. Delayed-onset HIT can still occur 9-45 days after heparin had been discontinued. In patients with delayed HIT, the patient might be admitted to the hospital for new thrombosis and reexposure to heparin further worsens the patient's condition. CASE REPORT: Our patient is a 71-year old female readmitted for worsening dyspnea 2 weeks after she was discharged from the hospital. On her previous hospitalization, she was diagnosed with bronchiolitis obliterans organizing pneumonia (BOOP). She had received prophylactic doses of LMWH. Dyspnea was initially thought to be secondary to CHF exacerbation secondary to atrial fibrillation with rapid ventricular response. She was started on a heparin. However, the patient's clinical condition deteriorated and she needed to be intubated. Her platelet counts also decreased rapidly. After CT angiography of the chest showed pulmonary embolism, HIT was strongly considered. All forms of heparin were discontinued and argatroban was started. However, the patient did not improve and she subsequently expired on the 7(th) hospital day. Heparin-induced antibodies came back positive that same day. CONCLUSIONS: HIT is an immune-mediated disorder characterized by formation of antibodies against heparin-platelet factor 4 complex. The major clinical presentation of HIT is arterial and venous thrombosis. Once HIT is suspected, immediate cessation of any form of heparin is needed. Alternative anticoagulation must be started. Early treatment decreases the incidence of new thrombosis and stroke, and improves survival and cost savings.

Kumar M; Abrina VM; Chittimireddy S

2012-01-01

212

Spontaneous hematoma of the atrial wall.  

UK PubMed Central (United Kingdom)

The clinical signs of heart masses tend to be nonspecific, generally depending more on their repercussions on heart function caused by their location rather than on their type. Imaging techniques make it possible to limit the differential diagnosis of heart masses based on their location, morphology, and characteristics of echogenicity, density, or intensity, depending on the technique used to study them. We present the case of a woman with squeezing mid chest pain irradiating to her shoulder and positive cardiac markers in whom a left atrial mass was identified at echocardiography. This finding was confirmed at chest CT. The signs at chest CT were compatible with a mural hematoma and this diagnosis was confirmed after intraoperative biopsy.

Iglesias López A; Rodríguez Pan A; Pazos Silva V

2012-01-01

213

[Delayed implantation and early developmental defects in the mouse caused by PCB: 2,2'-dichlorobiphenyl (author's transl)  

UK PubMed Central (United Kingdom)

Pregnant mice administered per os during the days 1--3 (plug day = day 0) post conception (p.c.) with 375 mg 2,2'-dichlorobiphenyl/kilograms/day revealed on day 18 p.c. increased number of resorptions and doses up from 500 milligrams/kilograms/day led to a substantial retardation of the prenatal development. Based on the investigations during the early development it is concluded, that retardation of the fetus is caused by a delayed implantation. It is assumed, that increased resorption is due to kyematopathies detected during the periimplantation period.

Török P

1978-08-01

214

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

Science.gov (United States)

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

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

1991-04-01

215

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

UK PubMed Central (United Kingdom)

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

Oppenheim JS; Gennuso R; Sacher M; Hollis P

1991-04-01

216

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

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

JiEun Park; SooMi Lim; Jeong Hyun Yoo

2011-01-01

217

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

UK PubMed Central (United Kingdom)

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

Izumihara A; Yamashita K; Murakami T

2013-01-01

218

[Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid].  

UK PubMed Central (United Kingdom)

Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid Atraumatic spontaneous mediastinal hematomas are uncommon. They are secondary to trauma, rupture of great vessels or heart and associated to iatrogenic events. We report a case of a 61 year-old woman who consults for mediastinal hematoma without previous trauma. Imaging studies ruled out cardiac or vascular lesions. At exploratory thoracotomy, a large mediastinal hematoma was evidenced without obvious mass or bleeding vessel. The material sent to the Pathology service was diagnosed as cystic adenoma of ectopic parathyroid gland. Mediastinal hematomas are related to traumatic causes, cardiac or great vessels rupture or iatrogenic proceedings. Once these causes are ruled out, an injury of ectopic parathyroid tissue must be considered in the differential diagnosis because mediastinum is the most frequent ectopic location. Histopathological and immunohistochemical studies are useful in determining the cause-related hematoma, as in this case determined the parathyroid origin of the lesion, and to rule out involvement by other tumors.

Bürgueser MV; Diller A; Bustos ME; Debernardi DM; Bernabeu F

2011-01-01

219

[Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid].  

Science.gov (United States)

Spontaneous mediastinal hematoma as initial presentation of cystic adenoma of ectopic parathyroid Atraumatic spontaneous mediastinal hematomas are uncommon. They are secondary to trauma, rupture of great vessels or heart and associated to iatrogenic events. We report a case of a 61 year-old woman who consults for mediastinal hematoma without previous trauma. Imaging studies ruled out cardiac or vascular lesions. At exploratory thoracotomy, a large mediastinal hematoma was evidenced without obvious mass or bleeding vessel. The material sent to the Pathology service was diagnosed as cystic adenoma of ectopic parathyroid gland. Mediastinal hematomas are related to traumatic causes, cardiac or great vessels rupture or iatrogenic proceedings. Once these causes are ruled out, an injury of ectopic parathyroid tissue must be considered in the differential diagnosis because mediastinum is the most frequent ectopic location. Histopathological and immunohistochemical studies are useful in determining the cause-related hematoma, as in this case determined the parathyroid origin of the lesion, and to rule out involvement by other tumors. PMID:22668569

Bürgueser, María Virginia; Diller, Ana; Bustos, Mario Eduardo; Debernardi, Diego Martín; Bernabeu, Francisco

2011-01-01

220

Computed tomography of isodense subdural hematomas  

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

1981-10-00

 
 
 
 
221

Computed tomography of isodense subdural hematomas  

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

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

1983-03-15

222

Duplication of the Wolf-Hirschhorn syndrome critical region causes neurodevelopmental delay.  

UK PubMed Central (United Kingdom)

Wolf-Hirschhorn Syndrome (WHS) is caused by deletions on chromosome 4p and is clinically well defined. Genotype-phenotype correlations of patients with WHS point to a critical locus to be responsible for the main characteristics of this disorder. Submicroscopic duplications of this region, however, are not known. Here we report a patient with an interstitial 560 kb duplication overlapping this critical locus. The present case shows that not only deletions but also duplications of the Wolf-Hirshhorn critical region cause mental retardation and multiple congenital anomalies. Interestingly, the duplication phenotype overlaps partially with the deletion phenotype. However, his facial phenotype differs from the typical WHS gestalt.

Hannes F; Drozniewska M; Vermeesch JR; Haus O

2010-05-01

223

Autologous blood-clot embolisation of cavernosal artery pseudoaneurysm causing delayed high-flow priapism.  

UK PubMed Central (United Kingdom)

BACKGROUND: High-flow priapism is a rare condition characterized by a prolonged and painless erection. Since it may permanently impair erectile function, it must be managed and treated as soon as possible, in order to restore potency. The case we are presenting here was successfully treated by embolizing the penile artery using an autologous clot. CASE REPORT: A case of delayed painless high-flow priapism that occured after blunt straddle-type perineal trauma, that was persistent for more than 30 days is being presented. Doppler ultrasonographic examination of the cavernosal artery revealed a 1.5 cm-diameter pseudoaneurysm at the right cavernosal artery, together with a high-velocity shunt between the two cavernous arteries. Extravasation from the proximal sites of both of the cavernous arteries and a right cavernosal artery pseudoaneurysm was detected on angiography. The patient was successfully treated by embolization of the penile artery with an autologous clot in two sessions with a 3-day interval. CONCLUSIONS: This experience along with a survey of the literature made us conclude that embolization of cavernous artery by means of an autologous clot is a very effective procedure and a method of choice for treatment of high-flow priapism and for restoration of penile erectile function. What makes our case even more interesting and important, is the fact that priapism of one month's duration could well be treated by means of this method.

Yesilkaya Y; Peynircioglu B; Gulek B; Topcuoglu M; Inci K

2013-04-01

224

Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy  

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

Scheppach, W.; Kulke, H.; Liebau, G.; Braun, H.

1983-06-01

225

Computed tomographic diagnosis of traumatic fetal subdural hematoma.  

UK PubMed Central (United Kingdom)

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

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

2013-04-01

226

Multiple cerebral hematoma and viral encephalitis  

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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.

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

1980-08-01

227

MRI findings of traumatic spinal subdural hematoma  

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

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

2000-04-01

228

MRI findings of traumatic spinal subdural hematoma  

International Nuclear Information System (INIS)

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

2000-01-01

229

Hematoma of the brainstem in childhood  

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Hematomas of the brainstem are revealed by signs of brainstem dysfunction. Sudden onset is characteristic but only demonstration of subarachnoid hemorrhage and typical CT-Scan appearance are diagnostic. Surgical evacuation of the hematoma may help in the acute stage but does not avoid recurrence; prognosis is guarded.

Texier, P.; Bruguier, A.; Ponsot, G.; Diebler, C.

1984-11-01

230

Unusual plain film appearance of extrapleural hematoma  

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Two cases of extrapleural hematoma, proven during autopsy, are presented. Plain chest films did not demonstrate the typical signs of an extrapleural mass lesion. The roentgenologic differential diagnosis of a free or partially encapsulated pleural effusion, as well as the pathogenesis of extrapleural hematoma is discussed.

Ranner, G.; Kullnig, P.; Dirnhofer, R.; Sigrist, T.

1986-10-01

231

A practical prediction model for early hematoma expansion in spontaneous deep ganglionic intracerebral hemorrhage.  

UK PubMed Central (United Kingdom)

OBJECTIVE: Early hematoma expansion is a known cause of morbidity and mortality in patients with intracerebral hemorrhage (ICH). The goal of this study was to identify clinical predictors of ICH growth in the acute stage. MATERIALS AND METHODS: We studied 201 patients with acute (<6 h) deep ganglionic ICH. Patients underwent CT scan at baseline and hematoma expansion (>33% or >12.5 ml increase) was determined on the second scan performed within 24 h. Fourteen clinical and neuroimaging variables (age, gender, GCS at admission, hypertension, diabetes mellitus, kidney disease, stroke, hemorrhagic, antiplatelet use, anticoagulant use, hematoma density heterogeneity, hematoma shape irregularity, hematoma volume and presence of IVH) were registered. Additionally, blood pressure was registered at initial systolic BP (i-SBP) and systolic BP 1.5 h after admission (1.5 h-SBP). The discriminant value of the hematoma volume and 1.5 h-SBP for hematoma expansion were determined by the receiver operating characteristic (ROC) curves. Factors associated with hematoma expansion were analyzed with multiple logistic regression. RESULTS: Early hematoma expansion occurred in 15 patients (7.0%). The cut-off value of hematoma volume and 1.5 h-SBP were determined to be 16 ml and 160 mmHg, respectively. Hematoma volume above 16 ml (HV>16) ([OR]=5.05, 95% CI 1.32-21.36, p=0.018), hematoma heterogeneity (HH) ([OR]=7.81, 95% CI 1.91-40.23, p=0.004) and 1.5 h-SBP above 160 mmHg (1.5 h-SBP>160) ([OR]=8.77, 95% CI 2.33-44.56, p=0.001) independently predicted ICH expansion. If those three factors were present, the probability was estimated to be 59%. CONCLUSIONS: The presented model (HV>16, HH, 1.5 h-SBP>160) can be a practical tool for prediction of ICH growth in the acute stage. Further prospective studies are warranted to validate the ability of this model to predict clinical outcome.

Takeda R; Ogura T; Ooigawa H; Fushihara G; Yoshikawa S; Okada D; Araki R; Kurita H

2013-07-01

232

Massive sublingual hematoma secondary to anticoagulant therapy complicated by a traumatic denture: a case report  

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Full Text Available Abstract Introduction Sublingual hematoma secondary to excessive anticoagulation is a rare but potentially fatal condition, and few cases have been documented in the literature. Case presentation We report the case of a 73-year-old Caucasian woman who attended our Accident and Emergency department with massive sublingual hematoma causing superior displacement of the tongue. The condition was found to be the result of an elevated international normalized ratio, further complicated by a traumatic mandibular denture. Conclusions In summary, we recommend the immediate reversal of anticoagulation therapy on admission of patients with severe sublingual hematoma. We further advise surgical decompression/drainage if required and to continue meticulous monitoring. In all cases of early recognition of sublingual hematoma, prompt medical treatment and continuous clinical monitoring is essential, and may prevent the need for a surgical airway procedure.

Puri Anchal; Nusrath Muzzammil A; Harinathan Deepak; Lyall Jamie

2012-01-01

233

High altitude induced bilateral non-traumatic subdural hematoma.  

UK PubMed Central (United Kingdom)

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

Ganau L; Prisco L; Ganau M

2012-09-01

234

The impact of etiological factors on mortality in retroperitoneal hematomas.  

UK PubMed Central (United Kingdom)

AIM: Retroperitoneal hematomas (RPH) mostly occur after blunt and penetrating traumas. However, these hematomas may develop spontaneously in the elderly and the patients who use anticoagulants. Between January 2006 and December 2011, 31 patients with RPH were evaluated retropectively. The patients were allocated into three groups according to the underlying etiological factor: Group I; spontaneous RPH, group II; RPH caused by penetrating trauma, group III; RPH caused by blunt trauma. RESULTS: There were 22 (71%) male and 9 (29%) female patients with a mean age of 35.7±18.7 (range: 15-88 years). Spontaneous RPH was diagnosed in eight patients (25.8%) while RPH caused by penetrating trauma in 13 patients (41.9%) and RPH induced by blunt trauma in 10 (32.3%) patients. Retroperitoneal hematomas were located at zone I in 2 patients (6.5%) whereas zone II in 19 patients (61.3%) and zone III in 9 patients (29%). On the other hand, RPH was regarded to be at zone II-III in 1 patient (3.2%). Additional organ injury was defined in 18 patients (58.1%). Twenty patients (65%) were treated surgically. The morbidity rates were 12.5%, 7.7% and 20% and the mortality rates were denoted as 12.5%, 15.4% and 50%, for group I, group II and group III, respectively. DISCUSSION: Additional organ injury, massive blood transfusion, the route of injury and the need for surgery are defined as the most significant factors associated with increased mortality. KEY WORDS: Blunt trauma, Penetrating trauma, Retroperitoneal hematoma.

Aliosmanoglu I; Gul M; Kapan M; Arikanoglu Z; Taskesen F; Onder A; Aldemir M

2013-01-01

235

Multimodal endoscopic treatment for delayed severe esophageal stricture caused by incomplete stent removal.  

UK PubMed Central (United Kingdom)

The usefulness of a covered self-expandable metallic stent for benign esophageal stricture and perforation was well established. In case of benign disease, early stent removal was recommended within 6-8 weeks after placement. A case with severe esophageal stricture caused by incomplete stent removal 7 years after stent placement for spontaneous esophageal rupture was reported. Residual stent fragments could be removed by step-by-step multimodal endoscopic treatment, producing satisfactory luminal diameter of the esophagus. In particular, stent trimming with argon plasma coagulation was safe and effective strategy. The endoscopic stent removal is minimally invasive and should be attempted before surgical intervention; however, it is most important to ensure early stent removal before tissue ingrowth or overgrowth can develop.

Setoyma T; Miyamoto S; Horimatsu T; Morita S; Ezoe Y; Muto M; Watanabe G; Tanaka E; Chiba T

2013-02-01

236

Traumatic mediastinal hematoma: a potentially fatal condition that may be overlooked by traditional Focused Assessment with Sonography for Trauma.  

UK PubMed Central (United Kingdom)

Mediastinal hematoma is an uncommon finding in blunt chest trauma. It may be caused by aortic injury, by mediastinal vascular injury such as aortic injury, and by fractures of the sternum and vertebral column. A huge mediastinal hematoma can result in extrapericardial cardiac tamponade by compressing the adjacent organs. Although Focused Assessment with Sonography for Trauma (FAST) can reliably assess the presence of pericardial effusion in the subxiphoid view, it may overlook mediastinal hematoma. We present a 67-year-old male victim of blunt chest trauma complicated with expanding anterior mediastinal hematoma that was undetectable with standard FAST protocol. The large mediastinal hematoma can only be seen in the parasternal long-axis view. When ultrasound is used to assess for anteriorly located mediastinal hematoma, the transducer should be positioned in the parasternal or precordial area to scan into the pericardium and mediastinum. However, these 2 views (parasternal and precordial) are not included in emergency department's traditional FAST examination. The subxiphoid view of FAST can easily miss a mediastinal hematoma. For trauma patients with probable mediastinal injuries, we suggest doing an extended FAST with parasternal long-axis view. Alternatively, one should consider lowering the threshold of thoracic computed tomographic scan in patients with persistent symptoms because a missed mediastinal hematoma could be insidious and fatal.

Hsu LW; Chong CF; Wang TL; Wu BH

2013-01-01

237

A case of delayed emergence from anesthesia caused by postoperative brain edema associated with unexpected cerebral venous sinus thrombosis.  

UK PubMed Central (United Kingdom)

Cerebral venous sinus thrombosis (CVST) is rare but displays various and often dramatic clinical symptoms. Few cases of CVST have been reported in the field of anesthesiology. We encountered an unexpected case of CVST that presented with delayed emergence from anesthesia after resection of a brain tumor. A 55-year-old man was scheduled for resection of an oligoastrocytoma in his right frontal lobe. After smooth induction of general anesthesia, anesthesia was maintained uneventfully for about 7 h with target-controlled infusion (TCI) of propofol and remifentanil, except for a seizure generated when the right anterior central gyrus was stimulated to allow motor evoked potential monitoring. Immediately after the cessation of TCI, spontaneous respiration was restored. However, the patient was unexpectedly comatose, and no response to painful stimuli or coughing during tracheal suctioning was observed. A computed tomogram taken 2 h after surgery showed diffuse brain edema, even though the neurosurgeons did not notice any cerebral swelling during closing of the dura mater. A magnetic resonance venogram revealed thromboses in the superior sagittal and straight sinuses. On the 9th postoperative day, the patient died without recovering consciousness or his brainstem reflexes. Anesthesiologists should be aware of CVST as a cause of delayed emergence from anesthesia after craniotomy.

Kozasa Y; Takaseya H; Koga Y; Hiraki T; Mishima Y; Niiyama S; Ushijima K

2013-03-01

238

A case of delayed emergence from anesthesia caused by postoperative brain edema associated with unexpected cerebral venous sinus thrombosis.  

Science.gov (United States)

Cerebral venous sinus thrombosis (CVST) is rare but displays various and often dramatic clinical symptoms. Few cases of CVST have been reported in the field of anesthesiology. We encountered an unexpected case of CVST that presented with delayed emergence from anesthesia after resection of a brain tumor. A 55-year-old man was scheduled for resection of an oligoastrocytoma in his right frontal lobe. After smooth induction of general anesthesia, anesthesia was maintained uneventfully for about 7 h with target-controlled infusion (TCI) of propofol and remifentanil, except for a seizure generated when the right anterior central gyrus was stimulated to allow motor evoked potential monitoring. Immediately after the cessation of TCI, spontaneous respiration was restored. However, the patient was unexpectedly comatose, and no response to painful stimuli or coughing during tracheal suctioning was observed. A computed tomogram taken 2 h after surgery showed diffuse brain edema, even though the neurosurgeons did not notice any cerebral swelling during closing of the dura mater. A magnetic resonance venogram revealed thromboses in the superior sagittal and straight sinuses. On the 9th postoperative day, the patient died without recovering consciousness or his brainstem reflexes. Anesthesiologists should be aware of CVST as a cause of delayed emergence from anesthesia after craniotomy. PMID:23526037

Kozasa, Yuko; Takaseya, Hikari; Koga, Yukari; Hiraki, Teruyuki; Mishima, Yasunori; Niiyama, Shuhei; Ushijima, Kazuo

2013-03-23

239

Delayed cavernous carotid artery pseudoaneurysm caused by absorbable plate following transsphenoidal surgery: case report and review of the literature.  

UK PubMed Central (United Kingdom)

Background Bioabsorbable plates are frequently utilized in the repair of skull base defects following transsphenoidal operations. Traumatic intracranial pseudoaneurysms are a rare complication of transsphenoidal surgery. To date, iatrogenic carotid pseudoaneurysm associated with the use of an absorbable plate has been reported once. Results A 57-year-old man with a large nonfunctional pituitary macroadenoma underwent an endoscopic transsphenoidal operation with gross total resection. An absorbable plate was placed extradurally to reconstruct the sellar floor. He experienced delayed repeated epistaxis, followed by a right middle cerebral artery distribution embolic stroke. Computed tomorgraphy (CT) angiogram 6 weeks postoperatively revealed a 6 × 4 mm pseudoaneurysm located on the medial wall of the right cavernous internal carotid artery. Stent coiling was used to successfully obliterate the pseudoaneurysm, and the patient fully recovered. Conclusion Delayed erosion of the carotid artery wall caused by a plate used to reconstruct the sellar floor may manifest with epistaxis or embolic stroke. The authors' preference is to avoid insertion of a rigid plate for sellar floor reconstruction in the absence of intraoperative cerebrospinal fluid (CSF) leaks, unless it is required to buttress a large skull base defect. Short-segment embolization with stent coiling is the preferred treatment option for carotid pseudoaneurysms following transsphenoidal operations.

Tuchman A; Khalessi AA; Attenello FJ; Amar AP; Zada G

2013-06-01

240

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

Scientific Electronic Library Online (English)

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

Senel, Ahmet Can; Gunduz, Abdul Kadir

2012-10-01

 
 
 
 
241

Cortical enhancement in chronic subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

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

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

1981-12-01

242

Cortical enhancement in chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1981-01-01

243

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

International Nuclear Information System (INIS)

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

1990-01-01

244

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

International Nuclear Information System (INIS)

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

1998-01-01

245

4 cases of iliopsoas hematoma associated with hemophilia  

International Nuclear Information System (INIS)

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

1984-01-01

246

4 cases of iliopsoas hematoma associated with hemophilia  

Energy Technology Data Exchange (ETDEWEB)

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

Oishi, Yukiyoshi; Iwata, Hisashi; Inoda, Kunio (Nagoya Univ. (Japan). Faculty of Medicine)

1984-03-01

247

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

UK PubMed Central (United Kingdom)

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

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

2013-01-01

248

Treatment of patients with spontaneous intracranial hematomas  

Directory of Open Access Journals (Sweden)

Full Text Available Spontaneous intracerebral haemorrhage is a common cause of stroke especially in the young. The term "spontaneous intracerebral haemorrhage" refers to bleeding without coincident trauma. About 80% of this haemorrhage occur supratentorial in the basal nuclei and they are associated with hypertension. Etiological factors range from congenital vascular malformations (aneurysmas, AVM, cavernomas) to acquired and degenerative vascular and brain conditions. In primary intracerebral hemorrhage arterial hypertension and consequent vascular changes are the major etiological factors. In secondary- nonhypertensive hemorrhage cause may be associated with aneurysms, AVM, tumors, coagulation disorders. Contemporary diagnosis imaging (CT, MRI) and neurological evaluation, allow early diagnosis and effective medical and/or surgical therapy in a majority patients. Without treatment, the risk of mortality and morbidity is high. Medical management involves normalization of blood pressure, reduction of intracranial pressure, control of brain edema and prevention of seizures. In design for operative treatment must be include age of the patient, hematoma size and location, clinical condition, the level of consciousness and patient outcome. The role of surgery remains controversial.

Jokovi? M.B.; Radulovi? D.V.; Tasi? G.M.; ?urovi? B.M.; Jovanovi? V.T.; Nikoli? I.M.; Slavik E.E.; Raki? M.Lj.

2008-01-01

249

Recanalization of symptomatic carotid artery dissections causing occlusion with multiple stents: the use of delayed double-contrast road map.  

UK PubMed Central (United Kingdom)

BACKGROUND AND PURPOSE: Internal carotid artery dissections (ICADs) with occlusion present with a high morbidity and mortality. No specific medical treatment has proven to be effective in this setting. In selected cases of ICAD with occlusion, stent-assisted angioplasty has been shown to be effective in restoring the perfusion. Spontaneous ICAD causing occlusion successfully recanalized with multiple telescoped stents extending intracranially has only been reported exceptionally. METHODS: We report cases of symptomatic acute carotid occlusion after spontaneous dissection extending from the cervical to the petrocavernous ICA segments. Imaging studies revealed the presence of an extensive penumbra area in every case. Patients were treated by means of multiple stents deployed in a telescoped fashion with the aid of a delayed double-contrast road map. RESULTS: Post-procedural angiography demonstrated restitution of the carotid lumen with no signs of residual dissection or intracranial emboli. The patients improved rapidly, showing no residual neurological deficit after a week. At follow-up, patients are clinically asymptomatic and the vessel is patent with no radiological signs of myointimal hyperplasia. CONCLUSIONS: The successful angiographic and clinical results observed in our cases of extraintracranial stenting of a long carotid dissection causing occlusion contribute to the literature of carotid dissection treated with multiple stents.

Cohen JE; Gomori JM; Leker RR; Ben-Hur T; Grigoriadis S; Rajz G

2010-04-01

250

Spontaneous disappearance of acute subdural hematoma on CT scan  

International Nuclear Information System (INIS)

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

1986-01-01

251

Spontaneous regression of traumatic lumbar epidural hematomas.  

UK PubMed Central (United Kingdom)

BACKGROUND: The aim of this report is to present a case of spontaneous regression of traumatic lumbar epidural hematomas. CASE REPORT: A 45-year-old man presented at our clinic after falling from a height. After admission, anterior compression was detected by X-ray, so lumbar spinal CT was performed. For ligament damage, emergency MR was performed. There was acute hematoma at 1 cm diameter, which began at the L3 vertebra superior surface and spread to L4 vertebra corpus; therefore the patient was informed and surgery recommended. The patient rejected the surgery, and medical management was designed. At day 45, lumbar MRI was performed. There was no evidence of traumatic epidural hematoma. CONCLUSIONS: The purpose of this study is to report a case with post-traumatic spinal epidural hematomas with normal neurologic findings and spontaneous regression.

Albayrak S; Atc? IB; Ayden O; Durda? E

2012-01-01

252

Tongue Hematoma Induced by Warfarin Overdose  

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Full Text Available Warfarin is one of the common oral anticoagulants. Anticoagulant response is affected by the amount of dietary Vitamin K, various drugs, foods and herbal treatments. Although, hemorrhage is one of the side effects of warfarin, tongue hematoma is a rare complication. In this research, 50 years old male patient developed tongue hematoma during the prophylactic warfarin treatment due to the atrial fibrillation is presented.

Mehmet Nail Bilen; Hasan Kara

2011-01-01

253

Acute subdural hematoma in infancy and childhood.  

UK PubMed Central (United Kingdom)

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

Gutierrez FA; Raimondi AJ

1975-01-01

254

Silencing of the ACC synthase gene ACACS2 causes delayed flowering in pineapple [Ananas comosus (L.) Merr.].  

UK PubMed Central (United Kingdom)

Flowering is a crucial developmental stage in the plant life cycle. A number of different factors, from environmental to chemical, can trigger flowering. In pineapple, and other bromeliads, it has been proposed that flowering is triggered by a small burst of ethylene production in the meristem in response to environmental cues. A 1-amino-cyclopropane-1-carboxylate synthase (ACC synthase) gene has been cloned from pineapple (ACACS2), which is induced in the meristem under the same environmental conditions that induce flowering. Two transgenic pineapple lines have been produced containing co-suppression constructs designed to down-regulate the expression of the ACACS2 gene. Northern analysis revealed that the ACACS2 gene was silenced in a number of transgenic plants in both lines. Southern hybridization revealed clear differences in the methylation status of silenced versus non-silenced plants by the inability of a methylation-sensitive enzyme to digest within the ACACS2 DNA extracted from silenced plants, indicating that methylation is the cause of the observed co-suppression of the ACACS2 gene. Flowering characteristics of the transgenic plants were studied under field conditions in South East Queensland, Australia. Flowering dynamics studies revealed significant differences in flowering behaviour, with transgenic plants exhibiting silencing showing a marked delay in flowering when compared with non-silenced transgenic plants and control non-transformed plants. It is argued that the ACACS2 gene is one of the key contributors towards triggering 'natural flowering' in mature pineapples under commercial field conditions.

Trusov Y; Botella JR

2006-01-01

255

Delayed treatment and late complications of a traumatic arteriovenous fistula.  

UK PubMed Central (United Kingdom)

An 18-year-old soldier had a gunshot wound to his left thigh during the Mexican Civil War (1910-1917). He presented with persistent bright red bleeding. His wound was treated by compression. A few years after the injury, he noticed a thrill, large varicose veins, limb swelling, and skin changes. A plain film showed an 8 x 10-cm midthigh mass. After a bullfighting incident, the pseudoaneurysm ruptured. Because of increased bulk and discomfort, the patient agreed 3 years later to be treated. Angiography showed a chronically obstructed femoral artery and vein. A 3000-mL hematoma was evacuated. This case illustrates the long-term sequelae of an arteriovenous fistula. This report describes a 51-year delay of treatment for causes unrelated to diagnosis. To our knowledge, this case is the longest delay in treatment of an arteriovenous fistula and its complications reported in the literature.

Huang W; Villavicencio JL; Rich NM

2005-04-01

256

Delayed treatment and late complications of a traumatic arteriovenous fistula.  

Science.gov (United States)

An 18-year-old soldier had a gunshot wound to his left thigh during the Mexican Civil War (1910-1917). He presented with persistent bright red bleeding. His wound was treated by compression. A few years after the injury, he noticed a thrill, large varicose veins, limb swelling, and skin changes. A plain film showed an 8 x 10-cm midthigh mass. After a bullfighting incident, the pseudoaneurysm ruptured. Because of increased bulk and discomfort, the patient agreed 3 years later to be treated. Angiography showed a chronically obstructed femoral artery and vein. A 3000-mL hematoma was evacuated. This case illustrates the long-term sequelae of an arteriovenous fistula. This report describes a 51-year delay of treatment for causes unrelated to diagnosis. To our knowledge, this case is the longest delay in treatment of an arteriovenous fistula and its complications reported in the literature. PMID:15874939

Huang, William; Villavicencio, J Leonel; Rich, Norman M

2005-04-01

257

Cerebral perfusion changes in chronic subdural hematoma.  

Science.gov (United States)

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

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

2013-02-11

258

Subcapsular hematoma after ureteroscopy and laser lithotripsy.  

Science.gov (United States)

Abstract Background and Purpose: Renal hematoma after ureteroscopic lithotripsy (URSL) using holmium:yttrium-aluminum-garnet (Ho:YAG) laser is a rare complication. We aimed to review our center's experience of post-URSL subcapsular hematoma. Patients and Methods: From 2007 to 2012, 1114 URSLs using 7.5F semi-rigid ureteroscopes were performed. Patients with post-URSL symptomatic renal hematoma were reviewed. Perioperative information on patients' preoperative morbidity, renal function, stone characteristics, and degree of hydronephrosis were reviewed. Operative information, postoperative presentation of symptoms, changes in blood parameters, CT findings, and subsequent management were documented. Results: Post-URSL subcapsular hematoma was diagnosed in 4 of 1114 (0.36%) patients, who ranged in age from 43 to 63 years. Preoperative imaging showed that all four patients had obstructing proximal ureteral stones ranging in size from 0.7 to 2.1?cm, and three of them had thin renal cortices. Pressure bags were not used, and Double-J ureteral stents were inserted in all cases. All four patients had the triad of loin pain, fever, and significant hemoglobin drop necessitating transfusion. Three patients presented within 2 days of URSL, and one patient presented on day 20. One patient was treated conservatively and recovered with bed rest and antibiotics. Urgent angiography was performed on one patient in view of a significant drop in hemoglobin, but no embolization was needed. One patient underwent ultrasonography-guided drainage of the hematoma, and another had an emergency open clot evacuation because of significant compression on the kidney by the hematoma. Follow-up CT scans confirmed the resolution of the hematoma in all cases. Conclusions: Post-URSL subcapsular hematoma is a rare but potentially serious complication. A high index of suspicion is needed when patients present with significant loin pain and fever after URSL for obstructing proximal ureteral stones with thin renal cortices. The management of post-URSL subcapsular hematomas needs to be customized for each patient. PMID:23682955

Chiu, Peter Ka-Fung; Chan, Chun-Ki; Ma, Wai-Kit; To, Kim-Chung; Cheung, Fu-Keung; Yiu, Ming-Kwong

2013-08-09

259

Modification of hematoma findings in the breast region.  

UK PubMed Central (United Kingdom)

Subcutaneous bruises caused by blunt injury are common findings in medicolegal case work. If the hematoma involves the anterior thoracic wall, bruises are mostly absent in the region of the nipples and the surrounding areola. A similar phenomenon has already been described for hypostatic skin hemorrhages. A possible explanation for both phenomena is the special tissue texture in the nipple-areola complex. Based on four cases from the forensic autopsy material and two cases from clinical forensic examinations, the macromorphological findings and the histological correlates are presented.

Pircher R; Pollak S; Thierauf A; Große Perdekamp M; Schmidt U

2013-01-01

260

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

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

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

2007-01-01

 
 
 
 
261

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

Scientific Electronic Library Online (English)

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

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

2007-12-01

262

Recurrent massive subperiosteal hematoma in a patient with neurofibromatosis  

Energy Technology Data Exchange (ETDEWEB)

The authors report the case of a 13-year-old neurofibromatosis (NF-I) patient who suffered a blunt trauma in 1993. The diagnosis of subperiosteal hematoma was made. The pathogenesis of subperiosteal hematoma is discussed. (orig.)

Steenbrugge, F.; Poffyn, B.; Uyttendaele, D.; Verdonk, R. [Dept. of Orthopaedic Surgery, Ghent University Hospital (Belgium); Verstraete, K. [Dept. of Radiology, Ghent University Hospital (Belgium)

2001-03-01

263

Spontaneous chronic epidural hematoma of the lumbar spine mimicking an extradural spine tumour.  

UK PubMed Central (United Kingdom)

PURPOSE: Spontaneous chronic epidural hematomas are extremely rare and can be extremely challenging to diagnose and differentiate. The clinical findings, computed tomographic scan and magnetic resonance imaging does not always enough to complete differentiate this condition. Our purpose is to report a case of a spontaneous chronic epidural hematoma presenting as an extradural mass leading to compressive radicular symptoms with images of bony scalloping which are sparsely reported in the literature. METHODS: We describe a 61-year-old woman who was evaluated after 18-month history of pain, disestesias and mild weakness in both lower extremities with significant radicular symptoms on the right side associated to neurogenic claudication. RESULTS: CT scans revealed a nodular image of soft tissue density located in the right anterolateral epidural space at the L4-L5 level demonstrating resorption of the bony margins. MRI studies revealed a round mass in the vertebral canal displacing the dural sac and scalloping the posterior wall of the L4 vertebral body. Diagnosis was established between a degenerative cyst versus an atypical neurinoma. Surgical findings demonstrated an isolated well-formed chronic hematoma. CONCLUSION: Spontaneous chronic epidural hematomas are rare, even more when they produce scalloping of bony structures becoming a diagnostic challenge. Therefore they should be always considered as a differential diagnosis in patients with extradural chronic compressions taking into account that also chronic epidural hematomas can cause bone involvement.

Fuster S; Castañeda S; Ferrer E; Wang J; Poblete J

2013-05-01

264

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

International Nuclear Information System (INIS)

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

2002-01-01

265

Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature  

International Nuclear Information System (INIS)

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.)

2010-01-01

266

Hematoma in the cervical ligamentum flavum. Report of a case and review of the literature  

Energy Technology Data Exchange (ETDEWEB)

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.)

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

267

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

Directory of Open Access Journals (Sweden)

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.

Fukunaga Naoto; Ikeyama Shizuo; Satomi Jyunichiro; Satoh Koichi

2009-01-01

268

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

Energy Technology Data Exchange (ETDEWEB)

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

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

2002-09-01

269

Spontaneous esophageal hematoma in a patient with atrial fibrillation.  

UK PubMed Central (United Kingdom)

We report a case of a spontaneous esophageal hematoma in an anticoagulated patient with atrial fibrillation previously complicated by a cerebrovascular accident. A multidisciplinary discussion resulted in holding of anticoagulation until the esophageal hematoma resolved. The patient was managed nonoperatively and discharged, but returned with a new neurologic deficit 3 weeks later. Aspirin treatment was resumed. After complete resolution of hematoma on outpatient scans, warfarin treatment was restarted. The challenges of managing an esophageal hematoma in a patient requiring anticoagulation are discussed.

Guzman R; Ding L; Watson TJ; Hobbs SK; Litle VR

2013-03-01

270

Subdural hematoma in regularly hemodialyzed patients.  

UK PubMed Central (United Kingdom)

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

Leonard A; Shapiro FL

1975-05-01

271

Subdural hematoma in regularly hemodialyzed patients.  

Science.gov (United States)

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

Leonard, A; Shapiro, F L

1975-05-01

272

Retropharyngeal hematoma secondary to whiplash injury in childhood: a case report.  

Science.gov (United States)

Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. We describe a case of retropharyngeal hematoma after whiplash injury in a childhood. PMID:22843480

Nurata, Hakan; Yilmaz, Muhammet Bahad?r; Borcek, Alp Ozgun; Oner, Ali Yusuf; Baykaner, M Kemali

2012-01-01

273

Retropharyngeal hematoma secondary to whiplash injury in childhood: a case report.  

UK PubMed Central (United Kingdom)

Whiplash Associated Disorders (WAD) has been reported as an adult phenomenon. Whiplash injury has classically been described as a cervical soft tissue hyperextension- flexion injury after a trauma such as a rear end impact car crash, contact sport injuries, blows to the head from a falling object or a punch and shaken baby syndrome and is mostly seen in adults . It is important as it may cause severe disability due to spinal cord injury, decrease work productivity and even retropharyngeal hematoma resulting airway obstruction and mortality due to bleeding amongst deep cervical fascias. We describe a case of retropharyngeal hematoma after whiplash injury in a childhood.

Nurata H; Yilmaz MB; Borcek AO; Oner AY; Baykaner MK

2012-01-01

274

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

Directory of Open Access Journals (Sweden)

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

Suri A; Pandey P; Mehta V

2002-01-01

275

Organizing Intracerebral Hematoma Mimicking a Recurrent Brain Tumor on FDG-PET.  

UK PubMed Central (United Kingdom)

A man underwent resection of low-grade astrocytoma, followed by radiation therapy at the age of 14 years old. He had been followed up for 33 years with no finding of recurrent disease on brain images until the most recent CT and MRI scans showed a mass at the postoperative site in the left parieto-occipital lobe. F-FDG PET/CT showed increased uptake in the mass. Resection was conducted, and microscopic examination of the whole mass demonstrated an organizing hematoma. A provisional diagnosis of organizing hematoma should be considered, along with other benign and malignant causes of increased FDG uptake.

Nakajima S; Okada T; Arakawa Y; Mikami Y; Togashi K

2013-03-01

276

Organizing Intracerebral Hematoma Mimicking a Recurrent Brain Tumor on FDG-PET.  

Science.gov (United States)

A man underwent resection of low-grade astrocytoma, followed by radiation therapy at the age of 14 years old. He had been followed up for 33 years with no finding of recurrent disease on brain images until the most recent CT and MRI scans showed a mass at the postoperative site in the left parieto-occipital lobe. F-FDG PET/CT showed increased uptake in the mass. Resection was conducted, and microscopic examination of the whole mass demonstrated an organizing hematoma. A provisional diagnosis of organizing hematoma should be considered, along with other benign and malignant causes of increased FDG uptake. PMID:23486328

Nakajima, Satoshi; Okada, Tomohisa; Arakawa, Yoshiki; Mikami, Yoshiki; Togashi, Kaori

2013-11-01

277

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

International Nuclear Information System (INIS)

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-[18F]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.)

2005-01-01

278

[Etiology and diagnosis of severe retroperitoneal hematoma: therapeutic options and surgical indication].  

UK PubMed Central (United Kingdom)

Retroperitoneal hematoma is a rare entity with clinical consequences that vary according to the speed and amount of bleeding. Thus, it may be asymptomatic, in which case it is usually diagnosed incidentally through imaging tests, or severe, in which case the most common symptoms are pain and hypovolemic shock. We report three cases of severe retroperitoneal hematoma. Although the literature on the subject describes a wide variety of causes, in all three patients the etiology was tumoral, consisting of one suprarenal myelolipoma, one renal adenocarcinoma and one suprarenal metastasis from bronchogenic adenocarcinoma. Computed tomography was the imaging test employed not only to determine the nature of the process (hematoma, abscess, tumor) but also to assess compression of adjacent structures and the occurrence of active bleeding. Conservative treatment consisting of volemic replacement and correction of coagulation was initially attempted. However, all three patients required emergency surgery due to hemodynamic instability in two patients and compression of the vena cava in the other.

Suárez G; Valera Z; Gómez MA; Docobo F; Alamo JM

2005-11-01

279

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

UK PubMed Central (United Kingdom)

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

Curry M; Whitney N; Roundy N; Selden NR

2013-10-01

280

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

International Nuclear Information System (INIS)

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

2012-01-01

 
 
 
 
281

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports  

International Nuclear Information System (INIS)

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

2009-01-01

282

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports  

Energy Technology Data Exchange (ETDEWEB)

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

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

2009-02-15

283

Bilateral subdural hematomas after lumboperitoneal shunt placement.  

UK PubMed Central (United Kingdom)

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

Barash IA; Medak AJ

2013-08-01

284

Chronic expanding hematoma in the stumps of persons following transfemoral amputation: A report of two cases.  

UK PubMed Central (United Kingdom)

Background:Two persons presented with severe stump pain following transfemoral amputation.Case description and methods:A 21-year-old female and a 31-year-old male with transfemoral amputation were ambulatory with prostheses and suffered from severe stump pain caused by the presence of masses around the tip of the bone stump. From the clinical courses, imaging studies, and the intraoperative findings, the masses were diagnosed as a relatively rare condition known as chronic expanding hematoma.Findings and outcome:The two patients were treated successfully with surgical resection. The hematomas were soft cystic masses with a thick capsule containing old blood clots and serous fluid. There were no pathological signs of malignancy. After surgical treatment, the patients achieved walking without stump pain.Conclusion:Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.Clinical relevanceStump pain is caused by many conditions. Although chronic expanding hematoma is a rare condition, it should be considered as a possible cause of stump pain.

Takakura T; Mikami T; Nishioka Y; Nemoto A; Mizuochi K

2013-07-01

285

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

Digital Repository Infrastructure Vision for European Research (DRIVER)

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

JiEun Park; SooMi Lim; Jeong Hyun Yoo

286

MR Imaging of Shaken Baby Syndrome Manifested as Chronic Subdural Hematoma  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was most...

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

287

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

UK PubMed Central (United Kingdom)

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

Takeuchi S; Takasato Y

2013-01-01

288

Solitary pulmonary nodule by pulmonary hematoma under warfarin therapy  

International Nuclear Information System (INIS)

[en] Pulmonary hematoma is a rare cause of a pulmonary nodule. Mostly it results from penetrating or blunt chest injuries. The case of a patient is reported, whose chest X-ray showed a pulmonary nodule suspected of malignancy. This patient was maintained permanently on anticoagulants (warfarin derivates) after cardiac valve replacement with a prosthesis. A definite diagnosis could not be established by non-invasive methods. A needle biopsy of the lung was impracticable because of the location of the pulmonary lesion; an exploratory thoracotomy could not be carried out due to a general indication of nonoperability. Control examinations showed that the pulmonary nodule had vanished completely within four months. In consideration of the patient's clinical situation it can be concluded that the pulmonary lesion was caused by a hematoma of the lung. (orig.)[de] Eine seltene Ursache eines Lungenrundschattens stellt das Lungenhaematom dar. Meist entsteht es nach penetrierenden oder stumpfen Thoraxtraumen. Es wird ueber einen Patienten berichtet, bei dem ein malignomverdaechtiger Rundschatten auftrat. Dieser Patient stand wegen einer Herzklappenprothese unter Langzeitantikoagulation mit Cumarinderivaten. Eine sichere differentialdiagnostische Klaerung des Befundes war mit nichtinvasiven Methoden nicht moeglich. Bioptische Verfahren schieden wegen der Lage des Rundschattens aus; eine explorative Thorakotomie musste wegen einer allgemeinen Operationskontraindikation unterbleiben. Daraufhin durchgefuehrte Kontrolluntersuchungen ergaben eine vollstaendige Rueckbildung des Rundschattens innerhalb von vier Monaten. Daraus ist, auch unter Beruecksichtigung des klinischen Gesamtbildes, zu folgern, dass es sich um ein Lungenhaematom handelte. (orig.)

1983-01-01

289

Head trauma and CT with reference to epidural hematoma  

International Nuclear Information System (INIS)

[en] Computed tomography (CT) is useful to detect lesions in patients with mild head trauma in its acute stage which may be followed by a lucid interval of hours to several days before exact diagnosis is made, or in serious patients with impairment in state of consciousness. Non-enhanced scan can determine the location of the lesion in 94% of patients with brain tumor, and enhanced scan can do in more than 98%. CT can reveal many anatomical changes due to trauma. Of these pathological changes, epidural hematoma is often caused by the damage of the middle meningeal artery or its branch. Therefore, CT should be performed if a bone-fracture line runs across the meningeal artery. CT is also applicable for the patients with some brain symptoms such as those who had not immediate post-traumatic unconsciousness but have developed impairment in state of consciousness after a lucid interval, or those who have persistent headache even if they have no impairment in stage of consciousness. In CT findings, the margin of hematoma and normal cerebral tissues is usually clear in acute causes but unclear in subacute cases. (Ueda, J.)

1979-01-01

290

Diagnostic and management of spontaneous rectus sheath hematoma.  

UK PubMed Central (United Kingdom)

BACKGROUND: Spontaneous rectus sheath hematoma is an uncommon and often misdiagnosed cause of abdominal pain. The aim of this study is to describe our experience in their management. METHODS: Retrospective analysis of the characteristics and outcomes of the spontaneous rectus sheath hematomas diagnosed over the last 12years was conducted. RESULTS: 24 patients were included (66% women; mean age: 74years; range: 54-87). All cases presented predisposing factors mainly anticoagulant therapy in 21 (87.5%) patients, hypertension in 19 (79.1%) and abdominal surgery in 12 (50%) cases. Eighteen (75%) referred triggering factors like coughing being the most common one, present in 17 (70.8%) patients. The main clinical findings were abdominal pain in 21 (87.5%) cases and the existence of an abdominal mass in 20 (83.3%). The diagnosis was confirmed by abdominal ultrasonography and/or computerized tomography in 23 (95.8%) patients. Nineteen cases (79.1%) responded to conservative management while 5 (20.8%) required interventional treatment, which consisted in an arteriography with selective embolization of the epigastric arteries in all cases. Four (80%) of the patients needing interventional treatment were receiving low molecular weight heparin. Nine (37.5%) patients developed hypovolemic shock and 1 (4%) died. CONCLUSIONS: Spontaneous rectus sheath hematomas should be considered in the differential diagnosis of abdominal pain, particularly in elderly women under anticoagulant therapy with onset of symptoms after a bout of cough. Most cases respond to conservative management, although those related to low molecular weight heparin might require interventional treatment; arteriography with selective embolization of the epigastric arteries is the first therapeutic option.

Smithson A; Ruiz J; Perello R; Valverde M; Ramos J; Garzo L

2013-03-01

291

Hematomas na fossa craniana posterior Haematomata in the posterior fossa  

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

Mário S. Cademartori

1969-01-01

292

Chronic Expanding Hematoma of Thorax Extended to the Neck.  

Science.gov (United States)

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

Ueda, Hitoshi; Baba, Hiromitsu; Ondo, Kaoru

2013-02-15

293

Chronic Expanding Hematoma of Thorax Extended to the Neck.  

UK PubMed Central (United Kingdom)

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

Ueda H; Baba H; Ondo K

2013-02-01

294

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

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

Celso Monteiro Soares; Antonio Carlos Pires Carvalho

2005-01-01

295

Tongue Hematoma Induced by Warfarin Overdose  

Digital Repository Infrastructure Vision for European Research (DRIVER)

Warfarin is one of the common oral anticoagulants. Anticoagulant response is affected by the amount of dietary Vitamin K, various drugs, foods and herbal treatments. Although, hemorrhage is one of the side effects of warfarin, tongue hematoma is a rare complication. In this research, 50 years old ma...

Mehmet Nail Bilen; Hasan Kara

296

Subdural hematoma associated with dural metastatic tumor  

Energy Technology Data Exchange (ETDEWEB)

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

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

1980-12-01

297

Intramural hematoma of colon having traumatic origin  

International Nuclear Information System (INIS)

The author presents a case of intramural hematoma of colon having traumatic origin, which triggered intestinal occlusion and was successfully treated though a right hemicolectomy.This is a rare form of anatomo clinical traumatic affectation of colon.The importance of CAT scan in its diagnosis and treatment planning should be highlighted

2003-01-01

298

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

Scientific Electronic Library Online (English)

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

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

2003-02-01

299

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

Directory of Open Access Journals (Sweden)

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

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

2003-01-01

300

Immediate Extinction Causes a Less Durable Loss of Performance than Delayed Extinction following Either Fear or Appetitive Conditioning  

Science.gov (United States)

Five experiments with rat subjects compared the effects of immediate and delayed extinction on the durability of extinction learning. Three experiments examined extinction of fear conditioning (using the conditioned emotional response method), and two experiments examined extinction of appetitive conditioning (using the food-cup entry method). In…

Woods, Amanda M.; Bouton, Mark E.

2008-01-01

 
 
 
 
301

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1998-11-01

302

Hematoma epidural espinal espontâneo: registro de dois casos Spontaneous epidural hematoma of the lumbar region: report of two cases  

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Full Text Available São discutidos os aspectos clínicos relativos ao diagnóstico e tratamento dos hematomas epidurals espinais espontâneos. Os dados obtidos em dois casos são apresentados, sendo salientada a localização lombar destes hematomas, os distúrbios neurológicos agudos, geralmente de. irradiação radicular, acompanhados por déficit neurológico de caráter progressivo. A problemática desses hematomas epidurals espinais, principalmente a sua pequena frequência, a demonstração radiológica por mielografia contrastada e o seu tratamento cirúrgico por laminectomia, são ressaltados. O tratamento de escolha é o cirúrgico, laminectomia com dissecção e remoção do hematoma que possibilita a recuperação do paciente.Two cases of spontaneous epidural hematoma of the lumbar region are reported. Some considerations are drawn about the values of the early diagnosis before the incidence of neurological sequela. The clinical and radiological findings and the treatment of these hematomas era discussed. Lumbar puncture and myelography are the best method for the diagnosis. Treatment should be surgical, consisting of laminectomy with total excision of the hematoma.

Rodrigo O. M. F Ferreira; José de Araujo Barros; Augusto V. B. Fonseca; Francisco José Rocha; Paulo Roberto De Paiva

1980-01-01

303

Secondary mania in a patient with delayed anoxic encephalopathy after carbon monoxide intoxication caused by a suicide attempt.  

UK PubMed Central (United Kingdom)

We report herein a female patient presenting with delayed anoxic encephalopathy after carbon monoxide (CO) intoxication. Five months after she attempted suicide in her car using burning charcoal, she showed manic symptoms including aggressive behaviors, irritability, decreased total sleep time, increased energy and sexual interest, and hyperactivity, as well as illusions and visual hallucinations related to bugs, certain animals, monsters and her ex-husband. Fluid-attenuated inversion recovery and T2-weighted images in brain magnetic resonance imaging showed white-matter hyperintensity in the frontal lobe and periventricular area. Her manic symptoms and psychotic features improved following daily administration of valproate (600 mg) and olanzapine (10 mg). These observations indicate that clinicians should monitor for delayed neuropsychiatric symptoms in patients with CO intoxication.

Park YM; Kim YS

2013-08-01

304

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

International Nuclear Information System (INIS)

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

2006-01-01

305

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

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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

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

2009-01-01

306

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese 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 inc (more) idência 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. Risk factors have not been completely established. OBJECTIVE: To demonstrate the incidence of post-sclerotherapy intramural esophageal hematoma in our hospital and discuss the p (more) ossible 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

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

2009-12-01

307

Delay in diagnosis of cancer as a patient safety issue - a root cause analysis based on a representative case report  

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Full Text Available Abstract Background It is well known in the literature that imaging has almost no value for diagnosis of superficial bladder cancer. However, wide gap exists between knowledge on diagnosis of bladder cancer and actual clinical practice. Case presentation Delay in diagnosis of bladder cancer in a male person with tetraplegia occurred because of reliance on negative flexible cystoscopy and single biopsy, negative ultrasound examination of urinary bladder, and computerised tomography of pelvis. Difficulties in scheduling cystoscopy also contributed to a delay of nearly ten months between the onset of haematuria and establishing a histological diagnosis of vesical malignancy in this patient. The time interval between transurethral resection and cystectomy was 42 days. This delay was mainly due to scheduling of surgery. Conclusion We learn from this case that doctors should be aware of the limitations of negative flexible cystoscopy and single biopsy, cytology of urine, ultrasound examination of urinary bladder, and computed tomography of pelvis for diagnosis of bladder cancer in spinal cord injury patients. Random bladder biopsies must be considered under general anaesthesia when there is high suspicion of bladder cancer. Spinal cord injury patients with lesions above T-6 may develop autonomic dysreflexia; therefore, one should be extremely well prepared to prevent or manage autonomic dysreflexia when performing cystoscopy and bladder biopsy. Spinal cord injury patients, who pass blood in urine, should be accorded top priority in scheduling of investigations and surgical procedures.

Vaidyanathan Subramanian; Soni Bakul M; Singh Gurpreet; Hughes Peter L; Mansour Paul; Oo Tun

2011-01-01

308

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

UK PubMed Central (United Kingdom)

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

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

2013-02-01

309

Capsular and thalamic infarction caused by tentorial herniation subsequent to head trauma  

International Nuclear Information System (INIS)

Five patients (4 male and 1 female) were observed to have capsular and thalamic infarction ascribed to descending transtentorial herniation (DTH) caused by head injury. A lucid interval immediately after the trauma and the presence of an epidural hematoma (EDH) characterized all five case. The low attenuation implicated the perforating arteries, that is the anterior thalamoperforating and anterior choroidal arteries, suggesting infarcted regions caused by occlusion of these arteries. Findings in the present study suggest that arterial occlusion in closed head injury may result from DTH. Moreover, infarction may be attributed to the delayed effects of injury. (orig./GDG).

1991-01-01

310

Capsular and thalamic infarction caused by tentorial herniation subsequent to head trauma  

Energy Technology Data Exchange (ETDEWEB)

Five patients (4 male and 1 female) were observed to have capsular and thalamic infarction ascribed to descending transtentorial herniation (DTH) caused by head injury. A lucid interval immediately after the trauma and the presence of an epidural hematoma (EDH) characterized all five case. The low attenuation implicated the perforating arteries, that is the anterior thalamoperforating and anterior choroidal arteries, suggesting infarcted regions caused by occlusion of these arteries. Findings in the present study suggest that arterial occlusion in closed head injury may result from DTH. Moreover, infarction may be attributed to the delayed effects of injury. (orig./GDG).

Endo, M.; Ichikawa, F. (International Goodwill General Hospital, Yokohama (Japan). Dept. of Neurosurgery); Miyasaka, Y.; Yada, K. (Kitasato Univ. School of Medicine (Japan). Dept. of Neurosurgery); Ohwada, T. (Kitasato Univ. School of Medicine (Japan). Critical Care and Emergency Medicine)

1991-08-01

311

Chronic expanding pituitary hematoma without rebleeding after pituitary apoplexy.  

UK PubMed Central (United Kingdom)

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

Hojo M; Goto M; Miyamoto S

2013-01-01

312

Chronic lumbar epidural hematoma in a patient suffering with spondylolytic spondylolisthesis at the L4-5 level: a case report  

International Nuclear Information System (INIS)

Nontraumatic spinal epidural hematoma (SEH) is a rare condition and the exact cause of the hemorrhage in SEH had never been established. However, there have been a few recent reports on some types of the epidural hematoma with a detectable origin of hemorrhage. We encountered a case of chronic SEH in a patient who had spondylolytic spondylolisthesis, which is also a rare condition to be associated with SEH. We report here on the radiologic findings of a case of chronic epidural hematoma in a patient who had spondylolytic spondylolisthesis at the L4-5 level, and we include a review of the related literatures.

2006-01-01

313

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

Scientific Electronic Library Online (English)

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

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

1996-03-01

314

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

Directory of Open Access Journals (Sweden)

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

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

1996-01-01

315

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

Scientific Electronic Library Online (English)

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

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

2007-02-01

316

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

Directory of Open Access Journals (Sweden)

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

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

2007-01-01

317

Ultrasonographic findings of psoas abscess and hematoma  

Energy Technology Data Exchange (ETDEWEB)

A retrospective analysis of the ultrasonographic findings of 9 cases tuberculous abscess, 5 cases of pyogenic abscess and 2 cases of hematoma of psoas and adjacent muscles was made. Fluid collection with or without internal echoes was seen in 12 cases out of total 16 cases. Other findings were 2 cases of only muscle swelling, 1 cases of highly echogenic mass-like appearance and 1 case of fluid collection with septae. Ultrasonography is considered an accurate method in identifying early pathologic changes of the psoas muscle and determining its extent, and in differentiating tumor from fluid collection of the psoas muscle. Authors dare to say that ultrasound examination is a procedure of choice in the diagnosis of psoas abscess and hematoma.

Kim, Eun Kyung; Lim, Jae Hoon; Ko, Young Tae; Choi, Yong Dae; Kim, Ho Kyun; Kim, Soon Yong [Kyung Hee University Hospital, Seoul (Korea, Republic of)

1984-06-15

318

Ultrasonographic findings of psoas abscess and hematoma  

International Nuclear Information System (INIS)

[en] A retrospective analysis of the ultrasonographic findings of 9 cases tuberculous abscess, 5 cases of pyogenic abscess and 2 cases of hematoma of psoas and adjacent muscles was made. Fluid collection with or without internal echoes was seen in 12 cases out of total 16 cases. Other findings were 2 cases of only muscle swelling, 1 cases of highly echogenic mass-like appearance and 1 case of fluid collection with septae. Ultrasonography is considered an accurate method in identifying early pathologic changes of the psoas muscle and determining its extent, and in differentiating tumor from fluid collection of the psoas muscle. Authors dare to say that ultrasound examination is a procedure of choice in the diagnosis of psoas abscess and hematoma

1984-01-01

319

Hematoma subdural crónico: Análisis de 95 casos  

Directory of Open Access Journals (Sweden)

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

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

2012-01-01

320

Hematoma subdural crónico: Análisis de 95 casos  

Scientific Electronic Library Online (English)

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

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

2012-03-01

 
 
 
 
321

Orbital subperiosteal hematoma from scuba diving.  

UK PubMed Central (United Kingdom)

Only a few cases of nontraumatic orbital subperiosteal hematoma due to scuba diving have been reported, and this is the first of such cases that underwent surgical intervention. This injury results from negative pressure within the face mask, suctioning orbital tissues into the mask after incomplete equilibration of pressure on descent. Valsalva maneuver is a second mechanism implicated in the etiology of this injury. Recognition of this injury is of the utmost importance because vision loss is a possible complication if there is compression of the optic nerve or increased intraocular pressure. In many cases of nontraumatic orbital hematoma, conservative management is adequate; however, this case was an exception due to worsening exam findings. Divers may be able to prevent this injury by frequent and gentle equilibration of mask pressure on descent.

Rosenberry C; Angelidis M; Devita D

2010-09-01

322

A new treatment for hypertensive intracerebral hematoma  

International Nuclear Information System (INIS)

Durining the last 2 years, 46 cases of hypertensive intracerebral hemorrhage in the basal ganglia were treated by CT guided stereotactic aspiration and their outcome was evaluated in terms of the rate of hematoma removal, the change of consciousness level and the recovery of motor and sensory functions. They are aged from 45 to 79 years old, the average 56, and aspirated 1 to 24 days after the onset, two third of them being within 1 week. The whole procedure was done in the CT room under direct CT guidance and by one trial. In putaminal type hemorrhage, the removed hematoma volumes ranged from 9 to 48 ml, average being 23.7 ml, in thalamic type from 5 to 29 ml, average being 15.5 ml. The average rate of removal was 81.1 % in 30 cases within 1 week. In most cases, preoperative consciousness was not severely disturbed, in putaminal type, 19 were alert or confused, 4 somnolent, 5 stuperous and in thalamic type, 6, 6, 3 respectively and 2 were semicomatous, one of them had herniation sign. In putaminal type all but 2 cases recovered to alert or confused state, the first one had postoperative bleeding and the other was already apallic preoperatively. In thalamic type, we lost 3 cases, 2 by gastrointestinal bleeding and 1 DIC, by rehemorrhage 2 months after the operation. All but one who was semicomatous preoperatively recovered to alertness. In motor function, some cases of the putaminal bleeding with intact internal capsule remained hemiplegic. On the other hand, most of the cases with partial destruction of the internal capsule on CT recovered well in both types of hematoma. Especially in thalamic type, only 2 had inability to walk durinig the follow-up period. In sensory function, two thirds of the cases recovered to almost normal level. CT guided stereotactic aspiration, therefore, can be evaluated as less invasive and more definitive treatment for intracerebral hematoma in the basal ganglia. (author).

1986-01-01

323

Intramyocardial dissecting hematoma and postinfarction cardiac rupture.  

UK PubMed Central (United Kingdom)

Potentially fatal cardiac rupture is a complication of myocardial infarction (MI), which can appear in the first hours of the acute event and during the course of the first week. The intramyocardial dissecting hematoma might appear as a component of the rupture during the evolution process. The description of the myocardium as a helical muscular band facilitates the explanation of the fiber dissection. With echocardiography, it is possible to diagnose intramyocardial dissecting hematomas (IDH), determine its location, progression, potential complications, and in some cases its reabsorption. It is necessary to search for neocavitations in the infarcted myocardium and identify the intramyocardial edge that surrounds the defect, as well as the flow inside the myocardial dissection, the pathway of the dissection, and its communication with ventricular cavities, and also to look for the complete or partial reabsorption of the cavitary image. The greater the myocardial dissection is, the worse the prognosis. If the dissecting hematoma is confined to the apical segments, it is more likely to reabsorb spontaneously. Tissue characterization with magnetic resonance during an acute myocardial infarction allows identification of reperfusion injuries with altered microcirculation and intramyocardial hemorrhage (IMH). It is necessary to search for IMH in reperfused patients with ventricular arrhythmias, stunned myocardium, and no reflow. These patients may develop an increased stiffness in the infarcted wall and a major likelihood to develop a parietal rupture. Everything seems to indicate that we are facing the same physiopathological process which can be characterized by 2 complementary imaging methods, echocardiography and magnetic resonance.

Vargas-Barrón J; Roldán FJ; Romero-Cárdenas Á; Vázquez-Antona CA

2013-01-01

324

Hematoma following primary total hip arthroplasty: a grave complication.  

UK PubMed Central (United Kingdom)

Hematoma following primary total hip arthroplasty (THA) can require a return to the operating room. The purpose of this study was to uncover risk factors for hematoma and how it affects the outcome of THA. This case-control study identified 38 patients requiring reoperation due to hematoma following THA between 2000 and 2007. The 38 patients were matched with 117 patients without hematoma. The mean follow-up was 4.1years (range, 2.1-9.6). Multivariate regression showed that blood loss, administration of fresh frozen plasma and Vitamin K, perioperative anticoagulation and hormonal therapy were independent predictors for hematoma formation. Chronic anticoagulation and autologous blood transfusion were independent risk factors for mortality. Hematoma itself was found to be an independent risk factor for adverse outcomes, increasing morbidity and mortality, despite adequate treatment.

Mortazavi SM; Hansen P; Zmistowski B; Kane PW; Restrepo C; Parvizi J

2013-03-01

325

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

International Nuclear Information System (INIS)

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

1994-01-01

326

Spontaneous subcapsular splenic hematoma associated with filgrastim in a patient undergoing allogeneic hematopoietic stem cell transplantation.  

UK PubMed Central (United Kingdom)

OBJECTIVE: To report the development of a spontaneous subcapsular splenic hematoma following filgrastim administration in a patient undergoing an allogeneic hematopoietic stem cell transplant. CASE SUMMARY: A 60-year-old female with myelodysplastic syndrome was admitted for a reduced-intensity allogeneic hematopoietic stem cell transplant from an unrelated donor. She received filgrastim 5 ?g/kg starting on day 1 to accelerate neutrophil recovery. On day 5, she began reporting severe left chest-wall pain. Contrast-enhanced computed tomography of the abdomen/pelvis revealed a spontaneous subcapsular splenic hematoma. Upon discontinuation of filgrastim, the pain fully resolved. The patient was subsequently rechallenged with filgrastim, which led to recurrence of the left-sided chest-wall pain. Filgrastim was discontinued and the patient reported resolution of the pain. DISCUSSION: Filgrastim has been associated with splenic hematoma and splenic rupture, predominantly in healthy donors undergoing mobilization of peripheral blood stem cells. Although splenic rupture attributed to filgrastim in a patient undergoing allogeneic hematopoietic stem cell transplantation has been reported, to our knowledge, this is the first case report to establish causality. Using the Naranjo probability scale, an objective causality assessment revealed that the adverse drug event was highly probable. CONCLUSIONS: Although filgrastim-induced splenomegaly, splenic hematomas, and splenic rupture are rare, clinicians working in the bone marrow transplant setting should be cognizant of the potential of growth factors to cause these adverse events.

Ganetsky A; Kucharczuk C; Del Percio S; Frey N; Gill S

2013-05-01

327

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

Energy Technology Data Exchange (ETDEWEB)

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

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

1981-05-01

328

Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma  

International Nuclear Information System (INIS)

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.)

2000-01-01

329

Renal subcapsular hematoma associated with brodifacoum toxicosis in a dog.  

UK PubMed Central (United Kingdom)

A 5-y-old female dog died acutely and was presented for postmortem examination. Hemorrhage in the thoracic and peritoneal cavities and a large subcapsular renal hematoma were present at necropsy. Brodifacoum, a second-generation coumarin anticoagulant, was detected in the liver by HPLC analysis. Renal subcapsular hematoma is a well known, but uncommon condition in man. To the authors' knowledge, this is the first report of a brodifacoum-associated renal subcapsular hematoma in a non-human species.

Radi ZA; Thompson LJ

2004-04-01

330

CT findings in a case of neonatal acute subdural hematoma  

International Nuclear Information System (INIS)

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

1981-01-01

331

CT findings in a case of neonatal acute subdural hematoma  

Energy Technology Data Exchange (ETDEWEB)

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

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

1981-06-01

332

Intramyocardial hematoma with epicardial rupture following percutaneous coronary intervention.  

UK PubMed Central (United Kingdom)

Intramyocardial (or subepicardial) hematomas are uncommon conditions that occur mostly after myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass surgery, cardiac surgery, or chest trauma. Coronary perforation is a rare complication of PCI and the subset of patients developing an intramyocardial hematoma, usually considered a catastrophic event, is even rarer. We describe here the case of 63-year-old man in whom an intramyocardial hematoma with epicardial rupture occurred after PCI. The patient was treated conservatively with a successful outcome.

Ertan C; Ozeke O; Demir AD

2013-02-01

333

Spontaneous bilateral perirenal hematomas in two patients with eclampsia.  

Science.gov (United States)

The purpose of this report is to provide two illustrative cases of spontaneous and bilateral perirenal hematomas that occurred during a pregnancy complicated by eclampsia. The sonographic and computed tomographic findings included bilateral perirenal hematoma with no evidence of an underlying malignancy. Since renal hematomas that occur in association with preeclampsia and eclampsia syndrome are extremely rare, but potentially life-threatening complications, prompt laboratory and radiologic evaluations are essential and can reduce the associated morbidity and mortality. PMID:12768075

Kably, Issam M; Chikhaoui, Nabil

334

Spontaneous bilateral perirenal hematomas in two patients with eclampsia.  

UK PubMed Central (United Kingdom)

The purpose of this report is to provide two illustrative cases of spontaneous and bilateral perirenal hematomas that occurred during a pregnancy complicated by eclampsia. The sonographic and computed tomographic findings included bilateral perirenal hematoma with no evidence of an underlying malignancy. Since renal hematomas that occur in association with preeclampsia and eclampsia syndrome are extremely rare, but potentially life-threatening complications, prompt laboratory and radiologic evaluations are essential and can reduce the associated morbidity and mortality.

Kably IM; Chikhaoui N

2003-03-01

335

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in spanish El hematoma subdural crónico constituye una enfermedad frecuente en la práctica neuroquirúrgica cotidiana. Su diagnóstico se realiza actualmente de forma temprana en la mayoría de los pacientes, a partir de la introducción de las modernas técnicas de imagenología. Se presenta el caso de un enfermo de 84 años de edad con historia de cefalea, mutismo acinético y cuadriparesia, cuyo examen tomográfico mostró una colección extraxial supratentorial hemisférica de (more) recha con calcificación masiva; se practicó la exéresis mediante una craneotomía y el estudio histopatológico confirmó el diagnóstico de hematoma subdural crónico. Se concluye que, al constituir la calcificación masiva del hematoma subdural crónico una rara forma de presentación imagenológica en la actualidad, deben contemplarse otras entidades en el diagnóstico diferencial como neoplasias y malformaciones vasculares intracraneales; por otro lado, aumenta la complejidad quirúrgica ya que es imprescindible la práctica de una craneotomía para la evacuación de la lesión. Abstract in english The chronic subdural hematoma constitutes a frequent disease in daily neurosurgical practice. Currently its diagnosis of premature form is performed in the majority of patients, since the introduction of imaging's modern techniques. An 84 years old patient with history of cephalea, akinetic mutism and cuadriparesis, whose tomographic exam showed a right hemispheric supratentorial extraxial collection with massive calcification; the exeresis was performed by means of a cra (more) niotomy and the histopathological study confirmed the diagnosis of chronic subdural hematoma. It was concluded that, when constitute the massive calcification of the chronic subdural hematoma a rare form of imaging presentation at present, should contemplate another entities in the differential diagnostic like neoplasias and intracranial vascular malformations; In addition, increases the surgical complexity since it is essential the practice of a craniotomy for the evacuation of the lesion.

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

2008-12-01

336

Benefits of Artcereb on the irrigation of chronic subdural hematoma  

International Nuclear Information System (INIS)

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

2011-01-01

337

Rapid spontaneous resolution of an acute subdural hematoma: Case report  

Energy Technology Data Exchange (ETDEWEB)

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

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

1989-10-15

338

Aortic intramural hematoma: Review of high-risk imaging features.  

UK PubMed Central (United Kingdom)

Aortic intramural hematoma is among the spectrum of pathologies that comprises acute aortic syndrome and carries a risk of progression to aortic dissection, aneurysm, rupture, and other complications. Evaluation by CT can identify imaging features associated with higher risk of complications. Ulcer-like projections, enlarged aortic diameter, increased hematoma thickness, and Stanford type A classification are associated with progression to complications. The significance of intramural blood pools within the hematoma and associated pleural/pericardial effusions is less certain. Detailed evaluation of intramural hematoma with CT can provide critical prognostic information with implications for patient management.

Kruse MJ; Johnson PT; Fishman EK; Zimmerman SL

2013-05-01

339

Rapid spontaneous resolution of an acute subdural hematoma: Case report  

International Nuclear Information System (INIS)

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

1989-01-01

340

21 CFR 882.1935 - Near Infrared (NIR) Brain Hematoma Detector.  

Science.gov (United States)

...2013-04-01 false Near Infrared (NIR) Brain Hematoma Detector. 882.1935 Section... § 882.1935 Near Infrared (NIR) Brain Hematoma Detector. (a) Identification. A Near Infrared (NIR) Brain Hematoma Detector is a...

2013-04-01

 
 
 
 
341

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

Directory of Open Access Journals (Sweden)

Full Text Available 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.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.

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

2005-01-01

342

[Cerebellar hematomas in a patient with atrial myxoma  

UK PubMed Central (United Kingdom)

We describe a case report of a 69 year old woman with atrial myxoma, presented as a cerebellar syndrome caused by ischemic infarctions of the posterior circulation. The transthoracic 2D echocardiogram provided the diagnosis of a left atrial myxoma. Seven months after surgical removal of the cardiac tumor, the cerebellar syndrome worse with the acute development of intracranial hypertension. A CT scan detected multiple hematomas of both lobes and vermix of the cerebellum and hydrocephalus. These late neurologic complications permitted us to suspect and discuss some diagnostic hypotheses. Cardiac myxomas are rare and their presentation as early neurologic manifestations occur in 20-25% of the cases. The late neurologic complications of myxoma are even more rare, only a few cases being reported in world literature.

Marcão I; Teixeira H; Germano I; Bandeira Costa J; Gonçalves C; Magalhães M; Farrajota F

1995-12-01

343

Penile intracavernous hematoma: diagnosis and surgical considerations.  

Science.gov (United States)

Soft tissue lesions of the penile corporeal bodies are rare and usually represent benign or malignant tumors, or Peyronie's disease. We report a unique case of a deep seated penile mass that at exploration proved to be an encapsulated hematoma of the inter-corporeal septum. Preoperative diagnosis of lesions of the corporeal bodies is facilitated by high resolution Doppler ultrasonography. Surgical exploration to exclude malignancy must be done unless the clinical and/or radiographic findings are unequivocally benign (Peyronie's plaque, simple cyst and so forth). Surgical exploration must be done according to the penile neurovascular anatomy to preserve potency and glanular sensation. PMID:7869509

Connolly, J A; Miller, K S; McAninch, J W

1995-04-01

344

Penile intracavernous hematoma: diagnosis and surgical considerations.  

UK PubMed Central (United Kingdom)

Soft tissue lesions of the penile corporeal bodies are rare and usually represent benign or malignant tumors, or Peyronie's disease. We report a unique case of a deep seated penile mass that at exploration proved to be an encapsulated hematoma of the inter-corporeal septum. Preoperative diagnosis of lesions of the corporeal bodies is facilitated by high resolution Doppler ultrasonography. Surgical exploration to exclude malignancy must be done unless the clinical and/or radiographic findings are unequivocally benign (Peyronie's plaque, simple cyst and so forth). Surgical exploration must be done according to the penile neurovascular anatomy to preserve potency and glanular sensation.

Connolly JA; Miller KS; McAninch JW

1995-04-01

345

Enoxaparin-associated giant retroperitoneal hematoma in pulmonary embolism treatment  

Science.gov (United States)

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.

Besir, Fahri Halit; Gul, Mesut; Ornek, Tacettin; Ozer, Tulay; Ucan, Bulent; Kart, Levent

2011-01-01

346

Intracranial Rhabdomyosarcoma Presented as Chronic Subdural Hematoma: A Case Report  

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

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

347

Diplopia from Subacute Bilateral Subdural Hematoma after Spinal Anesthesia  

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

Hassen, Getaw Worku; Kalantari, Hossein

348

Interhemispheric subdural hematoma: An uncommon sequel of trauma  

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

Shankar A; Joseph M; Chandy M

2003-01-01

349

Vertex epidural hematoma neuroradiological findings and management. A case report  

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Epidural hematomas occurring at the vertex are uncommon, and they can be difficult to diagnose by axial CT. We report a case of acute traumatic vertex epidural hematoma, which resolved spontaneously with time. We stress the importance of MR investigations in this diagnostic challenge.

Server, A.; Tollesson, G.; Solgaard, T.; Haakonsen, M.; Johnsen, U.L.H. [Ullevaal Univ. Hospital, Oslo (Norway). Depts. of Neuroradiology

2002-09-01

350

The risk factors for recurrence of chronic subdural hematoma.  

UK PubMed Central (United Kingdom)

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

Ohba S; Kinoshita Y; Nakagawa T; Murakami H

2013-01-01

351

Spontaneous subdural hematoma in a young adult with hemophilia  

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

Agrawal D; Mahapatra A

2003-01-01

352

Causes of developmental delay in children of 5 to 72 months old at the child neurology unit of Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon)  

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Full Text Available Background: According to the World Health Organization, about 5% of children world-wide of 14-year-old and under have a moderate to severe developmental disability, and up to 15% of children under 5-year-old are developmentally delayed. Purpose: To determine the prevalence, socio-demographic profile, aetiologies, and the clinical presentation of developmental delay in children less than 6-year-old at the child neurology unit in a university-affiliated hospital in Yaounde. Materials and methods: It was a crosssectional descriptive study carried out in Yaounde Gynaeco-Obstetric and Paediatric Hospital (Cameroon) from August to December 2012. Children aged between 5 - 72 months with a developmental quotient less than 70 were enrolled. Developmental delay (DD) was diagnosed and classified using the Denver developmental screening test (DDST). Data concerning the child (age, gender, severity of DD), the mother (age, age at conception, educational level, marital status), history of pregnancy and delivery, perinatal and postnatal events, results of para-clinical explorations (EEG, CT-scan, genetic tests), the severity of DD and the probable or demonstrate cause of DD were recorded on a standardized questionnaire. The chisquare test was used to compare variables. Results: During the study period, 2171 children aged 5 - 72 months consulted the paediatric department of the hospital, 296 were examined at the child neurology unit of which 153 had a developmental quotient less than 70, giving a hospital prevalence of 7.0% and a prevalence of 51.7% at the child neurology unit. The mean age was 26.6 ± 18.0 months and there were 56% males. The main reason for consulting was tonus disorder (43.8%) and the developmental area of parental concern was the motor domain (90.2%). Regarding the clinical presentation, 75.2% of our population were children with cerebral palsy. DD was severe, mild, moderate and profound respectively in 14.2%, 13.5%, 12.2%, and 11.1%. Gross DD represented 90.2% of all DD children. The causes of DD were hypoxic-ischemic encephalopathy (41.8%), epilepsy (13.7%), sequelae of meningitis (6.5%), sequelae of kernicterus (6.5%), and infectious embryofoetopathies (5.2%). Conclusion: Developmental delay is frequent in paediatric neurology, with perinatal disorders being the leading aetiologies in Cameroon. Prevention of perinatal hypoxic-ischemic encephalopathy risk factors needs to be reinforced.

Séraphin Nguefack; Karen Kengne Kamga; Boniface Moifo; Andréas Chiabi; Evelyn Mah; Elie Mbonda

2013-01-01

353

LEIOMYOSARCOMA PRESENTING AS A RECURRENT HEMATOMA OF THE DELTOID REGION  

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Full Text Available Leiomyosarcoma is a rare cancer of smooth muscle. The prognosis depends on the patient's age and the size, histologic grade and stage of the tumor.CASE REPORT: The case of a 63year-old man diagnosed with a leiomyosarcoma of the deltoid region is reported. The patient was previously admitted twice in our surgical unit with a largerecurrent posttraumatic hematoma of the right deltoid region which was incised and drained. One month later the patient was readmitted under the suspicion of malignancy. Following the large excision of the lesion, pathology and immunohistochemistry report showed a poorly differentiated leiomyosarcoma. One year later the recurrency of the tumour in the upper arm and axillary region imposed a large excision of the tumour of the upper arm and the axillary tumour, followed by alatissimus dorsi miocutaneous flap reconstruction. 4 months later multiple pulmonary metastases were documented at chest X-ray and chemotherapy with doxorubicine was commenced. A new axillary recurrence occured 9 months later and was resected with clear margins followed by radiotherapy. In conclusion, the natural history and clinical picture of leiomyosarcoma may lead to diagnosis delay, poor local control of the disease with multiple recurrences and repeatedsurgery

Lidia Ionescu; Camelia Tama?; Delia Ciobanu; D. Ferariu; Dana Clement ,; Anca Munteanu; R. D?nil?

2012-01-01

354

Gigantic retroperitoneal hematoma as a complication of anticoagulation therapy with heparin in therapeutic doses: a case report  

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Full Text Available Abstract Introduction Spontaneous retroperitoneal hemorrhage is a distinct clinical entity that can present as a rare life-threatening event characterized by sudden onset of bleeding into the retroperitoneal space, occurring in association with bleeding disorders, intratumoral bleeding, or ruptures of any retroperitoneal organ or aneurysm. The spontaneous form is the most infrequent retroperitoneal hemorrhage, causing significant morbidity and representing a diagnostic challenge. Case presentation We report the case of a patient with coronary artery disease who presented with transient ischemic attack, in whom anticoagulant therapy with heparin precipitated a massive spontaneous atraumatic retroperitoneal hemorrhage (with international normalized ratio 2.4), which was treated conservatively. Conclusion Delay in diagnosis is potentially fatal and high clinical suspicion remains crucial. Finally, it is a matter of controversy whether retroperitoneal hematomas should be surgically evacuated or conservatively treated and the final decision should be made after taking into consideration patient's general condition and the possibility of permanent femoral or sciatic neuropathy due to compression syndrome.

Daliakopoulos Stavros I; Bairaktaris Andreas; Papadimitriou Dimitrios; Pappas Perikles

2008-01-01

355

Moving the Blood and Transforming Stasis for Chronic Subdural Hematoma  

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

Liang-In Liu; Helen Chang; Lung Chan

2006-01-01

356

Hematomas na fossa craniana posterior/ Haematomata in the posterior fossa  

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

Cademartori, Mário S.

1969-09-01

357

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

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

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

358

CT guided stereotactic evacuation for hypertensive intracerebral hematoma  

International Nuclear Information System (INIS)

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

1990-01-01

359

Prospects for conservative treatment of chronic subdural hematomas  

International Nuclear Information System (INIS)

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

1982-01-01

360

CT-guided stereotaxic evacuation of cerebellar hematoma  

International Nuclear Information System (INIS)

Stereotaxic lateral approach for cerebellar hematoma is presented using Leksell's CT-stereotaxic system. All of the procedures are performed in the CT room. Patient's head is turned to contralateral side of the hematoma 30 to 400 with slight flexion of the neck. Stereotaxic apparatus is secured to the head under local anesthesia. Hematoma is confirmed by computerized tomograms. Three dimensional coordinates of the target point (center of the hematoma) are measured from the vertical and diagonal rods of Leksell's system. Linear skin incision 4 cm in length is made on retromastoid area. Burr-hole is put on just lateral position of the target point, usually 5 to 6 cm posterior and 1 cm above from the external auditory meatus. Transverse or sigmoid sinus does not appeared through the burr-hole by this approach. Specially made Dandy's cannula (3.0 mm in diameter, 220 mm in length) is inserted into the target point, and manual evacuation of the hematoma is performed carefully using a syringe. Then Dandy's cannula is replaced by silastic drainage tube (3.5 mm in diameter), and 6,000 Units of Urokinase solved in 2 ml of saline is administered to the hematoma cavity. Dissolved hematoma is aspirated every 24 hours until the most of the hematoma is evacuated. We operated three cases of cerebellar hematoma by this method with favorable results. Advantages of this method are as follows: Operative invasion is minimal; The surgeon can cbeck the residual hematoma and position of the tip of cannula even at operation, if necessary. (author).

1985-01-01

 
 
 
 
361

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

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos. Abstract in english A case of spontaneous dorso-lombar spinal epidural hematoma during pregnancy is reported. The hematoma was removed 8 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The motor deficit remained unchanged post-operatively. The etiology, clinical findings and the value of early laminectomy are discussed.

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

1984-03-01

362

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

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Full Text Available Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos.A case of spontaneous dorso-lombar spinal epidural hematoma during pregnancy is reported. The hematoma was removed 8 hours after the onset of paraplegia, and there was no evidence of vascular malformation. The motor deficit remained unchanged post-operatively. The etiology, clinical findings and the value of early laminectomy are discussed.

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

1984-01-01

363

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

Scientific Electronic Library Online (English)

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

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

2011-06-01

364

Mutations in NALCN Cause an Autosomal-Recessive Syndrome with Severe Hypotonia, Speech Impairment, and Cognitive Delay.  

UK PubMed Central (United Kingdom)

Sodium leak channel, nonselective (NALCN) is a voltage-independent and cation-nonselective channel that is mainly responsible for the leaky sodium transport across neuronal membranes and controls neuronal excitability. Although NALCN variants have been conflictingly reported to be in linkage disequilibrium with schizophrenia and bipolar disorder, to our knowledge, no mutations have been reported to date for any inherited disorders. Using linkage, SNP-based homozygosity mapping, targeted sequencing, and confirmatory exome sequencing, we identified two mutations, one missense and one nonsense, in NALCN in two unrelated families. The mutations cause an autosomal-recessive syndrome characterized by subtle facial dysmorphism, variable degrees of hypotonia, speech impairment, chronic constipation, and intellectual disability. Furthermore, one of the families pursued preimplantation genetic diagnosis on the basis of the results from this study, and the mother recently delivered healthy twins, a boy and a girl, with no symptoms of hypotonia, which was present in all the affected children at birth. Hence, the two families we describe here represent instances of loss of function in human NALCN.

Al-Sayed MD; Al-Zaidan H; Albakheet A; Hakami H; Kenana R; Al-Yafee Y; Al-Dosary M; Qari A; Al-Sheddi T; Al-Muheiza M; Al-Qubbaj W; Lakmache Y; Al-Hindi H; Ghaziuddin M; Colak D; Kaya N

2013-09-01

365

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

International Nuclear Information System (INIS)

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

2012-01-01

366

Clinical studies on cerebral blood flow in chronic subdural hematoma  

International Nuclear Information System (INIS)

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

1988-01-01

367

Clinical studies on cerebral blood flow in chronic subdural hematoma  

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

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

1988-11-01

368

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

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

Antonio Guevara Melcón; Ashley Obregón Marín

2012-01-01

369

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

Scientific Electronic Library Online (English)

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

Guevara Melcón, Antonio; Obregón Marín, Ashley

2012-03-01

370

Epidural hematoma confirmed by contrast enhancement in computed tomography  

International Nuclear Information System (INIS)

[en] Four cases of chronic epidural hematomas confirmed only by contrast enhancement are presented. In two cases, hematomas were found in the posterior fossa, in one, in both supra- and infratentorial regions, and in the remaining one, in the supratentorial region. Noncontrast CT failed to show the biconvex high-density area typical of an acute epidural hematoma. One supratentorial and two posterior fossa hematomas were definitely diagnosed only after an injection of the contrast medium. In the remaining one with combined supra- and infratentorial hematomas, a hematoma in the right occipital region was diagnosed on plain CT alone, but the left supratentorial lesion was confirmed only after the injection of an iodinated contrast medium. The mechanisms responsible for the enhancement of the margin of the chronic epidural hematoma are discussed. The dura mater in close contract with the inner table of the skull is usually not seen on the enhanced CT. The falx and tentorium are ordinarily well enhanced, however, and in patients who have undergone bone-flap removal, the dura mater without any juxtaposed skull is enhanced. It may be supposed that the enhanced margin as seen in chronic epidural hematoma represents either the enhanced dura mater displaced from the inner table of the skull, with or without overlying granulation tissue, or the compressed and congested brain underneath the hematoma, or both. An extravasation of the iodine from the immature neovasculature of the granulation tissue may prove to play an important role. The importance of the contrast enhancement in CT scanning of selected patients in chronic stage after the head injury is stressed. (author)

1980-01-01

371

Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism  

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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.

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

372

Spontaneously Developed Pulmonary Arterial Intramural Hematoma That Mimicked Thromboembolism  

International Nuclear Information System (INIS)

[en] 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.

2012-01-01

373

Endoscopic burr hole evacuation of an acute subdural hematoma.  

UK PubMed Central (United Kingdom)

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

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

2013-08-01

374

Computerized tomography of chronic subdural hematoma extending to the tentorium  

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

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

1987-06-01

375

Subgaleal hematoma in a child, without skull fracture.  

UK PubMed Central (United Kingdom)

The rare cases of subgaleal hematoma in childhood reported previously have all been related to head trauma. A case of apparently spontaneous subgaleal hematoma is reported which was associated with a qualitative platelet defect and not with trauma. Subgaleal hematoma must be differentiated from subgaleal infection and air from frontal sinusitis with bony erosion, and from an encephalocele or tumor erosion through the skull. Computed cranial tomography is useful in that differentiation. Most cases have been managed conservatively, but subgaleal tap may be indicated if there is severe headache or potential scalp necrosis.

Kirkpatrick JS; Gower DJ; Chauvenet A; Kelly DL Jr

1986-08-01

376

Subgaleal hematoma in a child, without skull fracture.  

Science.gov (United States)

The rare cases of subgaleal hematoma in childhood reported previously have all been related to head trauma. A case of apparently spontaneous subgaleal hematoma is reported which was associated with a qualitative platelet defect and not with trauma. Subgaleal hematoma must be differentiated from subgaleal infection and air from frontal sinusitis with bony erosion, and from an encephalocele or tumor erosion through the skull. Computed cranial tomography is useful in that differentiation. Most cases have been managed conservatively, but subgaleal tap may be indicated if there is severe headache or potential scalp necrosis. PMID:3758506

Kirkpatrick, J S; Gower, D J; Chauvenet, A; Kelly, D L

1986-08-01

377

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

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

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

2007-01-01

378

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.).

1982-01-01

379

Hematoma epidural espinal espontâneo: registro de dois casos/ Spontaneous epidural hematoma of the lumbar region: report of two cases  

Scientific Electronic Library Online (English)

Full Text Available Abstract in portuguese São discutidos os aspectos clínicos relativos ao diagnóstico e tratamento dos hematomas epidurals espinais espontâneos. Os dados obtidos em dois casos são apresentados, sendo salientada a localização lombar destes hematomas, os distúrbios neurológicos agudos, geralmente de. irradiação radicular, acompanhados por déficit neurológico de caráter progressivo. A problemática desses hematomas epidurals espinais, principalmente a sua pequena frequência, a demonst (more) ração radiológica por mielografia contrastada e o seu tratamento cirúrgico por laminectomia, são ressaltados. O tratamento de escolha é o cirúrgico, laminectomia com dissecção e remoção do hematoma que possibilita a recuperação do paciente. Abstract in english Two cases of spontaneous epidural hematoma of the lumbar region are reported. Some considerations are drawn about the values of the early diagnosis before the incidence of neurological sequela. The clinical and radiological findings and the treatment of these hematomas era discussed. Lumbar puncture and myelography are the best method for the diagnosis. Treatment should be surgical, consisting of laminectomy with total excision of the hematoma.

Ferreira, Rodrigo O. M. F; Barros, José de Araujo; Fonseca, Augusto V. B.; Rocha, Francisco José; Paiva, Paulo Roberto De

1980-09-01

380

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

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

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

1991-06-01

 
 
 
 
381

The outcome of the acute subdural hematoma  

International Nuclear Information System (INIS)

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

1984-01-01

382

Slippery platelet syndromes in subdural hematoma.  

UK PubMed Central (United Kingdom)

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

Akins PT; Guppy KH; Sahrakar K; Hawk MW

2010-06-01

383

Epidural hematoma after ventriculoperitoneal shunt surgery: report of two cases Hematoma epidural após derivação ventriculoperitoneal: relato de dois casos  

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Full Text Available Ventriculoperitoneal shunt operations represent the most used choice for treating hydrocephalus, although some related complications have been reported. Due to its rarity, potential dangers, and mortality rate, we present two cases of epidural hematoma following ventriculoperitoneal shunt, discussing its pathophysiology and prophylaxis.No tratamento cirúrgico da hidrocefalia, a derivação ventriculoperitoneal é a mais usada, porém ocorrem várias complicações e dentre elas o hematoma epidural. Os autores relatam dois casos de hematoma epidural após cirurgia de derivacão ventriculoperitoneal e discutem sua provável fisiopatologia e profilaxia.

CARLOS UMBERTO PEREIRA; MARCUS WAGNER DE SOUZA PORTO; RAFAEL RODRIGUES DE HOLANDA; WELLINGTON TORRES DE ANDRADE

1998-01-01

384

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

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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)

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

385

Delayed presentation of traumatic intraperitoneal bladder rupture  

Energy Technology Data Exchange (ETDEWEB)

A child with urine ascites as a delayed manifestation of post-traumatic intraperitoneal bladder rupture is presented. The diagnosis was suggested by abdominal CT scan and confirmed with a cystogram. While uncommon, late presentation of intraperitoneal bladder rupture following trauma may occur from masking of a primary laceration or development of secondary rupture at the site of a hematoma in the bladder wall. Since CT may be a primary diagnostic study performed following abdominal trauma, the radiologist should be aware of CT findings suggesting bladder rupture and of the possibility of delayed presentation of this injury.

Brown, D.; Magill, H.L.; Black, T.L.

1986-03-01

386

Delayed presentation of traumatic intraperitoneal bladder rupture  

International Nuclear Information System (INIS)

A child with urine ascites as a delayed manifestation of post-traumatic intraperitoneal bladder rupture is presented. The diagnosis was suggested by abdominal CT scan and confirmed with a cystogram. While uncommon, late presentation of intraperitoneal bladder rupture following trauma may occur from masking of a primary laceration or development of secondary rupture at the site of a hematoma in the bladder wall. Since CT may be a primary diagnostic study performed following abdominal trauma, the radiologist should be aware of CT findings suggesting bladder rupture and of the possibility of delayed presentation of this injury. (orig.).

1986-01-01

387

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

International Nuclear Information System (INIS)

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

2010-01-01

388

SURGICAL TREATMENT OF POSTCONTUSION ORBITAL LATE PHASE HEMATOMA: A CASE REPORT  

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Full Text Available The object of the study was to present a successfully performeddecompression of the orbit in orbital hematoma. Male, 51 years of age,sustained the contusion injury of the right eye during his fall on the bath tap.It caused the development of a large orbital hematoma with protrusion,restricted movement of the eyeball, pain, diplopia, folding of the retina due tohematoma pressuring the bulbus oculi and retinal hemorrhages, higherintraocular pressure and impaired visual acuity to 2/60. He wasmedicamentously treated for a month, but the results were not satisfactoryand one month after the injury, anterior-inferior transcutaneous orbitotomywas performed. During the surgical intervention, hematoma and a part oforbital fat tissue were removed. The globe of the eye was retracted and theexophthalmus disappeared immediately after the surgery, while the mobilityof the eye ball, disappearance of retinal folds with gradual receding ofhemorrhage, normal intraocular pressure, abatement of pain and diplopia aswell as the restoration of visual acuity to normal ensued in a few subsequentdays. This study illustrated that decompression of the orbit in orbitalhematoma might be successful even in the late phase, e.g., one monthfollowing the injury. It is assumed that surgical intervention would beperformed by an experienced orbital surgeon.

Milos Jovanovic; Dragan Veselinovic

2005-01-01

389

Acute pancreatitis secondary to intramural duodenal hematoma: Case report and literature review  

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Full Text Available Nontraumatic intramural duodenal hematoma (IDH) is rare disease and it is generally related to coagulation abnormalities. Reports of nontraumatic IDH associated with pancreatic disease are relatively rare, and various conditions including acute or chronic pancreatitis are thought to be associated with nontraumatic IDH. However, the association between IDH and acute pancreatitis remains unknown. We report the case of a 45-year-old man who presented with vomiting and right hypochondrial pain. He had no medical history, but was a heavy drinker. The diagnosis of IDH was established by computed tomography, ultrasonogra