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Sample records for intracranial epidural hematoma

  1. Spontaneous intracranial epidural hematoma during rivaroxaban treatment

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    Ruschel, Leonardo Gilmone; Rego, Felipe Marques Monteiro do; Milano, Jeronimo Buzetti; Jung, Gustavo Simiano; Silva Junior, Luis Fernando; Ramina, Ricardo, E-mail: leonardoruschel@yahoo.com.br [Instituto de Neurologia de Curitiba (INC), Curitiba, PR (Brazil)

    2016-11-15

    According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xarelto®. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban. (author)

  2. Langerhans' cell histiocytosis presenting with an intracranial epidural hematoma

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    Lee, K.-W. [Department of Pediatrics, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); McLeary, M.S. [Div. of Pediatric Radiology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Zuppan, C.W. [Dept. of Pathology, Loma Linda Children' s Hospital and University Medical Center, Loma Linda, CA (United States); Won, D.J. [Div. of Pediatric Neurosurgery, Loma Linda University Children' s Hospital, Loma Linda, CA (United States)

    2000-05-01

    An 8-year-old boy developed vomiting and severe headache following minor head trauma. A CT scan of the head demonstrated a lytic lesion of the skull and adjacent epidural hematoma. Surgical evacuation and removal of the skull lesion and hematoma were carried out, and pathologic evaluation resulted in a diagnosis of Langerhans' cell histiocytosis (LCH). Epidural involvement of Langerhans' cell histiocytosis is very rare, and we report the first case of LCH presenting as an intracranial epidural hematoma. (orig.)

  3. Traumatic epidural hematoma in children.

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    Rocchi, Giovanni; Caroli, Emanuela; Raco, Antonino; Salvati, Maurizio; Delfini, Roberto

    2005-07-01

    The purpose of this study was to investigate the characteristics of childhood acute epidural hematoma and to report our experience in recent years. A series of 35 patients below the age of 15 years treated for acute epidural hematoma at our institution between June 1991 and December 2000 was analyzed in detail. Pediatric epidural hematoma presents both age-related and atypical features when compared with epidural hematoma in adults. In selected cases, prompt surgical evacuation of the hematoma results in an excellent outcome. Outcomes seem to be directly related to the patient's preoperative neurologic status and the presence of associated intracranial lesions.

  4. Bilateral assymetric epidural hematoma

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    Edmundo Luis Rodrigues Pereira

    2015-01-01

    Full Text Available Background: Acute bilateral extradural hematoma is a rare presentation of head trauma injury. In sporadic cases, they represent 0.5-10% of all extradural hematomas. However, higher mortality rates have been reported in previous series. Case Description: The authors described the case of a 28-year-old male presenting head injury, comatose, Glasgow Coma Scale of 6, anisocoric pupils without puppilary light reflex. Computed tomography showed asymmetric bilateral epidural hematomas, effacement of the lateral ventricles and sulci, midline shift and a bilateral skull fracture reaching the vertex. Surgical evacuation was performed with simultaneous hematoma drainage. Patient was discharged on the 29 th postoperative day with no neurological deficit. Conclusion: The correct approach on bilateral epidural hematomas depends on the volume, moment of diagnosis, and neurological deficit level. Simultaneous drainage of bilateral hematomas has been demonstrated to be an effective technique for it, which soon decreases the intracranial pressure and promotes an efficient resolution to the neurological damage.

  5. [A case of acute intracranial epidural hematoma caused by chronic nasal sinusitis].

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    Kihara, Kazunori; Sato, Motoki; Kado, Ken; Fukuda, Kazumasa; Nakamura, Takao; Yamakami, Iwao

    2015-01-01

    Non-traumatic intracranial acute epidural hematoma(EDH)is rare. It is mostly caused by coagulation disorders, dural metastasis, or vascular malformations of the dura. We report a case of non-traumatic acute EDH caused by chronic nasal sinusitis and review the literature comprising 10 cases of acute EDH caused by chronic nasal sinusitis. A 16-year-old boy visited our outpatient clinic with a 2-day history of severe headache. He did not have fever or neurological abnormalities and showed no evidence of head trauma. Cranial computed tomography(CT)revealed sphenoid sinusitis and a small amount of epidural air in the middle fossa, but no other intracranial abnormalities. After eight days with no subsequent history of trauma, radiological exams showed a massive acute epidural hematoma in the left middle fossa and temporal convexity without any vascular lesion or skull fracture. The patient underwent a hematoma evacuation that revealed neither a skull fracture nor a vascular abnormality. In this adolescent, chronic nasal sinusitis caused fragility of the meningeal artery wall, an air collection in the epidural space, and the detachment of the dura mater from the inner surface of the skull, thereby resulting in a non-traumatic acute EDH.

  6. Epidural hematomas of posterior fossa

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    Radulović Danilo

    2004-01-01

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

  7. Rapid resolution of subdural hematoma after targeted epidural blood patch treatment in patients with spontaneous intracranial hypotension

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    Wang Jin; Zhang Dan; Gong Xiangyang; Ding Meiping

    2014-01-01

    Background Subdural hematoma (SDH) is a common complication of spontaneous intracranial hypotension (SIH).To date,the management of SDH caused by SIH remains controversial.In this paper,we reviewed the clinical course of SDH in patients with SIH,and discuss the underlying mechanism and attributing factors for rapid resolution of subdural hematomas after epidural blood patch (EBP) surgery.Methods We retrospectively reviewed a cohort of seventy-eight SIH patients diagnosed and treated with targeted EBP in our neurology center.Patients who received early CT/MRI follow-up after EBP operation were included.Results A series of four cases of SIH complicated with SDHs were evaluated.Early follow-up neuroimages of these patients revealed that SDHs could be partially or totally absorbed just two to four days after targeted epidural blood patch treatment.Conclusion Targeted epidural blood patch can result in rapid hematoma regression and good recovery in some patients with a combination of SDH and SIH.

  8. Rapid natural resolution of intracranial hematoma

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    吴明灿; 刘建雄; 罗国才; 张志文; 闵杰; 余辉; 姚远

    2004-01-01

    Objective:To investigate the clinical characteristics of intracranial hematoma and the mechanism involved in its rapid natural resolution. Methods:Seventeen cases of intracranial hematoma with typical clinical and CT manifestations were retrospectively studied. Results: Intracranial hematoma was found obviously decreased in size within 72 h after its occurrence in 8 cases. The rest 9 cases presented complete resolution. Conclusions: Rapid natural resolution of acute epidural hematoma is mostly found in teenagers and the resolution is correlated with cranial fracture at the hematoma site. As for acute subdural hematoma, its rapid resolution is associated with the transfer of cerebrospinal fluid toward subdural space, the lavage effect, and the compression caused by the increased intracranial pressure or the space left resulting from redistribution of the hematoma in brain atrophy.

  9. Epidural Hematoma in Lacrosse.

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    Rimel, R W; Nelson, W E; Persing, J A; Jane, J A

    1983-03-01

    In brief: Several hours after being hit by a lacrosse stick in the left temporoparietal area slightly anterior to the ear, a lacrosse player was found unresponsive and wrapped in a blanket in his dormitory room. He had not lost consciousness during the game, sat out only five minutes, and completed the game. His Glasgow Coma Scale score was 12 of a possible 15. A CT scan showed an epidural hematoma and a skull fracture. He underwent an immediate left temporoparietal craniotomy and evacuation of the epidural hematoma. He recovered fully and requested permission to return to play six months after the injury. The authors think that an improved lacrosse helmet design would help prevent this type of injury.

  10. Delayed epidural hematoma after mild head injury

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    Radulović Danilo

    2005-01-01

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

  11. Delayed epidural hematoma. A review.

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    Milo, R; Razon, N; Schiffer, J

    1987-01-01

    Since the CT has become the main diagnostic tool in head trauma, more cases of DEDH have become confirmed and published although some have been classified among other entities and under different criteria. This review tries to describe the characteristics of DEDH based on the cases previously published, as well as on three of our own cases. The entity is mainly radiological i.e. appearance of an epidural hematoma in a CT scan following up a previous one which has not shown this pathology. Although not specific, we have found some common features among the cases published. The patients are usually young people. The cause of many injuries is either a fall injury or involvement of a pedestrian in a road accident. Skull fracture under which the DEDH develops is the rule. DEDH is not found in the usual location of the classic epidural hematoma (the temporal fossa). Some of the patients developed DEDH after an earlier neurosurgical operation for evacuation of another traumatic mass lesion for urgent decompression. Others developed DEDH after medical treatment aimed at restoring normal blood pressure or reducing increased ICP. This main group of patients had other associated lesions, mainly intracranial. The others (including our case no. 1) were considered to have a skull fracture associated only with concussion of the brain, as the clinical picture changed or persistent headache developed, another CT scan was indicated and DEDH was then found. This group constitutes those patients in whom the prognosis is expected to be good or excellent. Keeping in mind the necessity for repeated CT scans in this group (we think the number will increase in the future), other patients will benefit from the awareness of the clinician of the importance of this diagnostic tool. CT scan is efficient, accurate and can be repeated at short intervals. It enables a correct diagnosis to be made in nearly 100% of cases of head trauma. Although this liberal use of CT may increase the number of

  12. Spinal and Intracranial Epidural Abscess

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    J Gordon Millichap

    2009-03-01

    Full Text Available Presentation, epidemiology, diagnosis and treatment of spinal epidural abscess (SEA and intracranial epidural abscess (ICEA are reviewed by researchers at The John's Hopkins University School of Medicine, Baltimore, MD, and Universidad de Santander, Columbia.

  13. Invasive and Ultrasound Based Monitoring of the Intracranial Pressure in an Experimental Model of Epidural Hematoma Progressing towards Brain Tamponade on Rabbits

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    Konstantinos Kasapas

    2014-01-01

    Full Text Available Introduction. An experimental epidural hematoma model was used to study the relation of ultrasound indices, namely, transcranial color-coded-Doppler (TCCD derived pulsatility index (PI, optic nerve sheath diameter (ONSD, and pupil constriction velocity (V which was derived from a consensual sonographic pupillary light reflex (PLR test with invasive intracranial pressure (ICP measurements. Material and Methods. Twenty rabbits participated in the study. An intraparenchymal ICP catheter and a 5F Swan-Ganz catheter (SG for the hematoma reproduction were used. We successively introduced 0.1 mL increments of autologous blood into the SG until the Cushing reaction occurred. Synchronous ICP and ultrasound measurements were performed accordingly. Results. A constant increase of PI and ONSD and a decrease of V values were observed with increased ICP values. The relationship between the ultrasound variables and ICP was exponential; thus curved prediction equations of ICP were used. PI, ONSD, and V were significantly correlated with ICP (r2=0.84±0.076, r2=0.62±0.119, and r2=0.78±0.09, resp. (all P<0.001. Conclusion. Although statistically significant prediction models of ICP were derived from ultrasound indices, the exponential relationship between the parameters underpins that results should be interpreted with caution and in the current experimental context.

  14. Sickle cell disease with orbital infarction and epidural hematoma

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

    2001-04-01

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

  15. Spontaneous extracranial decompression of epidural hematoma

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

    2008-03-15

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

  16. Medicolegal cases for spinal epidural hematoma and spinal epidural abscess.

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    French, Keisha L; Daniels, Eldra W; Ahn, Uri M; Ahn, Nicholas U

    2013-01-01

    Spinal epidural hematoma and spinal epidural abscess are rare surgical emergencies resulting in significant neurologic deficits. Making the diagnosis for spinal epidural hematoma and spinal epidural abscess can be challenging; however, a delay in recognition and treatment can be devastating. The objective of this retrospective analysis study was to identify risk factors for an adverse outcome for the provider. The LexisNexis Academic legal search database was used to identify a total of 19 cases of spinal epidural hematoma and spinal epidural abscess filed against medical providers. Outcome data on trial verdicts, age, sex, initial site of injury, time to consultation, time to appropriate imaging studies, time to surgery, and whether a rectal examination was performed or not were recorded. The results demonstrated a significant association between time to surgery more than 48 hours and an unfavorable verdict for the provider. The degree of permanent neurologic impairment did not appear to affect the verdicts. Fifty-eight percent of the cases did not present with an initial deficit, including loss of bowel or bladder control. All medical professionals must maintain a high level of suspicion and act quickly. Physicians who are able to identify early clinical features, appropriately image, and treat within a 48 hour time frame have demonstrated a more favorable medicolegal outcome compared with their counterparts in filed lawsuits for spinal epidural hematoma and spinal epidural abscess cases.

  17. Traumatic and alternating delayed intracranial hematomas

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    Lesoin, F.; Redford, H.; Jomin, M.; Viaud, C.; Pruvo, J.

    1984-11-01

    Repeat computed tomography has enabled us to confirm the concept of delayed hematomas. With this in mind we report two cases of alternating, post-traumatic intracranial hematomas; confirming also the role of tamponade after surgical removal of an intracranial hematoma.

  18. Value of Targeted Epidural Blood Patch and Management of Subdural Hematoma in Spontaneous Intracranial Hypotension: Case Report and Review of the Literature.

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    Rettenmaier, Leigh A; Park, Brian J; Holland, Marshall T; Hamade, Youssef J; Garg, Shuchita; Rastogi, Rahul; Reddy, Chandan G

    2017-01-01

    Spontaneous intracranial hypotension (SIH) is a more common than previously noted condition (1-2.5 per 50,000 persons) typically caused by cerebrospinal fluid (CSF) leakage. Initial treatment involves conservative therapies, but the mainstay of treatment for patients who fail conservative management is the epidural blood patch (EBP). Subdural hematoma (SDH) is a common complication occurring with SIH, but its management remains controversial. In this report, we discuss a 62-year-old woman who presented with a 5-week history of orthostatic headaches associated with nausea, emesis, and neck pain. Despite initial imaging being negative, the patient later developed classic imaging evidence characteristic of SIH. Magnetic resonance imaging was unrevealing for the source of the CSF leak. Radionuclide cisternography showed possible CSF leak at the right-sided C7-T1 nerve root exit site. After failing a blind lumbar EBP, subsequent targeted EBP at C7-T1 improved the patient's symptoms. Two days later she developed a new headache with imaging evidence of worsening SDH with midline shift requiring burr hole drainage. This yielded sustained symptomatic relief and resolution of previously abnormal imaging findings at 2-month follow-up. A literature review revealed 174 cases of SIH complicated by SDH. This revealed conflicting opinions concerning the management of this condition. Although blind lumbar EBP is often successful, targeted EBP has a lower rate of patients requiring a second EBP or other further treatment. On the other hand, targeted EBP has a larger risk profile. Depending on the clinic situation, treatment of the SDH via surgical evacuation may be necessary. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Traumatic cervical epidural hematoma in an infant

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    Vithal Rangarajan

    2013-01-01

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

  20. Spinal epidural hematoma; Spinales epidurales Haematom

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    Papanagiotou, P. [Universitaetsklinikum des Saarlandes, Klinik fuer Diagnostische und Interventionelle Neuroradiologie, Homburg/Saar (Germany)

    2012-05-15

    Spinal epidural hematoma is an accumulation of blood in the potential space between the dura and bone. On unenhanced computed tomography epidural hemorrhage appears as a high-density spinal canal mass with variable cord compression. Magnetic resonance imaging is the modality of choice for evaluating spinal epidural hematoma and can demonstrate the extent of the hematoma and degree of cord compression. When treated surgically the outcome depends on the extent of preoperative neurological deficits and on the operative timing interval. (orig.) [German] Das spinale epidurale Haematom ist eine Blutansammlung zwischen Dura und Knochen. Die klinische Praesentation ist aehnlich dem akuten Bandscheibenvorfall, die Symptomatik ist allerdings in der Regel progredient. In der CT stellt sich ein frisches Haematom hyperdens dar. Die MRT ist die Methode der Wahl zur Diagnose spinaler epiduraler Haematome und kann die Ausdehnung sowie auch das Ausmass der Kompression darstellen. Die wichtigste Differenzialdiagnose vom epiduralen Haematom ist das epidurale Empyem. (orig.)

  1. Postoperative epidural hematoma. Five cases of epidural hematomas developed after supratentorial craniotomy on the contralateral side

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    Sato, M. (Shiga Univ. of Medical Science, Ohtsu (Japan)); Mori, K.; Handa, H.

    1981-10-01

    Postoperative epidural hematomas developed far from the operative field are generally recognized as a complication of ventriculo-peritoneal shunt, ventricular drainage or suboccipital craniotomy. It is very rare but may occur after supratentorial craniotomy on the contralateral side. Five such cases are presented with a review of the relevant literature. The mechanism of this complication is not clearly understood. In hydrocephalus, these massive epidural hematomas are probably caused by dura-skull detachment when the brain volume is strikingly reduced by a decompressive procedure. On rare occasions, pins of head rest may detach the dura and cause epidural hematomas. When sudden brain swelling during craniotomy is encountered, attention should be directed not only to intracerebral hemorrhage but also epidural hematoma developed on the contralateral side.

  2. [A Case of Spinal Epidural Hematoma Presenting with Transient Hemiplegia].

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    Komai, Takanori; Nakashima, Kazuya; Tominaga, Takashi; Nogaki, Hidekazu

    2016-04-01

    We report a rare case of a patient with spinal epidural hematoma who presented with transient hemiplegia. A 90-year-old man awakened from sleep due to sudden neck pain. Fifteen minutes later, the man experienced progressively worsening weakness in his left hand, and was transported in an ambulance to our hospital. At the hospital, he presented with hemiplegia, and we suspected intracranial disease. Therefore, we performed magnetic resonance imaging (MRI), which revealed no intracranial lesions. Shortly after the MRI, the patient showed no signs of hemiplegia. However, since the severe neck pain persisted, we performed cervical MRI, which showed a high-intensity area at the C2-C5 level, predominantly on the left side. Despite recovery from hemiplegia, we performed a laminectomy of C3-C5 with evacuation of a hematoma at the C2-C6 level. After the surgery, the patient had no neck pain.

  3. [Spontaneous epidural hematoma after open heart surgery: case report].

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    Anegawa, S; Hayashi, T; Furukawa, Y; Nagashima, T; Kumate, M

    1999-11-01

    Acute epidural hematoma not associated with head injury is rarely encountered and is known as spontaneous epidural hematoma. To our knowledge, only five cases with epidural hematoma after open-heart surgery have been published. Pathogenesis and preventive measures have not yet been determined. We report a case of such spontaneous epidural hematoma and consider the possible pathogenesis. A 12-year-old female received a radical operation for severe subaortic stenosis. The intraoperative course was uneventful except for massive hemorrhage which was adequately controlled. Postoperatively, she was moved to the CCU still not having aroused from anesthesia. Eleven hours later, it was found that her pupils were fixed and dilated. CT scan demonstrated a huge bifrontal epidural hematoma with disappearance of the basal cistern. Even though immediate emergency evacuation was performed, the patient died of acute brain swelling four days after the operation.

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

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

    2009-02-15

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

  5. Skull infarction and epidural hematomas in a patient with sickle cell anemia.

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    Resar, L M; Oliva, M M; Casella, J F

    1996-11-01

    Epidural hematomas are unusual manifestations of sickling disorders. We report a patient with sickle cell anemia and multiple skull infarctions associated with epidural hematomas. The association of skull infarctions and epidural hematomas in sickling hemoglobinopathies is reviewed. A 14-year-old boy with hemoglobin SS presented with lower back pain, left hip pain, headache, and fever. A bone scan was used to evaluate the patient for possible osteomyelitis. Head computed tomography (CT) and magnetic resonance imaging (MRI) were employed to delineate intracranial pathology. The bone scan showed multiple areas of decreased uptake in the skull consistent with acute infarction before abnormalities were present on physical examination. CT scan showed a bony contour deformity of the right frontal bone, suggestive of infarction. A right frontal extra-axial collection of blood was also observed below the bony abnormality. MRI further delineated bilateral frontal and left parietal collections adjacent to the bony abnormalities consistent with subacute epidural hematomas. This case emphasizes the need to recognize skull infarctions and epidural hematomas as rare but potential complications of sickle cell disease. The diagnosis was facilitated by MRI, which has not been used in previous cases of skull infarctions. Moreover, our patient was successfully managed without surgical intervention.

  6. Bilateral Traumatic Intracranial Hematomas and its Outcome: a Retrospective Study.

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    Pandey, Sharad; Sharma, Vivek; Singh, Kulwant; Pandey, Deepa; Sharma, Mukesh; Patil, Deepak Bhanudas; Shende, Neeraj; Chauhan, Richa Singh

    2017-02-01

    The objective of this study was to evaluate the age distribution, mode of injury, type of hematomas, and their surgical outcome in patients with bilateral traumatic head injuries. The present study included 669 cases of traumatic head injury who presented at the neurosurgery emergency out of which 94 cases had bilateral head injuries from the period of August 2009 to April 2014. The data from the hospital computerized database were retrospectively analysed. Cases of bilateral traumatic head injury included 94 patients out of which 88.29 % (n = 83) were males and 11.70 % (n = 11) were females. Commonest mode of injury was road traffic accident in 56.38 % (n = 53) followed by fall from height in 29.78 % (n = 28). In our study, 25.53 % patients had epidural hematoma (EDH) with intracerebral hematoma (ICH) or contusion (n = 24), followed by EDH with subarachnoid hemorrhage (SAH) in 18.08 % (n = 17). At the time of discharge, all those patients managed conservatively had good Glasgow outcome scale (GOS) while with surgical intervention 58 % patients had good GOS, 19 % had moderate disability, and 9 % remained with severe disability. In cases of bilateral hematomas, EDH is most common and should be managed in neurosurgical emergency. Other combinations of bilateral intracranial hematomas should be managed according to the surgical indication and serial CT imaging.

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

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    Weijun Wang

    2016-01-01

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

  8. Acute cervical epidural hematoma: case report

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    BORGES GUILHERME

    2000-01-01

    Full Text Available A 74 year-old patient with a nocturnal onset of neck and chest pain was brought to an emergency clinic. Physical examination and cardiac assessment were normal. Three hours after the addmittance, a flaccid paralysis of the four limbs supervened. Suspecting of an unusual onset of central nervous system infection, a lumbar puncture was performed, yielding 20 ml of normal cerebrospinal fluid. Thirty oinutes after the puncture, the patient completely regained neurological funcion. He was then referred to a General Hospital where a computed tomography (CT scan was done showing a large cervical epidural bleeding in the posterolateral region of C4/C5 extending to C7/Th1, along with a C6 vertebral body hemangioma. A magnetic resonance imaging revealed the same CT findings. A normal selective angiography of vertebral arteries, carotid arteries and thyreocervical trunk was carried out. Spontaneous spinal epidural hematoma (ASSEH is a rare but dramatic cause of neurological impairment. In this article we report a fortunate case of complete recovery after an unusual spine cord decompression. We also review the current literature concerning diagnosis and treatment of ASSEH.

  9. Longterm surgery of posttraumatic intracranial hematoma

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    Babochkin D.S.

    2012-03-01

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

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

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    Basile Júnior Roberto

    1999-01-01

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

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

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

    2000-01-01

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

  12. Spontaneous Cervical Epidural Hematoma with Hemiparesis Mimicking Cerebral Stroke

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    Mehmet Tiryaki

    2014-01-01

    Full Text Available Aim. Spontaneous cervical epidural hematoma (SCEH is defined as an epidural hematoma that does not have an etiological explanation. The most common site for SCEH is cervicothoracic area. Early diagnosis and treatment are important for prognosis and good results. In this paper, we aimed to present a case who complains of sudden weakness on right extremities imitating cerebral stroke and that neuroimaging reveals spontaneous cervical epidural hematoma. Case. A 72-year-old woman was admitted to our hospital with acute neck pain and loss of strength on right extremities. On neurological examination, the patient had right hemiparesis. PT, aPTT, and INR results were 50.5, 42.8, and 4.8, respectively. Cranial MRI was in normal limits. Spinal MRI revealed a lesion that extends from C4 to C7 located on the right side and compatible with epidural hematoma. The patient was operated after normalization of INR values. Conclusion. Even though SCEH is a rare condition, it can cause severe morbidity and mortality. Early diagnosis and treatment are quiet important for prognosis. SCEH can easily be mistaken for stroke as with other pathologies and this diagnosis should come to mind especially in patients who have diathesis of bleeding.

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

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    M. Bermejo

    2004-11-01

    Full Text Available Introducción: El hematoma epidural secundario a una anestesia neuroaxial es una complicación poco frecuente, pero de gran trascendencia tanto por sus implicaciones clínicas como por las médico legales; según algunos autores su incidencia puede oscilar entre 1/190.000-1/200.000 para las punciones peridurales y 1/320.000 en el caso de las espinales. El aspecto prioritario en su manejo terapéutico es el del diagnóstico y tratamiento precoz, antes de las 6-12 primeras horas. No obstante, en determinados pacientes como en el caso que presentamos puede no ser precisa la cirugía, resolviéndose el cuadro con tratamiento conservador. Caso clínico: Varón de 73 años, ASA IV, con antecedentes de cirrosis con hipertensión portal, hiperesplenismo, EPOC, obesidad, cardiopatía hipertensiva e insuficiencia tricuspídea. Se programa para alcoholización prostática al haber sido desechada la cirugía. En la analítica preoperatoria destacaba una actividad de protrombina del 80% y 90.000 plaquetas. Se realizaron varios intentos fallidos de punción espinal, finalmente fue precisa una anestesia general con ventilación espontánea mediante mascarilla laríngea, propofol, fentanilo y sevoflurano. A las 36 horas, comienza la clínica en forma de dolor intenso lumbar, sin irradiación y arreflexia cutáneo plantar, confirmándose en la RMN la presencia de un hematoma epidural de L1 a L4. Ante la ausencia de paraparesia flácida, afectación esfinteriana u otros signos sensitivo-motores y tras consulta con la Unidad de Raquis y con el Servicio de Neurología se decide tratamiento conservador y actitud expectante en forma de analgesia y monitorización neurológica estricta, clínica y radiológica. Evolucionando favorablemente en los siguientes días. Discusión: Determinadas condiciones clínicas pueden influir en la aparición de un hematoma tras la realización de un bloqueo regional central: heparinas de bajo peso molecular, punciones dificultosas

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

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

    2001-07-01

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

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

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    Halim Tariq

    2008-01-01

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

  16. A spinal epidural hematoma with symptoms mimicking cerebral stroke.

    Science.gov (United States)

    Shima, Hiroshi; Yasuda, Muneyoshi; Nomura, Motohiro; Mori, Kentaro; Miyashita, Katsuyoshi; Tamase, Akira; Kitamura, Yoshihisa; Osuka, Koji; Takayasu, Masakazu

    2012-02-01

    A spontaneous cervical epidural hematoma (SCEH) is a rare condition, which usually requires urgent treatment. However, unusual manifestations, such as hemiparesis, may lead to a misdiagnosis. We herein report a case of SCEH that presented with pure motor hemiparesis to discuss the appropriate and prompt diagnosis and treatment of such cases. An 84-year-old female was brought to our emergency department complaining of nuchal pain, followed by right hemiparesis. A contrast-enhanced computed tomography (CT) scan of the neck demonstrated a spinal epidural hematoma right posterolateral to the spinal cord, extending from C2 to C3. She was managed conservatively and her symptoms improved significantly. The authors emphasize that cervical spinal lesions should be considered in the differential diagnosis for patients with acute onset of hemiparesis, when they are associated with neck pain. Even though magnetic resonance imaging is the gold standard, a CT scan is also useful for quick screening for SCEH.

  17. A Case of Spontaneous Spinal Epidural Hematoma Mimicking Stroke

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    Emine Rabia Koç

    2014-09-01

    Full Text Available Spontaneous spinal epidural hematoma is an uncommon cause of acute non-traumatic myelopathy and may present with various clinical phenotypes. Focal neurological symptoms can result in overlooking this differential diagnosis in patients presenting with neurological deficits and assuming the diagnosis of a stroke. Therefore, a thorough documentation of patient history is of great importance, since this can reveal symptoms suggestive of a different etiology. Here, we present a case of an 80-year-old female who was admitted with a hemiparesis without cortical or cranial neurological abnormalities. She mentioned of preceding shoulder and neck pain. Diagnosis of epidural hematoma was made by cervical magnetic resonance imaging. Symptoms resolved partially after surgical intervention. Our case illustrates the variation in the clinical presentation of spontaneous spinal epidural hematoma which can be misdiagnosed as stroke. Therefore, in patients with preceding neck, shoulder or interscapular pain and focal neurological deficits, this diagnosis should be included in the differential, particularly when cortical and cranial signs are lacking.

  18. MRI findings in spinal subdural and epidural hematomas

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

    2007-10-15

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

  19. Epidural hematoma secondary to sinusitis: a case report and review of the literature.

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    Aviner, Shraga; Olshinka, Noam; Cherniavsky, Evgenia; Forer, Boaz; Bibi, Haim

    2014-02-01

    Epidural hematoma is a potentially life threatening event that demands prompt diagnosis and surgical treatment, usually following head trauma. We present a case of a 9-year-old boy with no history of head trauma, and who was diagnosed with epidural hematoma secondary to frontal sinusitis; and the medical literature was reviewed.

  20. Operative treatment of spontaneous spinal epidural hematomas : a study of the factors determining postoperative outcome

    NARCIS (Netherlands)

    Groen, R J; van Alphen, H A

    1996-01-01

    OBJECTIVE: We clarify the factors affecting postoperative outcomes in patients who have suffered spontaneous spinal epidural hematomas. METHODS: We review 330 cases of spontaneous spinal epidural hematomas from the international literature and three unpublished cases of our own. Attention was focuse

  1. [Acute epidural hematoma with extravasation on cerebral angiogram in an infant (author's transl)].

    Science.gov (United States)

    Oseki, J; Oana, K; Kobayashi, T; Kawada, Y; Kanaya, H

    1977-03-01

    The authors recently operated on a boy four years of age with acute epidural hematoma showing an extravasation on the cerebral angiogram. The hematoma (hematoma volume 125 ml) was evacuated 7 hours after the head injury. The postoperative course was quite uneventful, and he was discharged a month after surgery without any neurologic deficits. The authors reviewed the literature and found 4 cases of acute epidural hematoma with extravasations in infants and children. In all cases the operative results were good. The age incidence and frequency of occurence overall for acute epidural hematomas, extravasations on cerebral angiograms and their mechanism, and the length of time from injury to operation were also discussed. It should be emphasized that, for acute epidural hematoma in infants and children, the early diagnosis and early surgery are essential to save the patients.

  2. MR imaging of epidural hematoma in the lumbar spine

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

    2002-12-01

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

  3. Treatment of cranial epidural hematoma in a neonate by needle aspiration of a communicating cephalhematoma.

    Science.gov (United States)

    Smets, Koenraad Jan; Vanhauwaert, Dimitri

    2010-05-01

    A newborn presented on day 15 of life with an epidural hematoma, extending through a diastatic sutura squamosa in an external cephalhematoma. There was no skull fracture. The cephalhematoma was punctured twice with 24-h interval, reducing both the cephalhematoma and the epidural component. In the absence of neurological signs or symptoms, aspirating a cephalhematoma to evacuate the communicating epidural hematoma in a newborn infant may avoid more invasive surgical intervention.

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

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    Fernando Campos Gomes Pinto

    2003-12-01

    Full Text Available INTRODUCTION: Head trauma is an important consequence of child abuse. Specific pathophysiological mechanisms in child abuse are responsible for the ''whiplash shaken-baby syndrome'', which would favour the occurrence of intracranial hemorrhages. CASE REPORT: We report the case of a child who developed epidural hematoma following minor-intensity head trauma. Initial diagnosis of child abuse was made, but subsequent investigation led to the diagnosis of hemophilia A. CONCLUSION: Even though epidural hematoma is not closely associated with child abuse, this aethiology must always be considered when the reported trauma mechanism is out of proportion to the magnitude of the encountered lesions.INTRODUÇÃO: Traumatismo crânio-encefálico é importante conseqüência de abuso infantil. Mecanismos fisiopatológicos específicos do abuso infantil são responsáveis pela ''whiplash shaken-baby syndrome'', o que favoreceria o aparecimento de hemorragias intracranianas. RELATO DE CASO: Relatamos o caso de uma criança que desenvolveu hematoma extradural após trauma de pequena intensidade. Foi feito diagnóstico inicial de abuso infantil, mas investigações subseqüentes levaram ao diagnóstico de hemofilia A. CONCLUSÃO: Embora o hematoma extradural não esteja intimamente relacionado com abuso infantil, esta etiologia deve ser sempre considerada quando o mecanismo de trauma relatado estiver fora de proporção com as lesões encontradas.

  5. Hemiparesis Caused by Cervical Spontaneous Spinal Epidural Hematoma: A Report of 3 Cases

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    Kinya Nakanishi

    2011-01-01

    Full Text Available We report three cases of spontaneous spinal epidural hematoma (SSEH with hemiparesis. The first patient was a 73-year-old woman who presented with left hemiparesis, neck pain, and left shoulder pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C3–C6 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The second patient was a 62-year-old man who presented with right hemiparesis and neck pain. A cervical MRI scan revealed a right posterolateral dominant epidural hematoma at the C6-T1 level. The condition of the patient improved after laminectomy and evacuation of the epidural hematoma. The third patient was a 60-year-old woman who presented with left hemiparesis and neck pain. A cervical MRI scan revealed a left posterolateral epidural hematoma at the C2–C4 level. The condition of the patient improved with conservative treatment. The classical clinical presentation of SSEH is acute onset of severe irradiating back pain followed by progression to paralysis, whereas SSEH with hemiparesis is less common. Our cases suggest that acute cervical spinal epidural hematoma should be considered as a differential diagnosis in patients presenting with clinical symptoms of sudden neck pain and radicular pain with progression to hemiparesis.

  6. Spontaneous cervical epidural hematoma: a case report and review of the literature; Hematoma epidural cervical espontaneo: a proposito de un caso y revision de la bibligrafia

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    Aparici, F.; Mas, F.; Solera, M. C.; Moro, G. [Hospital Universitario La Fe. Valencia (Spain)

    2002-07-01

    We present the case of a 78-year-old woman with a spontaneous spinal epidural hematoma that presented with sudden interscapular pain accompanied by left hemiparesis and a significant improvement 15 minutes later. Initially diagnosed as angina, the persistence of pain in dorsal cervical spine suggested the need to perform magnetic resonance imaging (MRI). The images demonstrated a lesion in the epidural spinal canal at level C3-D2 that presented a heterogeneous signal intensity, with hyperintense areas in T1-weighted sequences and hypointense areas in gradient-echo sequences, with no sign of compression myelopathy. A diagnosis of epidural hematoma was established and, given the favorable clinical course, conservative treatment was indicated. The second MRI study showed the complete resorption of the epidural hematoma. (Author) 12 refs.

  7. Epidural hematomas after the implantation of thoracic paddle spinal cord stimulators.

    Science.gov (United States)

    Moufarrij, Nazih A

    2016-10-01

    OBJECTIVE There is little information on the frequency of symptomatic epidural hematomas after the implantation of paddle spinal cord stimulators (SCSs) in the thoracic spine. The purpose of this paper is to provide this metric and compare it to the frequency of symptomatic epidural hematomas for all other thoracic laminectomies combined. METHODS This study involved retrospectively analyzing the experience of a single surgeon in a consecutive series of patients who underwent the implantation of a thoracic paddle SCS with respect to the occurrence of a symptomatic epidural hematoma. For comparison, the occurrence of a symptomatic epidural hematoma in non-SCS thoracic laminectomies done during the same period of time was determined. RESULTS One hundred fifty-four thoracic paddle SCSs were implanted between May 2002 and February 2015. Despite perfect hemostasis and no preoperative risk factors, 4 of 154 patients (2.60%) developed postoperative lower-extremity weakness caused by an epidural hematoma. There were no other causes of a neurological deficit. In 3 of the 4 patients, the symptoms were delayed. Over the same time period, only 1 of 119 patients (0.84%) developed a postoperative motor deficit from a symptomatic epidural hematoma after a non-SCS laminectomy. CONCLUSIONS The occurrence of epidural hematomas after thoracic paddle SCS implantation may be underreported. Suggestions are given to decrease its incidence. It seems paradoxical that an epidural hematoma occurred 3 times more often after small SCS thoracic laminectomies than after larger non-SCS thoracic laminectomies. If confirmed by future studies, this finding may suggest that the intrusion of instruments into a confined epidural sublaminar space or the presence of a paddle and a hematoma in this restricted space may account for this differential.

  8. Cervical spontaneous epidural hematoma as a complication of non-Hodgkin's lymphoma.

    Science.gov (United States)

    Mastronardi, L; Carletti, S; Frondizi, D; Spera, C; Maira, G

    1996-01-01

    Epidural hematoma is a rare cause of spinal cord compression, which usually provokes severe neurological deficits. It is presumed to originate from venous or, more probably, arterial bleeding. Thrombocytopenia and other disorders of coagulation may precipitate the onset of epidural hematoma and facilitate the evolution of the disease. We report the case of a patient suffering from a non-Hodgkin's lymphoma with severe thrombocytopenia during a MACOP-B schedule, who presented with a spontaneous cervical epidural hematoma. We discuss the etiopathological aspects, diagnosis, and treatment of this rare cause of acute cervical spinal cord compression.

  9. Hematoma epidural lombar pós-cirurgico em paciente com leucemia: relato de caso Hematoma epidural lumbar posquirúrgico en paciente con leucemia: relato de caso Postoperative lumbar epidural hematoma in a patient with leukemia: case report

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    Wagner Pasqualini

    2012-09-01

    Full Text Available A ocorrência de hematoma epidural como complicação pós-cirúrgica é relativamente baixa. O reconhecimento dessa patologia no diagnóstico diferencial nas paraplegias pós-cirúrgicas imediatas e o tratamento precoce por meio de intervenção cirúrgica com a descompressão do canal são fatores que estão diretamente relacionados à melhora do quadro neurológico. Este relato de caso é de um hematoma epidural no pós-operatório imediato de descompressão por estenose do canal vertebral lombar em paciente com leucemia.La ocurrencia de hematoma epidural, como complicación posquirúrgica, es relativamente baja. El reconocimiento de esa patología, en el diagnóstico diferencial en las paraplejías posquirúrgicas inmediatas y el tratamiento precoz por medio de intervención quirúrgica con la descompresión del canal, son factores que se relacionan directamente con la mejoría del cuadro neurológico. Este relato de caso es de un hematoma epidural en el posoperatorio inmediato, después de descompresión, por estenosis, del canal vertebral lumbar en paciente con leucemia.The occurrence of epidural hematoma as a postoperative complication is relatively low. The recognition of this condition in the differential diagnosis in the immediate postoperative paraplegia and the early surgical decompression are directly related with neurological improvement. We report a case of epidural hematoma in the early postoperative period of surgical decompression of the lumbar spinal canal, in a patient with leukemia.

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

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

    2000-10-01

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

  11. Spontaneous spinal epidural hematoma presenting as paraplegia after cardiac surgery.

    Science.gov (United States)

    Kin, Hajime; Mukaida, Masayuki; Koizumi, Junichi; Kamada, Takeshi; Mitsunaga, Yoshino; Iwase, Tomoyuki; Ikai, Akio; Okabayashi, Hitoshi

    2016-03-01

    An 86-year-old woman was scheduled to undergo aortic valve replacement and coronary artery bypass graft. On postoperative day 3, she developed sudden-onset neck pain followed by weakness in the right arm. Her symptoms worsened with time, and she developed paraplegia. At 60 h after the first complaint, spontaneous spinal epidural hematoma (SSEH) from C2 to C6 with spinal cord compression was diagnosed from a magnetic resonance image of the cervical region. We decided on conservative therapy because operative recovery was impossible. Delayed diagnosis led to grievous results in the present case. When neurological abnormalities follow neck or back pain after open heart surgery, SSEH must be considered in the differential diagnosis. Further, if it is suspected, early cervical computed tomography/magnetic resonance imaging and surgery should be considered.

  12. Acute posterior fossa epidural hematoma in a newborn infant with Menkes disease.

    Science.gov (United States)

    Takeuchi, Satoru; Horikawa, Masahiro; Wakamatsu, Hajime; Hashimoto, Jyunya; Nawashiro, Hiroshi

    2014-02-01

    Epidural hematoma (EDH) in newborn infants is rare compared with other types of intracranial hemorrhages. Furthermore, posterior fossa EDH is extremely rare. We present a case of posterior fossa EDH in an infant with Menkes disease with accessory bones in the occiput. A male infant with a condition diagnosed with Menkes disease by prenatal testing was born at 39 weeks via vacuum extraction. The patient presented with a mild tremor at 2 days after delivery. A brain computed tomography (CT) scan showed an acute EDH in the posterior fossa, extending into the occipitoparietal area. Three-dimensional CT and bone window CT scan revealed several accessory bones, diastasis of 1 accessory suture, a communicated fracture, and a linear fracture in the occipital bone. Furthermore, a bone fragment from a communicated fracture displaced toward the inside. The patient was treated conservatively for EDH because of his good general condition. The hematoma gradually resolved, and his tremor did not recur. We suggest the following mechanism of posterior fossa EDH development in our patient: (1) external force was applied to the occiput inside the birth canal during delivery, resulting in diastasis; (2) a communicated fracture occurred, and a bone fragment displaced toward the inside (linear fracture was caused indirectly by the force); (3) a transverse sinus was injured by the fragment; and (4) EDH developed in both the posterior fossa and supratentorial region. Copper deficiency can also cause fragility of connective tissues, vessels, and bones.

  13. [Intracranial epidural abscess in a newborn secondary to skin catheter].

    Science.gov (United States)

    Fernández, L M; Domínguez, J; Callejón, A; López, S; Pérez-Avila, A; Martín, V

    2001-08-01

    Intracranial epidural abscesses are uncommon lesions, being more frequents in older children and adults. They commonly arise as a result of direct extension of a preexisting infection and rarely present with focal deficit. We present a case of a 11-days old preterm infant who developed an intracranial epidural abscess as a result of an infected scalp vein catheter. The diagnosis was made on the basis of the cranial ultrasound and CT scan images. An identified strain of Enterococcus faecium was cultured from all the samples. The patient underwent a right frontal craniotomy with drainage of the abscess and a 2-week total course of intravenous antibiotics was administrated. CT scan imaging 3 week after the procedure demonstrated no evidence of residual lesion. When present, a scalp vein catheter, in absence of others predisponing factors, must be considered as an etiologic agent for an intracranial epidural abscess in this age-group.

  14. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation

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    Asad ABBAS

    2013-06-01

    Full Text Available How to Cite This Article: Abbad A, Afzal K, Mujeeb AA, Shahab T, Khalid M. Spontaneous Ventral Spinal Epidural Hematoma in an Infant: An Unusual Presentation. Iran J Child Neurol. 2013  Spring;7(2:47-50.Abstract Spontaneous ventral spinal epidural hematomas are extremely rare in children and clinically recognized by the appearance of acute asymmetric focal motor and sensory involvement. In infants, the initial presenting symptoms are very non-specific and irritability is often the only initial manifestation. Appearance of other neurological signs may be delayed up to hours or even days later. In the absence of significant precipitating factors such as severe trauma or previously known coagulopathies,the diagnosis is usually delayed until the full picture of severe cord compression is developed. The diagnosis is finally made by performing magnetic resonance imaging. We report a 5-month-old infant with spinal epidural hematoma who presented with symmetrical upper limb weakness and diaphragmatic involvement to highlight the importance of recognizing the atypical manifestations for early diagnosis andintervention. References:1. Phillips TW, Kling TF Jr, McGillicuddy JE. Spontaneous ventral spinal epidural hematoma with anterior cordsyndrome: report of a case. Neurosurgery 1981;9:440-3.2. Patel H, Boaz JC, Phillips JP, Garg BP. Spontaneous spinal epidural hematoma in children. Pediatr Neurol1998;19:302-7. Review.3. Penar PL, Fischer DK, Goodrich I, Bloomgarden GM, Robinson F. Spontaneous spinal epidural hematoma. IntSurg 1987;72:218-21.4. Noth I, Hutter JJ, Meltzer PS, Damiano ML, Carter LP. Spinal epidural hematoma in a hemophilic infant. Am JPediatr Hematol Oncol 1993;15:131-4. Review.5. Beatty RM, Winston KR. Spontaneous cervical epidural hematoma. A consideration of etiology. J Neurosurg1984;61:143-8.6. Alva NS. Traumatic spinal epidural hematoma of a 10-month-old male: a clinical note. Pediatr Neurol2000;23:88-9. Review.7. Aminoff MJ: Vascular

  15. Intracranial extradural hematoma: Spontaneous rapid decompression - not resolution

    Directory of Open Access Journals (Sweden)

    Abdul Rashid Bhat

    2015-01-01

    Full Text Available The surgical option to evacuate an intracranial extradural hematoma (EDH was postponed in a 2-year-old female child who appeared fully alert and active after a brief spell of unconsciousness following a fall from height. The child was received, with a swelling on and around the right parietal eminence, by the emergency staff just half an hour after the time of injury. The immediate X-ray skull and first computed tomography (CT scan head showed a parietal bone fracture, EDH, and cephalhematoma. However, follow-up CT scan head after about 4΍ h revealed the dramatic absence of EDH but increased size and bogginess of cephalhematoma. The EDH had transported into subgaleal space resulting in a decompression of intracranial compartment in <5 h, thereby preventing surgical intervention but necessitating monitoring, though there was no back flow intracranially.

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

    Science.gov (United States)

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

    2012-12-01

    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.

  17. Estimating the Incidence of Suspected Epidural Hematoma and the Hidden Imaging Cost of Epidural Catheterization: A Retrospective Review of 43,200 Cases

    Science.gov (United States)

    Henneman, Justin P.; Sandberg, Warren S.

    2013-01-01

    Introduction Hematoma associated with epidural catheterization is rare, but the diagnosis might be suspected relatively frequently. We sought to estimate the incidence of suspected epidural hematoma after epidural catheterization, and to determine the associated cost of excluding or diagnosing an epidural hematoma through radiologic imaging. Methods We conducted an electronic retrospective chart review of 43,200 patient charts using 4 distinct search strategies and cost analysis, all from a single academic institution from 2001 through 2009. Charts were reviewed for use of radiological imaging studies to identify patients with suspected and confirmed epidural hematomas. Costs for imaging to exclude or confirm the diagnosis were related to the entire cohort. Results In our analysis, over a 9-year period that included 43,200 epidural catheterizations, 102 patients (1:430) underwent further imaging studies to exclude or confirm the presence of an epidural hematoma—revealing 6 confirmed cases and an overall incidence (per 10,000 epidural blocks) of epidural hematoma of 1.38 (95% CI 0, 0.002). Among our patients, 207 imaging studies, primarily lumbar spine MRI, were performed. Integrating Medicare cost expenditure data, the estimated additional cost over a 9-year period for imaging and hospital charges related to identifying epidural hematomas nets to approximately $232,000 or an additional $5.37 per epidural. Discussion About 1 in 430 epidural catheterization patients will be suspected to have an epidural hematoma. The cost of excluding the diagnosis, when suspected, is relatively low when allocated across all epidural catheterization patients. PMID:23924685

  18. [Iatrogenic cervical epidural hematoma: case report and review of the literature].

    Science.gov (United States)

    Jusué-Torres, I; Ortega-Zufiria, J M; Tamarit-Degenhardt, M; Navarro Torres, R; López-Serrano, R; Riqué-Dormido, J; Aragonés-Cabrerizo, P; Gómez-Angulo, J C; Poveda-Nuñez, P; Jerez-Fernández, P; Del Pozo-García, J M

    2011-08-01

    Around 600 spinal epidural hematoma cases have been previously reported. Incidence of paraplegia after epidural anesthesia varies between 0,0005 and 0,02%. Several possible etiologies have been described in the literature, including surgery, trauma, anticoagulant therapy, arteriovenous malformations, pregnancy and lumbar puncture. Spinal and epidural anesthesic procedures represent the tenth most common cause. But in combination with anticoagulant therapy, the forementioned procedures increase its incidence until reaching the fifth most common etiological group. We report the case of an 80 year-old-man with a cervical epidural hematoma who had a good outcome with conservative management. 80 year-old-man that developed intense cervicalgia with lower limbs weakness showing complete paraplegia and arreflexia 2 hours after analgesic treatment with epidural cervical infiltration for cervicoartrosis. Cervical MRI showed epidural cervical hematoma between C4 and T1 levels. The patient is transferred to our facilities in order to perform surgery. But after showing fast recovery, medical conservative management was elected. After one month, the patient's condition has improved showing no neurological deficits and complete resorption is seen in MRI. Nowadays, trend is to perform surgery in patients with spinal hematoma and significant neurological deterioration during the first hours. However, good neurological outcomes can be achieved with conservative management, in well selected patients with non progressive, incomplete and partial deficits. Presently, we can not predict which is the best treatment for each case.

  19. Proptosis, skull infarction, and retro-orbital and epidural hematomas in a child with sickle cell disease.

    Science.gov (United States)

    Mallouh, A A; Young, M; Hamdan, J; Salamah, M M

    1987-10-01

    A Saudi child with homozygous sickle cell disease (SS) presented with bilateral periorbital swelling, right-sided proptosis, skull bone infarcts, and retro-orbital and epidural hematomas. The findings of skull bone infarcts, retro-orbital and epidural hematomas are rare in patients with sickle cell disease.

  20. Hematoma epidural espinal espontâneo durante a gravidez: registro de um caso

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    Ivan Hack

    1984-03-01

    Full Text Available Registro de caso de paciente no oitavo mês de gestação que desenvolveu hematoma epidural espinal espontâneo dorsolombar. A gravidez, determinando aumento da pressão intra-abdominal e, como consequência, aumento da pressão venosa no plexo epidural, poderia ter sido o fator desencadeante no hematoma- A paciente foi submetida a cirurgia precocemente, porém não apresentou recuperação do déficit sensitivo-motor. São discutidos aspectos clínicos, do tratamento cirúrgico, da evolução e da etiologia dos hematomas epidurals espinais espontâneos.

  1. A newly developed open-end intracranial hematoma drainage tube

    Institute of Scientific and Technical Information of China (English)

    Chao He; Nongnaphat Wanussakul; Dong Yang; Tianya Wu; Ming Zhao

    2016-01-01

    Methods:The newly developed device consists of two parts:the plunger and barrel. On one side, the barrel is bullet shaped with an opening tip. The plunger is located in the middle cavity of the tube barrel and extended out at the open-end. It was designed for strengthening the tube barrel and for convenience in performing the drainage procedure. It can be used by inserting the drainage tube into the lesion and pulling out the plunger, whereby blood will forcefully rise up inside the barrel, providing a satisfactory outcome. It is made for effusion drainage purposes. During the procedure, the drainage tip is placed at the deepest part of the intracranial hematoma to completely drain the blood. Moreover, the plunger fits tightly in the tube, preventing leakage during the operation. With the use of the device, brain can be separated. In addition, the device can help reduce the risk of cerebral damage because of the small operating area. The barrel sidewall has matching opening holes bilaterally and equally for exchanging substances between the inner and outer parts. The overlapping ratio in each horizontal pair is around 1/3–1/2. Each pair on the opposite side will form a different pressure. Thus, the opening holes will not easily get blocked with blood clot. Results: Blood and accumulated liquid from the deepest part of the intracranial hematoma can be directly drawn through the drainage tube without damaging a large area. The tube does not get blocked easily and allows for complete removal of the hematoma. Conclusions:The device is asuitable instrument for clinical application.

  2. Delayed onset of a spinal epidural hematoma after facet joint injection

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    Mirko Velickovic

    2016-10-01

    Full Text Available The treatment of chronic back pain is a challenging problem. Facet joint infiltration is an established treatment for chronic low back pain caused by arthrosis of the lumbar facet joints. Due to the increasing number of patients with chronic low back pain, this therapy has become more frequent. We treated a 51-year-old male patient, who developed an epidural hematoma 2 months after infiltration therapy. Our case shows that even a delayed onset of spinal epidural hematoma is possible and should be kept in mind as a possible cause of acute myelopathy after spinal intervention.

  3. [Acute epidural hematoma of the posterior fossa in a case of von Willebrand's disease].

    Science.gov (United States)

    Takenaka, N; Mine, T; Ikeda, E; Iwai, H; Kusano, S

    1988-01-01

    A rare case of acute epidural hematoma of the posterior fossa associated with von Willebrand's disease is reported. A 9-year-old boy fell down and hit his occipital region against a floor. Soon after he came home and slept, but three hours later he began to vomit and became drowsiness. He visited our hospital and his Glasgow Coma Scale showed 13 points. CT scan on admission showed acute epidural hematoma of left posterior fossa and contusional hematoma in the right temporal lobe. The bleeding time was over 18 minutes. He had been suspected to be suffering from von Willebrand's disease two years ago. Then fresh blood, fresh frozen plasma and anti-hemophilic globulin were prepared. Ten hours after injury, the operation was begun. Fresh epidural hematoma existed as a clot beyond transverse sinus. During the procedure of dural tenting suture, diffuse bleeding from bone, muscle, subcutaneous tissue and dura occurred and it was difficult to stop the bleeding. By using fresh blood and anti-hemophilic globulin, the bleeding was controlled, and then the operation was achieved. In the postoperative course a new epidural hematoma was found in the left temporal region and a new but asymptomatic retinal hemorrhage was found in his right eye. He was discharged without any neurological deficits 25 days after operation.

  4. Emergency department skull trephination for epidural hematoma in patients who are awake but deteriorate rapidly.

    Science.gov (United States)

    Smith, Stephen W; Clark, Michael; Nelson, Jody; Heegaard, William; Lufkin, Kirk C; Ruiz, Ernest

    2010-09-01

    Blunt head trauma patients who have been alert but are deteriorating (talk and deteriorate [T&D]) due to a rapidly expanding epidural hematoma (EDH) usually have poor outcome if they must wait for hospital transfer for evacuation. We therefore have continued to teach skull trephination to emergency physicians (EPs). We are unaware of any literature on EP trephination for EDH in the age of computed tomography (CT) scanning. Patients with EDH from blunt trauma, either in our institution or known to our graduate network, who were T&D with anisocoria despite intubation plus medical therapy, and who had pre-transfer EP trephination, were compared to those who were transferred without trephination. There were 5 patients with blunt trauma and CT-proven EDH who were T&D with anisocoria who underwent Emergency Department (ED) trephination at outlying hospitals before transfer. All 5 had improvement in condition and good outcomes. Three had complete recovery without disability and 2 others had mild disability with good cognitive function. None had complications. Two patients with T&D and anisocoria were transferred without trephination. Both had good neurologic outcomes. The mean time to pressure relief in the trephination group vs. transfer group was 55 vs. 207 min, respectively. In T&D patients with CT-proven EDH and anisocoria, ED skull trephination before transfer resulted in uniformly good outcomes without complications. Time to relief of intracranial pressure was significantly shorter with trephination. Neurologic outcomes were not different. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. Spinal Epidural Hematoma Following Cupping Glass Treatment in an Infant With Hemophilia A.

    Science.gov (United States)

    Fruchtman, Yariv; Dardik, Rima; Barg, Assaf Arie; Livnat, Tami; Feldman, Zeev; Rubinstein, Marina; Grinberg, Gahl; Rosenberg, Nurit; Kenet, Gili

    2016-06-01

    A 6 months old infant, diagnosed with a rare mutation causing severe hemophilia A, presented with spinal epidural hematoma. Parents later admitted the infant had glass cupping therapy performed within 2 weeks of the onset of symptoms. The rare mutation, rare bleeding complication, and the eventual course of therapy applied in this case will be discussed in our case report.

  6. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

    OpenAIRE

    Han-Song Sheng; Chao-Guo You; Liang Yang; Nu Zhang; Jian Lin; Fen-Chun Lin; Mao-De Wang

    2017-01-01

    Purpose: Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy. Methods: We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our department...

  7. Spontaneous Cervico-Thoracic Spinal Epidural Hematoma in an Elderly Patient: A Rare Presentation

    Directory of Open Access Journals (Sweden)

    Reyaz Ahmed Para,Muzamil Latief,Huma Noor

    2013-08-01

    Full Text Available Spontaneous spinal epidural hematoma (SSEH is a rare entity.SSEH is an accumulation of blood in the vertebral epidural space in the absence of trauma or iatrogenic procedure like lumbar puncture.The incidence of SSEH has been estimated at 0.1 patients per 100,000 individuals and represents less than 1% of spinal space-occupying lesions .Here we are presenting case of a 65year old female hypertensive on treatment with controlled blood pressure, who presented with sudden onset paraplegia and weakness of muscles of hand, associated with urinary and bowel incontinence that started 6 hours before presenting to Emergency Room .Patient was subjected to MRI spine that revealed a collection in spinal epidural space ,hypointense in T1W images and hyperintense in T2W images, extending from C6-C7 to T1-T2 suggestive of acute / subacute epidural hematoma (fig 1.In our case all possible causes of an epidural haematoma were ruled out by relevant investigations.Patient was subjected to surgical evacuation of hematoma after 48 hours of presentation.Perioperative and Postoperative period was uneventfull . Sensations over involved areas improved. Motor weakness also improved from Grade III to Grade IV+ in bilateral lower limbs and from Grade II to Grade IV in small muscles of hand and triceps, however Patient persisited with urinary incontinence.CONCLUSION: When a patient receiving anticoagulant therapy complains of sudden and unexplained neck or back pain, we should suspect the possibility of SSEH. For early diagnosis, immediate MRI is essential .In addition, we should consider SSEH as one of the important differential diagnoses in elderly patients who have developed acute myelopathy. [Natl J Med Res 2013; 3(4.000: 424-427

  8. Drug interaction as cause of spontaneously resolving epidural spinal hematoma on warfarin therapy

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    Amitabh Sagar

    2010-01-01

    Full Text Available We present a case of a 42-year-old male, an old case of deep vein thrombosis on warfarin and other drugs like quetiapine, aspirin, diclofenac sodium, fenofibrate, atorvastatin, propanolol and citalopram for concurrent illnesses, who presented with widespread mucocutaneous bleeding and epidural spinal hematoma. The epidural bleed presented clinically as a nontraumatic, rapidly improving myeloradiculopathy. Magnetic resonance imaging (MRI of the spine revealed an epidural hematoma at D12-L1 level. The case was managed conservatively due lack of neurosurgical facilities. The patient gained full neurological recovery on conservative management alone. This case highlights the problem of drug interaction on warfarin therapy and also an unusual spontaneous recovery of spinal hematoma. Our case was anticoagulated in the recommended therapeutic INR range of 2.2 to 2.4. Most of the similar cases reported in literature were also anticoagulated in the therapeutic range. Thus intraspinal hemorrhage is a rare but dangerous complication of anticoagulant therapy. It must be suspected in any patient on anticoagulant agents who complains of local or referred spinal pain associated with neurological deficits. Drug interactions with warfarin are common. High suspicion and immediate intervention are essential to prevent complications from intraspinal hemorrhage.

  9. Local skull trephination before transfer is associated with favorable outcomes in cerebral herniation from epidural hematoma.

    Science.gov (United States)

    Nelson, James A

    2011-01-01

    The patient with epidural hematoma and cerebral herniation has a good prognosis with immediate drainage, but a poor prognosis with delay to decompression. Such patients who present to nonneurosurgical hospitals are commonly transferred without drainage to the nearest neurosurgical center. This practice has never been demonstrated to be the safest approach to treating these patients. A significant minority of emergency physicians (EPs) have advised and taught bedside burr hole drainage or skull trephination before transfer for herniating patients. The objective of this study was to assess the effect of nonneurosurgeon drainage on neurologic outcome in patients with cerebral herniation from epidural hematoma. A structured literature review was performed using EMBASE, the Cochrane Library, and the Emergency Medicine Abstracts database. No evidence meeting methodologic criteria was found describing outcomes in patients transferred without decompressive procedures. For patients receiving local drainage before transfer, 100% had favorable outcomes. Although the total number of patients is small and the population highly selected, the natural history of cerebral herniation from epidural hematoma and the best available evidence suggests that herniating patients have improved outcomes with drainage procedures before transport. © 2010 by the Society for Academic Emergency Medicine.

  10. Spontaneous cervical epidural hematomas with acute hemiparesis should be considered a contraindication for intravenous thrombolysis: a case report with a literature review of 50 cases.

    Science.gov (United States)

    Ito, Hirotaka; Takai, Keisuke; Taniguchi, Makoto

    2014-01-01

    We herein report the case of a 63-year-old woman with an acute spontaneous cervical epidural hematoma who presented with acute hemiparesis and was successfully managed with surgery. Based on a literature review of 50 cases of spontaneous cervical epidural hematomas, we concluded that the relatively high frequency of hemiparesis (12 of 50 cases, 24%) is the result of the fact that epidural hematomas are predominantly distributed dorsolaterally in the region of the mid and lower cervical spine, leading to unilateral cervical cord compression. Clinicians should keep in mind that acute hemiparesis can be caused by spontaneous cervical epidural hematomas for which intravenous thrombolysis is contraindicated.

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

    Science.gov (United States)

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

    2014-03-01

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

  12. Hypertensive intracranial hematomas: endoscopic-assisted keyhole evacuation and application of patent viewing dissector

    Institute of Scientific and Technical Information of China (English)

    邱永明; 林毅兴; 田鑫; 罗其中

    2003-01-01

    Objective To study the effect of endoscopic-assisted keyhole operation (EAKO) on treating hypertensive intracranial hematomas and the value of our patent dissector appli ed during the operation.Methods A total of 25 patients with hypertensive intracranial hematomas underwent endos copic-assisted keyhole evacuation, during which, the viewing dissector, which h ad recently achieved national patent, was connected to the tip of endoscope and used to help dissect hematomas. The outcome of this procedure were compared wit h those of 22 comparable cases undergone conventional surgical treatment (large or smaller craniotomy). The items for comparison included the volum e of remaining hematoma, the duration of operation, postsurgical Glasgow Coma Sc ale (GCS) and Glasgow Outcome Scale (GOS).Results Remaining hematoma was ascertained 48 h after operation with the use of computerized tomography (CT) scans. In the case of EAKO, nearly complete evacuation (>84%) was achieved in 21 cases; GCS was evaluated at 7 d postsurgery result ing in GCS >12 in 9 patients, GCS 9-12 in 12 patients and GCS <9 in 4 patients. The follow-up period ranged from 6 to 21 mon. GOS was estimated at half a year and good recovery rate as defined by GOS was assigned to 76% of the EAKO pa tients. There are significant differences in the volumes of remaining hematomas and the duration of operation between the EAKO and craniotomy group (P<0.0 5). In addition, better clinical outcomes were obtained in EAKO. Conclusion EAKO has the advantage of being minimally invasive, improving surgical results and the prognosis of hypertensive intracranial hematoma patients. We conclude th at keyhole operation is a safe, effective alternative for removal of hypertensiv e intracranial hematoma, particularly during acute stages.

  13. [Correction of intracranial pressure in patients with traumatic intracranial hemorrhages].

    Science.gov (United States)

    Virozub, I D; Chipko, S S; Chernovskiĭ, V I; Cherniaev, V A

    1986-01-01

    Therapeutical correction of intracranial pressure changes were conducted in 14 patients suffering from traumatic intracranial hematomas by endolumbar administration of physiological solution. The distinguishing feature of this method is the possibility of continuous control of the intracranial pressure level by means of long-term graphic recording of epidural pressure. This makes it possible to perform endolumbar administration of physiological solution in a dose which is determined by the initial level of epidural intracranial pressure. Therapeutic correction of intracranial pressure by endolumbar injection of physiological solution proved successful in the initial stages of dislocation of the brain and in stable intracranial hypotension.

  14. Low pressure traumatic epidural hematoma in a child with a prior hemispherectomy: Case report

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    Fassil B Mesfin

    2015-01-01

    Full Text Available A 2½-year-old male child with a prior history of a left anatomic hemispherectomy to treat refractory epilepsy fell down two steps, striking his head on the ipsilateral side of the hemispherectomy. He presented with non-consolable crying and emesis. CT scan of the head demonstrated a left frontal epidural hematoma beneath the site of his prior craniectomy. The patient was initially treated by close observation. However, due to an increase in the hematoma from 29.5 to 49.3 ml over a 12-hour period along with the patient′s lack of clinical improvement, surgical evacuation was performed. Intraoperatively, the source of the hemorrhage was found to be the skull fracture. Postoperatively, he returned to his neurologic baseline and was discharged home on postoperative day 3.

  15. Pin-site epidural hematoma: A catastrophic complication of cranial fixation in a child

    Directory of Open Access Journals (Sweden)

    Prasad Krishnan

    2016-01-01

    Full Text Available Cranial fixation with pins is a routine adjunct in neurosurgery and is usually considered safe. A rarely reported complication is skull fracture at the pin site and consequent epidural hematoma. Usually, these are picked up only postoperatively and rarely, intraoperatively if there is unexplained “brain bulge” in which case the operation should be terminated and urgent imaging has to be done. We describe such a complication that occurred while operating on a 12-year-old child with a posterior fossa tumor and review the available literature dealing with such events.

  16. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients.

    Science.gov (United States)

    Sheng, Han-Song; You, Chao-Guo; Yang, Liang; Zhang, Nu; Lin, Jian; Lin, Fen-Chun; Wang, Mao-De

    2017-08-01

    Posterior fossa epidural hematomas (PFEDH) are uncommon in children but usually require timely surgical intervention due to the risk of life-threatening brainstem compression. We attempt to make the surgical procedure less invasive by treating selected pediatric patients with trephination mini-craniectomy. We retrospectively reviewed the clinical courses, radiological findings, surgical procedures, and prognoses of the pediatric patients who were treated in our departments for traumatic PFEDH from January 2010 to January 2015. During this period, a total of 17 patients were surgically treated for PFEDH and 7 were managed with trephination mini-craniectomy for hematoma evacuation. The outcomes were good in all 7 patients as evaluated with Glasgow Outcome Score. There was no mortality in this series. The on average 30-month clinical follow-up showed that patients experienced satisfactory recoveries without complications. Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects. Copyright © 2017 Daping Hospital and the Research Institute of Surgery of the Third Military Medical University. Production and hosting by Elsevier B.V. All rights reserved.

  17. Orbital compression syndrome complicated by epidural hematoma and wide cephalohematoma in a patient with sickle cell disease.

    Science.gov (United States)

    Ilhan, Nilufer; Acipayam, Can; Aydogan, Fusun; Atci, Nesrin; Ilhan, Ozgur; Coskun, Mesut; Daglioglu, Mutlu Cihan; Tuzcu, Esra Ayhan

    2014-04-01

    Orbital wall infarctions resulting in orbital and epidural hematomas are rare manifestations of sickle cell disease (SCD). We report orbital compression syndrome associated with an epidural hematoma and wide cephalohematoma in a 15-year-old boy with SCD. An infarcted orbital bone was observed on magnetic resonance imaging and three-phase bone scintigraphy with Technetium-99m methylene diphosphonate. The patient recovered completely without surgical intervention at the end of the fourth week. Prompt diagnosis and proper management are critical for complete recovery. Copyright © 2014 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.

  18. Postoperative epidural hematoma contributes to delayed upper cord tethering after decompression of Chiari malformation type I

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    Antonio Lopez-Gonzalez

    2014-01-01

    Full Text Available Background: Symptomatic arachnoiditis after posterior fossa surgical procedures such as decompression of Chiari malformation is a possible complication. Clinical presentation is generally insidious and delayed by months or years. It causes disturbances in the normal flow of cerebrospinal fluid and enlargement of a syrinx cavity in the upper spinal cord. Surgical de-tethering has favorable results with progressive collapse of the syrinx and relief of the associated symptoms. Case Description: A 30-year-old male with Chiari malformation type I was treated by performing posterior fossa bone decompression, dura opening and closure with a suturable bovine pericardium dural graft. Postoperative period was uneventful until the fifth day in which the patient suffered intense headache and progressive loose of consciousness caused by an acute posterior fossa epidural hematoma. It was quickly removed with complete clinical recovering. One year later, the patient experienced progressive worsened of his symptoms. Upper spinal cord tethering was diagnosed and a new surgery for debridement was required. Conclusions: The epidural hematoma compressing the dural graft against the neural structures contributes to the upper spinal cord tethering and represents a nondescribed cause of postoperative fibrosis, adhesion formation, and subsequent recurrent hindbrain compression.

  19. Progressive Epidural Hematoma in Patients with Head Trauma: Incidence, Outcome, and Risk Factors

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    Hao Chen

    2012-01-01

    Full Text Available Progressive epidural hematoma (PEDH after head injury is often observed on serial computerized tomography (CT scans. Recent advances in imaging modalities and treatment might affect its incidence and outcome. In this study, PEDH was observed in 9.2% of 412 head trauma patients in whom two CT scans were obtained within 24 hours of injury, and in a majority of cases, it developed within 3 days after injury. In multivariate logistic regression, patient gender, age, Glasgow Coma Scale (GCS score at admission, and skull fracture were not associated with PEDH, whereas hypotension (odds ratio (OR 0.38, 95% confidence interval (CI 0.17–0.84, time interval of the first CT scanning (OR 0.42, 95% CI 0.19–0.83, coagulopathy (OR 0.36, 95% CI 0.15–0.85, or decompressive craniectomy (DC (OR 0.46, 95% CI 0.21–0.97 was independently associated with an increased risk of PEDH. The 3-month postinjury outcome was similar in patients with PEDH and patients without PEDH (χ2=0.07, P=0.86. In conclusion, epidural hematoma has a greater tendency to progress early after injury, often in dramatic and rapid fashion. Recognition of this important treatable cause of secondary brain injury and the associated risk factors may help identify the group at risk and tailor management of patients with TBI.

  20. Early diagnosis and treatment of acute or subacute spinal epidural hematoma

    Institute of Scientific and Technical Information of China (English)

    YU Hang-ping; FAN Shun-wu; YANG Hui-lin; TANG Tian-si; ZHOU Feng; ZHAO Xing

    2007-01-01

    Background Despite low morbidity, acute or subacute spinal epidural hematoma may develop quickly with a high tendency to paralysis. The delay of diagnosis and therapy often leads to serious consequences. In this study we evaluated the effects of a series of methods for the diagnosis and treatment of the hematoma in 11 patients seen in our hospital.Methods Of the 11 patients (8 males and 3 females), 2 had the hematoma involving cervical segments, 2 cervico-thoracic, 4 thoracic, 1 thoraco-lumbar, and 2 lumbar. Three patients had quadriplegia, including one with central cord syndrome; another had Brown-Sequard's syndrome; and the other seven had paraplegia. Five patients were diagnosed at our hospitals within 3-48 hours afterappearance of symptoms, and 6 patients were transferred from community hospitals within 21-106 hours after development of symptoms. Key dermal points, key muscles and the rectal sphincter were determined according to the American Spinal Injury Society Impairment Scales as scale A in two patients,B in 5 and C in 4. Emergency MRI in each patient confirmed that the dura mater was compressed in the spinal canal, with equal intensity or hyperintensity on T1 weighted image and mixed hyperintensity on T2 weighted image. Preventive and curative measures were taken preoperatively and emergency operation was performed in all patients. Open laminoplasty was done at the cervical and cervico-thoracic segments, laminectomy at the thoracic segments, laminectomy with pedicle screw fixation at the thoraco-lumbar and lumbar segments involving multiple levels, and double-sided laminectomy with the integrity of articular processes at the lumbar segments involving only a single level. During the operation, special attention was given to hematoma evacuation, hemostasis and drainage tube placement.Results Neither uncontrollable hemorrhage nor postoperative complications occurred. All patients were followed up for 1-6 years. A marked difference was noted between

  1. Individual idea about the micro-invasive aspiration and drainage of intracranial hematoma

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    AIM:This study aimed to expound the individual idea of micro-invasive surgery from pre-operative preparation,intra-operative processing and post-operative management.METHODS:Pre-operative preparation was improved by analyzing pathological factors and hematoma property,and considering patients' age,basic disease,blood pressure control,with persistent haemorrhagia/rehaemorrhagia or not,operative occasion choice,positioning and other procedures.In the surgery,positioner was used.Initial aspiration volume was cautiously controlled.After operation,vital signs of patients were kept stable by cautiously using hematoma liquefacient and combining with free radical scavenger.RESULTS:The core content of individual micro-invasive surgery was mainly to relieve intracranial pressure.Under the condition of sufficient pre-operative preparation known by patients' family members,precise positioning was determined and individual therapeutic regimen was made.Meanwhile,caution should be taken in hematoma aspiration.Liquefaction and drainage should be paid more attention,and complications were processed actively.CONCLUSION:During the process of micro-invasive evacuation of intracranial hematoma for treating cerebral hemorrhage,attention should be paid to analyzing cerebral hematoma etiology and pathophysiological mechanism,and individual idea should be considered in surgical treatment aiming at patients' concrete disease condition.

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

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    Park, Hyeon Seon; Lee, Sang Ho; Lie, Wei Chiang; Park, Jee Young [Wooridul Spine Hospital, Seoul (Korea, Republic of); Lee, Sang Yeun [Chuk Spine Hospital, Seoul (Korea, Republic of)

    2006-11-15

    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.

  3. Spontaneous spinal epidural hematoma with hemiparesis mimicking acute cerebral infarction: Two case reports

    Science.gov (United States)

    Matsumoto, Hiroaki; Miki, Takanori; Miyaji, Yuki; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Yoshida, Yasuhisa; Yamaura, Ikuya; Matsumoto, Shigeo; Natsume, Shigeatsu; Yoshida, Kozo

    2012-01-01

    Context Acute hemiparesis is a common initial presentation of ischemic stroke. Although hemiparesis due to spontaneous spinal epidural hematoma (SSEH) is an uncommon symptom, a few cases have been reported and misdiagnosed as cerebral infarction. Design Case reports of SSEH with acute hemiparesis. Findings In these two cases, acute stroke was suspected initially and administration of intravenous alteplase therapy was considered. In one case, the presentation was neck pain and in the other case, it was Lhermitte's sign; brain magnetic resonance imaging (MRI) and magnetic resonance angiography were negative for signs of ischemic infarction, hemorrhage, or arterial dissection. Cervical MRI was performed and demonstrated SSEH. Conclusion Clinicians who perform intravenous thrombolytic treatment with alteplase need to be aware of this possible contraindication. PMID:22925753

  4. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

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    Tsuyoki Minato

    2016-01-01

    Full Text Available We present a rare case of spinal epidural hematoma (SEH after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case.

  5. Spinal Epidural Hematoma after Thoracolumbar Posterior Fusion Surgery without Decompression for Thoracic Vertebral Fracture

    Science.gov (United States)

    Minato, Tsuyoki; Miyagi, Masayuki; Saito, Wataru; Shoji, Shintaro; Nakazawa, Toshiyuki; Inoue, Gen; Imura, Takayuki; Minehara, Hiroaki; Matsuura, Terumasa; Kawamura, Tadashi; Namba, Takanori; Takahira, Naonobu; Takaso, Masashi

    2016-01-01

    We present a rare case of spinal epidural hematoma (SEH) after thoracolumbar posterior fusion without decompression surgery for a thoracic vertebral fracture. A 42-year-old man was hospitalized for a thoracic vertebral fracture caused by being sandwiched against his back on broken concrete block. Computed tomography revealed a T12 dislocation fracture of AO type B2, multiple bilateral rib fractures, and a right hemopneumothorax. Four days after the injury, in order to promote early orthostasis and to improve respiratory status, we performed thoracolumbar posterior fusion surgery without decompression; the patient had back pain but no neurological deficits. Three hours after surgery, he complained of acute pain and severe weakness of his bilateral lower extremities; with allodynia below the level of his umbilicus, postoperative SEH was diagnosed. We performed immediate revision surgery. After removal of the hematoma, his symptoms improved gradually, and he was discharged ambulatory one month after revision surgery. Through experience of this case, we should strongly consider the possibility of preexisting SEH before surgery, even in patients with no neurological deficits. We should also consider perioperative coagulopathy in patients with multiple trauma, as in this case. PMID:26989542

  6. 儿童外伤性颅内血肿某些临床特点(附145例分析)%Some Clinical Characteristics of Traumatic Intracranial Hematoma in Children

    Institute of Scientific and Technical Information of China (English)

    岳武; 杨世春; 李毅

    1984-01-01

    1.Among traumatic intracranial hematomas,epidural hematoma which is often seen in cases of skull fracture,has a higher incidence and is more frequent in older children than in infants.The incidence of subdural hematoma which is higher in infants decreases progressively with the advance of age.Intracerebral hematoma is a condition which dep.ressed skull fracture is often complicated with.2.As intracranial hematoma displays few haracteristics,diagnosis is mainly based on the progressive disturbance of consciousness.Its early manifestations include severe posttraumatic headache,frequent vomiting,rest Iness,progressive deterioration of consciousness,and early changes of vital signs.3.The mortality rate in this series is 31% (45 cases).The main factors are the tempo of formation of intracranial hematoma,preoperative condition of consciousness,compound injury,types of hematoma,the delay of operation,postoperative duration and complications.%@@ 我院自1960~1983年5月共收治小儿外伤性颅内血肿145例,占同期外伤性颅内血肿的12.7%.本组死亡率为31%(45例).本文就儿童外伤性颅内血肿某些临床特点:颅内血肿类型与年龄关系,临床特征及影响死亡率主要因素进行讨论.

  7. First aid treatment of critically acute epidural hematoma complicated by cerebral hernia using cranial trepanation and drainage decompression: a report of 16 cases

    Institute of Scientific and Technical Information of China (English)

    陈宁

    2002-01-01

    @@From October 1997 to February 2000, 16 cases of critically acute epidural hematoma (CAEH) complicated by cranial hernia were treated with cranial trepanation and drainage decompression (CTDD), which was used as the first aid treatment before craniotomy and evacuation of hematoma. Satisfactory results were obtained.

  8. 颅脑损伤患者术后迟发性颅内血肿的影响因素研究%Influencing Factors of Delayed Traumatic Intracranial Hematoma in Postoperative Traumatic Brain Injury Patients

    Institute of Scientific and Technical Information of China (English)

    马一鸣

    2016-01-01

    Objective To analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Methods A total of 264 traumatic brain injury patients were selected in the Second people′s Hospital of Neijiang from June 2010 to June 2015,all of them received emergency evacuation of intracranial hematoma,thereinto 37 patients complicated with delayed traumatic intracranial hematoma were served as observation group,other 227 patients did not complicated with delayed traumatic intracranial hematoma were served as control group. Self - made EXCEL table was used to collect related clinical data,including gender,age,injury mechanism(including accelerated injury and decelerated injury), the first examination time of CT,severity of traumatic brain injury,incidence of patulous injury,incidence of contusion and laceration of brain,incidence of skull fracture,hematoma locations( including epidural hematoma,subdural hematoma and intracerebral hematoma ), hematoma volume, blood pressure ( including SBp and DBp ), FBG, coagulation markers (including pT,TT,ApTT,FIB and pLT),duration between admission and operation,and the proportion of decompressive craniectomy,unconditional multivariate logistic regression analysis was used to analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Results Univariate analysis showed that,no statistically significant differences of gender,age,injury mechanism,the first examination time of CT,incidence of patulous injury, incidence of intracerebral hematoma,hematoma volume,SBp,pT,FIB or pLT was found between the two groups;severity of traumatic brain injury of observation group was statistically significantly more severe than that of control group,incidence of contusion and laceration of brain, of skull fracture, of epidural hematoma, of subdural hematoma, DBp, FBG andthe proportion of decompressive craniectomy of observation group were

  9. Intracranial subdural hematoma after spinal anesthesia for cesarean section: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Uma Srivastava

    2014-01-01

    Full Text Available Subdural hematoma (SDH is a rare but serious complication of spinal anesthesia. We report a case of intracranial SDH in a patient developing 11 days after spinal anesthesia for cesarean section. The patient complained of headache on the 2nd post-operative day that was relieved by analgesics, bed rest and hydration. Later she presented with severe headache, vomiting, dizziness, dysarthria, irritability and somnolence. Diagnosis of the left sided SDH was confirmed radiologically and treated surgically. The patient recovered completely. The report highlights the need of considering the possibility of SDH in patients when postdural puncture headache is prolonged or recurs after a headache free period with neurological symptoms.

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

    Directory of Open Access Journals (Sweden)

    Asdrúbal Falavigna

    2010-09-01

    Full Text Available We report two cases of spontaneous spinal epidural hematoma with different clinical presentations without precipitating factors and a brief review of the literature. Our case first developed acute and had progressive cervical spinal cord signs that determined emergency decompressive laminectomy. On the other hand, the second patient, who was chronic, was operated almost five months after the initial symptoms and the radiological diagnosis was a large facet cyst. Early surgical intervention is the chosen treatment for spontaneous spinal epidural hematomas. Spinal surgeons should bear in mind that spontaneous spinal epidural hematomas may have different clinical presentations according to their location in order to perform a differential diagnosis.Fueron relatados dos casos de hematoma epidural espinal espontáneo con diferentes presentaciones clínicas sin factores precipitantes, y fue hecha una breve revisión de la literatura. Nuestro caso 1 tuvo un desarrollo agudo y mostró señales progresivas en la columna cervical que determinaron una laminectomía descompresiva de emergencia. Por otro lado, el segundo paciente, crónico, fue operado casi cinco meses después de los síntomas iniciales y el diagnóstico radiológico fue de un gran quiste sinovial. La intervención quirúrgica temprana es el tratamiento de elección para hematomas espontáneos epidurales espinales. El tratamiento quirúrgico representa la forma más común de terapia para todos los tipos de presentaciones clínicas. Debemos considerar que el tratamiento conservador (o no sea más común en casos de presentación leve, principalmente en pacientes con hematoma espinal crónico. Para realizar un diagnóstico diferencial, los cirujanos deben recordar que los hematomas epidurales espinales espontáneos pueden tener distintas presentaciones clínicas según su ubicación.Os autores relatam dois casos de hematoma epidural espinhal espontâneo com diferentes apresentações cl

  11. Intracranial hematoma

    Science.gov (United States)

    ... daughter got kicked in the head during a soccer game. She seemed fine at the time, but ... of the people (full-grown adolescents versus young children), and the forces involved (such as impact with ...

  12. Intracranial Hematoma

    Science.gov (United States)

    ... so anytime you drive or ride in a motor vehicle may prevent or minimize head damage in an accident. Protect young children. Always use properly fitted car seats, pad countertops and edges of tables, block ...

  13. Intracranial Hematoma

    Science.gov (United States)

    ... skull, most commonly caused by rupture of a blood vessel within the brain or from trauma such as a car accident or fall. The ... in the brain. There are many causes, including trauma, rupture of an aneurysm, vascular malformation, high blood pressure and tumor. There are ...

  14. Quantitative estimation of a ratio of intracranial cerebrospinal fluid volume to brain volume based on segmentation of CT images in patients with extra-axial hematoma.

    Science.gov (United States)

    Nguyen, Ha Son; Patel, Mohit; Li, Luyuan; Kurpad, Shekar; Mueller, Wade

    2017-02-01

    Background Diminishing volume of intracranial cerebrospinal fluid (CSF) in patients with space-occupying masses have been attributed to unfavorable outcome associated with reduction of cerebral perfusion pressure and subsequent brain ischemia. Objective The objective of this article is to employ a ratio of CSF volume to brain volume for longitudinal assessment of space-volume relationships in patients with extra-axial hematoma and to determine variability of the ratio among patients with different types and stages of hematoma. Patients and methods In our retrospective study, we reviewed 113 patients with surgical extra-axial hematomas. We included 28 patients (age 61.7 +/- 17.7 years; 19 males, nine females) with an acute epidural hematoma (EDH) ( n = 5) and subacute/chronic subdural hematoma (SDH) ( n = 23). We excluded 85 patients, in order, due to acute SDH ( n = 76), concurrent intraparenchymal pathology ( n = 6), and bilateral pathology ( n = 3). Noncontrast CT images of the head were obtained using a CT scanner (2004 GE LightSpeed VCT CT system, tube voltage 140 kVp, tube current 310 mA, 5 mm section thickness) preoperatively, postoperatively (3.8 ± 5.8 hours from surgery), and at follow-up clinic visit (48.2 ± 27.7 days after surgery). Each CT scan was loaded into an OsiriX (Pixmeo, Switzerland) workstation to segment pixels based on radiodensity properties measured in Hounsfield units (HU). Based on HU values from -30 to 100, brain, CSF spaces, vascular structures, hematoma, and/or postsurgical fluid were segregated from bony structures, and subsequently hematoma and/or postsurgical fluid were manually selected and removed from the images. The remaining images represented overall brain volume-containing only CSF spaces, vascular structures, and brain parenchyma. Thereafter, the ratio between the total number of voxels representing CSF volume (based on values between 0 and 15 HU) to the total number of voxels

  15. Severe Vertex Epidural Hematoma in a Child: A Case Report of a Management without Expert Neurosurgical Care

    Directory of Open Access Journals (Sweden)

    Christophe Brévart

    2011-01-01

    Full Text Available Vertex epidural hematomas (VEDHs are an uncommon situation and difficulties may be encountered in their diagnosis and management. This is more complicated when the surgical management has to be performed by general surgeons, not specialized in neurosurgery, in a remote location. It was in this context that we were brought to care in charge a 2-year-old boy who required a neurosurgical emergency rescue for a severe VEDH in Djibouti. Through the description of this case, we want to emphasize the value of developing a network of teleconsultation for the benefit of remote and isolated locations and learning basic techniques of emergency neurosurgery.

  16. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases

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    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.

  17. On-site Rapid Diagnosis of Intracranial Hematoma using Portable Multi-slice Microwave Imaging System

    Science.gov (United States)

    Mobashsher, Ahmed Toaha; Abbosh, A. M.

    2016-11-01

    Rapid, on-the-spot diagnostic and monitoring systems are vital for the survival of patients with intracranial hematoma, as their conditions drastically deteriorate with time. To address the limited accessibility, high costs and static structure of currently used MRI and CT scanners, a portable non-invasive multi-slice microwave imaging system is presented for accurate 3D localization of hematoma inside human head. This diagnostic system provides fast data acquisition and imaging compared to the existing systems by means of a compact array of low-profile, unidirectional antennas with wideband operation. The 3D printed low-cost and portable system can be installed in an ambulance for rapid on-site diagnosis by paramedics. In this paper, the multi-slice head imaging system’s operating principle is numerically analysed and experimentally validated on realistic head phantoms. Quantitative analyses demonstrate that the multi-slice head imaging system is able to generate better quality reconstructed images providing 70% higher average signal to clutter ratio, 25% enhanced maximum signal to clutter ratio and with around 60% hematoma target localization compared to the previous head imaging systems. Nevertheless, numerical and experimental results demonstrate that previous reported 2D imaging systems are vulnerable to localization error, which is overcome in the presented multi-slice 3D imaging system. The non-ionizing system, which uses safe levels of very low microwave power, is also tested on human subjects. Results of realistic phantom and subjects demonstrate the feasibility of the system in future preclinical trials.

  18. Non-traumatic acute epidural spinal hematomas diagnosed by magnetic resonance; Hematomas espinales epidurales agudos no traumaticos: diagnostico por resonancia magnetica

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    Rovira, A.; Grive, E.; Pedraza, S.; Capellades, J.; Nos, C.; Alarcon, M.; Rovira, A. [Hospital Universitari Vall d' Hebron. Barcelona (Spain)

    2000-07-01

    The non-traumatic spinal epidural hematoma (NTSEH) is a rare entity that can be the cause of an acute spinal compression syndrome. the objective of this review is to identify the characteristics by MRI and NTSEH and to analyze the factors that influence in its prognosis. In the years 1994 and 1999, 12 patients with NTSEH have been diagnosed in our hospital, and a MRI was performed during the acute phase. the characteristics of the lesions have been analyzed by MRI, with special emphasis on the topographic data and resonance signal and the factors that can influence in the clinical prognosis of the patients. Initially, all of the patients presented pain in the cervical dorsal or interscapular site, followed by a sensitive-motor deficit picture. The MRI showed a lesion of expansive character and posterior epidural location in every case that would produce varying degrees of compression on the spinal cord. The NTSEH should be considered as one of the causes of acute spinal cord compression. The clinical association of intense cervical, dorsal or interscapular pain followed by a sensomotor deficit picture should lead to the suspicion of this entity, that would require an immediate examination with MRI to verify its diagnosis. Both the clinical manifestations as well as the characteristics observed by MRI of the NTSEH have a prognostic value and determine the therapeutic decision. (Author) 34 refs.

  19. Trephination mini-craniectomy for traumatic posterior fossa epidural hematomas in selected pediatric patients

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    Han-Song Sheng

    2017-08-01

    Conclusion: Our results suggest that trephination mini-craniectomy is a safe surgical technique for selected PFEDH patients with moderate hematoma volume and stabilized neurological functions. However, standard craniectomy is recommend when there are rapid deteriorations in patients' neurological functions or the hematomas are large and exerted severe mass effects.

  20. Intracranial hematoma and SAH: actual aspects in its interpretation with magnetic resonance. Hematoma intracraneal y hemorragia subaracnoidea: aspectos actuales en su interpretacion mediante resonancia magnetica

    Energy Technology Data Exchange (ETDEWEB)

    Muoz Gonzalez, A. (Hospital 12 de Octubre. Servicio de Radiodiagnostico. Madrid (Spain))

    1993-01-01

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

  1. 急诊早期锥颅在急性硬膜外血肿救治中的应用观察%The early emergency cone cranial application in treatment of acute epidural hematoma

    Institute of Scientific and Technical Information of China (English)

    张丰铎; 杨松; 何裕超

    2015-01-01

    -operation have breathing changed,breathing returns to normal after cone posterior;13 cases of patients with pre-operation,their consciousness is changed,consciousness appears to restore after cone posterior;no significant changes occurs in 7 cases of patients with pre-operation,4 cases of patients have hemorrhagic shock because of the combined fracture and other multiple trauma.ConclusionEarly emergency bedside cone transracial epidural hematoma smoke attract flow can effectively reduce the intracranial pressure and the decrease of problem of cerebral hernia,what's more,it can win over the time to the treatment for acute epidural hematoma,the method is simple and has the significant effect.

  2. Clinical analysis of 28 children suffering from intracranial hematoma and multiple injuries following traffic accidents

    Institute of Scientific and Technical Information of China (English)

    李江山; 程成; 江勇豪

    2004-01-01

    Objective: To evaluate the result of diagnosis and treatment of intracranial hematoma and multiple injuries caused by road traffic accidents. Methods: Twenty-eight patients, aged from 1 to 14 years, receiving craniotomy and other surgical treatments were retrospectively reviewed. Results: Among the 28 cases, 23 cured with the recovery rate of 82.3%, 2 had a sequel of moderate disability, and 3 died from severe brain injury, hemorrhagic shock, and other visceral complications. The clinical sympotoms and signs were severe and perplexing. The major characters included: severe head injury, usually combined by multiple injuries, and easy of access to missed diagnosis and misdiagnosis. Conclusions: The occurrence of infection is high after traffic accidents as a result of depression of humoral and cellular immunity, long-term bed rest, and fractures of limbs. Hence, on the basis of maintaining vital signs, the management of primary wound is essential to reduce infection and underlying death. In addition to the management of brain injury, concurrent injuries should also be highlighted so as to reach a good result for their patients.

  3. Lumbar subarachnoid hematoma following an epidural blood patch for meningeal puncture headache related to the implantation of an intrathecal drug delivery system.

    Science.gov (United States)

    Hustak, Erik C; Engle, Mitchell P; Viswanathan, Ashwin; Koyyalagunta, Dhanalakshmi

    2014-01-01

    Persistent meningeal puncture headache (MPH) is a known complication following both intentional and unintentional puncture of the dura mater.  We present a case of persistent MPH following implantation of an intrathecal drug delivery system (IDDS). Two separate epidural blood patches (EBP) were performed under radiographic guidance with contrast visualization of the epidural space on postoperative days 16 and 28, respectively. The case was complicated by the development of a symptomatic lumbar subarachnoid hematoma diagnosed on postoperative day 35. The patient subsequently underwent a laminectomy, evacuation of the hematoma, and explanation of the IDDS. This case illustrates a potential unique morbidity associated with the EBP in a patient with an IDDS. The report concludes with a brief review of MPH followed by a discussion of possible mechanisms underlying this complication.

  4. Clinical Analysis of CT in the Diagnosis of Traumatic Delayed Intracranial Hematoma%CT诊断外伤性迟发性颅内血肿临床分析

    Institute of Scientific and Technical Information of China (English)

    徐睿

    2016-01-01

    目的:分析CT诊断外伤性迟发性颅内血肿患者的临床价值。方法回顾性分析我院35例外伤性迟发性颅内血肿患者采用CT诊断及治疗的相关临床资料。结果本次经过CT检查表明,3例患者硬膜下血肿,3例患者硬膜外血肿,6例患者蛛网膜下腔出血,9例患者颅内骨折,14例患者脑挫裂伤。35例外伤性迟发性颅内血肿患者中有21例患者受伤后24 h以内发生颅内血肿。其中有11例患者选择保守治疗(31.4%),而有24例患者选择手术治疗(68.6%)。所有患者经过治疗后均取得相对满意的治疗效果,24例手术治疗恢复良好患者中,6例患者中度残疾,1例患者重度残疾,2例患者死亡。结论 CT检查可早期诊断外伤性迟发性颅内血肿,以便临床及时采取有效的治疗措施,降低患者的致残率、死亡率,改善患者预后。%Objective To analyze the clinical value of CT in the diagnosis of traumatic delayed intracranial hematoma.Methods Retrospective analysis of 35 patients with traumatic delayed intracranial hematoma in patients with CT diagnosis and treatment of clinical data.Results The CT examination showed that 3 cases of subdural hematoma, 3 cases of patients with epidural hematoma, 6 cases of subarachnoid hemorrhage, 9 cases of patients with intracranial fractures, 14 cases of brain contusion and laceration. In 35 patients with delayed traumatic intracranial hematoma, 21 patients had intracranial hematoma within 24 h after injury. Among them, 11 patients were treated with conservative therapy (31.4%), and 24 patients were selected for surgical treatment (68.6%). All patients achieved satisfactory results after treatment, 24 cases of patients with good recovery, 6 patients with moderate disability, 1 patients with severe disability, 2 patients died. Conclusion CT examination can be early diagnosis of traumatic delayed intracranial hematoma, in order to take effective treatment

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

    Directory of Open Access Journals (Sweden)

    Edno Magalhães

    2007-04-01

    ó las sensibilidades térmica y dolorosa y la regresión total del bloqueo motor. En la 12ª hora, deambulaba y refería dolor en la herida operada. El hematoma peridural no se visualizó en una nueva tomografía computadorizada en la 14ª hora después del inicio del tratamiento. La paciente recibió alta hospitalaria 86 horas después del inicio del tratamiento conservador, sin comprometimiento neurológico. Una tomografía computadorizada de control después de 7 meses, mostró el canal vertebral completamente normal. CONCLUSIONES: La eficiencia del abordaje conservadora fue una alternativa importante para la intervención quirúrgica en casos específicos. La evaluación de la progresión o estabilización del comprometimiento neurológico, particularmente después de la 8ª hora posterior a la punción peridural, es esencial para la elección del tratamiento.BACKGROUND AND OBJECTIVES: Hematoma associated with spinal compression after epidural anesthesia is a severe neurological complication, despite the reduced incidence reported (1:150,000. It is an acute episode and the traditional treatment includes urgent surgical decompression. More recently, treatment with corticosteroids has been used as an alternative, in specific cases, with good neurological resolution. The objective of this report was to present the case of an epidural hematoma treated conservatively with complete neurological recovery. CASE REPORT: Female patient, 34 years old, ASA physical status I, with no prior history of bleeding disorders or anticlotting treatment, underwent epidural anesthesia at the L2-L3 level for the surgical treatment of lower limb varicose veins. Eight hours after the regional anesthesia, the patient still presented complete motor blockade (Bromage scale, reduction of thermal and pain sensitivity below L3, hyperalgesia in the left plantar region, preserved tendon reflexes, and absence of lumbar pain. A CT scan showed an epidural hematoma in L2, with compression of the dural

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

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

    2016-04-01

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

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

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    Daniel S. Treister

    2014-01-01

    Full Text Available A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH. Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

  8. Spontaneous Intracranial Hypotension Treated with a Targeted CT-Guided Epidural Blood Patch

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    Inês Correia

    2016-01-01

    Full Text Available Spontaneous intracranial hypotension (SIH is an important cause of new daily persistent headache. It is thought to be due to spontaneous spinal cerebrospinal fluid (CSF leaks, which probably have a multifactorial etiology. The classic manifestation of SIH is an orthostatic headache, but other neurological symptoms may be present. An epidural blood patch is thought to be the most effective treatment, but a blind infusion may be ineffective. We describe the case of a young man who developed an acute severe headache, with pain worsening when assuming an upright posture and relief gained with recumbency. No history of previous headache, recent cranial or cervical trauma, or invasive procedures was reported. Magnetic resonance imaging showed pachymeningeal enhancement and other features consistent with SIH and pointed towards a cervical CSF leak site. After failure of conservative treatment, a targeted computer tomography-guided EBP was performed, with complete recovery.

  9. Significance of monitoring the initial intracranial pressure on hematoma irrigation with trephination therapy for acute subdural hematomas in critical conditions.

    Science.gov (United States)

    Otani, Naoki; Takasato, Yoshio; Masaoka, Hiroyuki; Hayakawa, Takanori; Yoshino, Yoshikazu; Yatsushige, Hiroshi; Miyawaki, Hiroki; Sumiyoshi, Kyoko; Sugawara, Takashi; Chikashi, Aoyagi; Takeuchi, Satoru; Suzuki, Go

    2010-01-01

    Acute subdural hematoma (ASDH) patients presenting in a severe condition tend to have poor outcomes due to the significant brain edema required to maintain the ICP at less than 20-25 mmHg. This study compared the surgical outcomes of 16 critically ill patients with ASDH who underwent hematoma irrigation with trephination therapy (HITT) based on their initial ICP values. The initial mean GCS score upon admission was four. A unilateral dilated pupil was seen in one and bilateral dilated pupils were seen in seven patients. The co-existence of a brain contusion was seen in seven patients, brain swelling was noted in six patients, and both basal cistern effacement and a midline shift greater than 5 mm were observed in all patients. The mean initial ICP value was 45 mmHg (range: 3 to 85 mmHg). Ten patients (62.5%) underwent a rapid external decompression to evacuate the hematoma. By using the Glasgow Outcome Scale upon discharge a score of good recovery (GR) was assigned to two (12.5 %), moderate disability (MD) to four (25.0 %), vegetative state (VS) to two (12.5 %), and death (D) to eight (50.0 %) patients. All six patients who showed an initial ICP greater than 60 mmHg died despite intensive care. Eight patients who showed an initial ICP less than 40 mmHg had a favorable outcome, but two patients deteriorated due to a traumatic cerebrovascular disorder. It seems that the initial ICP monitoring with HITT for ASDH patients in critical condition may be an important factor for predicting both surgical outcome and clinical course.

  10. Prospective randomized controlled study on small-window craniotomy versus ordinary large-window craniotomy in the evacuation of epidural hematoma

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    Lian-shui HU

    2014-05-01

    Full Text Available There is still controversy on the clinical efficacy of small-window craniotomy (SWCT for acute epidural hematoma with concurrent early-phase cerebral herniation. This study compared multiple surgical and prognostic parameters of SWCT versus ordinary large-window craniotomy (LWCT, which aimed at providing evidences for surgical decision. Compared with LWCT (N = 51, SWCT (N = 44 displayed shortened average operation time (P = 0.000, reduced intraoperative blood loss (P = 0.000 and lessened intraoperative blood transfusion (P = 0.031. Moreover, there was no differences of postoperative residual hematoma (P = 0.141, postoperative palinesthesia time (P = 0.201, the ratio of postoperative secondary ischemia (P = 0.865 or cerebral edema (P = 0.879, and 6-month Glasgow Outcome Scale (GOS score (P = 0.603 between the two surgical approaches.  Results suggested that, for patients with acute epidural hematoma and concurrent early-phase cerebral herniation, SWCT could effectively evacuate hematoma and relief brain herniation without significant differences of effect and prognosis from LWCT. In addition, SWCT has several advantages such as significantly reduced operation time, intraoperative blood loss and blood transfusion. doi: 10.3969/j.issn.1672-6731.2014.05.013

  11. Closed Drainage versus Non-Drainage for Single-Level Lumbar Disc Surgery: Relationship between Epidural Hematoma and Fibrosis

    Science.gov (United States)

    2016-01-01

    Study Design A prospective clinical series with prospectively collected data. Purpose The efficacy of using closed suction drains (CSD) after single-level lumbar disc surgery was evaluated. Postoperative CSD are regularly fitted to prevent postoperative epidural hematomas (EH) after multilevel lumbar decompression, although it remains unclear whether CSD also reduces postoperative EH following single-level lumbar disc surgery. Overview of Literature Few articles have addressed the clinical outcome in patients with single-level lumbar disc disease who were treated by two different operative methods (with and without drainage). Methods Between 2012 and 2014, 115 patients with a single level discectomy underwent two surgical procedures: with CSD (group A, 60 cases) and without CSD (group B, 55 cases). There were no significant differences in age, sex, segment level, herniation type, or disease duration between the groups. Wound infection, EH, and epidural fibrosis (EF) were evaluated by magnetic resonance imaging. Pain intensity was evaluated using the visual analog scale (VAS) and Oswestry disability index (ODI). Reduction in analgesic treatment and patient satisfaction were also recorded. Results The overall rate of postoperative EH was 5% and 16.3% in group A and B, respectively, whereas the rate of postoperative EF was 11.6% in group A and 21.8% in group B. The postoperative VAS score was 0.32 (standard deviation [SD], 0.45) for group A and 2.62 (SD, 06.9) for group B, whereas ODI was 9.11 (SD, 0.68) and 8.23 (SD, 0.78) for group A and and group B, respectively, with no significant differences observed. Conclusions In patients operated on by unilateral, single-level lumbar disc surgery, the use of suction CSD into the operation site results in lower levels of EH and EF radiologically, thereby providing a better clinical outcome. PMID:27994783

  12. Spreading epidural hematoma and deep subcutaneous edema: indirect MRI signs of posterior ligamentous complex injury in thoracolumbar burst fractures

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    Kim, Na Ra [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Konkuk University School of Medicine, Department of Radiology, Seoul (Korea); Hong, Sung Hwan [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Seoul National University Hospital, Department of Radiology, Seoul (Korea); Choi, Ja-Young; Myung, Jae Sung [Seoul National University College of Medicine, Department of Radiology, Seoul (Korea); Chang, Bong-Soon [Seoul National University College of Medicine, Department of Orthopedic Surgery, Seoul (Korea); Lee, Joon Woo; Kang, Heung Sik [Seoul National University Bundang Hospital, Department of Radiology, Seoul (Korea); Moon, Sung Gyu [Konkuk University School of Medicine, Department of Radiology, Seoul (Korea)

    2010-08-15

    The purpose of this study was to evaluate the diagnostic value of a spreading epidural hematoma (SEH) and deep subcutaneous edema (DSE) as indirect signs of posterior ligamentous complex (PLC) injuries on MR imaging of thoracolumbar burst fractures. We retrospectively reviewed spinal MR images of 43 patients with thoracolumbar burst fractures: 17 patients with PLC injuries (study group) and 26 without PLC injuries (control group). An SEH was defined as a hemorrhagic infiltration into the anterior or posterior epidural space that spread along more than three vertebrae including the level of the fracture. A DSE was regarded as a fluid-like signal lesion in the deep subcutaneous layer of the back, and its epicenter was at the burst fracture level. The frequency of the SEH/DSE in the two groups was analyzed. In addition, the association between each sign and the degree of vertebral collapse, the severity of central canal compromise, and surgical decisions were analyzed. Magnetic resonance images showed an SEH in 20 out of 43 patients (46%) and a DSE in 17 (40%). The SEH and DSE were more commonly seen in the study group with PLC injuries (SEH, 15 out of 17 patients, 80%; DSE, 16 out of 17 patients, 94%) than in the control group without PLC injuries (SEH, 5 out of 26, 19%; DSE, 1 out of 26, 4%) (P <0.0001). The SEH and DSE were significantly associated with surgical management decisions (17 out of 20 patients with SEH, 85%, vs 8 out of the 23 without SEH, 35%, P =0.002; 15 out of 17 with DSE, 88%, vs 10 out of 26 without DSE, 38%, P =0.002). The SEH and DSE did not correlate with the degree of vertebral collapse or the severity of central canal compromise. The SEH and DSE may be useful secondary MR signs of posterior ligamentous complex injury in thoracolumbar burst fractures. (orig.)

  13. Metabolic and clinical markers of prognosis in the era of CT imaging in children with acute epidural hematomas.

    Science.gov (United States)

    Ben Abraham, R; Lahat, E; Sheinman, G; Feldman, Z; Barzilai, A; Harel, R; Barzilay, Z; Paret, G

    2000-08-01

    Acute epidural hematoma (AEH), a relatively common complication of head injury in children, persists in bearing high morbidity and mortality. Early establishment of prognosis could guide optimal patient allocation, and early identification of predictive signs could assist in choosing appropriate therapeutic interventions. This study aimed to delineate expeditiously obtainable prognostic markers for determining outcome in a subset of children with AEH. We reviewed our 11-year experience with 61 consecutive children <16 years old with head trauma and isolated AEH. Treatment followed a standard advanced trauma life support protocol. A medical history was obtained, and all patients underwent neurosurgical and physical evaluations. CT scans were performed, as were laboratory tests which included arterial blood gases, glucose, electrolytes (K(+), Na(+)), hemoglobin and coagulation studies. Evaluation of the data collected on cause of injury, interval between trauma occurrence and presentation, clinical symptoms, Glasgow Coma Scale (GCS) scores, vital signs, laboratory test results, physical findings and surgical versus conservative management revealed that the best single predictors of outcome following AEH were the GCS and focal neurological deficits. Of all laboratory data obtained on admission, the blood potassium, pH and glucose test results correlated significantly with prognosis. Prognosis can be adequately and expeditiously estimated by selected markers within a comprehensive evaluation of children with AEH.

  14. Effect of residue hematoma volume on inflammation factors in hypertensive intracranial hemorrhage

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    You-san ZHANG

    2016-10-01

    Full Text Available Objectives  In this study, the relationships of residue hematoma volume to brain edema and inflammation factors were studied after intracerebral hematoma was evacuated with a frameless stereotactic aspiration. Methods  Eighty-nine patients with hypertensive intracerebral hemorrhage (ICH were treated by frameless stereotactic aspiration. According to residual volume of the hematoma, the patients were divided into gross-total removal of hematoma (GTRH (≤5ml and sub-total removal of hematoma (STRH (≥10ml groups after the operation. The pre-operative and postoperative data of the patients were compared between the two groups. The pre-operative data included age, sex, hematoma volume, time interval from the ictus to the operation, and Glasgow Coma Scale (GCS scores. The post-operative information included edema grade, level of thromboxane B2 (TXB2, 6-keto-prostaglandin F1α(6-K-PGF1α, tumor necrosis factor-α(TNF-α and endothelin (ET in hematoma cavity or cerebral spinal fluid (CSF. Results  There were 46 patients in GTRH group and 43 in STRH group respectively. There was no statistical difference in the pre-operative data between the two groups. The levels of TXB2, 6-K-PGF1α, TNF-αand ET were significantly lower in the GTRH group than in the STRH group at different post-operative time points. There was a significant difference between the two groups. The post-operative CT scan at different time points showed that the brain edema grades were better in the GTRH group than in the STRH group. Conclusions  GTRH is helpful for decreasing ICH-induced injury to brain tissue, which is related to decreased perihematomal edema formation and secondary injury by coagulation end products activated inflammatory cascade. DOI: 10.11855/j.issn.0577-7402.2016.09.12

  15. Cervical CT scan-guided epidural blood patches for spontaneous intracranial hypotension.

    Science.gov (United States)

    Maingard, Julian; Giles, Lauren; Marriott, Mark; Phal, Pramit M

    2015-12-01

    We describe two patients with spontaneous intracranial hypotension (SIH), presenting with postural headache due to C1-C2 cerebrospinal fluid (CSF) leak. Both patients were refractory to lumbar epidural blood patching (EBP), and subsequently underwent successful CT scan-guided cervical EBP. SIH affects approximately 1 in 50,000 patients, with females more frequently affected. Its associated features are variable, and as such, misdiagnosis is common. Therefore, imaging plays an important role in the diagnostic workup of SIH and can include MRI of the brain and spine, CT myelogram, and radionuclide cisternography. In patients with an established diagnosis and confirmed CSF leak, symptoms will usually resolve with conservative management. However, in a select subgroup of patients, the symptoms are refractory to medical management and require more invasive therapies. In patients with cervical leaks, EBP in the cervical region is an effective management approach, either in close proximity to, or directly targeting a dural defect. CT scan-guided cervical EBP is an effective treatment approach in refractory SIH, and should be considered in those patients who are refractory to conservative management.

  16. Predictors of the Treatment Response of Spontaneous Intracranial Hypotension to an Epidural Blood Patch.

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    Karm, Myong-Hwan; Choi, Jae-Hyung; Kim, Doohwan; Park, Jun Young; Yun, Hye Joo; Suh, Jeong Hun

    2016-05-01

    Spontaneous intracranial hypotension (SIH) is characterized by postural headache because of low cerebrospinal fluid (CSF) pressure. Brain magnetic resonance imaging (MRI) and radioisotope (RI) cisternography can be used to identify the site of a CSF leakage. Although autologous epidural blood patch (EBP) is a very effective treatment modality, some patients require a repeat autologous EBP. We investigated whether autologous EBP responses correlate with surrogate markers of quantitative findings.All cases of autologous EBP for SIH from January 2006 to December 2014 were enrolled. The demographic variables, number of EBPs, pain scores, RI cisternography (early visualization of bladder activity), and MRI findings (subdural fluid collections, pachymeningeal enhancement, engorgement of venous structures, pituitary hyperemia, and sagging of the brain) were reviewed.Patients with early bladder activity on RI cisternography had a tendency to need a higher number of autologous EBPs. Only sagging of the brain and no other variables showed a statistically significant negative correlation with the number of autologous EBPs.The response to autologous EBP may be related to the radiologic findings of early bladder activity on RI cisternography and sagging of the brain on MRI.

  17. 急性颅内血肿术后迟发性血肿临床诊治分析%Analysis of clinical diagnosis and treatment of delayed hematoma after the surgery for acute intracranial hematoma

    Institute of Scientific and Technical Information of China (English)

    吴世强; 骆安林; 方挺; 关惠东; 沈才锋

    2013-01-01

      目的:通过观察急性颅内血肿术后发生迟发性血肿现象,探讨分析其临床诊治方法。方法:选择34例急性颅内血肿术后出现迟发性血肿现象的患者,对患者的临床资料进行分析研究,决定再次手术清除还是保守治疗。结果:34例患者中有18例患者进行再次手术清除颅内血肿,4例家属拒绝再次手术治疗,其余12例采用保守治疗。有15例恢复较好,6例中度残废,6例重度残废,3例植物生存,4例死亡。结论:急性颅内血肿术后迟发性血肿的原因一般与头部钝挫伤、颅内压发生较大变化以及颅骨骨折有关,对病情恢复情况应给予严密监控以及定时定期复查头颅CT,早发现早治疗以便保证预后恢复。%Objective To explore the clinical diagnosis and treatment for delayed hematoma after the surgery for acute intracranial hematoma through observation.Methods Clinical data of 34 delayed hematoma patients after the surgery of acute intracranial hematoma who were treated in our hospital were analyzed and studied first and then whether they were treated with another dissection or conservative treatment was confirmed. Results Of the 34 patients,18 needed another surgery for dissecting intracranial hematoma,4 got their families refused a second surgery,and the rest 12 patients adopted conservative treatment.15 patients well recovered,6 patients were moderately disabled,6 patients were severely disabled,3 survived in vegetative state and 4 patients were dead.Conclusion The reasons for delayed hematoma after the surgery for acute intracranial hematoma are usually related to head blunt trauma,big changes of intracranial pressure,and skull fracture and it is required to closely monitor the recovery of disease and carry out periodic reexamination for skull CT,ensuring that the prognosis for recovery is good through early discovery and early treatment.

  18. 颅脑损伤术后非手术区迟发血肿再手术临床分析%Clinical Analysis of Reoperation for Nonsurgical Area Delayed Hematoma from Postoperative Intracranial Hematoma

    Institute of Scientific and Technical Information of China (English)

    许悦; 张瑜; 沈旭明; 舒张; 孙晓全; 徐清; 冯晓东; 陆小军

    2014-01-01

    Objective To explore the causes, mechanism, diagnosis and treatment of postoperative delayed traumatic intracranial hematoma. Methods The clinical information of 54 cases with postoperative delayed traumatic intracranial hematoma from 2005 to 2013 were retrospectively analyzed and studied. Results Of 54 cases, there were 11 cases of gradeⅠ, 10 cases of gradeⅡ, 11 cases of gradeⅢ, 13 cases of gradeⅣ, 9 cases of gradeⅤ. Conclusion Early diagnosis and treatment can improve prognosis and efficacy of the postoperative delayed traumatic intracranial hematoma. Intracranial pressure monitoring and timely review CT contribute to early detection of partially delayed traumatic intracranial hematoma for patients with risk factors.%目的:探讨颅脑损伤术后非手术区迟发性血肿的形成原因、发生机制及临床诊治。方法回顾性分析2005年1月~2013年12月54例颅脑损伤患者术后出现非手术区迟发性颅内血肿并再次手术的临床资料。结果54例患者伤后6个月时GOS评分:Ⅰ级11例,Ⅱ级10例,Ⅲ级11例,Ⅳ级13例,Ⅴ级9例。结论颅脑损伤术后发生非手术区迟发性血肿患者的预后取决于早期预防、早期发现,及早治疗。对存在高危因素者进行颅内压监测并动态复查CT,能够早期发现部分迟发性颅内血肿,改善预后。

  19. 术中迟发性硬膜外血肿防治体会(附10例报告)%Intraoperative Prevention and Treatment of Delayed Epidural Hematoma (Report of 10 cases)

    Institute of Scientific and Technical Information of China (English)

    俞辉; 李高义; 杨文进; 何斌; 郑平; 郭义君; 童武松

    2011-01-01

    Objective: To investigate the emergence of delayed surgery in the epidural hematoma (DEDH) the causes and preventive measures. Methods: A retrospective analysis of 10 cases of surgical procedures DEDH the causes, the phenomenon, treatment, clinical outcome and prognosis. Results: 10 cases DEDH occurred within 72h after injury, after surgical decompression, six cases with skull fractures, 3 cases with venous sinus injury. Seven cases more than the amount of preoperative mannitol 500ml, after surgical removal and conservative treatment, 1 died. Conclusion: The skull fracture and intracranial venous sinus injury is the pathological basis of the occurrence DEDH, decompression surgery and mannitol dehydration treatment is a strong contributing factor to its occurrence, GCS score and hematoma duration and prognosis.%目的:探讨颅脑外伤手术中出现迟发性硬膜外血肿(DEDH)的原因及预防对策.方法:回顾性分析10例手术过程中DEDH发生的原因、现象,治疗过程、结果及预后等临床资料.结果:10例DEDH发生于伤后72h以内、手术减压后,6例伴有颅骨骨折,3例伴静脉窦损伤.7例术前甘露醇用量超过500ml,经手术清除和保守治疗,死亡1例.结论:颅骨骨折和颅内静脉窦损伤是DEDH发生的病理基础,减压手术和甘露醇强力脱水治疗是其发生的促进因素,GCS评分和血肿持续时间与预后密切相关.

  20. [Evaluation on Ability to Detect the Intracranial Hematoma with Different Density Using C-Arm Cone-beam Computed Tomography Based on Animal Model].

    Science.gov (United States)

    Zhou, Mi; Zeng, Yongming; Yu, Renqiang; Zhou, Yang; Xu, Rui; Sun, Jingkun; Gao, Zhimei

    2016-02-01

    This study aims to evaluate the ability of C-arm cone-beam CT to detect intracranial hematomas in canine models. Twenty one healthy canines were divided into seven groups and each group had three animals. Autologous blood and contrast agent (3 mL) were slowly injected into the left/right frontal lobes of each animal. Canines in the first group, the control group, were only injected with autologous blood without contrast agent. Each animal in all the 7 groups was scanned with C-arm cone-beam CT and multislice computed tomography (MSCT) after 5 minutes. The attenuation values and their standard deviations of the hematoma and uniformed brain tissues were measured to calculate the image noise, signal to noise ratio (SNR) and contrast to noise ratio (CNR). A scale with scores 1-3 was used to rate the quality of the reconstructed image of different hematoma as a subjective evaluation, and all the experimental data were processed with statistical treatment. The results revealed that when the density of hematoma was less than 65 HU, hematomata were not very clear on C-arm CT images, and when the density of hematoma was more than 65 HU, hematomata showed clearly on both C-arm CT and MSCT images and the scores of them were close. The coherence between the two physicians was very reliable. The same results were obtained with C-arm cone-beam CT and MSCT grades in measuring SD value, SNR, and CNR. The reasonable choice of density detection range of intracranial hematoma with C-arm cone-beam CT could be effectively applied to monitoring the intracranial hemorrhage during interventional diagnosis and treatment.

  1. Cervical epidural hematoma in a healthy donor presenting stroke mimic symptoms: a rare adverse event following peripheral blood stem cell apheresis.

    Science.gov (United States)

    Terabe, Satomi; Nishiwaki, Satoshi; Koyama, Daisuke; Okuno, Shingo; Harada, Yasuhiko; Tomita, Hiroyuki; Yoshihara, Hisatake; Iwasaki, Toshihiro; Sugiura, Isamu

    2015-06-01

    Peripheral blood stem cell apheresis from a healthy donor is indispensable for allogeneic peripheral blood stem cell transplantation. Here, we report a rare adverse event following peripheral blood stem cell apheresis. A female sibling donor, aged 61 years with an unremarkable medical history, complained of pain in the left neck and shoulder and numbness in the left upper limb 1 h after the end of peripheral blood stem cell apheresis. Paralysis of the left upper and lower limbs appeared consecutively. Computed tomography and magnetic resonance imaging of the head showed no abnormalities. Anticoagulant therapy was initiated according to the standard treatment of atherothrombotic brain infarction. Magnetic resonance imaging of the cervical cord on the following day revealed a cervical epidural hematoma. An emergency C4-C5 laminectomy was performed, and the paralysis was improved immediately after surgery. This report is the first case of cervical epidural hematoma in a healthy donor who underwent peripheral blood stem cell apheresis and presented symptoms confusingly similar to those of brain infarction.

  2. Paraplegia and intracranial hypertension following epidural anesthesia: report of four cases Paraplegia e hipertensão craniana após anestesia epidural: relato de 4 casos

    Directory of Open Access Journals (Sweden)

    Frederico A. D. Kliemann

    1975-09-01

    Full Text Available Four patients who received epidural anesthesia presented sustained myelopathy; three of them had complete paraplegia and one a lumbo-sacral myelopathy with urinary retention. All four patients complained of very intense radicular pains immediately after the analgesic effect of Lidocaine was over. Two patients in whom lumbar puncture was done in the first 24 hours presented an aseptic meningitic reaction in CSF. Paraplegia completed in two to ten months in three patients and in two of them severe intracranial hypertension developped at this time. It is proposed that the disease runs a two-stages course, at least in some cases, characterized by an aseptic meningitis, followed, after a silent period of some months, by signs of adhesive spinal and intracranial arachnoiditis. Intracranial hypertension was controlled by ventriculo-peritoneal shunt; in two patients a transitory effect of intrathecal injections of methyl-prednisolone acetate was observed. Two patients recovered almost completely from paraplegia.Quatro pacientes que receberam anestesia epidural apresentaram mielopatia de longa evolução; em três ocorreu paraplegia completa e um apresentou uma síndrome medular lombo-sacra com retenção urinária. Todos os pacientes se queixaram de intensas dores radiculares imediatamente após a cessação do efeito analgésico da lidocaína. Dois pacientes apresentaram uma reação meningítica asséptica no líquido cefalorraqueano nas primeiras 24 horas. A paraplegia tornou-se completa em 2 a 10 meses após a anestesia; dois pacientes tiveram hipertensão craniana severa. Em alguns casos, senão em todos, esta afecção apresenta uma evolução em duas etapas, caracterizadas por meningite asséptica imediata, seguida, depois de um período silencioso de poucos meses, de sinais de aracnoidite adesiva espinal e intracraniana. A hipertensão intracraniana foi controlada por derivação ventriculo-peritoneal; em 2 pacientes houve melhora transit

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

    Directory of Open Access Journals (Sweden)

    Ranger Cavalcante da Silva

    2006-04-01

    drenaje del hematoma la paciente recuperó gradualmente la fuerza en los miembros inferiores, recibió alta en diez días con cuadro de disfunción de esfínteres. Después de tres meses el cuadro remitió y no hubo secuela neurológica definitiva. CONCLUSIONES: El rápido diagnóstico con intervención quirúrgica precoz es el tratamiento más eficaz para la reducción de la lesión neurológica, en pacientes que desarrollan hematoma peridural postoperatorio. La utilización de heparina de bajo peso molecular, con uso actual de catéter peridural, exige la adhesión estricta a protocolos establecidos, para que se reduzcan los riesgos del desarrollo de hematoma peridural.BACKGROUND AND OBJECTIVES: Presents a patient case with epidural hematoma, in the course of the use of epidural catheter and low molecular weight heparin, her clinical condition and treatment. CASE REPORT: A 75-year old female patient, submitted to the fixation of lumbar spine by anterior route, who, in the postoperative period, developed a clinical condition of progressive paralysis of the lower limbs, with loss of sensitivity and presenting no intense radicular pain. The treatment was the immediate medullar decompression, with drainage and surgical cleaning of a epidural hematoma, which extended from the 5th to the 10th thoracic vertebrae. After the drainage of the hematoma, the patient gradually recovered the strength in the lower limbs, was discharged in ten days with a condition of sphincterian dysfunction. After three months, the condition receded and there was no definitive neurological sequel. CONCLUSIONS: The quick diagnosis with early surgical intervention is the most effective treatment for the reduction of neurological damage, in patients that develop postoperative epidural hematoma. The use of low molecular weight heparin, in the course of the use of epidural catheter, requires the strict compliance with the established protocols so that the risks of epidural hematoma development can be

  4. 急性外伤性颅内血肿开颅血肿清除术后继发血肿的相关因素分析%Analysis of related factors of secondary hematoma of acute traumatic intracranial hematoma after hematoma removal by craniotomy

    Institute of Scientific and Technical Information of China (English)

    刘永生

    2016-01-01

    目的 探讨急性外伤性颅内血肿患者行开颅血肿清除术后继发血肿的相关危险因素.方法 回顾性分析我院126例行开颅血肿清除术急性外伤性颅内血肿患者的临床资料,单因素分析影响术后继发血肿发生的相关因素,多因素Logistic回归分析影响继发血肿发生的独立危险因素.结果 开颅血肿清除术后继发血肿发生率为19.05%.多因素Logistic回归分析表明:手术时机、血浆凝血酶时间、颅骨骨折为术后继发血肿的独立危险因素.结论 血浆凝血酶时间、手术时机、颅骨骨折是影响开颅血肿清除术后继发血肿发生的独立危险因素,临床中应采取相应的预防措施,以提高患者康复期间的治疗效果,降低继发颅内血肿的发生率.%Objective To investigate the related factors of secondary hematoma of acute traumatic intracranial hematoma after hematoma removal by craniotomy.Methods Retrospectively analyzed clinical data of 126 patients with acute traumatic intracranial hematoma underwent hematoma removal by craniotomy in our hospital.Carried out single factor analysis of related factors of secondary hematoma,and multi-factor Logistic regression analysis of independent risk factors of secondary hematoma.Results The incidence of secondary hematoma after hematoma removal by craniotomy was 19.05%.Multi-factor Logistic regression analysis showed that operation opportunity,plasma thrombin time,and skull fracture were independent risk factors of secondary hematoma.Conclusion Operation opportunity,plasma thrombin time,and skull fracture are independent risk factors of secondary hematoma.We should take preventive measures to improve the treatment effect and reduce the incidence of secondary hematoma.

  5. [Idiopathic intracranial hypertension: a caesarean with epidural anaesthesia after bringing the cerebrospinal fluid pressure back to normal].

    Science.gov (United States)

    Pérez Rodríguez, M; de Carlos Errea, J; Dorronsoro Auzmendi, M; Batllori Gastón, M

    2013-12-01

    Idiopathic intracranial hypertension is diagnosed by exclusion. Because of its uncertain physiopathology and infrequent occurrence, its anaesthetic management is not well defined. The patient in this case is a pregnant woman with this disease with no lumbar-peritoneal shunt who was referred for non-urgent caesarean section, consisting of CSF drainage and pressure normalisation before the administration of epidural anaesthesia. We believe this technique can de effective to achieve adequate blockage and increased patient comfort, as well as improving postoperative recovery. Copyright © 2012 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  6. Acute Traumatic Intracranial Hematoma in Children%小儿外伤性急性颅内血肿(附59例分析)

    Institute of Scientific and Technical Information of China (English)

    姚家楫; 陈学超; 张玉梁

    1985-01-01

    @@ 小儿外伤性急性颅内血肿有一些特点,了解这些特点对诊断、治疗和判断预后都有意义.本文对广州市几个医院1966年5月至1984年3月收治并手术证实的59例进行分析.本组病例自受伤至手术时间均在3天以内,属于急性颅内血肿范畸.%59 cases of acute traumaticintracranial hematoma in children are reported in this paper,with a mortality of 28.8%and sequela of 26.2%.Its characteristics include remarkable diffuse cerebral syruptom,less localization signs,rapid change of the patient's condition and early oecurence of brain herniation.In our series.extradural hematoma complicated by skull fracture had a higher rate(63.6%)compared with other reports.To evacuate the hematoma before the occurence of brain herniation was the key to reduce mottalky.Whenever intracranial hematoma is suspected and the patient's condition allows for further examination,CT examination should always be recommended.

  7. 老年人迟发性外伤性颅内血肿的早期诊治%Diagnosis and treatment of elderly with delayed traumatic intracranial hematoma at earliest period

    Institute of Scientific and Technical Information of China (English)

    戴新连; 李志强; 吴彬

    2011-01-01

    目的 探讨老年人迟发性外伤性颅内血肿(DTIH)的早期诊疗方案.方法 对老年人DTIH 171例的临床资料进行回顾性分析.结果 原发性昏迷125例,占73.1%;意识障碍一度好转又恶化49例,占28.7%;意识障碍进行性加重109例,占63.7%.首次头颅CT征像:未见异常9例,颅骨骨折15例;硬膜外血肿9例;硬膜外血肿伴对冲部脑挫裂伤4例;脑挫裂伤伴蛛网膜下腔出血83例,占48.5%;硬膜外血肿伴脑挫裂伤11例;蛛网膜下腔出血64例,占37.4%;上述征像均伴有不同程度脑受压.复查头颅CT征象:DTIH发生于首次CT无异常处25例,硬膜外6例;脑挫裂伤和/或蛛网膜下腔出血162例占94.7%;血肿量20~130mL,50mL以上87例,占50.9%.手术治疗122例,恢复良好83例,中残7例,重残4例,植物状态2例,死亡26例;非手术治疗49例,恢复良好36例,死亡8例,自动出院5例.结论 掌握老年人的病理生理特点及其DTIH的临床表现与头颅CT征像等特征,严密观察意识演变等病情变化,头颅CT追踪动态观察颅脑损伤病灶变化,是早期诊断的关键.血肿占位效应及意识状态是选择手术或非手术治疗的主要指标.%Objective It is to approach the diagnosis and treatment of elderly with delayed traumatic intracranial hematoma ( DTIH ) at earliest period. Methods The clinical data of 171 elderly with DTIH was analyzed retrospectively. Results Primary coma was 125 cases for 73. 1% . Consciousness disorders transient better and worse was 49 cases for 28. 7% . Consciousness disorders progressive exacerbation was 109 cases for 63. 7% . The first head CT signs: normal was 9 cases, skull fractures was 15 cases, epidural hematoma was 9 cases, epidural hematoma with hedge contusion and laceration of brain was 4 cases, contusion and laceration of brain with suharachnoid hemorrhage was 83 cases for 48. 5% , epidural hematoma with contusion and laceration of brain was 11 cases and subarachnoid hemorrhage was 64 cases

  8. 外伤性迟发性颅内血肿常规CT研究%Study on delayed traumatic intracranial hematoma using conventional CT

    Institute of Scientific and Technical Information of China (English)

    高志友

    2011-01-01

    目的 探讨常规CT如何尽早而准确地测出外伤性迟发性颅内血肿.方法 搜集常规CT复查证实的外伤性迟发性颅内血肿39例,对其首次常规CT检查及复查的CT图像特点进行分析.结果 39例迟发性颅内血肿首次常规CT检查主要异常表现包括:①局限性蛛网膜下腔出血30例.②局限性脑密度减低,灰白质分界不清15例.③局部轻度占位效应18例.④颅骨骨折5例.结论 外伤性迟发性颅内血肿的发生率与伤后首次常规CT检查表现密切相关,应在24h以内复查,以6~12h最佳.%Objective To determine how early and reliably delayed traumatic intracranial hematoma can be detected on conventional CT scanning. Methods The manifestations of the initial conventional CT studies and follow up CT examinations of 39 delayed traumatic intracranial hematoma were analyzed. Results The abnormal findings of conventional CT studies of the 39 delayed traumatic intracranial hematoma included:①Local subarachnoid space hemorrhage in 30 cases:②Decreased density of the local brain parenchyma and disappeared difference between gray and white matter of the same area in 15 cases: ③Slight space occupying effect in 18 cases:④skull bone fracture in 5 cases. Conclusion The morbidity of delayed traumatic intracranial hematoma is closely related to the manifestation of the first cranial conventional CT after injury, The time of observation should be within 24 hours of injury, and within 6 - 12 hours was the beat.

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

    Directory of Open Access Journals (Sweden)

    Sridhar Krishnamurthy

    2010-01-01

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

  10. 去大骨瓣减压术后迟发性血肿的临床研究进展%Clinical Research of Delayed Intracranial Hematoma after Decompressive Craniectomy

    Institute of Scientific and Technical Information of China (English)

    陈俊琛(综述); 赖润龙(审校)

    2015-01-01

    去大骨瓣减压术后迟发性血肿因其高致死率及致残率而受到重视。目前迟发性血肿的发病机制主要有填塞效应解除及微血管功能障碍两种假说,而术前颅内压增高、中线结构偏移及颅骨骨折等则是迟发性血肿发生的危险因素。及时对去大骨瓣减压术后迟发性血肿进行早期预测、诊断及治疗对改善患者预后可能有帮助,但是目前尚无明确定论,有待建立前瞻性研究和实验模型进行确定。%The delayed intracranial hematoma after decompressive craniectomy is highly attended because of its high mortality and disability .The mechanisms of delayed intracranial hematoma include the release of tamponade effect and dysfunction of microvascular circulation .Increased intracranial pressure,mid-line shift of the brain,cranial fracture are the risk factors of delayed intracranial hematoma .Early prediction, diagnosis and therapy of delayed intracranial hematoma are critical and may improve the prognosis .However perspective study and experimental model are still needed for confirmation .

  11. 术中非手术区迟发性颅内血肿致急性脑膨出的高危因素及抢救体会40例%The high risk factors and emergency treatments to the patients with in-traoperative acute encephalocele caused by delayed intracranial hematomas at non operating region:An investigate of 40 cases

    Institute of Scientific and Technical Information of China (English)

    赵刚; 刘帅; 李俊; 王宇; 孙继程; 张义; 王铂

    2014-01-01

    目的:探讨术中非手术区迟发性颅内血肿致急性脑膨出患者的临床高危因素及抢救经验。方法对2000年1月~2013年12月40例术中非手术区迟发性颅内血肿致急性脑膨出患者的临床资料进行回顾性分析,总结其高危因素及抢救经验。结果对冲伤22例。术前合并广泛脑挫裂伤14例,合并颅骨骨折16例,合并颅内小血肿(<15 mL)10例。致急性脑膨出的颅内血肿中对侧32例,其中硬膜外血肿24例。再手术32例,存活16例,总死亡率60%。结论术中非手术区迟发性颅内血肿致急性脑膨出高危因素为广泛脑挫裂伤、对侧颅骨骨折、非手术区的颅内小血肿。掌握其临床高危因素,有足够的预见性,充分的术前准备,正确的术中处理,术后科学系统的综合治疗才能最大限度地挽救患者生命。%Objective To investigate the high risk factors and emergency treatments to the patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region. Methods The clinical data of 40 patients with intraoperative acute encephalocele caused by delayed intracranial hematomas at non operating region from January 2000 to December 2013 were analyzed retrospectively. Summarized the high risk factors and emergency treatments in this case. Results The 22 cases with contrecoup injury. 14 cases with extensive contusion of brain,16 cases with skull fracture and 10 cases with small intracranial hematoma (Volume <15mL).The delayed intracranial hematomas to the acute encephalocele include,32 cases at the offside. And 24 cases with epidural hematoma. 32 cases had to undergo reoperation, survived 16 cases. The total death rate was 60%. Conclusion The high risk factors are ex-tensive contusion of brain, offside skull fracture and the delayed intracranial hematomas at non operating region. Under-standing Its high risk factors in clinical, with much more foreseeability, and

  12. Epidural blood patch for spontaneous intracranial hypotension with chronic subdural haematoma: A case report and literature review.

    Science.gov (United States)

    Zhang, Jian; Jin, Dan; Pan, Kong-Han

    2016-08-01

    Spinal leakage of cerebrospinal fluid (CSF) is considered to be the primary cause of spontaneous intracranial hypotension (SIH). Subdural haematoma (SDH) is a serious complication of SIH. This current report presents a case of bilateral SDH with SIH that was treated with epidural blood patching (EBP). A 43-year-old male complained of experiencing orthostatic headaches for 2 months without neurological signs. The patient worsened in a local hospital and was transferred to the Sir Run Run Hospital. Brain computed tomography showed bilateral SDH with a midline shift. The patient underwent emergency trephination in the left frontal temporal region. Postoperative magnetic resonance myelography showed a CSF leak originating at the T11-L2 level. As a consequence of clinical deterioration of the patient, EBP was subsequently performed at the T12-L1 level. The headache was rapidly relieved and later the SDH was completely absorbed. This case report and literature review aims to remind clinicians that SIH can cause SDH and that EBP is a viable treatment option. © The Author(s) 2016.

  13. 儿童创伤性颅后窝硬脑膜外血肿的治疗%Treatment of traumatic posterior cranial fossa epidural hematoma in children

    Institute of Scientific and Technical Information of China (English)

    孙育海; 吴海渡; 陈磊; 丁圣豪; 高国一; 包映晖; 潘耀华; 梁玉敏; 江基尧

    2011-01-01

    Objective To summarize the clinical features and treatment experience of traumatic posterior cranial fossa epidural hematomas (PFEDH) in child.Methods Clinical data of 30 patients with PFEDH diagnosed by surgery or imaging were analyzed retrospectively, including traffic accident injury in 18 cases, crash injury in 9, falling injury in 3, and all patients accompanied with occipital impact.The GCS scores were as follows: 8 to 10 scores in 3 cases, 11 to 12 in 9, 13 to 14 in 18.Surgical or conservative treatment was adopted according to the volume of hematoma and conditions of patients.Results Conservative treatment was performed in 6 patients, and the hematoma was completely absorbed according to CT 3 months after operation, and the neurological examination revealed no obvious abnormality.Surgical treatment was performed in 24 patients, whose state was stably improved,headache disappeared gradually, and the hematoma was basically absorbed according to CT postoperatively.No complications related to operation occurred.Good recovery was achieved in all patients according to GOS scores.Conclusions The patients with occipital impact and skull fracture have a higher risk of developing into PFEDH, and early diagnosis and prompt treatment of traumatic PFEDH can achieve satisfactory outcomes in children.%目的:总结儿童创伤性颅后窝硬脑膜外血肿(PFEDH)的临床特点和诊治经验.方法:回顾性分析30例经手术和(或)影像学检查确诊的儿童创伤性PFEDH的临床资料,其中车祸伤18例,坠落伤9例,跌伤3例;均有枕部着力伤.GCS评分:8~10分3例,11~12分9例,13~14分18例.根据血肿量和病人情况,采用非手术治疗或手术治疗.结果:非手术治疗6例,伤后3个月复查CT血肿均完全吸收,神经系统检查未见明显异常;手术治疗24例,术后所有病儿病情平稳好转,头痛症状逐渐消失,术后CT显示血肿基本清除.本组无手术相关并发症.出院时病儿按COS预后分级均恢复

  14. 儿童后颅窝硬膜外血肿35例临床分析%Posterior fossa epidural hematomas in children: a clinical analysis of 35 cases

    Institute of Scientific and Technical Information of China (English)

    王子德; 于如同; 祁正磊; 沈志刚; 苗发安; 谢满意; 纪培志; 王强

    2016-01-01

    Objective To investigate the clinical features,imaging findings,treatment and prognosis of posterior fossa epidural hematomas in children.Methods From August 2010 to April 2015,the clinical data of 35 children with traumatic posterior fossa epidural hematoma admitted to the Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical College were analyzed retrospectively.Eighteen of them were treated conservatively 8 were treated with skull drilling and drainage.Three of which received urokinase therapy because part of residual hematoma after procedure,and 9 were treated by craniotomy.Results In 18 children treated with the conservative treatment,CT revealed that their hematomas were absorbed about 1 month or so after symptom onset.The residual hematomas < 5 ml after procedure in 8 children were treated with skull drilling and drainage,and 9 were treated with craniotomy,their hematomas were removed completely after procedure.They were followed up for 4 months to 5 years.All children recovered well,without operation death and disability.Conclusions The occurrence of posterior fossa epidural hematomas in children are relatively more common.Most of them are falling and slipping injuries.The lambdoid suture separation fracture and occipital fracture are the main causes of bleeding.Headache,vomiting and disturbance of consciousness are more important for identifying the disease.Hemotomas in acute phase are easy to be liquefied.Drilling skull and drainage are safe and effective for the treatment of liquefied hematomas.The early diagnosis and appropriate treatment of posterior fossa epidural hematomas in children have good prognosis.%目的 探讨儿童后颅窝硬膜外血肿的临床特点、影像学表现、治疗方法及预后.方法 回顾性分析2010年8月至2015年4月徐州医学院附属医院神经外科收治的35例儿童外伤性后颅窝硬膜外血肿患儿的临床资料.采用保守治疗18例;钻孔引流治疗8例,其中3例因术后血

  15. Large Increase in Blood Pressure After Extubation and High Body Mass Index Elevate the Risk of Spinal Epidural Hematoma After Spinal Surgery.

    Science.gov (United States)

    Yamada, Kentaro; Abe, Yuichiro; Satoh, Shigenobu; Yanagibashi, Yasushi; Hyakumachi, Takahiko; Masuda, Takeshi

    2015-07-01

    Matched case-control study. To identify factors other than a multilevel procedure that increase the risk of symptomatic postoperative spinal epidural hematoma (SEH). Postoperative SEH is a potentially devastating complication of spinal surgery. Previous studies that reported risk factors for postoperative SEH all identified a multilevel procedure as a risk factor, but the other risk factors remain unclear. Patients who developed postoperative SEH requiring surgical evacuation were identified from database. Each patient was matched with 3 controls who underwent spinal decompression at the same number of levels in the same part of the spine by the same surgeon during the preceding or following year. Multiple logistic regression analysis was performed to identify the risk factors for postoperative SEH to obtain adjusted odds ratios with 95% confidence intervals. Clinical outcomes after evacuation were investigated separately divided with or without severe paralysis or time until the second surgery. Postoperative SEH evacuation was performed after 32 of 8250 (0.39%) spinal decompression procedures. The incidence was significantly higher after thoracic procedures (2.41%) than after cervical (0.21%) or lumbar (0.39%) procedures. Multivariate analysis identified a 50 mm Hg or greater increase in systolic blood pressure after extubation (adjusted odds ratio: 3.22, 95% confidence interval: 1.22-8.51) and higher body mass index (adjusted odds ratio 1.15, 95% confidence interval: 1.01-1.31) as risk factors. Among 14 patients with severe paralysis due to postoperative SEH, those who underwent evacuation within 24 hours of the onset had a significantly better improvement in clinical outcome and Frankel grade than did those after 24 hours. A 50 mm Hg or greater increase in systolic blood pressure after extubation and high body mass index were identified as risk factors for SEH. Appropriate blood pressure control especially at the end of surgery is important for the prevention of

  16. Spontaneous Intracranial Hypotension With Site of Leak Detected Only After 111In-DTPA Cisternogram.

    Science.gov (United States)

    Parsian, Sana; Matesan, Manuela C; Kumbhar, Sachin Shivaji; Lewis, David H

    2017-04-01

    A 54-year-old man with a 3-week history of orthostatic headache and acute on chronic subdural hematoma presented with imaging findings suggestive of spontaneous intracranial hypotension. Three myelograms were negative for leak, and nontargeted epidural blood patches did not result in symptom relief. A cerebrospinal fluid leak study using In-DTPA with SPECT/CT demonstrated a focal area of asymmetric activity at the left C2 nerve root. A left C2 root tie-off, targeted epidural blood patch, and Dura seal glue resulted in resolution of patient symptomatology highlighting the importance of fused SPECT/CT images in detection of an occult cerebral spinal fluid leak.

  17. Early surgical treatment of Hunt-Hess Ⅳ~Ⅴ grade intracranial aneurysms and intracranial hematoma%Hunt-Hess Ⅳ~Ⅴ级颅内动脉瘤并颅内血肿早期手术治疗

    Institute of Scientific and Technical Information of China (English)

    薛万抚

    2014-01-01

    Objective To investigate early surgical treatment results of Hunt-Hess Ⅳ ~Ⅴ grade intracranial aneurysms and in-tracranial hematoma.Methods The complete clinical data of 56 cases Hunt-Hess Ⅳ~Ⅴ grade intracranial aneurysms and intracranial he-matoma who adopted emergency surgery in our hospital from March 2008 to March 201 3 were retrospectively analysed.There were 30 cases of Hunt-Hess Ⅳ type and 26 cases of Hunt-Hess Ⅴtype.The patients were followed up for 3 to 24 months.The prognosis good rate,postopera-tive complications,and mortality were analyzed using a statistical approach.Results Among the 56 cases of Hunt-Hess Ⅳ and Ⅴ grade in-tracranial aneurysms and intracranial hematoma,there were 20 cases of anterior communicating artery aneurysm,1 8 of cerebral aneurysm,1 2 of posterior communicating artery aneurysm,3 of cervical aneurysms,and 2 of anterior cerebral artery aneurysm.GOS score after the surgery was:3 patients died (GOS I grade),5 patients were in a vegetative state (GOS II level),4 patients had severe disability,and could not take care of themselves (GOS III level),4 patients had moderate disability,and could take care of themselves (GOS IV grade),and 40 patients recov-ered well without affecting the work and study (GOS V level).The overall good rate was 30.40%.The mortality rate was 32.1 2%.Conclu-sion Early surgery of Hunt-Hess Ⅳ~Ⅴ grade intracranial aneurysms and intracranial hematoma for patients can reduce the postoperative complications and mortality.%目的:探讨Hunt-Hess Ⅳ~Ⅴ级颅内动脉瘤并颅内血肿早期手术治疗的效果。方法回顾分析我院2008年3月至2013年3月采用急诊手术治疗的Hunt-Hess Ⅳ~Ⅴ级颅内动脉瘤并颅内血肿患者完整病例资料,共计56例。Hunt-Hess Ⅳ型30例,Hunt-Hess Ⅴ型26例,术后均随访3~24个月。采用统计学的方法对患者的预后良好率、术后并发症以及病死率进行分析。结果56例患者中,20

  18. Clinical analysis on the related factors of cerebral edema after surgery for acute epidural hematoma%硬膜外血肿术后脑水肿的相关因素分析

    Institute of Scientific and Technical Information of China (English)

    赵鹏洲; 罗江兵; 吴敬伦; 欧英雄; 余瑞钿

    2011-01-01

    Objective To analyze the related factors of cerebral edema after surgery for acute epidural hema-toma. Methods The clinical data of patients with cerebral edema after surgery for acute epidural hematoma from April 2007 to April 2011 were collected and analyzed. The correlation between the incidence & prognosis of cerebral edema and the following factors were investigated: age, sex, surgery preconscious level, clinical status, hematoma volume, hematoma, midline shift level, pupil size, Glasgow coma Scale (GCS), and time from injury to surgery. Results A total of 30 patients suffered cerebral edema after the surgery. ANOVA showed that coma, age, and location of hematoma showed no significant correlation with cerebral edema (P>0.05); Preoperative GCS score, clinical status, time from injury to surgery, shift of midline structures, hematoma volume, and pupil size were significantly related to postoperative cerebral edema (P<0.05); Preoperative pupil size is a relative high risk independent factor of postoperative cerebral edema. Conclusion Patients with acute epidural hematoma may have different degrees of cerebral edema. Therefore, patients should be carefully evaluated before and after surgery for the related factors of cerebral edema, in order to reduce the incidence of this disease.%目的 探讨硬膜外血肿术后脑水肿的相关因素.方法 收集2007年4月至2011年4月硬膜外血肿术后发生脑水肿的30例患者的资料,分析患者术后脑水肿发生及预后与年龄、性别、术前意识水平、临床状态、血肿体积、血肿部位、中线移位程度、瞳孔大小、格拉斯哥昏迷评分(GCS)、受伤至手术时间的关系.结果 63例硬膜外血肿患者术后共有30例患者出现脑水肿,经单因素方差分析显示是否有昏迷、年龄及血肿的部位与术后脑水肿无明显相关(P>.05);术前GCS评分、临床状态、受伤至手术时间、脑中线结构移位程度、血肿量、瞳孔大小、临床

  19. 术中窦汇区迟发性硬膜外血肿致急性脑膨出的治疗%The treatment of malignant encephalocele caused by acute epidural hematoma around confluens sinuum in operation

    Institute of Scientific and Technical Information of China (English)

    徐勤义; 董吉荣; 蔡学见; 王玉海; 刘斌; 时忠华; 金东; 冯毅; 何建青

    2010-01-01

    目的 探讨颅脑损伤患者术中窦汇区迟发性硬膜外血肿所致急性脑膨出的临床特点及诊治经验.方法 回顾我院2007年5月至2009年5月收治的10例颅脑损伤患者,均为开颅术中发现急性脑膨出,术中复查头颅CT明确窦汇区迟发性硬膜外血肿的诊断后,取顶枕部"U"形切口,做窦汇区骨瓣成形加自体筋膜加压修补术.结果 根据GOS评分判断愈后:中残2例,重残1例,植物生存1例,死亡6例.结论 窦汇区硬膜外血肿做跨窦骨瓣成形术,骨瓣足够大,出血点完全暴露,再用自体筋膜加压修补术彻底止血,是理想的手术方法 .早期诊断及正确的手术方法 是救治成功的关键.%Objective To investigate the characteristics of malignant encephalocele caused by acute epidural hematoma around confluens sinuum during operation. Method Ten patients admitted from May 2007 to May 2009 in our hospital was reviewed. All cases presented malignant encephalocele during operation and acute epidural hematoma around confluens sinuum after CT scan. We made craniotomy with a bone flap under U - shape incision and self - fascia was used to patch compressively for hemostasis. Results According to the GOS score 2 cases had satisfactory outcome with moderately disability, 1 severe disability, 1 vegetative state, 6 dead.Conclusion Patients with acute epidural hematoma around confluens sinuum might be made craniotomy in a big enough bone - flap so that bleeding point exposed wholly and stopped bleeding by self - fascia patch repair compressively. Early diagnosis and correct operative technique might be key point for successful remedy.

  20. 重型颅脑损伤术后迟发性颅内血肿的危险因素观察%The risk factors of delayed intracranial hematoma after severe braininjury

    Institute of Scientific and Technical Information of China (English)

    路顺利

    2016-01-01

    目的:探讨颅脑损伤术后迟发性颅内血肿发生的危险因素。方法选取2012年6月~2016年2月我院行急性外伤性颅脑血肿清除术患者200例作为研究对象,将其按照术后是否发生迟发性颅内血肿进行分组,其中术后发生迟发性颅内血肿者30例(血肿组),未发生迟发性颅内血肿者170例(非血肿组)。对比两组患者的临床基线特征与颅内血肿发生的危险因素。结果多因素logistic回归分析结果显示:颅骨骨折(OR=1.864,95%CI 1.162~3.465,P=0.021)、脑挫裂伤(OR=2.874,95%CI 1.574~4.264, P=0.018)、重度颅脑损伤(OR=3.757,95%CI 2.475~5.797,P=0.001)及血浆TT水平(OR=1.964,95%CI 1.254~4.038,P=0.015)是迟发性颅内血肿的独立危险因素。结论颅骨骨折、脑挫裂伤、重度颅脑损伤及血浆TT水平是颅脑损伤术后迟发性颅内血肿的独立危险因素。%Objective To investigate the risk factors of delayed intracranial hematoma after craniocerebral injury operation.Methods Delayed intracranial hematoma occurred in 30 patients (hematoma group), 170 cases of delayed intracranial hematoma (non hematoma group). The clinical baseline characteristics of the two groups were compared with the risk factors of the occurrence of intracranial hematoma.Results Multivariate logistic regression analysis showed that skull fracture (OR=1.864,95%CI 1.162~7.095 3.465, P=0.021), cerebral contusion and laceration (OR=2.874,95%CI 157.4 ~ 4.264, P=0.018), severe craniocerebral injury (OR=3.757, 95% CI 2.475 to 5.797, P=0.001) and plasma TT levels (or=196.4, 95% CI 125.4 ~ 4.038, P= 0.015) is delayed intracranial hematoma of independent risk factors.Conclusion Skull fracture, brain contusion severe traumatic brain injury and plasma TT level are the independent risk factors of delayed intracranial hematoma after craniocerebral injury operation.

  1. Suprarrenal hematoma Hematoma suprarrenal

    OpenAIRE

    1996-01-01

    Neonatal asymptomatic suprarrenal hemorrhage is relatively frequent; sometimes it is detected only after resolution when a calcification is found; symptomatic forms are rare; most times hemorrhage and hematoma are due to an obstetric trauma and are related to macrosomia, breech presentation, maternal diabetes and neonatal hypoxia. Clinical picture is characterized by abdominal mass and anemia; diagnosis is confirmed by imagenology. Two patients with suprarrenal hematoma from the University Ho...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1993-12-31

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

  3. 婴儿颅内血肿的早期诊断和手术治疗(附3例报告)%Early Diagnosis and Operation on Intracranial Hematoma in Infancy: A Report of 3 Cases

    Institute of Scientific and Technical Information of China (English)

    张源; 张慧玲; 李秀莲; 辛骥

    1989-01-01

    本文报道3例婴儿颅内血肿,均早期作出诊断,皆施行开颅术,手术获得成功.文中对婴儿颅内出血的原因、诊断和手术问题进行了分析和讨论.%This article reports 3 infants with intracranial hematoma. All cases got an early diagnosis and operation and a successful recovery. The main causes of intracranial hematoma are trauma,asphyxia or hypoxia during delivery,hemorrhagic disease,Vit. K deficiency and congenital malformation of cerebral vessels. Plateau anoxia is a predisposition. The diagnosis is based on the history,lumbar puncture,CT and B-ultrasonography of the fontanel,CT being the first of chioce. Craniotomy is attempted to the treatment via a U-shaped skin flap to elear and drain the hematoma. One of the 3 cases was operated on at 3 days after birth. The 2 year follow-up of these patients has showed normal intelligence and a developing nerve system.

  4. Suprarrenal hematoma Hematoma suprarrenal

    Directory of Open Access Journals (Sweden)

    Concepción Guardo B.

    1996-04-01

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

  5. Minimally invasive intracranial hematoma in patients with hypertensive cerebral hemorrhage%高血压脑出血微创颅内血肿清除术

    Institute of Scientific and Technical Information of China (English)

    赵勇

    2015-01-01

    Objective To observe the clinical effect of minimally invasive intracranial hematoma in treatment of hypertensive in-tracerebral hemorrhage patients. Methods 100 cases of hypertensive cerebral hemorrhage patients were selected as the research object in our hospital from January, 2010 to January, 2014. All the cases are in line with the Chinese Medical Association related diagnostic standard setting the fourth national academic meeting for cerebrovascular disease, 100 patients were randomly divided into observation group and control group with 50 cases in each group, the control group was given the conservative drug treatment, the observation group was given minimally invasive intracranial hematoma. The clinical curative effect and complications incidence and follow-up of quality of life of 6 months were compared between the two groups. Results The clinical efficacy of two groups were compared, the effect of observation group was significantly better than the control group (P<0.05). The observation group there were three cases of digestive tracThemorrhage, pulmonary infection in six cases, cardiac changes in three cases, two cases of cen-tral high fever, the complication rate was 28%; the control group occurred in 7 cases of digestive tracThemorrhage, pulmonary in-fection in 12 cases, cardiac changes in 5 cases, 4 cases of central high fever, the incidence of complications was 56%, group com-parison between observation group than in the control group, with significant difference (P<0.05). The observation group in physio-logical function(RP), social function(SF), the physiological function of overall health (PF), self rating (GH) four aspects of the scores were significantly higher than control group (P<0.05). Conclusion Compared with conservative treatment clinical department of in-ternal medicine, invasive intracranial hematoma is better, which is conducive to the quality of life in patients with recovery, and it has higher security. Therefore, hypertensive

  6. Traumatic progressive epidural hematomas: reports of 93 cases%外伤性进展性硬脑膜外血肿(附93例报告)

    Institute of Scientific and Technical Information of China (English)

    粱玉敏; 陈磊; 唐超; 包映晖; 高国一; 潘耀华; 书国伟; 江基尧

    2012-01-01

    目的 探讨外伤性进展性硬脑膜外血肿(TPEDH)的临床特点和早期诊治方法.方法 回顾性总结93例TPEDH的临床、影像学资料和预后结果,并结合文献进行分析.结果 本组93例中男72例,女21例,平均年龄(33±12)岁;受伤至TPEDH确诊的平均时间为(8±13)h;41例为首次CT扫描上少量出血的增大,52例为新发血肿;其中28例为首次开颅减压术后发生.血肿部位以颞顶部和额颞部最多见(54%),其次为额部、顶部、枕顶部和枕部;本组单侧83例,双侧10例.以意识障碍加重为最常见的临床表现,术后发生者则以颅内压增高为突出表现.本组5例保守治疗,88例手术治疗,其中同时去除骨瓣33例.83例TPEDH处有骨折存在.本组出院时GOS评分5分56例,4分20例,3分10例,2分3例,1分4例.结论 TPEDH多于伤后12h内发生,冲击部位最多见,颅骨骨折是其发生的根本因素.动态神经状态评估和CT复查有助于早期诊断,对有占位效应的TPEDH及时手术清除有助于改善预后.%Objective To investigate the clinical characteristics and methods for early diagnosis and treatment of traumatic progressive epidural hematoma (TPEDH).Methods The clinical and radiological data and outcome of 93 patients with TPEDH were reviewed retrospectively. On basis of reviewing literatures,results of these cases were analyzed.Results Among the 93 cases,72 were male and 21 were female,with an average age was 33 12 years. The average interval time from injury to the confirmed diagnosis of TPEDH was 8 13 hours.TPEDH was formed by the enlargement of small hemorrhage on initial CT scanning in 41 cases,and in the other 52 cases,the TPEDH occurred in the location of no hemorrhage on initial CT scanning.Among them,TPEDH in 28 cases was found after initial decompressive cranioctomy.The most common locations of TPEDH were tempo - parietal region and fronto - temporal region,followed by frontal,parietal,parieto - occipital and occipital

  7. Experimental model of intracranial hypertension with continuous multiparametric monitoring in swine

    Directory of Open Access Journals (Sweden)

    Almir Ferreira de Andrade

    2013-10-01

    Full Text Available Objective Intracranial hypertension (IH develops in approximately 50% of all patients with severe traumatic brain injury (TBI. Therefore, it is very important to identify a suitable animal model to study and understand the pathophysiology of refractory IH to develop effective treatments. Methods We describe a new experimental porcine model designed to simulate expansive brain hematoma causing IH. Under anesthesia, IH was simulated with a balloon insufflation. The IH variables were measured with intracranial pressure (ICP parenchymal monitoring, epidural, cerebral oximetry, and transcranial Doppler (TCD. Results None of the animals died during the experiment. The ICP epidural showed a slower rise compared with parenchymal ICP. We found a correlation between ICP and cerebral oximetry. Conclusion The model described here seems useful to understand some of the pathophysiological characteristics of acute IH.

  8. Research on Influence of Mannitol on Curative Effect after Intracranial Hematoma Microinvasive Removal%甘露醇对颅内血肿微创清除术患者疗效的影响

    Institute of Scientific and Technical Information of China (English)

    江思德; 唐明山; 邹耀兵; 肖静; 潘成德

    2011-01-01

    目的 探讨甘露醇对脑出血血肿微创清除术后患者疗效的影响.方法 将96例高血压脑出血血肿行微创清除术患者分为不用甘露醇组和用甘露醇组进行临床对比研究.结果 不用甘露醇组48例中,恢复良好、生活能自理29例(60.42%),中残、部分生活自理12例(25.00%).重残5例(10.42%),死亡2例(4.17%);用甘露醇组48例中,恢复良好、生活能自理24例(50.00%),中残、部分生活自理14例(29.17%),重残6例(12.50%),死亡4例(8.33%).手术1 d后复查头颅CT,不用甘露醇组血肿体积明显比用甘露醇组小,两组术后神经功能评分及血肿体积比较存在显著性差异(P<0.05).结论 颅内血肿微创清除术后不用甘露醇的治疗效果明显优于应用甘露醇,而甘露醇在颅内血肿微创清除术后需谨慎应用.%Objective To study the influence of mannitol on the curative effects after intracranial hematoma microinvasive removal. Methods Ninety- six cases of hematoma after hypertensive cerebral hemorrhage were given intracranial hematoma microinvasive removal. After the operation, the patients were divided equally into two groups. One group was given an injection of mannitol and another group was not. Then the clinical curative effects were evaluated and compared between the two groups. Results Among 48 cases in the group without using mannitol, 29 cases (60. 42% ) recovered well with the ability of living independence, 12 cases (25.00%) were mildly disabled with partial ability of living independence, 5 cases (10.42%) were seriously disabled (including vegetative stage) and 2 cases (4. 17% ) died. Among 48 cases in using mannitol group, 24 cases(50. 00% ) recovered well with the ability of living independence, 14 cases(29. 17% ) were mildly disabled with partial ability of living independence, 6 cases(12.50% ) were seriously disabled(including vegetative stage) and 4 cases (8. 33% ) died. On postoperative 1 d, the cranial CT

  9. Comparison of the efficacy of epidural autologous blood patch in the treatment of spontaneous intracranial hypotension and post-dural puncture headache

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Sung Hyun; Lee, Jon Woo; Lee, Geun Young; Lee, Eu Gene; Kang, Heung Sik [Dept. of Radiology, Seoul National University Bundang Hospital, Seongnam (Korea, Republic of)

    2014-04-15

    To evaluate and compare the effectiveness of fluoroscopy-guided epidural blood patch (EBP) in patients with post-dural puncture headache (PDPH) and spontaneous intracranial hypotension (SIH). Between August 2012 and September 2013, 16 patients (12 with PDPH, 4 with SIH; 5 males, 11 females; age range 19-58 years, mean age 32.8 years) who underwent EBP in the Department of Radiology were included in this study. Pain relief within three days after EBP was evaluated based on medical record and classified on a 3-level scale: complete relief; incomplete relief; and failure. Recurrence is defined as aggravated postural headache after three days. We evaluated and compared treatment outcome between PDPH and SIH, using Fisher's exact test (considered as significant when p < 0.05). In 12 PDPH patients, the EBP provided complete relief in 5 patients (41.7%), and incomplete relief in 7 patients (58.3%). In 4 SIH patients, the EBP provided complete relief in 1 patient (25%), and incomplete relief in 3 patients (75%). There was no significant difference (p = 0.511) of pain relief rate between PDPH and SIH. There was recurrence in 5 patients with PDPH and 1 patient with SIH. Five PDPH patients were retreated by EBP with incomplete relief. Fluoroscopy-guided EBP provides effective treatment of postural headache for both SIH and PDPH patients.

  10. 23岁以下创伤性硬膜外血肿临床特点研究%Investigation on Clinical Characteristics of Traumatic Epidural Hematoma in Less than 23 Years Old Patients

    Institute of Scientific and Technical Information of China (English)

    田万管; 张文涛; 朱志宏; 黎檀实

    2013-01-01

    Objective To investigate the clinical characteristics of traumatic epidural hematoma ( EDH ) in young patients under 23 years. Methods 196 EDH patients from 0 to 23 years old admitted to our hospital from January 2005 to December 2011 were divided into three groups by age: infants and children group ( 0 to 11 years old ) 49 cases, teenagers group ( 12 to 17 years old ) 40 cases and youth group ( 18 to 23 years old ) 107 cases. Sex composition, injury causes, injury sites, injury severity ( GCS and ISS ), different types of EDH, fracture of skull, operation and prognosis of the 196 patients were retrospectively analyzed. Results ( 1 ) Sex composition, injury causes and injury sites between the three groups showed statistically significant differences ( P 0. 05 ). ( 2 ) Among the 196 cases, 85 of them were small EDH ( 43. 4% ), 61 of them were large EDH ( 31. 1% ), 41 of them were EDH combined with other intracranial injuries ( 20. 9% ), 6 of them were without further information ( 3. 1% ) and 3 of them were bilateral EDH ( 1. 5% ) . The composition of EDH types between the three groups showed no statistically significant difference ( P >0. 05 ) . ( 3 ) Among the 196 cases, 145 cases ( 74. 0% ) had skull fracture, 86 cases ( 59. 3% ) had fracture of skull vault, 40 cases ( 27. 6% ) had fracture of skull base, 19 cases ( 13. 1% ) had fractures of skull vault and skull base and 51 cases ( 26. 0% ) had no skull fracture. The difference of skull fractures between the three groups was statistically significant ( P <0. 01 ). (4) Among the 196 cases, 62 cases ( 31. 6% ) were given operation treatment, 14 ( 28. 6% ) of which were in infants and children group, 12 ( 30. 0% ) of which were in teenagers group and 36 (33. 6% ) of which were in youths group. The difference of operation rate between the three groups was not statistically significant (x2 =0. 462, P = 0. 794 ) . ( 5 ) Among the 196 cases, 9 cases ( 4. 6% ) were died, 3 ( 6. 1 % ) of which were in infants and

  11. Conservative management of a cervical ligamentum flavum hematoma: Case report

    Directory of Open Access Journals (Sweden)

    Hanna Algattas

    2016-01-01

    Conclusion: Spontaneous epidural hematoma arising from ligamentum flavum is a rare cause of spinal cord compression. Previous reports have described success with surgical decompression. However, initial observation and conservative management may be successful as illustrated in this case.

  12. 颅脑损伤患者进展性颅内血肿增多196例诊治体会%Clinical experience of 196 patients of craniocerebral injury with intracranial hematoma increasing evolution-ally

    Institute of Scientific and Technical Information of China (English)

    张国栋; 徐雅彪; 张萌; 姜晓玲; 郑建辉; 黄春刚; 刘维田; 常久魁; 李建华; 刘全良; 周晋

    2013-01-01

    目的:探讨颅脑损伤患者入院后颅内血肿进展性增多的诊断及治疗方法,总结如何尽量降低死亡率和致残率。方法回顾性分析2005-07-2013-07我院收治的颅脑损伤患者196例,住院时首次CT扫描未见颅内血肿23例,颅内已形成血肿173例,血肿量为12~32 mL,观察1.5~72 h内病情变化,再次复查CT见颅内出现血肿和原有血肿不同程度增多,及时采取相应的治疗措施。结果患者出院后6个月,根据格拉斯哥预后评分( GOS)评订预后,其中恢复良好124例,中残40例,重残19例,植物生存5例,死亡8例。结论因外伤性致颅内血肿的患者住院后,颅内血肿短时间有继续增多的可能,注意观察病情变化,及时诊断并采取治疗措施,患者能得到较好的治疗效果。%Objective To summarize the diagnosis and treat method about intracranial hematoma increasing evolutionally after patients with craniocerebral injury admitting to hospital and about how to reduce the mortality and morbidity to the greatest extent .Methods The clinical data of 196 patients with craniocerebral injury from July 2005 to July 2013 in Fengrun District people's hospital was analyzed retrospectively .There are 173 cases of intracranial he-matoma by brain CT scan on 196 patients admitting to hospital , with 12~32 mL of hematoncus ;Not 23 cases of in-tracranial hematoma.After observing conditions in 1.5~72 hours, relevant treatments were carried on when observ-ing the emerging and Original hematoma increasing to some degree by reviewing brain CT scan .Results All cases were followed up for more than half an year .According to GOS , 124 cases were in good recovery , 40 cases in moder-ate disability, 19 cases in severe disability, 5 cases in plants survived and 8 cases in death.Conclusion After pa-tients with craniocerebral injury admit to hospital , there is possibillity of intracranial hematoma increasing evolutional-ly, so it

  13. 急性外伤性颅内血肿患者术后发生迟发性脑出血的临床分析%Clinical analysis of acute traumatic intracranial hematoma with postoperative delayed cerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    蔡亮

    2013-01-01

    目的:探讨急性外伤性颅内血肿患者的临床特征与术后迟发性脑出血发生的相关性,寻找防治措施。方法:回顾分析58例急性外伤性颅内血肿患者开颅血肿清除术后再出血的临床资料,其中23例患者术后发生迟发性脑出血( DTIH组),35例未发生( NDTIH)组。对2组患者的临床特征进行总结归纳,分析寻找再出血原因,对迟发性脑出血患者行再次手术治疗,并随访行GOS评分。结果:与NDTIH组比较DTIH组有如下特征:术前GCS评分<8分(p<0.05);术前头颅CT提示多有多发脑挫伤,对冲伤,合并颅骨骨折等,并予及时再次手术治疗,术后随访行GOS评估≥4分18例。结论:根据急性外伤性颅内血肿开颅术后患者的临床特征,及时发现迟发性脑出血,并清除迟发性颅内血肿,是提高疗效的关键。%Objective:To explore the corelation between the clinical features of patients with incidence of acute traumatic intracranial hematoma and late postoperative hemorrhage occurs and to make prevention and control measures .Methods:The clinical data of 58 cases divided two groups,postoperative delayed cerebral hemorrhage (DTIH,n=23) and did not occur (NDTIH,n=35),of acute traumatic in-tracranial hematoma in patients with invasive hematoma removal were retrospectively analyzed ,which to invastigate the reason of rehaemor-rhagia and did surgical treatment again ,to follow up through GOS score .Results:Compared with the NDTIH group ,the DTIH had the fol-lowing characteristics:preoperative GCS score <8 points ( p <0.05);Preoperative skull CT indicated that multiple cerebral contusion , hedge, skull fractures, etc,which to timely surgery again , there were18 cases those value of GOS evaluation were four points or more . Conclusion:According to the clinical features of patients with acute traumatic intracranial hematoma after craniotomy , timely detected the late-onset cerebral

  14. Surgical Management of Vertex Epidural Hematoma Straddling the Superior Sagittal Sinus%顶部跨上矢状窦硬膜外血肿的外科治疗策略探讨

    Institute of Scientific and Technical Information of China (English)

    韩瑞璋; 苏国军; 于烽; 赵保; 叶晶亮; 李斌; 张建忠

    2012-01-01

    Objective: To investigate the diagnosis and surgical treatment strategies of vertex epidural hematoma (VEDH) straddling the superior sagittal sinus and improve its clinical outcome. Methods: The clinical data, surgical procedures and the therapeutic effects in 27 cases of vertex epidural hematoma after brain injury admitted in our hospital from January 2002 and October 2011 were retrospectively analyzed. Results: According to GOS, 15 cases of conservative treatment all recovered well; in 12 cases of craniotomy, 7 cases recovered well, moderate disability was found in 1 case, severe disability was found in 1 case, plant survival was found in 1 case, 2 cases died. All patients had skull X-ray or CT scan hematoma region or coronal suture fracture or diastasis of the sagittal suture, and patients in operation group were confirmed by surgery, the superior sagittal sinus rupture was found in 2 cases. The prognosis of patients with Simple vertex fracture was usually better than those associated with superior sagittal sinus torn. Conclusions: VEDH is an unusual disease in clinic, progresses quickly, so correctly grasping its diagnosis and surgery indications are helpful to improve the prognosis of those patients%目的:探讨顶部跨上矢状窦硬膜外血肿的诊断和外科治疗策略,提高其临床治疗效果.方法:回顾分析2002年1月~2011年10月我院收治的27例颅脑创伤后发生的跨上矢状窦硬膜外血肿病例的临床资料、手术方法,总结分析其治疗效果.结果:按GOS治疗结果评定,保守治疗的15例患者均恢复良好;开颅手术的12例患者中,7例恢复良好,1例中残,1例重残,1例植物生存,2例死亡.全组病人均经头颅X线或CT检查提示血肿区域有骨折或冠状缝或矢状缝分离,并经手术证实,其中伴有上矢状窦破裂2例.单纯骨折不伴有矢状窦损伤者手术效果较好,而伴有矢状窦撕裂者预后较差.结论:顶叶跨上矢状窦硬膜外血肿临床少见,病情

  15. Paraplegia After Thoracic Epidural Steroid Injection.

    Science.gov (United States)

    Loomba, Vivek; Kaveeshvar, Hirsh; Dwivedi, Samvid

    2016-09-01

    Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case.

  16. Traumatic epidural hematoma straddling the transverse sinus:clinical type and selection of operative meth-ods%外伤性骑跨横窦硬膜外血肿的临床类型分析及术式选择

    Institute of Scientific and Technical Information of China (English)

    覃思杰; 杨博函

    2013-01-01

    Objective To explore the clinical characteristics and selection of surgical procedure of traumatic epidural hematoma straddling the transverse sinus .Methods The clinical data ,including operative methods and clin-ical curative effect of 36 cases of traumatic epidural hematoma straddling the transverse sinus was retrospectively ana-lyzed.Results Of 27 cases receiving surgical treatment , 22 cases had hematoma removal of satisfaction , 5 cases had hematoma part residual .According to GOS scores , prognosis estimating showed: 15 cases were cured , almost re-turned to normal in 8 cases, moderate disability in 2 cases, severe disability in 1 case, 1 case died.In 9 cases receiv-ing of conservative treatment , all recovered well .Conclusion Paying affection to clinical monitoring of patients with the traumatic epidural hematoma straddling the transverse sinus , dynamically reviewing head CT , choosing different operation method according to the different type of hematoma , can improve the clinical curative effect and the rescue success rate .%目的:探讨外伤性骑跨横窦硬膜外血肿的临床类型特点及手术方式选择。方法分析36例外伤性骑跨横窦硬膜外血肿的临床资料、术式选择及临床疗效。结果手术治疗27例,22例血肿清除满意,5例血肿部分残留,按GOS评分评估预后:痊愈15例,基本恢复正常8例,中残2例,重残1例,死亡1例。保守治疗9例,均恢复良好。结论重视外伤性骑跨横窦硬膜外血肿的临床监护,动态复查头颅CT,根据不同的血肿类型,选择不同的手术方式,可提高临床疗效及抢救成功率。

  17. Effect of Microinvasive Aspiration and Drainage of Intracranial Hematoma in the Treatment of Cerebral Hemorrhage%脑出血应用微创颅内血肿抽吸引流术治疗的效果探讨

    Institute of Scientific and Technical Information of China (English)

    陈容

    2016-01-01

    Objective To explore the clinical effect of microinvasive aspiration and drainage of intracranial hematoma in the treatment of cerebral hemorrhage. Methods 80 cases with cerebral hemorrhage admitted in our hospital from January 2014 to June 2015 were selected as the subjects and randomly divided into two groups with 40 cases in each. Patients in the con-trol group were treated by medical conservative treatment, and those in the experimental group were treated by microinva-sive aspiration and drainage of intracranial hematoma. And the treatment effect was evaluated by comparing the values of indexes of the two groups. Results The treatment results showed that the total effective rate of the experimental group was significantly higher than that of the control group (P<0.05). The experimental group had significantly lower incidence of complications than the control group (P<0.05). The conscious disturbance scores and nerve function impairment scores were significantly better than those before treatment in both groups, and the conscious disturbance scores and nerve function im-pairment scores were significantly better in the experimental group than in the control group (P<0.05). Conclusion Microin-vasive aspiration and drainage of intracranial hematoma has good overall clinical effect on cerebral hemorrhage, which can significantly improve the symptoms of neurological deficit and the state of consciousness, so it is suitable for wide clinical application.%目的:对脑出血应用微创颅内血肿抽吸引流术治疗的临床效果进行探讨。方法整群选取该院于2014年1月—2015年6月接收的80例脑出血患者为研究对象,将所有患者随机将其分为两组,各40例。其中对照组患者采取内科保守进行干预,而实验组患者采取微创颅内血肿抽吸引流术治疗,在治疗结束后通过比较两组患者的各项指标,评价治疗效果。结果治疗结果表明,实验组患者的治疗总有效率明显高

  18. Intracranial Hypotension Syndrome, Diagnosis and Treatment in Radiology Clinics

    Directory of Open Access Journals (Sweden)

    S. Albayram

    2005-08-01

    the region of the cauda equina, and Rabin et al (4 described another case of intracranial hypotension with prominent flow voids within the ventral epidural space near the midline of the upper thoracic spine adjacent to a ventral extradural fluid collection. Treatment of intracranial hypotension varies, depending on its origin and type. If intracranial hypotension is the result of a shunt procedure or surgery, then treatment is usually surgical. Spontaneous intracranial hypotension is often treated first with conservative management, and if this is not effective, an epidural blood patch is used. Surgical correction may be required when all other measures have failed, especially if a dural tear or other meningeal defect has been demonstrated. In addition to the correction of meningeal defects, surgical drainage of subdural hematomas, a frequent complication of ICH, also may be necessary.

  19. Intracranial Hypotension with Multiple Complications: An Unusual Case Report

    Directory of Open Access Journals (Sweden)

    Swetha Ade

    2013-01-01

    Full Text Available Background. Undiagnosed intracranial hypotension can result in several complications including subdural hematoma (SDH, subarachnoid hemorrhage (SAH, dural venous sinuses thrombosis (CVT, cranial nerve palsies, and stupor resulting from sagging of the brain. It is rare to see all the complications in one patient. Furthermore, imaging of the brain vasculature may reveal incidental asymptomatic small aneurysms. Given the combination of these imaging findings and a severe headache, the patients are often confused to have a primary subarachnoid hemorrhage. Case Report. We present a patient with spontaneous intracranial hypotension (SIH who had an incidental ophthalmic artery aneurysm on MR imaging, and this presentation led to coiling of the aneurysm. The key aspect in the history “postural headaches” was missed, and this led to life threatening complications and unnecessary interventions. Revisiting the history and significant improvement in symptoms following an epidural blood patch resulted in the diagnosis of SIH. Conclusion. We strongly emphasize that appropriate history taking is the key in the diagnosis of SIH and providing timely treatment with an epidural blood patch could prevent potentially life threatening complications.

  20. Hematoma Vulvar

    Directory of Open Access Journals (Sweden)

    Andrea W. Choque Campero

    2012-06-01

    Full Text Available Paciente de Sexo femenino de 29 anos de edad acudio a consulta externa del Hospital “German Urquidi” por dolor y molestia en region peri vulvar, diagnosticándose “hematoma vulvar” de causa obstétrica (Laceracion de trayecto, mala técnica de sutura de episiotomia.

  1. 微创手术治疗外伤性亚急性颅内血肿伴剧烈头痛的效果观察%Effect of minimally invasive surgery in the treatment of subacute traumatic intracranial hematoma with intense headache

    Institute of Scientific and Technical Information of China (English)

    林宽; 谢才兰; 卢家璋

    2012-01-01

    目的 探讨微创手术治疗外伤性亚急性颅内血肿减轻头痛的效果.方法 对39例血肿量在8~30 ml,GCS评分14~15分的外伤性亚急性颅内血肿患者应用颅骨钻孔颅内血肿清除、置管引流术及YL-1型微创颅内碎吸引流针锥颅引流术治疗,观察效果.结果 所有患者经微创手术治疗后,次日即感觉剧烈头痛减轻,可以正常进食睡眠;无需继续服止痛药者37例,其余2例于3~7 d内停用止痛药;无死亡病例.出院后患者门诊随诊复查2~3个月,基本无头痛或仅有轻微头晕.结论 微创手术治疗亚急性颅内血肿能迅速有效减轻患者头痛,促进神经恢复,缩短住院时间,减少患者痛苦.%Objective To investigate the headache alleviation effect of minimally invasive surgery in the treatment of subacute traumatic intracranial hematoma. Methods Thirty-nine patients of subacute traumatic intracra-nial hematoma, with hematoma volume of 8~30 ml and GCS score of 14~15, were treated by sphenotresia (to remove intracranial hematoma), catheter drainage and drilling skull drainage with YL-1 type minimally invasive intracranial aspiration needle. The clinical efficacy was observed. Results After minimally invasive surgery, all the patients were found with relieved headache the next day, taking food and sleep as usual. Thirty-seven patients had no need to take painkillers, and the rest 2 patients stopped using painkillers within 3~7 days. No case of death was found. The patients were followed up and checked at clinic 2-3 months after discharge. They were found to have almost no headache or just mild dizziness. Conclusion Treating subacute intracranial hematoma with minimally invasive surgery could rapidly and effectively relieve the patient's headache, stimulate neurology recovery, shorten the hospitalization time, and alleviate patients' pain.

  2. Early diagnosis and treatment for contralateral progressive epidural hematomas after decompressive craniectomy of acute traumatic subdural hematoma%急性硬脑膜下血肿减压术后对侧进展性硬脑膜外血肿的早期诊治

    Institute of Scientific and Technical Information of China (English)

    徐立; 江基尧; 唐超; 陈磊; 曹铖; 丁圣豪; 高国一; 包映晖; 潘耀华; 梁玉敏

    2012-01-01

    Objective To investigate the clinical features and the methods for early diagnosis and treatment of contralateral progressive epidural hematoma (EDH) after decompressive craniectomy ( DC) of acute traumatic subdural hematoma (SDH). Methods The clinical data of 23 patients with contralateral EDH after DC of acute traumatic SDH were analyzed retrospectively. Its clinical manifestations, results of CT scanning and outcome were summarized. Results The average interval time of confirmed diagnosis for contralateral progressive EDH after DC was (4±3)hours. The EDH was located in parietotemporal regions in 12 cases, parieto-occipital regions in 9 and fronto-temperal regions in 2. The main manifestations included intra-operative brain swelling in 8 cases, contralateral pupil dilation post-DC in 4, increasing of ICP value in 4 and no neurological change in 7. Conservative therapy was made for 1 patient, and second operation was made in 22 for the evacuation of EDH with that skull fracture was found in 21 below EDH. According to Glasgow Outcome Scale(GOS), scores of 5,4,3,2 and 1 were experienced in 5,7,7,1 and 3 patients respectively on discharge. Conclusions Majority of contralateral progressive EDH after DC of acute traumatic SDH are occurred in parietotemperal and perieto-occipital regions. And delayed bleeding from skull fracture at the site of the EDH is its main mechanism of such EDH. Early diagnosis and prompt management is contributed to the improvement of such cases.%目的 探讨颅脑外伤去骨瓣减压术(DC)后对侧进展性硬脑膜外血肿(EDH)的临床特点和早期诊治方法.方法 对23例颅脑外伤术后对侧进展性EDH患者的资料进行回顾性分析.结果 术后对侧进展性EDH的平均确诊时间为(4±3)h;EDH的部位为颞顶部12例,枕顶部9例,额颞部2例;主要表现为术中脑肿胀8例,术后对侧瞳孔散大4例,术后ICP逐渐增高4例,神经系统无明显异常改变者7例.保守治疗1例,再手术22例,21例确

  3. Technique of ICP monitored stepwise intracranial decompression effectively reduces postoperative complications of severe bifrontal contusion

    Directory of Open Access Journals (Sweden)

    Guan eSun

    2016-04-01

    Full Text Available Background Bifrontal contusion is a common clinical brain injury. In the early stage, it is often mild, but it progresses rapidly and frequently worsens suddenly. This condition can become life threatening and therefore requires surgery. Conventional decompression craniectomy is the commonly used treatment method. In this study, the effect of ICP monitored stepwise intracranial decompression surgery on the prognosis of patients with acute severe bifrontal contusion was investigated. Method A total of 136 patients with severe bifrontal contusion combined with deteriorated intracranial hypertension admitted from March 2001 to March 2014 in our hospital were selected and randomly divided into two groups, i.e., a conventional decompression group and an intracranial pressure (ICP monitored stepwise intracranial decompression group (68 patients each, to conduct a retrospective study. The incidence rates of acute intraoperative encephalocele, delayed hematomas, and postoperative cerebral infarctions and the Glasgow outcome scores (GOSs 6 months after the surgery were compared between the two groups.Results (1 The incidence rates of acute encephalocele and contralateral delayed epidural hematoma in the stepwise decompression surgery group were significantly lower than those in the conventional decompression group; the differences were statistically significant (P < 0.05; (2 6 months after the surgery, the incidence of vegetative state and mortality in the stepwise decompression group were significantly lower than those in the conventional decompression group (P < 0.05; the rate of favorable prognosis in the stepwise decompression group was also significantly higher than that in the conventional decompression group (P < 0.05.Conclusions The ICP monitored stepwise intracranial decompression technique reduced the perioperative complications of traumatic brain injury through the gradual release of intracranial pressure and was beneficial to the prognosis of

  4. Subdural Hematoma

    Science.gov (United States)

    2006-07-01

    presence of and severity of other associated brain injuries. As many patients can experience rapid clinical improvement after successful...greater than 21 days old. They have a tendency to present in older patients and after non-accidental trauma in children and may be associated with... whiplash force caused by violent shaking. Subdural hematomas in infants are only rarely caused by accidental injury. A heterogeneous subdural

  5. Idiopathic Thoracic Spontaneous Spinal Epidural Hematoma

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available A 33-year-old male patient experienced temporary sensory loss and weakness in the right lower extremity one month prior to admission. The patient was admitted to a private clinic with a three-day history of acute onset of sensory loss and weakness in both lower extremities and was treated and followed up with a prediagnosis of transverse myelitis and the Guillain-Barre syndrome (GBS. The patient was subsequently transferred to our clinic and the neurologic examination revealed paraplegia in both lower extremities, positive bilateral Babinski signs, and hypesthesia below the T10 dermatome with saddle anesthesia. The patient had urinary incontinence and thoracic magnetic resonance imaging (MRI showed an image of a mass compressing the medulla.

  6. Endoscopic evacuation of cerebellar hematoma in a term newborn.

    Science.gov (United States)

    Tanriverdi, Sema Rala; Turhan, Tuncer; Uygur, Ozgun; Koroglu, Ozge Altun; Yalaz, Mehmet; Kultursay, Nilgun

    2013-10-01

    Intracerebellar hemorrhage is very rare in term infants and only severe cases with massive intracranial hemorrhage, posthemorrhagic hydrocephalus and clinical deterioration due to increased intracranial pressure require neurosurgical evacuation. In recent adult studies endoscopic hematoma evacuation has been shown as a rapid, effective, and safe technique. A term newborn hospitalized for meconium aspiration syndrome showed hypertonia, jitteriness and abnormal amplitude integrated electroencephalogram findings. He was diagnosed with cerebellar hematoma which caused hydrocephalus by cranial magnetic resonance imaging (MRI). The hematoma was successfully evacuated neuroendoscopically as the first case in literature to our knowledge. Neurologic, a-EEG and MRI findings resolved.

  7. Acute cervical spinal subdural hematoma not related to head injury.

    Science.gov (United States)

    Kim, Hee Yul; Ju, Chang Il; Kim, Seok Won

    2010-06-01

    We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/mm(3). She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

  8. Spinal subdural hematoma following meningioma removal operation.

    Science.gov (United States)

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

    2014-03-01

    Although blood contamination of cerebrospinal fluid (CSF) after an intracranial operation can occur, the development of a symptomatic spinal hematoma after craniotomy has been anecdotally reported and it is uncommon reported after a supratentorial meningioma removal operation. We report a case of spinal subdural hematoma following a supratentorial meningioma removal operation and discuss the mechanism of spinal subdural hematoma (SSDH) development. A 54-year-old woman presented with lumbago and radicular pain on both legs 4 days after a right parietooccipital craniotomy for meningioma removal. Only the straight leg raising sign was positive on neurologic examination but the magnetic resonance imaging (MRI) demonstrated a lumbosacral spinal subdural hematoma. The patient received serial lumbar tapping, after which her symptoms showed improvement.

  9. Spinal radiological findings in nine patients with spontaneous intracranial hypotension

    Energy Technology Data Exchange (ETDEWEB)

    Chiapparini, L.; Farina, L.; D' Incerti, L.; Erbetta, A.; Savoiardo, M. [Department of Neuroradiology, Istituto Nazionale Neurologico, Milan (Italy); Pareyson, D.; Carriero, M.R. [Department of Neurology, Istituto Nazionale Neurologico, Milan (Italy)

    2002-02-01

    Cranial magnetic resonance imaging (MRI) findings in spontaneous intracranial hypotension (SIH) are well known, while spinal studies have received less attention. Radiological spinal findings in nine patients with SIH are presented, looking for possible characteristic features. Five of the nine patients had histories of previous minor trauma, one of previous surgery; in three patients possible relevant preceding events were completely absent. All nine patients had cervical, seven thoracic, and four lumbar spine MRI studies; post-contrast studies were obtained in seven cases, MRI myelograms in five. Radioisotope myelocisternography was performed in four patients and myelo-CT in four. Epidural fluid collections were found in seven patients. In six cases the dural sac had collapsed, with a festooned appearance; intense epidural enhancement on post-contrast studies demonstrated marked dilatation of the epidural venous plexus. In three cases an irregular root sleeve suggested a possible point of cerebrospinal fluid (CSF) leakage. Myelo-CT demonstrated the CSF fistula in two cases, radioisotope myelocisternography in three. The pattern of spinal abnormalities is different from that seen in cranial MRI for anatomical reasons: in the spinal canal the dura is not adherent to the bone; therefore, collapse of the dural sac and dilatation of epidural venous plexus occur, rather than subdural hematomas. In most cases the search for the dural tear is difficult. Radioisotope cisternography is probably the most sensitive examination for documenting the leakage of CSF out of the subarachnoid space; myelo-CT may precisely demonstrate the point of the CSF fistula, whereas MRI may only suggest it. (orig.)

  10. Spontaneous ligamentum flavum hematoma in the lumbar spine

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-09-15

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

  11. Intracranial Hemorrhage in Pregnancy

    Directory of Open Access Journals (Sweden)

    Afshan B. Hameed

    2012-11-01

    Full Text Available A pregnant woman with a mechanical prosthetic mitral valve was anticoagulated with low-molecular-weight heparin in the first trimester followed by warfarin until 36 weeks' gestation. She was then switched to intravenous unfractionated heparin infusion to allow for regional anesthesia in anticipation of vaginal delivery. She developed severe headache on hospital day 2 that was refractory to pain medications. Cranial imaging demonstrated a large subdural hematoma with midline shift. She delivered a healthy baby girl by cesarean section. Eventually, symptoms and intracranial abnormalities resolved over time. In conclusion, subdural hematoma is a relatively rare complication that requires multidisciplinary management plan.

  12. Epidural catheterization in cardiac surgery: The 2012 risk assessment

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    Thomas M Hemmerling

    2013-01-01

    Full Text Available Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552. Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

  13. 外伤性迟发性颅内血肿的危险因素及其预测价值%Risk factors and predictive value of delayed traumatic intracranial hematoma

    Institute of Scientific and Technical Information of China (English)

    尹华锦

    2015-01-01

    目的:探讨外伤性迟发性颅内血肿(DTICH)的危险因素及其预测价值。方法:收集95例急性颅脑外伤患者的临床资料,分为迟发血肿组(62例)和无血肿复发对照组(33例)。比较两组临床资料,采用Logistic回归模型分析DTICH的危险因素,并以受试者工作特征曲线(ROC)评价相关危险因素的预测价值。结果:与无血肿复发组比较,迟发血肿组患者年龄[(46.72±6.45)岁比(52.18±7.13)岁]明显较大,血肿量[(51.21±11.25) ml比(56.89±12.37) ml]、空腹血糖[(8.13±1.55) mmol/L比(10.62±1.73) mmol/L]、活化部分凝血活酶时间[APTT ,(25.27±6.19) s比(27.35±7.45) s]、凝血酶时间[TT ,(17.53±5.14) s比(21.26±7.31) s ]均明显增加,基底池受压(24.2%比46.8%)、脑挫伤(42.4%比69.4%)、去除骨瓣(45.5%比67.7%)、Babinski征阳性(39.4%比61.3%) 等比例均明显增大, GCS评分[(9.46±3.29)分比(7.63±3.07)分]、收缩压[(146.57±18.23) m m H g比(132.18±17.18) m m H g ]、手术时机[(12.74±4.39) h比(5.47±2.16) h ]等均明显减少, P<0.05或<0.01;Logistic回归分析显示,凝血功能(APTT、TT)、颅骨骨折和手术时机为术后迟发血肿的危险因素(OR=4.076~5.430, P<0.05或<0.01),其 ROC曲线下面积分别为0.826、0.748和0.661。结论:凝血功能、颅骨骨折及手术时机是颅脑外伤患者术后迟发性颅脑血肿的危险因素,有较大预测价值。%Objective:To explore the risk factors its predictive value of delayed traumatic intracranial hematoma (DTICH) . Methods:Clinical data of 95 patients with acute craniocerebral trauma were collected .All patients were divided into DTICH group (n=62) and no recurrent hematoma control group (n=33) .Clinical data were compared between two groups ,Lo‐gistic regression model was used to analyze risk factors

  14. Pseudoarachnoiditis in Spontaneous Intracranial Hypotension

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    Özlem Alkan

    2011-03-01

    Full Text Available Spontaneous intracranial hypotension is an important cause of new daily persistent headaches in young and middle-aged individuals. The diagnosis is made based on low cerebrospinal fluid pressure with characteristic findings upon brain and spinal magnetic resonance imaging (MRI. We present the case of a 15-year-old boy with spontaneous intracranial hypotension. Although his brain MRI was normal, his lumbar spinal MRI showed clustering of the nerve roots characteristic of arachnoiditis. Radionuclide cisternography revealed an epidural leak, which was treated with an epidural blood patch. The patient reached a near-full recovery within 24 h, and the lumbar spinal MRI findings mimicking arachnoiditis disappeared.

  15. Reversible cerebral vasoconstriction syndrome and posterior reversible encephalopathy syndrome associated with intracranial hypotension.

    Science.gov (United States)

    Feil, Katharina; Forbrig, Robert; Thaler, Franziska S; Conrad, Julian; Heck, Suzette; Dorn, Franziska; Pfister, Hans-Walter; Straube, Andreas

    2017-02-01

    Reversible cerebral vasoconstriction syndrome (RCVS) and posterior reversible encephalopathy syndrome (PRES) are both rare disorders. The pathophysiology of both diseases is not yet fully understood. We report the unique case of a 19-year-old comatose woman who was brought to the ER after a series of generalized tonic-clonic seizures 6 days post peridural anesthesia for cesarean section. Vital signs and initial laboratory testing including urine analysis and drug screening were unremarkable. Initial cranial CT scan showed an acute small subdural hematoma (17 mm length × 6 mm width × 30 mm height), cerebral edema with slit ventricles, and slight cerebellar tonsillar herniation as signs of intracranial hypotension. CT angiography depicted narrowing of the proximal intracranial vessels consistent with RCVS. MR imaging was also suggestive of both intracranial hypotension and RCVS and showed, in addition, vasogenic edema consistent with PRES. An extensive CSF leakage involving T1 to L2/L3 was confirmed by spinal MRI. The patient underwent conservative therapy for intracranial hypotension (e.g., head-down position) as well as epidural blood patch, which led to regression of the clinical symptoms within a few days. Follow-up MRI showed complete resolution of all radiological changes. In summary, our patient developed clinical and neuroradiological signs of intracranial hypotension and a combination of PRES and RCVS associated with a CSF leakage caused by peridural anesthesia; by treating the intracranial hypotension, the other syndromes resolved. From a clinical point of view, it is important to look for CSF leakage as a treatable possible cause of PRES and/or RCVS triggered by intracranial hypotension as in our patient postpartum. Moreover, it is vital to obtain a good history as, in cases of suspected CSF leakage with classic postural headache, a recent spinal/cranial procedure is typically present.

  16. Two cases of medically-refractory spontaneous orthostatic headaches with normal cerebrospinal fluid pressures responding to epidural blood patching: Intracranial hypotension versus hypovolemia and the need for clinical awareness

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    Kaukab M Hassan

    2013-01-01

    Full Text Available The diagnosis of spontaneous intracranial hypotension or cerebrospinal fluid (CSF hypovolemia syndrome requires a high index of suspicion and meticulous history taking, demonstration of low CSF pressure and/or neuroimaging features. A 31-year-old male, presented with subacute onset moderate occipital and sub-occipital headaches precipitated by upright posture and relieved on recumbency and neck pain for 2 years. There was no trauma, cranial/spinal surgery. Clinical examination was normal and CSF opening pressure and laboratory study were normal. Magnetic resonance imaging (MRI brain showed thin subdural hygroma. Another patient, 41-year-old male presented with 1 month of subacute onset severe bifrontal throbbing orthostatic headaches (OHs. CSF opening pressure was normal. Contrast MRI brain showed the presence of bilateral subdural hygromas, diffuse meningeal enhancement, venous distension, sagging of the brain, and tonsillar herniation. We report two cases of "spontaneous OHs" with normal CSF pressures who were successfully treated with epidural blood patching after poor response to conservative management.

  17. 颅脑损伤术中继发颅内出血原因分析%Cause analysis of intracranial hemorrhage during operation on patients with brain injury

    Institute of Scientific and Technical Information of China (English)

    张学军; 梁伟; 陈文军

    2010-01-01

    Objective To study the possible reasons and the processing strategy of brain injury operation complicated with intracranial hemorrhage.Methods The clinical data about 22 patients who were digged skull operation because of brain injury and complicated with intracranial hemorrhage in operation in neurosurgery from 2007 June to 2008 February were retrospectively analyzed,and different types intracranial hemorrhage were classified.Results In 22 patients,12 patients were complicated with epidural hematoma,in which the patients (9/12,75.0%) complicated with opposite hematoma were common;5 patients were complicated with intracerebral hematoma,in which the patients (3/5,60%) complicated with ipsilateral hematoma were common;4 patients were complicated with acute subdural hematoma,and all the patients complicated with opposite hematoma;1 patient was complicated with sub-flap hematoma.Conclusions In the patients who are complicated with intracranial hemorrhage because of digging skull operation to brain injury,epidural hematoma are most,then intracerebral hematoma,subdural hematoma,sub-flap hematoma.The important measures of preventing secondary intracranial hemorrhage are definiting force mechanism and distinguishing fracture line before operation,gradiently decompressing,completely removing crushing brain tissue,protecting reflux veins,rigorously stopping bleeding during operation.%目的 探讨颅脑损伤手术中继发颅内出血的可能原因及其处理策略.方法 回顾性分析22例因颅脑损伤行开颅手术治疗且术中继发颅内出血患者的临床资料,对不同类型颅内出血进行归类.结果 22例患者中继发硬膜外血肿12例,以并发手术对侧血肿多见;脑内血肿者5例,以手术同侧脑内血肿多见;急性硬膜下血肿者4例,均发生于首次手术对侧;皮瓣下血肿1例.结论 颅脑损伤开颅手术中所继发的颅内出血以硬膜外出血最多见,其次为脑内、硬膜下出血及手术皮瓣下出血,术

  18. Delayed Presentation of a Cervical Spinal Epidural Abscess of Dental Origin after a Fall in an Elderly Patient.

    Science.gov (United States)

    Bodman, Alexa; Riordan, Margaret; Chin, Lawrence S

    2016-05-23

    Spinal epidural abscesses are an uncommon cause of spinal cord injury but, depending on the size and presence of neurological deficits, urgent neurosurgical intervention may be required. We present a unique case of a patient presenting with a spinal epidural collection several days after a fall. While a spinal epidural hematoma was suspected based on the patient's history and MRI findings, a spinal epidural abscess was found during surgery. The patient underwent laminectomy and instrumented fusion with successful treatment of her infection.

  19. Paraplegia following epidural analgesia: A potentially avoidable cause?

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    Jeson R Doctor

    2014-01-01

    Full Text Available Neurological deficit is an uncommon but catastrophic complication of epidural anesthesia. Epidural hematomas and abscesses are the most common causes of such neurological deficit. We report the case of a patient with renal cell carcinoma with lumbar vertebral metastasis who developed paraplegia after receiving thoracic epidural anesthesia for a nephrectomy. Subsequently, on histo-pathological examination of the laminectomy specimen, the patient was found to have previously undiagnosed thoracic vertebral metastases which led to a thoracic epidural hematoma. In addition, delayed reporting of symptoms of neurological deficit by the patient may have impacted his outcome. Careful pre-operative investigation, consideration to using alternative modalities of analgesia, detailed patient counseling and stringent monitoring of patients receiving central neuraxial blockade is essential to prevent such complications.

  20. 颅脑创伤开颅术中、术后对侧迟发性硬膜外血肿诊治探讨(附26例分析)%Discuss of the diagnosis and treatment of contralateral delayed epidural hematoma in and after the operation of ;traumatic brain injury:reports of 26 cases

    Institute of Scientific and Technical Information of China (English)

    孙宇; 袁从华; 吴良发; 潘耀华; 王经发; 王海伟; 厉进辉; 惠晓伟

    2014-01-01

    目的:探讨颅脑创伤开颅术中、术后对侧迟发性硬膜外血肿的发生机制与处理方法。方法分析2008-01—2014-04颅脑创伤开颅术中、术后发生对侧迟发性硬膜外血肿26例患者的临床资料。结果随访3~6个月,按格拉斯哥预后评分( GOS)判定预后,恢复良好15例,轻残4例,重残2例,植物生存1例,死亡4例。结论颅脑创伤开颅术前应仔细研究患者的受伤机制,分析影像学资料,及时诊断并处理对侧迟发性硬膜外血肿,能提高其治愈率,减少死残率,改善患者预后。%Objective To discuss the occurring mechanism and therapeutic method of contralateral delayed epidural hematoma ( DEDH) in and after traumatic brain injury .Methods The clinical and radiological data and outcome of 26 patients were reviewed retrospec-tively between January ,2008 and January 2014.Results All the patients were followed up in 3-6 months after discharge and were analyzed the prognosis according the Glasgow Outcome Scale ( GOS) .There were 15 cases in Low disability , 4 in Moderate disability ,2 in Severe disa-bility,1 in Persistent vegetative state and 4 in Death.Conclusion The brain injury mechanisms and radiological datas of the patients should be deliberately analyzed before the brain surgery and early diagnosis and evacuation of the contralateral epidural hematoma may contribute to im -provement of its cure rate and prognosis , decrease of the death and disability .

  1. Late vitamin K deficiency intracranial hemorrhage CT diagnosis value%晚发性维生素K缺乏症颅内出血的CT诊断价值

    Institute of Scientific and Technical Information of China (English)

    关春

    2013-01-01

    Objective:To explore the CT late vitamin K deficiency intracranial hemorrhage diagnosis value. Materials and methods:Col ection of 16cases with late vitamin K deficiency intracranial hemorrhage in children with CT clinical data analysis. Results:Intracerebral hemorrhage in 14 cases,11 cases with subarachnoid hemorrhage, subdural hematoma in 8 cases,4 cases of epidural hematoma, intraventricular hemorrhage in 2 cases. Conclusion:CT can rapidly and accurately display intracranial hemorrhage, bleeding location, quantity, for clinical diagnosis, treatment and has the important value.%目的:探讨CT对晚发性维生素K缺乏症颅内出血的诊断价值。资料与方法:收集16例晚发性维生素K缺乏症颅内出血患儿的CT临床资料进行分析。结果:脑实质内出血14例,蛛网膜下腔出血11例,硬膜下血肿8例,硬膜外血肿4例,脑室内出血2例。结论:CT检查能快速准确地显示颅内出血的部位、范围、出血量的多少,对临床诊断、治疗等具有重要价值。

  2. The lucid interval associated with epidural bleeding: evolving understanding.

    Science.gov (United States)

    Ganz, Jeremy C

    2013-04-01

    The aim of this paper was to elucidate the evolution of our understanding of the term "lucid interval." A number of texts were reviewed to assess their suitability for analysis. The primary requirement was that the text contain detailed descriptions of a series of patients. Details of the clinical course, the findings and timing of surgery, and, when relevant, the time of death and postmortem findings were required. Books written by Henri-François Le Dran, Percival Pott, and James Hill fulfilled these criteria. Surgical findings included the presence and type of fractures, changes in the bone, separation of periosteum, malodorous or purulent material, tense brain, and hematoma. Postmortem findings supplemented and/or complemented the surgical findings. The courses of the patients were then tabulated, and the correlation between different clinical and operative findings was thereby determined. Our understanding of a lucid interval began in the early 18th century with the work of Henri-François Le Dran and Percival Pott in London. They did not, however, demonstrate an interval without symptoms between trauma and deterioration in patients with epidural hematomas (EDHs). The interval they described was longer than usually expected with EDHs and occurred exclusively in patients who had a posttraumatic infection. In 1751, James Hill, from Dumfries, Scotland, described the first hematoma-related lucid interval in a patient with a subdural hematoma. The first case of a lucid interval associated with an EDH was described by John Abernethy. In the 19th century, Jonathan Hutchinson and Walter Jacobson described the interval as it is known today, in cases of EDH. The most recent work on the topic came from studies in Cincinnati and Oslo, where it was demonstrated that bleeding can separate dura mater and that hemorrhage into the epidural space can be shunted out via the veins. This shunting could delay the accumulation of a hematoma and thus the rise in intracranial pressure

  3. Postoperative extradural hematomas.

    Science.gov (United States)

    Pichierri, Angelo; Ruggeri, Andrea; Donnarumma, Pasquale; Delfini, Roberto

    2013-01-01

    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.

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

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

    1992-01-01

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

  5. An epidural catheter removal after recent percutaneous coronary intervention and coronary artery stenting: Epidural catheter and antiaggregation therapy

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    Joksić Nikola

    2016-01-01

    Full Text Available Introduction: Anticoagulation and antiplatelet therapy in the presence of the epidural catheter is still controversial. It is well known that dual antiplatelet therapy is indicated for 12 months after the placement of drug-eluting stents (DES. Removal of an epidural catheter during that period is related to an increased risk of stent occlusion in case of discontinuation of platelet function inhibitors or, on the other hand, increased risk of epidural hematoma associated with neurological deficit if suppressed platelet function is still present. Case Report: Here we present a case of a 63-year-old man who was admitted to Institute for Cardiovascular Diseases Dedinje for elective aortic surgery. Before the induction, an epidural catheter was inserted at the Th10-Th11 epidural space. Uneventful surgery was performed under the combined epidural and general anesthesia. On the 2nd postoperative day, the patient sustained a ST depression myocardial infarction treated with percutaneous coronary intervention with DES placement, while epidural catheter was still in place. Dual antiplatelet therapy with 600mg of clopidogrel, 100 mg of acetilsalicylic acid (ASA and low molecular weight heparin (LMWH were started during the procedure. The next day, clopidogrel (75 mg and ASA (100 mg were continued as well as LMWH. The decision to remove the epidural catheter was made on the 9th postoperative day, after platelet aggregation assays were performed. Six hours after catheter removal the patient again received clopidogrel, ASA and LMWH. There were no signs of epidural hematoma. Conclusion: This case shows that point-of-care testing with platelet aggregation assays may be useful in increasing the margin of safety for epidural catheter removal during dual antiplatelet therapy.

  6. Bilateral subdural hematoma secondary to accidental dural puncture

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    Sofía Ramírez

    2015-08-01

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

  7. 幕上下联合入路治疗骑跨横窦幕上下平均型枕部硬膜外血肿分析%The combined supra-and infra-tentorial approach to average supra-and infra-tentorial occipital epidural hematoma straddling transverse sinus

    Institute of Scientific and Technical Information of China (English)

    吴义天; 路春雨; 王斌; 刘晓辉

    2016-01-01

    目的 探讨幕上下联合入路治疗骑跨横窦幕上下平均型枕部硬膜外血肿的方法及适应证.方法 回顾分析淮北市人民医院幕上下联合入路手术治疗骑跨横窦幕上下平均型枕部硬膜外血肿患者的临床资料,17例患者伤后3 h内均行头颅CT及颅骨三维重建,急诊清除血肿,保留骨桥并悬吊硬膜.随访3个月,GOS评价术后恢复情况.结果 17例患者术后生命体征基本平稳,随访3个月,GOS评分均为5分,患者术后恢复良好.结论 骑跨横窦幕上下平均型枕部硬膜外血肿病情进展迅速,病死率高.早期确诊,准确把握手术指征,及时手术,术中保留骨桥、妥善处理横窦是成功抢救骑跨横窦幕上下平均型枕部硬膜外血肿患者的关键.%Objective o explore the combined supra-and infra-tentorial approach to average supra-and infra-tentorial occipital epi-dural hematoma(OEH)straddling transverse sinus.Methods The clinical data of 17 patients of our department from January 2012 to April 2015 were analyzed retrospectively .They all received cranial CT ,3D reconstruction of skull bone ,emergency evacuation of hematoma ,reten-tion of bone bridge and suspense of dura mater in three hours after injury .The patients were then followed up for three months to evaluate the recovery by GOS .Results All the 17 patients recovered well .Conclusion This case often progresses rapidly with high mortality .There-fore,early diagnosis,accurate identification of operation indication ,and timely surgery with retention of bone bridge and proper treatment of transverse sinus are the keys to rescue such patients successfully .

  8. Endoscopic Surgery for Traumatic Acute Subdural Hematoma

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    Hiroyuki Kon

    2014-01-01

    Full Text Available Traumatic acute subdural hematoma (ASDH is generally addressed by craniotomy under general anesthesia. We report a patient whose traumatic ASDH was treated under local anesthesia by one-burr-hole endoscopic surgery. This 87-year-old woman had undergone coil embolization for a ruptured right middle-cerebral artery aneurysm and placement of a ventriculoperitoneal shunt for normal pressure hydrocephalus 5 years earlier. Upon admission, she manifested consciousness disturbance after suffering head trauma and right hemiplegia. Her Glasgow Coma Scale score was 8 (E2V2M4. Computed tomography (CT demonstrated a thick, left-frontotemporal ASDH. Due to her advanced age and poor condition, we performed endoscopic surgery rather than craniotomy to evacuate the ASDH. Under local anesthesia, we made a burr hole in her left forehead and increased its size to 15 mm in diameter. After introducing a transparent sheath into the hematoma cavity with a rigid endoscope, the clot was evacuated with a suction tube. The arterial bleeding point was electrically coagulated. A postoperative CT scan confirmed the reduction of the hematoma. There was neither brain compression nor brain swelling. Her consciousness disturbance and right hemiplegia improved immediately. Endoscopic surgery may represent a viable method to address traumatic intracranial hematomas in some patients.

  9. Spontaneous retroclival hematoma: a case series.

    Science.gov (United States)

    Narvid, Jared; Amans, Matthew R; Cooke, Daniel L; Hetts, Steven W; Dillon, William P; Higashida, Randall T; Dowd, Christopher F; Halbach, Van V

    2016-03-01

    Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cases of idiopathic or angiographically negative subarachnoid hemorrhage (SAH) of the posterior fossa, only a single case report of a patient with a unique spontaneous retroclival hematoma has been identified. In this study, the authors reviewed the presentation, management, and clinical outcome of this rare entity. The authors performed a retrospective analysis of all patients with diagnosed SRH at their institution over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. Four patients had SRH. All were appropriately evaluated for coagulopathic and/or traumatic etiologies of hemorrhage, though no etiology could be found. Moreover, all of the patients demonstrated SRH that both clearly crossed the basioccipital synchondrosis and was contained within a nondependent configuration along the retroclival dura mater. Spontaneous retroclival hematoma, often associated with IVH, is a rare subtype of intracranial hemorrhage frequently recognized only when MRI demonstrates compartmentalization of the posterior fossa hemorrhage. When angiography fails to reveal an underlying lesion, SRH patients, like patients with traditional angiographically negative SAH, enjoy a remarkably good prognosis.

  10. Effects of body temperature on serum levels of ischemia-modified albumin and malondialdehyde after surgery for intracranial hematomas in patients with severe traumatic brain injury%体温控制对重型颅脑损伤血肿清除术后的疗效及血清IMA、MDA的影响

    Institute of Scientific and Technical Information of China (English)

    刘军; 袁辉纯; 徐立新

    2016-01-01

    目的:探讨体温控制对重型颅脑损伤(sTBI)血肿清除术后的疗效及血清缺血修饰蛋白(IMA)、丙二醛(MDA)的影响。方法2012年3月到2013年1月收治符合标准的sTBI 45例,均行开颅血肿清除术;术后根据体温控制水平分为观察组(25例)和对照组(20例)。观察组使用亚低温治疗仪联合冬眠药物将肛温控制在36.0~36.4℃,维持7 d后自然复温;对照组采用传统降温措施将肛温控制在36.5~37.7℃。采用ELISA法检测血清IMA、MDA水平。结果观察组颅内压在治疗后3 d开始逐渐下降,7 d明显低于对照组(P0.05)。两组血清IMA及MDA水平均在治疗前最高,治疗后1~7 d逐渐下降,治疗组较对照组下降更明显(P<0.05)。结论肛温控制在36.0~36.4℃对sTBI颅内血肿清除术后患者有脑保护作用,其机制可能与降低血清IMA及MDA水平,减轻缺血再灌注损伤有关。%Objective To investigate the effect of body temperature on the serum levels of ischemia-modified albumin (IMA) and malondialdehyde (MDA) after the surgery for the intracranial hematomas in patients with severe traumatic brain injury (sTBI). Methods Forty-five patients with sTBI after the surgery for intracranial hematomas were divided into observed group (n=25) and control group (n=20). In observed group, mild hypothermia therapy apparatus and hibernation drugs were used to control rectal temperature at 36.0~36.4℃for 7 days. In control group, conventional cooling methods were used to control rectal temperature at 36.5~37.7℃. The serum levels of IMA and MDA were detected by ELISA. Results The intracranial pressure, which began to decline 3 days after the body temperature control, was significantly lower in observed group than control group 7 days after the body temperature control (P<0.05). The prognosis was significantly better in observed group than control group 3 months after the body temperature control (P<0.05). There

  11. Chronic spinal subdural hematoma; Spinales chronisches subdurales Haematom

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-10-15

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

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

    Directory of Open Access Journals (Sweden)

    Shusuke Yamamoto

    2015-01-01

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

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

    Science.gov (United States)

    Juković, Mirela; Petrović, Kosta; Till, Viktor

    2014-01-01

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

  14. Mucocele and pyocele with marked intracranial extension

    Energy Technology Data Exchange (ETDEWEB)

    Tsuchiya, Kazuhiro; Machida, Tohru; Iio, Masahiro

    1984-08-01

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

  15. Intracranial aneurysms.

    Science.gov (United States)

    Puskar, G; Ruggieri, P M

    1995-08-01

    MR angiography provides a rapid, accurate, and extremely flexible noninvasive evaluation of intracranial aneurysms without the cost and risk of conventional angiography. TOF and phase contrast techniques each have specific advantages and disadvantages that can be selectively exploited to optimize aneurysm evaluation. Present indications for MR angiography in aneurysm evaluation include: (1) the presence of incidental findings on a CT or MR examination that suggest the possibility of aneurysm (Figs. 7 and 8), (2) when angiography is contraindicated or when the risk is too high, (3) non-invasive follow-up of patients with known aneurysms, (4) patient refusal of contrast angiography, and (5) evaluation of patients with specific clinical symptoms (i.e., third cranial nerve palsy) or patients with non-specific subacute symptoms in whom an aneurysm might explain the clinical presentation. Although MR angiography certainly can detect aneurysms with a high rate of sensitivity and specificity, detailed decision analyses generally have not supported the overall benefit of this type of screening. Future technical advances as well as advances in the overall understanding of aneurysms may one day prove unequivocally the benefit of MR angiography in screening high-risk patient groups. MR angiography has not yet been clinically evaluated as a tool in the evaluation of acute subarachnoid hemorrhage. Potential obstacles to such an evaluation include the clinical instability of SAH patients, limited spatial resolution of the MR angiography acquisitions, the potential for subarachnoid blood or focal intraparenchymal hematomas to obscure or mimic small aneurysms, and the unreliability of MR angiography in demonstrating vasospasm. Currently these factors continue to provide an integral role for contrast angiography in aneurysm evaluation.

  16. 重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素分析%Clinical Research of Risk Factors of the Delayed Intracranial Hematoma Followed by Craniotomy in Severe Head Injury Patients

    Institute of Scientific and Technical Information of China (English)

    沈佳; 杨渭林; 裘申忠; 毛伟; 殷怀明

    2014-01-01

    目的:探讨重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素,以期能够改善患者预后质量。方法选取2010年3月-2014年3月富阳市人民医院收治的行开颅手术治疗的重型颅脑损伤患者102例,依据患者术后是否发生迟发性颅内血肿将其分为迟发组和非迟发组,记录两组患者临床资料,包括性别、年龄、发病至手术时间、颅骨骨折、蛛网膜下腔出血、Babinski 征阳性、基底池受压、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、格拉斯哥昏迷量表(GCS)评分、收缩压、舒张压、血小板计数、纤维蛋白原、血肿量等。采用多因素 Logistic 回归分析探讨影响患者行开颅手术后发生迟发性颅内血肿的危险因素。结果依据患者术后是否发生迟发性颅内血肿将其分为迟发组41例和非迟发祖61例。两组性别、年龄、蛛网膜下腔出血发生率、血浆凝血酶原时间、收缩压、血小板计数、血肿量比较,差异均无统计学意义(P >0.05);两组发病至手术时间、颅骨骨折发生率、Babins-ki 征阳性发生率、基底池受压发生率、活化部分凝血活酶时间、血浆凝血酶时间、GCS 评分、舒张压、纤维蛋白原水平比较,差异均有统计学意义(P 0. 05). The time from onset to operation,inci-dence of fracture of skull,incidence of positive Babinski symptoms and compression of basilar cistern,activated partial thrombo-plastin time,plasma thrombin time,GCS score,diastolic pressure and fibrinogen level showed statistically significant differences between the two groups(P < 0. 05). Multivariate Logistic regression analysis showed that the time from onset to operation,frac-ture of skull,positive Babinski symptoms and plasma thrombin time were independent factors for delayed intracranial hematoma followed by craniotomy in severe head injury patients(P < 0. 05). Conclusion

  17. The relationship between the size of traumatic epidural hematoma and the length,type and location of fracture line%外伤性硬膜外血肿大小与骨折线长度、类型及部位的关系

    Institute of Scientific and Technical Information of China (English)

    李振; 侯黎明; 何彦雨; 裴玉春; 汪棋生; 唐清明

    2014-01-01

    Objective To investigate the relationship between the size of traumatic epidural hematoma (TEDH) and the length ,type and location of fracture line. Methods The data of 173 patients with TEDH in our hospital from June 2010 to May 2013 were collected including demographics ,clinical manifestations ,CT and other ancillary test results. The patients with TEDH were divided into the group H (n=95 ,> 15 mL) and group L (n=78 ,<15 mL) according to the hematoma size. The fracture line length ,hematoma volume and bleeding site were measured by CT and (or CTA). Results Group H had more comminuted fracturesmore and less linear fracture compared with group L ,which had significant difference. The fracture line length in group H was longer than that in group L in patients with linear fracture. Moreover ,the linear fracture was more com-mon than comminuted fracturesmore in occiput of patients with TEDH. Conclusion Hematoma volume of patients with TEDH has the certain relationship with the fracture type and fracture line length.%目的:通过观察外伤性硬膜外血肿患者的CT特点,探讨硬膜外血肿大小与骨折线长度、类型及部位的关系,为临床观察病情和手术止血提供依据。方法2010-06-2013-05在我院神经外科连续入院的外伤性硬膜外血肿患者。收集包括人口学因素、临床表现、CT及其他辅助检查结果等数据。根据血肿大小将研究对象分为H组(>15mL)和L组(<15mL)。以冠状缝、人字缝、颞骨鳞状缝将脑颅分为额部、顶部、枕部、颞部4个区域,如血肿跨区域的则以主要部分分类。通过CT和(或CTA)测量骨折线长度和血肿量、出血部位。结果共纳入173例,其中H组患者95例(54.9%)。左侧H组比例明显低于L组(22%vs27.7%,P<0.05),而右侧H组的比例高于L组(34.1%vs19.7%,P<0.05)。与L组相比,H组中粉碎性骨折较常见(26%vs10.4%,P<0.05),但线性骨折比例

  18. Spinal and epidural anesthesia

    Science.gov (United States)

    ... you epidural or spinal anesthesia is called an anesthesiologist. First, the area of your back where the ... Chan VWS. Spinal, epidural, and caudal anesthesia. In: Miller RD, ed. Miller's Anesthesia . 8th ed. Philadelphia, PA: ...

  19. 以慢性硬膜下血肿为首诊的儿童颅内蛛网膜囊肿五例并文献复习%Clinical study on patients of intracranial arachnoid cyst concurring initially chronic subdural hematoma in children: report of five cases and literature review

    Institute of Scientific and Technical Information of China (English)

    梅文忠; 林志雄

    2012-01-01

    Objective To explore the etiopathogenisis and treatment strategies of chronic subdural hematoma associated with arachnoid cyst in children.Methods A retrospective analysis was made for 5 cases of chronic subdural hematoma associated with arachnoid cyst in children from January 2006 to April 2012.There were 4 males and 1 female with a mean age of 7.2 years old ( rang:4 - 11 ).The symptom of intracranial hypertension was appeared in all cases,as well as,epilepsy in 1 case and paralysis in another.History of previous head injury was found in lcase and no history of injury in 4 cases.Results The symptoms were relieved without neurologic deficits by undergoing burr hole evacuation.The absence of the subdural hematoma were ocuured in 1 to 3 days for 4 cases wih tension cysts and 6 days for another case complicating intracystic hematoma postoperatively.The ensuing operation of cyst - peritoneal shunt for 3 cases with tension cysts were preformed in three weeks to three months later.The follow - up duration was vary from six month to two years,None had recurrent subdural hematoma and cysts disappear approximatively for the patients of undergoing cyst - peritoneal shunt.Conclusions Arachnoid cyst is a causative factor for subdural hematoma in preschoolers and school children.The subdural hematoma perhaps was a secondary event from local inflammatory reaction,which was prevoked by restoring the leakage of arachnoid cyst wall.A burr hole evacuation is a first - line treatment and has a full recovery.%目的 探讨儿童颅内蛛网膜囊肿相关性的慢性硬膜下血肿的病因机制及治疗方法.方法 回顾性分析福建医科大学附属第一医院2006年1月至2012年4月5例以慢性硬膜下血肿为首诊患儿的临床资料,男4例,女1例,年龄4 ~11岁,平均7.2岁,均以典型颅高压表现首诊,其中1例并发癫痫,另1例并发健侧肢体无力;发病前3个月内明确颅脑损伤史1例,无明确外伤史4例.结果 5例患儿术后颅高压

  20. Advances in surgical treatment of chronic subdural hematoma

    Institute of Scientific and Technical Information of China (English)

    张作洪; 刘建雄

    2003-01-01

    @@ Chronic subdural hematoma (CSDH) represents one of the most frequent types of intracranial hemorrhage. Management of the patients with CSDH has been evolved through a vast variety of methods and techniques. Although there is general agreement that surgical therapy is usually the preferred treatment, there are few other neurosurgical conditions that spark such strong discussions and differences of opinion concerning the optimal surgical technique.1,2 In this paper, we review advances in surgical treatment of CSDH.

  1. Severe hypotension related to high negative pressure suction drainage on a thoracic epidural drain during multilevel spinal fixation.

    Science.gov (United States)

    Brahmbhatt, Anjalee; Hall, Nicholas D P; Bradley, William Pierre Litherland

    2013-11-15

    Hypotension or bradycardia or both related to intracranial hypotension after craniotomy has been reported in the literature. However, such reports are uncommon with thoracic epidural drains. We describe a case in which application of high negative pressure suction to a thoracic epidural drain caused a sudden decrease in arterial blood pressure.

  2. Bilateral chronic subdural hematoma

    DEFF Research Database (Denmark)

    Andersen-Ranberg, Nina Christine; Poulsen, Frantz Rom; Bergholt, Bo

    2016-01-01

    OBJECTIVE Bilateral chronic subdural hematoma (bCSDH) is a common neurosurgical condition frequently associated with the need for retreatment. The reason for the high rate of retreatment has not been thoroughly investigated. Thus, the authors focused on determining which independent predictors ar...

  3. [Prolonged hypothermia in refractory intracranial hypertension. Report of one case].

    Science.gov (United States)

    Rovegno, Maximiliano; Valenzuela, José Luis; Mellado, Patricio; Andresen, Max

    2012-02-01

    The use of hypothermia after cardiac arrest caused by ventricular fibrillation is a standard clinical practice, however its use for neuroprotection has been extended to other conditions. We report a 23-year-old male with intracranial hypertension secondary to a parenchymal hematoma associated to acute hydrocephalus. An arterial malformation was found and embolized. Due to persistent intracranial hypertension, moderate hypothermia with a target temperature of 33°C was started. After 12 hours of hypothermia, intracranial pressure was controlled. After 13 days of hypothermia a definitive control of intracranial pressure was achieved. The patient was discharged 40 days after admission, remains with a mild hemiparesia and is reassuming his university studies.

  4. Analysis of Transsinus Acute Epidural Hematoma with Concurrent Bone Fracture Combined with Cerebral Venous Flow Obstruction%跨窦急性硬膜外血肿并骨折并发脑静脉窦回流障碍的分析

    Institute of Scientific and Technical Information of China (English)

    王文浩; 林洪; 林俊明; 郁毅刚; 黄巍; 李君; 罗飞; 胡连水

    2014-01-01

    目的:探讨脑外伤后跨窦急性硬膜外血肿并骨折发生脑静脉窦回流障碍(CVFO)的早期诊断和治疗方法。方法:回顾性分析跨窦硬膜外血肿和/或骨折患者403例,所有患者均早期行MRV检查,部分行CTV检查。对CVFO患者给予早期静脉应用小剂量尿激酶治疗,对损伤占位效应明显且早期出现脑疝的患者,积极手术解除机械压迫。结果:跨窦硬膜外血肿并骨折131例,CVFO 107例(81.7%);单纯跨窦线形骨折242例,CVFO 100例(41.3%);跨窦凹陷骨折30例,CVFO 24例(80.0%)。跨窦硬膜外血肿并骨折与跨窦凹陷骨折患者的CVFO发生率均显著高于单纯跨窦线形骨折患者(<0.001)。231例CVFO患者中有88例影像学随访3月,再通良好53例,好转18例,无明显改变16例,变差1例。结论:跨窦硬膜外血肿并骨折后并发CVFO的机率较高,且其风险随损伤程度而增大。早期诊断和尿激酶干预是静脉窦回流恢复通畅的关键。%Objective: To investigate the early diagnosis and treatment for patients with cerebral venous flow obstruction (CVFO) secondary to transsinus acute epidural hematoma (EDH) and concurrent bone fracture. Methods:The clinical data of 403 patients with transsinus acute EDH and bone fracture was analyzed retrospec-tively. All the patients underwent radiographic examinations by MRV and adjuvant CTV as early as on admission to identify potentially complicated CVFO. Then the CVFO patients were treated with low-dose urokinase via intravenous drip. For patients having traumatic lesions with mass effect and/or brain hernia at a quite early time after injury, surgical intervention was performed to relieve the mechanical compression. Results:CVFO was found in 107 (81.7%) out of 131 patients with concurrent transsinus EDH and fracture, in 100 (41.3%) out of 242 patients with simple transsinus linear fracture, and in 24 (80.0%) out of 30 patients with transsinus

  5. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove

    1995-01-01

    Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of cen...... frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections. Comment in: J Hosp Infect. 1997 Mar;35(3):245....

  6. Treatment of intracranial hydatid cysts

    Institute of Scientific and Technical Information of China (English)

    Sailike Duishanbai; WEN Hao; GENG Dangmurenjiafu; LIU Chen; GUO Huai-rong; HAO Yu-jun; LIU Bo; WANG Yong-xin; LUO Kun; ZHOU Kai

    2011-01-01

    Background Echinococcosis is still endemic in many countries, including China, where it is especially prevalent in the northwest. The aim of this study was to enrich the international literature about the treatment of intracranial hydatid cysts.Methods We retrospectively reviewed the clinical features, radiological manifestations, and surgical outcome of 97 patients with intracranial hydatid cysts, who received surgical treatment at the Neurosurgical Department of First Affiliated Hospital of Xinjiang Medical University from 1985 to 2010 and followed up the patient via sending a questionnaire or telephone contact. Clinical outcome was evaluated using the Karnofsky Performance Scale Index.Results Headache and vomiting were the most common initial symptoms in our patients. Neurological deficits caused by the mass effect of the cysts were seen in 82 cases. On the X-ray, significant bone erosion was seen in only two cases with epidural hydatid cysts. Round-shaped and thin-walled homogeneous low-density cystic lesions without surrounding edema and enhancement were the main findings on computerized tomography (CT) in 95 patients with intraparenchymal hydatid cysts, while two cases with epidural hydatid cysts presented as a heterodensity lesions. On magnetic resonance imaging (MRI), hydatid cyst presented as a round-shaped low signal lesion in T1-weighted images and high signal lesion in T2-weighted images, without enhancement after contrast media injection, while the two cases with epidural cysts presented as mixed signal masses. Surgical removal of cyst was performed in all cases. Total removal was achieved in 93 cases without rupturing the cyst wall. Only two cysts ruptured during the dissection, resulting in two surgery-related mortalities. There was no other additional neurological deficit caused directly by surgery. In 97.2% of the patients, the Karnofsky Performance Scale score was 80 to 90 at the last follow-up.Conclusions Intracranial hydatid cyst is still a

  7. Hematoma subdural intracraneal: una rara complicación después de la raquianestesia: relato de caso

    OpenAIRE

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

    2012-01-01

    BACKGROUND AND OBJECTIVES: Intracranial subdural hematoma is a rare complication following spinal anesthesia. The diagnosis is usually difficult because initial symptoms are the same of post-dural puncture headache. The objective was to report a case of early diagnosed subdural hematoma after spinal anesthesia performed with a fine-gauge needle and single puncture. CASE REPORT: 48-year old female patient, ASA I, undergoing spinal anesthesia for surgery to correct urinary incontinence. The spi...

  8. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns.

    Science.gov (United States)

    Hansda, Upendra; Agarwal, Jyotsna; Patra, Chitralekha; Ganjoo, Pragati

    2013-05-01

    Hutchinson-Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.

  9. Extradural hematoma surgery in a child with Hutchinson–Gilford progeria syndrome: Perioperative concerns

    Science.gov (United States)

    Hansda, Upendra; Agarwal, Jyotsna; Patra, Chitralekha; Ganjoo, Pragati

    2013-01-01

    Hutchinson–Gilford progeria syndrome (HGPS) is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult. PMID:24082942

  10. Extradural hematoma surgery in a child with Hutchinson-Gilford progeria syndrome: Perioperative concerns

    Directory of Open Access Journals (Sweden)

    Upendra Hansda

    2013-01-01

    Full Text Available Hutchinson-Gilford progeria syndrome (HGPS is a very rare genetic disorder characterized by premature ageing, severe growth failure, and very early onset atherosclerosis. Psychologically and emotionally child-like, these patients suffer from physiological changes of old age. Early and progressive atherosclerosis of intra-cranial vessels in HGPS patients, along with a thin skin and fragile vessels, make these patients susceptible to intra-cranial hematomas following relatively trivial injuries and to severe intra-cranial disease. Anesthetizing HGPS patients for surgery can be challenging due to the presence of a possible difficult airway, multi-system derangements, and associated skin, bone and joint disease. We report here one such child with HGPS who underwent craniotomy and evacuation of an extradural hematoma that developed after minor head trauma. Securing his airway during surgery was difficult.

  11. [MRI semiotics features of experimental acute intracerebral hematomas].

    Science.gov (United States)

    Burenchev, D V; Skvortsova, V I; Tvorogova, T V; Guseva, O I; Gubskiĭ, L V; Kupriianov, D A; Pirogov, Iu A

    2009-01-01

    The aim of this study was to assess the possibility of revealing intracerebral hematomas (ICH), using MRI, within the first hours after onset and to determine their MRI semiotics features. Thirty animals with experimental ICH were studied. A method of two-stage introduction of autologous blood was used to develop ICH as human spontaneous intracranial hematomas. Within 3-5h after blood introduction to the rat brain. The control MRI was performed in the 3rd and 7th days after blood injections. ICH were definitely identified in the first MRI scans. The MRI semiotics features of acute ICH and their transformations were assessed. The high sensitivity of MRI to ICH as well as the uniform manifestations in all animals were shown. In conclusion, the method has high specificity for acute ICH detection.

  12. Pathophysiology and management of spontaneous intracranial hypotension--a review.

    Science.gov (United States)

    Syed, Nadir Ali; Mirza, Farhan Arshad; Pabaney, Aqueel Hussain; Rameez-ul-Hassan

    2012-01-01

    Spontaneous Intracranial Hypotension is a syndrome involving reduced intracranial pressure secondary to a dural tear which occurs mostly due to connective tissue disorders such as Marfans Syndrome, and Ehler Danlos Syndrome. Patients with dural ectasias leading to CSF leakage into the subdural or epidural space classically present with orthostatic headaches and cranial nerve deficits mostly seen in cranial nerves V-VIII. Diagnosis of SIH is confirmed with the aid of neuroimaging modalities of which Cranial MR imaging is most widely used. SIH can be treated conservatively or with epidural blood patches which are now widely being used to repair dural tears, and their effectiveness is being recognized. Recently epidural injection of fibrin glue has also been used which has been found to be effective in certain patients.

  13. Clinical evaluation of a new epidural pressure monitor.

    Science.gov (United States)

    Czech, T; Korn, A; Reinprecht, A; Schramm, W; Kimla, T; Spiss, C K

    1993-01-01

    Comparative measuring of epidural pressure using the Spiegelberg probe 1 and ventricular fluid pressure was carried out in 15 neurosurgical intensive-care patients. Deviations in both directions were established, with a trend toward overestimating ventricular pressure in epidural pressure measuring (r = 0.77). Individual pulsations, spontaneous wave courses and therapy-induced pressure changes were reflected without delays. There were no complications observed with probe implantation periods for up to 6 days. The system has been shown to be mechanically stable and easy to implant. We believe the device to be fit for trend monitoring of intracranial pressure. As with other epidural pressure monitoring systems, false assessments of ventricular pressure may lead to wrong decisions as to required therapy.

  14. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove

    1995-01-01

    patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more......Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence...

  15. A prospective evaluation of complications of 10,000 fluoroscopically directed epidural injections.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Malla, Yogesh; Wargo, Bradley W; Cash, Kimberly A; Pampati, Vidyasagar; Fellows, Bert

    2012-01-01

    Among the multiple modalities of treatments available in managing chronic spinal pain, including surgery and multiple interventional techniques, epidural injections by various routes, such as interlaminar epidural injections, caudal epidural injections, transforaminal epidural injections, and percutaneous adhesiolysis are common. Even though the complications of fluoroscopically directed epidural injections are fewer than blind epidural injections, and have better effectiveness, multiple complications have been reported in scattered case reports, with only minor complications in randomized or non-randomized studies and systematic reviews. Thus, prospective studies with large patient series are essential to determine the types and incidences of complications. A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009. A private interventional pain management practice, a specialty referral center in the United States. To assess the complication rate of fluoroscopically directed epidural injections. This study was carried out over a period of 20 months and included over 10,000 procedures: 39% caudal epidurals, 23% cervical interlaminar epidurals, 14% lumbar interlaminar epidurals, 13% lumbar transforaminal epidurals, 8% percutaneous adhesiolysis, and 3% thoracic interlaminar epidural procedures. All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians. The complications encountered during the procedure and postoperatively were prospectively evaluated. Measurable outcomes employed were intravascular entry of the needle, profuse bleeding, local hematoma, bruising, dural puncture and headache, nerve root or spinal cord irritation with resultant injury, infectious complications, vasovagal reactions, and facial flushing. Intravascular entry was higher for adhesiolysis (11.6%) and lumbar transforaminal (7.9%) procedures compared to other epidurals which

  16. Spontaneous spinal epidural abscess.

    LENUS (Irish Health Repository)

    Ellanti, P

    2011-10-01

    Spinal epidural abscess is an uncommon entity, the frequency of which is increasing. They occur spontaneously or as a complication of intervention. The classical triad of fever, back pain and neurological symptoms are not always present. High index of suspicion is key to diagnosis. Any delay in diagnosis and treatment can have significant neurological consequences. We present the case of a previously well man with a one month history of back pain resulting from an epidural abscess.

  17. Spontaneous intraorbital hematoma: case report

    Directory of Open Access Journals (Sweden)

    Vinodan Paramanathan

    2010-12-01

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

  18. Bilateral Symmetrical Parietal Extradural Hematoma

    African Journals Online (AJOL)

    had multiple episodes of vomiting. ... careful planning, adequate exposure, judicious surgical approach, and time ... Key words: Bilateral extradural hematoma, CT scan, double ... Figure 4: Intraoperative photograph showing bilateral trephine.

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

    Directory of Open Access Journals (Sweden)

    Suri A

    2002-10-01

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

  20. Spontaneous spinal epidural hemorrhage from intense piano playing.

    Science.gov (United States)

    Chang, Hui-Ju; Su, Fang Jy; Huang, Ying C; Chen, Shih-Han

    2014-06-01

    Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.

  1. Intracranial haemorrhage

    African Journals Online (AJOL)

    His interests include vascular neurosurgery and spinal deformities. ... he returned to specialise in neurosurgery after time spent working abroad. ... at Groote Schuur Hospital, where his major interests are skull base surgery and ... intracranial bleed is hypertension – this is an ... cerebellar signs and symptoms or with raised.

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

    Science.gov (United States)

    2016-07-25

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

  3. Idiopathic Retroperitoneal Hematoma

    Directory of Open Access Journals (Sweden)

    Tomoyuki Abe

    2010-09-01

    Full Text Available A 34-year-old female presented with sudden onset of severe abdominal pain in a flank distribution. A large mass was palpable in the right upper quadrant on physical examination. Abdominal contrast-enhanced computed tomography showed a well-defined, right-sided, retroperitoneal cystic lesion located between the abdominal aorta and the inferior vena cava (IVC. The tumor size was 55 × 58 mm, and it compressed the gallbladder and the duodenum. Upper gastrointestinal radiography revealed a stricture of the second portion of the duodenum by the tumor. T2-weighted magnetic resonance imaging showed that the whole part was hyperintense with hypointense rims, but the inner was partially hypointense. Based on the radiological findings, the preoperative differential diagnosis included retroperitoneal teratoma, Schwannoma, abscess, and primary retroperitoneal tumor. On laparotomy, the tumor was located in the right retroperitoneal cavity. Kocher maneuver and medial visceral rotation, which consists of medial reflection of the upper part of right colon and duodenum by incising their lateral peritoneal attachments, were performed. Although a slight adhesion to the IVC was detected, the tumor was removed safely. Thin-section histopathology examination detected neither tumor tissues nor any tissues such as adrenal gland, ovarian tissue, or endometrial implants. The final pathological diagnosis was idiopathic retroperitoneal hematoma; the origin of the bleeding was unclear. The patient was discharged without any complication 5 days after the operation.

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

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, Tatsuya; Sakai, Toshinori; Sairyo, Koichi; Katoh, Shinsuke; Yasui, Natsuo [The University of Tokushima Graduate School, Department of Orthopedics, Institute of Health Biosciences, Tokushima (Japan); Takao, Shoichiro [The University of Tokushima Graduate School, Department of Radiology, Institute of Health Biosciences, Tokushima (Japan); Kagawa, Seiko [The University of Tokushima Graduate School, Department of Human Pathology, Institute of Health Biosciences, Tokushima (Japan)

    2010-03-15

    Hematoma of the cervical ligamentum flavum is very rare, and its pathogenesis is unknown. We describe a case of ligamentum flavum hematoma in the cervical spine causing severe myelopathy. Postoperative histological examination suggested it was the result of the rupture of a hemangioma or of an arteriovenous malformation in the ligamentum flavum. After removal of the lesion, the patient's condition immediately improved. Review of all three reported cases, including this one, showed that complete resection of the mass resulted in immediate relief of symptoms of incomplete paraplegia. The findings of magnetic resonance imaging (MRI) of the hematoma may vary with time, and they may show no characteristic intensity. However, MRI of this case revealed that the tissues surrounding the mass were enhanced with gadolinium diethylene triamine penta-acetic acid, and an area of homogeneous iso-intensity was clearly surrounded by a low-intensity area (flavum) on T2-weighed short-tau inversion recovery images. These findings could be characteristic of the ligamentum flavum hematoma and might help in the differentiation from a cervical epidural hematoma. (orig.)

  5. 28 CASES OF TRAUMATIC POSTERIOR FOSSA EXTRA DURAL HEMATOMA OUR EXPERIENCE : CASE SERIES

    Directory of Open Access Journals (Sweden)

    Hayagriva

    2015-04-01

    Full Text Available A retrospective study of 28 1 cases of traumatic posterior fossa Extra dural hematoma 2,3 in K ing George Hospital, V isakhapatnam from A ugust 2012 to February 2015 . This study was aimed to present the experience in treating patients with traumatic posterior fossa extra dural hematoma 2 and to discuss the clinical features, risk factors 4 and outcome . 5 Posterior fossa e xtradural hematoma 2,3 uncommon but potentially fatal condition. The incidence of posterior fossa extra dural hematoma 2,3 among intracranial extra dural hematomas has been reported 4% to 7%. Occipital skull bone fracture with venous sinus bleeding that resulted in a posterior fossa extradural haematoma . 2 low Gcs [or] hematoma more than 10ml were subjected to evacuation . Since the volume of the posterior fossa 6 is small, patients deteriorate early because of compression of vital structures in the brain stem, development of obstructive hydrocephalus, which is visible in the CT scan in only thirty percent of cases

  6. Compression of the posterior fossa venous sinuses by epidural hemorrhage simulating venous sinus thrombosis: CT and MR findings

    Energy Technology Data Exchange (ETDEWEB)

    Singh, Sumit; Ramakrishnaiah, Raghu H.; Hegde, Shilpa V.; Glasier, Charles M. [University of Arkansas for Medical Sciences, Pediatric Radiology, Little Rock, AR (United States)

    2016-01-15

    Posterior fossa dural venous sinus thrombus is a well-described complication of head trauma, especially when fracture crosses the dural sinus grooves or in association with epidural hemorrhage. We have found that post-traumatic posterior fossa epidural hematoma compressing a dural venous sinus can mimic dural venous thrombus. To discuss the CT and MRI findings of posterior fossa epidural hemorrhages simulating sinus thrombosis, to make radiologists aware of this important imaging pitfall. We describe radiologic findings in four children in whom a posterior fossa epidural hemorrhage mimicked dural venous sinus thrombus. Routine CT head and CT venography were obtained on Toshiba volume and helical CT scanners. MRI and MR venography were performed on a Philips scanner. In all cases there was medial displacement and compression of the posterior fossa dural venous sinuses without intraluminal thrombosis. The epidural hemorrhage was seen tracking along sinus grooves in the occipital bone, peeling the dura containing the sinuses from the calvarium and compressing the sinus, simulating thrombosis on axial CT views. Both venous sinus thrombosis and posterior fossa epidural hemorrhages in children are well-described complications of head trauma. Posterior fossa epidural hemorrhage can mimic a sinus thrombus by compressing and displacing the sinuses. It is important to recognize this pitfall because treatment of a suspected thrombus with anticoagulation can worsen epidural hemorrhage. (orig.)

  7. Mozart's chronic subdural hematoma.

    Science.gov (United States)

    Drake, M E

    1993-11-01

    No commemoration of the bicentennial of Mozart's death would be complete without some consideration of that premature yet predictable demise. Mozart's premonitions of death are well known and apparently played a role in the composition of the K.626 Requiem and perhaps other works. His death has traditionally been ascribed to infectious causes, chiefly rheumatic fever or post-streptococcal glomerulonephritis, exacerbated by intemperance and chronic penury. Pathology has been difficult because of his supposed burial in a pauper's grave, the location and contents of which were later supposedly lost. Mozart's burial place in St. Mark's Cemetery in Vienna was known and, in the parlance of the day, "reorganized" a decade later, as the occupants of plots were disinterred to make room for the more recently decreased. A skull believed to the Mozart's was saved by the successor of the gravedigger who had supervised Mozart's burial, and then passed into the collections of the anatomist Josef Hyrtl, the municipality of Salzburg, and the Mozarteum museum (Salzburg). Forensic reconstruction of soft tissues related to this skull reveals substantial concordance with Mozart's portraits. The skull suggests premature closure of the metopic suture, which has been suggested on the basis of his physiognomy. A left temporal fracture and concomitant erosions raise the question of chronic subdural hematoma, which would be consistent with several falls in 1789 and 1790 and could have caused the weakness, headaches, and fainting he experienced in 1790 and 1791. Aggressive bloodletting to treat suspected rheumatic fever could have decompensated such a lesion to produce his death on December 5, 1791.

  8. Bradycardia without hypertension and bradypnea in acute traumatic subdural hematoma is a sensitive predictor of the Cushing triad: 3 case reports

    OpenAIRE

    2016-01-01

    Acute traumatic subdural hematomas (SDHs) are very common. These hematomas are usually neurosurgical emergencies, although conservative therapy is indicated in certain cases. SDH can increase intracranial pressure (ICP) and compress or stretch the brainstem. Lately, it has been recognized that increased ICP can lead to hemodynamic instability and bradycardia. Bradycardia can be an early warning sign in many neurosurgical conditions. We observed bradycardia in serial cases of the patient witho...

  9. 闪光视觉诱发电位对颅内压变化的评估作用%Evaluative effects of flash visual evoked potential on the changes of intracranial pressure

    Institute of Scientific and Technical Information of China (English)

    周冀英; 贾建平; 王磊; 张拥波; 彭国光

    2005-01-01

    average of(38 ±9) years old were selected from the First Affiliated Hospital of Chongqing Medical University and Xuanwu Hospital Affiliated to Capital University of Medical Sciences. The selected diseases were: epidural hematoma( n=20),subdural hematoma(n = 26),cerebral contusion( n = 4),subdural hematoma companied with cerebral contusion( n = 92),and cerebral contusion companied with intracerebral hematoma( n = 55).METHODS: The level of intracranial pressure of 197 patients with brain trauma was detected with fVEP and epidural manometry. Data of traumatic surveillance were collected after the completion of fVEP. Changes of blood pressure and heart rate in patients were recorded simultaneously.MAIN OUTCOME MEASURES: fVEP results,and levels of intracranial pressure.RESULTS: The average intracranial pressure of 197 patients with brain trauma was(2.75 ± 0.64) kPa,( 1.54 - 4. 02 kPa) . The dispersion of both traumatic and non-traumatic surveillance was relatively big in patients with confirmed visual pathway injury. No typical wave was induced by fVEP in2.79% of patients. Scatter diagram suggested that the consistence between fVEP and epidural manometry was relatively good. Linear regression analysis showed that heart rate was the most sensitive one to the fluctuation of intracranial pressure (β = -0. 369) followed by systolic pressure (β= 0. 316),while diastolic pressure was not so sensitive (β = 0. 147). There was negative correlation between heart rate and intracranial pressure,which could quite sensitively reflect the fluctuation of intracranial pressure,systolic pressure was the next,and diastolic pressure was not easily to be affected by the changes of intracranial pressure.CONCLUSION: Non-traumatic surveillance,fVEP,has favorable consistence with traumatic detection,which can quantitatively evaluate the changes of intracranial pressure non-traumatically.

  10. Endoscopic appearance of esophageal hematomas

    Institute of Scientific and Technical Information of China (English)

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos

    2000-01-01

    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

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

    OpenAIRE

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

    2013-01-01

    Background: Cerebral venous sinus thrombosis (CVST) can cause elevated intracranial pressure, hemorrhagic venous infarct, and cortical subarachnoid hemorrhage. We present a case series and literature review to illustrate that CVST can also present with subdural hematoma (SDH). Case Description: Chart review was completed on a retrospective case series of CVST with spontaneous SDH. We also conducted a literature search. Over a 6 year interval, three patients with CVST and SDH were admitted to ...

  12. Isolated oculomotor nerve palsy resulting from acute traumatic tentorial subdural hematoma

    Directory of Open Access Journals (Sweden)

    Cui V

    2016-10-01

    Full Text Available Victoria Cui,1 Timur Kouliev2 1Washington University School of Medicine, St Louis, MO, USA; 2Emergency Department, Beijing United Family Hospital, Beijing, China Abstract: Acute subdural hematoma (SDH resulting from head trauma is a potentially life-threatening condition that requires expedient diagnosis and intervention to ensure optimal patient outcomes. Rapidly expanding or large hematomas, elevated intracranial pressure, and associated complications of brain herniation are associated with high mortality rates and poor recovery of neurological function. However, smaller bleeds (clot thickness <10 mm or hematomas occurring in infrequent locations, such as the tentorium cerebelli, may be difficult to recognize and patients may present with unusual or subtle signs and symptoms, including isolated cranial nerve palsies. Knowledge of neuroanatomy supported by modern neuroimaging can greatly aid in recognition and diagnosis of such lesions. In this report, we present a case of isolated oculomotor nerve palsy resulting from compressive tentorial SDH following blunt head trauma, review the literature concerning similar cases, and make recommendations regarding the diagnosis of SDH in patients presenting with isolated cranial nerve palsies. Keywords: head injury, oculomotor, palsy, subdural hematoma, trauma, tentorium, cerebral herniation, intracranial hemorrhage

  13. Postoperative Paraplegia as a Result of Undiagnosed Primitive Neuroectodermal Tumor, Not Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Pei-Ching Hung

    2007-10-01

    Full Text Available Postoperative paraplegia is a rare complication after epidural analgesia and often occurs with spinal hematoma or cord injury. We present the case of a 16-year-old girl who suffered from a tumor mass in the neck and abdomen who underwent gynecologic operation. Preoperatively, liver metastasis was found by computed tomography. Pathologic findings revealed that the abdominal mass was an ovarian dermoid cyst. After the operation, the patient complained of paraplegia while receiving epidural analgesia for postoperative pain control. A peripheral primitive neuroectodermal tumor in the thoracic and lumbar spines with spinal cord compression was later detected using magnetic resonance imaging. Learning from this case, we suggest that when a patient is preoperatively diagnosed with tumor metastasis, back pain and soreness, spinal cord compression from tumor metastasis should be excluded before epidural analgesia is implemented.

  14. Infections following epidural catheterization

    DEFF Research Database (Denmark)

    Holt, MS; Andersen, SS; Andersen, Ove

    1995-01-01

    patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more...

  15. Intracranial endoscopy.

    Science.gov (United States)

    Schroeder, H W; Gaab, M R

    1999-04-15

    The authors' intention is to reduce the invasiveness of intracranial procedures while avoiding traumatization of brain tissue, to decrease the risk of neurological and mental deficits. Intracranial endoscopy is a minimally invasive technique that provides rapid access to the target via small burr holes without the need for brain retraction. Craniotomy as well as microsurgical brain splitting and dissection can often be avoided. Furthermore, because obstructed cerebrospinal fluid pathways can be physiologically restored, the need for shunt placement is eliminated. The ventricular system and subarachnoid spaces provide ideal conditions for the use of an endoscope. Therefore, a variety of disorders, such as hydrocephalus, small intraventricular lesions, and arachnoid and parenchymal cysts can be effectively treated using endoscopic techniques. With the aid of special instruments, laser fibers, and bipolar diathermy, even highly vascularized lesions such as cavernomas may be treated. Moreover, during standard microsurgical procedures, the endoscopic view may provide valuable additional information ("looking around a corner") about the individual anatomy that is not visible with the microscope. In transsphenoidal pituitary surgery, transseptal dissection can be avoided if an endonasal approach is taken. In the depth of the intrasellar space, the extent of tumor removal can be more accurately controlled, especially in larger tumors with para- and suprasellar growth. The combined use of endoscopes and computerized neuronavigation systems increases the accuracy of the approach and provides real-time control of the endoscope tip position and approach trajectory. In the future, the indications for neuroendoscopy will certainly expand with improved technical equipment.

  16. Complications corner: Anterior thoracic disc surgery with dural tear/CSF fistula and low-pressure pleural drain led to severe intracranial hypotension

    Directory of Open Access Journals (Sweden)

    Eline A Oudeman

    2015-01-01

    Conclusion: Severe neurological deterioration occurring after thoracic decompressive surgery may rarely be attributed to intracranial hypotension due to a subarachnoid-pleural fistula. Patients should be treated with external lumbar drainage of cerebrospinal fluid for 3-5 days rather than a low-pressure pleural drain to avoid the onset of intracranial hypotension leading to symptomatic subdural hematomas.

  17. Postoperative course of chronic subdural hematoma

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-10-01

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

  18. Direct cervical arterial access for intracranial endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Blanc, R. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); APHP, Hopital Henri Mondor, Service de Neuroradiologie Diagnostique et Therapeutique, Creteil Cedex (France); Piotin, M.; Mounayer, C.; Spelle, L. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Moret, J. [Fondation Rothschild, Department of Interventional Neuroradiology, Paris (France); Hopital de la Fondation Ophtalmologique Adolphe de Rothschild, Service de Neuroradiologie Interventionnelle, Paris Cedex 19 (France)

    2006-12-15

    Tortuous vasculature is a cause of failure of endovascular treatment of intracranial vascular lesions. We report our experience of direct cervical accesses in patients in whom the arterial femoral route was not attainable. In this retrospective study, 42 direct punctures of the carotid or the vertebral arteries at the neck were performed in 38 patients. The vessel harboring the intracranial lesion was punctured at the neck above the main tortuosity, a sheath was then positioned under fluoroscopic control to allow a stable access to the intracranial circulation. After the procedure, the sheath was removed and hemostasis was gained either by manual compression or by an arterial closure device (4 of 42, 9%). The cervical route allowed access to all intracranial lesions in all 42 procedures. A complication was encountered in six procedures (14%) related to the direct puncture. In 2 of the 42 procedures (4%), a transient vasospasm was encountered. A cervical hematoma formed in 3 of the 42 procedures (7%) after sheath withdrawal (one patient in whom an 8F sheath had been used, required surgical evacuation of a hematoma compressing the upper airways; the other patients did well without surgical evacuation). In the remaining patient (1 of 42 procedures, 2%), a small asymptomatic aneurysm at the puncture site was seen on the follow-up angiogram. Direct cervical arterial approaches to accessing the intracranial circulation is effective in patients in whom the femoral route does not allow the navigation and stabilization of guiding catheters. (orig.)

  19. SPONTANEOUS SPINAL EPIDURAL ABSCESS FOLLOWING TRAUMA TO BACK IN A HEALTHY ADULT WITHOUT PREDISPOSING FACTORS - A RARE CASE REPORT

    Directory of Open Access Journals (Sweden)

    Shanmuga Sundaram

    2014-02-01

    Full Text Available Spinal epidural abscess due to its varied presentation , poses a great challenge, more so in a healthy adult, without any predisposing factors. Early diagnosis and treatment is paramount, as late diagnosis and delayed treatment result in increased mortality and morbidity. In this case report, we are presenting a case of spinal extradural abscess in a healthy young adult without predisposing factors, provisionally diagnosed as extradural hematoma and early surgical intervention confirmed the diagnosis of spinal epidural abscess and prevented any devastating consequence

  20. 急性颅脑创伤后进展性颅内出血的CT表现%CT scan manifestations of progressive intracranial hemorrhage of patients with acute traumaticbrain injury

    Institute of Scientific and Technical Information of China (English)

    黄卫兵

    2014-01-01

    Objective To investigate the CT scan manifestations and clinical significance of progressive intracranial hemor-rhage (PTH) of patients with acute traumatic brain injury .Methods The clinical data of 626 patients with acute traumatic brain injury in our hospital from February 2009 to September 2013 were retrospectively analyzed to observe the CT scan mani-festations of PIH and non-PIH patients and the risk factors of PIH .Results Single factor regression analysis showed that there were statistical difference in the CT scan manifestations of PIH and non-PIH patients such as skull fracture ,subarachnoid hemorrhage ,cerebral contusion and laceration ,epidural hematoma ,subdural hematoma .Multivariate regression analysis found that skull fracture ,subarachnoid hemorrhage ,cerebral contusion and laceration ,epidural hematoma were independent risk fac-tor of PIH in patients with acute traumatic brain injury .Conclusion Patients with acute traumatic brain injury should be tested by CT scan as early as possible to confirm PIN in favor of treating PIH timely .%目的:探讨急性颅脑创伤后进展性颅内出血(PIH)发生的CT表现与临床价值。方法回顾性分析我院2009-02-2013-09收治的626例急性颅脑创伤患者的临床资料,分析PIH患者与非 PIH患者的CT 表现差异以及PIH发生的危险因素。结果单因素回归分析发现,PIH组与非 PIH组首次CT 表现中颅骨骨折、蛛网膜下腔出血、脑挫裂伤、硬膜外血肿、硬膜下血肿差异有统计学意义(P<0·05)。多因素回归分析发现,颅骨骨折、蛛网膜下腔出血、脑挫裂伤、硬膜外血肿是影响急性颅脑创伤后进展性颅内出血的独立危险因素(P<0·05),蛛网膜下腔出血是最强因素。结论急性颅脑创伤后应尽快进行头颅CT检查,以便尽快确诊PIH及时进行治疗。

  1. Is human fracture hematoma inherently angiogenic?

    LENUS (Irish Health Repository)

    Street, J

    2012-02-03

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

  2. Aspergillus spinal epidural abscess

    Energy Technology Data Exchange (ETDEWEB)

    Byrd, B.F. III (Vanderbilt Univ. School of Medicine, Nashville, TN); Weiner, M.H.; McGee, Z.A.

    1982-12-17

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host.

  3. Ethmoid Hematoma of the Equine

    OpenAIRE

    Etherington, W G; Vasey, J. R.; Horney, F. D.

    1982-01-01

    Two cases of ethmoid hematoma of the equine are reported. Clinically both horses had intermittent unilateral epistaxis unassociated with exercise. In one horse, diagnosis was based on the use of an endoscope for visualization and for biopsy of a mass associated with the ethmoid turbinates. In the other horse, exploratory trephination of the posterior maxillary sinus was necessary to obtain a diagnostic biopsy specimen. Radiography was helpful in the diagnosis of one case. Surgical removal of ...

  4. Interventricular septum hematoma during cineventriculography

    Directory of Open Access Journals (Sweden)

    Melzer Christoph

    2008-01-01

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

  5. Technique of stepwise intracranial decompression combined with external ventricular drainage catheters improve the prognosis of acute post-traumatic hemispheric brain swelling patients

    Directory of Open Access Journals (Sweden)

    Lei eShi

    2015-09-01

    Full Text Available Background: Acute post-traumatic cerebral hemispheric brain swelling (ACHS is a serious disorder that occurs after traumatic brain injury (TBI, and it often requires immediate treatment. The aim of our clinical study was to assess the effects of stepwise intracranial decompression combined with external ventricular drainage catheters on the prognosis of ACHS patients.Methods: A retrospective study was performed on 172 cases of severe craniocerebral trauma patients with acute cerebral hemispheric swelling. The patients were divided into two groups: unilateral stepwise standard large trauma craniectomy (S-SLTC combined with external ventricular drainage (EVD catheter implants (n = 86 and unilateral routine frontal temporal parietal SLTC (control group, n = 86.Result: No significant differences in age, sex, or preoperative Glasgow Coma Scale score were observed between groups (P < 0.05. There were no significant differences in the ipsilateral subdural effusion incidence rates between the S-SLTC+EVD treatment group and the routine SLTC group. However, the incidence rates of intraoperative acute encephalocele and contralateral epidural and subdural hematoma in the S-SLTC+EVD group were significantly lower than those in the SLTC group (17.4% and 3.5% vs. 37.2% and 23.3%, respectively. The mean intracranial pressure (ICP values of patients in the S-SLTC+EVD group were also lower than those in the SLTC group at days 1 through7 (P<0.05. A positive neurological outcome (GOS score 4 to 5, 50.0% and decreased mortality (15.1% was observed in the S-SLTC+EVD group compared to the neurological outcome (GOS score 4 to 5, 33.8%; 36.0% in the SLTC group (P<0.05.Conclusions: Our data suggest that S-SLTC+EVD is more effective for controlling ICP, improving neurological outcome, and decreasing mortality rate compared with routine SLTC.

  6. Efficacy of epidural blood patches for spontaneous low-pressure headaches: a case series.

    Science.gov (United States)

    Ansel, S; Rae, A; Tyagi, A

    2016-12-01

    Patients with a spontaneous cerebrospinal fluid leak, normally at a spinal level, typically present with low-pressure headache. In refractory cases, an epidural blood patch may be attempted. We aimed to assess the efficacy of lumbar epidural blood patching in spontaneous, low-pressure headaches. Methods We retrospectively analysed notes of patients who had an epidural blood patch performed for spontaneous low-pressure headaches in a single centre. Information regarding demographics, radiology and clinic follow-up was extracted from an electronic patient record system. Questionnaires regarding outcome were sent to patients a minimum of 6 months post-procedure. All patients received an epidural blood patch in the lumbar region irrespective of the site of cerebrospinal fluid leak. Results Sixteen patients who underwent lumbar epidural blood patching were analysed (11 female; mean age 43 years). The site of cerebrospinal fluid leak was evident in only 3/16 patients. Thirteen patients attended clinic follow-up; three reported complete headache resolution, four reported improvement in intensity or frequency and six described no change. Five of eight questionnaire respondents reported reduction in pain, and in these responders, mean headache severity improved from 9/10 to 3/10. Five of eight patients returning follow-up questionnaires reported sustained improvement in headache symptoms. Conclusion Epidural blood patch procedures can provide sustained improvement in headache symptoms in selected patients with spontaneous intracranial hypotension, but an untargeted approach has a lower success rate than reported in other case series.

  7. Intraoperative contralateral extradural hematoma during evacuation of traumatic acute extradural hematoma

    Directory of Open Access Journals (Sweden)

    Sharma Anand

    2015-09-01

    Full Text Available Introduction: Extradural hematomas (EDHs accounts for approximately 2% of patients following head trauma and 5-15% of patients with fatal head injuries. When indicated, the standard surgical management consists of evacuation of the hematoma via craniotomy. Intraoperative development of acute extradural hematoma (AEDH on the contralateral side following evacuation of acute extradural hematoma is uncommon and very few cases have been reported.

  8. Clinical characteristics and prognosis of traumatic basal ganglia hematomas: A retrospective analysis of 40 cases

    Institute of Scientific and Technical Information of China (English)

    Jialiang Li; Chunjiang Yu

    2006-01-01

    30 minutes to 24 hours after injury in 37 cases, and delayed TBGH was diagnosed by serial CT reexamination at 24 to 48 hours after injury in 3 cases. Apart from the TBGH, signs of diffuse axonal injury (DAI) were observed in 22 cases and the criterion of CT diagnosis was that apart from TBGH, small hemorrhagic foci were found in the deep white matter of the hemisphere, corpus callosum, dorsolateral quadrants of the midbrain and the upper pons, internal capsule, basal ganglia area, intraventricle, and cerebellum, etc., but there was no obvious mass effect (clinically manifested by conscious disturbance immediately after brain injury, and primary coma lasted for longer than 6 hours). Secondary intraventricular hemorrhage occurred in 19 cases, acute subdural hematoma in 3 cases, acute epidural hematoma in 1 case, cerebral contusion in 7 cases, and diffuse cerebral swelling in 3 cases. TBGH located at contralateral to the side of impact in 29 cases. The volume of TBGH was 3-9 mL in 8 cases, 10-19 mL in 10 cases, 20-29 mL in 12 cases, and more than 30 mL in 9 cases. ④Ten patients underwent surgical treatment, including TBGH were evacuated by craniotomy in 7 cases, drained by drilling hole in 2 cases, and hematoma drainage combined with extraventricular drainage in 1 case. 30 patients received conservative treatment, including hyperbaric oxygen treatment in 22 cases. ⑤ At 6 months after injury, good recovery obtained in 10 cases (25%), moderately disabled in 17 cases (42.5%), severely disabled in 2 cases (5%) and dead in 11 cases (27.5%) respectively.CONCLUSION: In our study, the proportion of TBGH in closed brain injury was 3.2%, and it had a higher incidence of disability. Most of the patients were young people and injured in traffic accident, and TBGH mostly occurred at contralateral to the side of impact. The patients suffered from hemiplegia and long-term coma, incidence rate of diffuse axonal injury was higher, but conscious disturbance was milder

  9. [Sudden motor and sensorial loss due to retroperitoneal hematoma during postoperative periods: a case report].

    Science.gov (United States)

    Şen, Pelin; Gültekin, Havva Gül; Caymaz, İsmail; Özel, Ömer; Türköz, Ayda

    A 68 year-old male patient was hospitalized for radical prostatectomy. He had no abnormal medical history including neurological deficit before the operation. Prior to general anesthesia, an epidural catheter was inserted in the L3-4 interspace for intraoperative and postoperative analgesia. After surgery for nine hours, he developed confusion and flaccid paralysis of bilateral lower extremities occurred. No pathology was detected from cranial computed tomography and diffusion magnetic resonance imaging no pathology was detected. His thoracic/lumbar magnetic resonance imaging. Intraabdominal pressure was shown to be 25mmHg, and abdominal ultrasonography revealed progression in the inflammation/edema/hematoma in the perirenal region. The Bromage score was back to 1 in the right foot on the 24th hour and in the left foot on the 26th hour. Paraplegia developed in patients after epidural infusion might be caused by potentiated local anesthetic effect due to retroperitoneal hematoma and/or elevated intra-abdominal pressure. Copyright © 2016 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  10. Surgical Management of Traumatic Acute Subdural Hematoma in Adults: A Review

    Science.gov (United States)

    KARIBE, Hiroshi; HAYASHI, Toshiaki; HIRANO, Takayuki; KAMEYAMA, Motonobu; NAKAGAWA, Atsuhiro; TOMINAGA, Teiji

    2014-01-01

    Traumatic acute subdural hematoma (ASDH) is a major clinical entity in traumatic brain injury (TBI). It acts as a space occupying lesion to increase intracranial pressure, and is often complicated by co-existing lesions, and is modified by cerebral blood flow (CBF) changes, coagulopathy, and delayed hematomas. Because of its complicated pathophysiology, the mortality of ASDH is still remaining high. In this review article, its epidemiology, pathophyiology, surgical treatment, and salvage ability are described. With regard to epidemiology, as the population ages, growing number of elderly patients with ASDH, especially patients with prehospital anticoagulant and antiplatelets, increase. Concerning pathophysiology, in addition to well-known initial intracranial hypertension and subsequent ischemia, delayed hyperemia/hyperperfusion, or delayed hematoma is being recognized frequently in recent years. However, optimal treatments for these delayed phenomenons have not been established yet. With regard to surgical procedures, all of craniotomy, decompressive craniectomy, and initial trephination strategies seem to be effective, but superiority of each procedure have not been established yet. Since Glasgow Coma Scale (GCS) scores, age, papillary reaction, and computed tomographic findings are strongly correlated to outcome, each factor has been investigated as an indicator of salvage ability. None of them, however, has been defined as such one. In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed. PMID:25367584

  11. Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis

    Directory of Open Access Journals (Sweden)

    Chul Hee Lee

    2014-05-01

    Full Text Available A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

  12. Brain herniation in a patient with apparently normal intracranial pressure: a case report

    Directory of Open Access Journals (Sweden)

    Dahlqvist Mats B

    2010-08-01

    Full Text Available Abstract Introduction Intracranial pressure monitoring is commonly implemented in patients with neurologic injury and at high risk of developing intracranial hypertension, to detect changes in intracranial pressure in a timely manner. This enables early and potentially life-saving treatment of intracranial hypertension. Case presentation An intraparenchymal pressure probe was placed in the hemisphere contralateral to a large basal ganglia hemorrhage in a 75-year-old Caucasian man who was mechanically ventilated and sedated because of depressed consciousness. Intracranial pressures were continuously recorded and never exceeded 17 mmHg. After sedation had been stopped, our patient showed clinical signs of transtentorial brain herniation, despite apparently normal intracranial pressures (less than 10 mmHg. Computed tomography revealed that the size of the intracerebral hematoma had increased together with significant unilateral brain edema and transtentorial herniation. The contralateral hemisphere where the intraparenchymal pressure probe was placed appeared normal. Our patient underwent emergency decompressive craniotomy and was tracheotomized early, but did not completely recover. Conclusions Intraparenchymal pressure probes placed in the hemisphere contralateral to an intracerebral hematoma may dramatically underestimate intracranial pressure despite apparently normal values, even in the case of transtentorial brain herniation.

  13. Subdural hematoma decompression model: A model of traumatic brain injury with ischemic-reperfusional pathophysiology: A review of the literature.

    Science.gov (United States)

    Yokobori, Shoji; Nakae, Ryuta; Yokota, Hiroyuki; Spurlock, Markus S; Mondello, Stefania; Gajavelli, Shyam; Bullock, Ross M

    2016-05-25

    The prognosis for patients with traumatic brain injury (TBI) with subdural hematoma (SDH) remains poor. In accordance with an increasing elderly population, the incidence of geriatric TBI with SDH is rising. An important contributor to the neurological injury associated with SDH is the ischemic damage which is caused by raised intracranial pressure (ICP) producing impaired cerebral perfusion. To control intracranial hypertension, the current management consists of hematoma evacuation with or without decompressive craniotomy. This removal of the SDH results in the immediate reversal of global ischemia accompanied by an abrupt reduction of mass lesion and an ensuing reperfusion injury. Experimental models can play a critical role in improving our understanding of the underlying pathophysiology and in exploring potential treatments for patients with SDH. In this review, we describe the epidemiology, pathophysiology and clinical background of SDH.

  14. [Computed tomographic semiotics of chronic subdural hematomas].

    Science.gov (United States)

    El'-Kadi, Kh A; Likhterman, L B; Kornichenko, V N

    1990-01-01

    Analysis of the results of investigation of 72 patients with verified chronic subdural hematomas (CSH) has revealed their CT dense characteristics, the peculiarities of their structure compared with the time of their formation, the patients' age, the clinical stage of disease, and operative findings. Direct and indirect CT signs of uni- and bilateral hemispherical chronic subdural hematomas were described.

  15. Intra-uterine hematoma in pregnancy

    DEFF Research Database (Denmark)

    Glavind, K; Nøhr, S; Nielsen, P H

    1991-01-01

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

  16. Intra-uterine hematoma in pregnancy

    DEFF Research Database (Denmark)

    Glavind, K; Nøhr, S; Nielsen, P H

    1991-01-01

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

  17. Sudden Sensorineural Hearing Loss after Orthopedic Surgery under Combined Spinal and Epidural Anesthesia

    OpenAIRE

    Ditza de Vilhena; Luís Pereira; Delfim Duarte; Nuno Oliveira

    2016-01-01

    Postoperative hearing loss following nonotologic surgery is rare. For patients undergoing subarachnoid anesthesia, the loss of cerebral spinal fluid and hence the drop in intracranial pressure can result in hearing loss and cranial nerve palsy. We report a case in which a patient sustained orthopedic surgery under combined spinal and epidural anesthesia complicated by severe and persistent sensorineural hearing loss. This report is a reminder that postoperative sudden sensorineural hearing lo...

  18. [Epidural emphysema complicating bronchial asthma].

    Science.gov (United States)

    Rouetbi, N; Ben Saad, A; Joobeur, S; Skhiri, N; Cheikh Mhamed, S; Mribah, H; El Kamel, A

    2012-12-01

    Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.

  19. Occult intracranial injury in infants.

    Science.gov (United States)

    Greenes, D S; Schutzman, S A

    1998-12-01

    The objectives of this study were as follows: (1) to determine whether clinical symptoms and signs of brain injury are sensitive indicators of intracranial injury (ICI) in infants admitted with head trauma, (2) to describe the clinical characteristics of infants who have ICI in the absence of symptoms and signs of brain injury, and (3) to determine the clinical significance of those ICIs diagnosed in asymptomatic infants. We conducted a retrospective analysis of all infants younger than 2 years of age admitted to a tertiary care pediatric hospital with acute ICI during a 6(1/2)-year period. Infants were considered symptomatic if they had loss of consciousness, history of behavior change, seizures, vomiting, bulging fontanel, retinal hemorrhages, abnormal neurologic examination, depressed mental status, or irritability. All others were considered to have occult ICI. Of 101 infants studied, 19 (19%; 95% confidence interval [CI] 12%, 28%) had occult ICI. Fourteen of 52 (27%) infants younger than 6 months of age had occult ICI, compared with 5 of 34 (15%) infants 6 months to 1 year, and none of 15 (0%) infants older than 1 year. Eighteen (95%) infants with occult ICI had scalp contusion or hematoma, and 18 (95%) had skull fracture. Nine (47%) infants with occult ICI received therapy for the ICI. No infants with occult ICI (0%) (95% CI 0, 14%) required surgery or medical management for increased intracranial pressure. Only 1 subject (5%) with occult ICI had any late symptoms or complications: a brief, self-limited convulsion. We found that 19 of 101 ICIs in infants admitted with head trauma were clinically occult. All 19 occult ICIs occurred in infants younger than 12 months of age, and 18 of 19 had skull fractures. None experienced serious neurologic deterioration or required surgical intervention. Physicians cannot depend on the absence of clinical signs of brain injury to exclude ICI in infants younger than 1 year of age.

  20. Hematoma da aorta ascendente Intramural hematoma of the ascending aorta

    Directory of Open Access Journals (Sweden)

    Noedir Antônio G. Stolf

    2006-12-01

    Full Text Available É relatado o caso de um paciente do sexo masculino com idade de 71 anos, dando entrada no pronto-atendimento com palidez cutaneomucosa, acompanhada de hipertensão arterial sistêmica e dor torácica. Na investigação diagnóstica não foi evidenciada alteração compatível com isquemia miocárdica aguda. A radiografia de tórax evidenciava alargamento importante do mediastino. Ao ecocardiograma, a aorta ascendente media 47 mm, no nível do tronco pulmonar. Um dia após o eco, o paciente foi submetido a exame de ressonância magnética (RNM, quando se evidenciou aorta ascendente de 62 mm, sem evidenciar fluxo em falsa luz ou "flap" intimal, mas mostrando hematoma intramural da aorta ascendente, estendendo-se da raiz da aorta até um terço proximal do arco aórtico. Procedeu-se a correção cirúrgica, sendo realizada substituição da aorta ascendente e parte do arco aórtico (hemiarco, com preservação da valva aórtica pela suspensão das comissuras. Paciente evolui bem sem intercorrência, recebendo alta no nono dia de pós-operatório. Enfatizamos nesse relato de caso a semelhança do quadro clínico do hematoma intramural da aorta com o quadro de dissecção da aorta, a importância de se estabelecer diagnóstico correto e o melhor tratamento.It is reported the case of a 71 year old male patient admitted to the emergency service pale and with systemic arterial hypertension and thoracic pain. In the diagnostic investigation, there was no evidence of compatible with acute myocardial ischemia. The thorax x-ray showed important enlargement of the mediastinum. In the echocardiogram the ascending aorta measured 47mm, at the level of the pulmonary artery. One day after the echo, submitted to exam of magnetic resonance (RNM, the ascending aorta had a diameter of 62mm, without false lumen flow or intimal "flap", but showing intramural hematoma envolving the ascending aorta and the proximal portion of the aorta. It was submitted to the surgical

  1. Epidural injections for back pain

    Science.gov (United States)

    ESI; Spinal injection for back pain; Back pain injection; Steroid injection - epidural; Steroid injection - back ... be pregnant What medicines you are taking, including herbs, supplements, and other drugs you bought without a ...

  2. Monitoring of Intracranial Pressure During Intracranial Endoscopy

    Directory of Open Access Journals (Sweden)

    Rajeev Kumar

    2013-08-01

    Full Text Available Background: Intracranial endoscopy is a minimum invasive procedure, which reduces trauma to the brain, is cost-effective, and carries a shortened hospital stay with an improved postoperative outcome. Objective: To monitor intracranial pressure changes during intracranial endoscopy among children and adults under general anesthesia/sedation, and to compare the intracranial pressure changes between children and adults receiving general anesthesia and among adults receiving general anesthesia and sedation. Methods: The present cross-sectional study was conducted in one of the tertiary care hospitals of Lucknow. This was carried out in the department of neurosurgery from January 2008 to December 2008. Patients who were not fit for general anesthesia received local anesthesia under sedation. Patients participating in the study were divided into three groups. Intracranial pressure was recorded at specific intervals. Parametric data were subjected to statistical analysis using a student\\s t test. Result: A total of 70 patients were undergoing intracranial endoscopy under general anesthesia during the study period. In both groups A and B, intracranial pressure increases the maximum during inflation of the balloon. In group C, all the variations in ICP were found to be statistically significant. In the comparison of intracranial pressure changes between groups A and B, no significant difference was found. All correlations in the comparison of groups B and C were found to be statistically significant (p< 0.001. Conclusion: There is a need for continuous intraoperative monitoring of ICP intracranial endoscopy, because ICP increases in various stages of the procedure, which can be detrimental to the perfusion of the brain. [Arch Clin Exp Surg 2013; 2(4.000: 240-245

  3. Antibacterial activity of epidural infusions.

    Science.gov (United States)

    Coghlan, M W; Davies, M J; Hoyt, C; Joyce, L; Kilner, R; Waters, M J

    2009-01-01

    The incidence of epidural abscess following epidural catheterisation appears to be increasing, being recently reported as one in 1000 among surgical patients. This study was designed to investigate the antibacterial activity of various local anaesthetics and additives, used in epidural infusions, against a range of micro-organisms associated with epidural abscess. The aim was to determine which, if any, epidural infusion solution has the greatest antibacterial activity. Bupivacaine, ropivacaine and levobupivacaine crystals were dissolved and added to Mueller-Hinton Agar in concentrations of 0.06%, 0.125%, 0.2%, 0.25%, 0.5% and 1%. Fentanyl, adrenaline and clonidine were also mixed with agar in isolation and in combination with the local anaesthetics. Using a reference agar dilution method, the minimum inhibitory concentrations were determined for a range of bacteria. Bupivacaine showed antibacterial activity against Staphylococcus aureus, Enterococcus faecalis and Escherichia coli with minimum inhibitory concentrations between 0.125% and 0.25%. It did not inhibit the growth of Pseudomonas aeruginosa at any of the concentrations tested. Levobupivacaine and ropivacaine showed no activity against Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa, even at the highest concentrations tested, and minimal activity against Escherichia coli (minimum inhibitory concentrations 0.5% and 1% respectively). The presence of fentanyl, adrenaline and clonidine had no additional effect on the antibacterial activity of any of the local anaesthetic agents. The low concentrations of local anaesthetic usually used in epidural infusions have minimal antibacterial activity. While the clinical implications of this in vitro study are not known, consideration should be given to increasing the concentration of bupivacaine in an epidural infusion or to administering a daily bolus of 0.25% bupivacaine to reduce the risk of epidural bacterial growth.

  4. A blackhole over brain: Interdural hematoma - A challenging diagnosis.

    Science.gov (United States)

    Babayev, Rasim; Ekşi, Murat Şakir

    2015-01-01

    Hematoma in between two dura leaves, named as 'interdural hematoma', is a very rare entity in adulthood. Interdural hematoma may emerge spontaneously or secondary to coagulopathies. A 61-year-old male patient, who had a medical history of alcoholic cirrhosis, presented with interdural hematoma. The case has been discussed with a literature review about diagnostic and therapeutic approaches in this pathology.

  5. Subcapsular hematoma after ureteroscopy and laser lithotripsy.

    Science.gov (United States)

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

    2013-09-01

    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. 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. 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. 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

  6. Clinical indicators of intracranial injury in head-injured infants.

    Science.gov (United States)

    Greenes, D S; Schutzman, S A

    1999-10-01

    1) To determine whether clinical signs of brain injury are sensitive indicators of intracranial injury (ICI) in head-injured infants. 2) To determine whether radiographic imaging of otherwise asymptomatic infants with scalp hematoma is a useful means of detecting cases of ICI. 3) To determine whether head-injured infants without signs of brain injury or scalp hematoma may be safely managed without radiographic imaging. We performed a 1-year prospective study of all infants younger than 2 years of age presenting to a pediatric emergency department with head trauma. Data were collected on historical features, physical findings, radiographic findings, and hospital course. Follow-up telephone calls were made 2 weeks after discharge to assess for any late deterioration. Of 608 study subjects, 30 (5%) had ICI; 12/92 (13%) infants 0 to 2 months of age had ICI, compared with 13/224 (6%) infants 3 to 11 months of age, and 5/292 (2%) infants 12 months of age or older. Only 16/30 (52%) subjects with ICI had at least one of the following clinical symptoms or signs of brain injury: loss of consciousness, history of behavior change, seizures, emesis, depressed mental status, irritability, bulging fontanel, focal neurologic findings, or vital signs indicating increased intracranial pressure. Of the 14 asymptomatic subjects with ICI, 13 (93%) had significant scalp hematoma. Among subjects who had head computed tomography, significant scalp hematoma had an odds ratio of 2.78 (95% confidence interval: 1.15,6.70) for association with ICI. A total of 265 subjects (43%) were asymptomatic and had no significant scalp hematoma. None (95% confidence interval: 0,1.2%) required specific therapy or had any subsequent clinical deterioration. Clinical signs of brain injury are insensitive indicators of ICI in infants. A substantial fraction of infants with ICI will be detected through radiographic imaging of otherwise asymptomatic infants with significant scalp hematomas. Asymptomatic infants

  7. Massive Preperitoneal Hematoma after a Subcutaneous Injection

    Directory of Open Access Journals (Sweden)

    Hideki Katagiri

    2016-01-01

    Full Text Available Preperitoneal hematomas are rare and can develop after surgery or trauma. A 74-year-old woman, receiving systemic anticoagulation, developed a massive preperitoneal hematoma after a subcutaneous injection of teriparatide using a 32-gauge, 4 mm needle. In this patient, there were two factors, the subcutaneous injection of teriparatide and systemic anticoagulation, associated with development of the hematoma. These two factors are especially significant, because they are widely used clinically. Although extremely rare, physicians must consider this potentially life-threatening complication after subcutaneous injections, especially in patients receiving anticoagulation.

  8. Myocardial Ischemia Caused by Subepicardial Hematoma

    Science.gov (United States)

    Grieshaber, Philippe; Nef, Holger; Böning, Andreas; Niemann, Bernd

    2017-01-01

    Background Bleeding from bypass anastomosis leakage occurs early after coronary artery bypass grafting. Later, once the anastomosis is covered by intima, spontaneous bleeding is unlikely. Case Description A 63-year-old male patient developed a pseudoaneurysm-like, subepicardial late-term bleeding resulting in a hematoma that compromised coronary artery flow by increasing extracoronary pressure. This resulted in severe angina pectoris (Canadian Cardiovascular Society IV) and myocardial ischemia within the affected area. After surgical removal of the hematoma and repair of the anastomosis, the patient's symptoms disappeared and no signs of myocardial ischemia were present. Conclusion Surgical removal is an efficient therapy for subepicardial hematoma inducing myocardial ischemia.

  9. [Congenital anomalies of cerebral artery and intracranial aneurysm].

    Science.gov (United States)

    Nakajima, K; Ito, Z; Hen, R; Uemura, K; Matsuoka, S

    1976-02-01

    It is well known that congenital anomalies such as polycystic kidney, aortic coarctation, Marfan syndrome, Ehler-Danlos syndrome are apt to be complicated by intracranial aneurysms. In this report we attempt to reveal the relation and incidence between cerebrovascular anomalies and intracranial aneurysms. The etiology of aneurysms has been discussed, too. 12 cases of persistent trigeminl artery, 2 cases of persistent hypoglossal artery and 11 cases of fenestration were obtained from 3841 patients who were angiographically examined in our clinic for 5 years. The incidence is 0.31%, 0.05% and 0.29%, respectively. Persistent trigeminal arteries were complicated by 2 cases of intracranial aneurysms and one case of arterivenous malformations (AVM), persistent hypoglossal arteries were complicated by one case of aneurysm, and fenestrations were complicated by 2 cases of aneurysms and one case of AVM. One case of congenital agenesis of right internal carotid artery was obtained which was complicated by aneurysm of anterior communicating artery. Totally, 8 cases of aneurysms and AVM were obtained from 26 cases of cerebrovascular anomalies (incidence 30.8%). On the other hand, thalamic or caudate hemorrhage revealed the highest incidence of complication of intracranial aneurysms among intracerebral hematomas (10.7%). Compared with the incidence of aneurysms between cerebro vascular anomalies (30.8%) and thalamic or caudate hemorrhage (10.7%), the difference is statistically signigicant (P less than 0.05). The cause of intracranial aneurysm has not yet been clarified. But it is well accepted that the defect of tunica media vasorum is most responsible factor as to the occurrence of intracranial aneurysms. We concluded that the genetic error of cerebral vessels including defect of media caused intracranial aneurysms, and this result was supported from the evidence that cerebrovascular anomalies showed statistically high incidence of complication of intracranial aneurysms.

  10. Acute subdural hematoma: potential soccer injury in an otherwise healthy child.

    Science.gov (United States)

    Lutfi, Riad; Mullett, Charles J; Nield, Linda S

    2009-09-01

    A 16-year-old adolescent boy presented with headache, dizziness, loss of consciousness, and a tonic-clonic seizure after heading a soccer ball in a competitive match. A computed tomographic scan of the head revealed an acute subdural hematoma with a mass effect. The patient was emergently referred to a tertiary care facility where he eventually recovered completely with conservative care. No predisposing medical conditions were found. To the best of our knowledge, this is the first report of an intracranial hemorrhage secondary to the heading of a soccer ball alone in an otherwise healthy child without any underlying predisposing central nervous system abnormalities.

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

    Directory of Open Access Journals (Sweden)

    Jacinto Barbosa Lay Chaves

    2007-08-01

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

  12. MR imaging of intracranial hemorrhage in neonates and infants at 2.35 Tesla.

    Science.gov (United States)

    Zuerrer, M; Martin, E; Boltshauser, E

    1991-01-01

    The variations of the relative signal intensity and the time dependent changing contrast of intracranial hemorrhages on high-field spin-echo magnetic resonance images (MRI) were studied in 28 pediatric patients. For T1-weighted images, a repetition time (TR) of 500 ms and an echo time (TE) of 30 or 23 ms was used. The corresponding times for T2-weighted images were TR 3000 ms and TE 120 ms. Intracranial hematomas, less than 3 days old, were iso- to mildly hypointense on short TR/TE scans and markedly hypointense on long TR/TE scans (acute stage). In the following four days the signal of the hematomas became hyperintense on short TR/TE scans, beginning in the periphery and proceeding towards the center. On long TR/TE scans the signal remained markedly hypointense (early subacute stage). 7-14 days old hematomas were of high signal intensity on short TR/TE scans. On long TR/TE scans they appeared hypointense in the center and hyperintense in the periphery (late subacute stage). By the end of the second week the hematomas were of high signal intensity on all pulse sequences (chronic stage). Chronic hematomas were surrounded by a parenchymal rim of hypointensity on long TR/TE scans. 28 neonates and infants (with 11 follow-up examinations) of 31.5-70.6 weeks postconceptional age (PCA), with an intracranial hemorrhage were examined. The etiologies of the hemorrhages were: asphyxia (17 cases), brain infarct (2), thrombocytopenia (1), clotting disorder (1) and unknown origin (7). The aim of this study was to describe the appearance of intracranial hemorrhages in neonates and infants with MRI at 2.35 Tesla using spine-cho sequences.

  13. Influence of different hematoma clearance rates on patients with hypertensive intracerebral hemorrhage

    Institute of Scientific and Technical Information of China (English)

    Cheng Zhong; Jing-Zhu Shi; Yu Liu; Tao Ou; Guo-Jing Liu; Bin Wang

    2016-01-01

    Objective:To evaluate the influence of different hematoma clearance rates patients with hypertensive intracerebral hemorrhage.Methods: A total of 94 cases with hypertensive intracerebral hemorrhage treated with operation from June 2012 to June 2015 were selected. According to theirhematoma clearance rates, they were divided into groups A (50%-70%, 28 cases), B (70%-90%,48 cases) and C (90%, 18 cases). The recovery and perioperative levels of serum neuron-specific enolase (NSE) and soluble S-100 protein of the three groups were compared.Results: The perioperative mortality and the rates of postoperative rebleeding, intracranial infection and other complications of the three groups showed no statistical significant difference (P>0.05). With the increase of the hematoma clearance rate, the drainage tube removal time and hematoma complete absorption time reduced significantly (P<0.05). In the groups B and C, the grade levels of ADL in postoperative 3 months were significantly superior to those in the group A (P<0.05). The levels of serum NSE and S-100 in the three groups increased in the initial stage and then declined after surgery. In the group B and C, the serum levels of NSE and S-100 were significantly higher than those in the group A on the 7th day after surgery (P<0.05). With the increase of the hematoma clearance rate, the serum levels of NSE and S-100 were significantly reduced on the 14th day after surgery (P<0.05). Conclusions:High level of hematoma clearance rate can help to increase the operation efficacy and prognosis of patients with hypertensive intracerebral hemorrhage.

  14. Subdural Hematoma: An Adverse Event of Electroconvulsive Therapy—Case Report and Literature Review

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    Ranganath R. Kulkarni

    2012-01-01

    Full Text Available Electroconvulsive therapy (ECT is commonly used in the management of medication nonresponsive depressive disorder, with proven efficacy in psychiatric practice since many decades. A rare complication of intracranial bleed following this therapeutic procedure has been reported in sporadic case reports in the English literature. We report a case of such a complication in a 42-year-old male, a known case of nonorganic medication nonresponsive depressive disorder for the last two years who required ECT application. Presenting symptoms included altered mental state, urinary incontinence, and repeated episodes of vomiting; following ECT procedure with magnetic resonance imaging (MRI of the brain suggestive of bilateral acute subdural hematoma. Despite the view that it may be used in neurological conditions without raised intracranial tension, it will be worthwhile to be vigilant during post-ECT recovery for any emergent complications.

  15. Reversible Parkinsonism secondary to chronic subdural hematoma

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    Wajid Nazir Wani

    2013-01-01

    Full Text Available Secondary parkinsonism is attributable to a wide variety of causes including supratentorial mass lesions. While tumors are known to present with parkinsonism, chronic subdural hematoma is rarely seen presenting as rapidly deteriorating parkinsonian features with complete disappearance following evacuation of hematoma. The authors present two such patients-70- and 78-year-old males who presented with sudden onset of parkinsonism features. Both failed to recollect any significant head injury. Imaging diagnosed the presence of chronic subdural hematomas, being unilateral in one and bilateral in other. Surgical evacuation resulted in complete resolution of parkinsonian symptoms. These cases reinforce earlier studies for chronic subdural hematoma to be one of the causes of reversible parkinsonism apparently from distortion of basal ganglia mechanically and bringing changes in dopaminergic function, harming the susceptible aging brain.

  16. Cervical Ligamentum Flavum Hematoma: A Case Report.

    Science.gov (United States)

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

    2016-02-01

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

  17. Nontraumatic intracranial hemorrhage.

    Science.gov (United States)

    Fischbein, Nancy J; Wijman, Christine A C

    2010-11-01

    Nontraumatic (or spontaneous) intracranial hemorrhage most commonly involves the brain parenchyma and subarachnoid space. This entity accounts for at least 10% of strokes and is a leading cause of death and disability in adults. Important causes of spontaneous intracranial hemorrhage include hypertension, cerebral amyloid angiopathy, aneurysms, vascular malformations, and hemorrhagic infarcts (both venous and arterial). Imaging findings in common and less common causes of spontaneous intracranial hemorrhage are reviewed.

  18. Delayed extradural hematoma : a case report.

    Directory of Open Access Journals (Sweden)

    Alappat J

    2002-07-01

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

  19. [Spontaneous hepatic hematoma in twin pregnancy].

    Science.gov (United States)

    Quesnel, Carlos; Weber, Alejandro; Mendoza, Dalila; Garteiz, Denzil

    2012-02-01

    The hepatic hematoma or rupture appear in 1 of every 100,000 pregnancies. The most common causes of hepatic hematoma in pregnancy are severe preeclampsia and HELLP syndrome; some predisposing factors are seizures, vomiting, labor, preexistent hepatic disease and trauma. A 33 year old primigravid with a normal 33 week twin pregnancy presented abdominal pain and hypovolemic shock due to spontaneous subcapsular hepatic hematoma; laparoscopy was performed to evaluate the possibility of rupture, which was not found, later emergency cesarean section was carried out followed by hepatic hematoma drainage and abdominal packaging by laparoscopy. After surgery the flow through drainage was too high additionally hemodynamic instability and consumption coagulopathy. Abdominal panangiography was performed without identifying bleeding areas. Intesive care was given to the patient evolving satisfactorily, was discharged 19 days after the event. Seven months later she had laparoscopic cholecystectomy due to acute litiasic colecistitis. We found 5 cases in literatura about hepatic hematoma during pregnancy no related to hypertensive disorders of pregnancy; these were related to hepatoma, amebian hepatic abscess, falciform cell anemia, cocaine consumption and molar pregnancy. Hepatics hematomas have high morbidity and mortality so is significant early diagnosis and multidisciplinary approach.

  20. History of Chronic Subdural Hematoma

    Science.gov (United States)

    2015-01-01

    Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion. PMID:27169062

  1. [Inadvertent epidural infusion of paracetamol].

    Science.gov (United States)

    Charco Roca, L M; Ortiz Sánchez, V E; del Pino Moreno, A L

    2014-10-01

    A 45-year-old woman was accidentally administered an epidural infusion of paracetamol instead of levobupivacaine for postoperative pain therapy during the postoperative period of abdominal hysterectomy under general anesthesia combined with epidural analgesia. The patient had no neurological symptoms at any time, although a slight tendency to arterial hypotension that did not require treatment was observed. No rescue analgesia was necessary until 8h after the start of epidural infusion. The incidence of these types of errors is probably underestimated, although there are several cases reported with various drugs. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  2. Recent Advances in Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Maria Bauer

    2012-01-01

    Full Text Available Neuraxial anesthesia is a term that denotes all forms of central blocks, involving the spinal, epidural, and caudal spaces. Epidural anesthesia is a versatile technique widely used in anesthetic practice. Its potential to decrease postoperative morbidity and mortality has been demonstrated by numerous studies. To maximize its perioperative benefits while minimizing potential adverse outcomes, the knowledge of factors affecting successful block placement is essential. This paper will provide an overview of the pertinent anatomical, pharmacological, immunological, and technical aspects of epidural anesthesia in both adult and pediatric populations and will discuss the recent advances, the related rare but potentially devastating complications, and the current recommendations for the use of anticoagulants in the setting of neuraxial block placement.

  3. Epidural Naloxone to Prevent Buprenorphine Induced PONV

    Directory of Open Access Journals (Sweden)

    Ashok Jadon

    2008-01-01

    Full Text Available Epidural infusion of local analgesic and opioid are commonly used for postoperative pain relief. This combina-tion gives excellent anlgesia but nausea and vomiting remains a major concern. Low dose epidural naloxone prevents PONV induced by spinal opioids like morphine, fentanyl and sufentanil. However, it is not known that epidural naloxone administration prevents PONV induced by epidural buprenorphine. We have reported three cases of major abdominal operation in which lowdose epidural infusion of naloxone releived the symptom of buprenorphine induced severe PONV and improved the quality of analgesia.

  4. Spontaneous Intracranial Hypotension: An Etiology for Consciousness Disorder and Coma.

    Science.gov (United States)

    Collange, Olivier; Wolff, Valérie; Cebula, Hélène; Pradignac, Alain; Meyer, Alain; Kindo, Michel; Diemunsch, Pierre; Proust, François; Mertes, Paul-Michel; Kremer, Stéphane

    2016-11-15

    We report 3 cases of spontaneous intracranial hypotension (SIH) associated with consciousness disorder and coma. In patients, SIH was suspected on a computed tomography scan and diagnosed by cerebral magnetic resonance imaging (MRI). Spinal MRI confirmed cerebrospinal fluid leakage. SIH should be seen as an underestimated cause of consciousness disorder and coma, especially in patients with a history of orthostatic headache, spinal injury, or oculomotor signs. Computed tomography scans should be examined for signs of SIH before operating on patients with a spontaneous subdural hematoma. Brain and spine MRI should be performed when SIH is suspected. Our 3 patients have shown good recovery without any neurological sequelae.

  5. Spontaneous intracranial hypotension.

    LENUS (Irish Health Repository)

    Fullam, L

    2012-01-31

    INTRODUCTION: Spontaneous\\/primary intracranial hypotension is characterised by orthostatic headache and is associated with characteristic magnetic resonance imaging findings. CASE REPORT: We present a case report of a patient with typical symptoms and classical radiological images. DISCUSSION: Spontaneous intracranial hypotension is an under-recognised cause of headache and can be diagnosed by history of typical orthostatic headache and findings on MRI brain.

  6. NOISY INTRACRANIAL TUMORS

    NARCIS (Netherlands)

    VANDOOREN, BTH; VANBRUGGEN, AC; MOOIJ, JJA; HEW, JM; JOURNEE, HL

    1994-01-01

    Transorbital sound recordings were obtained from 21 patients with intracranial tumours, 28 patients with intracranial aneurysms and 20 control patients. The group of patients with tumours consisted of 12 patients with gliomas, of whom 6 had low-grade gliomas and 6 had high-grade gliomas, and 9 patie

  7. Unruptured intracranial aneurysms

    NARCIS (Netherlands)

    Backes, Daan

    2016-01-01

    Rupture of an intracranial aneurysm results in aneurysmal subarachnoid hemorrhage (SAH), a subtype of stroke with an incidence of 9 per 100,000 person-years and a case-fatality around 35%. In order to prevent SAH, patients with unruptured intracranial aneurysms can be treated by neurosurgical or end

  8. Paediatric intracranial aneurysms

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    A A Wani

    2006-01-01

    Full Text Available Intracranial aneurysms in childhood account for 1-2% of intracranial aneurysms.[1],[2] These aneurysms have unique characteristics that make them different from those in adults. These differences are evident in their epidemiology, location, clinical spectrum, association with trauma and infection, complications and outcome.

  9. 创伤性侧裂区血肿术后再发血肿50例临床分析%Clinical analysis of rehematoma after operation of traumatic hematoma of peri-sylvian area in 50 cases

    Institute of Scientific and Technical Information of China (English)

    曾昭明; 郭予大; 邵强; 吴波; 冯志铁

    2008-01-01

    Objective To study the causes of rehematomas after operations of traumatic hematomas of perisylvian area.Methods The causes of 50 cases of rehematoma after operation were analyzed retrospectively.Results The big hematoma in primary contusion and laceration of brain happened in 19 cases(38%),delayed epidural hematoma in opposite side in 15 cases(30%),increased intracerebral hematoma in 9 cases(18%),epidural hematoma in primary area in 3 cases(6%),subdural hematoma caused by postoperative lumbaropuncture in 3 cases(6%),hematoma in encephalonecrosis in 1 case(2%).Conclusion Insuitable operation and hemostasis are the main causes of rehemorrhage,and fracture line in the opposite side,and thrombocytopenia are high risk factors of rehematoma.%目的 探讨创伤性侧裂区血肿术后再发血肿的原因,提高抢救成功率.方法 回顾性分析50例创伤性侧裂区血肿术后再发血肿的情况,分析其原因.结果 在原脑挫裂伤部位出现大块血肿19例(38%),出现对侧迟发性硬膜外血肿15例(30%),脑内血肿扩大9例(18%),原术区硬膜外血肿3例(6%),术后腰椎穿刺致硬膜下血肿3例(6%),脑组织坏死区血肿1例(2%).结论 手术操作和止血不利是再发血肿的主要原因,首次手术对侧存在骨折线和患者血小板减少是再出血的高危因素.

  10. Spontaneous subdural hematoma and antiplatelet therapy: Does efficacy of Ticagrelor come with added risk?

    Science.gov (United States)

    Suryanarayana Sharma, Pattanagere Manjunatha; Tekkatte Jagannatha, Aniruddha; Javali, Mahendra; Hegde, Anupama Venkatasubba; Mahale, Rohan; Madhusudhan; Srinivasa, Rangasetty

    2015-12-01

    Antiplatelet therapy has established clinical benefit on cardiovascular outcome and has reduced the rates of re-infarction/in stent thrombosis following percutaneous coronary intervention in acute coronary syndromes. Major bleeding episodes can occur with antiplatelet therapy and intracranial hemorrhage (ICH) is one of the most feared complications resulting in significant morbidity and mortality. Identification of high risk groups and judicious use of antiplatelet therapy reduces the bleeding risk. Ticagrelor is a newer P2Y12 receptor antagonist with established clinical benefit. However, risks of having an ICH with these newer molecules cannot be ignored. Here, we report a case of spontaneous acute subdural hematoma developing in a patient on antiplatelet therapy with aspirin and ticagrelor. Early recognition, discontinuation of the medication and appropriate management resulted in resolution of hematoma and good clinical outcome. Authors have reviewed the antithrombotic drugs and their tendencies in causing intracranial bleeds from a neurophysicians perspective. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  11. [Case of spinal epidural abscess after continuous epidural block to manage the pain of herpes zoster].

    Science.gov (United States)

    Miyamoto, Tatsuhito; Nakatani, Toshihiko; Narai, Yasuhiro; Sakakibara, Manabu; Hashimoto, Tatsuya; Saito, Youji

    2014-03-01

    A woman in her 90's received continuous epidural block for the pain of herpes zoster. Four days after epidural catheterization, she was found with cellutitis. Fourteen days after epidural catheterization, spinal epidural abscess was pointed out on MRI. Since there were no neurological symptoms, we performed conservative medical management with antibiotics. She recovered without sequela When the symptoms of cellutitis appeared after epidural block (even if there are neither neurological symptoms nor infectious signs), there is a possibility of progressing into spinal epidural abscess.

  12. Traumatic duodenal hematoma in the pediatric patient.

    Science.gov (United States)

    Winthrop, A L; Wesson, D E; Filler, R M

    1986-09-01

    Twenty children with duodenal hematomas secondary to blunt trauma were treated between 1953 and 1983. The duodenal injury was isolated in ten cases and associated with intra-abdominal injuries in the others. In ten, the duodenal injury was suspected on admission and the diagnosis was confirmed within 24 hours by radiographic contrast studies. All ten were managed successfully with nasogastric suction and intravenous fluids. Ten patients underwent laparotomy for increasing abdominal tenderness and guarding. An isolated duodenal hematoma was found in four and treated by evacuation and/or gastroenterostomy. In five of the remaining six surgical patients, all of whom had multiple intra-abdominal injuries, the duodenum was left untouched. Three of these patients had postoperative contrast studies that showed early resolution of the duodenal hematoma. No duodenal stricture or leak developed in any patient. The children with isolated duodenal hematomas who were treated conservatively had a mean hospital stay of six days, whereas those treated surgically had a mean stay of 17 days. The ten patients with multiple intra-abdominal injuries had a mean hospital stay of 32 days. In this group, eight required total parenteral nutrition or nasojejunal feeds for nutritional support. In these patients, an isolated duodenal hematoma resulted in minimal morbidity and nonoperative management was usually successful. The presence of associated intra-abdominal injuries was responsible for the prolonged hospitalization and delayed return of normal intestinal function in some patients.

  13. Is Subdural Peritoneal Shunt Placement an Effective Tool for the Management of Recurrent/Chronic Subdural Hematoma?

    Science.gov (United States)

    Alvarez-Pinzon, Andres M; Valerio, Jose E; Delgado, Victor; Escalante, Jennifer A; Lopez, Nithia; Wolf, Aizik L

    2016-01-01

    Objective  To describe a surgical technique and to report using a retrospective study the efficacy of peritoneal shunts for the treatment of recurrent/chronic subdural hematoma (CSDH). We describe the considerations, complications, and outcomes related to this technique. Methods  In a retrospective cohort study, 125 charts with a diagnosis of subacute/chronic subdural hematoma were assigned for evaluation. Of the charts reviewed, 18 charts were found from subjects with a diagnosis of recurrent sub-acute or chronic subdural hematoma. All patients had undergone initial surgical treatment of their condition followed by peritoneal shunt placement to help alleviate intracranial pressure. Factors including the age, size of subdural hematoma, number of previous events, BMI, complications, survival, and clinical course were analyzed. Results  After subdural peritoneal shunt placement all patients had full neurological recovery with no complaints of headaches, lethargy, weakness, confusion or seizures. None of the cases had new subdural hematoma episodes after placement for a minimum of a two-year period (mean 26.1 months) (range 24.3-48.6 months). No postoperative complications were reported. The rates of postoperative hemorrhage, infection, distal catheter revision, and perioperative seizures was found to be zero percent. Shunt drainage was successful in all cases, draining 85% of the blood in the first 48 hours. There was no significant relationship between complications and the use of anticoagulants four weeks after surgery. Conclusions Peritoneal shunts, though rarely used, are a viable option in the treatment of sub-acute/chronic subdural hematomas. When pursuing this treatment, this technique is recommended to mitigate the risks of repeat surgical intervention and lessen perioperative time in high-risk patients. PMID:27335718

  14. Mount Fuji sign with concavo-convex appearance of epidural haematoma in a patient with tension pneumocephalus

    Directory of Open Access Journals (Sweden)

    Brij Raj Singh

    2009-01-01

    Full Text Available Intracranial pneumatocele is a non-infected accumulation of air within the cranial cavity. We report a case of a 22-year-old male who sustained a fracture of anterior cranial fossa following a motor vehicle accident and the imaging findings showed a concave-convex epidural haematoma. Simple traumatic pneumocephalus usually does not require surgical treatment and non-operative management has been advocated for small, asymptomatic convexity extradural haematomas.

  15. Easy ways to remember the progression of MRI signal intensity changes of intracranial hemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Maizlin, Z.V. [Dept. of Radiology, McMaster Univ. Medical Centre, Hamilton, Ontario (Canada)], E-mail: zeev25@yahoo.com; Shewchuk, J.R. [Medical Imaging, Royal Columbian Hospital, New Westminster, British Columbia (Canada); Clement, J.J. [Radiology, St Paul' s Hospital, Vancouver, British Columbia (Canada)

    2009-04-15

    This paper discusses the different ways to remember the progression of MRI signal intensity changes of intracranial hemorrhage. Several techniques that have been proposed to remember the progression of MRI signal intensity changes occurring in hematomas with time are discussed. In the opinion of the authors, the graph method is the easiest to remember. This may be because radiology is a highly visual speciality, and visual mnemonics seem easier to remember.

  16. A Case of Hemophilia A Associated with Spontaneous Hemorrhagic Pleural Effusion and Intracranial Hem

    Directory of Open Access Journals (Sweden)

    Nuri Tutar

    2014-03-01

    Full Text Available Hemophilia A is a sex-linked recessive coagulation disorder almost exclusively occurring in male subjects and caused by a deficiency of factor VIII. It  is a rare disorder characterized by spontaneous hemorrhages. Spontaneous bleeding in the pleural space is very rare in hemophilia both in children and adults. Here in, we present the case of a 56-year-old hemophilia A patient with hemorrhagic pleural effusion and intracranial hematoma.

  17. Massive expanding hematoma of the chin following blunt trauma

    Directory of Open Access Journals (Sweden)

    K Thanvir Mohamed Niazi

    2016-01-01

    Full Text Available Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.

  18. Massive expanding hematoma of the chin following blunt trauma.

    Science.gov (United States)

    Niazi, K Thanvir Mohamed; Raja, Dharmesh Kumar; Prakash, R; Balaji, V R; Manikandan, D; Ulaganathan, G; Yoganandha, R

    2016-10-01

    Posttraumatic hematoma of the face is common and usually self-limiting in nature. We report an unusual massive expanding hematoma of the chin within 9 h following a blunt trauma with no associated injuries or fracture.

  19. Rectus sheath hematoma: three case reports

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    Kapan Selin

    2008-01-01

    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.

  20. Intracranial structural alteration predicts treatment outcome in patients with spontaneous intracranial hypotension.

    Science.gov (United States)

    Choi, Hanna; Lee, Mi Ji; Choi, Hyun Ah; Cha, Jihoon; Chung, Chin-Sang

    2017-01-01

    Background Intracranial structural dislocation in spontaneous intracranial hypotension (SIH) can be measured by various intracranial angles and distances. We aimed to identify the clinical significance of structural dislocation in relation to treatment outcome in patients with SIH. Methods In this retrospective analysis, we identified patients with SIH who received an epidural blood patch (EBP) at Samsung Medical Center from January 2005 to March 2015. Structural dislocation in pretreatment MRIs of SIH patients was assessed by measuring tonsillar herniation, mamillopontine distance, the angle between the vein of Galen and straight sinus (vG/SS angle), the pontomesencephalic angle, and the lateral ventricular angle. After the first EBP, poor response was defined as the persistence of symptoms that prompted a repeat EBP. Results Out of the 95 patients included, 31 (32.6%) showed poor response. Among the radiological markers of structural dislocation, the vG/SS angle was associated with poor response (49.82 ± 16.40° vs 66.58 ± 26.08°, p = 0.002). Among clinical variables, premorbid migraine ( p = 0.036) was related to poor response. In multivariate analysis, reduced vG/SS angle was independently associated with poor response (OR 1.04 [95% CI 1.01 - 1.07] per 1° decrease, p = 0.006). In 23 patients who underwent MRI after successful treatment, the vG/SS angle significantly increased after the EBP ( p < 0.001, by paired t-test), while two patients with aggravation or recurrence showed a further reduction of their vG/SS angles. Conclusions Intracranial structural dislocation, measured by the vG/SS angle, is associated with poor response to the first EBP in patients with SIH. Successful treatment can reverse the structural dislocation.

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

    OpenAIRE

    2007-01-01

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

  2. Subcorneal hematomas in excessive video game play.

    Science.gov (United States)

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

    2016-01-01

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

  3. Spontaneous Epiglottic Hematoma Secondary to Supratherapeutic Anticoagulation

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    Cody A. Koch

    2010-01-01

    Full Text Available Hemorrhage into the soft tissues of the airway represents a potentially life-threatening complication of long-term anticoagulation. We report the case of a chronically anticoagulated 37-year-old male who developed a spontaneous hematoma of the epiglottis secondary to a supra-therapeutic INR. Epiglottic hematoma should be considered in the differential of any anticoagulated patient presenting with upper airway compromise. The airway should be secured in a controlled fashion, and the coagulopathy should be rapidly corrected.

  4. Pulsative hematoma: A penile fracture complication

    Directory of Open Access Journals (Sweden)

    Nale Đorđe

    2007-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Hayes Jackson

    2012-11-01

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

  6. Systematic review and case report: Intracranial complications of pediatric sinusitis.

    Science.gov (United States)

    Patel, Neha A; Garber, David; Hu, Shirley; Kamat, Ameet

    2016-07-01

    Intracranial complications of rhinosinusitis are rare in the post-antibiotic era. However, due to potentially devastating outcomes, prompt recognition and management are essential. This study aims to perform the first systematic review of the intracranial complications of rhinosinusitis in order to better characterize their clinical presentation, diagnosis, and treatment, and report a case of frontal lobe empyema secondary to pediatric frontoethmoid sinusitis. Ovid MEDLINE, Cochrane Library, and Google Scholar. Full-text, peer-reviewed journal publications from 1947 to January 1, 2015 in English; focus on intracranial complications of sinusitis; pediatric patients (<18 years of age); studies including data on diagnostic workup and treatment. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Sixteen studies involving 180 patients were included. An overwhelming majority of patients were young adolescent males (70%). The most common intracranial complications were subdural empyema (49%), epidural abscess (36%), cerebral abscess (21%), and meningitis (10%). Patients most often presented with nonspecific symptoms such as headache, fever, nausea and vomiting. Computed tomography with contrast or magnetic resonance imaging confirmed the diagnosis when intracranial complications were suspected. Typical treatment included surgical incision and drainage, often involving joint neurosurgical and otolaryngological procedures, combined with a long course of antibiotics. The morbidity rate was 27%, and the mortality rate was 3.3%. All studies were retrospective chart reviews, case series or case reports. A review of the currently available literature shows that with a high degree of suspicion, multidisciplinary cooperation and aggressive treatment, favorable outcomes are attainable. The most effective surgical treatment for intracranial complications remains unclear and should be investigated further. Copyright © 2016 Elsevier Ireland Ltd. All rights

  7. Intracranial pressure monitoring

    Science.gov (United States)

    ICP monitoring; CSF pressure monitoring ... There are 3 ways to monitor pressure in the skull (intracranial pressure). INTRAVENTRICULAR CATHETER The intraventricular catheter is the most accurate monitoring method. To insert an intraventricular catheter, a ...

  8. Increased intracranial pressure

    Science.gov (United States)

    ... patient's bedside in an emergency room or hospital. Primary care doctors may sometimes spot early symptoms of increased intracranial pressure such as headache, seizures, or other nervous system problems. An MRI ...

  9. Spontaneous epidural hematoma of the spine associated with oral anticoagulants: 3 Case Studies

    Directory of Open Access Journals (Sweden)

    C. Tawk

    2015-01-01

    Conclusion: This rare entity should be suspected in every acute medullary syndrome with spinal pain, motor and/or sensory deficit. In order to decrease the sequelae, neurologically unstable patients should benefit from early diagnosis and urgent surgical decompression.

  10. The experience of labour with epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid; Keller, Kurt Dauer

    2014-01-01

    of the epidural analgesia as high, in general, their satisfaction with labour is unchanged or even lower when epidural analgesia is used. Question: How do women experience being in labour with epidural analgesia, and what kind of midwifery care do they, consequently, need? Methods: A field study and semi......-structured interviews were conducted on a phenomenological basis. Nine nulliparous women were observed from initiation of epidural analgesia until birth of their baby. They were interviewed the day after the birth and again 2 months later. The involved midwives were interviewed 2–3 h after the birth. Findings......: Initiation of epidural analgesia can have considerable implications for women’s experience of labour. Two different types of emotional reactions towards epidural analgesia are distinguished, one of which is particularly marked by a subtle sense of worry and ambivalence. Another important finding refers...

  11. Unusual Initial Manifestation of Acquired Hemophilia A: A Normal Activated Partial Thromboplastin Time, Intramuscular Hematoma and Cerebral Hemorrhage

    Science.gov (United States)

    Tsuyama, Nobuaki; Ichiba, Toshihisa; Naito, Hiroshi

    2016-01-01

    We herein present a case of acquired hemophilia A with a normal activated partial thromboplastin (aPTT), intramuscular hematoma and cerebral hemorrhage occurring in a 73-year-old man. The patient visited our emergency department with gait disturbance, pain and swelling in his right leg. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed intramuscular hematoma and intracranial hemorrhage. The results of initial coagulation studies were normal, but repeated coagulation studies revealed an isolated prolongation of the aPTT. Additional laboratory tests confirmed the diagnosis of acquired hemophilia A. If the initial aPTT is normal, we should therefore repeat the aPTT and also perform other coagulation studies including a mixing study, factor VIII level and inhibitor, to investigate the underlying diseases in elderly patients with spontaneous hemorrhaging of unknown etiology. PMID:27853081

  12. Post traumatic pituitary apoplexy with contiguous intra cerebral hematoma operated through endonasal route--a case report.

    Science.gov (United States)

    Dev, Ravi; Singh, Sunil Kumar; Sharma, Mahesh Chandra; Khetan, Prakash; Chugh, Ashish

    2007-01-01

    Pituitary apoplexy is a clinical syndrome occurring as a consequence of fulminant expansion of pituitary tumor due to massive infarction, necrosis, and hemorrhage. Its association with head injury is rare and only few reports are available. Shear forces on stalk and arterial vasospasm have been proposed to be the possible reasons. The clinical picture is characterized by sudden onset headache, visual symptoms, multiple cranial nerves involvement, meningismus, altered mental status, and hormonal dysfunction. Transsphenoidal decompression is the standard treatment but suprasellar and widespread extension of hematoma may need intracranial approach. We are reporting a rare association of head injury with pituitary apoplexy, where endonasal surgery proved to be a simple useful approach to evacuate contiguous intra-cerebral hematoma with excision of apoplectic pituitary adenoma.

  13. Idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne M; Jensen, Rigmor H

    2015-01-01

    AIMS: The aims of this article are to characterize the headache in idiopathic intracranial hypertension (IIH) and to field-test the ICHD diagnostic criteria for headache attributed to IIH. MATERIALS AND METHODS: We included 44 patients with new-onset IIH. Thirty-four patients with suspected...... tinnitus may suggest intracranial hypertension. Based on data from a well-defined IIH cohort, we propose a revision of the ICDH-3 beta diagnostic criteria with improved clinical applicability and increased sensitivity and specificity....

  14. Epidural Analgesia in the Postoperative Period

    Science.gov (United States)

    2001-10-01

    epidurally. They are opiods and local anesthetics. The pharmacokinetics and pharmacodynamics of each class are different, and they may act...overall pharmacodynamics of the drug. Epidural Opioids Brown (2000) states that opioids are one class of drug that may be used for epidural analgesia...morphine with lidocaine or bupivacaine with the effects of these medications when administered alone in mice. They used various tests to measure

  15. Chronic expanding hematoma of thorax extended to the neck.

    Science.gov (United States)

    Ueda, Hitoshi; Baba, Hiromitsu; Ondo, Kaoru

    2014-01-01

    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 fluid, 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.

  16. Risk for intracranial pressure increase related to enclosed air in post-craniotomy patients during air ambulance transport: a retrospective cohort study with simulation.

    Science.gov (United States)

    Brändström, Helge; Sundelin, Anna; Hoseason, Daniela; Sundström, Nina; Birgander, Richard; Johansson, Göran; Winsö, Ola; Koskinen, Lars-Owe; Haney, Michael

    2017-05-12

    Post-craniotomy intracranial air can be present in patients scheduled for air ambulance transport to their home hospital. We aimed to assess risk for in-flight intracranial pressure (ICP) increases related to observed intracranial air volumes, hypothetical sea level pre-transport ICP, and different potential flight levels and cabin pressures. A cohort of consecutive subdural hematoma evacuation patients from one University Medical Centre was assessed with post-operative intracranial air volume measurements by computed tomography. Intracranial pressure changes related to estimated intracranial air volume effects of changing atmospheric pressure (simulating flight and cabin pressure changes up to 8000 ft) were simulated using an established model for intracranial pressure and volume relations. Approximately one third of the cohort had post-operative intracranial air. Of these, approximately one third had intracranial air volumes less than 11 ml. The simulation estimated that the expected changes in intracranial pressure during 'flight' would not result in intracranial hypertension. For intracranial air volumes above 11 ml, the simulation suggested that it was possible that intracranial hypertension could develop 'inflight' related to cabin pressure drop. Depending on the pre-flight intracranial pressure and air volume, this could occur quite early during the assent phase in the flight profile. DISCUSSION: These findings support the idea that there should be radiographic verification of the presence or absence of intracranial air after craniotomy for patients planned for long distance air transport. Very small amounts of air are clinically inconsequential. Otherwise, air transport with maintained ground-level cabin pressure should be a priority for these patients.

  17. Bacteriological Profile of Epidural Catheters

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    B. M. Sahay, Sanjot Dahake, D. K Mendiratta*,Vijayshree Deotale*,B. Premendran, P.S.Dhande, Pratibha Narang*

    2010-01-01

    Full Text Available The bacteriological profile of epidural catheters was studied in 88 patients. Skin swabs before catheterizationand before removal of catheter with their controls were cultured in TSB Medium. The catheter hub, theportion at the skin puncture site and at the tip were cultured in TSB Medium. The 1cm of the catheter bitjust before the tip was cultured in TGB medium for anaerobes.Both, the skin controls swabs and theanaerobic culture, were negative. From the remaining, 56 positive cultures were obtained. Staphylococcusepidermidis was the predominant organism in 52% followed by staphylococcus aureus 25%. The remaining23% was shared by Acinetobacter, Pseudomonas, Klebsiella, and E. coli. All the positive cultures fromskin prior to epidural catheterization had turned sterile by 48 hours, indicating continued bactericidal actionof the disinfectant. The likely source of positive skin cultures at 48 hours is hair follicles.The catheter tipculture was positive in 9 specimen, none of which resulted in the formation of epidural abscess. In 3 casesthe cultures of skin puncture site and the tip were identical indicating tracking-in of the organisms.

  18. Estudio observacional de la analgesia epidural para trabajo de parto: Complicaciones de la técnica en 5.895 embarazadas Observational study of epidural analgesia used in labour: Complications of this technique in 5,895 pregnant women

    Directory of Open Access Journals (Sweden)

    M. Calvo

    2005-04-01

    ón a largo plazo todavía desconocida. Otras complicaciones como el dolor de espalda o la retención urinaria, necesitan de estudios prospectivos controlados y aleatorizados con gran número de pacientes para aclarar la posible relación con la analgesia epidural. La cefalea postpunción dural aparece en la mitad de los casos de punciones durales inadvertidas, que suele ocurrir en el 1,5% de las gestantes a las que se les realiza la técnica de analgesia epidural, aunque en nuestro estudio ha ocurrido con una frecuencia menor a la esperada a pesar de ser un hospital docente en Anestesiología. También se necesitan estudios con muchos pacientes para conocer la incidencia real de complicaciones como el hematoma epidural o el absceso epidural.Objectives: a To determine the incidence of complications related to regional analgesia technique during the procedure, during dilatation and after delivery; and b to ascertain whether post-delivery complications related to the analgesic technique are more frequent when the combined epidural-subarachnoid (CES technique is used, compared to epidural analgesia. Material and method: We conducted a descriptive and analytical observational study. The study population included all women that demanded regional analgesia at the Epidural Analgesia Unit of our Hospital (5,895 pregnant women and fulfilled all the inclusion criteria, from January 1, 2002 to January 1, 2003. Techniques used for the management of labour pain were epidural analgesia and combined epidural-subarachnoid technique. Results: The most frequent complication associated to the technique was paresthesia (43.5% followed by hematic puncture (5.9%. Unintentional dura mater puncture occurred in 0.6%. The most frequent complications during the dilatation period were itching (11.4% and lateralized analgesia (9%. The most frequent complications during the post-delivery period were back pain (9.8% and headache (2%. Complications were, in general, more frequent among pregnant women

  19. Catheter failure rates and time course with epidural versus combined spinal-epidural analgesia in labor.

    Science.gov (United States)

    Groden, J; Gonzalez-Fiol, A; Aaronson, J; Sachs, A; Smiley, R

    2016-05-01

    The combined spinal-epidural technique for labor analgesia has several advantages over the traditional epidural technique, including faster onset, greater maternal satisfaction, and decreased need for physician boluses. Proponents of the epidural technique criticize the combined spinal-epidural technique, arguing that the epidural catheter remains untested and thus may not be reliable if needed for surgical intervention. We compared failure rates and time of failure between techniques in our tertiary-care academic practice. Data regarding failed catheters were collected from October 2012 to September 2014 as part of our Quality Assurance program. Failed catheters were defined as any catheter replaced after it was considered to be properly placed and then determined to be intravascular, one sided or resulting in poor maternal analgesia or anesthesia. A total of 5487 analgesics were performed (3980 combined spinal-epidural; 1507 epidural). Eighty-five combined spinal-epidural catheters (2.1%) and 59 epidural catheters (3.9%) were replaced during labor (Plabor and that the time to detection of a failed catheter was significantly longer in the combined spinal-epidural group. Our findings validate the combined spinal-epidural technique as reliable for labor analgesia and tend to refute the theory of the untested catheter. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Idiopathic Spinal Epidural Abscess: A Case Report

    Directory of Open Access Journals (Sweden)

    Chaitali Biswas

    2011-11-01

    Full Text Available Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

  1. Idiopathic Spinal Epidural Abscess: A Case Report

    OpenAIRE

    Chaitali Biswas; Anirban Pal; Saswata Bharati; Nitesh Sinha

    2011-01-01

    Epidural abscess is a potentially life-threatening disease which can lead to medical-surgical emergency. Idiopathic spinal epidural abscess (SEA) with atypical manifestations is extremely rare. We describe such a case which led to severe neurological compromise and was not associated with any known risk factors.

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

    Directory of Open Access Journals (Sweden)

    Hagino Tetsuo

    2012-03-01

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

  3. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

    Directory of Open Access Journals (Sweden)

    Armando Bedoya

    2010-01-01

    Full Text Available Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  4. Prosthetic Valve Endocarditis: A Complication of Spinal Epidural Abscess

    OpenAIRE

    Bedoya, Armando; Gentilesco, Bethany

    2010-01-01

    Epidural injections for chronic low back pain are controversial, and their effectiveness is debated. Although epidural injections are considered a minor procedure with low morbidity, catastrophic complications may occur. We describe a case of prosthetic valve endocarditis secondary to an epidural abscess after epidural injection to alert clinicians to this unusual association.

  5. Lumbar Epidural Varix Mimicking Perineural Cyst

    Science.gov (United States)

    Pusat, Serhat; Kural, Cahit; Aslanoglu, Atilla; Kurt, Bulent

    2013-01-01

    Lumbar epidural varices are rare and usually mimick lumbar disc herniations. Back pain and radiculopathy are the main symptoms of lumbar epidural varices. Perineural cysts are radiologically different lesions and should not be confused with epidural varix. A 36-year-old male patient presented to us with right leg pain. The magnetic resonance imaging revealed a cystic lesion at S1 level that was compressing the right root, and was interpreted as a perineural cyst. The patient underwent surgery via right L5 and S1 hemilaminectomy, and the lesion was coagulated and removed. The histopathological diagnosis was epidural varix. The patient was clinically improved and the follow-up magnetic resonance imaging showed the absence of the lesion. Lumbar epidural varix should be kept in mind in the differential diagnosis of the cystic lesions which compress the spinal roots. PMID:23741553

  6. Orbital subperiosteal hematoma from scuba diving.

    Science.gov (United States)

    Rosenberry, Clark; Angelidis, Matthew; Devita, Diane

    2010-09-01

    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.

  7. Subcapsular hepatic hematoma. Serious complication during pregnancy

    Directory of Open Access Journals (Sweden)

    María Teresa Pérez Hernández

    2010-12-01

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

  8. Urologic manifestations of the iliacus hematoma syndrome.

    Science.gov (United States)

    Colapinto, V; Comisarow, R H

    1979-08-01

    Anticoagulated patients may have a characteristic syndrome of femoral neuropathy from an iliacus muscle hematoma. They may present with urologic signs and symptoms, including groin, flank and thigh pain, groin tenderness, an iliac fossa mass and hematuria. Urography may reveal an enlarged psoas shadow and hydronephrosis from ureteral obstruction. Prompt diagnosis is essential so that early operative decompression of the femoral nerve can be done. The urologist has an important role in the diagnosis and treatment of this syndrome.

  9. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours for postopera......Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...... than 0.03) in the other five patients as the level of sensory analgesia regressed postoperatively. These data suggest that changes in epidural blood flow during continuous epidural infusion of bupivacaine, and thus changes in rates of vascular absorption of bupivacaine from the epidural space, may...

  10. Idiopathic Adrenal Hematoma Masquerading as Neoplasm

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    Kazuki Sasaki

    2012-04-01

    Full Text Available We report herein a case of idiopathic adrenal hematoma. A 59-year-old Japanese man was referred to our hospital for evaluation of a 7.0 cm mass in the right upper abdominal cavity. The tumor was suspected to originate from either the posterior segment of the liver or the right adrenal gland. His chief complaint was weight loss of 8 kg over the previous 6 months. He had no past medical history and took no medications, including no anticoagulants. Laboratory data were almost normal except for a slight elevation of PIVKA-II. The origin of the tumor was found to be the adrenal gland, as angiography revealed the blood supply to the mass to derive from the right superior and inferior adrenal arteries. A fine needle biopsy of the lesion was unable to confirm the diagnosis. Open right adrenalectomy was performed. The histopathological findings of the surgical specimen revealed a hematoma with normal adrenal tissue. In the absence of any obvious etiology, the diagnosis was idiopathic adrenal hematoma.

  11. Transforaminal Blood Patch for the Treatment of Chronic Headache from Intracranial Hypotension: A Case Report and Review

    Directory of Open Access Journals (Sweden)

    Kirk Bowden

    2012-01-01

    Full Text Available This case report describes the successful treatment of chronic headache from intracranial hypotension with bilateral transforaminal (TF lumbar epidural blood patches (EBPs. The patient is a 65-year-old male with chronic postural headaches. He had not had a headache-free day in more than 13 years. Conservative treatment and several interlaminar epidural blood patches were previously unsuccessful. A transforaminal EBP was performed under fluoroscopic guidance. Resolution of the headache occurred within 5 minutes of the procedure. After three months without a headache the patient had a return of the postural headache. A second transforaminal EBP was performed again with almost immediate resolution. The patient remains headache-free almost six months from the time of first TF blood patch. This is the first published report of the use of transforaminal epidural blood patches for the successful treatment of a headache lasting longer than 3 months.

  12. Association of Antithrombotic Drug Use With Subdural Hematoma Risk

    DEFF Research Database (Denmark)

    Gaist, David; Rodríguez, Luis Alberto García; Hellfritzsch, Maja

    2017-01-01

    Importance: Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown. Objectives: To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural...... with antithrombotic drug use, subdural hematoma incidence rate, and annual prevalence of treatment with antithrombotic drugs. Results: Among 10 010 patients with subdural hematoma (mean age, 69.2 years; 3462 women [34.6%]), 47.3% were taking antithrombotic medications. Current use of low-dose aspirin (cases: 26...... hematoma incidence and antithrombotic drug use in the general population. Design, Setting, and Participants: Case-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400...

  13. [Chronic subdural hematoma: a disease of elderly people].

    Science.gov (United States)

    Tagle, Patricio; Mery, Francisco; Torrealba, Gonzalo; Del Villar, Sergio; Carmona, Hans; Campos, Manuel; Méndez, Jorge; Chicharro, Ada

    2003-02-01

    The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. To report the experience of a Neurosurgical Service in chronic subdural hematoma. One hundred patients (77 male, mean age 77 +/- 13 years) with chronic subdural hematoma were analyzed. 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. Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome.

  14. Intracranial tuberculoma: MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Salgado, P.; Zenteno, M.A.; Rodriguez-Carbajal, J.; Brutto, O.H. del; Talamas, O.

    1989-09-01

    MR studies of 6 patients with intracranial tuberculoma are reviewed. All patients also underwent CT scans which showed hypo- or isodense lesions with abnormal enhancement following contrast administration. MR showed lesions with prolongation of the T1 relaxation time in every case. On the T2-weighted sequences, the signal properties of the tuberculoma varied according to the stage of evolution of the lesion. Incipient tuberculomas appeared as scattered areas of hypointensity surrounded by edema. Mature tuberculomas were composed of a dark necrotic center surrounded by an isointense capsule which was, in turn, surrounded by edema. In one patient, the center of the lesion was hyperintense probably because of liquefaction and pus formation (tuberculous abscess). While both, CT and MR, were equally sensitive in visualizing the intracranial tuberculoma in every patient, MR was slightly superior in demonstrating the extent of the lesion, especially for brainstem tuberculomas. Nevertheless, the potential role for MR diagnosis of intracranial tuberculoma is limited by the fact that other infectious or neoplasic diseases may present similar findings. The diagnosis of intracranial tuberculoma should rest on a proper integration of data from clinical manifestations, cerebrospinal fluid analysis, and neuroimaging studies. (orig.).

  15. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    2014-01-01

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  16. Intracranial artery dissection

    NARCIS (Netherlands)

    Sikkema, T.; Uyttenboogaart, Maarten; Eshghi, O.; De Keyser, J.; Brouns, R.; van Dijk, J.M.C.; Luijckx, G. J.

    The aim of this narrative review is to evaluate the pathogenesis, clinical features, diagnosis, treatment and prognosis of intracranial artery dissection (IAD). IAD is a rare and often unrecognized cause of stroke or subarachnoid haemorrhage (SAH), especially in young adults. Two types of IAD can be

  17. Hematoma shape, hematoma size, Glasgow coma scale score and ICH score: which predicts the 30-day mortality better for intracerebral hematoma?

    Directory of Open Access Journals (Sweden)

    Chih-Wei Wang

    Full Text Available To investigate the performance of hematoma shape, hematoma size, Glasgow coma scale (GCS score, and intracerebral hematoma (ICH score in predicting the 30-day mortality for ICH patients. To examine the influence of the estimation error of hematoma size on the prediction of 30-day mortality.This retrospective study, approved by a local institutional review board with written informed consent waived, recruited 106 patients diagnosed as ICH by non-enhanced computed tomography study. The hemorrhagic shape, hematoma size measured by computer-assisted volumetric analysis (CAVA and estimated by ABC/2 formula, ICH score and GCS score was examined. The predicting performance of 30-day mortality of the aforementioned variables was evaluated. Statistical analysis was performed using Kolmogorov-Smirnov tests, paired t test, nonparametric test, linear regression analysis, and binary logistic regression. The receiver operating characteristics curves were plotted and areas under curve (AUC were calculated for 30-day mortality. A P value less than 0.05 was considered as statistically significant.The overall 30-day mortality rate was 15.1% of ICH patients. The hematoma shape, hematoma size, ICH score, and GCS score all significantly predict the 30-day mortality for ICH patients, with an AUC of 0.692 (P = 0.0018, 0.715 (P = 0.0008 (by ABC/2 to 0.738 (P = 0.0002 (by CAVA, 0.877 (P<0.0001 (by ABC/2 to 0.882 (P<0.0001 (by CAVA, and 0.912 (P<0.0001, respectively.Our study shows that hematoma shape, hematoma size, ICH scores and GCS score all significantly predict the 30-day mortality in an increasing order of AUC. The effect of overestimation of hematoma size by ABC/2 formula in predicting the 30-day mortality could be remedied by using ICH score.

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

    Directory of Open Access Journals (Sweden)

    Abrar Ahad Wani

    2012-01-01

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

  19. Pelvic compartment syndrome caused by retroperitoneal hematoma of pelvic fracture

    Institute of Scientific and Technical Information of China (English)

    ZHANG Feng-qi; ZHANG Ying-ze; PAN Jin-she; PENG A-qin; WANG Hui-juan

    2005-01-01

    @@ Retroperitoneal hematoma is an obligatory complication in pelvic ring fracture.1 In most cases, the bleeding originates from venous vessels of the presacral plexus, small arteries and veins from fracture fragments. External fixation of the pelvis can control blood loss by reducing diastasis and dramatically decreasing the volume of the pelvis. But this tamponade effect can not prevent the presence of hematoma in the adjoining retroperitoneal space. It is well known that complication of retroperitoneal hematoma is infection and sepsis.

  20. Epidural volume extension in combined spinal epidural anaesthesia for elective caesarean section: a randomised controlled trial.

    Science.gov (United States)

    Loubert, C; O'Brien, P J; Fernando, R; Walton, N; Philip, S; Addei, T; Columb, M O; Hallworth, S

    2011-05-01

    We investigated the effect of epidural volume extension on spinal blockade in pregnant women undergoing elective caesarean section with a combined spinal-epidural technique. We randomly allocated 90 healthy subjects to three groups to receive spinal hyperbaric bupivacaine 7.5 mg (group B7.5), spinal hyperbaric bupivacaine 7.5 mg immediately followed by epidural volume extension with saline 5 ml (group B7.5-EVE) or spinal hyperbaric bupivacaine 10 mg without epidural volume extension (group B10). We evaluated the height of the block every 5 min for 15 min following the spinal injection. The overall sensory block level increased with time (p epidural volume extension with 5 ml saline as part of a combined spinal epidural technique in term parturients undergoing elective caesarean section.

  1. Embolization of the Middle Meningeal Artery Effectively Treats Refractory Chronic Subdural Hematoma: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Gobran Alfotih

    2014-10-01

    Full Text Available Chronic subdural hematoma (CSDH formation mechanism is very complex, and has not entirely understood. It represents a frequent type of intracranial hemorrhage, and is very common disease in Neurosurgery practice, especially in older patients. Various surgical treatments have been proposed for the treatment of CSDH. The rate of recurrence in CSDH after surgery ranges from 5% to 30%, repeated surgery must be considered. But in some cases subdural collections are still persistent. Endovascular embolization of the middle meningeal artery (MMA is an option for treatment of refractory CSDH. We review all cases that were treated with embolization to assess the effect of this intervention. Our review revealed 6 papers with a total enrollment of 14 patients were treated with MMA embolization for refractory chronic subdural hematoma without any postoperative complication or recurrence. In this study we suggest MMA embolization as an alternative for treatment of non-curable CSDH, especially for old people with systematic diseases, who cannot tolerate repeat surgery.

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

    Directory of Open Access Journals (Sweden)

    Sujita Kumar Kar

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Gabaeff, Steven C

    2011-05-01

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

  4. Hemostasis in Intracranial Hemorrhage

    Science.gov (United States)

    Gulati, Deepak; Dua, Dharti; Torbey, Michel T.

    2017-01-01

    Spontaneous non-traumatic intracerebral hemorrhage (ICH) is associated with high morbidity and mortality throughout the world with no proven effective treatment. Majority of hematoma expansion occur within 4 h after symptom onset and is associated with early deterioration and poor clinical outcome. There is a vital role of ultra-early hemostatic therapy in ICH to limit hematoma expansion. Patients at risk for hematoma expansion are with underlying hemostatic abnormalities. Treatment strategy should include appropriate intervention based on the history of use of antithrombotic use or an underlying coagulopathy in patients with ICH. For antiplatelet-associated ICH, recommendation is to discontinue antiplatelet agent and transfuse platelets to those who will undergo neurosurgical procedure with moderate quality of evidence. For vitamin K antagonist-associated ICH, administration of 3-factor or 4-factor prothrombin complex concentrates (PCCs) rather than fresh frozen plasma to patients with INR >1.4 is strongly recommended. For patients with novel oral anticoagulant-associated ICH, administering activated charcoal to those who present within 2 h of ingestion is recommended. Idarucizumab, a humanized monoclonal antibody fragment against dabigatran (direct thrombin inhibitor) is approved by FDA for emergency situations. Administer activated PCC (50 U/kg) or 4-factor PCC (50 U/kg) to patients with ICH associated with direct thrombin inhibitors (DTI) if idarucizumab is not available or if the hemorrhage is associated with a DTI other than dabigatran. For factor Xa inhibitor-associated ICH, administration of 4-factor PCC or aPCC is preferred over recombinant FVIIa because of the lower risk of adverse thrombotic events. PMID:28360881

  5. PATOBIOLOGÍA DEL HEMATOMA SUBDURAL CRÓNICO.

    Directory of Open Access Journals (Sweden)

    Rubén Sabogal Barrios

    2008-01-01

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

  6. Reversible coma and Duret hemorrhage after intracranial hypotension from remote lumbar spine surgery: case report.

    Science.gov (United States)

    Bonow, Robert H; Bales, James W; Morton, Ryan P; Levitt, Michael R; Zhang, Fangyi

    2016-03-01

    Intracranial hypotension is a rare condition caused by spontaneous or iatrogenic CSF leaks that alter normal CSF dynamics. Symptoms range from mild headaches to transtentorial herniation, coma, and death. Duret hemorrhages have been reported to occur in some patients with this condition and are traditionally believed to be associated with a poor neurological outcome. A 73-year-old man with a remote history of spinal fusion presented with syncope and was found to have small subdural hematomas on head CT studies. He was managed nonoperatively and discharged with a Glasgow Coma Scale score of 15, only to return 3 days later with obtundation, fixed downward gaze, anisocoria, and absent cranial nerve reflexes. A CT scan showed Duret hemorrhages and subtle enlargement of the subdural hematomas, though the hematomas remained too small to account for his poor clinical condition. Magnetic resonance imaging of the spine revealed a large lumbar pseudomeningocele in the area of prior fusion. His condition dramatically improved when he was placed in the Trendelenburg position and underwent repair of the pseudomeningocele. He was kept flat for 7 days and was ultimately discharged in good condition. On long-term follow-up, his only identifiable deficit was diplopia due to an internuclear ophthalmoplegia. Intracranial hypotension is a rare condition that can cause profound morbidity, including tonsillar herniation and brainstem hemorrhage. With proper identification and treatment of the CSF leak, patients can make functional recoveries.

  7. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

    OpenAIRE

    2006-01-01

    La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was com...

  8. Dorsal spinal epidural cavernous hemangioma

    Directory of Open Access Journals (Sweden)

    Darshana Sanghvi

    2010-01-01

    Full Text Available A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

  9. Dorsal spinal epidural cavernous hemangioma.

    Science.gov (United States)

    Sanghvi, Darshana; Munshi, Mihir; Kulkarni, Bijal; Kumar, Abhaya

    2010-07-01

    A 61-year-old female patient presented with diffuse pain in the dorsal region of the back of 3 months duration. The magnetic resonance imaging showed an extramedullary, extradural space occupative lesion on the right side of the spinal canal from D5 to D7 vertebral levels. The mass was well marginated and there was no bone involvement. Compression of the adjacent thecal sac was observed, with displacement to the left side. Radiological differential diagnosis included nerve sheath tumor and meningioma. The patient underwent D6 hemilaminectomy under general anesthesia. Intraoperatively, the tumor was purely extradural in location with mild extension into the right foramina. No attachment to the nerves or dura was found. Total excision of the extradural compressing mass was possible as there were preserved planes all around. Histopathology revealed cavernous hemangioma. As illustrated in our case, purely epidural hemangiomas, although uncommon, ought to be considered in the differential diagnosis of spinal epidural soft tissue masses. Findings that may help to differentiate this lesion from the ubiquitous disk prolapse, more common meningiomas and nerve sheath tumors are its ovoid shape, uniform T2 hyperintense signal and lack of anatomic connection with the neighboring intervertebral disk or the exiting nerve root. Entirely extradural lesions with no bone involvement are rare and represent about 12% of all intraspinal hemangiomas.

  10. Hipertensão intracraniana em vítimas fatais de acidente de trânsito Increased intracranial pressure in victims of fatal road traffic accident

    Directory of Open Access Journals (Sweden)

    JOSÉ EYMARD HOMEM PITTELLA

    1999-09-01

    Full Text Available Foi realizada análise morfológica, macro e microscópica, das lesões encefálicas de 120 vítimas fatais de acidente de trânsito. A hérnia para-hipocampal, a hemorragia de Duret e o infarto médio-basal occipital, indicadores fidedignos de que o paciente apresentou hipertensão intracraniana (HIC, ocorreram em 43 pacientes (35,8%. A HIC no trauma cranioencefálico é causada pela tumefação cerebral congestiva e pelos hematomas intracranianos. Na presente casuística foram observados 3 hematomas extradurais (7,0%, 9 hematomas subdurais agudos (20,9%, 6 hematomas intracerebrais (14%, 6 explosões lobares (14% e 9 tumefações cerebrais congestivas (20,9%.A morphological study, macro and microscopical, was made of brain lesions in 120 victims of fatal road traffic accidents. Parahipoccampal hernia, Duret haemorrhage and infarction in the medio-basal occipital lobe, clear evidence of raised intracranial pressure, occurred in 43 (35.8% patients. The increased intracranial pressure from the head injury is caused by brain swelling and by intracranial haematomas. In this series 3 cases of extradural haematomas (7.0%, 9 of subdural haematomas (20.9%, 6 of intracerebral haematomas (14%, 6 of burst lobe (14% and 9 of brain swelling (20.9% were observed.

  11. Does hypernatremia cause subdural hematoma in children?: two case reports and a meta-analysis of the literature.

    Science.gov (United States)

    Ali, Syed Adnaan; Jaspan, Timothy; Marenah, Christine; Vyas, Harish

    2012-06-01

    Hypernatremia has been causally linked with subdural hematoma (SDH), but more recently this has been called into question. Conversely, there is a well-established link between SDH and injury. We wish to examine the evidence base that hypernatremia in infants and young children causes SDH.We present 2 cases of children with severe hypernatremia whose intracranial contents were assessed by imaging in the first case and postmortem examination in the second. Neither demonstrated SDH. The first case was important as the hypernatremia was iatrogenic occurring in a controlled hospital environment.We also searched the literature from 1950 to 2007, collecting data on all reported cases of hypernatremia in children younger than 7 years whose intracranial contents were examined by imaging, surgery, and/or postmortem examination. Of 124 cases reported in 31 articles, 112 cases developed hypernatremia in the community, and 12 in the hospital. Subdural hematoma was demonstrated in 7 cases, all of which had developed hypernatremia in the community under circumstances that would make it difficult to exclude nonaccidental injury. None of the 12 cases that developed hypernatremia in a controlled hospital environment had SDH.The evidence base supporting the hypothesis that hypernatremia causes SDH is poor, depending on isolated reports with uncertain histories.

  12. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    Directory of Open Access Journals (Sweden)

    J. Höltje

    2015-01-01

    Full Text Available Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours. Results. A slight hemorrhagic infarction (HI1 was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1 was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3 or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone.

  13. Mechanical Recanalization following i.v. Thrombolysis: A Retrospective Analysis regarding Secondary Hemorrhagic Infarctions and Parenchymal Hematomas

    Science.gov (United States)

    Höltje, J.; Bonk, F.; Anstadt, A.; Terborg, C.; Pohlmann, C.; Urban, P. P.; Brüning, R.

    2015-01-01

    Introduction. In acute stroke by occlusion of the proximal medial cerebral artery (MCA) or the distal internal carotid artery, intravenous thrombolysis is an established treatment. Another option is mechanical recanalization. It remains unclear if the combination of both methods poses an additional bleeding risk. The aim of this retrospective analysis is to determine the proportion of hemorrhagic infarctions and parenchymal hematomas. Methods. Inclusion criteria were an occlusion of the carotid T or proximal MCA treated with full dose thrombolysis and mechanical recanalization. 31 patients were selected. Devices used were Trevo, Penumbra Aspiration system, Penumbra 3D Retriever, and Revive. The initial control by computed tomography was carried out with a mean delay to intervention of 10.9 hours (SD: 8.5 hours). Results. A slight hemorrhagic infarction (HI1) was observed in 2/31 patients, and a more severe HI2 occurred in two cases. A smaller parenchymal hematoma (PH1) was not seen and a space-occupying PH2 was seen in 2/31 cases. There was no significant difference in the probability of intracranial bleeding after successful (thrombolysis in cerebral infarctions 2b and 3) or unsuccessful recanalization. Conclusion. The proportion of intracranial bleeding using mechanical recanalization following intravenous thrombolysis appears comparable with reports using thrombolysis alone. PMID:26640710

  14. Field distribution of epidural electrical stimulation.

    Science.gov (United States)

    Xie, Xiaobo; Cui, Hong yan; Xu, Shengpu; Hu, Yong

    2013-11-01

    Epidural electrical stimulation has been applied in clinics for many years. However, there is still a concern about possible injury to spinal nerves. This study investigated electrical field and current density distribution during direct epidural electrical stimulation. Field distribution models were theoretically deduced, while the distribution of potentials and current were analyzed. The current density presented an increase of 70-80%, with one peak value ranging from -85° to 85° between the two stimulated poles. The effect of direct epidural electrical stimulation is mainly on local tissue surrounding the electrodes, concentrated around the two stimulated positions. © 2013 Elsevier Ltd. All rights reserved.

  15. Spinal epidural compression in chronic lymphocytic leukemia.

    Science.gov (United States)

    Michalevicz, R; Burstein, A; Razon, N; Reider, I; Ilie, B

    1989-11-01

    Spinal epidural compression is a rare neurologic complication in patients with lymphoma. It occurs mostly in those with intermediate-grade to high-grade malignancy disease. This type of neurologic involvement has not been described in chronic lymphocytic leukemia (CLL). A patient with a long, stable CLL course developed spinal epidural compression and consequently died. The frequency of spinal epidural compression in lymphoma, according to the histologic subtypes and the considerations in making the right choice of therapy are discussed in light of the presented case.

  16. Espondilodiscitis y absceso epidural candidiásico Candida spondylodiscitis and epidural abscess

    Directory of Open Access Journals (Sweden)

    Gisela Di Stilio

    2006-08-01

    Full Text Available La espondilodiscitis candidiásica asociada a absceso epidural es una enfermedad de aparición excepcional. Se presenta el caso de un paciente con linfoma de Hodgkin en tratamiento quimioterápico que desarrolló candidiasis sistémica complicada con espondilodiscitis y absceso epidural por dicho germen.Candida spondylodiscitis associatd with epidural abscess is rarely seen. We present a patient with Hodgkin lymphoma who received chemotherapy and developed systemic Candida infection, which was complicated by Candida spondylodiscitis and epidural abscess.

  17. Acute subdural hematoma because of boxing.

    Science.gov (United States)

    Kushi, Hidehiko; Saito, Takeshi; Sakagami, Yuichiro; Ohtsuki, Jyoji; Tanjoh, Katsuhisa

    2009-02-01

    To identify factors determining the clinical characteristics and prognosis of acute subdural hematoma (ASDH) arising from boxing injuries by comparing with ASDH due to any nonboxing cause. Two groups were selected for this study: 10 patients with ASDH because of boxing injuries and 26 patients with nonboxer ASDH. All of the patients underwent neurologic examination by neurosurgeons. Primary resuscitation and stabilization as well as operative therapy were performed to all patients according to the European Brain Injury Consortium Guidelines. Two groups were compared in terms of age, the Glasgow Coma Scale at admission, neurologic findings, craniogram and brain computed tomography scan findings, operative findings, and prognosis. As potential prognostic indicators for boxers, the time interval until surgery, the Glasgow Outcome Scale, hematoma thickness, midline shift, and the site of bleeding were analyzed. The characteristics of patients because of boxing injuries are that patients were younger, had lucid interval, and had no cerebral contusion or contralateral brain injury. There was no significant difference in initial Glasgow Coma Scale, hematoma thickness, midline shift, and their prognosis. The most peculiar clinical presentation of boxers' ASDH was that all bleedings were limited from "bridging veins" or "cortical veins." The prognosis of boxers was most closely correlated with the site of bleeding (r2 = 0.81; p = 0.0001) and the midline shift (r2 = 0.67; p = 0.007). Our study shows that ASDH because of boxing is characterized by bleeding from bridging or cortical veins, and that the site of bleeding is a significant determinant of their prognosis.

  18. [Renal angiomyolipoma complicated by retroperitoneal hematoma].

    Science.gov (United States)

    Rabii, R; Fekak, H; Moufid, K; Joual, A; Benjelloun, S; Khaleq, K; Idali, B; Harti, A; Barrou, L

    2002-07-01

    Renal angiomyolipoma (AML) is a benign tumor, they are generally asymptomatic or can manifested by abdominal pain, palpable mass or hematuria. We report an uncommoun case of 65 years old women who consulted for retroperitoneal hemorrhage by spontaneous rupture of renal AML with palpable mass. The ultrasound and CT abdominopelvic scan were performed in the preoperative diagnosis and showed a typical right renal AML with retroperitoneal hematoma. The right nephrectomy by transperitoneal approach was performed with a good follow-up. The histological examination confirmed the diagnosis for renal AML. About this case, the authors discuses the diagnosis and the management for AML with retroperitoneal hemorrhage.

  19. Successful medical treatment of spinal epidural abscess.

    Science.gov (United States)

    Xiao, Bo-Ren; Wang, Chih-Wei; Lin, Jung-Chung; Chang, Feng-Yee

    2008-04-01

    Spinal epidural abscess is a rare but potentially fatal disease. A 67-year-old female suffered fever and painful swelling of the right knee and lower leg for one week. Both synovial fluid and blood cultures yielded methicillin-sensitive Staphylococcus aureus. Low back pain developed and fever was sustained despite the administration of intravenous oxacillin. Magnetic resonance imaging (MRI) of the thoracolumbar spine revealed spinal epidural abscess from T12 to S1. Because of severe hypoalbuminemia and general anasarca and followed by exploratory laparotomy for massive duodenal bleeding, she did not receive surgical intervention for the spinal epidural abscess. After intravenous administration of oxacillin 2 g 4-hourly for 12 weeks, she recovered and follow-up MRI confirmed the efficacy of the medical treatment. She remained well at 1-year follow-up. In a patient with minimal neurological deficit or surgical contraindication, spinal epidural abscess can be successfully treated with a medical regimen.

  20. EPIDURAL ANAESTHESIA FOR SURGERY IN ADVANCED CANCER

    African Journals Online (AJOL)

    Femi Olaleye

    Running title: Epidural Anaesthesia in Advanced Carcinoma. INTRODUCTION ... underlying muscle. His respiratory rate was ... Digoxin and management of congestive heart failure Omole M.K.. 2. ... the ventricle and suggests an elevated.

  1. Epidural anaesthesia and analgesia for liver resection.

    Science.gov (United States)

    Tzimas, P; Prout, J; Papadopoulos, G; Mallett, S V

    2013-06-01

    Although epidural analgesia is routinely used in many institutions for patients undergoing hepatic resection, there are unresolved issues regarding its safety and efficacy in this setting. We performed a review of papers published in the area of anaesthesia and analgesia for liver resection surgery and selected four areas of current controversy for the focus of this review: the safety of epidural catheters with respect to postoperative coagulopathy, a common feature of this type of surgery; analgesic efficacy; associated peri-operative fluid administration; and the role of epidural analgesia in enhanced recovery protocols. In all four areas, issues are raised that question whether epidural anaesthesia is always the best choice for these patients. Unfortunately, the evidence available is insufficient to provide definitive answers, and it is clear that there are a number of areas of controversy that would benefit from high-quality clinical trials.

  2. [Epidural analgesia in combination with general anesthesia].

    Science.gov (United States)

    Gottschalk, Antje; Poepping, Daniel M

    2015-07-01

    Epidural anaesthesia is a widely used and accepted technique for perioperative analgesia in different kinds of surgery. Apart from analgetic effect and due to wide positve effects on patients outcome epidural analgesia is often used with general anaesthesia. It represents a reliable and reversible neural deafferentation technique that effectively contributes to a reduction of the surgical stress response with subsequent positive effects on cardiopulmonary, gastrointestinal, and immune function. Animal studies suggest that the use of epidural anaesthesia may be beneficial for cancer surgery because of less tumour recurrence. Further, a benefit is expected in patient's mortality. This article summarizes and critically discusses the current knowledge on the effects of epidural anaesthesia on pain management, cardiopulmonary as well as gastrointestinal functions and patient's outcome.

  3. Intracranial Atherosclerotic Disease

    Directory of Open Access Journals (Sweden)

    Maria Khan

    2011-01-01

    Full Text Available Intracranial atherosclerotic disease (ICAD is the most common proximate mechanism of ischemic stroke worldwide. Approximately half of those affected are Asians. For diagnosis of ICAD, intra-arterial angiography is the gold standard to identify extent of stenosis. However, noninvasive techniques including transcranial ultrasound and MRA are now emerging as reliable modalities to exclude moderate to severe (50%–99% stenosis. Little is known about measures for primary prevention of the disease. In terms of secondary prevention of stroke due to intracranial atherosclerotic stenosis, aspirin continues to be the preferred antiplatelet agent although clopidogrel along with aspirin has shown promise in the acute phase. Among Asians, cilostazol has shown a favorable effect on symptomatic stenosis and is of benefit in terms of fewer bleeds. Moreover, aggressive risk factor management alone and in combination with dual antiplatelets been shown to be most effective in this group of patients. Interventional trials on intracranial atherosclerotic stenosis have so far only been carried out among Caucasians and have not yielded consistent results. Since the Asian population is known to be preferentially effected, focused trials need to be performed to establish treatment modalities that are most effective in this population.

  4. Risk Factors for Postoperative Fibrinogen Deficiency after Surgical Removal of Intracranial Tumors.

    Science.gov (United States)

    Wei, Naili; Jia, Yanfei; Wang, Xiu; Zhang, Yinian; Yuan, Guoqiang; Zhao, Baotian; Wang, Yao; Zhang, Kai; Zhang, Xinding; Pan, Yawen; Zhang, Jianguo

    2015-01-01

    Higher levels of fibrinogen, a critical element in hemostasis, are associated with increased postoperative survival rates, especially for patients with massive operative blood loss. Fibrinogen deficiency after surgical management of intracranial tumors may result in postoperative intracranial bleeding and severely worsen patient outcomes. However, no previous studies have systematically identified factors associated with postoperative fibrinogen deficiency. In this study, we retrospectively analyzed data from patients who underwent surgical removal of intracranial tumors in Beijing Tiantan Hospital date from 1/1/2013to12/31/2013. The present study found that patients with postoperative fibrinogen deficiency experienced more operative blood loss and a higher rate of postoperative intracranial hematoma, and they were given more blood transfusions, more plasma transfusions, and were administered larger doses of hemocoagulase compared with patients without postoperative fibrinogen deficiency. Likewise, patients with postoperative fibrinogen deficiency had poorer extended Glasgow Outcome Scale (GOSe), longer hospital stays, and greater hospital expenses than patients without postoperative fibrinogen deficiency. Further, we assessed a comprehensive set of risk factors associated with postoperative fibrinogen deficiency via multiple linear regression. We found that body mass index (BMI), the occurrence of postoperative intracranial hematoma, and administration of hemocoagulasewere positively associated with preoperative-to-postoperative plasma fibrinogen consumption; presenting with a malignant tumor was negatively associated with fibrinogen consumption. Contrary to what might be expected, intraoperative blood loss, the need for blood transfusion, and the need for plasma transfusion were not associated with plasma fibrinogen consumption. Considering our findings together, we concluded that postoperative fibrinogen deficiency is closely associated with postoperative

  5. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De;

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  6. Stereotactic fibrinolysis of spontaneous intracerebral hematoma using infusion of recombinant tissue plasminogen activator Fibrinólise com infusão de rtPA e drenagem estereotáxica de hematoma intracerebral espontâneo profundo

    Directory of Open Access Journals (Sweden)

    José Augusto Nasser

    2002-06-01

    Full Text Available PURPOSE: The authors present a prospective study on 10 patients with stereotactic infusion of tissue plasminogen activator (rtPA intraparenchimal hemorrhage. METHODS: Between 1999 and 2000, 10 patients with deep seated hematomas in the basal ganglia were selected for stereotactic infusion of rtPA and spontaneous clot drainage. RESULTS: All cases had about 80% reduction of the hematoma volume in the CT scan at the third day. The intracranial pressure was normalized by the third day too. There were no local or systemic complications with the use of this trombolitic. The results were shown by the Glasgow Outcome Scale with six patients in V, three in IV and one in III after 3 months. CONCLUSION: Early treatment and drainage with minimally invasive neurosurgery , can make these patients with deep-seated hematomas recover the consciousness and they can be rehabilitated earlier avoiding secondary complications.OBJETIVO: Estudo prospectivo em 10 pacientes com infusão de trombolítico (rtPA dentro do hematoma cerebral profundo supratentorial e drenagem estereotáxica. MÉTODO: Entre 1999 e 2000 10 pacientes com hematomas de profundidade foram selecionados para infusão de rtPA e drenagem do coágulo espontânea. RESULTADO: Todos os casos obtiveram 80% de redução do volume do hematoma medidos por TC no terceiro dia. A pressão intracraniana estava normalizada no terceiro dia. Não houve complicações locais ou sistêmicas relacionadas com o uso deste trombolítico. Os resultados comparados foram mostrados pela Escala de Prognóstico de Glasgow com 6 pacientes em GrauV, 3 pacientes em Grau IV e 1 paciente em Grau III após três meses. CONCLUSÃO: Tratamento precoce e drenagem com técnica neurocirúrgica minimamente invasiva pode fazer estes pacientes terem uma recuperação da consciência mais rápida e assim serem reabilitados mais precocemente evitando complicações secundárias.

  7. [A Case of Postoperative Paraplegia Caused by Idiopathic Spinal Cord Infarction following Hepatectomy under Both General and Epidural Anesthesia].

    Science.gov (United States)

    Koga, Yukari; Hiraki, Teruyuki; Ushijima, Kazuo

    2015-04-01

    A 73-year-old woman (height : 155 cm, weight : 55 kg) was scheduled to undergo a laparotomic hepatectomy and radiofrequency ablation for hepatocellular carcinoma. Her medical history did not include any relevant conditions such as cardiovascular or neurological disorders. A thoracic epidural catheter was introduced at T8-9 before the induction of anesthesia with intravenous propofol. General anesthesia was maintained with the inhalation of oxygen, air, and desflurane, and the continuous infusion of remifentanil. Several intraoperative episodes of mild hypotension occurred, each of which was successfully treated with intravenous ephedrine, but otherwise her anesthetic course was uneventful, and she recovered from the anesthesia smoothly. Her postoperative pain was well controlled with continuous epidural infusion of levobupivacaine and fentanyl, and she could walk by herself on postoperative day (POD) 1. However, she suffered weakness in her lower extremities on POD2 and subsequently fell into complete paraplegia with sensory loss below the T4 level on POD3. A magnetic resonance imaging scan taken on POD4 showed an idiopathic spinal cord infarction (SCI) involving levels T1 through T4, although no epidural abnormalities, e.g., hematomas, were detected. Immediate treatment with methylprednisolone, ozagrel, and edaravone failed to resolve her symptoms. We suggest that it is of great importance to consider SCI as a differential diagnosis as soon as possible in cases of unanticipated postoperative paraplegia.

  8. Gamma Knife surgery for clival epidural-osseous dural arteriovenous fistulas.

    Science.gov (United States)

    Lee, Cheng-Chia; Chen, Ching-Jen; Chen, Shao-Ching; Yang, Huai-Che; Lin, Chung Jung; Wu, Chih-Chun; Chung, Wen-Yuh; Guo, Wan-Yuo; Hung-Chi Pan, David; Shiau, Cheng-Ying; Wu, Hsiu-Mei

    2017-06-16

    OBJECTIVE Clival epidural-osseous dural arteriovenous fistula (DAVF) is often associated with a large nidus, multiple arterial feeders, and complex venous drainage. In this study the authors report the outcomes of clival epidural-osseous DAVFs treated using Gamma Knife surgery (GKS). METHODS Thirteen patients with 13 clival epidural-osseous DAVFs were treated with GKS at the authors' institution between 1993 and 2015. Patient age at the time of GKS ranged from 38 to 76 years (median 55 years). Eight DAVFs were classified as Cognard Type I, 4 as Type IIa, and 1 as Type IIa+b. The median treatment volume was 17.6 cm(3) (range 6.2-40.3 cm(3)). The median prescribed margin dose was 16.5 Gy (range 15-18 Gy). Clinical and radiological follow-ups were performed at 6-month intervals. Patient outcomes after GKS were categorized as 1) complete improvement, 2) partial improvement, 3) stationary, and 4) progression. RESULTS All 13 patients demonstrated symptomatic improvement, and on catheter angiography 12 of the 13 patients had complete obliteration and 1 patient had partial obliteration. The median follow-up period was 26 months (range 14-186 months). The median latency period from GKS to obliteration was 21 months (range 8-186 months). There was no intracranial hemorrhage during the follow-up period, and no deaths occurred. Two adverse events were observed following treatment, and 2 patients required repeat GKS treatment with eventual complete obliteration. CONCLUSIONS Gamma Knife surgery offers a safe and effective primary or adjuvant treatment modality for complex clival epidural-osseous DAVFs. All patients in this case series demonstrated symptomatic improvement, and almost all patients attained complete obliteration.

  9. Effect of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits

    Institute of Scientific and Technical Information of China (English)

    LIU Li-min; SONG Yue-ming; DUAN Hong; DING Yong-li; LU Bing

    2006-01-01

    Objective: To determine the efficacy of polylactic acid glue in preventing epidural scar adhesion after laminectomy in rabbits.Methods: Twenty-four apanese white rabbits underwent laminectomy (including the attached ligaments)at L2 and Ls. After laminectomy at L5, polylactic acid glue was sprayed on the dura and nerve roots and this segment was taken as the experimental group. After laminectomy at L2 , nothing was used and this segment was enrolled as the self control group. Four rabbits were killed every two weeks postoperatively till the end of the experiment at 12weeks. Then the operated spine was observed grossly,histologically and ultrastructurally to check the degree of scar formation, the status of epidural scar adhesion, the absorption of the glue, and the intracellular structure of fibroblasts.Results: The glue coagulated immediately after spraying and showed excellent hemostatic effect. The glue membrane was easy to be taken away from the dura mater of the samples for 2 weeks and there were no cells in the epidural space in the experimental group. But the dura mater was covered by hematoma in the control group,which formed mild adhesion, with fibroblasts proliferating actively. In the 4th week, some glue shivers remained in the epidural space with fibroblasts increasing a little, and the dura mater was smooth in the experimental group.However, in the control group, the formed scar was fragile and conglutinated with the dura mater diffusely and fibroblasts were much more than those in the experimental group. In the 6th-12th weeks, there was a potential interspace between the scar and the dura mater, and the polylactic acid glue was absorbed completely in the experimental group. Much tough scar was found in the control group, which was very difficult to dissect from the dura mater and the surrounding tissues. From the ultrastructural observation of the fibroblasts, the nucleus became much bigger and the rough endoplasmic reticulum was much more plentiful in

  10. [History and Technique of Epidural Anaesthesia].

    Science.gov (United States)

    Waurick, Katrin; Waurick, René

    2015-07-01

    In 1901, the first Epidural anesthesia via a caudal approach was independently described by two FrenchmanJean-Anthanase Sicard and Fernand Cathelin.. The Spanish military surgeon, Fidel Pagés Miravé, completed the lumbar approach successfully in 1921. The two possibilities for identification of the epidural space the "loss of resistance" technique and the technique of the "hanging drop" were developed by Achille Mario Dogliotti, an Italian, and Alberto Gutierrez, an Argentinean physician, at the same time. In 1956 John J. Bonica published the paramedian approach to the epidural space. As early as 1931 Eugene Aburel, a Romanian obstetrician, injected local anaesthetics via a silk catheter to perform lumbar obstetric Epidural analgesia. In 1949 the first successful continuous lumbar Epidural anaesthesia was reported by Manuel Martinez Curbelo, a Cuban. Epidural anaesthesia can be performed in sitting or lateral position in all segments of the spinal column via the median or paramedian approach. Different off-axis angles pose the challenge in learning the technique.

  11. Spinal epidural abscess in brucellosis.

    Science.gov (United States)

    Boyaci, Ahmet; Boyaci, Nurefsan; Tutoglu, Ahmet; Dokumaci, Dilek Sen

    2013-09-26

    Involvement of the skeletal system is a common complication of brucellosis. However, muscle involvement or paraspinal abscess formation are rare complications. Paraspinal abscess usually develops secondary to spondylitis. A case is reported here of a 33-year-old woman with symptoms of night sweats, fever and low back pain. Rose-Bengal test for brucellosis was positive and Brucella standard tube agglutination test was positive at a titre of 1/160. The diagnosis was made on MRI. The patient was treated with doxycycline and rifampin daily for 16 weeks. On day 14 of treatment, decline was observed in the patient's symptoms. In the presence of inflammatory lower back pain and fever, brucellosis should be considered particularly in the endemic areas. Furthermore, tuberculosis should be remembered in the differential diagnosis when a spinal epidural abscess is determined.

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

    Directory of Open Access Journals (Sweden)

    Cengiz Kaplan

    2015-02-01

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

  13. Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma.

    Science.gov (United States)

    Yi, Tae Im; Yoon, Tae Hee; Kim, Joo Sup; Lee, Ga Eun; Kim, Bo Ra

    2012-04-01

    Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.

  14. Association of Antithrombotic Drug Use With Subdural Hematoma Risk

    DEFF Research Database (Denmark)

    Gaist, David; Rodríguez, Luis Alberto García; Hellfritzsch, Maja

    2017-01-01

    Importance: Incidence of subdural hematoma has been reported to be increasing. To what extent this is related to increasing use of antithrombotic drugs is unknown. Objectives: To estimate the association between use of antithrombotic drugs and subdural hematoma risk and determine trends in subdural...... hematoma incidence and antithrombotic drug use in the general population. Design, Setting, and Participants: Case-control study of 10 010 patients aged 20 to 89 years with a first-ever subdural hematoma principal discharge diagnosis from 2000 to 2015 matched by age, sex, and calendar year to 400...... 380 individuals from the general population (controls). Subdural hematoma incidence and antithrombotic drug use was identified using population-based regional data (population: 484 346) and national data (population: 5.2 million) from Denmark. Conditional logistic regression models were used to estimate odds...

  15. A Rare Cause of Acute Pancreatitis: Intramural Duodenal Hematoma

    Directory of Open Access Journals (Sweden)

    Hemant Goyal

    2012-01-01

    Full Text Available We describe an interesting case of intramural duodenal hematoma in an otherwise healthy male who presented to emergency room with gradually progressive abdominal pain, nausea, and vomiting. This condition was missed on initial evaluation and patient was discharged from emergency room with diagnosis of acute gastritis. After 3 days, patient came back to emergency room and abdominal imaging studies were conducted which showed that patient had intramural duodenal hematoma associated with gastric outlet obstruction and pancreatitis. Hematoma was the cause of acute pancreatitis as pancreatic enzymes levels were normal at the time of first presentation, but later as the hematoma grew in size, it caused compression of pancreas and subsequent elevation of pancreatic enzymes. We experienced a case of pancreatitis which was caused by intramural duodenal hematoma. This case was missed on initial evaluation. We suggest that physicians should be more vigilant about this condition.

  16. Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas

    Directory of Open Access Journals (Sweden)

    Rong Li

    2011-01-01

    Full Text Available We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are also discussed. While extramedullary hematopoiesis is seen anecdotally by neuropathologists in chronic subdural hematomas, only a few cases are documented in the literature. Furthermore, extramedullary hematopoiesis in subdural hematoma can pose a diagnostic challenge for general pathologists who encounter subdural hematoma evacuations seldom in their surgical pathology practices.

  17. Manipulation with prolonged epidural analgesia for treatment of TKA complicated by arthrofibrosis.

    Science.gov (United States)

    Pariente, Gerardo Mangino; Lombardi, Adolph V; Berend, Keith R; Mallory, Thomas H; Adams, Joanne B

    2006-01-01

    Inability to achieve adequate range of motion (ROM) after total knee arthroplasty (TKA) represents a frustrating complication for both patient and surgeon. Manipulation under anesthesia is indicated in TKA having less than 90 degrees ROM after six weeks, with no progression or regression in ROM. A modified technique has evolved for patients with chronic regional pain syndrome (CRPS) symptoms or persistent stiffness after standard manipulation. A retrospective review was conducted to determine the efficacy of the modified technique, which uses epidural anesthesia continued for postoperative analgesia, hospital stay of one to three days, continuous passive motion (CPM) for two to three days, and daily physical therapy (PT). Between 1997 and 2003, 5714 TKAs were performed in 4106 patients. Manipulation using a standard technique was performed on 334 (5.8%) knees in 273 patients. Manipulation using a modified technique was performed on 65 (1%) knees in 60 patients. Age averaged 58 years and body mass index (BMI) averaged 34.39. Follow up averaged 18.4 months. ROM improved significantly from 71 degrees to 102 degrees (p arthrofibrosis, which included one full revision, five polyethylene exchanges, and three revisions of femoral component and polyethylene. Two significant complications occurred: one subdural hematoma and one death due to pulmonary embolism. Although not without complications, manipulation under epidural anesthesia represents a viable option for treatment of persistent stiffness after TKA; 80% of these difficult cases achieved successful results.

  18. Mouse models of intracranial aneurysm.

    Science.gov (United States)

    Wang, Yutang; Emeto, Theophilus I; Lee, James; Marshman, Laurence; Moran, Corey; Seto, Sai-wang; Golledge, Jonathan

    2015-05-01

    Subarachnoid hemorrhage secondary to rupture of an intracranial aneurysm is a highly lethal medical condition. Current management strategies for unruptured intracranial aneurysms involve radiological surveillance and neurosurgical or endovascular interventions. There is no pharmacological treatment available to decrease the risk of aneurysm rupture and subsequent subarachnoid hemorrhage. There is growing interest in the pathogenesis of intracranial aneurysm focused on the development of drug therapies to decrease the incidence of aneurysm rupture. The study of rodent models of intracranial aneurysms has the potential to improve our understanding of intracranial aneurysm development and progression. This review summarizes current mouse models of intact and ruptured intracranial aneurysms and discusses the relevance of these models to human intracranial aneurysms. The article also reviews the importance of these models in investigating the molecular mechanisms involved in the disease. Finally, potential pharmaceutical targets for intracranial aneurysm suggested by previous studies are discussed. Examples of potential drug targets include matrix metalloproteinases, stromal cell-derived factor-1, tumor necrosis factor-α, the renin-angiotensin system and the β-estrogen receptor. An agreed clear, precise and reproducible definition of what constitutes an aneurysm in the models would assist in their use to better understand the pathology of intracranial aneurysm and applying findings to patients.

  19. Acute Spontaneous Posterior Fossa Subdural Hematoma

    Directory of Open Access Journals (Sweden)

    Osama Shukir Muhammed Amin

    2014-02-01

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

  20. An autopsy case of methanol induced intracranial hemorrhage.

    Science.gov (United States)

    Kim, Hye-Jeong; Na, Joo-Young; Lee, Young-Jik; Park, Jong-Tae; Kim, Hyung-Seok

    2015-01-01

    The major component of car washer fluid is a methanol. Intracranial hemorrhage is a rare but lethal complication in methanol poisoning. We report a case of massive bilateral basal ganglia hematoma in a 32-year-old man with methanol poisoning. He drank car washer solution twice time (about 500 ml), and was admitted to a territorial hospital 10 hours post-ingestion for depressed mental status, lower blood pressure, and high anion gap metabolic acidosis. Computed tomographic (CT) scan showed lesions in both putamen and cerebral deep white matter. Twenty-one days after methanol exposure, he suddenly developed cardiorespiratory arrest. In autopsy, external examination revealed moderate cerebral edema, but no evidence of herniation. Coronal sections of the brain showed softening and about 34 g hematoma in the bilateral putamen and 3rd ventricles. The toxic effect of methanol on the visual system has been noted in the absence of neurologic manifestations; however, there have also been a report of concomitant brain in Korea.

  1. Intracranial Hypertension in Children without Papilledema

    OpenAIRE

    Chelse, Ana B.; Epstein, Leon G.

    2015-01-01

    Researchers at Nationwide Children's Memorial Hospital studied the frequency of intracranial hypertension without papilledema in children followed in a multispecialty pediatric intracranial hypertension clinic.

  2. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv...

  3. Peripartum Isolated Cortical Vein Thrombosis in a Mother with Postdural Puncture Headache Treated with an Epidural Blood Patch

    Directory of Open Access Journals (Sweden)

    Etienne Laverse

    2013-01-01

    Full Text Available A 32-year-old woman presented with low pressure headache 3 days after delivery of her baby. An assessment of postdural puncture headache was made. This was initially treated with analgesia, caffeine, and fluids for the presumed cerebrospinal fluid (CSF leak. The woman was readmitted two days after her hospital discharge with generalised seizures. A brain scan showed features of intracranial hypotension, and she was treated for CSF leak using an epidural blood patch. Her symptoms worsened and three days later, she developed a left homonymous quadrantanopia. An MRI scan confirmed a right parietal haematoma with evidence of isolated cortical vein thrombosis (ICVT.

  4. Newborns from deliveries with epidural anaesthesia

    Directory of Open Access Journals (Sweden)

    Avramović Lidija

    2010-01-01

    Full Text Available Introduction. The use of epidural anaesthesia in delivery with the purpose to reduce pain and fear in a pregnant woman has the influence on the physiological status of the woman in childbirth and the course of delivery. From the epidural space of the pregnant woman, one part of free anaesthetic comes in the foetal circulation through the mother's circulation and placenta and connects with the foetal proteins. A lower value of albumins and serum proteins in the foetal circulation give bigger free fraction of anaesthetic which is accumulated in the foetal liver, brain and heart full of blood. Objective. The aim of the study was to examine the influence of epidural anaesthesia on the newborn. Methods. Retrospective study of 6,398 documents of newborns was performed in our Clinic of Gynaecology and Obstetrics 'Narodni front' during 2006. The first group was made of 455 newborns from deliveries with epidural anaesthesia and the second was the control group of 5,943 remaining newborns. In both groups we analysed the following: sex, week of gestation, weight, Apgar score, measure of care and resuscitation, perinatal morbidity and then the obtained results were compared. Results. Most of deliveries were vaginal without obstetric intervention (86.6%. The number of deliveries finished with vacuum extractor (4.6% was statistically significantly bigger in the group with epidural anaesthesia than in the control group. Most of the newborns in the first group were born on time (96.5% in 39.0±1.0 week of gestation and with foetal weight 3448±412 grammes. There was no statistical significance in Apgar score between both groups. Epidural anaesthesia does not increase the degree of the newborn's injury. Lower pH of blood was found in the newborns from deliveries with vacuum extractor or operated on (the Ceasarean section. Conclusion. Application of epidural anaesthesia decreases duration of delivery and has no adverse effects on the newborn and hypoxic

  5. INTRACRANIAL PRESSURE MONITORING

    Directory of Open Access Journals (Sweden)

    Retno Widiyanthi

    2013-07-01

    Full Text Available Normal 0 false false false EN-US X-NONE X-NONE Intracranial pressure is total of pressure that is produced by brain, blood, and cerebrospinal fluid/CSF in the tight cranial space. As a respon to intracranial pressure increasing, compensation begin by movement of CSF from ventricle to cerebral subarachnoidal space, and increase the absorption of CSF. Increasing of ICP usually caused by increasing of brain volume (cerebral oedem, blood (intracranial bleeding, space occupying lesion, or CSF (hidrocephalus. Indication in ICP monitoring can be seen from : neurological criteria, abnormal CT-scan result when admission, normal CT-scan result, but had more two risk factors. According to the procedure that must be done, there are two methods in ICP monitoring: invasive ICP monitoring methodes and non-invasive measuring method. Increasing of ICP will decrease the compliance of brain, pulsation of artery more clearly, and the component of vein is lost. /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin:0in; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;}

  6. A novel method for long-term monitoring of intracranial pressure in rats

    DEFF Research Database (Denmark)

    Uldall, Maria Schmidt; Juhler, Marianne; Skjolding, Anders Daehli;

    2014-01-01

    BACKGROUND: In preclinical neurological studies, monitoring intracranial pressure (ICP) in animal models especially in rodents is challenging. Further, the lack of methods for long-term ICP monitoring has limited the possibilities to conduct prolonged studies on ICP fluctuations in parallel...... and in the epidural space. The two pressures were recorded twice a week for 59 days and the correlation was studied. RESULTS: The two pressure recordings correlated exceptionally well and the R(2) values on each recording day ranged between 0.99 and 1.00. However, the ventricular probes caused a number...

  7. Pediatric intracranial aneurysms.

    Science.gov (United States)

    Tripathy, L N; Singh, S N

    2009-01-01

    The incidence of subarachnoid haemorrhage from intracranial aneurysms in the paediatric age group is extremely rare. Interestingly, occurrence of vasospasm has been reported to be less in comparison to the adults. Both coiling and clipping have been advocated in selected cases. Because of the thinness of the wall of the arteries, utmost care should be taken while handling these arteries during surgery. The overall results of surgery in children have been reported to be better than their adult counterparts. We present four such cases from our own experience. All these children were operated upon, where the solitary aneurysm in each case was clipped and all of them made a good recovery.

  8. Intracranial abscess in Ectopia Cordis.

    Science.gov (United States)

    Merola, Joseph; Tipper, Geoffrey Adrian; Hussain, Zakier; Balakrishnan, Venkataraman; Gan, Peter

    2014-08-25

    We present a case of intracranial abscess in a young female with Ectopia Cordis, an exceptionally rare cardiac condition. The neurosurgical implication is the predisposition to intracranial abscess formation. A heightened awareness of this association will aid diagnosis in similar clinical scenarios.

  9. Risk of Familial Intracranial Aneurysm

    OpenAIRE

    J Gordon Millichap; Millichap, John J.

    2014-01-01

    Investigators at University Medical Center Utrecht, Netherlands, studied the yield of long-term (up to 20 years) screening for intracranial aneurysms in individuals with a positive family history (2 or more first-degree relatives) of aneurysmal subarachnoid hemorrhage (aSAH) or unruptured intracranial aneurysm (1993-2013).

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

    Directory of Open Access Journals (Sweden)

    FABIANO DA CUNHA TANURI

    1999-09-01

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

  11. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    epidural analgesia significantly lowers the risk of thromboembolic complications after lower body procedures, while no effect is seen after major abdominal surgery. Unfortunately, many studies have inadequate study design, with use of lumbar epidural analgesia for abdominal procedures, or the epidural...

  12. Difficulty in the removal of epidural catheter for labor analgesia

    Directory of Open Access Journals (Sweden)

    Mohamed S Hajnour

    2017-01-01

    Full Text Available For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications.

  13. Difficulty in the removal of epidural catheter for labor analgesia.

    Science.gov (United States)

    Hajnour, Mohamed S; Khokhar, Rashid Saeed; Ejaz, Abdul Aziz Ahmed; Al Zahrani, Tariq; Kanchi, Naveed Uddin

    2017-01-01

    For labor pain management epidural analgesia is a popular and an effective method. Difficult removal of epidural catheters occasionally occurs, and several maneuvers have been recommended. The purpose of this article is to raise awareness of the problem of retained epidural catheter fragments and identify the potential impact of complications.

  14. Depth of the thoracic epidural space in children.

    NARCIS (Netherlands)

    Masir, F.; Driessen, J.J.; Thies, K.C.; Wijnen, M.H.W.A.; Egmond, J. van

    2006-01-01

    Thoracic epidural anaesthesia in anaesthetized children requires a meticulous technique and may have an increased success rate when the distance between skin and epidural space is known. The objective of this observational study was to measure the skin to epidural distance (SED) during thoracic epid

  15. Sciatica due to pelvic hematoma: case report

    Directory of Open Access Journals (Sweden)

    Kocaman Umit

    2016-12-01

    Full Text Available Sciatica is defined as pain in the sciatic nerve distribution. The most common reason of sciatica is radiculopathy due to lumbar disc hernia. Other causes can be congenital, acquired, infectious, neoplastic, or inflammatory. The piriformis syndrome is another cause. The pain starts in an insidious manner when the cause of sciatica is an extraspinal tumor. It is intermittent at first but a constant and progressive pain that does not decrease with position or rest gradually develops in all patients. The possibility of an intraabdominal or pelvic mass should always be considered and the relevant tests requested when the cause of the sciatica cannot be explained. We present an 83-year-old male who presented with non-traumatic and non-vascular lumbosacral plexopathy due to a large hematoma in the left adductor muscle following the use of warfarin sodium.

  16. Epidural steroid injection for lumbosacral radiculopathy

    Energy Technology Data Exchange (ETDEWEB)

    Sung, Mi Sook [The Catholic University of Korea, Pucheon (Korea, Republic of)

    2006-06-15

    Low back pain combined with radicular pain remains as one of the most challenging musculoskeletal problems for its therapeutic management. This malady results from nerve root impingement and/or inflammation that causes neurologic symptoms in the distribution of the affected nerve root(s) Conservative treatment, percutaneous spine interventions and surgery have all been used as treatment; and the particular treatment that's chosen depends on the severity of the clinical and neurologic presentation. In 1930, Evans reported that sciatica could treated by epidural injection. The use of epidural corticosteroid injections for the treatment of axial and radicular back pain was first reported in 1953. Epidural steroid injections are currently used by many medical professionals for the treatment of lumbosacral radiculopathy. Performing 'blind' epidural steroid injection lacks target specificity that often results in incorrect delivery of medication to the lesion. Imaging-guided steroid injections are now becoming more popular despite the controversy regarding their efficacy. Many reports, including a few randomized controlled trials, have documented the clinical utility of epidural steroid injections.

  17. Unusual Spinal Epidural Lipomatosis and Lumbosacral Instability

    Science.gov (United States)

    Ruiz Picazo, David; Ramírez Villaescusa, José

    2016-01-01

    Introduction. Epidural lipomatosis is most frequently observed in patients on chronic steroid treatment. Only a few idiopathic epidural lipomatosis cases have been described. Material and Methods. 64-year-old male patient presented with low back pain and left leg pain. Later, the patient experienced neurogenic claudication and radicular pain in the left leg without urinary dysfunction. Plain radiography and magnetic resonance imaging demonstrated an abnormal fat tissue overgrowth in the epidural space with compression of the dural sac, degenerative disc disease at L4-L5 level, and instability at L5-S1. Endocrinopathic diseases and chronic steroid therapy were excluded. If conservative treatment failed, surgical treatment can be indicated. Results. After surgery, there was a gradual improvement in symptoms and signs, and six months later the patient returned to daily activities and was neurologically normal. Conclusion. In the absence of common causes of neurogenic claudication, epidural lipomatosis should be considered. The standard test for the diagnosis of epidural lipomatosis is magnetic resonance (MR). At first, conservative treatment must be considered; weight loss and the suspension of prior corticosteroid therapy are indicated. In the presence of neurological impairment, the operative treatment of wide surgical decompression must be performed soon after diagnosis. PMID:27069704

  18. Solitary Spinal Epidural Metastasis from Gastric Cancer

    Directory of Open Access Journals (Sweden)

    Taisei Sako

    2016-01-01

    Full Text Available Solitary epidural space metastasis of a malignant tumor is rare. We encountered a 79-year-old male patient with solitary metastatic epidural tumor who developed paraplegia and dysuria. The patient had undergone total gastrectomy for gastric cancer followed by chemotherapy 8 months priorly. The whole body was examined for suspected metastatic spinal tumor, but no metastases of the spine or important organs were observed, and a solitary mass was present in the thoracic spinal epidural space. The mass was excised for diagnosis and treatment and was histopathologically diagnosed as metastasis from gastric cancer. No solitary metastatic epidural tumor from gastric cancer has been reported in English. Among the Japanese, 3 cases have been reported, in which the outcome was poor in all cases and no definite diagnosis could be made before surgery in any case. Our patient developed concomitant pneumonia after surgery and died shortly after the surgery. When a patient has a past medical history of malignant tumor, the possibility of a solitary metastatic tumor in the epidural space should be considered.

  19. First report of hepatic hematoma after presumed Bothrops envenomation

    Directory of Open Access Journals (Sweden)

    Fernanda Cristina Cunha

    2015-10-01

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

  20. Delayed duodenal hematoma and pancreatitis from a seatbelt injury.

    Science.gov (United States)

    Deambrosis, Katherine; Subramanya, Manjunath S; Memon, Breda; Memon, Muhammed A

    2011-02-01

    Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution.

  1. Delayed Duodenal Hematoma and Pancreatitis from a Seatbelt Injury

    Directory of Open Access Journals (Sweden)

    DeAmbrosis, Katherine

    2011-02-01

    Full Text Available Traumatic duodenal hematoma is a rare condition that is encountered in the paediatric age group following blunt abdominal trauma. It poses both a diagnostic and therapeutic challenge. The main concern is increased morbidity secondary to delayed diagnosis and associated occult injuries to the adjacent structures. Most of these hematomas resolve spontaneously with conservative management, and the prognosis is good. We present a case of a 15-year-old boy who had a delayed presentation of duodenal hematoma and acute pancreatitis, which was treated conservatively with complete resolution. [West J Emerg Med. 2011;12(1:128-130.

  2. Hematoma subperiosteal de órbita: relato de caso

    OpenAIRE

    2007-01-01

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

  3. Supraspinatus Intramuscular Calcified Hematoma or Necrosis Associated with Tendon Tear

    Directory of Open Access Journals (Sweden)

    Alexandre Lädermann

    2015-01-01

    Full Text Available Introduction. Rotator cuff intramuscular calcification is a rare condition usually caused by heterotopic ossification and myositis ossificans. Case Presentation. We describe a patient with voluminous calcified mass entrapped in supraspinatus muscle associated with corresponding tendon tear. Histological examination corresponded to a calcified hematoma or necrosis. Patient was surgically managed with open excision of the calcified hematoma and rotator cuff arthroscopic repair. At 6 months, supraspinatus muscle was healed, and functional outcome was good. Discussion and Conclusion. We hypothesized that supraspinatus intramuscular calcified hematoma was responsible for mechanical stress on the tendon. This association has never been described.

  4. Life-threatening paraspinal muscle hematoma after percutaneous vertebroplasty

    Directory of Open Access Journals (Sweden)

    Chang-Hoon Jeon

    2016-01-01

    Full Text Available Bleeding and hematoma formation is rarely reported in percutaneous vertebroplasty procedure. An 84 year old male presented with a large paraspinal muscle hematoma after a percutaneous vertebroplasty. The patient had neither any prior bleeding disorder nor any anticoagulant treatment. Vital signs of the patient were unstable, and his hemoglobin level decreased daily. After a month of conservative treatment, including transfusion, cryotherapy, pain control and bed rest, his hemoglobin level remained stable and he showed relief from pain. Four months later, hematoma resolved spontaneously and he could walk without back pain.

  5. Multiple intracranial lipoma

    Directory of Open Access Journals (Sweden)

    B P Venkatesh

    2014-01-01

    Full Text Available Intracranial lipomas are rare congenital, non-neoplastic lesions discovered incidentally on computerised tomography (CT or magnetic resonance imaging (MRI with an incidence rate of less than 0.1% of all intracranial tumours. Most lipomas are asymptomatic pericallosal lesions sometimes presenting with seizures or headache. Corpus callosum agenesis and defects of midline structures differentiation may be present. Callosal lipomas are of two types: Anterior bulky tubulonodular variety associated with forebrain and rostral callosal anomalies, and posterior ribbon-like curvilinear lipoma generally seen with a normal or near normal corpus callosum. Corpus callosal hypogenesis/agenesis is seen in up to 90% of anterior and 30% of posterior pericallosal lipomas. The association of corpus callosal lipoma with choroid plexus lipoma is variable with its reported incidence rate being 20-50%. A 50-year-old patient was referred to our department for CT scan of brain with history of recent onset of headache and one episode of seizure. We present the imaging findings in this rare case of callosal tubulonodular lipoma having prominent intralesional vessels and extensive calcification with a concomitant intraventricular lipoma in a patient with dysgenetic corpus callosum.

  6. Intracranial hemorrhage of the mature newborn infant. Centering around the CT picture

    Energy Technology Data Exchange (ETDEWEB)

    Takemine, Hisao

    1983-08-01

    The labour course, treatment, and prognoses were discussed concerning four mature newborn infants with intracranial hemorrhage diagnosed by CT. Of intracranial hemorrhage, 70.7% was small hemorrhage along the cerebellar tentorium and the falx cerebri, 12.2% subdural hemorrhage in the posterior cranial fossa, and 9.8% subdural hemorrhage in the fornex. Intraventricular or extradural hemorrhage was rarely found. The prognosis is determined by the severity of neurotic symptoms due to cerebral hypoxia. Subdural hemorrhage of the posterior cranial fossa resulted in cerebral palsy in one fifth of the cases, and in slight enlargement of the ventricle in three fifths. Subdural hematoma left porencephaly in one fourth of the patients, but the remaining recovered to normal.

  7. Organic electronics based pressure sensor towards intracranial pressure monitoring

    Science.gov (United States)

    Rai, Pratyush; Varadan, Vijay K.

    2010-04-01

    The intra-cranial space, which houses the brain, contains cerebrospinal fluid (CSF) that acts as a fluid suspension medium for the brain. The CSF is always in circulation, is secreted in the cranium and is drained out through ducts called epidural veins. The venous drainage system has inherent resistance to the flow. Pressure is developed inside the cranium, which is similar to a rigid compartment. Normally a pressure of 5-15 mm Hg, in excess of atmospheric pressure, is observed at different locations inside the cranium. Increase in Intra-Cranial Pressure (ICP) can be caused by change in CSF volume caused by cerebral tumors, meningitis, by edema of a head injury or diseases related to cerebral atrophy. Hence, efficient ways of monitoring ICP need to be developed. A sensor system and monitoring scheme has been discussed here. The system architecture consists of a membrane less piezoelectric pressure sensitive element, organic thin film transistor (OTFT) based signal transduction, and signal telemetry. The components were fabricated on flexible substrate and have been assembled using flip-chip packaging technology. Material science and fabrication processes, subjective to the device performance, have been discussed. Capability of the device in detecting pressure variation, within the ICP pressure range, is investigated and applicability of measurement scheme to medical conditions has been argued for. Also, applications of such a sensor-OTFT assembly for logic sensor switching and patient specific-secure monitoring system have been discussed.

  8. ¿Se debe mantener la analgesia epidural como técnica de base en la UDA?

    Directory of Open Access Journals (Sweden)

    F. Caba

    2010-05-01

    Full Text Available La analgesia epidural se ha convertido en una técnica rutinaria en el manejo perioperatorio de los pacientes quirúrgicos que se ha extendido fuera de los quirófanos y de las unidades de alta dependencia hacia las salas de hospitalización. La irrupción en este nuevo escenario ha mejorado la analgesia postoperatoria con aceptables márgenes de seguridad, lo que le ha servido para colocarse en un lugar predominante entre las pautas analgésicas de las Unidades de Dolor Agudo (UDA. La analgesia epidural con anestésicos locales y opioides frente a la sistémica con opioides ha presentado históricamente una superior eficacia analgésica, y una disminución de complicaciones derivadas de la atenuación del estrés quirúrgico y de la mejora en la función cardiorrespiratoria. Sin embargo, frente a estas ventajas la analgesia epidural también presenta inconvenientes como la hipotensión arterial o la retención urinaria, junto a las potencialmente graves derivadas del daño neurológico ocasionado por un hematoma epidural, una infección o una lesión directa del tejido nervioso. Si sus ventajas han resultado consistentes y fundamentadas, en este momento no lo parecen tanto. El avance que ha supuesto la cirugía mínimamente invasiva con altas más precoces, junto al desarrollo de estrategias multimodales, está conduciendo a un replanteamiento de la utilización de técnicas como la epidural y a una reevaluación de sus indicaciones. Las últimas evidencias nos inducen a pensar que la epidural probablemente haya tocado techo en el tratamiento del dolor postoperatorio y comenzará a perder terreno frente a otras técnicas igualmente efectivas, con menores complicaciones y efectos secundarios. Este será un proceso lento en el que deberá quedar asegurado que las alternativas analgésicas ofrecen realmente mejores resultados en cuanto a eficacia, seguridad, tolerabilidad y calidad de la recuperación desde la perspectiva del paciente.

  9. Lumbar Epidural Varix Mimicking Disc Herniation.

    Science.gov (United States)

    Bursalı, Adem; Akyoldas, Goktug; Guvenal, Ahmet Burak; Yaman, Onur

    2016-07-01

    Lumbar radiculopathy is generally caused by such well-recognized entity as lumbar disc herniation in neurosurgical practice; however rare pathologies such as thrombosed epidural varix may mimic them by causing radicular symptoms. In this case report, we present a 26-year-old man with the complaint of back and right leg pain who was operated for right L4-5 disc herniation. The lesion interpreted as an extruded disc herniation preoperatively was found to be a thrombosed epidural varix compressing the nerve root preoperatively. The nerve root was decompressed by shrinking the lesion with bipolar thermocoagulation and excision. The patient's complaints disappeared in the postoperative period. Thrombosed lumbar epidural varices may mimic lumbar disc herniations both radiologically and clinically. Therefore, must be kept in mind in the differential diagnosis of lumbar disc herniations. Microsurgical techniques are mandatory for the treatment of these pathologies and decompression with thermocoagulation and excision is an efficient method.

  10. Intraparenchymal intracranial pressure monitoring in patients with acute liver failure Monitoreo intraparenquimatoso de presión intracraneana en pacientes con falla hepática aguda

    OpenAIRE

    Rabadán, Alejandra T.; Natalia Spaho; Diego Hernández; Adrián Gadano; Eduardo de Santibañes

    2008-01-01

    BACKGROUND: Elevated intracranial pressure (ICP) is a common cause of death in acute liver failure (ALF) and is determinant for decision-making regarding the timing of liver transplantation. The recommended type ICP monitoring device is controversial in ALF patients. Epidural devices had less risk of hemorrhagic complications, but they are less reliable than intraparenchymal ones. METHOD: Twenty-three patients with ALF were treated, and 19 of them received a liver transplant. Seventeen patien...

  11. Idiopathic intraparenchymal hematoma of the liver in a neonate

    Energy Technology Data Exchange (ETDEWEB)

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

    2004-04-01

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

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

    Science.gov (United States)

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

    2013-03-01

    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.

  13. Evaluation of closed-suction drainage for treating auricular hematomas.

    Science.gov (United States)

    Swaim, S F; Bradley, D M

    1996-01-01

    The principal and dynamics of closed-suction wound drainage lend themselves to use on auricular hematomas. This type of drainage was evaluated in the treatment of 10 auricular hematomas on nine animals. Seven animal owners rated the results of the procedure as "good," and two rated them as "fair." The two rating the procedure as having "fair" results owned dogs with allergic dermatitis, and the auricular hematomas recurred. In both dogs, auricular hematomas again recurred after other means of treatment were used. If the pocket for the vacuum tube is not secure and the animal is quite active, or if it molests the bandage, or both, it is possible for the tube to break or the needle to come off of the tubing.

  14. Acute femoral neuropathy secondary to an iliacus muscle hematoma.

    Science.gov (United States)

    Seijo-Martínez, M; Castro del Río, M; Fontoira, E; Fontoira, M

    2003-05-15

    We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation. The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.

  15. Rapidly Progressive Spontaneous Spinal Epidural Abscess

    Directory of Open Access Journals (Sweden)

    Abdurrahman Aycan

    2016-01-01

    Full Text Available Spinal epidural abscess (SEA is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

  16. Rapidly Progressive Spontaneous Spinal Epidural Abscess.

    Science.gov (United States)

    Aycan, Abdurrahman; Aktas, Ozgür Yusuf; Guzey, Feyza Karagoz; Tufan, Azmi; Isler, Cihan; Aycan, Nur; Gulsen, İsmail; Arslan, Harun

    2016-01-01

    Spinal epidural abscess (SEA) is a rare disease which is often rapidly progressive. Delayed diagnosis of SEA may lead to serious complications and the clinical findings of SEA are generally nonspecific. Paraspinal abscess should be considered in the presence of local low back tenderness, redness, and pain with fever, particularly in children. In case of delayed diagnosis and treatment, SEA may spread to the epidural space and may cause neurological deficits. Magnetic resonance imaging (MRI) remains the method of choice in the diagnosis of SEA. Treatment of SEA often consists of both medical and surgical therapy including drainage with percutaneous entry, corpectomy, and instrumentation.

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

    Institute of Scientific and Technical Information of China (English)

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

    2009-01-01

    An iliopsoas hematoma can occur either spontaneously or secondary to trauma or bleeding tendency due to hemophilia and anticoagulant therapy. Although liver cirrhosis is commonly associated with coagulopathy, iliopsoas hematoma is very rare. We herein, present a case of bilateral iliopsoas hematoma in a patient with alcoholic cirrhosis, and review the literature on muscle hematoma associated with cirrhosis. A 56-year-old man with alcoholic cirrhosis was admitted in a state of shock with 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 isclosely 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.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-09-15

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

  19. Spontaneous Meckel's cave hematoma: A rare cause of trigeminal neuralgia

    OpenAIRE

    Concetta Alafaci; Giovanni Grasso; Francesca Granata; Daniele Marino; Salpietro, Francesco M.; Francesco Tomasello

    2015-01-01

    Background: The most common etiology of classic trigeminal neuralgia (TN) is vascular compression. However, other causes must be considered. Among these, spontaneous hematoma of the Meckel′s cave (MC) causing symptomatic TN is very rare. Case Description: We present the case of a 60-year-old woman with a 2-month history of left TN and diplopia. Neuroradiological examinations revealed a well-defined hematoma in the left MC. The patient underwent surgical decompression with a progressive ne...

  20. Intracranial Large Artery Occlusive Disease

    Institute of Scientific and Technical Information of China (English)

    Wong KS; Li H; Kay R

    2000-01-01

    @@Intracranial large artery stenosis is the most commonly found vascular lesion in stroke patient of Chinese, Hispanic and African ancestry. There .have been few studies on the epidemiology, pathophysiology, treatment and prognosis of this important disease. Recent advances in technology provide safe and reliable investigation for studying large number of patients. Transcranial Doppler is an easily accessible, cheap and reliable method to diagnose intracranial stenosis. It is suitable for screening for and monitoring the progress of intracranial stenosis. Magnetic resonance angiography and CT angiography provide the morphology of lumenal stenosis but are less accessible.

  1. Effect of postoperative epidural analgesia on surgical outcome

    DEFF Research Database (Denmark)

    Holte, K; Holte, Kathrine

    2002-01-01

    Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity is controv......Pain relief allowing sufficient mobilization after major surgical procedures can only be achieved by continuous epidural analgesia with local anesthetics, which also reduces the stress response to surgery. However, the role of postoperative epidural analgesia on postoperative morbidity...... is controversial. We therefore update the effects of postoperative analgesia on surgical outcome. After major abdominal surgery, postoperative epidural analgesia with local anesthetics significantly reduces postoperative ileus and pulmonary complications while effects on cardiac morbidity are debatable. Continuous...... regimen does not contain a sufficient amount of local anesthetics. Future evaluation of the effects of epidural analgesia on postoperative outcome also requires integration of epidural analgesia within a multimodal rehabilitation programme....

  2. How first time mothers experience the use of epidural analgesia

    DEFF Research Database (Denmark)

    Jepsen, Ingrid

    2010-01-01

    How first time mothers experience the use of epidural analgesia during birth Ingrid Jepsen, Midwife, SD, MPH, Kurt Dauer Keller cand.psych, PhD Contact email irj@ucn.dk Aim: to investigate the experiences of epidural analgesia as to the choice of epidurals, the changes in pain, the period from th...... midwives handle the epidurals. Conclusion: In particular, the use of an epidural does not diminish the need for an individual approach. The woman’s level of consciousness and the entire situation makes her very sensitive to the midwives care....... factors influencing the relationship with the midwives were: the very choice of an epidural, the midwives accept of that choice, satisfaction with the presence of the midwifes, the continuity of the process, and a high level of information. Clearly, the establishment of an epidural implies important...

  3. Intracranial Pressure Monitoring

    DEFF Research Database (Denmark)

    Raboel, P H; Bartek, J; Andresen, M;

    2012-01-01

    Monitoring of intracranial pressure (ICP) has been used for decades in the fields of neurosurgery and neurology. There are multiple techniques: invasive as well as noninvasive. This paper aims to provide an overview of the advantages and disadvantages of the most common and well-known methods as ......-invasive techniques are without the invasive methods' risk of complication, but fail to measure ICP accurately enough to be used as routine alternatives to invasive measurement. We conclude that invasive measurement is currently the only option for accurate measurement of ICP....... as well as assess whether noninvasive techniques (transcranial Doppler, tympanic membrane displacement, optic nerve sheath diameter, CT scan/MRI and fundoscopy) can be used as reliable alternatives to the invasive techniques (ventriculostomy and microtransducers). Ventriculostomy is considered the gold...

  4. Spinal epidural abscess and meningitis following short-term epidural catheterisation for postoperative analgaesia.

    Science.gov (United States)

    van Rappard, Juliaan R M; Tolenaar, Jip L; Smits, Anke B; Go, Peter M N Y H

    2015-08-20

    We present a case of a patient with a spinal epidural abscess (SEA) and meningitis following short-term epidural catheterisation for postoperative pain relief after a laparoscopic sigmoid resection. On the fifth postoperative day, 2 days after removal of the epidural catheter, the patient developed high fever, leucocytosis and elevated C reactive protein. Blood cultures showed a methicillin-sensitive Staphylococcus aureus infection. A photon emission tomography scan revealed increased activity of the spinal canal, suggesting S. aureus meningitis. A gadolinium-enhanced MRI showed a SEA that was localised at the epidural catheter insertion site. Conservative management with intravenous flucloxacillin was initiated, as no neurological deficits were seen. At last follow-up, 8 weeks postoperatively, the patient showed complete recovery.

  5. Refractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman

    Science.gov (United States)

    Montiel, Virginie; Grandin, Cécile; Goffette, Pierre; Fomekong, Edward; Hantson, Philippe

    2009-01-01

    Intraventricular hemorrhage during pregnancy is usually followed by a poor recovery. When caused by moyamoya disease, ischemic or hemorrhagic episodes may complicate the management of high intracranial pressure. A 26-year-old Caucasian woman presented with generalized seizures and a Glasgow Coma Score (GCS) of 3 during the 36th week of pregnancy. The fetus was delivered by caesarean section. The brain CT in the mother revealed bilateral intraventricular hemorrhage, a callosal hematoma, hydrocephalus and right frontal ischemia. Refractory high intracranial pressure developed and required bilateral ventricular drainage and intensive care treatment with barbiturates and hypothermia. Magnetic resonance imaging and cerebral angiography revealed a moyamoya syndrome with rupture of the abnormal collateral vascular network as the cause of the hemorrhage. Intracranial pressure could only be controlled after the surgical removal of the clots after a large opening of the right ventricle. Despite an initially low GCS, this patient made a good functional recovery at one year follow-up. Management of refractory high intracranial pressure following moyamoya related intraventricular bleeding should require optimal removal of ventricular clots and appropriate control of cerebral hemodynamics to avoid ischemic or hemorrhagic complications. PMID:20508823

  6. Refractory High Intracranial Pressure following Intraventricular Hemorrhage due to Moyamoya Disease in a Pregnant Caucasian Woman

    Directory of Open Access Journals (Sweden)

    Virginie Montiel

    2009-02-01

    Full Text Available Intraventricular hemorrhage during pregnancy is usually followed by a poor recovery. When caused by moyamoya disease, ischemic or hemorrhagic episodes may complicate the management of high intracranial pressure. A 26-year-old Caucasian woman presented with generalized seizures and a Glasgow Coma Score (GCS of 3 during the 36th week of pregnancy. The fetus was delivered by caesarean section. The brain CT in the mother revealed bilateral intraventricular hemorrhage, a callosal hematoma, hydrocephalus and right frontal ischemia. Refractory high intracranial pressure developed and required bilateral ventricular drainage and intensive care treatment with barbiturates and hypothermia. Magnetic resonance imaging and cerebral angiography revealed a moyamoya syndrome with rupture of the abnormal collateral vascular network as the cause of the hemorrhage. Intracranial pressure could only be controlled after the surgical removal of the clots after a large opening of the right ventricle. Despite an initially low GCS, this patient made a good functional recovery at one year follow-up. Management of refractory high intracranial pressure following moyamoya related intraventricular bleeding should require optimal removal of ventricular clots and appropriate control of cerebral hemodynamics to avoid ischemic or hemorrhagic complications.

  7. Epidural fentanyl decreases the minimum local analgesic concentration of epidural lidocaine

    Institute of Scientific and Technical Information of China (English)

    ZHANG Jian; ZHENG Yue-ying; FENG Zhi-ying; CHEN Chao-qin; ZHU Sheng-mei

    2012-01-01

    Background Epidural lidocaine can be used when regional anesthesia needs to be established quickly,but the effect of co-administering epidural fentanyl on the minimum local analgesic concentration(MLAC)of lidocaine is not known.We compared the MLAC of epidural lidocaine in combination with different doses of fentanyl for epidural anesthesia in adults.Methods One hundred and twenty patients requiring epidural analgesia were randomly allocated to receive 20 ml of one of four solutions:lidocaine,or lidocaine plus fentanyl 1 μg/ml,2 μg/ml,or 3 μg/ml.The first patient in each group was administered 1% lidocaine weight by volume;subsequent patients received a concentration determined by the response of the previous patient to a higher or lower concentration according to up and down sequential allocation in 0.1% increments.Efficacy was assessed using a visual analog pain scale,and accepted if this was ≤10 mm on a 100 mm scale within 30 minutes.The extent of motor block and of nausea and vomiting were recorded at 30 minutes after administration of the epidural solution and two hours after surgery,respectively.Results The MLAC of lidocaine in those receiving lidocaine alone was 0.785%(95%C/0.738-0.864).A significant dose-dependent reduction was observed with the addition of fentanyl:the MLAC of lidocaine with fentanyl at 2 μg/ml was 0.596%(95%Cl 0.537-0.660)and 0.387% with fentanyl at 3 μg/ml(95%Cl 0.329-0.446,P<0.001).Conclusion Epidural fentanyl significantly reduces the dose of lidocaine required for effective epidural analgesia in adults without causing adverse side effects.

  8. Optimal Dose of Epidural Dexmedetomidine Added to Ropivacaine for Epidural Labor Analgesia: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Zhang Wangping

    2017-01-01

    Full Text Available Background. Dexmedetomidine combined with local anesthetics can decrease the concentration of epidural ropivacaine. However, the optimal dose of epidural dexmedetomidine combined with ropivacaine for labor analgesia is still uncertain. This study investigated the effect of adding different dose of epidural dexmedetomidine to ropivacaine during epidural labor analgesia. Methods. One hundred women were randomly assigned to one of the four groups (Groups A, B, C, and D received 0.25, 0.5, 0.75, and 1 μg/ml of dexmedetomidine plus 0.1% ropivacaine, resp.. The onset of epidural anesthesia and stages of labor were studied, and pain was assessed using a visual analogue scale (VAS. Hemodynamic parameters and fetal heart rate were monitored. Apgar scores and umbilical artery pH were recorded. The side effects, if any, were recorded also. Results. The addition of 0.25, 0.5, and 0.75 μg/ml of dexmedetomidine to 0.1% ropivacaine provided safe and effective analgesia, but 1 μg/ml of dexmedetomidine resulted in increasing incidence of motor block. The hemodynamic parameters were similar between groups (P>0.05. Side effects in Group D were significantly higher than those in the other three groups (P<0.05. Conclusions. When dexmedetomidine is combined with 0.1% ropivacaine, the optimal concentration of dexmedetomidine is 0.5 μg/ml for epidural labor analgesia (this trial is registered with ChiCTR-OPC-16008548.

  9. Epidural blood flow and regression of sensory analgesia during continuous postoperative epidural infusion of bupivacaine

    DEFF Research Database (Denmark)

    Mogensen, T; Højgaard, L; Scott, N B;

    1988-01-01

    Epidural blood flow was measured in seven patients undergoing elective abdominal surgery during combined lumbar epidural and general anesthesia. After an initial dose of 20 ml plain bupivacaine 0.5%, a continuous epidural infusion of bupivacaine 0.5% (8 ml/hr) was given for 16 hours...... for postoperative pain relief. The epidural blood flow was measured by a local 133Xe clearance technique in which 15-35 MBq 133Xe diluted in 1 ml saline was injected through the epidural catheter on the day before surgery (no bupivacaine), 30 minutes after the initial dose of bupivacaine on the morning before...... surgery, and 8, 12, and 16 hours later during the continuous infusion. Initial blood flow was 6.0 +/- 0.7 ml/min per 100 g tissue (mean +/- SEM). After epidural bupivacaine, blood flow increased in all seven patients to 7.4 +/- 0.7 ml (P less than 0.02). Initial level of sensory analgesia was T4.5 +/- 0...

  10. Idiopathic Intracranial Hypertension (Pseudotumor Cerebri)

    Science.gov (United States)

    ... children and tends to be “secondary” which affects males and females equally. The second group, post pubescent teenagers, tends to fit the adult stereotype. How is pediatric idiopathic intracranial hypertension diagnosed? If ...

  11. Optimal management of hemophilic arthropathy and hematomas

    Directory of Open Access Journals (Sweden)

    Lobet S

    2014-10-01

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

  12. Infektioner i forbindelse med epidural kateterisation

    DEFF Research Database (Denmark)

    Holt, H M; Gahrn-Hansen, B; Andersen, S S

    1996-01-01

    coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose...

  13. [Maternal postures and epidural analgesia during labour].

    Science.gov (United States)

    Ducloy-Bouthors, A-S; De Gasquet, B; Davette, M; Cuisse, M

    2006-06-01

    The evolution of birth is of interest for obstetricians and midwives. Postures with asymmetric stretching and balance, kneeling, or sitting have been claimed to be able to help foetal head rotation. Although walking during labour have no influence on the outcome of labour, hip-flexed postures enlarging the pelvic diameter are yet evaluated to improve the obstetric course of labour. In a prospective randomised study including 93 parturients, we compared the supine 30 degrees lateral tilt (control group) to three hip-flexed postures: sitting (S), right hip-flexed left lateral position (L) and left hip-flexed right lateral position (R). Epidural analgesia with 12 ml ropivacaine 0.1% and sufentanil 0.5 microg/ml was administered over a period of six minutes. The total epidural spread was 15+/-0.3 dermatomes and the upper level of thermo-analgesic blockade reached T7-T8 (T5 to T10) in each group. There were no differences between groups for the left and right total spread and upper level of epidural blockade, for the time to maximal block and pain relief. There was no motor block and no maternal or foetal side effects. We conclude that, for the three hip-flexed postures tested, position does not influence local anesthetic spread or symmetry of analgesia after induction of obstetric epidural anaesthesia.

  14. MRI features of epidural extramedullary hematopoiesis

    Energy Technology Data Exchange (ETDEWEB)

    Alorainy, Ibrahim A. E-mail: alorainy@ksu.edu.sa; Al-Asmi, Abdullah R.; Carpio, Raquel del

    2000-07-01

    A case of {beta}-thalassemia intermedia with spinal cord compression due to extramedullary hematopoiesis, which was successfully treated by blood transfusion, is presented. Emphasis was made on the MRI appearance of extramedullary hematopoiesis on different pulse sequences. The theories that aimed to explain the involvement of the epidural space by extramedullary hematopoiesis are discussed.

  15. Neuraxial block and postoperative epidural analgesia

    DEFF Research Database (Denmark)

    Leslie, K; McIlroy, D; Kasza, J

    2016-01-01

    BACKGROUND: We assessed associations between intraoperative neuraxial block and postoperative epidural analgesia, and a composite primary outcome of death or non-fatal myocardial infarction, at 30 days post-randomization in POISE-2 Trial subjects. METHODS: 10 010 high-risk noncardiac surgical pat...

  16. MRI features of spinal epidural angiolipomas

    Energy Technology Data Exchange (ETDEWEB)

    Hu, Su; Hu, Chun Hong; Wang, Xi Ming; Dai, Hui [Dept. of Radiology, The First Affiliated Hospital of Soochow University, Jiangsu (China); Hu, Xiao Yun; Fang, Xiang Ming [Dept. of Radiology, Wuxi People' s Hospital Affiliated to Nanjing Medical University, Jiangsu (China); Cui, Lei [Dept. of Radiology, The Second Affiliated Hospital of Nantong University, Jiangsu (China)

    2013-10-15

    To describe the MRI findings in ten patients of spinal epidural angiolipoma for differentiated diagnosis presurgery. Ten surgically proved cases of spinal epidural angiolipomas were retrospectively reviewed, and the lesion was classified according to the MR findings. Ten tumors were located in the superior (n = 4), middle (n = 2), or inferior (n = 4) thoracic level. The mass, with the spindle shape, was located in the posterior epidural space and extended parallel to the long axis of the spine. All lesions contained a fat and vascular element. The vascular content, correlating with the presence of hypointense regions on T1-weighted imaging (T1WI) and hyperintense signals on T2-weighted imaging, had marked enhancement. However, there were no flow void signs on MR images. All tumors were divided into two types based on the MR features. In type 1 (n = 3), the mass was predominantly composed of lipomatous tissue (> 50%) and contained only a few small angiomatous regions, which had a trabeculated or mottled appear. In type 2 (n = 7), the mass, however, was predominantly composed of vascular components (> 50%), which presented as large foci in the center of the mass. Most spinal epidural angiolipomas exhibit hyperintensity on T1WI while the hypointense region on the noncontrast T1WI indicates to be vascular, which manifests an obvious enhancement with gadolinium administration.

  17. Errores en el procedimiento del bloqueo epidural

    Directory of Open Access Journals (Sweden)

    P. Murad

    2015-07-01

    Conclusión: El bloqueo epidural es una práctica frecuentemente usada en el manejo del dolor lumbar crónico. Los errores técnicos y las complicaciones del procedimiento son poco comunes, pero para su manejo y posterior corrección es importante conocerlos y contar con un médico experimentado.

  18. Epidural Brain Metastases in a Patient with Early Onset Pancreatic Cancer: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Aibek E. Mirrakhimov

    2012-01-01

    Full Text Available We present a case of early onset pancreatic cancer related extra-axial brain metastases. A 46-year-old Caucasian non-Jewish nonobese male with a history of PC diagnosed 3 months ago with metastases to the liver, omentum, malignant ascites, and a history of a pulmonary embolism was admitted to the hospital because of a new onset headache, nausea, and vomiting which started 2 days prior to the encounter. Brain MRI was ordered, which showed acute bihemispheric subdural hematomas and left hemispheric extra-axial heterogeneously enhancing lesions consisting with metastatic disease. The patient was started on ondansentron, metoclopramide, and dexamethasone. The cranial irradiation was started, and the patient’s headache and nausea significantly improved. There are only 9 published reports of extra-axial brain metastases related to the pancreatic cancer, whereas our paper is the first such case reported on a patient with epidural metastases and early onset pancreatic cancer.

  19. A unique pattern of intracranial pressure in a patient with traumatic paroxysmal sympathetic storm.

    Science.gov (United States)

    Woo, Hyun Jin; Park, Seong Hyun; Hwang, Sung Kyoo

    2010-01-01

    Paroxysmal sympathetic storm (PSS), or diencephalic seizure, usually appears in patients with severe traumatic brain injury and is characterized by various sympathetic symptoms. The physiological effects of this syndrome are not well studied. The authors monitored intracranial pressure (ICP) in a patient with PSS and reviewed its impact on the physiology and management of the syndrome. A 12-year-old male patient was involved in a traffic accident. Upon arrival at the emergency room, his Glasgow Coma Scale score was 5 and he showed decerebration. A brain CT showed an intracerebral hematoma in the right basal ganglia, at which point craniotomy and removal of the hematoma were performed. Continuous intracranial monitoring was performed using the fiber-optic intraparenchymal method. Beginning the day after the trauma, the patient began exhibiting sympathetic symptoms including intermittent episodes of fever, tachycardia, increased blood pressure, tachypnea, diaphoresis and decerebrate rigidity. These episodes were accompanied by ICP elevation of greater than 20 mm Hg. ICP was decreased during hyperventilation, and the episodic symptoms subsided as ICP normalized. PaCO(2) was periodically altered in association with hyperventilation. Electroencephalogram did not show epileptiform discharges, and the sympathetic spells were aborted by continuous intravenous midazolam infusion. The authors report on a pattern of ICP monitoring in association with PSS. Traumatic PSS should be recognized in the appropriate setting to prevent secondary brain damage.

  20. Subperiostal Orbital Abscess and Frontal Epidural Abscess Due to Sinusitis: A Case Report

    Directory of Open Access Journals (Sweden)

    Burak Ulaş

    2013-12-01

    Full Text Available A seventeen-year-old girl was admitted to our clinic with complaint of rubor, swelling, and pain on the left upper eyelid. Her medical history revealed that she had received high-dose oral steroid treatment for one week for the diagnosis of acute angioedema in another clinic. On ophthalmologic examination, her left upper eyelid had edema, swelling, and hyperemia. Additionally, she had restriction in up-gaze in the left eye. Her best-corrected visual acuity was 0.7. The patient’s computerized tomography revealed ethmoidal, maxillary and frontal sinusitis, as well as subperiostal orbital abscess, and frontal epidural abscess. Intravenous antibiotic treatment has been arranged. Due to persistence of the clinical signs, surgical drainage of the abscesses has been performed. Following, she has been discharged from the hospital on oral antibiotic treatment. Postoperatively, at the first-month visit, the left eye’s up-gaze restriction was recovered, and visual acuity was improved to 1.0. If a patient presents with eyelid swelling, differential diagnosis should be performed carefully before making the decision to start steroid treatment. Sinusitis, which is seen frequently in clinical practice, should be kept in mind due to its potential to cause orbital abscess, epidural abscess, and intracranial complications. (Turk J Ophthalmol 2013; 43: 464-7

  1. Epidural morphine for postoperative pain relief in children

    DEFF Research Database (Denmark)

    Henneberg, S W; Hole, P; Haas, Inge Madsen De

    1993-01-01

    Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine for postop......Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine...... for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case...... the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been...

  2. INTRACRANIAL PRESSURE MONITORING TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Ida Bagus Adi Kayana

    2013-03-01

    Full Text Available Head injury is the most significant cause of increased morbidity and mortality. An estimated 1.4 million head injuries occur each year, with and more than 1.1 million come to the Emergency Unit. On each patient head injury, an increase in intracranial pressure (ICP related to poor outcomes and aggressive therapy to increased ICP can improve the outcomes. ICP monitoring is the most widely used because of the prevention and control of ICP as well as maintain the pressure increase perfusion of cerebral (Cerebral Perfusion Pressure/CPP is the basic purpose of handling head injury. There are two methods of monitoring ICP that is an invasive methods (directly and non-invasive techniques (indirectly. The method commonly used, namely intraventricular and intraparenkimal (microtransducer sensor because it is more accurate but keep attention to the existence of the risk of bleeding and infection resulting from installation. Monitoring of ICT can determine the actions that avoid further brain injury, which can be lethal and irreversibel.

  3. Intramural aortic hematomas; Intramurale Haematome der Aorta

    Energy Technology Data Exchange (ETDEWEB)

    Raab, B.W.; Vosshenrich, R.; Fischer, U.; Funke, M.; Grabbe, E. [Goettingen Univ. (Germany). Abt. fuer Roentgendiagnostik

    2001-08-01

    Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can be differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membran are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection. (orig.) [German] Das intramurale Haematom (IMH) ist eine Einblutung in die Aortenwand. Grundsaetzlich kann zwischen traumatischer Genese und einer atraumatischen spontanen Form unterschieden werden. Praedisponierend sind arterielle Hypertension und mesoektodermale Dysplasiesyndrome. Die Diagnose ergibt sich aus der Klinik und den Befunden in den bildgebenden Verfahren. Zu den klinischen Symptomen zaehlen akut oder subakut auftretende Schmerzen, assoziiert mit einer Kollapsneigung. Typische Befunde in der transoesophagealen Echokardiographie, der Computer- oder der Magnetresonanztomographie sind eine halbmondfoermige oder konzentrische Wandverdickung der Aorta ohne Nachweis von Blutfluss oder einer Dissektionsmembran mit Dichtewerten bzw. Signalintensitaeten in Abhaengigkeit vom Alter der Einblutung. Differenzialdiagnostisch ist eine Abgrenzung

  4. A tale of two acute extradural hematomas

    Science.gov (United States)

    Adeleye, Amos Olufemi; Jite, Ikechi E.; Smith, Omolara A.

    2016-01-01

    Background: In much of the Western hemisphere, mortality from traumatic acute extradural hematomas (AEDH) has been drastically brought down toward 0%. This is still not the case however in most developing countries. Case Description: This report represents a tragi-comic tale of two cases of traumatic AEDH managed by an academic neurosurgeon in a neurosurgically ill-resourced private health facility during a nationwide industrial strike action preventing clinical-surgical care in the principal author's University Teaching Hospital. A young man presented with altered consciousness, Glasgow Coma Score (GCS) 14/15, following a road accident. The cranial computed tomography (CT) scan was obtained only 9 h after its request, long after the man had actually deteriorated to GCS 7/15 with pupillary changes. The neurosurgeon, summoned from the nearby University Teaching Hospital for the operative care of this man, arrived on-site and was about moving the patient into the operative room when he took the final breaths and died, all within 2 h of the belated neuroimaging. This scenario repeated itself in the same health facility just 24 h later with another young man who presented GCS 7/15 and another identical CT evidence of traumatic AEDH. With more financially able relations, the diagnostic/surgical care of this second patient was much more prompt. He made a very brisk recovery from neurosurgical operative intervention. He is alive and well, 5-month postoperative. Conclusions: In most low-resourced health systems of the developing countries, a significant proportion of potentially salvageable cases of AEDH still perish from this disease condition. PMID:27213108

  5. Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

    Directory of Open Access Journals (Sweden)

    Clark K. Choi

    2013-01-01

    Full Text Available Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

  6. Recurrence of chronic subdural hematoma after trepanation and drainage

    Institute of Scientific and Technical Information of China (English)

    张建平; 许文辉; 朱立平; 张翔

    2003-01-01

    Objective: To sum up the causes of recurrence of chronic subdural hematoma (CSDH) from failure of trepanation and drainage and explore its prevention and treatment.Methods: From October 1988 to June 2002 a total of 358 patients with CSDH were treated with trepanation and drainage in our hospital. Among them 15 patients had recurrence of CSDH after operation. The data of the 15 patients were reviewed retrospectively.Results: Of the 15 patients, 13 were cured by retrepanation and redrainage, one cured by removal of hematoma by craniotomy with bone flap, and one, a 1-year old child, gave up reoperation due to severe encephalatrophy. Conclusions: Most CSDHs which recur after trepanation and drainage can be cured by retrepanation and redrainage. For the patients with repeated recurrence of CSDH removal of hematoma capsule can be considered. The causes of recurrence of CSDH are related to disease course, the thickness of hematoma capsule, the severity of encephalatraphy and whether the hematoma cavity is drained or irrigated completely, and operation methods.

  7. Splenic hematoma in acute pancreatitis. Role of coagulation disorders.

    Science.gov (United States)

    Clavé, P; Guillaumes, S; Blanco, I; Martínez de Hurtado, J; Esquius, J; Marruecos, L; Fontcuberta, J; Pérez, C; Farré, A; Lluís, F

    1992-08-01

    Splenic hematomas are infrequent complications of acute pancreatitis. In some cases, local factors that may play a role in the pathogenesis of the hematoma (thrombosis of the splenic artery or veins, intrasplenic pseudocysts, perisplenic adhesions, enzymatic digestion) are found. In the absence of local factors, the etiology of splenic hemorrhage remains unknown. We report two cases of splenic hematoma occurring during an acute necro-hemorrhagic pancreatitis associated with renal failure that required renal replacement therapy (hemodialysis and continuous arteriovenous hemodialysis). In both cases, more than half of splenic parenchyma was affected by multiple infarctions. No local factors responsible for the splenic abnormalities were detected in either case. Thrombosis of the splenic arterial microcirculation and a coagulation disorder consistent with disseminated intravascular coagulation was detected in one patient. In the second patient, coagulation disorders secondary to either liver disease, pancreatitis and its septic complications, or extracorporeal circuit heparinization for renal replacement therapy were present. Coagulation disorders should be considered whenever a splenic hematoma is found in a patient with acute pancreatitis. Disseminated intravascular coagulation may be the etiology of a splenic hematoma in acute pancreatitis.

  8. Pleural puncture with thoracic epidural: A rare complication?

    Directory of Open Access Journals (Sweden)

    Rachna Wadhwa

    2011-01-01

    Full Text Available Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

  9. 外伤性迟发性颅内血肿临床特点及首次CT的影像学特征分析%Clinical manifestations and initial CT imaging features of delayed traumatic intracerebral hematoma

    Institute of Scientific and Technical Information of China (English)

    葛培林; 刘华明; 刘仁忠; 易伟; 杨振兴; 连海伟; 邵灵敏

    2011-01-01

    目的 分析外伤性迟发性颅内血肿临床特点及首次CT影像学特征,早期诊断外伤性迟发性颅内血肿,提高疗效.方法 回顾性分析我院2005年至2009年经CT证实的外伤性迟发性颅内血肿患者的临床资料,总结临床特点和首次CT影像学特征.结果 迟发性血肿多发生在伤后3d内,额颞部好发,老年人容易发生,进行性的意识水平下降或出现新的神经系统体征往往意味着迟发性血肿;首次CT发现头皮血肿、颅骨骨折、气颅、脑挫伤、蛛网膜下腔出血、外侧裂血肿等预警征象时,要警惕迟发性血肿的发生.结论 如果首次CT扫描有头皮血肿、颅骨骨折、脑挫伤、蛛网膜下腔出血、外侧裂血肿者,或颅内血肿成功清除后,但临床症状和特征未改善甚至加重者,进行性的意识水平下降者,伤后应将头部CT动态扫描作为常规检查,做到早期诊断、及时治疗.%Objective To examine the clinical manifestations and initial CT imaging features of delayed traumatic intracranial hematoma. Methods Clinical data of 236 patients who were proved to have delayed traumatic intracranial hematoma by CT imaging in our hospital from 2005 to 2009 were retrospectively analyzed. The clinical and CT imaging features were summarized. Results Delayed hematomas usually occurred within 3 days after injury and had frontotemporal predilection. It was more common in the elderly. Progressive decline in consciousness and nerve system signs newly found were more indicative of delayed hematoma. When initial CT imaging showed scalp hematoma, skull fractures, gas skull, brain contusion, subarachnoid hemorrhage, hematoma of lateral fissure and other early warning signs, clinicians would be alert to delayed hematomas. Conclusion If the first CT scanning reveals scalp hematoma, cranial fracture,brain contusion, subarachnoid hemorrhage or lateral fissure hematoma, and the clinical symptoms fail to be alleviated and the patients

  10. Comparison of continuous epidural infusion and programmed intermittent epidural bolus in labor analgesia

    Directory of Open Access Journals (Sweden)

    Lin Y

    2016-07-01

    Full Text Available Yunan Lin, Qiang Li, Jinlu Liu, Ruimin Yang, Jingchen Liu Department of Anesthesiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China Background: This study aims to investigate differences between continuous epidural infusion (CEI and programmed intermittent epidural bolus (IEB analgesia for the Chinese parturients undergoing spontaneous delivery and to approach their safety to parturients and neonates.Methods: Two hundred healthy American Society of Anesthesiologists class I or II, term (≥37 weeks’ gestation, nulliparous women who requested analgesia for labor were recruited. Epidural analgesia was initiated with a solution of 0.15% ropivacaine 10 mL and maintained with 0.1% ropivacaine mixed with sufentanil 0.3 µg/mL by CEI at a rate of 5 mL/h combined with a patient-controlled epidural analgesia (PCEA bolus of 5 mL of ropivacaine sufentanil mixture or IEB of 5 mL of ropivacaine sufentanil mixture combined with a PCEA bolus of 5 mL of ropivacaine sufentanil mixture. The lockout interval was 20 minutes in each arm between the CEI and the IEB group. After 20 minutes of first dosage, visual analog scale (VAS score was obtained every 60 minutes. The maternal and fetal outcome and total consumption of analgesic solution were compared.Results: There was no difference in demographic characteristics, duration of first and second stages, delivery methods, sensory block, fetal Apgar scores, and the maternal outcomes between the CEI and IEB groups. There was a significant difference in VAS scores and epidural ropivacaine total consumption between the two groups (IEB vs CEI: 51.27±9.61 vs 70.44±12.78 mg, P<0.01. Conclusion: The use of programmed IEB mixed with PCEA improved labor analgesia compared to CEI mixed with PCEA, which could act as maintenance mode for epidural labor analgesia. Keywords: intermittent epidural bolus, continuous epidural infusion, labor analgesia, patient

  11. Epidural catheter fragment entrapment: a case report

    Directory of Open Access Journals (Sweden)

    Mohammadi M

    2010-07-01

    Full Text Available "n Normal 0 false false false EN-US X-NONE AR-SA MicrosoftInternetExplorer4 st1":*{behavior:url(#ieooui } /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-qformat:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Calibri","sans-serif"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Arial; mso-bidi-theme-font:minor-bidi;} Background: Epidural catheters are seldom difficult to remove from patients. The breakage of the catheters is uncommon, troublesome and occasionally dangerous. "n"nCase presentation: A lumbar epidural catheter inserted in a 17 year-old man for applying anesthesia for internal fixation of femur fracture and subsequent postoperative epidural analgesia. In the third postoperative day, during unsuccessful attempt for removing the catheter, it was broken and was retained in his back. A CT- scan was performed and shows a fragment of catheter in the sub- laminar ligament between L3 and L4 without any connection with epidural space. As the patient had no complaint the fractured fragment was left in site and he was just followed up in the clinic."n"nConclusion: The knowledge of practical method in locating the retained epidural catheter, and the indication for surgical removal are very important. CT- scan is useful in showing the mechanism and locating the epidural catheter entrapment and facilitating surgical follow-up.

  12. Pathophysiological Substantiation of Epidural Administration of Tenoxicam in Dorsalgia Treatment

    OpenAIRE

    Yastrebov D.N.; Shpagin М.V.; Artifexov S.B.

    2012-01-01

    The aim of the investigation is to assess the efficiency of Tenoxicam epidural administration, and represent pathophysiological substantiation of new techniques of dorsalgias treatment. Materials and Methods. There have been examined 75 patients with intense lumbar pain syndrome who underwent epidural pharmacotherapy of pain syndrome. The 1st group (n=50) had epidural Tenoxicam introduction, by 20 mg in 10–20 ml of saline solution, the control group (n=25) was given the combination of cor...

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

    Science.gov (United States)

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

    2016-02-01

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

  14. A case of right renal infarction and subcapsular hematoma that simultaneously developed after cardiac angiography.

    Science.gov (United States)

    Kwon, S H; Cho, H C; Lee, S W; Kim, D Y; Joo, W C; Lee, W H; Song, J H; Kim, M-J

    2009-01-01

    Of the several complications known to develop after cardiac catheterization, simultaneous acute renal infarction and renal subcapsular hematoma is rare. Here, the authors report a case of acute renal infarction with subcapsular hematoma that developed 4 hours after cardiac catheterization.

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

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    Sagar Bhargava

    2014-01-01

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

  16. Subserosal hematoma of the sigmoid colon after vaginal delivery

    Science.gov (United States)

    Bacalbașa, N; Bohîlțea, RE; Dumitru, M; Turcan, N; Cîrstoiu, MM

    2017-01-01

    Postpartum hemorrhage is an obstetrical emergency that represents the leading cause of maternal mortality. Severe hemorrhagic complications that could appear postpartum are the abdomino-pelvic hematomas, which result from the rupture of the pelvic vessels. We reported a very rare case of puerperal retroperitoneal subserosal hematoma of sigmoid colon following vaginal delivery, which was successfully managed by conservative methods. As far as we know, there are only a few case reports of intramural hematoma of sigmoid colon in literature, having other etiologies than vaginal delivery trauma. The particularities of the case consisted in the association of hemangiomas and the low risk thrombophilia. Diagnosis was based on the clinical exam and the paraclinical founding. Laparotomy is generally considered the last choice, in life threatening cases with hemodynamic instability, compression signs, and presence of contrast leakage on noninvasive imaging methods, but avoiding colonic resection after dissection represented the true challenge of the case. PMID:28255383

  17. Retroperitoneal hematoma after manual reduction of indirect inguinal hernia.

    Science.gov (United States)

    Xu, Xiequn; Hong, Tao; Li, Binglu; Liu, Wei; Zheng, Chaoji; He, Xiaodong

    2013-07-01

    This report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy. The bleeding ruptured inferior epigastric artery at the interior side of the deep inguinal ring was found, the deep inguinal ring was avulsed, ligature of the inferior epigastric artery and removal of the retroperitoneal hematoma were done, and the patient was discharged from hospital on the seventh postoperative day. This is the first report in the literature on retroperitoneal hematoma caused by manual reduction of indirect inguinal hernia.

  18. Lab in a needle for epidural space identification

    Science.gov (United States)

    Carotenuto, B.; Micco, A.; Ricciardi, A.; Amorizzo, E.; Mercieri, M.; Cutolo, A.; Cusano, A.

    2016-05-01

    This work relies on the development of a sensorized medical needle with an all-optical guidance (Lab in a Needle) system for epidural space identification. The device is based on the judicious integration of a Fiber Bragg grating sensor inside the lumen of an epidural needle to discriminate between different types of tissue and thus providing continuous and real time measurements of the pressure experienced by the needle tip during its advancement. Experiments carried out on an epidural training phantom demonstrate the validity of our approach for the correct and effective identification of the epidural space.

  19. Serratia marcescens spinal epidural abscess formation following acupuncture.

    Science.gov (United States)

    Yang, Chih-Wei; Hsu, Shun-Neng; Liu, Jhih-Syuan; Hueng, Dueng-Yuan

    2014-01-01

    The formation of spinal epidural abscess following acupuncture is very rare. We herein report the case of a 54-year-old woman who presented with progressive low back pain and fever with a root sign. She underwent surgical decompression, with an immediate improvement of the low back pain. A culture of the epidural abscess grew Serratia marcescens. One year postoperatively, magnetic resonance imaging revealed the almost complete eradication of the abscess. This case is the first case of Serratia marcescens-associated spinal epidural abscess formation secondary to acupuncture. The characteristics of spinal epidural abscess that develop after acupuncture and how to prevent such complications are also discussed.

  20. Imaging in spinal posterior epidural space lesions: A pictorial essay

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    Foram B Gala

    2016-01-01

    Full Text Available Spinal epidural space is a real anatomic space located outside the dura mater and within the spinal canal extending from foramen magnum to sacrum. Important contents of this space are epidural fat, spinal nerves, epidural veins and arteries. Due to close proximity of posterior epidural space to spinal cord and spinal nerves, the lesions present with symptoms of radiculopathy and/or myelopathy. In this pictorial essay, detailed anatomy of the posterior epidural space, pathologies affecting it along with imaging pearls to accurately diagnose them are discussed. Various pathologies affecting the posterior epidural space either arising from the space itself or occurring secondary to vertebral/intervertebral disc pathologies. Primary spinal bone tumors affecting the posterior epidural space have been excluded. The etiological spectrum affecting the posterior epidural space ranges from degenerative, infective, neoplastic - benign or malignant to miscellaneous pathologies. MRI is the modality of choice in evaluation of these lesions with CT scan mainly helpful in detecting calcification. Due to its excellent soft tissue contrast, Magnetic Resonance Imaging is extremely useful in assessing the pathologies of posterior epidural space, to know their entire extent, characterize them and along with clinical history and laboratory data, arrive at a specific diagnosis and guide the referring clinician. It is important to diagnose these lesions early so as to prevent permanent neurological complication.

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

    Science.gov (United States)

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

    2010-03-01

    Outcome from acute subdural hematoma is often worse than would be expected from the pure increase of intracranial volume by bleeding. The aim was to test whether volume-independent pathomechanisms aggravate damage by comparing the effects of blood infusion with those of an inert fluid, paraffin oil, on intracranial pressure (ICP), cerebral perfusion pressure (CPP), local cerebral blood flow (CBF), edema formation, glucose metabolism ([18F]-deoxyglucose, MicroPET ), and histological outcome. Rats were injured by subdural infusion of 300 muL venous blood or paraffin. ICP, CPP, and CBF changes, assessed during the first 30 mins after injury, were not different between the injury groups at most time points (n=8 per group). Already at 2 h after injury, blood caused a significantly more pronounced decrease in glucose metabolism in the injured cortex when compared with paraffin (P<0.001, n=5 per group). Ipsilateral brain edema did not differ between groups at 2 h, but was significantly more pronounced in the blood-treated groups at 24 and 48 h after injury (n=8 per group). These changes caused a 56.2% larger lesion after blood when compared with paraffin (48.1+/-23.0 versus 21.1+/-11.8 mm(3); P<0.02). Blood constituent-triggered pathomechanisms aggravate the immediate effects due to ICP, CPP, and CBF during hemorrhage and lead to early reduction of glucose metabolism followed by more severe edema and histological damage.

  2. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...... or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant...... antibiotic treatment, signs and symptoms of elevated intracranial pressure resolved completely. Syphilis is a rare, but very important, differential diagnosis that in this case was clinically indistinguishable from IIH....

  3. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K;

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation. T....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  4. Sex differences in intracranial arterial bifurcations

    DEFF Research Database (Denmark)

    Lindekleiv, Haakon M; Valen-Sendstad, Kristian; Morgan, Michael K

    2010-01-01

    Subarachnoid hemorrhage (SAH) is a serious condition, occurring more frequently in females than in males. SAH is mainly caused by rupture of an intracranial aneurysm, which is formed by localized dilation of the intracranial arterial vessel wall, usually at the apex of the arterial bifurcation....... The female preponderance is usually explained by systemic factors (hormonal influences and intrinsic wall weakness); however, the uneven sex distribution of intracranial aneurysms suggests a possible physiologic factor-a local sex difference in the intracranial arteries....

  5. Myelopathy with syringomyelia following thoracic epidural anaesthesia.

    Science.gov (United States)

    Aldrete, J A; Ferrari, H

    2004-02-01

    Under general anaesthesia and muscle relaxation, a thoracic epidural catheter was inserted at the T8-T9 level in a 7-year-old boy scheduled to have a Nissen fundoplication to provide postoperative analgesia. After 4 ml of lignocaine 1.5% was injected through the catheter, hypotension resulted. Fifty-five minutes later 5 ml of bupivacaine 0.25% produced the same effect. In the recovery room a similar injection resulted in lower blood pressure and temporary apnoea. Sensory and motor deficits were noted the next day and four days later magnetic resonance imaging demonstrated spinal cord syringomyelia extending from T5 to T10. Four years later, dysaesthesia from T6 to T10 weakness of the left lower extremity and bladder and bowel dysfunction persist. The risks of inserting thoracic epidural catheters in patients under general anaesthesia and muscle relaxation are discussed, emphasising the possibility of spinal cord injury with disastrous consequences.

  6. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

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

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    Turan Calhan

    2015-01-01

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

  8. Scrotal hematoma as a sign of adrenal hemorrhage in newborns

    Directory of Open Access Journals (Sweden)

    Renata Gonçalves

    Full Text Available CONTEXT: Bluish discoloration and swelling of the scrotum in newborns can arise from a number of diseases, including torsion of the testes, orchitis, scrotal or testicular edema, hydrocele, inguinal hernia, meconium peritonitis, hematocele, testicular tumor and traumatic hematoma. Forty-two cases of scrotal abnormalities as signs of neonatal adrenal hemorrhage were found in the literature. CASE REPORT: We present a case of scrotal hematoma due to adrenal hemorrhage in a newborn. Conservative treatment with clinical follow-up was adopted, with complete resolution within 10 days. The possible differential diagnoses are reviewed and discussed.

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

    Directory of Open Access Journals (Sweden)

    Ji Seon Cheon

    2013-07-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-02-15

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

  11. Ketamina epidural en cirugía de hemiabdomen inferior Epidural ketamine in low abdominal surgery

    Directory of Open Access Journals (Sweden)

    S. F. González-Pérez

    2006-04-01

    Full Text Available Introducción: La ketamina de uso corriente es una droga utilizada principalmente para la inducción y el mantenimiento de la anestesia, compuesta por una mezcla racémica de enantiómeros R (- y S (+. En la década de los años 80 comienza la administración humana de la ketamina por vía epidural. A partir de entonces se han presentado disímiles investigaciones para justificar su acción analgésica en este espacio con varias hipótesis: 1 supresión específica laminar de las astas dorsales, 2 mediación por el sistema opioide endógeno y sustancia gris periacueductal, y 3 bloqueo de los canales del calcio por antagonismo no competitivo de los receptores N-metil-d-aspartato. Objetivo: Demostrar la eficacia de la ketamina por vía epidural como analgésico postoperatorio en la cirugía de hemiabdomen inferior. Material y Método: Se realizó un ensayo clínico aleatorizado y prospectivo en una muestra de 50 pacientes operados de hernia inguinal electiva. Los pacientes fueron divididos en dos grupos, un grupo tratado con 50 mg de ketamina y otro grupo al que se le administró una dosis de 2 mg de morfina liofilizada. Resultados: la ketamina por vía epidural en una dosis de 50 mg proporciona una analgesia adecuada por un período de al menos de 6 horas. La morfina brinda una analgesia por encima de las 18 horas. Conclusión: La ketamina por vía epidural es menos efectiva que la morfina desde el punto de vista analgésico, pero es una alternativa importante pues permite disminuir la dosis de morfina si se combinan ambos fármacos o se asocia a anestésicos locales.Introduction: Ketamine is a drug used for induction and maintenance of anesthesia, exists as a racemic mixture of R- and S+-enantiomers. Epidural ketamine starts to human administration about 80’ years. After that, various studies have been published about the mechanism of analgesic action of ketamine: lamina-specific suppression of dorsal-horn unit activity (1, opiate agonist at

  12. Epidural analgesia and anticoagulant therapy. Experience with one thousand cases of continuous epidurals.

    Science.gov (United States)

    Odoom, J A; Sih, I L

    1983-03-01

    One thousand lumbar epidural blocks in 950 patients undergoing vascular surgery are reported. All patients were receiving oral anticoagulants pre-operatively. Mean thrombotest (TT) was 19.3% (normal range 70-130%). During surgery intravascular heparin was administered. At the end of surgery, the kaolin cephalin clotting time (KCCT) was 68 (+/- 0.8) seconds (normal range 35-60 seconds), and partial thromboplastin time (PTT) was 536 (77.9%, normal control of 100%). Despite the anticoagulant therapy, no side effects were observed in any patient which could be related to haemorrhage or haematoma formation in the epidural space. It is concluded that, provided adequate precautions are taken, epidural analgesia can be safely used in patients receiving anticoagulant therapy.

  13. CT in thrombosed dilated posterior epidural vein

    Energy Technology Data Exchange (ETDEWEB)

    Bammatter, S.; Schnyder, P.; Preux, J. de

    1987-05-01

    The authors report a case of thrombosis of the distal end of an enlarged right posterior epidural vein. The patient had a markedly narrow lumbar canal due to L5 spondylolisthesis. The dilated vein and the thrombosis were displayed by computed tomography but remained unrecognized until surgery. Pathogenesis of this condition is discussed. A review of the English, French and German literature revealed no prior radiological reports of a similar condition.

  14. Intracranial calcification in central diabetes insipidus.

    Science.gov (United States)

    Al-Kandari, Salwa Ramadan; Pandey, Tarun; Badawi, Mona H

    2008-01-01

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification.

  15. Intracranial calcification in central diabetes insipidus

    Energy Technology Data Exchange (ETDEWEB)

    Al-Kandari, Salwa R. [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); Pandey, Tarun [Al Razi Hospital, Department of Clinical Radiology, Kuwait (Kuwait); University of Arkansas for Medical Sciences, Radiology Department, Little Rock, AR (United States); Badawi, Mona H. [Al-Adan Hospital, Department of Paediatrics, Kuwait (Kuwait)

    2008-01-15

    Intracranial calcification is a known but extremely rare complication of diabetes insipidus. To date, only 16 patients have been reported and all had the peripheral (nephrogenic) type of diabetes insipidus. We report a child with intracranial calcification complicating central diabetes insipidus. We also report a child with nephrogenic diabetes insipidus, and compare the patterns of intracranial calcification. (orig.)

  16. Intracranial, intradural aneurysmal bone cyst.

    Science.gov (United States)

    Afnan, Jalil; Snuderl, Matija; Small, Juan

    2015-01-01

    Aneurysmal bone cysts (ABCs) are benign, expansile, blood-filled, osteolytic lesions with internal septations that may be intraosseous or extraosseous. The cysts may cause local mass effect, and changes in the regional vascular supply necessitating intervention. A case of an intracranial, intradural ABC in a young male patient with progressively severe headaches is presented. This is only the third recorded intradural case, the majority of these rare lesions being extracranial and only a minute fraction intracranial. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Syphilis mimicking idiopathic intracranial hypertension

    DEFF Research Database (Denmark)

    Yri, Hanne; Wegener, Marianne; Jensen, Rigmor

    2011-01-01

    or an atypical disease course should alert the physician to reevaluate a presumed IIH-diagnosis. The authors report a case of a 32-year-old non-obese male with intracranial hypertension, secondary to a syphilitic central nervous system infection, initially misdiagnosed as being idiopathic. Upon relevant......Idiopathic intracranial hypertension (IIH) is a condition of yet unknown aetiology affecting predominantly obese females of childbearing age. IIH is a diagnosis of exclusion as raised cerebrospinal fluid pressure may occur secondary to numerous other medical conditions. An atypical phenotype...

  18. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication.

    Science.gov (United States)

    Panourias, Ioannis G; Skandalakis, Panajiotis N

    2006-06-01

    Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.

  19. Epidural anesthesia in repeated cesarean section.

    Directory of Open Access Journals (Sweden)

    Rolando T. Espín González

    2003-04-01

    Full Text Available Background: A spectacular development has been experimented in the Anesthesiology branch in the last few years in the different areas of its competence in which the attendance activity on obstetric patients as well as every aspect related with its adequate practice is of a great importance. Objective: to evaluate the efficacy of epidural anesthesia in repetitive cesarean. Methods: a descriptive retrospective study of a series of cases (112in which epidural anesthesia in repetitive cesarean was applied from January 2001 to December 2001 in the surgical unit of the Gynecological obstetric service at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in Cienfuegos city, Cuba. Some variables such as fixation time of the anesthesia, its duration, transurgical and postsurgical hemodynamic behavior, complications related with the anesthesia, evaluation of the new born baby and, the level of satisfaction of the patients were analyzed. Results: The immediate transurgical and postsurgical hemodynamic behavior was stable predominating normotension and the normal cardiac frequency. The complications related to anesthesia were minimal. The level of satisfaction of the patients was elevated. No alterations in new born babies were presented. As a conclusion, it may be stated that epidural anesthesia in repetitive cesarean is a safety and reliable anesthetic method.

  20. Epidural analgesia in cattle, buffalo, and camels

    Directory of Open Access Journals (Sweden)

    Zuhair Bani Ismail

    2016-12-01

    Full Text Available Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1 and first intercoccygeal intervertebral space (Co1-Co2. The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg, bupivacaine (0.125 mg/kg, ropivacaine (0.11 mg/kg, xylazine (0.05 mg/kg, medetomidine (15 μg/kg, romifidine (30-50 μg/kg, ketamine (0.3-2.5 mg/kg, tramadol (1 mg/kg, and neostigmine (10 μg/kg, and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  1. Epidural anesthesia in agoutis (Dasyprocta azarae

    Directory of Open Access Journals (Sweden)

    Leandro Luis Martins

    2010-06-01

    Full Text Available In this research, the epidural anesthesia technique in nulliparous and non non-nulliparous submitted to ovarysalpingohysterectomy was studied. These are rodents belonging to the “Missina Palmeira Zancaner” municipal zoo of catanduva in São Paulo. The tranquilizationwas achieved using azaperone (4mg/kg and meperidine (4mg/kg followed by injection of cetamine (20mg/kg and xylazine (0.4mg/kg, intramuscularly from the same syringe. Subsequently, lidocaine (5mg/kg was injected into the lumbosacral space. The time of latency of the anesthesic association (4.0±1.51min, time of latency of epidural lidocaine (6.87±2.35min and time of analgesia (115.0±12.49min were analyzed, in addition to rectal temperature, which decreased 2.12±0.86°C on average from the beginning of the anesthesia to the end of its effective time. All animals recovered satisfactorily without presenting signs of excitation or complications due to the epidural tecnique. It was concluded that the balanced anesthesia tecnique provided adequate analgesia during a time considered sufficient for several procedures, by means of low doses of xylazine and ketamine.

  2. Epidural analgesia in cattle, buffalo, and camels.

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-12-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed.

  3. Epidural analgesia in cattle, buffalo, and camels

    Science.gov (United States)

    Ismail, Zuhair Bani

    2016-01-01

    Epidural analgesia is commonly used in large animals. It is an easy, cheap, and effective technique used to prevent or control pain during surgeries involving the tail, anus, vulva, perineum, caudal udder, scrotum, and upper hind limbs. The objectives of this article were to comprehensively review and summarize all scientific data available in the literature on new techniques and drugs or drug combinations used for epidural anesthesia in cattle, camel, and buffalo. Only articles published between 2006 and 2016 were included in the review. The most common sites for epidural administration in cattle, camels, and buffalos were the sacrococcygeal intervertebral space (S5-Co1) and first intercoccygeal intervertebral space (Co1-Co2). The most frequently used drugs and dosages were lidocaine (0.22-0.5 mg/kg), bupivacaine (0.125 mg/kg), ropivacaine (0.11 mg/kg), xylazine (0.05 mg/kg), medetomidine (15 µg/kg), romifidine (30-50 µg/kg), ketamine (0.3-2.5 mg/kg), tramadol (1 mg/kg), and neostigmine (10 µg/kg), and the clinical applications, clinical effects, recommendations, and side effects were discussed. PMID:28096620

  4. Percutaneous epidural drainage through a burr hole

    Directory of Open Access Journals (Sweden)

    Priscila M Falsarella

    2016-01-01

    Full Text Available Intracranial extradural collection may cause an increase in intracranial pressure, requiring rapid emergency treatment to reduce morbidity and mortality. We described an alternative CT-guided percutaneous access for extradural collection drainage. We report a case of a patient with previous craniectomy for meningioma ressection who presented to the Emergency Department with symptoms of intracranial hypertension. Brains CT showed a extradural collection with subfalcine herniation. After multidisciplinary discussion a CT-guided percutaneous drainage through previous burr hole was performed. The patient was discharged after 36 hours of admission, without further symptoms. We describe a safe and effective alternative percutaneous access for extradural collection drainage in patients with previous burr hole.

  5. BENIGN INTRACRANIAL HYPOTENSION WITH INCIDENTAL PARASAGITTAL MENINGIOMA

    Directory of Open Access Journals (Sweden)

    Sukumar

    2015-12-01

    Full Text Available Benign intracranial hypotension, otherwise called as idiopathic intracranial hypotension is caused by CSF leaks due to disruption in spinal meninges. It is most commonly caused by disruption and leak at cervical and thoracic spine. Imaging is sometimes the most important key to the diagnosis of idiopathic intracranial hypotension, which helps in appropriate treatment of the patient. Here, we are presenting a case of benign intracranial hypotension associated with incidental parasagittal meningioma. The presence of benign intracranial hypotension was confirmed by taking MR myelogram.

  6. Feasibility of high-resolution MR imaging for the diagnosis of intracranial vertebrobasilar artery dissection

    Energy Technology Data Exchange (ETDEWEB)

    Han, Miran; Rim, Nae-Jung; Kim, Sun Yong; Choi, Jin Wook [Ajou University School of Medicine, Ajou University Medical Center, Department of Radiology, Suwon (Korea, Republic of); Lee, Jin Soo [Ajou University School of Medicine, Ajou University Medical Center, Department of Neurology, Suwon (Korea, Republic of)

    2014-12-15

    To evaluate the feasibility of high-resolution MRI (HR-MRI) for diagnosing intracranial vertebrobasilar artery dissection (VBD) and to identify the most useful imaging findings suggesting dissection. We retrospectively reviewed 50 patients with suspected intracranial VBDs who underwent HR-MRI. Two neuroradiologists independently reviewed the HR-MR images. The diagnosis based on HR-MRI was compared with the final diagnosis by consensus among the neuroradiologists, neurointerventionist, and neurologist. Two neuroradiologists also sought signs of dissection (mural hematoma, dissection flap, outer-diameter enlargement on T2WI of steno-occlusive lesions). Inter- and intraobserver agreements were analysed. HR-MRI corroborated the final diagnosis in 47 (94 %; 31 VBD and 16 non-VBD) patients. A mural haematoma was best detected on T1WI and contrast-enhanced (CE)-T1WI (54.3 %). Dissection flaps were observed in almost all cases on CE-T1WI (91.4 %), and then were detected on T2WI (68.6 %). Outer-diameter enlargement of the steno-occlusive lesions on angiography was detected in more than half of the cases (62.9 %). The two reviewers showed almost perfect agreement for the diagnosis of VBD and detecting dissection signs on every sequence. HR-MRI can be a useful and non-invasive diagnostic tool for intracranial VBD, and dissection flaps on CE-T1WI are the signs with the greatest diagnostic value. (orig.)

  7. Imaging intracranial tuberculosis in childhood

    Energy Technology Data Exchange (ETDEWEB)

    Jamieson, D.H. [Dept. of Radiology, Red Cross War Memorial Children`s Hospital, Rondebosch (South Africa)

    1995-05-01

    A morphologically based imaging review of intracranial tuberculosis in childhood is presented. The computed tomography and magnetic resonance features of parenchymal tuberculoma, tuberculous meningitis and meningeal/meniningocerebral tuberculoma are illustrated. Recent insight into the nature of tuberculoma necrosis and its magnetic resonance correlation is reviewed. Pathogenesis, relevant clinical background and the role of modern imaging is discussed. (orig.)

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

    Directory of Open Access Journals (Sweden)

    Chang Patricia

    2011-04-01

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

  9. Intramural hematoma of the esophagus : Appearance on magnetic resonance imaging

    NARCIS (Netherlands)

    Kamphuis, AGA; Baur, CHJCM; Freling, NJM

    1995-01-01

    A 73-yr-old woman on anticoagulant therapy experienced progressive dyspnea and dysphagia due to a large compressing mass in the posterior mediastinum. Because her clinical condition deteriorated rapidly surgery was performed. A large intramural hematoma along the full length of the esophagus with di

  10. Cerebral atrophy after acute traumatic subdural orextradural hematomas in adults

    Institute of Scientific and Technical Information of China (English)

    冯海龙; 谭海斌; 黄光富; 廖晓灵

    2002-01-01

    @@ Cerebral atrophy is one of the serious sequelae ofsevere head injury. 1 Neuropathologicalinvestigation has revealed that cerebral atrophy iscaused by either diffuse axonal injury or cerebralhypoxia and ischemia. Secondary ipsilateral cerebralatrophy caused by acute subdural hematomas in infantshas been reported recently, but this unilateral cerebralatrophy after head injury in adult patients has rarelybeen reported.

  11. Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion

    OpenAIRE

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-01-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  12. Roseomonas spinal epidural abscess complicating instrumented posterior lumbar interbody fusion.

    Science.gov (United States)

    Maraki, Sofia; Bantouna, Vasiliki; Lianoudakis, Efstratios; Stavrakakis, Ioannis; Scoulica, Efstathia

    2013-07-01

    The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.

  13. Extensive spinal epidural abscess as a complication of Crohn's disease.

    Science.gov (United States)

    Smith, Chez; Kavar, Bhadrakant

    2010-01-01

    A spinal epidural abscess is a neurosurgical emergency. Successful treatment frequently requires decompression of the spinal canal in combination with intravenous antibiotics. We report a patient with Crohn's disease who developed an extensive spinal epidural abscess communicating with an intra-abdominal collection.

  14. Minimally invasive treatment of multilevel spinal epidural abscess.

    Science.gov (United States)

    Safavi-Abbasi, Sam; Maurer, Adrian J; Rabb, Craig H

    2013-01-01

    The use of minimally invasive tubular retractor microsurgery for treatment of multilevel spinal epidural abscess is described. This technique was used in 3 cases, and excellent results were achieved. The authors conclude that multilevel spinal epidural abscesses can be safely and effectively managed using microsurgery via a minimally invasive tubular retractor system.

  15. Epidural anesthesia, hypotension, and changes in intravascular volume

    DEFF Research Database (Denmark)

    Holte, Kathrine; Foss, Nicolai B; Svensén, Christer;

    2004-01-01

    BACKGROUND: The most common side effect of epidural or spinal anesthesia is hypotension with functional hypovolemia prompting fluid infusions or administration of vasopressors. Short-term studies (20 min) in patients undergoing lumbar epidural anesthesia suggest that plasma volume may increase wh...

  16. Acute onset headache complicating labor epidural caused by intrapartum pneumocephalus.

    Science.gov (United States)

    Smarkusky, Loren; DeCarvalho, Helena; Bermudez, Ady; González-Quintero, Víctor Hugo

    2006-09-01

    Epidural placement for obstetric anesthesia is a common procedure. Pneumocephalus, the introduction of air into the cranial cavity after epidural placement, is a rare complication encountered when air is used for identification of the epidural space. A 42-year-old primipara undergoing epidural placement reported sudden onset of severe headache with associated neurologic symptoms and nuchal rigidity. Emergent CT scan revealed pneumocephalus. With conservative management, her symptoms resolved with interval resumption of the air collection evidenced on interval CT. Acute onset headache after epidural placement can present with impressive neurologic signs and symptoms. Prompt identification of the cause of this pathology is of vital importance to delineate pneumocephalus from potentially treatable or life-threatening disorders.

  17. Citrobocter kasori spinal epidural abscess: a rare occurrence.

    Science.gov (United States)

    Kumar, Ashok; Jain, Pramod; Singh, Pritish; Divthane, Rupam; Badole, C M

    2013-01-01

    Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. MRI pointed towards an epidural abscess extending from T12 vertebral level to S1 vertebral level. Surgical decompression in the form of laminectomy and evacuation of pus was done and antibiotics were given according to culture and sensitivity. Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.

  18. Effects of 4% Icodextrin on Experimental Spinal Epidural Fibrosis.

    Science.gov (United States)

    Karanci, Turker; Kelten, Bilal; Karaoglan, Alper; Cinar, Nilgun; Midi, Ahmet; Antar, Veysel; Akdemir, Hidayet; Kara, Zeynep

    2017-01-01

    The aim of this experimental study was to investigate whether spinal epidural 4% glucose polymer solution is effective in the prevention of postoperative fibrosis. Twenty eight adult Wistar albino rats were randomly divided into two equal groups, including treatment and control. Both groups underwent L1 vertebral total laminectomy to expose the dura. Topical treatment group received 4% icodextrin. Four weeks later, epidural fibrosis was examined in both groups histologically, biochemically and macroscopically. Topical use of 4% icodextrin prevented significantly epidural fibrosis following the laminectomy operation. Topical 4% icodextrin application inhibits postoperative epidural fibrosis with various mechanisms and prevents adhesions by playing barrier role between tissue surfaces through flotation. Our study is first to present evidence of experimental epidural fibrosis prevention with 4% icodextrin.

  19. [Targeted small craniotomy and evacuation for subscute subdural hematomas: technical report of two cases].

    Science.gov (United States)

    Tanaka, Masaki; Kurita, Hiroki; Shiokawa, Yoshiaki

    2005-02-01

    The etiology and proper treatment of symptomatic subacute subdural hematomas remains to be elucidated. We describe two cases of this entity successfully treated with small craniotomy and evacuation. Both patients initially treated conservatively for traumatic thin subdural hematomas because of poor medical condition and mild neurological symptoms, but suffered abrupt neurological deterioration between 2 and 3 weeks after the admission. CT scan showed decreased density of hematomas with minimal increase in volume, and significant swelling of ipsilateral cerebral hemisphere. Urgent two-burr-hole small craniotomy was effective for evacuation of partially organized hematoma. During surgery, definite hematoma membrane was not confirmed. Postoperatively, brain swelling rapidly disappeared and both patients discharged ambulatory without neurological deficit. The present cases are a reminder of this peculiar type of hematoma in patients with delayed neurological deterioration after nonsurgical management of acute subdural hematoma. The rationale for use of small craniotomy is discussed in terms of current understanding of pathogenetic mechanism for this unusual condition.

  20. Spinal epidural abscess presenting as intra-abdominal pathology: a case report and literature review.

    Science.gov (United States)

    Bremer, Andrew A; Darouiche, Rabih O

    2004-01-01

    Spinal epidural abscess is a rare infectious disease. However, if left unrecognized and untreated, the clinical outcome of spinal epidural abscess can be devastating. Correctly diagnosing a spinal epidural abscess in a timely fashion is often difficult, particularly if the clinician does not actively consider the diagnosis. The most common presenting symptoms of spinal epidural abscess include backache, radicular pain, weakness, and sensory deficits. However, early in its course, spinal epidural abscess can also present with vague and nondescript manifestations. In this report, we describe a case of spinal epidural abscess presenting as abdominal pain, and review the literature describing other cases of spinal epidural abscess presenting as intra-abdominal pathology.