Outcome in Chronic Subdural Hematoma After Subdural vs. Subgaleal Drain.

Science.gov (United States)

Ishfaq, Asim

2017-07-01

To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. Quasi experimental study. Combined Military Hospital, Lahore, from July 2015 to June 2016. Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space (Group 1), and subdual space (Group 2), (n=31 patients each). Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p hematoma was 15 ±6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 (35.4%) vs. 6 (19.3%), and intracerebral hemorrhage 4 (12.9%) vs. 2 (6.4%). Clinical outcome was good in both groups 27 (87%) in Group 1 and 28 (90%) in Group 2. Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another.

Intracranial hemorrhage of the mature newborn infant

International Nuclear Information System (INIS)

Takemine, Hisao

1983-01-01

Concerning four mature newborn infants with intracranial hemorrhage diagnosed by CT, the labour course, treatment, and prognoses were discussed. 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 severeness 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. (Ueda, J.)

Outcome in Chronic Subdural Hematoma After Subdural vs. Subgaleal Drain

International Nuclear Information System (INIS)

Ishfaq, A.

2017-01-01

Objective: To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital, Lahore, from July 2015 to June 2016. Methodology: Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space (Group 1), and subdual space (Group 2), (n=31 patients each). Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p <0.05 was utilized using Statistical Package of Social Sciences (SPSS version 17). Results: Median age of the 62 patients was 72 +-12.5 years. Headache was the most common symptom reported in both groups, (n=47,75.8%) patients. Median thickness of hematoma was 15 +-6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 (35.4%) vs. 6 (19.3%), and intracerebral hemorrhage 4 (12.9%) vs. 2 (6.4%). Clinical outcome was good in both groups 27 (87%) in Group 1 and 28 (90%) in Group 2. Conclusion: Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another. (author)

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

Directory of Open Access Journals (Sweden)

Leodante B. Costa Jr

2004-03-01

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

Traumatic subdural hematoma in the lumbar spine.

Science.gov (United States)

Song, Jenn-Yeu; Chen, Yu-Hao; Hung, Kuang-Chen; Chang, Ti-Sheng

2011-10-01

Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits. Copyright © 2011. Published by Elsevier B.V.

MRI Findings of Early-Stage Hyperacute Hemorrhage Causing Extramedullary Compression of the Cervical Spinal Cord in a Dog with Suspected Steroid-Responsive Meningitis-Arteritis

Directory of Open Access Journals (Sweden)

Adriano Wang-Leandro

2017-09-01

Full Text Available A 9-month-old female Weimaraner was presented to the emergency service due to episodes of fever and neck pain. Physical examination revealed a stiff neck posture and elevated body temperature. Shortly after clinical examination was performed, the dog developed peracute onset of non-ambulatory tetraparesis compatible with a C1–C5 spinal cord (SC lesion. Immediately thereafter (<1 h, MRI of the cervical SC was performed with a 3-T scanner. A left ventrolateral intradural-extramedullary SC compression caused by a round-shaped structure at the level of C3––C4 was evidenced. The structure was iso- to slightly hyperintense in T1-weighted (T1W sequences compared to SC parenchyma and hyperintense in T2-weighted, gradient echo, and fluid-attenuated inversion recovery. Moreover, the structure showed a strong homogeneous contrast uptake in T1W sequences. Cerebrospinal fluid (CSF analysis revealed a mixed pleocytosis, as well as elevated protein and erythrocyte count. Early-stage hyperacute extramedullary hemorrhage was suspected due to immune mediated vasculitis. The dog was maintained under general anesthesia and artificial ventilation for 24 h and long-term therapy with corticosteroids and physiotherapy was initiated. Eight weeks after initial presentation, the dog was ambulatory, slightly tetraparetic. Follow-up MRI showed a regression of the round-shaped structure and pleocytosis was not evident in CSF analysis. This report describes an early-stage hyperacute extramedullary hemorrhage, a condition rarely recorded in dogs even in experimental settings.

Subdural Instillation of a Thrombolytic Agent for Treatment of Recurrent Subdural Hematoma.

Science.gov (United States)

Frenkel, Mark B; Sarwal, Aarti; Wren, Mary Petrulis; Newey, Christopher R; Couture, Daniel E

This study aims to report the case of a patient with recurrent subdural hemorrhage (SDH) who was administered tissue plasminogen activator through a subdural drain to enhance drainage and prevent recurrence. An 85-year-old man was treated for subacute over chronic SDH that kept on reaccumulating despite serial twist drill drainage, burr hole drainage, and craniotomy. No coagulopathy was identified with adequate blood pressure control. Treatment with tissue plasminogen activator resulted in successful drainage of the SDH, and the patient had no further recurrence at 9-month follow-up.

Acute Intracranial and Spinal Subdural Hematoma Associated with Vardenafil.

Science.gov (United States)

Nakamura, Takaaki; Watanabe, Genya; Harada, Ryuhei; Kawasaki, Emiko; Tsukita, Kenichi; Suzuki, Yasushi

2018-05-02

A 28-year-old healthy man was admitted to our hospital because of right-sided headache, vomiting, and lower back pain after the administration of vardenafil. Computed tomography and magnetic resonance imaging of the brain showed a small, right-sided, subdural hematoma. A lumbar magnetic resonance imaging showed a longitudinally extended subdural hematoma. He had no history of trauma. We speculated that vardenafil might have had an association with the bleeding. Several reports have suggested a relationship between phosphodiesterase-5 inhibitors and intracerebral or subarachnoid hemorrhage. Our case suggested that there may also be risks of bleeding into the subdural space. Although headache and nausea are common side effects of vardenafil, hemorrhagic diseases should also be considered when symptoms are severe or prolonged. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Clinically silent subdural hemorrhage causes bilateral vocal fold paralysis in newborn infant.

Science.gov (United States)

Alshammari, Jaber; Monnier, Yan; Monnier, Philippe

2012-10-01

Bilateral congenital vocal fold paralysis (BVFP) may result from multiple etiologies or remain idiopathic when no real cause can be identified. If obstructive dyspnea is significant and requires urgent stabilization of the airway, then intubation is performed first and an MRI of the brain is conducted to rule out an Arnold-Chiari malformation that can benefit from a shunt procedure and thus alleviate the need for a tracheostomy. Clinically silent subdural hemorrhage without any birth trauma represents another cause of neonatal BVFP that resolves spontaneously within a month. It is of clinical relevance to recognize this potential cause of BVFP as its short duration may alleviate the need for a tracheostomy. In this article, we present such a case and review the literature to draw the otolaryngologist's attention to this possible etiology. Copyright © 2012. Published by Elsevier Ireland Ltd.

Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature

Science.gov (United States)

Shekarchizadeh, Ahmad; Masih, Saburi; Reza, Pourkhalili; Seif, Bahram

2017-01-01

The present report describes an acute subdural hematoma (ASDH) associated with subarachnoid hemorrhage (SAH), due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT) scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows. PMID:28503501

Symptomatic Acute-on-Chronic Subdural Hematoma: A Clinicopathological Study.

Science.gov (United States)

Castellani, Rudy J; Mojica-Sanchez, Gruschenka; Schwartzbauer, Gary; Hersh, David S

2017-06-01

The pathophysiology of acute-on-chronic subdural hematoma (ACSDH) is complex and incompletely understood. Evidence to date indicates that the overall process is initiated by rotational force with movement of the brain inside the skull, which exerts tensile strain and rupture of bridging veins, leading in turn to acute hemorrhage in the subdural potential space. This is followed by the proliferation of mesenchymal elements with angiogenesis and inflammation, which in turn becomes a substrate for repeated hemorrhage and expansion of the lesion. Given the prevalence of traumatic subdural processes in the forensic setting and the importance of proper assessment of timing, etiology, risk factors, and clinicopathological correlation, we studied 47 patients presenting to the University of Maryland Shock Trauma Center, all of whom underwent craniotomy with resection of the outer membrane due to symptomatic ACSDH. The surgically resected tissue was examined for histopathologic features in all cases. Our findings highlight that ACSDH is a condition precipitated by trauma that affects middle-aged and older adults, is relatively indolent, is unilateral or asymmetric, and has a low in-hospital mortality rate. Pathological analysis demonstrates a substantial outer membrane in all cases with varying degrees of inflammation and organization that cannot be precisely dated as a function of clinical presentation. The extrapolation of adult ACSDH to mixed acute and chronic subdural hemorrhage in the pediatric setting is problematic due to substantial differences in clinical presentation, severity of underlying brain injury, gross and microscopic findings, and outcome.

CT findings of subdural fluid collections and the histology of the organized neomembrane, (1)

International Nuclear Information System (INIS)

Shibata, Taichiro; Nitta, Masahiro; Fukuoka, Hidekazu; Umemura, Satoshi; Nagai, Hajime

1981-01-01

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

Spreading depolarizations in patients with spontaneous intracerebral hemorrhage

DEFF Research Database (Denmark)

Helbok, Raimund; Schiefecker, Alois Josef; Friberg, Christian

2017-01-01

, subarachnoid hemorrhage and traumatic brain injury patients. Its role in intracerebral hemorrhage patients and in particular the association with perihematomal-edema is not known. A total of 27 comatose intracerebral hemorrhage patients in whom hematoma evacuation and subdural electrocorticography...... was performed were studied prospectively. Hematoma evacuation and subdural strip electrode placement was performed within the first 24 h in 18 patients (67%). Electrocorticography recordings started 3 h after surgery (IQR, 3-5 h) and lasted 157 h (median) per patient and 4876 h in all 27 patients. In 18...

Radiologic findings of acute spontaneous subdural hematomas

Energy Technology Data Exchange (ETDEWEB)

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

1998-03-01

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

Scalp Nerve Block pada Kraniotomi Evakuasi Pasien Moderate Head Injury dengan Subdural Hemorrhage dan Intracerebral Hemorrhage Frontotemporoparietal Dekstra Mencegah Stress Response Selama dan Pascabedah

Directory of Open Access Journals (Sweden)

Mariko Gunadi

2013-12-01

Full Text Available Skin incision and craniotomy are recognized as an acute noxious stimulation during intracranial surgery which may result in stress response causing an increase in intracranial pressure. Scalp nerve block may be effective in reducing stress response. It can also be used to provide post-operative analgesia. A twenty two years old male with moderate head injury, subdural hemorrhage, intracerebral hemorrhage at right fronto-temporo-parietal region underwent evacuation craniotomy with combined scalp nerve block and general anesthesia at Dr. Hasan General Sadikin Hospital Bandung on August 14th 2012. After induction and before incision of the skin, a scalp nerve block was performed using 0.5% bupivacaine. Hemodynamic (blood pressure and heart rate changes after incision of the skin and craniotomy were not significant, and so was post-operative blood glucose concentration. Post-operative analgetic was given eight hours after the block. The result demonstrates that scalp nerve block using 0.5% bupivacaine successfully blunts stress response and can be used as post-operative analgesia.

Correlation of magnetic resonance imaging findings of spinal intradural extramedullary schwannomas with pathologic findings

Energy Technology Data Exchange (ETDEWEB)

Kim, Yeo Ju; Park, In Suh; Yoon, Seung Hwan; Choi, Suk Jin; Kim, Youn Jeong; Kang, Young Hye; Lee, Ha Young; Kim, Woo Chul; Han, Jun Gu; Cho, Soon Gu [Inha University Hospital, Incheon (Korea, Republic of)

2015-06-15

To evaluate the magnetic resonance imaging (MRI) findings of spinal intradural extramedullary schwannomas with pathologic correlation and to determine whether these schwannomas share the imaging features of schwannomas in the peripheral nerves. The MRIs of 17 cases of pathologically proven spinal intradural extramedullary schwannomas were reviewed retrospectively, and cystic changes, enhancement, and intratumoral hemorrhage of the tumors were evaluated. Imaging features known to be common findings of schwannoma in the peripheral nerves, such as encapsulation, the target sign, the fascicular sign, and visualization of entering or exiting nerve rootlets, were also evaluated. The histopathology of the tumors was correlated with the MRI findings. Cystic changes were detected in 14 cases by MRI and in 16 cases by pathology. The most common pattern of enhancement was a thick peripheral septal pattern (70.59%). Intratumoral hemorrhage was detected in four cases on MRI, but in all cases on pathology. Encapsulation was observed in all cases. The fascicular sign was seen in only four cases, and thickening of an exiting rootlet was visualized in one case. None of the cases showed the target sign. Spinal intradural extramedullary schwannomas were typical encapsulated cystic tumors and had few imaging features of schwannomas in the peripheral nerves.

[Traumatic intracerebral hemorrhage developing in the apparent course].

Science.gov (United States)

Fujiwara, S; Nishimura, A; Yanagida, Y; Nakagawa, K; Mizoi, Y; Tatsuno, Y

1991-06-01

The victim, 52 year old man, was thrust down and hit his left occiput against the concrete floor. He was hospitalised and his comatose state continued to the death. On admission, blood pressure was 212/110 mmHg and the computed tomography scan of the head showed only an extensive right subdural hematoma. But the intracerebral hemorrhages in the right frontal, temporal and parietal lobes were recognized 10.5 hours after the trauma. A subdural hematoma was evacuated by operation on the second hospital day. The intracerebellar hemorrhage also appeared 16 hours after the trauma. Blood pressure fluctuated between 160/80 and 200/110 mmHg. The photo of CT scan at 38.5 hours after the trauma showed little subdural hematoma and new intracerebral hemorrhage located in the left temporal lobe. On the third hospital day, he was equipped with a respirator and blood pressure was between 132/84 and 242/100 mmHg. The reaction of the pupils to light disappeared on the 8th hospital day. Blood pressure gradually decreased on the 9th and 10th hospital days and he died on the 11th day. Autopsy revealed a bruise in the left occiput, a linear fracture in the frontal and left parietal bones and a small amount of subdural hematoma on the surface of the right cerebral hemisphere. Cortical contusions were found in the right frontal, the both temporal and the left parietal lobes. Intracerebral hemorrhages were found in the right frontal, the both temporal and the right parietal lobes. Intracerebellar hemorrhage was also found. Cardiac hypertrophy and atherosclerosis of the aorta were recognized. We thought that small hemorrhages which were not clearly detectable by CT scan immediately after injury may have developed into massive intracerebral and intracerebellar hemorrhages due to high blood pressure after a hospitalization.

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

International Nuclear Information System (INIS)

Takahashi, Yoshio; Mikami, Junichi; Sato, Hiroyuki; Takeda, Satoshi; Matsuoka, Takahiro

1982-01-01

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

Analysis of infantile subdural hematoma caused by abuse

International Nuclear Information System (INIS)

Park, Young-Soo; Nishio, Kenji; Fujimoto, Takatoshi; Nakase, Hiroyuki; Okuchi, Kazuo

2010-01-01

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

Prevalence of subdural collections in children with macrocrania.

Science.gov (United States)

Greiner, M V; Richards, T J; Care, M M; Leach, J L

2013-12-01

The relationship between enlarged subarachnoid spaces and subdural collections is poorly understood and creates challenges for clinicians investigating the etiology of subdural collections. The purpose of this study was to determine the prevalence of subdural collections on cross sectional imaging in children with macrocephaly correlating with subarachnoid space enlargement. The radiology information system of a large pediatric medical center was reviewed for "macrocrania" and "macrocephaly" on reports of cranial MRI/CT examinations in children collection presence and subarachnoid space size. Children with prior cranial surgery, parenchymal abnormalities, hydrocephalus, or conditions predisposing to parenchymal volume loss were excluded. Chart review was performed on those with subdural collections. Imaging from 177 children with enlarged head circumference was reviewed. Nine were excluded, for a final cohort of 168 subjects (108 with enlarged subarachnoid space). Subdural collections were identified in 6 (3.6%), all with enlarged subarachnoid space (6/108, 5.6%). In 4, subdural collections were small, homogeneous, and nonhemorrhagic. In 2, the collections were complex (septations or hemorrhage). Two children were reported as victims of child abuse (both with complex collections). No definitive etiology was established in the other cases. The prevalence of subdural collections in imaged children with macrocrania was 3.6%, all occurring in children with enlarged subarachnoid space. Our results suggest that enlarged subarachnoid space can be associated with some subdural collections in this cohort. Despite this, we believe that unexpected subdural collections in children should receive close clinical evaluation for underlying causes, including abusive head trauma.

Follow up study and interested cases in subdural hematoma

International Nuclear Information System (INIS)

Kano, Mitsumasa; Goh, Jyunto; Koomura, Eiji; Nakao, Kazutami

1983-01-01

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

Extramedullary plasmocytomas

International Nuclear Information System (INIS)

Ben Salah, H.; Daoud, J.; Hdiji, S.; Elloumi, M.; Makni, S.; Boudawara, T.; Ghorbel, A.M.

2012-01-01

Purpose. - To study the localization, treatment and prognosis of extramedullary plasmocytoma through a series of eight patients and a literature review. Patients and methods. - Eight patients with extramedullary plasmocytoma were treated in the university's hospital of Sfax in Tunisia. The average age was 57.3 years. Female represented 75% of patients. The diagnosis of plasmocytoma was based on anatomo-pathology and immunohistochemistry of a biopsy or resected tumour. Extramedullary location was confirmed if biological and radiological exams and medullary biopsy were normal. The therapeutic decision was made after multidisciplinary meetings regarding tumour location and anterior treatment. Results. - Solitary extramedullary plasmocytoma was located in nasal cavity, cervical node, testis, ovary, bladder and the tongue. One patient was treated for three simultaneous locations of extramedullary plasmocytoma (node, bowel, pleura) without evidence of myeloma. Radiotherapy was proposed in six cases but refused in one case (plasmocytoma of the bladder is currently receiving radiotherapy). Treatment consisted in chemotherapy in two cases. Evaluation after treatment revealed complete remission in 86% of the cases. Nodal recurrence was noted in two cases. These two patients were lost to follow up. The five other patients were in complete remission after a mean follow up of 5.7 years. No local recurrence or myeloma was noted. Conclusion. - Extramedullary plasmocytoma is a rare affection. It can occur in any region of the body. Head and neck is most frequent localization. The treatment is irradiation or surgery in some localization. Progression to myeloma is the most important factor that influences the prognosis of the disease. (authors)

Postoperative subdural hygroma and chronic subdural hematoma after unruptured aneurysm surgery: age, sex, and aneurysm location as independent risk factors.

Science.gov (United States)

Park, Jaechan; Cho, Jae-Hoon; Goh, Duck-Ho; Kang, Dong-Hun; Shin, Im Hee; Hamm, In-Suk

2016-02-01

This study investigated the incidence and risk factors for the postoperative occurrence of subdural complications, such as a subdural hygroma and resultant chronic subdural hematoma (CSDH), following surgical clipping of an unruptured aneurysm. The critical age affecting such occurrences and follow-up results were also examined. The case series included 364 consecutive patients who underwent aneurysm clipping via a pterional or superciliary keyhole approach for an unruptured saccular aneurysm in the anterior cerebral circulation between 2007 and 2013. The subdural hygromas were identified based on CT scans 6-9 weeks after surgery, and the volumes were measured using volumetry studies. Until their complete resolution, all the subdural hygromas were followed using CT scans every 1-2 months. Meanwhile, the CSDHs were classified as nonoperative or operative lesions that were treated by bur-hole drainage. The age and sex of the patients, aneurysm location, history of a subarachnoid hemorrhage (SAH), and surgical approach (pterional vs superciliary) were all analyzed regarding the postoperative occurrence of a subdural hygroma or CSDH. The follow-up results of the subdural complications were also investigated. Seventy patients (19.2%) developed a subdural hygroma or CSDH. The results of a multivariate analysis showed that advanced age (p = 0.003), male sex (p 60 years, which achieved a 70% sensitivity and 69% specificity with regard to predicting such subdural complications. The female patients ≤ 60 years of age showed a negligible incidence of subdural complications for all aneurysm groups, whereas the male patients > 60 years of age showed the highest incidence of subdural complications at 50%-100%, according to the aneurysm location. The subdural hygromas detected 6-9 weeks postoperatively showed different follow-up results, according to the severity. The subdural hygromas that converted to a CSDH were larger in volume than the subdural hygromas that resolved

Extramedullary plasmacytoma involving perirenal space accompanied by extramedullary hematopoiesis and amyloid deposition.

Science.gov (United States)

Mimura, Rie; Kamishima, Tamotsu; Kubota, Kanako C; Nakano, Fumihito; Yabe, Ichiro; Sasaki, Hidenao; Maruyama, Satoru; Shinohara, Nobuo; Harris, Ardene A; Haga, Hironori; Shirato, Hiroki; Terae, Satoshi

2010-05-01

A 62-year-old man was referred to us after unsuccessful treatment of bilateral weakness in his upper and lower extremities with paresthesia in both lower extremities. Computed tomography (CT) revealed soft tissue masses in the left kidney along the capsule and paraaortic region that were of relatively low attenuation with accompanying granular calcifications. Pathological diagnosis of the biopsy specimen was extramedullary plasmacytoma accompanied by extramedullary hematopoiesis and amyloid deposition. Although the CT findings correlated well with the pathological results, the case was extremely atypical for extramedullary plasmacytoma in respect to location and the accompaniment with extramedullary hematopoiesis.

Venous or arterial blood components trigger more brain swelling, tissue death after acute subdural hematoma compared to elderly atrophic brain with subdural effusion (SDE) model rats.

Science.gov (United States)

Wajima, Daisuke; Sato, Fumiya; Kawamura, Kenya; Sugiura, Keisuke; Nakagawa, Ichiro; Motoyama, Yasushi; Park, Young-Soo; Nakase, Hiroyuki

2017-09-01

Acute subdural hematoma (ASDH) is a frequent complication of severe head injury, whose secondary ischemic lesions are often responsible for the severity of the disease. We focused on the differences of secondary ischemic lesions caused by the components, 0.4ml venous- or arterial-blood, or saline, infused in the subdural space, evaluating the differences in vivo model, using rats. The saline infused rats are made for elderly atrophic brain with subdural effusion (SDE) model. Our data showed that subdural blood, both venous- and arterial-blood, aggravate brain edema and lesion development more than SDE. This study is the first study, in which different fluids in rats' subdural space, ASDH or SDE are compared with the extension of early and delayed brain damage by measuring brain edema and histological lesion volume. Blood constituents started to affect the degree of ischemia underneath the subdural hemorrhage, leading to more pronounced breakdown of the blood-brain barrier and brain damage. This indicates that further strategies to treat blood-dependent effects more efficiently are in view for patients with ASDH. Copyright © 2017 Elsevier B.V. All rights reserved.

Chronic Subdural Hematoma in the Aged, Trauma or Degeneration?

Science.gov (United States)

Lee, Kyeong-Seok

2016-01-01

Chronic subdural hematomas (CSHs) are generally regarded to be a traumatic lesion. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. From 20th century, it became a traumatic lesion. CSH frequently occur after a trauma, however, it cannot occur when there is no enough subdural space even after a severe head injury. CSH may occur without trauma, when there is sufficient subdural space. The author tried to investigate trends in the causation of CSH. By a review of literature, the author suggested a different view on the causation of CSH. CSH usually originated from either a subdural hygroma or an acute subdural hematoma. Development of CSH starts from the separation of the dural border cell (DBC) layer, which induces proliferation of DBCs with production of neomembrane. Capillaries will follow along the neomembrane. Hemorrhage would occur into the subdural fluid either by tearing of bridge veins or repeated microhemorrhage from the neomembrane. That is the mechanism of hematoma enlargement. Trauma or bleeding tendency may precipitate development of CSH, however, it cannot lead CSH, if there is no sufficient subdural space. The key determinant for development of CSH is a sufficient subdural space, in other words, brain atrophy. The most common and universal cause of brain atrophy is the aging. Modifying Virchow's description, CSH is sometimes traumatic, but most often caused by degeneration of the brain. Now, it is reasonable that degeneration of brain might play pivotal role in development of CSH in the aged persons.

Traumatic Intraventricular Hemorrhage In Severe Blunt Head Trauma: A One Year Analysis

Directory of Open Access Journals (Sweden)

G.R. Bahadorkhan

2006-05-01

Full Text Available Background:High resolution CT scan has made early diagnosis of intraventricular hemorrhage (IVH easier. Posttraumatic intraventricular hemorrhage has been reported to a greater extent because of the CT scan. Methods:904 patients were admitted in the NSICU from March 2001 to March 2002 with severe closed head injury, of those only 31 patients with intraventricular hemorrhage (GCS less than 8 are reported herein and the mechanism involved is discussed. Results: Nine cases had intracerebral hemorrhage (contusional group, four cases in the frontal lobe, three cases in the temporal lobe and two cases in the parietal lobe. Nine cases (basal ganglia hemorrhage group had hemorrhage in basal ganglia, six in the caudate nucleus and three in the thalamus, all spreading into the ventricles. In thirteen cases the original site of hemorrhage could not be determined. In this group six cases had accompanying peri-brain stem hemorrhage (peri-brain stem hemorrhage group and different brain stem injury signs. Four cases had IVH less than 5 mL with or without minor intracranial lesions (minor intracranial lesion group. Accompanying major intracranial hemorrhage was found in sixteen cases, six cases had epidural hematoma, four cases had subdural hematoma, and seven had a combination of ASDH, EDH and contusional prarenchymal hemorrhages, all requiring primary surgical evacuation, and seven cases had different degrees of minor abnormalities (i.e. minor epidural hemorrhage, minor subdural hemorrhage,sub-arachnoid hemorrhage, minor cortical contusions or subdural effusions which did not need surgical intervention.Two cases had acute hydrocephalus and needed ventricular external drainage. Conclusion:Acceleration-deceleration impact along the long axis of the skull might be the possible mechanism in shearing injury to perforating vessels of the basal ganglia for early appearance of hemorrhage in the caudate nucleus and thalamus. Hemorrhage in basal ganglia and brain

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

Science.gov (United States)

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

2016-03-01

Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. Copyright © 2015 Elsevier Ltd. All rights reserved.

Chronic subdural hematoma secondary to traumatic subdural hygroma

International Nuclear Information System (INIS)

Hong, Deok Hwa; Lim, Han Hyuk; Bae, Won Kyung; Kim, Pyo Nyun; Kim, Il Young; Lee, Byung Ho; Lee, Kyeong Seok

1994-01-01

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

Chronic subdural hematoma secondary to traumatic subdural hygroma

Energy Technology Data Exchange (ETDEWEB)

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

1994-02-15

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

[Three cases of acute interhemispheric subdural hematoma].

Science.gov (United States)

Takeda, N; Kurihara, E; Matsuoka, H; Kose, S; Tamaki, N; Matsumoto, S

1988-01-01

Traumatic acute subdural hematomas over the convexity of the cerebral hemispheres are often encountered, but acute interhemispheric subdural hematomas are rare. Fourty-eight cases of acute subdural hematomas was admitted to our hospital between 1977 and 1986, and three cases of them (6%) were located in the interhemispheric subdural space. In this paper, these three cases are reported with 20 documented cases. Case 1: an 81-year-old female was admitted to our hospital because of headache, nausea and vomiting. She hit her occiput a week ago. CT scan demonstrated contusion in the right frontal lobe and a high density in the interhemispheric space of the right frontal region. Her complaints disappeared gradually by conservative therapy and she returned to her social life. Case 2: a 50-year-old male fell downstairs and hit his vertex. As he lost consciousness, he was admitted to our hospital. He was stuporous and had left-hemiparesis. Skull X-ray film showed fracture line extending from the right temporal bone to the left parietal bone across the midline. CT scan revealed intracerebral hematoma in both frontal lobe and right parietal lobe and subarachnoid hemorrhage in the basal cistern and Sylvian fissure of the right side. And interhemispheric subdural hematoma in the right parietal region was visualized. Angiography demonstrated a lateral displacement of the right callosomarginal artery and an avascular area between the falx and the callosomarginal artery. After admission his consciousness recovered and convulsion was controlled by drug. Left-hemiparesis was improved by conservative therapy and he was discharged on foot.(ABSTRACT TRUNCATED AT 250 WORDS)

Multiple myeloma with extramedullary disease.

Science.gov (United States)

Oriol, Albert

2011-11-01

Plasmacytoma is a tumor mass consisting of atypical plasma cells. Incidence of plasmacytomas associated with multiple myeloma range from 7% to 17% at diagnosis and from 6% to 20% during the course of the disease. In both situations, occurrence of extramedullary disease has been consistently associated with a poorer prognosis of myeloma. Extramedullary relapse or progression occurs in a variety of clinical circumstances and settings, and therefore requires individualization of treatment. Alkylating agents, bortezomib, and immunomodulatory drugs, along with corticoids, have been used to treat extramedullary relapse but, because of the relatively low frequency or detection rate of extramedullary relapse, no efficacy data are available from controlled studies in this setting.

Focal splenic masses of the extramedullary hematopoiesis

International Nuclear Information System (INIS)

Incedayi, M.; Sivrioglu, A.

2012-01-01

Full text: Extramedullary hematopoiesis arises from pleuripotential stem cells distributed throughout the body. It is most common in patients with congenital hemolytic anemia, such as thalassemia, sickle cell anemia and hereditary spherocytosis as a response to ineffective red blood cell formation. Although microscopic foci of Extramedullary hematopoiesis are commonly seen in the spleen and liver parenchyma, focal mass-like lesion of extramedullary hematopoiesis in the liver and spleen are rare. We report a case of intrasplenic focal extramedullary hematopoiesis lesions and the imaging features of extramedullary hematopoiesis on computed tomography and magnetic resonance imaging. Extramedullary hematopoiesis should always be considered as a diagnosis in a patient with a known hematological disorder

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

International Nuclear Information System (INIS)

Nishimoto, Hiroshi; Kurihara, Jun

2006-01-01

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

Extramedullary plasmacytoma of the larynx

Directory of Open Access Journals (Sweden)

Pinto, José Antônio

2012-01-01

Full Text Available Introduction: The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx. Objective: To describe a case of extramedullary plasmocytoma of the larynx, with literature review. Case Report: Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma. Conclusion: Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a "follow up" appropriate.

Extramedullary plasmacytoma of the larynx.

Science.gov (United States)

Pinto, José Antônio; Sônego, Thiago Branco; Artico, Marina Spadari; Leal, Carolina de Farias Aires; Bellotto, Silvana

2012-07-01

 The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx.  To describe a case of extramedullary plasmocytoma of the larynx, with literature review.  Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma.  Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a "follow up" appropriate.

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.

MRI features of epidural extramedullary hematopoiesis

International Nuclear Information System (INIS)

Alorainy, Ibrahim A.; Al-Asmi, Abdullah R.; Carpio, Raquel del

2000-01-01

A case of β-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

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

International Nuclear Information System (INIS)

Sho, Atsuko; Asaeda, Masahiro; Ohtake, Minoru

2002-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2002-09-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Kamiya, Kazuko; Inagawa, Tetsuji; Nagasako, Ren

1987-08-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1989-10-01

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

Neonatal intracranial hemorrhages (perinatal onset)

International Nuclear Information System (INIS)

Ban, Sadahiko; Ogata, Masahiro; Yamamoto, Toyoshiro; Nakao, Satoshi; Mizue, Hidenari; Kobayashi, Yutaka.

1982-01-01

1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages. (author)

Ruptured cervical arteriovenous fistulas presenting with subarachnoid hemorrhage and quadriplegia: an uncommon case.

Science.gov (United States)

Liu, Chien-Liang; Su, Yung-Cheng; Chen, Chien-Chih; Chong, Chee-Fah; Wang, Tzong-Luen

2008-02-01

Nontraumatic subarachnoid hemorrhage is a neurologic emergency, and prompt treatment is necessary to avoid catastrophic result. We present a patient with subarachnoid hemorrhage caused by ruptured cervical intradural extramedullary arteriovenous fistulas, which rapidly progressed to quadriplegia. Because of the timely management, the patient had a good recovery. This is a rare but important case that emergency physicians should be aware of.

Anatomy and development of the meninges: implications for subdural collections and CSF circulation

Energy Technology Data Exchange (ETDEWEB)

Mack, Julie [Penn State Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Squier, Waney [John Radcliffe Hospital, Department of Neuropathology, Oxford (United Kingdom); Eastman, James T. [Lancaster General Hospital, Department of Pathology and Laboratory Medicine, Lancaster, PA (United States)

2009-03-15

The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system. (orig.)

Anatomy and development of the meninges: implications for subdural collections and CSF circulation.

Science.gov (United States)

Mack, Julie; Squier, Waney; Eastman, James T

2009-03-01

The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system.

The False Falx and Tentorium Sign: Case Report of Subdural Haematoma and Sickle Cells Disease

Directory of Open Access Journals (Sweden)

Alvis-Miranda Hernando Raphael

2014-10-01

Full Text Available The increased density in the basal cisterns and the subarachnoid space on CT scans is a well-known characteristic of subarachnoid hemorrhage. Have been described diverse conditions that can emulate subarachnoid hemorrhage, such as purulent leptomeningitis, intrathecal contrast material and leak of high doses of intravenous contrast material to the subarachnoid space. We present the case of a male patient who presented a subdural hematoma in the setting of non-diagnosed sickle cell disease. To this patient was performed a panangiography which discard any aneurismal hemorrhage origin

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

OpenAIRE

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

2014-01-01

Burr-hole craniostomy with closed-system drainage is a safe and effective method for the management of chronic subdural hematoma. However, contralateral acute subdural hematoma has been reported to be a rare and devastating complication. Only 3 cases have been described in the literature. Herein, we reported an 80-year-old male with chronic subdural hematoma and contralateral subdural hygroma. The burr-hole craniostomy with closed-system drainage was initially performed to treat the chronic s...

Eleven cases of neonatal intracranial hemorrhage

International Nuclear Information System (INIS)

Matsuda, Tadashi; Asao, Toyohiko; Shibata, Takeo

1981-01-01

Eleven cases of neonatal intracranial hemorrhage were diagnosed and followed up by CT scanning. By CT, hemorrhagic lesions were shown as high density areas in an acute stage and imaged as low density areas after the hemorrhage was absorbed. The time of absorption varies depending upon the site and the severity of hemorrhage. Intraventricular hemorrhage, petechial hemorrhage and subdural hematoma were absorbed rapidly in more than 70% of the exanimed cases, CT scanning 1 - 2 weeks after the onset revealed absorption of hemorrhage. However, the absorption delayed in intracerebral hematoma; CT scan taken after one month showed hemorrhagic lesions remaining in 75% of the cases. In nine cases who survived, following the absorption of the hemorrhagic lesions, cerebral atrophy was observed in 4 cases (44%), ventricular enlargement in 3 cases (33%), and complete recovery in 2 cases (22%). From these results, CT scanning for diagnosis of neonatal intracranial hemorrhage should be done before the hemorrhagic lesion is absorbed (within 7 days of the onset). Follow-up study by CT is important for observing changes and predicting prognosis of intracranial hemorrhage. (Ueda, J.)

Unilateral traumatic hemorrhage of the basal ganglion and bihemisferic cerebral infarction

Directory of Open Access Journals (Sweden)

Moscote-Salazar Luis Rafael

2017-09-01

Full Text Available Among the various injuries caused by the cerebral tramatic lesion are traumatic brain contusions. Hemorrhagic contusions of the basal ganglia are unusual. Different injuries such as cranial fractures, epidural hemorrhage, subdural hematoma, subarachnoid hemorrhage among others may be associated with brain contusions. In some cases traumatic brain injury arises. We present a case of a patient with unilateral cerebral contusion associated with bihemispheric cerebral infarction.

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

International Nuclear Information System (INIS)

Kannuki, Seiji; Oi, Shizuo

1986-01-01

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

Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.

Science.gov (United States)

Geisenberger, D; Huppertz, L M; Büchsel, M; Kramer, L; Pollak, S; Große Perdekamp, M

2015-12-01

Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Life-threatening subdural hematoma after aortic valve replacement in a patient with Heyde syndrome: a case report.

Science.gov (United States)

Uchida, Tetsuro; Hamasaki, Azumi; Ohba, Eiichi; Yamashita, Atsushi; Hayashi, Jun; Sadahiro, Mitsuaki

2017-08-08

Heyde syndrome is known as a triad of calcific aortic stenosis, anemia due to gastrointestinal bleeding from angiodysplasia, and acquired type 2A von Willebrand disease. This acquired hemorrhagic disorder is characterized by the loss of the large von Willebrand factor multimers due to the shear stress across the diseased aortic valve. The most frequently observed type of bleeding in these patients is mucosal or skin bleeding, such as epistaxis, followed by gastrointestinal bleeding. On the other hand, intracranial hemorrhage complicating Heyde syndrome is extremely rare. A 77-year-old woman presented to our hospital with severe aortic stenosis and severe anemia due to gastrointestinal bleeding and was diagnosed with Heyde syndrome. Although aortic valve replacement was performed without recurrent gastrointestinal bleeding, postoperative life-threatening acute subdural hematoma occurred with a marked midline shift. Despite prompt surgical evacuation of the hematoma, she did not recover consciousness and she died 1 month after the operation. Postoperative subdural hematoma is rare, but it should be kept in mind as a devastating hemorrhagic complication, especially in patients with Heyde syndrome.

MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma

International Nuclear Information System (INIS)

Altinok, Deniz; Saleem, Sheena; Smith, Wilbur; Zhang, Zaixiang; Markman, Lisa

2009-01-01

Retinal hemorrhage is a well-recognized manifestation of child abuse found in many babies with shaken baby syndrome. The presence of retinal hemorrhage is generally associated with more severe neurological damage and a worse clinical outcome. MR imaging findings of retinal hemorrhages are not well described in the pediatric literature. We present a 6-month-old boy with new-onset seizures, subdural hemorrhage and bilateral retinal hemorrhages that were detected by MRI and confirmed by indirect ophthalmoscopy. This case demonstrates the MR imaging findings of retinal hemorrhages and the importance of radiologists being able to recognize these specific imaging features. (orig.)

MR imaging findings of retinal hemorrhage in a case of nonaccidental trauma

Energy Technology Data Exchange (ETDEWEB)

Altinok, Deniz; Saleem, Sheena; Smith, Wilbur [Children' s Hospital of Michigan, Department of Pediatric Imaging, Detroit, MI (United States); Zhang, Zaixiang [Wayne State University School of Medicine, Department of Radiology, Detroit, MI (United States); Markman, Lisa [Children' s Hospital of Michigan, Child Protection Team, Detroit, MI (United States)

2009-03-15

Retinal hemorrhage is a well-recognized manifestation of child abuse found in many babies with shaken baby syndrome. The presence of retinal hemorrhage is generally associated with more severe neurological damage and a worse clinical outcome. MR imaging findings of retinal hemorrhages are not well described in the pediatric literature. We present a 6-month-old boy with new-onset seizures, subdural hemorrhage and bilateral retinal hemorrhages that were detected by MRI and confirmed by indirect ophthalmoscopy. This case demonstrates the MR imaging findings of retinal hemorrhages and the importance of radiologists being able to recognize these specific imaging features. (orig.)

Magnetic resonance imaging (MRI) of an intraventricular hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Kwak, Ryungchan; Higashi, Tooru; Ito, Shotaro; Kadoya, Satoru; Takarada, Akira; Sato, Shuji; Kurauchi, Manabu.

1987-08-01

The utility of MRI was investigated in 10 patients with intraventricular hemorrhage. MRI was found to be, in many respects, superior to CT: 1) MRI is able to detect to some extent the aging of an intraventricular hematoma. 2) It can determine the character of intraventricular cerebrospinal fluid, whether it is normal, bloody, or hyperprotein. 3) It can detect the cause of hemorrhage in the case of arterio-venous malformation. 4) MRI permits the detection of the penetration course and the location of a ventricular hematoma. 5) It can clearly detect periventricular lesions of early-stage hydrocephalus, accompanied by increased intracranial pressure and followed by intraventricular hemorrhage, by imaging the periventricular high-signal-intensity area. 6) MRI can clearly diagnose complications of intracranial lesions. For instance, it can distinguish subdural fluid collection from chronic subdural hematoma and can detect whether a cerebral infarction is new or old. On the other hand, MRI also has some disadvantages: 1) The imaging time is long, and clinical application is difficult, in serious and/or infant cases. 2) It is impossible to use MRI in some patients who have magnetic material in their bodies. 3) The spatial-image resolution is not good.

Hemorrhage and vascular abnormalities

International Nuclear Information System (INIS)

Bradley, W.G.

1990-01-01

While many brain lesions have a similar appearance on MRI and CT, this is not true of hemorrhage. On CT, acute hemorrhage becomes hyperdense within an hour as the clot forms. This lasts for several days and then fades to isodensity and eventually hypodensity. On MRI, hemorrhage less than 12 to 24 hours old may not be distinguishable from vasogenic edema. Its appearance subsequently is an evolving pattern of variable signal intensity which depends on the specific form of hemoglobin which is present, or whether the red cells are intact or lysed, on the operating field strength, on the type of signal (that is, spin echo or gradient echo), and on contrast (that is, T 1 - or T 2 -weighing). The appearance of hemorrhage also depends on the compartment of the brain involved---subarachnoid, subdural, or intraparenchymal. Finally, for parenchymal hematomas, different zones may be defined from the inner core to the outer rim which all vary in appearance depending on field strength and imaging technique

Subdural Hematomas in Children under 2 Years. Accidental or Inflicted? A 10-Year Experience.

Science.gov (United States)

Tzioumi, Dimitra; Oates, R. Kim

1998-01-01

Analysis of 38 children under 2 with subdural hematomas found the most common causes were nonaccidental injury (55%), accidents (39%), and nontraumatic causes (6%). Also, the frequent presence of retinal hemorrhages, bone and rib fractures, delay in presentation, and young age suggests child abuse as the most common cause of these injuries.…

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

Energy Technology Data Exchange (ETDEWEB)

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

1987-06-01

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

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

Directory of Open Access Journals (Sweden)

Ufuk Utku

2013-01-01

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

Cortical herniation through compressive subdural membrane in an infant with a history of a large bihemispheric subdural hematoma and subdural-peritoneal shunt: case report.

Science.gov (United States)

Scoco, Aleka; Emily Bennett, E; Recinos, Violette

2017-02-01

Cortical herniation through subdural membrane formation is a rare complication of chronic subdural fluid collections and may occur following subdural shunting. The authors present a unique case of progressive cortical herniation through a compressive subdural membrane that occurred concomitant with a functioning subdural-peritoneal shunt.

Mass-like extramedullary hematopoiesis: imaging features

Energy Technology Data Exchange (ETDEWEB)

Ginzel, Andrew W. [Synergy Radiology Associates, Houston, TX (United States); Kransdorf, Mark J.; Peterson, Jeffrey J.; Garner, Hillary W. [Mayo Clinic, Department of Radiology, Jacksonville, FL (United States); Murphey, Mark D. [American Institute for Radiologic Pathology, Silver Spring, MD (United States)

2012-08-15

To report the imaging appearances of mass-like extramedullary hematopoiesis (EMH), to identify those features that are sufficiently characteristic to allow a confident diagnosis, and to recognize the clinical conditions associated with EMH and the relative incidence of mass-like disease. We retrospectively identified 44 patients with EMH; 12 of which (27%) had focal mass-like lesions and formed the study group. The study group consisted of 6 male and 6 female subjects with a mean age of 58 years (range 13-80 years). All 12 patients underwent CT imaging and 3 of the 12 patients had undergone additional MR imaging. The imaging characteristics of the extramedullary hematopoiesis lesions in the study group were analyzed and recorded. The patient's clinical presentation, including any condition associated with extramedullary hematopoiesis, was also recorded. Ten of the 12 (83%) patients had one or more masses located along the axial skeleton. Of the 10 patients with axial masses, 9 (90%) had multiple masses and 7 (70%) demonstrated internal fat. Eight patients (80%) had paraspinal masses and 4 patients (40%) had presacral masses. Seven patients (70%) had splenomegaly. Eleven of the 12 patients had a clinical history available for review. A predisposing condition for extramedullary hematopoiesis was present in 10 patients and included various anemias (5 cases; 45%), myelofibrosis/myelodysplastic syndrome (4 cases; 36%), and marrow proliferative disorder (1 case; 9%). One patient had no known predisposing condition. Mass-like extramedullary hematopoiesis most commonly presents as multiple, fat-containing lesions localized to the axial skeleton. When these imaging features are identified, extramedullary hematopoiesis should be strongly considered, particularly when occurring in the setting of a predisposing medical condition. (orig.)

Pathogenesis of chronic subdural hematoma

International Nuclear Information System (INIS)

Taguchi, Yoshio; Nakamura, Norio; Sato, Jun; Hasegawa, Yoshio.

1982-01-01

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

Intracranial hemorrhage complicating thrombolytic therapy for acute myocardial infarction

International Nuclear Information System (INIS)

Uglietta, J.P.; Boyko, O.B.; O'Connor, C.M.; Aldrich, H.; Massey, E.W.; Heinz, E.R.

1990-01-01

This paper determines the incidence and types of intracranial hemorrhage (ICH) in 1,696 patients treated with thrombolytic therapy for acute myocardial infarction (AMI). Thirteen of 1,696 patients experienced ICH, and their nonenhanced brain CT scans were reviewed. Their mean age was 62 years (range, 53-74 years), and nine of 13 were male. Six patients received tissue plasminogen activator (tPA), four streptokinase, two urokinase, and one tPA and urokinase. The hemorrhages were classified according to CT location: intraparenchymal (IPH), subarachnoid (SAH), subdural (SDH), and intraventricular (IVH). The incidence of ICH was 0.76%. There were 31 hemorrhages in 13 patients. Twelve hemorrhages were IPH, 10 were SDH, seven were SAH, and two were IVH. Excluding IVH, 24 of 29 hemorrhages (83%) were supratentorial

Intracranial hemorrhage in infants due to vitamin K deficiency with special reference to the prognostic evaluation by CT and follow-up study

International Nuclear Information System (INIS)

Hirata, Yoshifumi; Matsukado, Yasuhiko; Kaku, Motoyuki

1982-01-01

The authors reported sixteen cases with intracranial hemorrhage due to Vitamin K deficiency and their follow-up studies. Intracranial hemorrhages were classified into four groups according to the CT findings. Eight cases were with hemorrhage of single location, whereas combined multiple hemorrhages were seen in also eight cases; four acute subdural hematomas (Group A), and four subarachnoid or intraventricular hemorrhages (Group B), four acute subdural and subarachnoid hemorrhages (Group C), and four combined intracerebral hemorrhages (Group D). Clinical symptoms were almost identical in any group. Beside CT classification of hemorrhage it was characteristic to see extensive edema in the ipsilateral hemisphere. Follow-up studies were performed in fifteen children whose age ranged from nine months to five years old. In follow-up CT, ventricular dilatation was most frequently encountered in 53%, and cortical atrophy in 33%, leukomalacia in 27%. Chronic subdural hematomas and porencephaly were also seen. In the examination of mental development (Tsumori-Inage's). normal DQ were seen in 40%, and slight or severe mental disturbance were of 40%. In conclusion, the patients of Group A and B showed good recovery and normal development, although marked cortical atrophy and ventricular dilatation were noted on follow-up CT, in which follow-up study in longer period should be indicated. In Group C and D, three cases showed severe mental disturbance and had leukomalacia on CT due to respiratory disturbance. Combined multiple hemorrhage in Vitamin K deficiency should be particularly emphasized as one of the poorest prognostic factors in mental development. (author)

Subdural effusion

Science.gov (United States)

... page: //medlineplus.gov/ency/article/001422.htm Subdural effusion To use the sharing features on this page, please enable JavaScript. A subdural effusion is a collection of cerebrospinal fluid (CSF) trapped ...

Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

OpenAIRE

Vien, Christine; Marovic, Paul; Ingram, Brendan

2016-01-01

Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma

Directory of Open Access Journals (Sweden)

Christine Vien

2016-01-01

Full Text Available Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.

Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma.

Science.gov (United States)

Kpelao, E; Beketi, K A; Moumouni, A K; Doleagbenou, A; Ntimon, B; Egbohou, P; Mouzou, T; Tomta, K; Sama, D H; Abalo, A; Walla, A; Dossim, A

2016-04-01

Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.

Spontaneous Absorption of Extensive Subinternal Limiting Membrane Hemorrhage in Shaken Baby Syndrome

Directory of Open Access Journals (Sweden)

Tatiana Tarules Azzi

2014-01-01

Full Text Available The Shaken Baby Syndrome (SBS is characterized by subdural hematomas (SH, retinal hemorrhages (RH, and multiple fractures of long bones without external evidence of head trauma. Subinternal limiting membrane (ILM hemorrhage, also known as macular schisis, is a characteristic finding of this entity. There is no guideline on the right time to indicate surgical treatment. This report describes an abused child with massive sub-ILM hemorrhage, which showed spontaneous absorption after less than two months of follow-up. Due to the possible spontaneous resolution, we suggest an initial conservative treatment in cases of sub-ILM hemorrhage related to SBS.

Epidural extramedullary haemopoiesis in thalassaemia

International Nuclear Information System (INIS)

Boyacigil, S.; Ali, A.; Ardic, S.; Yuksel, E.

2002-01-01

lntrathoracic extramedullary haematopoiesis is a rare condition. Involvement of the spinal epidural space with haematopoietic tissue is rather unusual. A 31-year-old-man with a known diagnosis of β-thalassaemia was referred with focal back pain. Magnetic resonance imaging revealed diffuse bone-marrow changes, thoracic paraspinal masses and lobulated epidural masses, suggesting extramedullary haemopoiesis. The patient was treated with radiotherapy and blood transfusions. Follow-up MRI was performed for evaluation efficacy of the treatment. Copyright (2002) Blackwell Science Pty Ltd

Treatment of extramedullary plasmacytoma

International Nuclear Information System (INIS)

Wang Weihu; Li Suyan; Gao Li; Qu Yuan; Xu Guozhen; Li Yexiong

2004-01-01

Objective: To analyze the clinical feature of extramedullary plasmacytoma (EMP) and treatment results. Methods: From Jan. 1960 to Aug. 2000, 28 EMP patients accumulated in a period of 40 odd years were evaluated retrospectively. Sixteen of them were treated with radiotherapy alone (R group, 57.1%) with a median dose of 50 Gy, 11 with combined modality therapy (CMT group, 39.3%) and 1 with surgery alone (S group, 3.6%). Results: During a median follow-up of 90 months (4-280 months), 2 developed local recurrence and 2 were converted to multiple myeloma. The overall 3-, 5-, and 10-year survival rates were 92.6%, 75.6% and 75.6%, respectively. In the R group, the overall 3-, 5-, and 10-year survival rates were 93.8%, 77.3% and 77.3%, as compared with 90.9%, 72.7% and 72.7% in the CMT group (P>0.05). Conclusions: Extramedullary plasmacytoma may well be cured with small field and limited dose of radiation therapy alone. The diagnosis of extramedullary plasmacytoma requires a complete work-up (including MRI) and strict criteria to exclude multiple myeloma. Close follow-up is necessary in those converted to multiple myeloma. (authors)

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.

Differentiation of subdural effusions

International Nuclear Information System (INIS)

Wetterling, T.; Rama, B.

1989-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1987-04-01

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

Dual-energy bone removal computed tomography (BRCT): preliminary report of efficacy of acute intracranial hemorrhage detection.

Science.gov (United States)

Naruto, Norihito; Tannai, Hidenori; Nishikawa, Kazuma; Yamagishi, Kentaro; Hashimoto, Masahiko; Kawabe, Hideto; Kamisaki, Yuichi; Sumiya, Hisashi; Kuroda, Satoshi; Noguchi, Kyo

2018-02-01

One of the major applications of dual-energy computed tomography (DECT) is automated bone removal (BR). We hypothesized that the visualization of acute intracranial hemorrhage could be improved on BRCT by removing bone as it has the highest density tissue in the head. This preliminary study evaluated the efficacy of a DE BR algorithm for the head CT of trauma patients. Sixteen patients with acute intracranial hemorrhage within 1 day after head trauma were enrolled in this study. All CT examinations were performed on a dual-source dual-energy CT scanner. BRCT images were generated using the Bone Removal Application. Simulated standard CT and BRCT images were visually reviewed in terms of detectability (presence or absence) of acute hemorrhagic lesions. DECT depicted 28 epidural/subdural hemorrhages, 17 contusional hemorrhages, and 7 subarachnoid hemorrhages. In detecting epidural/subdural hemorrhage, BRCT [28/28 (100%)] was significantly superior to simulated standard CT [17/28 (61%)] (p = .001). In detecting contusional hemorrhage, BRCT [17/17 (100%)] was also significantly superior to simulated standard CT [11/17 (65%)] (p = .0092). BRCT was superior to simulated standard CT in detecting acute intracranial hemorrhage. BRCT could improve the detection of small intracranial hemorrhages, particularly those adjacent to bone, by removing bone that can interfere with the visualization of small acute hemorrhage. In an emergency such as head trauma, BRCT can be used as support imaging in combination with simulated standard CT and bone scale CT, although BRCT cannot replace a simulated standard CT.

Clinical and CT analysis of GCS 15 patients with intracranial hemorrhage

International Nuclear Information System (INIS)

Yang Lin; He Jianyuan; Jiang Shanyue; Zhang Yanling

2007-01-01

Objective: To analyze the clinical symptoms and CT manifestations of GCS 15 patients with intracranial hemorrhage. Methods: Clinical data and manifestations of the CT images of 35 patients with GCS 15 and intracranial hemorrhage were retrospectively analyzed and followed up. in short term. Results: Clinical symptoms: Deficits in short-term memory appeared in 17% of patients, vomiting in 26%, headache in 97%, physical evidence of trauma above the clavicles in 100%. CT scanning: intracerebral hemorrhage occurred in 18 patients, epidural hemorrhage in 9 patients, subarachnoid hemorrhage in 8 patients, subdural hemorrhage in 7 patients. During follow up, clinical severe degree was in consistent of craniocerebral CT scanning. Conclusion: For patients with GCS 15 brain injuries early head CT scanning is very important. Intracranial hemorrhage may occur in these patients. If possible, re-assessment of clinical examination and CT scanning is remarkably necessary. (authors)

A Case of Mediastinal Extramedullary Plasmacytoma Associated with Multiple Myeloma

Energy Technology Data Exchange (ETDEWEB)

Min, Ji Hye; Kim, Tae Sung; Ko, Young Hyeh; Kim, Ki Hyun [Samsung Medical Center, Sungkyunkwan University, Seoul (Korea, Republic of)

2010-08-15

Extramedullary plasmacytoma is a rare manifestation of multiple myeloma, and involvement of the mediastinum by extramedullary plasmacytoma is very rare. We report here on a rare case of a large mediastinal extramedullary plasmacytoma and several pleural nodules with pleural effusions in a 45-year-old male patient with multiple myeloma that involved the thoracic spine and the calvarium. The mediastinal extramedullary plasmacytoma manifested on CT as an 11 x 4.5 cm-sized, relatively homogeneous, mildly enhancing, anterior mediastinal mass with several pleural nodules, and this simulated malignant lymphoma or malignant thymic epithelial tumor.

Surgical treatment of an unusual case of pelvic extramedullary hematopoiesis.

Science.gov (United States)

Khen-Dunlop, Naziha; Girot, Robert; Brunelle, Francis; Révillon, Yann; Nihoul-Fékété, Claire; Sarnacki, Sabine

2006-07-01

Extramedullary hematopoiesis affects about 15% of the patients treated for thalassemia intermedia. Usually seen in adulthood, the most common location is the paraspinal region. Diagnosis and treatment of extramedullary hematopoiesis located in the pelvis of a young 15-year-old girl is discussed. The young age of the patient and the uncommon site of the mass first lead to the diagnosis of an ovarian dermoid cyst. Because of the clinical history and the typical feature on computed tomography scan, extramedullary hematopoiesis was concluded. A specific treatment based on blood transfusion and hydroxyurea was first proposed but remained inefficient. Surgical excision was thus successfully performed. Whereas surgery is limited to spinal cord compression in paraspinal extramedullary hematopoiesis, this observation argues for surgical treatment in symptomatic intraabdominal extramedullary hematopoiesis when medical treatment fails.

Epidemiology of Mild Traumatic Brain Injury with Intracranial Hemorrhage: Focusing Predictive Models for Neurosurgical Intervention.

Science.gov (United States)

Orlando, Alessandro; Levy, A Stewart; Carrick, Matthew M; Tanner, Allen; Mains, Charles W; Bar-Or, David

2017-11-01

To outline differences in neurosurgical intervention (NI) rates between intracranial hemorrhage (ICH) types in mild traumatic brain injuries and help identify which ICH types are most likely to benefit from creation of predictive models for NI. A multicenter retrospective study of adult patients spanning 3 years at 4 U.S. trauma centers was performed. Patients were included if they presented with mild traumatic brain injury (Glasgow Coma Scale score 13-15) with head CT scan positive for ICH. Patients were excluded for skull fractures, "unspecified hemorrhage," or coagulopathy. Primary outcome was NI. Stepwise multivariable logistic regression models were built to analyze the independent association between ICH variables and outcome measures. The study comprised 1876 patients. NI rate was 6.7%. There was a significant difference in rate of NI by ICH type. Subdural hematomas had the highest rate of NI (15.5%) and accounted for 78% of all NIs. Isolated subarachnoid hemorrhages had the lowest, nonzero, NI rate (0.19%). Logistic regression models identified ICH type as the most influential independent variable when examining NI. A model predicting NI for isolated subarachnoid hemorrhages would require 26,928 patients, but a model predicting NI for isolated subdural hematomas would require only 328 patients. This study highlighted disparate NI rates among ICH types in patients with mild traumatic brain injury and identified mild, isolated subdural hematomas as most appropriate for construction of predictive NI models. Increased health care efficiency will be driven by accurate understanding of risk, which can come only from accurate predictive models. Copyright © 2017 Elsevier Inc. All rights reserved.

Extramedullary paraspinal hematopoiesis in thalassemia: CT and MRI evaluation

International Nuclear Information System (INIS)

Tsitouridis, J.; Stamos, S.; Hassapopoulou, E.; Tsitouridis, K.; Nikolopoulos, P.

1999-01-01

We present a comparative CT and MRI study of the paraspinal extramedullary hematopoiesis in 32 thalassemic patients. The patients were classified into four groups according to the MRI and CT imaging findings. Active recent extramedullary paraspinal hematopoietic masses show soft tissue behavior in both CT and MRI. Older inactive masses reveal iron deposition or fatty replacement. Combined imaging findings of paraspinal extramedullary hematopoiesis revealed the phase of its evolution and the correct diagnosis

Extramedullary paraspinal hematopoiesis in thalassemia: CT and MRI evaluation

Energy Technology Data Exchange (ETDEWEB)

Tsitouridis, J.; Stamos, S.; Hassapopoulou, E.; Tsitouridis, K.; Nikolopoulos, P

1999-04-01

We present a comparative CT and MRI study of the paraspinal extramedullary hematopoiesis in 32 thalassemic patients. The patients were classified into four groups according to the MRI and CT imaging findings. Active recent extramedullary paraspinal hematopoietic masses show soft tissue behavior in both CT and MRI. Older inactive masses reveal iron deposition or fatty replacement. Combined imaging findings of paraspinal extramedullary hematopoiesis revealed the phase of its evolution and the correct diagnosis.

Spinal subdural hematoma following cranial subdural hematoma : a case report with a literature review.

Science.gov (United States)

Ji, Gyu Yeul; Oh, Chang Hyun; Chung, Daeyeong; Shin, Dong Ah

2013-12-01

Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.

A follow-up study by CT scan of intracranial hemorrhages in newborn children

International Nuclear Information System (INIS)

Shibata, Iekado; Kushida, Yoshimasa; Seiki, Yoshikatsu; Tsutsumi, Shunichiro; Kuramitsu, Toru

1983-01-01

Intracranial hemorrhages in perinatal babies and their sequelae are two of the targets of recent investigations. This study was designed to make clear the correlation between intracranial hemorrhage in perinates and the sequential widening of the cerebrospinal fluid space, including ventricles. 600 cases with moderate or severe clinical symptoms were treated in the Neonatal Intensive Care Unit of the Toho University Hospital from February, 1981, to October, 1982. Of these, 137 cases were suspected clinically to have had an intracranial hemorrhage at birth. In the CT study of these cases, intracranial hemorrhages of various types were confirmed in 55 cases. These included subarachnoid hemorrhages (29 cases), intraventricular hemorrhages (3 cases), intracerebral hemorrhages (3 cases), and combined hemorrhages (20 cases). A follow-up check of these cases by means of CT scan and neurological examinations was done for a period of from 40 days to 20 months. In 35 cases (63.5%) out of the 55, a temporary or persistent enlagement of the ventricle and/or widenings of the CSF space of various types were demonstrated. The latter included subdural effusion, the widening of the Sylvian fissure and/or interhemispheric fissure, and the widening of the basal cisterns. An enlargement of the ventricle occurred often following an intraventricular or intracerebral hemorrhage. On the other hand, subdural effusion was a common sequela after a subarachnoid hemorrhage. These changes in the ventricle or CSF space seem to be benign in nature and were improved in most cases during the period of the follow-up study. The ventricular enlargement disappeared substantially in 5 cases, and in the remaining 30 cases the abnormalities on the CT scans were much improved. Clinically, retarded physical development was evident in 3 cases, but the others showed no developmental retardation

Comparision between Brain Atrophy and Subdural Volume to Predict Chronic Subdural Hematoma: Volumetric CT Imaging Analysis.

Science.gov (United States)

Ju, Min-Wook; Kim, Seon-Hwan; Kwon, Hyon-Jo; Choi, Seung-Won; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun

2015-10-01

Brain atrophy and subdural hygroma were well known factors that enlarge the subdural space, which induced formation of chronic subdural hematoma (CSDH). Thus, we identified the subdural volume that could be used to predict the rate of future CSDH after head trauma using a computed tomography (CT) volumetric analysis. A single institution case-control study was conducted involving 1,186 patients who visited our hospital after head trauma from January 1, 2010 to December 31, 2014. Fifty-one patients with delayed CSDH were identified, and 50 patients with age and sex matched for control. Intracranial volume (ICV), the brain parenchyme, and the subdural space were segmented using CT image-based software. To adjust for variations in head size, volume ratios were assessed as a percentage of ICV [brain volume index (BVI), subdural volume index (SVI)]. The maximum depth of the subdural space on both sides was used to estimate the SVI. Before adjusting for cranium size, brain volume tended to be smaller, and subdural space volume was significantly larger in the CSDH group (p=0.138, p=0.021, respectively). The BVI and SVI were significantly different (p=0.003, p=0.001, respectively). SVI [area under the curve (AUC), 77.3%; p=0.008] was a more reliable technique for predicting CSDH than BVI (AUC, 68.1%; p=0.001). Bilateral subdural depth (sum of subdural depth on both sides) increased linearly with SVI (pSubdural space volume was significantly larger in CSDH groups. SVI was a more reliable technique for predicting CSDH. Bilateral subdural depth was useful to measure SVI.

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

Science.gov (United States)

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

2010-02-01

An infant had a subdural empyema caused by the rare Salmonella species enterica subspecies houtenae (IV) serotype 44:z4,z23:- after only indirect exposure to exotic reptiles in her foster home. Infants recovering from preexisting subdural hematoma are at risk for development of empyema. Copyright 2010 Mosby, Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Rocque Brandon G

2008-06-01

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

Evaluation of subdural space after evacuation of chronic subdural hematoma

International Nuclear Information System (INIS)

Odake, Genya

1988-01-01

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

Evaluation of subdural space after evacuation of chronic subdural hematoma

Energy Technology Data Exchange (ETDEWEB)

Odake, Genya

1988-09-01

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

Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age.

Science.gov (United States)

Melo, José Roberto Tude; Di Rocco, Federico; Bourgeois, Marie; Puget, Stephanie; Blauwblomme, Thomas; Sainte-Rose, Christian; Meyer, Philippe G; Zerah, Michel

2014-04-01

Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker-Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days-23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients

Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature.

Science.gov (United States)

Mehta, Vikram; Harward, Stephen C; Sankey, Eric W; Nayar, Gautam; Codd, Patrick J

2018-04-01

Chronic subdural hematomas are encapsulated blood collections within the dural border cells with characteristic outer "neomembranes". Affected patients are more often male and typically above the age of 70. Imaging shows crescentic layering of fluid in the subdural space on a non-contrast computed tomography (CT) scan, best appreciated on sagittal or coronal reformats. Initial medical management involves reversing anticoagulant/antiplatelet therapies, and often initiation of anti-epileptic drugs (AEDs). Operative interventions, such as twist-drill craniostomy (TDC), burr-hole craniostomy (BHC), and craniotomy are indicated if imaging implies compression (maximum fluid collection thickness >1 cm) or the patient is symptomatic. The effectiveness of various surgical techniques remains poorly characterized, with sparse level 1 evidence, variable outcome measures, and various surgical techniques. Postoperatively, subdural drains can decrease recurrence and sequential compression devices can decrease embolic complications, while measures such as early mobilization and re-initiation of anticoagulation need further study. Non-operative management, including steroid therapy, etizolam, tranexamic acid, and angiotensin converting enzyme inhibitors (ACEI) also remain poorly studied. Recurrent hemorrhages are a major complication affecting around 10-20% of patients, and therefore close follow-up is essential. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

International Nuclear Information System (INIS)

Tillich, M.; Kammerhuber, F.; Reittner, P.; Szolar, D.H.; Leber, K.A.

1999-01-01

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

Unilateral optic neuropathy following subdural hematoma: a case report

Directory of Open Access Journals (Sweden)

Witte Otto W

2010-01-01

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

[Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report].

Science.gov (United States)

Konno, Takuya; Yamada, Kei; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya

2015-01-01

A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma.

Science.gov (United States)

Kristof, Rudolf A; Grimm, Jochen M; Stoffel-Wagner, Birgit

2008-02-01

The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of beta -trace protein (beta TP) in the subdural fluid (betaTPSF) and serum (betaTPSER), and the CSDH/SH recurrence rate. The betaTPSF was considered to indicate an admixture of CSF to the subdural fluid if betaTPSF/betaTPSER>2. The median beta TPSF level for the whole patient group was 4.29 mg/L (range 0.33-51 mg/L). Cerebrospinal fluid leakage, as indicated by betaTPSF/betaTPSER>2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p=0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the betaTPSF concentrations (median 6.69 mg/L, range 0.59-51 mg/L) were significantly higher (p=0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33-26.8 mg/L). As indicated by the presence of betaTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of betaTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images.

Science.gov (United States)

Bodanapally, U K; Dreizin, D; Issa, G; Archer-Arroyo, K L; Sudini, K; Fleiter, T R

2017-10-01

Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma. We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images. Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60-78 years; P subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81-1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%-100%) and the specificity was 91.67% (95% CI, 73%-99%). Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies. © 2017 by American Journal of Neuroradiology.

Computed tomography of isodense subdural hematomas

International Nuclear Information System (INIS)

Youn, Eun Kyung; Kim, Jae Won; Kim, Ock Dong; Woo, Won Hyung

1983-01-01

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

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

International Nuclear Information System (INIS)

Ahmed, E.; Aurangzeb, A.; Khan, S.A.; Ali, A.; Maqbool, S.

2012-01-01

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

CT and MRI diagnosis of traumatic basal ganglia hemorrhage

International Nuclear Information System (INIS)

Wu Shike; Zhang Yalin; Xu Derong; Zou Gaowei; Chen Dan; He Sujun; Zhou Lichao

2009-01-01

Objective: To analyze CT and MRI features of traumatic basal ganglia hemorrhage and investigate the diagnostic value. Methods: 21 cases with traumatic basal ganglia hemorrhage diagnosed by clinic, CT and MRI in our hospital were collected in this study Plain CT scan were immediately performed in 21 cases after injury, plain MR scan were performed in 1 to 3 days. 12 cases of them underwent diffusion weighted imagine (DWI). The CT and MRI findings were retrospectively summarized. Results: 8 cases were found with simple traumatic basal ganglia hemorrhage. Complexity of basal ganglia hemorrhage occurred in 13 cases, 6 cases combined with subdural hemorrhage, 3 cases with epidural hematoma, 2 cases with subarachnoid hemorrhage, 6 cases with brain contusion and laceration in other locations, 4 cases with skull fracture. 26 lesions of basal ganglia hematoma were showed in 21 cases, 14 lesions of pallidum hemorrhage in 11 cases confirmed by MR could not be distinguished from calcification at the fast CT scan. 5 more lesions of brain contusion and laceration and 4 more lesions of brain white matter laceration were found by MR. Conclusion: CT in combination with MRI can diagnose traumatic basal ganglia hemorrhage and its complications early, comprehensively and accurately, which plays an important role in the clinical therapy selection and prognosis evaluation. (authors)

MRI of subdural fluid collections in infants

International Nuclear Information System (INIS)

Fukushima, Tsuneyuki; Takagi, Takuji; Nagai, Hajime; Banno, Tatsuo

1988-01-01

Twenty cases of subdural fluid collectioin in infants were examined by MRI (0.5 Tesla). The findings of MRI were classified into 3 groups as follows: Group I: Blood component is observed in the entire subdural fluid (4 cases, 20 %). Group II: Blood component is observed in a part of the subdural fluid (4 cases, 20 %). Group III: Subdural fluid consists of pure CSF (12 cases, 60 %). In general, operative treatment should be considered for cases which have blood components in the subdural space and/or symptoms and signs of increased ICP. In group I, operation was performed on 2 cases (50 %). In group II, subdural fluid collections were associated with dilated subarachnoid spaces and 2 cases were operated on in this group (50 %). In group III, only one case was operated on (8.3 %) and subdural fluid collections disappeared spontaneously in 4 cases of this group. The precise anatomical location of subdural fluid collections could not be decided in several cases even by MRI. The cases which had blood components, tended to demonstrate membranes frequently on MRI. However, the existence of blood components did not affect the DQ S significantly. The prognosis of subdural fluid collection is supposedly related to the degree of preexistent brain damage. (author)

Intracranial extramedullary hematopoiesis: a rare cause of headaches.

Science.gov (United States)

Singer, Adam; Quencer, Robert

2014-01-01

Ectopic bone marrow production, known as extramedullary hematopoiesis, may result in symptoms due to compression on normal structures. We present the multimodality imaging findings and subsequent management of a rare case of symptomatic extramedullary hematopoiesis within the calvarium. Case report. A 54-year-old male with a history of myelofibrosis and no previous diagnosis of a headache disorder presented to the emergency department with worsening severe bilateral headaches. A nonenhanced CT of the brain was performed and diffuse extra-axial nodular hyperdensities were visualized. MRI of the brain demonstrated diffuse extra-axial avidly enhancing nodular masses, dural thickening and marked susceptibility. No paravertebral masses, typical for extramedullary hematopoiesis, were present in the chest or abdomen. Although the clinical team considered a biopsy to confirm the diagnosis, we suggested a noninvasive confirmatory test. The subsequent Tc99m sulfur colloid scan corroborated the diagnosis. The patient was then referred to radiation oncology for treatment. In summary, extramedullary hematopoiesis is a hematologic compensatory disorder that rarely occurs within the CNS and may cause neurological compromise due to compression on underlying structures. The diagnosis can be made with noninvasive imaging and treated with low dose radiation therapy. Copyright © 2013 by the American Society of Neuroimaging.

Subdural effusions in children under two years

International Nuclear Information System (INIS)

Rothenberger, A.; Brandl, H.

1980-01-01

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

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.

[Infected subdural hematoma having a surgery of chronic subdural hematoma 1 year ago:a case report].

Science.gov (United States)

Nagao, Takaaki; Miyazaki, Chikao; Ando, Shunpei; Haga, Daisuke; Kuroki, Takao; Sugo, Nobuo; Nagao, Takeki

2015-02-01

We report a case of an infected subdural hematoma that occurred 1 year after burr-hole irrigation for chronic subdural hematoma. A 78-year-old woman who had developed left hemiparesis was admitted to our hospital. A computed tomography(CT)scan revealed the presence of a chronic subdural hematoma in the right hemisphere. Her clinical symptoms improved immediately after emergency burr-hole irrigation, which allowed her discharge from the hospital. One year after the initial surgery, she developed an infection of the urinary tract infection, which led to severe pyelonephritis and septic shock. Treatment of the urological symptoms eliminated the systemic inflammation. One month after the urinary infection, the patient was readmitted to the hospital in a comatose state. A CT scan showed regrowth of a residual subdural hematoma surrounded by a thick capsule, causing a midline shift in the brain. An emergency operation for removal of the subdural hematoma by burr-hole irrigation was performed, and pus was drained from the subdural mass. Microbiological cultures of the abscess revealed the presence of Proteus mirabilis. After surgery, the patient was administered an antibiotic treatment for three weeks and she was discharged with no neurological deficits. Cultures of blood from the septic shock as well as from the abscess both revealed the presence of Proteus mirabilis. Therefore, a diagnosis of infected subdural hematoma, which was caused by hematogenous infection, was made. We conclude that attention should be paid to the risk of infection of the hematoma capsule in subdural hematomas.

Subdural Hematoma Mimickers: A Systematic Review.

Science.gov (United States)

Catana, Dragos; Koziarz, Alex; Cenic, Aleksa; Nath, Siddharth; Singh, Sheila; Almenawer, Saleh A; Kachur, Edward

2016-09-01

A variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas. A systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes. We included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes. Identification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology. Copyright © 2016 Elsevier Inc. All rights reserved.

Computed tomography in intracranial hemorrhage in leukemia

International Nuclear Information System (INIS)

Hanyu, Haruo; Katsunuma, Hideyo; Yoshimura, Masahiro; Tomonaga, Masanori.

1984-01-01

In tracranial hemorrhage in leukemia was clinicopathologically studied in 62 cases of autopsy materials, with special attention paid to a morphological comparison of CT images with pathological findings. Intracranial hemorrhage was found in 32 of the 62 leukemic patients (51.6%), and in 13 of these patients (21.0%) it was responsible for death. Leukemic intracranial hemorrhage occurred more often in the acute leukemic type than in the chronic type, and even more often in younger leukemic patinents; it was pathologically characterized by multiple lesions in the white matter of the cerebral hemisphere, prone to combination with SAH or SDH. The hemorrhages could be divided into five types: (1) scattered small hemorrhagic type, (2) hematoma type, (3) fusion type (large hemorrhage composed of assembled small hemorrhages), (4) SAH type, and (5) SDH type. Among these types, the fusion type was considered to be characteristic of leukemia. CT was undertaken in 5 pathologically proven cases, with findings of the scattered small hemorrhagic type in 1, of the SDH type in 3, and of the fusion type in 1. Yet, one case with scattered small hemorrhages and two cases with SDH failed to be detected by CT. However, one case with a typical fusion hemorrhage was found to have multiple, irregular, high-density areas with surrounding edema and a mass effect as well as pathological findings. Therefore, a large-fusion hemorrhage, which is one of the most characteristic types of leukemic intracranial hemorrhage, could be demonstrated as distinctive CT images which reflected neuropathological findings. On the other hand, small parenchymal hemorrhages and relatively thin subdural hemorrhages could not be detected by CT. In conclusion, it seems that CT has value in the diagnosis of intracranial hemorrhage in leukemia. (J.P.N.)

Extramedullary versus intramedullary tibial cutting guides in megaprosthetic total knee replacement

Directory of Open Access Journals (Sweden)

Karade Vikas

2012-10-01

Full Text Available Abstract Background In a standard total knee replacement, tibial component alignment is a key factor for the long term success of the surgery. The purpose of this study is to compare the accuracy of extramedullary and intramedullary tibial cutting guides used in indigenous and imported implants respectively, in positioning of the tibial components in megaprosthetic knee replacements. Methods A comparative study of the accuracy of extramedullary and intramedullary tibial cutting guides was carried out in 92 megaprosthetic knee replacements for distal femoral tumors. For the proximal tibia cut for tibial component placement, an extramedullary guide was used in 65 patients and an intramedullary guide was used in 27 patients. Tibial component alignment angles were measured in postoperative X-rays with the help of CAD software. Results There was more varus placement in coronal plane with extramedullary cutting guide (−1.18 +/− 2.4 degrees than the intramedullary guide (−0.34 +/− 2.31 degrees but this did not reach statistical significance. The goal of 90 +/− 2 degrees alignment of tibial component was achieved in 54% of patients in the extramedullary group versus 67% in the intramedullary group. In terms of sagittal plane alignment, extramedullary guide showed less accurate results (2.09 +/− 2.4 degrees than intramedullary guide (0.50 +/− 3.80 degrees for tibial component alignment, though 78% of patients were aligned within the goal of 0–5 degrees of tibial slope angle in extramedullary group versus 63% in intramedullary group. The mean error in the measurements due to rotation of the knee during taking the X-rays was less than 0.1 degrees and distribution of the X-rays with the rotation of knee was similar in both the groups. Conclusions Overall, in megaprosthetic knee replacement intramedullary guides gave more accurate results in sagittal plane and exhibited similar variability as of extramedullary guides in coronal plane.

A clinical study on neonatal intracranial hemorrhage, 2

International Nuclear Information System (INIS)

Matsuda, Hiroo; Inoue, Takao; Shimura, Kohji

1980-01-01

Clinical pigns, laboratory data, CT findings, CSF spectrophotometric findings and CSF/blood glucose ratio were reviewed on thirty six newborns with intracranial hemorrhage confirmed by CT and/or autopsy and the following findings were obtained. The sites of hemorrhage were: intraventricular 14, intracerebral 4, subdural 2, subarachnoidal 16. 1) Convulsion (39%), hypotonia (58%), apnea (47%), and bradycardia (58%) were seen, but those were not regarded as specific for the intracranial hemorrhage. 2) Severe anemia of hemoglobin value less than 14 g/dl (17%), more than 10% fall of hematocrit (10%), and hyperglycemia of blood glucose more than 200 mg/gl (42%) were seen almost equally in every type of hemorrhage. 3) On CSF spectrophotometry, ajj twelve cases of intraventricular and four cases of intracerebral hemorrhage had the oxyhemoglobin peak absorbance. However, of fourteen cases of subarachnoidal hemorrhage, three had the oxyhemoglobin peak absorbance but the other eleven cases had the bilirubin peak absorbance. 4) Hypoglycorrachia, defined as CSF/blood glucose ratio less than 0.4, was recognized only in the intraventricular hemorrhage group (5/9, 56%). It was concluded that lumbar puncture should be done first of all when intracranial hemorrhage is suspected. If hypoglycorrachia or oxyhemoglobin peak absorbance is recognized, computed tomography should be performed immediately to know the accurate site and extent of hemorrhage. Although hypoglycorrachia is more specific for the intraventricular hemorrhage, it is usually found several days after the hemorrhage. On the other hand, oxyhemoglobin can be identified in CSF within a day after the episode of hemorrhage and this method is more benifical for the early diagnosis. (author)

Triple manifestation of extramedullary plasmacytoma in the upper airway: an unusual clinical entity.

LENUS (Irish Health Repository)

Morariu, I

2012-02-01

OBJECTIVE: We report an extremely rare case of extramedullary plasmacytoma. METHOD: Case report and review of the English-literature concerning extramedullary plasmacytoma and multiple myeloma. RESULT: We present an unusual case of multiple extramedullary plasmacytomas, which, over a protracted course of 30 years, presented on different occasions at three separate sites in the head and neck. The patient was managed surgically on all occasions, and was disease-free at the time of writing. CONCLUSION: Following review of the literature, we believe this to be the only case with this extremely unusual presentation. This case is noteworthy, not only because of the rarity of extramedullary plasmacytoma, but also because it highlights a number of important clinical issues. The diagnosis and management of extramedullary plasmacytoma require close cooperation between multiple disciplines.

Analysis of Risk Factor for the Development of Chronic Subdural Hematoma in Patients with Traumatic Subdural Hygroma

Science.gov (United States)

Ahn, Jun Hyong; Jun, Hyo Sub; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho

2016-01-01

Objective Although a high incidence of chronic subdural hematoma (CSDH) following traumatic subdural hygroma (SDG) has been reported, no study has evaluated risk factors for the development of CSDH. Therefore, we analyzed the risk factors contributing to formation of CSDH in patients with traumatic SDG. Methods We retrospectively reviewed patients admitted to Hallym University Hospital with traumatic head injury from January 2004 through December 2013. A total of 45 patients with these injuries in which traumatic SDG developed during the follow-up period were analyzed. All patients were divided into two groups based on the development of CSDH, and the associations between the development of CSDH and independent variables were investigated. Results Thirty-one patients suffered from bilateral SDG, whereas 14 had unilateral SDG. Follow-up computed tomography scans revealed regression of SDG in 25 of 45 patients (55.6%), but the remaining 20 patients (44.4%) suffered from transition to CSDH. Eight patients developed bilateral CSDH, and 12 patients developed unilateral CSDH. Hemorrhage-free survival rates were significantly lower in the male and bilateral SDG group (log-rank test; p=0.043 and p=0.013, respectively). Binary logistic regression analysis revealed male (OR, 7.68; 95% CI 1.18–49.78; p=0.033) and bilateral SDG (OR, 8.04; 95% CI 1.41–45.7; p=0.019) were significant risk factors for development of CSDH. Conclusion The potential to evolve into CSDH should be considered in patients with traumatic SDG, particularly male patients with bilateral SDG. PMID:27847577

Computed tomography and intracranial hemorrhages in the neonate

International Nuclear Information System (INIS)

Shibata, Iekado; Kushida, Yoshimasa; Shishido, Masaru; Nagasawa, Sadatsugu; Seiki, Yoshikatsu

1983-01-01

Thirty-two of 290 neonates admitted to the Perinatal Intensive Care Unit, Toho University Medical School, were examined by CT scan because of tentative clinical diagnosis of intracranial hemorrhage. CT scanner employed in this study was TCT-60 A from the Toshiba The Electric Co., Ltd. Fourteen cases (44%) were confirmed by the CT scan to have intracranial hemorrhage. Four cases had hemorrhage in the ventricle, while the remaining ten cases had subarachnoid hemorrhage. Subdural hemorrhage was not revealed in our series. Three of the four cases with intraventricular hemorrhage showed a typical subependymal germinal matrix hemorrhage. The prognosis of intraventricular hemorrhage in neonates seemed to be poor; two of the four cases died within a week. Their body weight at birth was apparently under the standard, and their Apgar score was 3 points. The subarachnoid hemorrhage was the main type of intracranial neonatal hemorrhages. In our series, it was constituted approximately 70% of the intracranial hemorrhages. The CT images of the subarachnoid hemorrhage in neonate were greatly different from those in adults. An irregular, wide high-density area around the falxtentorial junction was characteristic of the CT in many neonatal subarachnoid hemorrhages. In severe subarachnoid hemorrhages, a characteristic Y-shaped, high-density figure was demonstrated. In cases of subarachnoid hemorrhage from the deep venous system, high-density spreading immediately ventral to the falx-tentrium junction was demonstrated. These high-density areas due to blood in the subarachnoid space rapidly disappeared with the lapse of time. On the other hand, high-density areas in cerebral cisterns and/or fissures were rarely demonstrated in neonatal subarachnoid hemorrhages. The prognosis of subarachnoid hemorrhage in neonates was fairly good in the sense of life and cerebral functions. (author)

FLAIR images of subarachnoid hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Mikami, Takeshi; Saito, Koji; Okuyama, Tohru; Sakamoto, Yasuo; Takahashi, Akira; Shibata, Kazunori [Kushiro Neurosurgical Hospital, Hokkaido (Japan)

1996-12-01

We studied MR fluid attenuated inversion recovery (FLAIR) pulse sequences in 37 cases with subarachnoid hemorrhage caused by aneurysmal rupture. FLAIR sequence suppressed the CSF signal and produced very heavy T{sub 2} weighted images. Subarachnoid hemorrhage was able to be demonstrated as high signal intensity on FLAIR sequences in all patients clear visualization of acute subarachnoid hemorrhage was able to be obtained by MR FLAIR sequences in not only Fisher`s group 3 or 4, but also Fisher`s group 2. Moreover it was suited for the detection of intraaxial hematoma, Sylvian hematoma, subdural hematoma and subarachnoid hemorrhage in the posterior fossa and interhemispheric fissure. Especially, it was useful for detecting intraventricular hemorrhage. Therefore, if patients suffering from subarachnoid hemorrhage present slight headache or atypical symptoms, sometimes it may be more suitable to perform MRI FLAIR pulse sequences first. Aneurysms were found in 21 cases (56.8%). When the aneurysmal size is more than 7 mm, the rate of detection becomes 100%. Aneurysms present various MR appearances because of flow characteristics. Aneurysms were demonstrated as low signal intensity except in 3 cases. In one out of 3 cases, aneurysms were revealed as high signal intensity and in the other two cases, it was revealed as mixed signal intensity. According to the previous studies, rapid flow was demonstrated as low signal intensity by vascular flow void, and delayed flow was demonstrated as high or mixed signal intensity by flow related enhancement and even echo rephasing. MR clearly delineates the size, the lumen, the flow, and the extraaxial location of aneurysms. (K.H.)

Solitary extramedullary plasmacytoma of the sinonasal region.

Science.gov (United States)

Hazarika, Produl; Balakrishnan, R; Singh, Rohit; Pujary, Kailesh; Aziz, Benazim

2011-07-01

Less than 10% of the patients with plasma cell neoplasms present with a solitary plasmacytoma. Though the nasal cavity is a common extramedullary site, the occurrence is extremely rare. Two cases of solitary extramedullary plasmacytoma of the sinonasal region are reported. The first of which is sinonasal plasmacytoma with concomitant HIV, an association that has been reported rarely in literature to date and is matter of much debate. In the second case report, we present an instance of surgical excision of the tumor using KTP 532 laser. The diagnosis was established using immunohistochemical techniques and multiple myeloma workups were negative in all cases.

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

Localized extramedullary relapse after autologous hematopoietic stem cell transplantation in multiple myeloma

International Nuclear Information System (INIS)

Erkus, Muhan; Meteoglu, Ibrahim; Bolaman, Zahit; Kadikoylu, Gurhan

2005-01-01

Extramedullary plasmacytomas are rare manifestation of plasma cell malignancies. After hematopoietic stem cell transplantation HSCT, presentation of localized plasmacytoma with extramedullary growth is very unusual. We report a case of a 56-year-old woman with Dune-Salmon stage IIIA immunoglobulin A-kappa multiple myeloma, which presented 120 days after autologous HSCT with extramedullary plasmacytoma arising from a lymph node in supraclavicular region. The patient had no pretransplant-history related with extramedullary disease. There was no increase of plasma cells in bone marrow or monoclonal protein in urine or serum. Aspiration smears of lymph node revealed a population of plasmacytoid cells at various stages of maturation. The patient was successfully treated with local radiotherapy and has remained progression-free for more than 20 months. (author)

Age determination of subdural hematomas: survey among radiologists.

Science.gov (United States)

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

2014-08-01

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

Computed tomography of the adult traumatic subdural effusion

International Nuclear Information System (INIS)

Ara, Seiji; Matsuzaki, Takayuki; Yasumura, Shuichi; Nishiya, Mikio; Nakamura, Junichi

1979-01-01

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

Hemispheric Chronic Subdural Hematoma Concealing Subdural Metastases: Terrible Surprise Behind Routine Emergency Department Consultation.

Science.gov (United States)

Caruso, Riccardo; Pesce, Alessandro; Martines, Valentina

2017-10-01

The patient is a 79-year-old male, suffering from advanced metastatic prostate cancer, who developed a progressively worsening ideomotor slowing and was therefore referred to the emergency department of our institution. A plain axial computed tomography (CT) scan revealed a vast hemispheric subdural fluid collection, apparently a subdural hematoma. On closer inspection, and most of all, in hindsight, a tenuously isohyperdense signal irregularity at the frontal aspect of the fluid collection appears. Because of the declined general medical conditions and the paucity of the neurologic impairment, a high-dose, corticosteroid-based conservative strategy was performed. The total body CT scan for the routine oncologic follow-up of the prostate cancer scan fell at 20 days from the first CT of the emergency department. A second contrast-enhanced axial CT scan demonstrated the presence of 2 subdural metastases, presumably the initial pathogenesis of the subdural fluid collection. Copyright © 2017 Elsevier Inc. All rights reserved.

Postoperative course of chronic subdural hematoma

International Nuclear Information System (INIS)

Takahashi, Toshiaki; Tsubone, Kyoji; Kyuma, Yoshikazu; Kuwabara, Takeo

1983-01-01

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

Subdural abscess in infant and child

Energy Technology Data Exchange (ETDEWEB)

Honda, E; Shigemori, M; Hayashi, T; Kuratomi, A; Kuramoto, S [Kurume Univ., Fukuoka (Japan). School of Medicine

1980-02-01

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

Myelomatous ascites as an initial manifestation of extramedullary involvement of multiple myeloma

Energy Technology Data Exchange (ETDEWEB)

Choi, Seo Youn; Lee, Hae Kyung; Yi, Boem Ha; Lee, Min Hee; Kim, Hee Kyung; Park, Seong Kyu [Soonchunhyang University Bucheon Hospital, Bucheon (Korea, Republic of)

2017-03-15

Multiple myeloma is a common hematological malignancy. Aggressive myeloma invades the organs outside the bone marrow, lymph, or reticuloendothelial systems. Among the extramedullary involvements of multiple myeloma, myelomatous ascites are extremely rare and are associated with a poor prognosis. We describe a case of myelomatous ascites as an initial manifestation of extramedullary involvement of multiple myeloma in 39-year-old patient. The patient was treated with high-dose chemotherapy, but extensive extramedullary involvement progressed, and the patient expired approximately five months after the initial detection of ascites.

Extramedullary plasmacytoma in the trachea of a dog.

Science.gov (United States)

Chaffin, K; Cross, A R; Allen, S W; Mahaffey, E A; Watson, S K

1998-05-15

A 10-year-old spayed female mixed-breed dog was examined because of acute inspiratory dyspnea. Radiography and tracheoscopy revealed a discrete, solitary mass originating from the membranous portion of the trachea at the level of the thoracic inlet. Tracheal resection and anastomosis were performed, and on histologic examination of the resected tissue, extramedullary plasmacytoma was diagnosed. Although tracheal tumors are rare in dogs, they should be considered during evaluation of dogs with signs of airway obstruction. Prognosis is excellent for dogs with extramedullary plasmacytoma in which surgical excision is complete.

Chronic spinal subdural hematoma

International Nuclear Information System (INIS)

Hagen, T.; Lensch, T.

2008-01-01

Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma. (orig.) [de

Complications and results of subdural grid electrode implantation in epilepsy surgery.

Science.gov (United States)

Lee, W S; Lee, J K; Lee, S A; Kang, J K; Ko, T S

2000-11-01

We assessed the risk of delayed subdural hematoma and other complications associated with subdural grid implantation. Forty-nine patients underwent subdural grid implantation with/without subdural strips or depth electrodes from January 1994 to August 1998. To identify the risk associated with subdural grid implantation, a retrospective review of all patients' medical records and radiological studies was performed. The major complications of 50 subdural grid electrode implantations were as follows: four cases (7.8%) of delayed subdural hematoma at the site of the subdural grid, requiring emergency operation; two cases (3.9%) of infection; one case (2.0%) of epidural hematoma; and one case (2.0%) of brain swelling. After subdural hematoma removal, the electrodes were left in place. CCTV monitoring and cortical stimulation studies were continued thereafter. No delayed subdural hematoma has occurred since routine placement of subdural drains was begun. In our experience the worst complication of subdural grid implantation has been delayed subdural hematoma. Placement of subdural drains and close observation may be helpful to prevent this serious complication.

[A case of cutaneous extramedullary hematopoiesis associated with idiopathic myelofibrosis].

Science.gov (United States)

Corella, F; Barnadas, M A; Bordes, R; Curell, R; Espinosa, I; Vergara, C; Alomar, A

2008-05-01

Cutaneous extramedullary hematopoiesis is a rare manifestation of chronic myeloproliferative processes, mainly chronic idiopathic myelofibrosis. In adults, it manifests as macules, papules, nodules, and ulcers on the trunk. The lesions usually appear soon after diagnosis and the possibility of a relationship between splenectomy and the appearance of extramedullary foci of hematopoiesis is still debated. Diagnosis is based on histopathology showing an infiltrate with different combinations of myeloid and erythroid cell precursors and megakaryocytes. Symptomatic treatment is provided alongside treatment of the underlying disease. We report a new case associated with chronic idiopathic myelofibrosis in which foci of cutaneous extramedullary hematopoiesis were observed 9 years after initial diagnosis. The lesions were progressive and the patient went on to develop acute myeloid leukemia.

Pulmonary Extramedullary Hematopoiesis in a Patient with Chronic Asthma Resembling Lung Cancer: A Case Report

Directory of Open Access Journals (Sweden)

Massood Hosseinzadeh

2012-01-01

Full Text Available Background. Extramedullary hematopoiesis is most often seen in reticuloendothelial organs specially spleen, liver, or lymph nodes, and it is rarely seen in lung parenchyma. Almost all reported cases of pulmonary extramedullary hematopoiesis occurred following myeloproliferative disorders specially myelofibrosis. Other less common underlying causes are thalassemia syndromes and other hemoglobinopathies. There was not any reported case of pulmonary extramedullary hematopoiesis in asthmatic patients in the medical literature. Case. Here we reported a 65-year-old lady who was a known case of bronchial asthma with recent developed right lower lobe lung mass. Chest X-ray and CT studies showed an infiltrating mass resembling malignancy. Fine needle aspiration cytology of mass revealed pulmonary extramedullary hematopoiesis. The patient followed for 10 months with serial physical examination and laboratory evaluations which were unremarkable. Conclusion. Extramedullary hematopoiesis of lung parenchyma can be mistaken for lung cancer radiologically. Although previous reported cases occurred with myelofibrosis or hemoglobinopathies, we are reporting the first case of asthma-associated extramedullary hematopoiesis.

Neonatal intracranial hemorrhages (perinatal onset). Comparison of pre- and post-CT era and their prognostic factors

Energy Technology Data Exchange (ETDEWEB)

Ban, S.; Ogata, M.; Yamamoto, T.; Nakao, S.; Mizue, H. (Kobe Central Municipal Hospital (Japan)); Kobayashi, Y.

1982-04-01

1. We have reviewed 34 cases of neonatal intracranial hemorrhages (perinatal onset, 23 mature and 11 premature infants) experienced in 10-year period from 1971 to 1980, with special reference to gestational age, birth weight, type of delivery, presence or absence of asphyxia, symptoms and cause of death. 2. Regarding 9 autopsied cases and 7 cases diagnosed by CT-scan, 10 mature infants composed of 3 subarachnoid hemorrhages, 2 intraventricular hemorrhages, 2 subdural hematomas, 2 intracerebral and 1 subependymal hemorrhage; 6 premature infants consisted of 4 subependymal hemorrhages with ventricular rupture and 2 subarachnoid hemorrhages. Most of them presented with respiratory distress, vomiting and convulsive seizures which developed within 5 days after birth. 3. Poor outcome including death amounted 49% of mature and 63% of premature infants. Along with degree of intracranial hematoma, prematurity and pulmonary complication were felt to be important prognostic factors. 4. Introduction of CT-scan led to prompt diagnosis and treatment, thus lowering mortality rate of neonatal intracranial hemorrhages.

Soft Tissue Extramedullary Plasmacytoma

Directory of Open Access Journals (Sweden)

Fernando Ruiz Santiago

2010-01-01

Full Text Available We present the uncommon case of a subcutaneous fascia-based extramedullary plasmacytoma in the leg, which was confirmed by the pathology report and followed up until its remission. We report the differential diagnosis with other more common soft tissue masses. Imaging findings are nonspecific but are important to determine the tumour extension and to plan the biopsy.

Renal extramedullary hematopoiesis: interstitial and glomerular pathology.

Science.gov (United States)

Alexander, Mariam P; Nasr, Samih H; Kurtin, Paul J; Casey, Edward T; Hernandez, Loren P Herrera; Fidler, Mary E; Sethi, Sanjeev; Cornell, Lynn D

2015-12-01

Renal extramedullary hematopoiesis is rarely recognized in the antemortem setting. We identified 14 patients with renal extramedullary hematopoiesis on antemortem specimens from 1994 to 2015. The mean age was 68 years (range 47-87 years); males predominated (M:F=9:5). All presented with renal insufficiency, including five (36%) with acute kidney injury. The mean serum creatinine at biopsy was 2.9 mg/dl (range 1.2-7.3 mg/dl). All had proteinuria (mean 7.9 g/24 h; range 0.5-28; n=13), including 9 with ≥3 g/24 h. Renal extramedullary hematopoiesis appeared histologically as an interstitial infiltrate (n=12) and/or a perirenal infiltrate (n=3) or mass-like lesion (n=1). Five were misdiagnosed as interstitial nephritis. Concurrent glomerular disease was prevalent and included fibrillary-like glomerulonephritis (n=3), chronic thrombotic microangiopathy (n=5), focal segmental glomerulosclerosis (n=6), and diabetic glomerulosclerosis (n=2). All patients had an underlying hematologic malignancy: primary myelofibrosis in 9, myeloproliferative neoplasm not otherwise specified in 1, essential thrombocythemia in 1, polycythemia vera in 1, and plasma cell myeloma in 2. Clinical follow-up was available in 12 patients, mean of 29 months (range 4-120 months). In 10 patients for whom treatment history could be obtained, 9 were treated with chemotherapy, and 1 was treated with steroids. The mean creatinine at last follow-up was 2 mg/dl (range 1.2-3.9 mg/dl) (n=9). Ten patients died in the follow-up period from their underlying hematological disease and had persistent renal disease. The two remaining patients had persistent chronic kidney disease. Renal extramedullary hematopoiesis should be considered in the differential diagnosis of interstitial infiltrates, particularly in the presence of a glomerulopathy and a hematologic malignancy.

A case of acute spinal subdural hematoma with subarachnoid hemorrhage: Rapid spontaneous remission, relapse, and complete resolution

Directory of Open Access Journals (Sweden)

Michito Namekawa

2017-06-01

In addition to rostrocaudal spreading of bloody components in the subdural space, rupture of the hematoma into the subarachnoid space must have released pressure, compressing the spinal cord. In this case report, we also describe the serial MRI studies and note the limitations of the resolution of spinal MRI in the acute phase.

Case report: treatment of subdural hematoma in the emergency department utilizing the subdural evacuating port system.

Science.gov (United States)

Asfora, Wilson T; Klapper, Hendrik B

2013-08-01

Patients with acute or chronic subdural hematomas may present with rapidly deteriorating neurological function and are at risk for irreversible brainstem injury. In such cases, rapid surgical intervention is required to evacuate the hematoma and reverse critically elevated intracranial pressure. A variety of surgical drainage methods are in existence, none of which are clearly superior to the others. This report presents the case of a 74-year-old woman who suffered an acute-on-chronic subdural hematoma which was evacuated in the emergency department utilizing the subdural evacuating port system (SEPS). The SEPS provides for a minimally invasive technique to drain subdural hematomas and is advantageous in that it can be performed at the bedside. The SEPS is relatively simple to use and may be especially useful to emergency department staff in outlying areas where there is a shortage of neurosurgical coverage.

Management of Recurrent Subdural Hematomas.

Science.gov (United States)

Desai, Virendra R; Scranton, Robert A; Britz, Gavin W

2017-04-01

Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement. Copyright © 2016 Elsevier Inc. All rights reserved.

Primary extramedullary plasmacytoma of the penis: a case report.

Science.gov (United States)

Wang, Yao; Li, Hong-Yan; Liang, Ting-Ting; Han, Yu-Ping; Wang, Xue-Ju; Wei, Xin; Fan, Li; Wang, Wei-Hua

2013-10-01

Extramedullary plasmacytoma involving the penis is extremely rare. Here, we describe a case of primary extramedullary plasmacytoma of the penis in a 64-year-old man who presented with a palpable penile mass. Nuclear magnetic resonance imaging revealed the presence of a large, round non-encapsulated mass in the perineum. A contrast-enhanced computed tomography scan of the pelvis showed that the mass was located in the tunica albuginea and corpora cavernosa at the base of the penis. The mass encased the urethra and demonstrated no marked enhancement during the arterial phase. The patient underwent successful surgical resection of the tumor. Histologically, the tumor was composed primarily of neoplastic plasma cells that were positive for CD38, vimentin and Ki 67. Postoperatively, the patient recovered well and exhibited no evidence of development of multiple myeloma, local recurrence or distant metastasis at 2 months post-surgery. To the best of our knowledge, our case represents the first documented case of human primary extramedullary plasmacytoma of the penis.

Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

International Nuclear Information System (INIS)

Aydingoez, Ue.; Oto, A.; Cila, A.

1997-01-01

Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.)

Detection of subdural empyema with radionuclides

International Nuclear Information System (INIS)

McKillop, J.H.; Holtzman, D.S.; McDougall, I.R.

1980-01-01

Computed tomography (CT) is now the standard method of confirming a diagnosis of suspected subdural empyema. We report a case in which the radionuclide brain scan was abnormal at a time when the CT scan was normal. An 111 In-labeled leukocyte scan was also performed in this patient and demonstrated abnormal uptake in the empyema. The scintigraphic findings in a second case of subdural empyema are also described. The relative roles of radionuclide studies and CT scans in the patient with suspected subdural empyema are discussed

Subdural hematomas: an analysis of 1181 Kashmiri patients.

Science.gov (United States)

Nayil, Khursheed; Ramzan, Altaf; Sajad, Arif; Zahoor, Sheikh; Wani, Abrar; Nizami, Furqan; Laharwal, Masood; Kirmani, Altaf; Bhat, Rashid

2012-01-01

We endeavored to analyze patients of subacute and chronic subdural hematomas studied in a 4-year period at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. The study was a retrospective analysis of 1181 patients of subdural hematomas. Demographic characteristics, clinico-radiologic features, operative modalities, and outcome were studied. Acute subdural hematomas were excluded from the study. The mean age was 60.4 ± 12.4 and males outnumbered females. Chronic subdural collections were more common than subacute subdural hematomas and left side predominated. Two burr holes with closed-system drainage was used in most patients. Incidence of postoperative seizures is very low. Overall recurrence rates were low; however, multilocular hematomas had the highest incidence of recurrence. Morbidity and mortality were 7.53% and 2.96%, respectively. Preoperative neurologic grade correlated with outcome. Subdural hematomas are common in elderly males. Preoperative neurologic grade dictates the outcome. Multilocular hematomas have a higher chance of recurrence. Craniotomy should be reserved for recurrent hematomas, and there may be a scope of craniotomy for multilocular chronic subdural hematomas at the outset. Antiepileptic prophylaxis is not routinely recommended. Copyright © 2012 Elsevier Inc. All rights reserved.

A case report and technical tip of chronic subdural hematoma treated by the placement of a subdural peritoneal shunt

Directory of Open Access Journals (Sweden)

Andres M. Alvarez-Pinzon

2017-02-01

Full Text Available Background: Chronic subdural hematomas (CSDH tend to occur most commonly in the elderly population, usually resulting from minor or insignificant head trauma. The pathophysiology behind CSDH is often directly associated with cerebral atrophy, and other causes of cerebral atrophy such as alcoholism or dementia. Other predisposing factors include diabetes, coagulopathy, use of anticoagulants (including aspirin, seizure disorders, and CSF shunts. Considerable evidence supporting the use of external drainage after evacuation of primary CSDH is readily available in the literature. Case report: We report the case of a 72 year-old male with a history of recurrent left subdural hematoma presenting to the neurosurgical clinic with a two-day history of personality changes, difficulty speaking, urinary incontinence, and headaches. Burr hole evacuation was performed with the placement of a subdural peritoneal shunt. At the one-month follow-up appointment, the patient had complete resolution of symptoms and CT scan showed no new recurrence of the subdural hematoma. Conclusions: Although several treatment options are available for the management of CSDH, recurrence of hematoma is a major and very common complication that may result in re-injury due to mass effect caused by chronic hematoma. However, placement of subdural peritoneal shunt for the treatment of CSDH can reduce the recurrence rate of CSDH and therefore, reduce the risk of brain re-injury. Keywords: Chronic subdural hematoma, CSDH, Subdural peritoneal shunt, Head trauma

MRI findings of extramedullary haemopoiesis

International Nuclear Information System (INIS)

Chourmouzi, D.; Pistevou-Gompaki, K.; Plataniotis, G.; Skaragas, G.; Papadopoulos, L.; Drevelegas, A.

2001-01-01

Extramedullary haemopoiesis (EH) is a compensatory process associated with chronic haemolytic anaemia. It is rare, however, for such an abnormality to cause spinal cord compression. We present two patients with known beta-thalassaemia intermedia who developed spinal cord compression due to masses of extramedullary haematopoietic tissue in the epidural space of the thoracic spine. The EH masses were diagnosed by MRI as an isointense epidural lesion on both T1- and T2-weighted images, compressing severely the spinal cord. After administration of a paramagnetic agent, an intermediate enhancement of the masses was evident. All the vertebral bodies had low to intermediate signal intensity as a result of displacement of fatty marrow by haematopoietic marrow. Expansion of thoracic ribs with bilateral paravertebral masses were characteristic. A small dose of radiotherapy was given and marked improvement in neurological symptoms was evident. An MRI examination established shrinkage of the mass and decompression of spinal cord. The role of MRI in diagnosis of EH masses is essential and radiation therapy is a very effective treatment for this rare complication. (orig.)

Extramedullary plasmacytomas in the context of multiple myeloma.

Science.gov (United States)

Aguado, Beatriz; Iñigo, Belen; Sastre, Jose L; Oriol, Albert

2011-11-01

Plasmacytoma is a frequent complication of multiple myeloma, either at diagnosis or within disease progression. The extramedullary disease confers a poorer prognosis and is biologically distinct with high-risk molecular and histological features, being resistant to conventional treatments. Radiation therapy remains the most effective treatment for extramedullary lesions to achieve local control. There are very limited data from randomized trials regarding the most appropriate systemic treatment. Case reports such as those presented here, as well as retrospective analysis of series, suggest that lenalidomide is an effective agent, in combination with dexamethasone, in this setting. Additional studies are needed to define the proper management of this condition.

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

Science.gov (United States)

Bellut, David; Woernle, Christoph Michael; Burkhardt, Jan-Karl; Kockro, Ralf Alfons; Bertalanffy, Helmut; Krayenbühl, Niklaus

2012-01-01

Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial. The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison. We analyzed the data of 143 scSDHs in 113 patients undergoing surgery for subdural hematoma with placement of subperiosteal or subdural drainage after double burr-hole trepanation for hematoma evacuation. Overall, there were no statistically significant differences regarding general patient characteristics, preoperative and postoperative symptoms, postoperative hematoma remnant, rates of recurrences, mortality, complications, and outcome at discharge and at 3-month follow up between the groups. There was a close to significant tendency of lower mortality after placement of subperiosteal drainage system and a tendency towards lower rate of recurrent hematoma after placement of subdural drainage system. Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burr-hole trepanation, irrigation, and placement of subperiosteal drainage is our treatment of choice in patients with predictable high risk of complications. Copyright © 2012 Elsevier Inc. All rights reserved.

[Two cases of mesial temporal lobe epilepsy associated with old intracerebral hemorrhage in the lateral temporal lobe without "dual pathology"].

Science.gov (United States)

Morioka, T; Nishio, S; Hisada, K; Muraishi, M; Ishibashi, H; Mamiya, K; Ohfu, M; Fukui, M

1998-05-01

Two cases of intractable temporal lobe epilepsy associated with old intracerebral hemorrhage in the lateral temporal lobe were reported. Although preoperative magnetic resonance imaging (MRI) failed to reveal hippocampal atrophy with T2 hyperintensity, electrocorticographic (ECoG) recording with chronic invasive subdural electrodes indicated the mesial temporal lobe to be an ictal onset zone. After anterior temporal lobectomy involving the lesion and hippocampectomy, the patients became seizure-free. Hippocampal sclerosis, namely "dual pathology", was not noted on histological examination. Careful ECoG recording with chronic subdural electrodes is mandatory even when the preoperative MRI does not demonstrate the radiological hippocampal sclerosis.

Endoscopic burr hole evacuation of an acute subdural hematoma.

Science.gov (United States)

Codd, Patrick J; Venteicher, Andrew S; Agarwalla, Pankaj K; Kahle, Kristopher T; Jho, David H

2013-12-01

Acute subdural hematoma evacuations frequently necessitate large craniotomies with extended operative times and high relative blood loss, which can lead to additional morbidity for the patient. While endoscopic minimally invasive approaches to chronic subdural collections have been successfully demonstrated, this technique has not previously been applied to acute subdural hematomas. The authors report their experience with an 87-year-old patient presenting with a large acute right-sided subdural hematoma successfully evacuated via an endoscopic minimally invasive technique. The operative approach is outlined, and the literature on endoscopic subdural collection evacuation reviewed. Copyright © 2013. Published by Elsevier Ltd.

Rivaroxaban-Induced Nontraumatic Spinal Subdural Hematoma: An Uncommon Yet Life-Threatening Complication

Directory of Open Access Journals (Sweden)

Mazen Zaarour

2015-01-01

Full Text Available In the last decade, the desire for safer oral anticoagulants (OACs led to the emergence of newer drugs. Available clinical trials demonstrated a lower risk of OACs-associated life-threatening bleeding events, including intracranial hemorrhage, compared to warfarin. Nontraumatic spinal hematoma is an uncommon yet life-threatening neurosurgical emergency that can be associated with the use of these agents. Rivaroxaban, one of the newly approved OACs, is a direct factor Xa inhibitor. To the best of our knowledge, to date, only two published cases report the incidence of rivaroxaban-induced nontraumatic spinal subdural hematoma (SSDH. Our case is the third one described and the first one to involve the cervicothoracic spine.

Spinal cord compression due to epidural extramedullary haematopoiesis in thalassaemia: MRI

Energy Technology Data Exchange (ETDEWEB)

Aydingoez, Ue.; Oto, A.; Cila, A. [Department of Radiology, Hacettepe University School of Medicine, Ankara (Turkey)

1997-12-01

Spinal epidural extramedullary haematopoiesis is very rare in thalassaemia. A 27-year-old man with thalassaemia intermedia presented with symptoms and signs of spinal cord compression. MRI showed a thoracic spinal epidural mass, representing extramedullary haematopoietic tissue, compressing the spinal cord. Following radiotherapy, serial MRI revealed regression of the epidural mass and gradual resolution of spinal cord oedema. (orig.) With 3 figs., 6 refs.

Ectopic extramedullary hematopoiesis: evaluation and treatment of a rare and benign paraspinal/epidural tumor.

Science.gov (United States)

Mattei, Tobias A; Higgins, Michael; Joseph, Flynn; Mendel, Ehud

2013-03-01

Ectopic extramedullary hematopoiesis (EMH), defined as the formation of blood cells outside the bone marrow, usually occurs in a scenario of chronic anemia when, even after conversion of the bony yellow marrow to red marrow, the body is still unable to meet the demand for red blood cells. Ectopic extramedullary hematopoiesis most commonly occurs in the liver and spleen but may, in fact, occur almost anywhere in the body. Although previous reports have documented EMH presenting as paraspinal masses, such lesions have almost always been associated with a predisposing hematological disorder such as hemolytic anemia, myelofibrosis or myelodysplastic syndromes, thalassemia, polycythemia vera, leukemia, or lymphoma. The authors of this report describe the first reported instance of EMH in a patient presenting with a symptomatic epidural and paraspinal cervical lesion arising from the posterior spinal elements and no known predisposing hematological disease. Initial radiographs revealed a bony lesion arising posteriorly from the C2-3 laminae and spinous processes. Subsequent imaging suggested the diagnosis, which was confirmed by CT-guided biopsy, peripheral blood smears, and bone marrow aspirate. Despite epidural compression and slight displacement of the cervical cord and thecal sac, the patient's symptoms were limited to pain and diminished cervical range of motion. Therefore, surgery was deferred in favor of nonsurgical therapy. Several alternative modalities for the treatment of EMH have been suggested in the literature, including cytotoxic agents and radiotherapy. The authors opted for an approach utilizing directed low-dose radiotherapy of a total of 25 Gy divided in 2.5-Gy fractions. At the 3-month follow-up, the patient continued to be asymptomatic, and MRI demonstrated a significant reduction in the dimensions of the lesion. Extramedullary hematopoiesis with spinal cord compression in the absence of a preexisting hematological disorder has not been described in

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.

MRI findings of traumatic spinal subdural hematoma

Energy Technology Data Exchange (ETDEWEB)

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

2000-04-01

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

Chronic Subdural Hematoma Preceded by High-Impact Trauma: Does the Intensity of Trauma Influence the Pathogenesis of Traumatic Chronic Subdural Hematoma?

Science.gov (United States)

Park, Ki-Su; Lee, Chang-Heon; Park, Seong-Hyun; Hwang, Sung-Kyoo; Hwang, Jeong-Hyun

2017-01-01

The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic subdural hematoma (CSDH). Thirty-one patients treated surgically for traumatic CSDH were divided into high-impact and lowimpact groups according to the intensity of trauma. They were respectively evaluated with respect to clinical and radiological findings at presentation, and the subdural concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and beta-trace protein (ΒTP) [a highly specific protein in the cerebrospinal fluid (CSF)] related to the pathogenesis of CSDH. If ΒTP (subdural fluid/serum) was > 2, an admixture of CSF to the subdural fluid was indicated. The ΒTP (subdural fluid/serum) was > 2 in all patients with a traumatic CSDH. The mean concentration of subdural ΒTP in the high-impact group was higher than in the low-impact group (6.1 mg/L versus 3.9 mg/L), and the difference was statistically significant (p=0.02). In addition, mean concentrations of IL-6, IL-8 and VEGF were higher in the high-impact group, as compared to the low-impact group, though the differences did not reach statistical significance. Trauma may be related to CSF leakage into the subdural space in CSDH, and the intensity of trauma may influence the amount of CSF leakage. Although there is no direct correlation between the amount of CSF leakage and other subdural molecules, the intensity of trauma may be associated with larger concentrations of molecules in traumatic CSDH.

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

International Nuclear Information System (INIS)

Fukui, Keiji; Sadamoto, Kazuhiko; Ohue, Shiro; Takeda, Sadanori; Kimura, Hideki; Sakaki, Saburo.

1986-01-01

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

Cerebral and subdural abscess with spatio-temporal multiplicity 12 years after initial craniotomy for acute subdural hematoma. Case report.

Science.gov (United States)

Wakui, Daisuke; Nagashima, Goro; Takada, Tatsuro; Ueda, Toshihiro; Itoh, Hidemichi; Tanaka, Yuichiro; Hashimoto, Takuo

2012-01-01

A 34-year-old man presented with a case of subdural empyema and cerebral abscess that developed 12 years after initial neurosurgical intervention for a traffic accident in 1998. Under a diagnosis of acute subdural hematoma and cerebral contusion, several neurosurgical procedures were performed at another hospital, including hematoma removal by craniotomy, external decompression, duraplasty, and cranioplasty. The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field. Surgical intervention was refused and antimicrobial treatment was initiated, but proved ineffective. Surgical removal of artificial dura and cranium with subdural empyema, and resection of a cerebral abscess were performed on May 12, 2010. No organism was recovered from the surgical samples. Meropenem and vancomycin were selected as perioperative antimicrobial agents. No recurrence of infection has been observed. Postneurosurgical subdural empyema and cerebral abscess are recently emerging problems. Infections of neurosurgical sites containing implanted materials occur in 6% of cases, usually within several months of the surgery. Subdural empyema and cerebral abscess developing 12 years after neurosurgical interventions are extremely rare. The long-term clinical course suggests less pathogenic organisms as a cause of infection, and further investigations to develop appropriate antimicrobial selection and adequate duration of antimicrobial administration for these cases are needed.

Synchronous infiltrating ductal carcinoma and primary extramedullary plasmacytoma of the breast

Directory of Open Access Journals (Sweden)

Liu Yan-Xue

2009-04-01

Full Text Available Abstract Background Extramedullary plasmacytomas are seldom solitary and usually progress to diffuse myelomatosis. Plasmacytomas of the breast are rare, especially when not associated multiple myeloma. Synchronous infiltrating ductal carcinoma and primary extramedullary plasmacytoma of the breast have not previously reported. Case presentation A 27-years-old woman with an untreated upper outer quadrant breast mass for 1-year was referred to our cancer hospital for surgical evaluation of increasing breast pain. Postoperatively, microscopic examination revealed an infiltrating ductal carcinoma complicated by an extramedullary plasmacytoma divided by fibrous tissue in one section. Following surgery, the patient received chemotherapy for the carcinoma and radiotherapy for the plasmacytoma. Conclusion In this case, careful histopathology examination was essential to make the correct diagnosis and therapy for these synchronous lesions. The patient finished chemotherapy and radiotherapy without significant adverse effects.

Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma

Energy Technology Data Exchange (ETDEWEB)

Ryan, Maura E.; Jaju, Alok [Northwestern University Feinberg School of Medicine, Department of Radiology, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Medical Imaging, Chicago, IL (United States); Ciolino, Jody D. [Northwestern University, Biostatistics Collaboration Center, Department of Preventive Medicine Feinberg School of Medicine, Chicago, IL (United States); Alden, Tord [Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, Chicago, IL (United States); Ann and Robert H. Lurie Children' s Hospital of Chicago, Department of Neurosurgery, Chicago, IL (United States)

2016-08-15

Rapid MRI with ultrafast T2 sequences can be performed without sedation and is often used in place of computed tomography (CT) to evaluate pediatric patients for indications such as hydrocephalus. This study investigated the sensitivity of rapid magnetic resonance imaging (MRI) for detection and follow-up of acute intracranial hemorrhage in comparison to CT, which is commonly the first-line imaging. Patients presenting to a pediatric hospital with acute intracranial hemorrhage on CT and follow-up rapid MRI within 48 h were included. Rapid MRI studies consisted of three plane ultrafast T2 sequences either with or without axial gradient echo (GRE) sequences. Identification of hemorrhage on rapid MRI was assessed by readers both blinded and unblinded to prior CT results. One hundred two acute hemorrhages in 61 patients were identified by CT. Rapid MRI detection of subdural and epidural hemorrhages was modest in the absence of prior CT for comparison (sensitivity 61-74 %), but increased with review of the prior CT (sensitivity 80-86 %). Hemorrhage size was a significant predictor of detection (p < 0.0001). Three plane fast T2 images alone without GRE sequences were poor at detecting subarachnoid hemorrhage (sensitivity 10-25 %); rapid MRI with GRE sequences identified the majority of subarachnoid hemorrhage (sensitivity 71-93 %). GRE modestly increased detection of other extra-axial hemorrhages. Rapid MRI with GRE sequences is sensitive for most acute intracranial hemorrhages only when a prior CT is available for review. Rapid MRI is not adequate to replace CT in initial evaluation of intracranial hemorrhages but may be helpful in follow-up of known hemorrhages. (orig.)

Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma

International Nuclear Information System (INIS)

Ryan, Maura E.; Jaju, Alok; Ciolino, Jody D.; Alden, Tord

2016-01-01

Rapid MRI with ultrafast T2 sequences can be performed without sedation and is often used in place of computed tomography (CT) to evaluate pediatric patients for indications such as hydrocephalus. This study investigated the sensitivity of rapid magnetic resonance imaging (MRI) for detection and follow-up of acute intracranial hemorrhage in comparison to CT, which is commonly the first-line imaging. Patients presenting to a pediatric hospital with acute intracranial hemorrhage on CT and follow-up rapid MRI within 48 h were included. Rapid MRI studies consisted of three plane ultrafast T2 sequences either with or without axial gradient echo (GRE) sequences. Identification of hemorrhage on rapid MRI was assessed by readers both blinded and unblinded to prior CT results. One hundred two acute hemorrhages in 61 patients were identified by CT. Rapid MRI detection of subdural and epidural hemorrhages was modest in the absence of prior CT for comparison (sensitivity 61-74 %), but increased with review of the prior CT (sensitivity 80-86 %). Hemorrhage size was a significant predictor of detection (p < 0.0001). Three plane fast T2 images alone without GRE sequences were poor at detecting subarachnoid hemorrhage (sensitivity 10-25 %); rapid MRI with GRE sequences identified the majority of subarachnoid hemorrhage (sensitivity 71-93 %). GRE modestly increased detection of other extra-axial hemorrhages. Rapid MRI with GRE sequences is sensitive for most acute intracranial hemorrhages only when a prior CT is available for review. Rapid MRI is not adequate to replace CT in initial evaluation of intracranial hemorrhages but may be helpful in follow-up of known hemorrhages. (orig.)

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.

The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note.

Science.gov (United States)

Fichtner, Jens; Beck, Jürgen; Raabe, A; Stieglitz, Lennart Henning

2015-09-01

For chronic subdural hematoma, placement of a Blake drain with a two-burr-hole craniotomy is often preferred. However, the placement of such drains carries the risk of penetrating the brain surface or damaging superficial venous structures. To describe the use of a Nelaton catheter for the placement of a subdural drain in two-burr-hole trephination for chronic subdural hematoma. A Nelaton catheter was used to guide placement of a Blake drain into the subdural hematoma cavity and provide irrigation of the hematoma cavity. With the two-burr-hole method, the Nelaton catheter could be removed easily via the frontal burr hole after the Blake drain was in place. We used the Nelaton catheters in many surgical procedures and found it a safe and easy technique. This method allows the surgeon to safely direct the catheter into the correct position in the subdural space. This tool has two advantages. First, the use of a small and flexible Nelaton catheter is a safe method for irrigation of a chronic subdural hematoma cavity. Second, in comparison with insertion of subdural drainage alone through a burr hole, the placement of the Nelaton catheter in subdural space is easier and the risk of damaging relevant structures such as cortical tissue or bridging veins is lower. Thus this technique may help to avoid complications when placing a subdural drain. Georg Thieme Verlag KG Stuttgart · New York.

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

Directory of Open Access Journals (Sweden)

João Flavio M. Araújo

1996-03-01

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

Malignant Subdural Hematoma Associated with High-Grade Meningioma

Science.gov (United States)

Teramoto, Shinichiro; Tsunoda, Akira; Kawamura, Kaito; Sugiyama, Natsuki; Saito, Rikizo; Maruki, Chikashi

2018-01-01

A 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously. PMID:29896565

Independent predictors for recurrence of chronic subdural hematoma.

Science.gov (United States)

Chon, Kyu-Hyon; Lee, Jong-Myong; Koh, Eun-Jeong; Choi, Ha-Young

2012-09-01

Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence. We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution. Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma. We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.

Cortical enhancement in chronic subdural hematoma

International Nuclear Information System (INIS)

Taguchi, Yoshio; Sato, Jun; Makita, Tadatoshi; Hayashi, Shigetoshi; Nakamura, Norio.

1981-01-01

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

Recurrent subdural hematoma secondary to headbanging: A case report.

Science.gov (United States)

Nitta, Naoki; Jito, Junya; Nozaki, Kazuhiko

2015-01-01

"Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging. Headbanging has the hazardous potential to cause a subdural hematoma.

Secondary Insults of Traumatic Brain Injury in CCATT Patients Returning from Iraq/Afghanistan: 2001-2006

Science.gov (United States)

2010-08-31

and hemorrhage. Hemorrhage is further divided into epidural hematoma , subdural hematoma , and intracerebral hematoma . Diffuse brain injuries...fiber Brain Injury Focal Injuries Contusion Laceration Hemorrhage Epidural Hematoma Subdural Hematoma Intracerebral Hematoma Diffuse

Extramedullary plasmacytoma of small bowel mesentery in associated with cecal cancer: a case report

International Nuclear Information System (INIS)

Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo; Park, Yong Wook; Oh, Young Ha

2005-01-01

Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer

Extramedullary plasmacytoma of small bowel mesentery in associated with cecal cancer: a case report

Energy Technology Data Exchange (ETDEWEB)

Kim, Sung Kyu; Kim, Yong Soo; Kim, Young Sun; Cho, On Koo; Koh, Byung Hee; Rhim, Hyun Chul; Park, Choog Ki; Park, Dong Woo [Hanyang University College of Medicine, Seoul (Korea, Republic of); Park, Yong Wook; Oh, Young Ha [Hanyang University Guri Hospital, Guri (Korea, Republic of)

2005-07-15

Extramedullary plasmacytoma is a rare disease that is histopathologically defined as a solitary tumor composed of a monoclonal proliferation of cells with plasmacytic differentiation in an extramedullary site. Most of these tumors occur in the submucosa of the upper aerodigestive tract, and they rarely occur in the small bowel mesentery. We report here on a case of extramedullary plasmacytoma of the small bowel mesentery that was in association with a cecal cancer. Abdominal ultrasound and CT revealed a lobulated soft tissue mass with a cystic portion and peripheral calcification. In this case, the preoperative radiological diagnosis was difficult due to accompanying cecal cancer.

Simultaneous Intracranial and Spinal Subdural Hematoma: Two Case Reports

Energy Technology Data Exchange (ETDEWEB)

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

2009-02-15

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

Use of Subdural Evacuating Port System Following Open Craniotomy with Excision of Native Dura and Membranes for Management of Chronic Subdural Hematoma.

Science.gov (United States)

Cage, Tene; Bach, Ashley; McDermott, Michael W

2017-04-26

An 86-year-old woman was admitted to the intensive care unit with a chronic subdural hematoma (CSDH) and rapid onset of worsening neurological symptoms. She was taken to the operating room for a mini-craniotomy for evacuation of the CSDH including excision of the dura and CSDH membrane. Postoperatively, a subdural evacuation port system (SEPS) was integrated into the craniotomy site and left in place rather than a traditional subdural catheter drain to evacuate the subdural space postoperatively. The patient had a good recovery and improvement of symptoms after evacuation and remained clinically well after the SEPS was removed. We offer the technique of dura and CSDH membrane excision plus SEPS drain as an effective postoperative alternative to the standard craniotomy leaving the native dura intact with traditional subdural drain that overlies the cortical surface of the brain in treating patients with CSDH.

Chronic subdural haematoma complicating spinal anaesthesia: A ...

African Journals Online (AJOL)

Subdural haematoma is a rare but serious complication of dural puncture. We report a case of chronic subdural haematoma, which occurred following spinal anaesthesia for elective caesarean section. A 34-year-old multiparous woman presented with a post-dural puncture headache (PDPH) following spinal anaesthesia.

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...

Atypical location of extramedullary hematopoietic masses in thalassemia

International Nuclear Information System (INIS)

Gemenis, T.; Philippou, A.; Gouliamos, A.; Kalovidouris, A.; Papavasiliou, C.; Papacharalambus, X.; Panani, A.; Chalevelakis, G.; Raptis, S.

1989-01-01

A case of β-thalassemia with multiple foci of extramedullary hematopoiesis (EH) is reported. EH masses were demonstrated in the presacral and the costovertebral space. EH foci were also encountered in the spleen. (orig.) [de

Rapid Spontaneously Resolving Acute Subdural Hematoma

Science.gov (United States)

Gan, Qi; Zhao, Hexiang; Zhang, Hanmei; You, Chao

2017-01-01

Introduction: This study reports a rare patient of a rapid spontaneously resolving acute subdural hematoma. In addition, an analysis of potential clues for the phenomenon is presented with a review of the literature. Patient Presentation: A 1-year-and-2-month-old boy fell from a height of approximately 2 m. The patient was in a superficial coma with a Glasgow Coma Scale of 8 when he was transferred to the authors’ hospital. Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. His guardians refused invasive interventions and chose conservative treatment. Repeat imaging after 15 hours showed the evident resolution of the hematoma and midline reversion. Progressive magnetic resonance imaging demonstrated the complete resolution of the hematoma, without redistribution to a remote site. Conclusions: Even though this phenomenon has a low incidence, the probability of a rapid spontaneously resolving acute subdural hematoma should be considered when patients present with the following characteristics: children or elderly individuals suffering from mild to moderate head trauma; stable or rapidly recovered consciousness; and simple acute subdural hematoma with a moderate thickness and a particularly low-density band in computed tomography scans. PMID:28468224

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

International Nuclear Information System (INIS)

Mori, Kentaro; Adachi, Keiji; Cho, Kajin; Ishimaru, Sumio; Maeda, Minoru

1998-01-01

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

Extramedullary intradural spinal tumors; Extramedullaere intradurale spinale Tumoren

Energy Technology Data Exchange (ETDEWEB)

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

2011-12-15

The category of extramedullary intradural tumors includes a variety of lesions ranging from meningiomas originating from meningeal cells and nerve sheath tumors (neurofibromas, schwannomas) to less common primary tumors, such as lipomas, ependymomas, hemangiopericytomas, epidermoid cysts and dermoid cysts. Extramedullary metastases can occur as transcoelomic metastases in tumors of the central nervous system (CNS) or metastasization from other tumors. Magnetic resonance imaging (MRI) is the method of choice for localization and characterization of these lesions before treatment. (orig.) [German] Die Kategorie der extramedullaeren intraduralen Tumoren enthaelt Laesionen, die von den Nervenhuellen (Schwannome und Neurofibrome) oder von den meningealen Zellen ausgehen (Meningeome). Ependymome, Lipome, Haemangioperizytome, Epidermoidzysten und Dermoidzysten entsprechen selteneren primaeren Tumoren. Extramedullaere Metastasen koennen als Abtropfmetastasen bei ZNS-Tumoren oder als Metastasierung anderer Karzinomerkrankungen auftreten. Die Magnetresonanztomographie (MRT) ist die Methode der Wahl zur Abklaerung einer intraduralen Raumforderung. (orig.)

Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis

Directory of Open Access Journals (Sweden)

Marco Casaccia

Full Text Available Introduction: Primary myelofibrosis (MF is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. Case presentation: We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT. A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules. Conclusion: In primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF. Keywords: Myelofibrosis, Splenomegaly, Splenectomy, Extramedullary hematopoiesis

Extramedullary plasmacytoma of the larynx. A report of three cases

International Nuclear Information System (INIS)

Strojan, P.

2002-01-01

Purpose. To report three cases of extramedullary plasmacytoma of the larynx treated at the Institute of Oncology in Ljubljana between 1969-1999. Results. All three patients were treated with radiotherapy only, which resulted in permanent local and regional control of 7.8, 4.7 and 3.5 years. The function of the larynx was preserved in all of them. Two patients died, both to the causes other than plasmacytoma. In none of the patients disease progressed to multiple myeloma. Conclusions. Extramedullary plasmacytoma of the larynx is a rare disease, highly curable when radiotherapy is used. Moderate radiation doses and limited fields ensure excellent cosmetic and functional result. (author)

Experimental models of chronic subdural hematoma.

Science.gov (United States)

D'Abbondanza, Josephine A; Loch Macdonald, R

2014-02-01

Chronic subdural hematoma (CSDH) is a common neurosurgical problem. Most studies of pathogenesis and treatment involve humans. Advances in understanding of human diseases may be made using animal models. We reviewed all animal models of CSDH and report here their results, conclusions and limitations in order to set a baseline upon which further advanced experimental work related to this disease can be made. PubMed, Medline, Embase and ISI Web of Knowledge were searched with no time limits using the keyword 'chronic subdural hematoma' and MeSH term 'hematoma, subdural, chronic'. The authors reviewed all papers written related to this disease and selected all publications involving animals. There were no other restrictions. The findings and conclusions of the papers are summarized here. No formal analysis was done because of the variation in species used, methods for induction of CSDH, times of assessment and reporting of results. Attempts to create CSDH have been made in mice, rats, cats, dogs and monkeys. Methods include injection or surgical implantation of clotted blood or various other blood products and mixtures into the potential subdural space or the subcutaneous space. No intracranial model produced a progressively expanding CSDH. Transient hematoma expansion with liquification could be produced by subcutaneous injections in some models. Spontaneous subdural blood collections were found after creation of hydrocephalus in mice by systemic injection of the neurotoxin, 6-aminonicotinamide. The histology of the hematoma membranes in several models resembles the appearance in humans. None of the models has been replicated since its first description. We did not find a report of a reproducible, well-described animal model of human CSDH.

Extramedullary plasmacytoma. Fine needle aspiration findings.

Science.gov (United States)

Kumar, P V; Owji, S M; Talei, A R; Malekhusseini, S A

1997-01-01

To determine the role of fine needle aspiration cytology in the diagnosis of extramedullary plasmacytoma. The study group consisted of 13 patients with palpable masses at various sites. The tumors were aspirated for cytologic study. The smears revealed groups of mature and immature plasma cells at various stages of maturation. Mature plasma cells showed an eccentric nucleus and abundant, deep, basophilic cytoplasm with a paranuclear halo. Plasmablasts (immature plasma cells) showed a prominent, eccentric nucleus with single, large nucleolus and abundant, deep, basophilic cytoplasm with no paranuclear halo. Binucleate and multinucleate forms were also seen quite often. The tumors were excised, and the histologic sections confirmed the cytologic diagnosis. All the patients received radiotherapy. One patient (18 years old) developed recurrence and died due to extensive infiltration into the maxilla and mandible. Two patients (57 and 62 years) developed multiple myeloma one to two years after the excision of tumors, and both died two to three months later. The remaining 10 patients were alive and well at this writing. The smears from all 13 patients were diagnosed as extramedullary plasmacytomas by fine needle aspiration cytology.

Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage

International Nuclear Information System (INIS)

Panughpath, Sridhar G; Kumar, Savith; Kalyanpur, Arjun

2013-01-01

To evaluate the utility of a mobile device to detect and assess intracranial hemorrhage (ICH) on head computed tomographys (CT) performed in the emergency setting. 100 head CT scans were randomly selected from our emergency radiology database and anonymized for patient demographics and clinical history. The studies were independently interpreted by two experienced radiologists in a blinded manner, initially on a mobile device (iPad, Apple computers) and subsequently, at an interval of one week, on a regular desktop workstation. Evaluation was directed towards detection, localization and characterization of hemorrhage. The results were assessed for accuracy, sensitivity, specificity and positive predictive value. Statistical significance was ascertained using Fisher's exact test. 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used. We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT

Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage

Directory of Open Access Journals (Sweden)

Sridhar G Panughpath

2013-01-01

Full Text Available Aim: To evaluate the utility of a mobile device to detect and assess intracranial hemorrhage (ICH on head computed tomographys (CT performed in the emergency setting. Materials and Methods: 100 head CT scans were randomly selected from our emergency radiology database and anonymized for patient demographics and clinical history. The studies were independently interpreted by two experienced radiologists in a blinded manner, initially on a mobile device (iPad, Apple computers and subsequently, at an interval of one week, on a regular desktop workstation. Evaluation was directed towards detection, localization and characterization of hemorrhage. The results were assessed for accuracy, sensitivity, specificity and positive predictive value. Statistical significance was ascertained using Fisher′s exact test. Results: 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used. Conclusion: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS is effective in the detection of intracranial hemorrhage present on head CT.

Age determination of subdural hematomas: survey among radiologists

NARCIS (Netherlands)

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

2014-01-01

Abusive head trauma is a severe form of child abuse. One important diagnostic finding is the presence of a subdural hematoma. Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as

Spontaneous resolution of post-traumatic chronic subdural hematoma

African Journals Online (AJOL)

Here, we present a case of spontaneously resolved post-traumatic bilateral chronic subdural hematoma within a period of one month in a 55-year-old male and we discuss the probable mechanisms of pathophysiology in the spontaneous resolution of chronic subdural hematoma. Keywords: Antiaggregation therapy, chronic ...

Developing a model of chronic subdural hematoma.

Science.gov (United States)

Tang, Jingyang; Ai, Jinglu; Macdonald, R Loch

2011-01-01

Chronic subdural hematoma (CSDH) is a common neurosurgical condition that has a high incidence in the increasing elderly population of many countries. Pathologically, it is defined as a persistent liquefied hematoma in the subdural space more than 3 weeks old that is generally encased by a membraneous capsule. CSDHs likely originate after minor head trauma, with a key factor in its development being the potential for a subdural cavity to permit its expansion within, which is usually due to craniocerebral disproportion. The pathogenesis of CSDH has been attributed to osmotic or oncotic pressure differences, although measurements of these factors in the CSDH fluid do not support this theory. Current belief is that CSDH arises from recurrent bleeding in the subdural space, caused by a cycle of local angiogenesis, inflammation, coagulation and ongoing fibrinolysis. However, because of a lack of detailed knowledge about the precise mechanisms, treatment is often limited to surgical interventions that are invasive and often prone to recurrence. Thus, it is possible that an easily reproducible and representative animal model of CSDH would facilitate research in the pathogenesis of CSDH and aid with development of treatment options.

Parkinsonsim due to a Chronic Subdural Hematoma

Directory of Open Access Journals (Sweden)

Bosuk Park

2009-05-01

Full Text Available Subdural hematoma is a rare cause of parkinsonism. We present the case of a 78-year-old man with right-side dominant parkinsonism about 3 months after a minor head injury. MRI reveals a chronic subdural hematoma on the left side with mildly displaced midline structures. The parkinsonian features were almost completely disappeared after neurosurgical evacuation of the hematoma without any anti-parkinson drug.

Parkinsonsim due to a Chronic Subdural Hematoma

Science.gov (United States)

Park, Bosuk; Song, Sook Keun; Hong, Jin Yong; Lee, Phil Hyu

2009-01-01

Subdural hematoma is a rare cause of parkinsonism. We present the case of a 78-year-old man with right-side dominant parkinsonism about 3 months after a minor head injury. MRI reveals a chronic subdural hematoma on the left side with mildly displaced midline structures. The parkinsonian features were almost completely disappeared after neurosurgical evacuation of the hematoma without any anti-parkinson drug. PMID:24868353

Bilateral Pleural Effusion in a Patient with an Extensive Extramedullary Hematopoietic Mass

Directory of Open Access Journals (Sweden)

Yun Luo

2013-01-01

Full Text Available We present a 56-year-old woman with bilateral pleural effusions, widespread enlarged lymph nodes, and soft tissue masses located within the renal pelvis. The initially working diagnosis was tuberculosis and lymphoma. Further pathological examination of the lymph node biopsy confirmed a diagnosis of extramedullary hematopoiesis, and a bone marrow biopsy revealed myelofibrosis. Unlike common treatment options such as radiotherapy and/or surgery, intrathoracic cisplatin and dexamethasone for the treatment of pleural effusions secondary to extramedullary hematopoiesis demonstrated an improvement in feasibility and efficacy in the present case.

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

International Nuclear Information System (INIS)

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

1983-01-01

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

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

International Nuclear Information System (INIS)

Masuzawa, T.; Sato, F.

1984-01-01

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

Shedding new light on rapidly resolving traumatic acute subdural hematomas.

Science.gov (United States)

Brooke, Magdalene; Patel, Atul; Castro-Moure, Federico; Victorino, Gregory P

2017-11-01

Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015. Inclusion criteria were ASDH on computed tomography (CT), admission Glasgow coma score >7, and repeat CT to evaluate ASDH change. RRASDH was defined as reduced hematoma thickness by 50% within 72 h. Clinical data, CT findings, and trauma end points were analyzed for the RRASDH and nonresolving groups. There were 154 ASDH patients included, with 29 cases of RRASDH. The RRASDH group had a lower rate of comorbidities than the nonresolving group (58.6% versus 78.4%, P = 0.03) and a lower rate of prehospital anticoagulation (7.7% versus 37.1%, P = 0.004). Previously reported predictors of RRASDH did not differ between the groups, nor did any clinical outcome measures. When compared with patients who experienced rapid growth (>50% increased width in 72 h), the RRASDH group had lower mortality (3.4% versus 23.5%, P = 0.04). To our knowledge, this is the largest review of RRASDHs. We identified two previously unrecognized factors that may predict resolution; however, previously reported predictors were not associated with resolution. We also found no relationship between RRASDHs and improved standard trauma outcomes, calling into question the clinical significance of RRASDH. Copyright © 2017 Elsevier Inc. All rights reserved.

CT findings in a case of neonatal acute subdural hematoma

International Nuclear Information System (INIS)

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

1981-01-01

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

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.

Chronic Subdural Hematoma Associated with Acute Biphenotypic Leukemia: Case Report

OpenAIRE

Besime Utku; Uygar Utku

2015-01-01

Spontaneous chronic subdural hematoma associated with neoplasm is a rare disorder. A rare case of chronic subdural hematoma associated with acute biphenotypic leukemia presented here. A 78-year-old woman who diagnosed as acute biphenotypic leukemia by hematology was complicated with a large chronic subdural hematoma. She presented to our emergency medicine service of hospital with left-sided weakness. Her non-contrast brain computerized tomography scan showed a non-traumatic right-sided, larg...

Acute Subdural Hematoma

Directory of Open Access Journals (Sweden)

Ellen Lester

2017-04-01

Full Text Available History of present illness: A 21-year-old female with no past medical history presented to the ED after multiple tonic-clonic seizures over the previous 12 hours, the longest lasting 20 seconds. She returned to baseline after each seizure, had no obvious signs of trauma, and did not exhibit any focal neurologic deficits. She denied illicit drugs or new medications. A family member noted that she had fallen from her bed (approximately 3 feet high 2 days ago. Significant findings: Non-contrast Computed Tomography (CT of the Head showed a dense extra-axial collection along the left frontal and parietal regions, extending superior to the vertex with mild mass effect, but no midline shift. Discussion: Intracranial hemorrhage (ICH is a term to describe any abnormal bleeding within the bony confines of the skull. Most commonly, subdural hemorrhages (SDH result from injury to the bridging veins that lead to bleeding between the dura and arachnoid maters. However, in 20%-30% of cases an arterial source of bleeding can be found.1 For adults, motor vehicle collisions and other unintentional head trauma are typically the provoking factors in developing SDH. Falls in the elderly are a common cause of SDH since diffuse cerebral atrophy leads to increased shear forces upon vasculature structures during the fall. The risk of SDH increases with the use of anti-thrombotic agents.2 Clinical presentation varies from asymptomatic to coma (in 50 percent of acute SDH. Chronic SDH may present with headaches, light-headedness, cognitive impairment, and seizures.1 The risk of posttraumatic epileptic seizures (PTS is higher in acute SDH. Risk factors for acute SDH PTS include low Glasgow Coma Score and craniotomy, whereas risk factors for PTS in chronic SDH include alcohol abuse, change in mental status, previous stroke, and hematoma density on CT.3 CT is the most widely used imaging modality for identifying ICH. Acute SDH (within 1-2 days are visualized as hyperdense

Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.

Science.gov (United States)

Yamaguchi, Yoshitaka; Koga, Masatoshi; Matsuki, Takayuki; Hino, Tenyu; Yokota, Chiaki; Toyoda, Kazunori

2016-07-01

A 79-year-old lean man with a height of 157cm and weight of 42kg (body mass index, 17.2kg/m(2)) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44mL/min, his dosage of rivaroxaban was reduced from 15 to 10mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space. Copyright © 2016 Elsevier Ltd. All rights reserved.

Bilateral chronic subdural hematoma

DEFF Research Database (Denmark)

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

2017-01-01

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...... are associated with the retreatment of bCSDH with a focus on surgical laterality. METHODS In a national database of CSDHs (Danish Chronic Subdural Hematoma Study) the authors retrospectively identified all bCSDHs treated in the 4 Danish neurosurgical departments over the 3-year period from 2010 to 2012...... that a separated hematoma density and the absence of postoperative drainage were independent predictors of retreatment. CONCLUSIONS In bCSDHs bilateral surgical intervention significantly lowers the risk of retreatment compared with unilateral intervention and should be considered when choosing a surgical...

Modeling Cerebral Vascular Injury

Science.gov (United States)

2016-01-01

epidural hematoma , 16% had a subdural hematoma , 11% had an intraventricular hemorrhage, and 14% had mixed hemorrhages (Armonda et al. 2006). In order... hematoma , 16% had a subdural hematoma , 11% had an intraventricular hemorrhage, and 14% had mixed hemorrhages (Armonda et al. 2006). Injuries such as...vasospasm and pseudoaneurysm can lead to further damage to the brain over time. Intracranial hemorrhages and hematomas can be life threatening and

Development of a Traumatic Brain Injury Assessment Score Using Novel Biomarkers Discovered Through Autoimmune Profiling

Science.gov (United States)

2013-07-03

10 mm and a subdural or epidural hematoma of 5 mm. The thirty-day extended Glasgow outcome scale ranged from 2 to 7 with an average of 5 for the...0.6) 0 CT- 16 (10) 0 Subdural Hematoma Acute - - CT-Subarachnoid _Hemorrhage 24 (16) 0 CT-Contusion 11 (7) 0 CT-Intracerebral_ Hemorrhage IO (6) 0... Hematoma 0 (0) 0 MRI- 21 (14) 0 Subdural Hematoma Acute - - MRI- 23 (15) 0 Subarachnoid _Hemorrhage MRI-Contusion 19 (12) 0 MRI-IntracerebraJ

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

LENUS (Irish Health Repository)

Kaliaperumal, Chandrasekaran

2012-11-01

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

Electrochemotherapy treatment of oral extramedullary plasmacytoma of the tongue: a retrospective study of three dogs

Directory of Open Access Journals (Sweden)

Rúbia Monteiro de Castro Cunha

2017-11-01

Full Text Available ABSTRACT: Extramedullary plasmacytomas (EPs are responsible for 2.5% of neoplasms in dogs. They are solitary, smooth, elevated, pink or red nodules, of 1 to 2cm in diameter. Cutaneous and oral extramedullary plasmacytomas in dogs are usually benign tumors, treated with local therapies. Prognosis is generally good. Recurrence and metastatic rates are low. Electrochemotherapy is a local treatment that combines chemotherapy and electroporation and shows objective responses of 70% to 94% with few local and systemic side effects. This scientific communication has the objective to report treatment of three canine patients with oral extramedullary plasmacytoma. Nodules were located on the tongue and patients were submitted to one or two electrochemotherapy sessions, which preserved the tongue without mutilation and cured the patients.

Infiltración extramedular en la leucemia mielomonocítica crónica (LMMC Extramedullary infiltration in chronic myelomonocytic leukemia (CMML

Directory of Open Access Journals (Sweden)

Onel Ávila Cabrera

2008-12-01

Full Text Available La leucemia mielomonocítica crónica (LMMC constituye un proceso oncohematológico de naturaleza mixta, mieloproliferativa y mielodisplásica. Su forma habitual de presentación es consecuencia, generalmente, de las citopenias en sangre periférica (síndrome anémico, infecciones o diátesis hemorrágica. La infiltración extramedular en la LMMC frecuentemente involucra el bazo, hígado, piel y nódulos linfáticos; sin embargo, es poco frecuente su localización en otros sitios. Se describe un paciente de 70 años con el diagnóstico de LMMC con infiltración extramedular en piel (nódulos subcutáneos, paladar duro y testículos; se comentan aspectos diagnósticos, terapéuticos y evolutivos.Chronic myelomonocytic leukemia is an oncohematological process of mixed, myeloproliferative and myelodisplastic nature. Its habitual form of presentation generally results from cytopenias in peripheral blood (anemic syndrome, infections or hemorrhagic diathesis. The extramedullary infiltration in the CMML frequently involves the spleen, the liver, the skin and the lymphatic nodules; however, its localization in other sites is not usual. The case of a 70-year-old patient with diagnosis of CMML and with extramedullary infiltration in the skin (subcutaneous nodules, hard palate and testicles is described. Comments on diagnostic, therapeutic and evolutive aspects are made

Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

Science.gov (United States)

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

2015-01-01

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

The risk factors for recurrence of chronic subdural hematoma.

Science.gov (United States)

Ohba, Shigeo; Kinoshita, Yu; Nakagawa, Toru; Murakami, Hideki

2013-01-01

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

MRI of perineural extramedullary granulocytic sarcoma

Energy Technology Data Exchange (ETDEWEB)

Graham, A. [Rehabilitation Medicine, Hunters Moor Neurological Rehabilitation Centre, Newcastle-Upon-Tyne (United Kingdom); Hodgson, T. [Neuroradiology Dept., Royal Hallamshire Hospital, Sheffield (United Kingdom); Jacubowski, J. [Neurosurgical Dept., Royal Hallamshire Hospital, Sheffield (United Kingdom); Norfolk, D. [Haematology Department, Leeds General Infirmary, Leeds LS1 3EX (United Kingdom); Smith, C. [Pathology Dept., Royal Hallamshire Hospital, Sheffield (United Kingdom)

2001-06-01

Granulocytic sarcoma is an extramedullary solid tumour consisting of myelogenous leukaemic blast cells, usually seen in acute myeloid leukaemia and less commonly in patients with chronic myeloid leukaemia or myeloproliferative disorders. Blast cells have a predilection for periosteal and perineural regions and rarely precede evidence of systemic disease. We present two patients, aleukaemic on peripheral blood counts, both at presentation and during subsequent treatment. We present the MRI features of this rare but important condition. (orig.)

Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child.

Science.gov (United States)

Glenn, Chad A; Fung, Kar-Ming; Tullos, Hurtis J; McNall-Knapp, Rene Y; Gunda, Divya; Mapstone, Timothy B

2016-02-01

Chronic subdural hematoma in the pediatric population often results from trauma. Asymptomatic and benign-appearing subdural collections are generally managed conservatively without operative intervention. Primary intracranial sarcomas are uncommon entities. Diagnosis of sarcoma can be difficult because these lesions often manifest as apparent hematoma. Presented is the case of a primary intracranial mucoid spindle cell sarcoma that arose in a child with a history of benign-appearing bilateral subdural fluid collections in the setting of nonaccidental trauma. The patient was initially managed conservatively because her neurological examination result was normal and her subdural collections decreased in size on repeated imaging. The collections did not resolve completely. Years later, she exhibited weakness, seizure, and an increase in the size of her subdural fluid collection. Subdural drainage was attempted without significant effect. Cytologic assessment of fluid was negative for malignant cells. Magnetic resonance imaging revealed multiple enhancing masses along the subdural collection. The patient eventually underwent craniotomy in which a diagnosis of sarcoma was obtained. Pathological and radiographic findings as well as oncological management are reviewed. The authors also review the natural history and treatment of primary intracranial sarcoma in the pediatric population. Early contrasted magnetic resonance imaging should be obtained in patients with subdural fluid collections that appear asymmetric or do not resolve in the expected time course, despite having a normal neurologic examination result. Negative cytologic assessment does not exclude sarcoma diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

A case with Parkinsonism secondary to bilateral subdural hematoma

Directory of Open Access Journals (Sweden)

Adalet Arıkanoğlu

2011-03-01

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

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies

Energy Technology Data Exchange (ETDEWEB)

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

1996-10-01

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

Extramedullary Relapse of Acute Lymphoblastic Leukemia Presenting as Abnormal Uterine Bleeding: A Case Report.

Science.gov (United States)

Robillard, Diana T; Kutny, Matthew A; Chewning, Joseph H; Arbuckle, Janeen L

2017-06-01

Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy. Relapse of ALL occurs in 15%-20% of patients, with 2%-6% occurring exclusively in extramedullary sites. Relapse of ALL in gynecologic organs is extremely rare. We present a case of a 12-year-old girl with a history of ALL who was referred to the pediatric gynecology clinic with abnormal uterine bleeding. She was determined to have an extramedullary uterine relapse of her ALL. Abnormal uterine bleeding in the setting of childhood malignancy is a frequent reason for consultation to pediatric and adolescent gynecology services. This bleeding is commonly attributed to thrombocytopenia due to bone marrow suppressive chemotherapeutic agents. However, as shown in this report, abnormal uterine bleeding might be a manifestation of an extramedullary relapse. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

Energy Technology Data Exchange (ETDEWEB)

Fernando, Sujan [University of Missouri-Kansas School of Medicine, Department of Medicine, Kansas City, MO (United States); Obaldo, Ruby E. [The University of Kansas Medical Center, Department of Radiology, Kansas City, MO (United States); Walsh, Irene R. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Emergency Medicine, Kansas City, MO (United States); Lowe, Lisa H. [The University of Missouri-Kansas City, Children' s Mercy Hospitals and Clinics, Department of Radiology, Kansas City, MO (United States)

2008-08-15

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

Neuroimaging of nonaccidental head trauma: pitfalls and controversies

International Nuclear Information System (INIS)

Fernando, Sujan; Obaldo, Ruby E.; Walsh, Irene R.; Lowe, Lisa H.

2008-01-01

Although certain neuroimaging appearances are highly suggestive of abuse, radiological findings are often nonspecific. The objective of this review is to discuss pitfalls, controversies, and mimics occurring in neuroimaging of nonaccidental head trauma in order to allow the reader to establish an increased level of comfort in distinguishing between nonaccidental and accidental head trauma. Specific topics discussed include risk factors, general biomechanics and imaging strategies in nonaccidental head trauma, followed by the characteristics of skull fractures, normal prominent tentorium and falx versus subdural hematoma, birth trauma versus nonaccidental head trauma, hyperacute versus acute on chronic subdural hematomas, expanded subarachnoid space versus subdural hemorrhage, controversy regarding subdural hematomas associated with benign enlarged subarachnoid spaces, controversy regarding hypoxia as a cause of subdural hematoma and/or retinal hemorrhages without trauma, controversy regarding the significance of retinal hemorrhages related to nonaccidental head trauma, controversy regarding the significance of subdural hematomas in general, and pitfalls of glutaric aciduria type 1 and hemophagocytic lymphohistiocytosis mimicking nonaccidental head trauma. (orig.)

Treatment with hydroxyurea in thalassemia intermedia with paravertebral pseudotumors of extramedullary hematopoiesis.

Science.gov (United States)

Cario, H; Wegener, M; Debatin, K-M; Kohne, E

2002-08-01

Excessive ineffective erythropoiesis in thalassemia intermedia may cause paravertebral pseudotumors of extramedullary hematopoiesis. Due to the proximity to the spinal canal, these paravertebral masses carry the risk of severe neurological damage. Treatment strategies include hypertransfusion, radiotherapy, and laminectomy. Hydroxyurea, stimulating fetal hemoglobin synthesis, may represent an alternative therapeutic approach. We report on a 26-year-old patient suffering from thalassemia intermedia with progressive anemia symptoms and presenting multiple intrathoracic paravertebral pseudotumors of extramedullary hematopoiesis. Hypertransfusion therapy and splenectomy were followed by regular transfusion (baseline hemoglobin 10 g/dl) and chelation with desferrioxamine. With this treatment, clinical symptoms disappeared, paravertebral hematopoietic masses did not progress, but severe hemosiderosis developed within a few years. Hydroxyurea therapy was initiated to increase the efficacy of erythropoiesis, thereby reducing the required transfusion volume but suppressing concomitantly further expansion of extramedullary hematopoiesis, and finally leading to a reduction of transfusional iron load. Treatment was started with 4 mg/kg per day and stepwise increased to 12.5 mg/kg per day. The fetal hemoglobin concentration increased from 4.5 to 5.5 g/dl after 1 year and to 9.9 g/dl after 2 years of treatment. The yearly transfusion volume was halved during the 1st year of treatment. At present, after 26 months of treatment, the patient has been transfusion-independent for 10 months. Serum ferritin levels decreased from 2844 to 1335 ng/ml. Size and shape of paravertebral hematopoietic pseudotumors remained stable. No side effects of hydroxyurea have been observed. In thalassemia intermedia patients with extramedullary hematopoiesis, hydroxyurea may lead to independence from regular transfusion therapy without further expansion of ectopic hematopoietic tissue.

A case of subdural hematoma following lumbar puncture

Directory of Open Access Journals (Sweden)

Ramatharaknath Vemuri

2017-01-01

Full Text Available Lumbar puncture (LP is a frequent procedure done for administration of spinal anesthesia or for obtaining cerebrospinal fluid for analysis. The common complications of LP are pain at the local site and headache. Fortunately, the serious complications such as infections of central nervous system, brain stem herniation, and subdural hematoma are rare. We present a rare case of subdural hematoma following a LP.

Spectrophotometry of cerebrospinal fluid in subacute and chronic subdural haematomas

Science.gov (United States)

Kjellin, K. G.; Steiner, L.

1974-01-01

Spectrophotometric examinations were performed on cerebrospinal and subdural fluids in subacute (five patients) and chronic (20 patients) subdural haematomas, with special reference to the diagnostic aid of CSF spectrophotometry. Spectrophotometric xanthochromia of haemorrhagic origin was found in all CSFs examined, while definite visible xanthochromia was observed in only 28% and the CSF was judged as colourless in 52% of those cases. Characteristic bleeding patterns were found spectrophotometrically in all the 20 CSFs examined within 24 hours after lumbar puncture, haematoma patterns being detected in 90-95% of the cases. In many cases the electrophoretically separated protein fractions of CSF and subdural fluids were spectrophotometrically examined. In conclusion, CSF spectrophotometry is a simple, fast, and extremely sensitive method, which in our opinion should be used routinely in the diagnosis of suspected subdural haematomas, if lumbar puncture is not contraindicated. PMID:4140892

Bilateral subdural hematoma secondary to accidental dural puncture

Directory of Open Access Journals (Sweden)

Sofía Ramírez

2015-07-01

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. Resumo: Apresentamos o caso clínico de uma paciente de 25 anos de idade, na qual uma técnica peridural foi realizada durante o trabalho de parto e posteriormente apresentou cefaleia com características de cefaleia pós-punção dural. Foi iniciado tratamento conservador e tampão de sangue peridural. Devido a ausência de melhora clínica e à mudança do componente postural da cefaleia, decidiu-se realizar um exame de imagem cerebral que demostrou a presença de hematoma subdural bilateral.A cefaleia pós-punção dural é relativamente frequente, mas a falta de resposta ao tratamento médico instaurado, assim como a mudança em suas características e a presença de foco neurológico, devem levantar a suspeita de presença de um hematoma subdural que, embora infrequente, pode chegar a ser devastador se não for diagnosticado e tratado oportunamente. Keywords: Accidental dural puncture, Epidural analgesia, Post-dural puncture headache, Subdural hematoma, Epidural blood patch, Palavras chave: Dura-Máter, Analgesia epidural, Cefaleia pós-punção dural, Hematoma subdural, Placa de sangue epidural

The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report

Science.gov (United States)

Yeo, Chang-Gi; Jeon, Woo-Yeol; Kim, Seong-Ho; Kim, Oh-Lyong

2016-01-01

Objective A subdural drain using urokinase after a burr hole hematoma evacuation was performed for subacute subdural hematoma (SASDH), and its effectiveness and safety in elderly patients were evaluated. Methods Between January 2013 and May 2015, subdural drains using urokinase after burr hole hematoma evacuation were performed in 19 elderly patients. The inclusion criteria were as follows: 1) a subdural hematoma occurring between 4 and 20 days after injury; 2) worsening neurological symptoms, from mild to moderate or severe, due to injury during the subacute stage; 3) a mix of solid clots (high-density lighter shadow) and fluid hematoma (low-density darker shadow) on the computed tomography (CT) scan; 4) a score of ≥9 on the Glasgow Coma Scale (GCS) assessed immediately before surgery; and 5) an age of ≥65 years. When the majority of the hematoma was evacuated on the CT, we removed the catheter. Results Under local anesthesia, a catheter was inserted into the hematoma through a burr hole. The mean age of the patients was 73.7 years (range, 65-87 years). The mean preoperative GCS score was 11.2 (range, 10-13), and the mean Glasgow Outcome Scale score for all patients was 5 at discharge. No recurrences of hematomas or surgical complications were observed. Conclusion A subdural drain using urokinase after burr hole hematoma evacuation under local anesthesia is thought to be an effective and safe method of blood clot removal with low morbidity. This surgical method is less invasive for treating elderly patients with SASDH. PMID:27857916

Extramedullary hematopoiesis (EMH) in laboratory animals: offering an insight into stem cell research.

Science.gov (United States)

Chiu, Shao-Chih; Liu, Hua-Hsing; Chen, Chia-Ling; Chen, Pin-Ru; Liu, Ming-Chao; Lin, Shinn-Zong; Chang, Ko-Tung

2015-01-01

Extramedullary hematopoiesis (EMH) is a pathological process secondary to underlying bone marrow (BM) insufficiency in adults. It is characterized by the emergence of multipotent hematopoietic progenitors scattered around the affected tissue, most likely in the spleen, liver, and lymph node, etc. EMH in patients frequently receives less medical attention and is neglected unless a compressive or obstructive hematopoietic mass appears to endanger the patient's life. However, on a biological basis, EMH reflects the alteration of relationships among hematopoietic stem and progenitor cells (HSPCs) and their original and new microenvironments. The ability of hematopoietic stem cells (HSCs) to mobilize from the bone marrow and to accommodate and function in extramedullary tissues is rather complicated and far from our current understanding. Fortunately, many reports from the studies of drugs and genetics using animals have incidentally found EMH to be involved. Thereby, the molecular basis of EMH could further be elucidated from those animals after cross-comparison. A deeper understanding of the extramedullary hematopoietic niche could help expand stem cells in vitro and establish a better treatment in patients for stem cell transplantation.

Spinal cord compression due to extramedullary hematopoiesis in beta-thalassemia intermedia

International Nuclear Information System (INIS)

Munn, Rita K.; Kramer, Carol A.; Arnold, Susanne M.

1998-01-01

Background: Extramedullary hematopoiesis (EMH) occurs in many disorders, including thalassemias and other hemoglobinopathies, and commonly presents in the spleen and liver. We present a case of spinal cord compression in a patient with beta-thalassemia intermedia, and review the literature and available treatment options. Patient and Methods: A 35-year-old black female with beta-thalassemia intermedia presented with a 3-week history of back pain and lower extremity weakness. Neurologic examination was consistent with spinal cord compression, and gadolinium enhanced magnetic resonance imaging (MRI) confirmed this diagnosis. She was given intravenous steroids and radiotherapy was begun in 200 cGy fractions to a total dose of 2000 cGy. Results: At the completion of radiotherapy the patient was ambulatory with mild residual weakness. MRI scans 16 months later showed smaller, but persistent masses, and she remains asymptomatic 5 years from her diagnosis. Conclusion: Recognition of spinal cord EMH requires prompt physical examination and MRI for accurate diagnosis. EMH can be managed with radiation, surgery, transfusions, or a combination of these therapies. Radiation in conservative doses of (750-3500 cGy) is non-invasive, avoids the surgical risks of potentially severe hemorrhage and incomplete resection, and has a high complete remission rate in the majority of patients. Relapse rates are moderate (37.5%), but retreatment provides excellent chance for second remission

Case report: Calcified chronic subdural haematoma in an elderly ...

African Journals Online (AJOL)

Calcified chronic subdural haematoma [CCSDH] is a rare complication of the relatively more common condition of Chronic Subdural Haematoma (CSDH). We present the case of a 68yr old man referred with a 2 week history of sudden onset Right hemi paresis generalized tonic clonic seizures and aphasia. There was a ...

Assessment of drainage techniques for evacuation of chronic subdural hematoma

DEFF Research Database (Denmark)

Sjåvik, Kristin; Bartek, Jiri; Sagberg, Lisa Millgård

2018-01-01

OBJECTIVE Surgery for chronic subdural hematoma (CSDH) is one of the most common neurosurgical procedures. The benefit of postoperative passive subdural drainage compared with no drains has been established, but other drainage techniques are common, and their effectiveness compared with passive...

Computed tomography of intraventricular hemorrhage

International Nuclear Information System (INIS)

Cho, Bum Shin; Shin, Kyoung Hee; Hahm, Chang Kok

1982-01-01

Computed tomography (CT) is a new non-invasive diagnostic imaging method, which has ability to differentiate C.S.F., hematoma, and even edematous brain from normal brain tissue. Prior to the introduction of the CT, the diagnosis of the intraventricular hemorrhage in living patients was difficult and was confirmed by surgery of autopsy. Intracranial hemorrhages are visible on the CT with density higher than brain tissue in acute phase. CT is an accurate method for detecting of intraventricular hemorrhage including detection of nature, location, amount, and associated changes. CT is also useful as a guidance and in the evaluation of fate of the hematomas by easily performable follow up studies. The causes of the intraventricular hemorrhages are hypertension, rupture of aneurysm, arteriovenous malformation, head trauma, brain tumor, and others. This study included evaluation of CT of 69 patients who show the high density in cerebral ventricular system during the period of 31 months from Feb. 1979 to Aug. 1981 in the Department of Radiology, College of Medicine, Hanyang University. The results were as follows. 1. Age distribution of the total 69 patient was broad ranging from 1 month to 80 years. 28% of patients were in the 6th decade. The mate to female ratio was 2 : 1. 2. The consciousness of patients at CT study: Those were conscious in 11 cases, stuporous in 41 cases and unconscious in 17 cases. 3. The causes of intraventricular hemorrhages were hypertension in 28 cases, head trauma in 12 cases, aneurysm in 4 cases, tumor in 2 cases and others in 23 cases. 4. 9 cases showed intraventricular hematomas only, other 60 cases showed associated intracranial hematomas: Those were intracerebral hematomas in 53 cases including 30 cases of basal ganglial and thalamic hematomas, subarachnoid hemorrhage in 17 cases, epidural hematomas in 3 cases, and subdural hematomas in 2 cases. 5. All cases of the intraventricular hematomas except one sowed hematoma in the lateral

Chronic subdural hematoma fluid and its computerized tomographic density

International Nuclear Information System (INIS)

Masuzawa, Hideaki; Sato, Jinichi; Kamitani, Hiroshi; Yamashita, Midori

1983-01-01

Laboratory and in vivo CT analysis were performed on 19 chronic subdural hematomas and five subdural hygromas. In these 25 hematoma samples, red blood cells (RBC), hematocrit, and hemoglobin (Hgb) varied greatly, though, these values correlated well with the CT densities. Plasma protein content was fairly constant with an average of 7.1+-0.8g/dl. There were four hematoma samples with RBC of less than 20x10 4 μl or Hgb of less than 2.0g/dl. Their CT values ranged between 18 and 23 H.U., which were considered close to the in vivo serum level CT density. Five hygroma fluid showed no RBC and very little protein content of less than 0.4g/dl. CT density ranged between -2 and 13 H.U. The edge effect of the skull was experimentally studied using a phantom skull filled with water. This revealed a remarkable overshoot of the CT values within ten pixels from the inner wall of the skull. Visual observation of the original CT pictures revealed four low density hematomas and seven mixed density ones. When compared to the density of the ventricular cavity, all of the low density hematomas and the supernatant part of the mixed density ones were clearly higher in density. All five hygromas appeared CSF dense or lower. In conclusion, because of the edge effect by the skull, thin subdural fluids could not be diagnosed by CT alone. Thick subdural fluids could be differentiated as either hematoma or hygroma by their CT densities. Subdural hematomas had in vivo CT densities of at least serum level or approximately 20 H.U., while subdural hygromas had densities close to CSF. These characteristics were best appreciated by visual observation of the CT scan films. (J.P.N.)

Biomechanical Comparison of an Intramedullary and Extramedullary Free-Tissue Graft Reconstruction of the Acromioclavicular Joint Complex

Science.gov (United States)

Garg, Rishi; Javidan, Pooya; Lee, Thay Q.

2013-01-01

Background Several different surgical techniques have been described to address the coracoclavicular (CC) ligaments in acromioclavicular (AC) joint injuries. However, very few techniques focus on reconstructing the AC ligaments, despite its importance in providing stability. The purpose of our study was to compare the biomechanical properties of two free-tissue graft techniques that reconstruct both the AC and CC ligaments in cadaveric shoulders, one with an extramedullary AC reconstruction and the other with an intramedullary AC reconstruction. We hypothesized intramedullary AC reconstruction will provide greater anteroposterior translational stability and improved load to failure characteristics than an extramedullary technique. Methods Six matched cadaveric shoulders underwent translational testing at 10 N and 15 N in the anteroposterior and superoinferior directions, under AC joint compression loads of 10 N, 20 N, and 30 N. After the AC and CC ligaments were transected, one of the specimens was randomly assigned the intramedullary free-tissue graft reconstruction while its matched pair received the extramedullary graft reconstruction. Both reconstructed specimens then underwent repeat translational testing, followed by load to failure testing, via superior clavicle distraction, at a rate of 50 mm/min. Results Intramedullary reconstruction provided significantly greater translational stability in the anteroposterior direction than the extramedullary technique for four of six loading conditions (p < 0.05). There were no significant differences in translational stability in the superoinferior direction for any loading condition. The intramedullary reconstructed specimens demonstrated improved load to failure characteristics with the intramedullary reconstruction having a lower deformation at yield and a higher ultimate load than the extramedullary reconstruction (p < 0.05). Conclusions Intramedullary reconstruction of the AC joint provides greater stability in the

Renal Bleeding Due to Extramedullary Hematopoiesis in a Patient With Chronic Myelogenous Leukemia

Directory of Open Access Journals (Sweden)

Stephanie Zettner

2014-11-01

Full Text Available Chronic myelogenous leukemia (CML is a myeloproliferative disorder that normally presents in middle-aged adults. Renal infiltration and extramedullary hematopoiesis in renal tissue has been rarely reported. This case report presents a patient with CML and renal insufficiency who developed gross hematuria. Efforts at controlling the hematuria led to a cascade of events propelled by the underlying disorder that ultimately led to a radical nephrectomy, multiorgan failure, and prolonged hospitalization. We suggest that management of gross hematuria in clinically stable patients with CML, suspected of having extramedullary hematopoiesis, should prioritize treatment of the myeloproliferative disorder over efforts to control bleeding.

Renal Bleeding Due to Extramedullary Hematopoiesis in a Patient With Chronic Myelogenous Leukemia.

Science.gov (United States)

Zettner, Stephanie; Mistry, Sandeep G

2014-11-01

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder that normally presents in middle-aged adults. Renal infiltration and extramedullary hematopoiesis in renal tissue has been rarely reported. This case report presents a patient with CML and renal insufficiency who developed gross hematuria. Efforts at controlling the hematuria led to a cascade of events propelled by the underlying disorder that ultimately led to a radical nephrectomy, multiorgan failure, and prolonged hospitalization. We suggest that management of gross hematuria in clinically stable patients with CML, suspected of having extramedullary hematopoiesis, should prioritize treatment of the myeloproliferative disorder over efforts to control bleeding.

Computed tomography in subarachnoid hemorrhage

International Nuclear Information System (INIS)

Lee, Seung Ro; Chang, Kee Hyun; Choi, Byung Ihn; Han, Man Chung; Sim, Bo Sung

1981-01-01

Computed Tomography has become increasingly important diagnostic method as the initial examination in the diagnosis of subarachnoid hemorrhage with direct detection of extravasated blood in basal cistern and cortical sulci. Furthermore, CT provides better and exact visualization of the presence, localization, extent and degree of intracerebral, intraventricular and subdural hemorrhage, infarction, hydrocephalus and rebleeding which may be associated with subarachnoid hemorrhage, and also could detect the causative lesions with contrast enhancement in many cases. The purpose of the paper is to describe the CT findings of subarachnoid hemorrhage due to various causes and to evaluate the diagnostic accuracy of CT in subarachnoid hemorrhage. Authors analysed a total of 153 cases with subarachnoid hemorrhage confirmed by lumbar puncture at Seoul National University Hospital from March 1979 to April 1981, with special emphasis on CT findings. All of the cases took CT scan and 125 cases of them angiography. The results are as follows: 1. Most prevalent age group was 4th to 6th decades (78%). The ratio of male to female was 1.1: 1. 2. Of 125 cases with angiography, aneurysm was a major cause (68%). Others were arterio-venous malformation (9.6%), Moya-moya disease (4%) and unknown (18.4%). 3. Of all 153 cases with CT scan, hemorrhage was demonstrated in 98 cases (64.1%); SAH in 72 cases (47.1%), ICH in 65 cases (42.5%), IVH in 34 cases (22.2%) and SDH in 1 case (0.7%). SAH combined with ICH was a major group (34.7%) in SAH. Detection rate of SAH was 68.3% within the first 7 days and 5.8% after 7 dyas. 4. In aneurysms, SAH was detected in 60 of 85 cases (70.6%); 88.1% within the first 7 dyas and 5.6% after 7 dyas. Anterior communicating artery was the most common site of the aneurysms (40%), in which detection rate of SAH was 100% within the first 7 days. SAH was combined with ICH in 38.3%. 5. On CT, SAH of unilateral Sylvian fissure was pathognomonic for ruptured MCA

Extramedullary leukemia in children with acute myeloid leukemia

DEFF Research Database (Denmark)

Støve, Heidi Kristine; Sandahl, Julie Damgaard; Abrahamsson, Jonas

2017-01-01

BACKGROUND: The prognostic significance of extramedullary leukemia (EML) in childhood acute myeloid leukemia is not clarified. PROCEDURE: This population-based study included 315 children from the NOPHO-AML 2004 trial. RESULTS: At diagnosis, 73 (23%) patients had EML: 39 (12%) had myeloid sarcoma...... the OS. No patients relapsed at the primary site of the myeloid sarcoma despite management without radiotherapy....

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

Science.gov (United States)

Fujii, Norio; Naito, Yuichiro; Takanashi, Shigehiko; Ueno, Toshiaki; Nakagomi, Tadayoshi

2013-05-01

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

Solitary extramedullary plasmacytoma of the colon, rectum and anus ...

African Journals Online (AJOL)

Solitary extramedullary plasmacytoma (SEP) is a neoplastic proliferation of a single clone of plasma cells that occur outside of the bone and bone marrow. It is rare, commonly occurring in the head and neck region, followed by the gastrointestinal tract. The aetiology, risk factors, natural history and consequent treatment are ...

Start or STop Anticoagulants Randomised Trial (SoSTART)

Science.gov (United States)

2018-05-02

Intracranial Hemorrhages; Intracranial Hemorrhage, Hypertensive; Subarachnoid Hemorrhage; Subdural Hematoma; Intraventricular Hemorrhage; Atrial Fibrillation; Atrial Flutter; Small Vessel Cerebrovascular Disease; Microhaemorrhage

Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

Energy Technology Data Exchange (ETDEWEB)

Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui [Nan fang Hospital, Southern Medical University, Guangzhou (China); Tamrakar, Karuna [Zhujiang Hospital, Southern Medical University, Guangzhou (China)

2012-03-15

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

Intracranial extramedullary hematopoiesis in beta-thalassemia.

Science.gov (United States)

Karki, Bivek; Xu, Yi-Kai; Tamrakar, Karuna; Wu, Yuan-Kui

2012-01-01

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

Intracranial Extramedullary Hematopoiesis in Beta-Thalassemia

International Nuclear Information System (INIS)

Karki, Bivek; Xu, Yi Kai; Wu, Yuan Kui; Tamrakar, Karuna

2012-01-01

Extramedullary hematopoiesis (EMH) represents tumor-like proliferation of hemopoietic tissue which complicates chronic hemoglobinopathy. Intracranial EMH is an extremely rare occurrence. Magnetic resonance imaging (MRI) offers a precise diagnosis. It is essential to distinguish EMH from other extradural central nervous system tumors, because treatment and prognosis are totally different. Herein, we report the imaging findings of beta-thalassemia in a 13-year-old boy complaining of weakness of left side of the body and gait disturbance; CT and MRI revealed an extradural mass in the right temporoparietal region.

An unusual complication of invasive video-EEG monitoring: subelectrode hematoma without subdural component: case report.

Science.gov (United States)

Bozkurt, Gokhan; Ayhan, Selim; Dericioglu, Nese; Saygi, Serap; Akalan, Nejat

2010-08-01

The potential complications of the subdural electrode implantation providing identification of the seizure focus and direct stimulation of the cerebral cortex for defining the eloquent cortical areas are epidural and subdural hematoma, cortical contusions, infection, brain edema, raised intracranial pressure, CSF leakage, and venous infarction have been previously reported in the literature. To present the first case of subelectrode hematoma without subdural component that was detected during invasive EEG monitoring after subdural electrode implantation. A 19-year-old female with drug resistant seizures was decided to undergo invasive monitoring with subdural electrodes. While good quality recordings had been initially obtained from all electrodes placed on the right parietal convexity, no cerebral cortical activity could be obtained from one electrode 2 days after the first operation. Explorative surgery revealed a circumscribed subelectrode hematoma without a subdural component. Awareness of the potential complications of subdural electrode implantation and close follow-up of the clinical findings of the patient are of highest value for early detection and successful management.

Chronic subdural hematoma with persistent hiccups: A case report

Directory of Open Access Journals (Sweden)

Yushin Takemoto

2016-03-01

Full Text Available Supratentorial hiccup is a rare condition and no patients with persistent hiccups and chronic subdural hematoma have been reported. A 38-year-old man with intractable hiccups, headache, and nausea was admitted to our hospital. Computed tomography revealed a supratentorial chronic subdural hematoma on the left side. After burr hole surgery to remove the hematoma his hiccups disappeared immediately and he was discharged home on the 3rd postoperative day with no neurological deficits. Although the role of the supratentorial nervous system in hiccups is not clearly understood, supratentorial areas play an important role in the stimulation or suppression of the hiccup centers. Chronic hiccups may be a presenting symptom of chronic subdural hematoma attending headache with nausea if it has no gastrointestinal abnormality.

Simulation of spreading depolarization trajectories in cerebral cortex: Correlation of velocity and susceptibility in patients with aneurysmal subarachnoid hemorrhage

Directory of Open Access Journals (Sweden)

Denny Milakara

2017-01-01

Full Text Available In many cerebral grey matter structures including the neocortex, spreading depolarization (SD is the principal mechanism of the near-complete breakdown of the transcellular ion gradients with abrupt water influx into neurons. Accordingly, SDs are abundantly recorded in patients with traumatic brain injury, spontaneous intracerebral hemorrhage, aneurysmal subarachnoid hemorrhage (aSAH and malignant hemispheric stroke using subdural electrode strips. SD is observed as a large slow potential change, spreading in the cortex at velocities between 2 and 9 mm/min. Velocity and SD susceptibility typically correlate positively in various animal models. In patients monitored in neurocritical care, the Co-Operative Studies on Brain Injury Depolarizations (COSBID recommends several variables to quantify SD occurrence and susceptibility, although accurate measures of SD velocity have not been possible. Therefore, we developed an algorithm to estimate SD velocities based on reconstructing SD trajectories of the wave-front's curvature center from magnetic resonance imaging scans and time-of-SD-arrival-differences between subdural electrode pairs. We then correlated variables indicating SD susceptibility with algorithm-estimated SD velocities in twelve aSAH patients. Highly significant correlations supported the algorithm's validity. The trajectory search failed significantly more often for SDs recorded directly over emerging focal brain lesions suggesting in humans similar to animals that the complexity of SD propagation paths increase in tissue undergoing injury.

Secondary encephalocele in infant following subdural empyema repaired endoscopically-A case report.

Science.gov (United States)

Verma, Roshan K; Kaur, Navjot

2017-09-01

Subdural empyema (SDE) is an uncommon entity, mostly associated with meningitis and can be life threatening in infants. Rarely, a subdural empyema can lead to nasal encephalocele which can be challenging situation to manage especially in infant. We present a case of 7 month old infant who presented with subdural empyema that led to formation of nasal encaphalocele after 4 months which was managed endoscopic route. Copyright © 2017 Elsevier B.V. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Zhi JIANG

2015-08-01

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

Peritoneal carcinomatosis-like implants of extramedullary hematopoiesis. An insolite occurrence during splenectomy for myelofibrosis.

Science.gov (United States)

Casaccia, Marco; Fornaro, Rosario; Frascio, Marco; Palombo, Denise; Stabilini, Cesare; Firpo, Emma; Gianetta, Ezio

2017-01-01

Primary myelofibrosis (MF) is a myeloproliferative neoplasm that results in debilitating constitutional symptoms, splenomegaly, and cytopenias. In patients with symptomatic splenomegaly, splenectomy remains a viable treatment option for MF patients with medically refractory symptomatic splenomegaly that precludes the use of ruxolitinib. We present the clinical case of a patient who was admitted to our Department to perform a splenectomy in MF as a therapeutic step prior to an allogeneic stem cell transplantation (ASCT). A laparotomic splenectomy and excision of whitish wide-spread peritoneal and omental nodulations was performed. There were no operative complications and the surgery was completed with minimal blood loss. The histopathological exam revealed an extramedullary hematopoiesis in both spleen and peritoneal nodules. In primary myelofibrosis it must always be kept in mind the possible presence of peritoneal implants of extramedullary hematopoiesis and ascites of reactive genesis. We report a rare case of peritoneal carcinomatosis-like implants of extramedullary hematopoiesis found at splenectomy for MF. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Subdural haemorrhage following endoscopic third ventriculostomy. A rare complication.

LENUS (Irish Health Repository)

Kamel, M H

2012-02-03

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

MR findings of cerebral arteriovenous malformations associated with hemorrhage

Energy Technology Data Exchange (ETDEWEB)

Tsuchiya, Kazuhiro (National Defence Medical Coll., Tokorozawa, Saitama (Japan))

1990-10-01

This study was developed to assess the role of magnetic resonance (MR) imaging in the diagnosis of cerebral arteriovenous malformations (AVMs) associated with hemorrhage. MR images were retrospectively reviewed in 10 patients (age 8 to 60 years) who had an AVM with intracerebral or intraventricular hemorrhage. MR imaging was performed at 1.5 T obtaining T{sub 1}- and T{sub 2}-weighted spin-echo images with a slice thickness of 5 mm, and a slice interval of 0-5 mm. The AVM was detected on MR in seven patients (70%), while enhanced CT was positive in six of eight patients (75%). In six patients in whom both the AVM and intracerebral hematoma (ICH) were depicted on MR, the nidi were located not inside but adjacent to the ICH. In three patients, MR disclosed a thin subdural hematoma (SDH) which was not noted on CT. There is little difference in the detectability of AVMs by MR and enhanced CT. However, MR clearly demonstrates the anatomic relationship to associated ICH. A non-traumatic SDH with an ICH demonstrated on MR may indicate the presence of an AVM even when the AVM itself is not apparent. (author).

Massive neonatal intracranial hemorrhage caused by bromadiolone: A case report.

Science.gov (United States)

Ma, Mingsheng; Zhang, Mengqi; Tang, Xiaoyan; Li, Zhenghong

2017-11-01

Bromadiolone, often called a super-warfarin, is a potent rodenticide with long half-life. Skin and mucosal bleeding is the most common clinical manifestations of its intoxication. Bromadiolone intoxications in adults and children have been reported, but this phenomenon is rarely seen in fetuses. This paper presents a case of neonate with massive intracranial hemorrhage mediated by bromadiolone intoxication, highlighting that the bromadiolone is potentially lethal to the fetus. The male neonate presented with poor respiratory effort, decreased muscle tone, and pallor at birth. He developed generalized seizures on day 1 of life. His mother suffered from bleeding of oral mucosa and the subsequent lab screening for toxicants showed a bromadiolone level of 126 ng/mL. Laboratory tests revealed that prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT). A computed tomography (CT) of his head revealed a severe subdural hematoma, which lead to midline shift, bilateral intraventricular hemorrhage, and subarachnoid hemorrhage. Serum from cord blood was collected and screened for toxicants. The result returned with a bromadiolone level of 94 ng/mL. The neonate was treated with vitamin K, fresh-frozen plasma, and red blood cells. His parents required termination of all treatments, and the neonate unfortunately died shortly after. Through clinical experience from this case, we believe that bromadiolone can be passed down to the fetus via placenta. Neonatal intracranial hemorrhage caused by bromadiolone is rare but potentially lethal. Pregnant women should be informed of the serious side effects of bromadiolone and this poisonous reagent should be avoided in any period during pregnancy.

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

Energy Technology Data Exchange (ETDEWEB)

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

1995-02-01

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

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

International Nuclear Information System (INIS)

Hayashi, Hideaki

1995-01-01

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

Influence of Postoperative Thrombosis Prophylaxis on the Recurrence of Chronic Subdural Hematoma After Burr-Hole Drainage.

Science.gov (United States)

Licci, Maria; Kamenova, Maria; Guzman, Raphael; Mariani, Luigi; Soleman, Jehuda

2018-01-01

Chronic subdural hematoma is a commonly encountered disease in neurosurgic practice, whereas its increasing prevalence is compatible with the ageing population. Recommendations concerning postoperative thrombosis prophylaxis after burr-hole drainage of chronic subdural hematoma are lacking. The aim of this study was to analyze the correlation between recurrence of chronic subdural hematoma and postoperative application of thrombosis prophylaxis. Retrospective, consecutive sample of patients undergoing burr-hole drainage for chronic subdural hematoma over 3 years. Single, academic medical center. All patients undergoing surgical evacuation of a chronic subdural hematoma with burr-hole drainage. Exclusion: patients under the age of 18 years, who presented with an acute subdural hematoma and those who underwent a craniotomy. We compared patients receiving thrombosis prophylaxis treatment after burr-hole drainage of chronic subdural hematoma with those who were not treated. Primary outcome measure was reoperation of chronic subdural hematoma due to recurrence. Secondary outcome measures were thromboembolic and cardiovascular events, hematologic findings, morbidity, and mortality. In addition, a subanalysis comparing recurrence rate dependent on the application time of thrombosis prophylaxis ( 48 hr) was undertaken. Overall recurrence rate of chronic subdural hematoma was 12.7%. Out of the 234 analyzed patients, 135 (57.3%) received postoperative thrombosis prophylaxis (low-molecular-weight heparin) applied subcutaneously. Recurrence of chronic subdural hematoma occurred in the thrombosis prophylaxis group and control group in 12 patients (8.9%) and 17 patients (17.2%), respectively, showing no significant difference (odds ratio, 0.47 [95% CI, 0.21 - 1.04]). A subanalysis comparing recurrence rate of chronic subdural hematoma dependent on the application time of thrombosis prophylaxis ( 48 hr) showed no significant difference either (odds ratio, 2.80 [95% CI, 0

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

International Nuclear Information System (INIS)

Okamura, Akitake; Kawamoto, Yukihiko; Yoshioka, Hiroyuki; Murakami, Taro; Yonezawa, Koki

2012-01-01

Percutaneous subdural tapping for chronic subdural hematoma (CSDH) can measure initial hematoma pressure, which cannot be measured using burr-hole craniotomy. Initial hematoma pressure has not been discussed as a risk factor for recurrence. We evaluated the clinical features for recurrence, which included initial hematoma pressure. The study involved 71 unilateral CSDH cases whose initial hematoma pressure was measured using percutaneous subdural tapping. Clinical recurrence was identified in 19 cases (23%). Age, sex, neurological grading, alcohol consumption, presence of head injury, hypertension, diabetes mellitus, antiplatelet, anticoagulant medication, hematoma volume on computed tomography (CT) images, and initial hematoma pressure were compared between non-recurrence and recurrence groups. The initial hematoma pressure was 12.6±4.5 cmH 2 O in the non-recurrence group, and 15.5±6.2 cmH 2 O in the recurrence group (p<0.05). The other factors did not differ significantly except hematoma volume on CT images (92±45 ml in the non-recurrence group and 123±43 ml in the recurrence group, p<0.05). Cases with high initial hematoma pressure should be closely observed. (author)

A Rare Complication of Spinal Anesthesia: Subdural Hematoma

Directory of Open Access Journals (Sweden)

Fuldem Yıldırım Dönmez

2014-03-01

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

Two cases of subdural hematoma with niveau formation on CT

International Nuclear Information System (INIS)

Shimizu, Satoshi; Fukuda, Atsuhiro; Sato, Masaharu; Kohama, Akitsugu

1984-01-01

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

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

OpenAIRE

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

2011-01-01

Subdural hematoma is a well known complication of ventriculoperitoneal shunt insertion for hydrocephalus and usually spreads out over the cerebral convexity, and appears as a crescent shaped lesion on imaging. Chronic subdural hematoma in a case of untreated compensated congenital hydrocephalus has not been reported in English literature. We report the rare case of an adult with congenital hydrocephalus with a huge unusual shaped hemispheric subdural hematoma.

Effect of addition of clopidogrel to aspirin on subdural hematoma: meta-analysis of randomized clinical trials.

Science.gov (United States)

Bakheet, Majid F; Pearce, Lesly A; Hart, Robert G

2015-06-01

Clopidogrel combined with aspirin is routinely prescribed after coronary artery stenting, in patients with acute coronary syndromes, and recently to prevent stroke in patients with acute minor ischemic stroke and TIA. Subdural hematomas are an important complication of antithrombotic treatment, but the risk associated with clopidogrel plus aspirin has not been previously defined. To quantify the risk of subdural hematoma associated with dual antiplatelet therapy with clopidogrel plus aspirin. Randomized clinical trials comparing clopidogrel plus aspirin with aspirin alone were identified by searching the Cochrane Central Register of Controlled Trials from 1990 to 2014, and restricted to those with more than 7 days of treatment. Two reviewers independently extracted data about subdural hematomas. Of 24 randomized trials testing clopidogrel added to aspirin, results for subdural hematoma were available for 11 trials, of which eight did not identify any subdural hematomas. The three trials reporting subdural hematomas were double-blind and included patients with recent lacunar stroke, acute coronary syndromes or atrial fibrillation with a total of 23,136 patients (mean age 66 years) and reported 39 subdural hematomas during a mean follow-up 2.1 years per patient. Clopidogrel plus aspirin was associated with a significantly increased risk of subdural hematoma compared with aspirin alone (risk ratio 2.0, 95% CI 1.0, 3.8; P = 0.04; fixed effects model; I2 for heterogeneity of 0%, P = 0.51). The average absolute incidence of subdural hematoma averaged 1.1 (95% CI 0.7,1.6) per 1000 patient - years among those assigned clopidogrel plus aspirin in 11 randomized trials. The absolute rate of subdural hematoma during dual antiplatelet therapy is low, averaging 1.1 per 1000 patient-years. Chronic treatment with clopidogrel plus aspirin significantly increases the risk of subdural hematoma compared with aspirin alone. © 2014 World Stroke Organization.

Postoperative CT appearance in chronic subdural hematomas

Energy Technology Data Exchange (ETDEWEB)

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

1988-05-01

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

Bifrontal acute subdural hematoma

Directory of Open Access Journals (Sweden)

Suryapratap Singh

2013-01-01

Full Text Available Though, acute subdural hematoma (ASDH is one of the most common emergencies in neurological surgery practice, bilateral bifrontal ASDH is uncommon and may constitute diagnostic and therapeutic challenge. Computer tomography and magnetic resonance imaging have important roles in the diagnosis of ASDH. We present a case of bifrontal ASDH that was successfully managed in our institution.

Intrathoracic extramedullary hematopoiesis presenting as tumor-simulating lesions of the mediastinum in α-thalassemia: A case report.

Science.gov (United States)

An, Jun; Weng, Yimin; He, Jinyuan; Li, Yun; Huang, Shaohong; Cai, Songwang; Zhang, Junhang

2015-10-01

Extramedullary hematopoiesis (EMH) is a rare disease, where hematological disorder drives extramedullary hematopoietic tumor formation in multiple regions of the body. The present study reports a case of EMH presenting as multiple tumor-like lesions of mediastinum in a 61-year-old male with α-thalassemia, which was subjected to a video-assisted thoracoscopic surgery tissue biopsy to differentiate it from other mediastinal tumors. To date, only three cases of EMH in patients with α-thalassemia have been described in the literature. Patients with EMH typically exhibit no hematological disorder preoperatively and therefore EMH is frequently misdiagnosed. In the present study, along with a literature review of the clinicopathological features of EMH, the diagnosis and treatment of this rare case was discussed, in order to differentiate diagnosis, and particularly to distinguish EHM from extramedullary myeloid sarcoma.

Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients

Directory of Open Access Journals (Sweden)

Ryota Tamura

2016-01-01

Full Text Available Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery. Case Presentation. Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case 1 was an 81-year-old man who took antiplatelet drugs for brain infarction. Case 2 was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved. Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.

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

Energy Technology Data Exchange (ETDEWEB)

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

2004-03-01

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

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

International Nuclear Information System (INIS)

Warmuth-Metz, M.; Solymosi, L.; Kuehl, J.; Krauss, J.

2004-01-01

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

Subdural haematoma complicating shunting for normal pressure hydrocephalus in the setting of concomitant antiplatelet medication

DEFF Research Database (Denmark)

Birkeland, Peter; Lauritsen, Jens; Poulsen, Frantz Rom

2016-01-01

OBJECTIVE: To report on the occurrence and management of subdural haematoma after shunt implantation for normal pressure hydrocephalus and to determine the risk of recurrence in the setting of antiplatelet medication. METHODS: From a consecutive series of 80 patients implanted with a cerebrospinal...... fluid shunt for normal pressure hydrocephalus, records from 11 patients taking antiplatelet drugs, who subsequently had surgery for subdural haematoma were extracted and retrospectively reviewed. RESULTS: Patients were followed up for a mean of 1819 days after shunt implantation. Subdural haematomas...... reoperations done before the subdural collection disappeared. Only one patient had a late recurrence almost 11 years after shunt implantation. CONCLUSIONS: Subdural haematoma in the setting of a ventriculoperitoneal implantation for normal pressure hydrocephalus and concomitant antiplatelet medication can...

Leptomeningeal metastasis mimicking Chronic Subdural Hematoma

OpenAIRE

Jain Saurabh

2017-01-01

The presentation of Leptomeningeal Metastasis varies widely. It can also present a condition very similar to Chronic Subdural Hematoma. One should have a low threshold for suspicion while diagnosing such conditions to avoid catastrophic events.

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

Directory of Open Access Journals (Sweden)

Pattanagere Manjunatha Suryanarayana Sharma

2015-12-01

Full Text Available 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.

Premature epiphyseal fusion and extramedullary hematopoiesis in thalassemia

International Nuclear Information System (INIS)

Colavita, N.; Orazi, C.; Danza, S.M.; Falappa, P.G.; Fabbri, R.

1987-01-01

The main skeletal abnormalities in β-thalassemia are widening of medullary spaces, rarefaction of bone trabeculae, thinning of cortical bone, and perpendicular periosteal spiculation. Premature epiphyseal fusion (PEF) and extramedullary hematopoiesis (EH) are found, though more rarely. The incidence of PEF and EH in 64 patients affected by β-thalassemia is reported. The different incidence of such complications in thalassemia major and intermedia is reported, and a possible correlation with transfusion regimen is also considered. (orig.)

Traumatic acute posterior fossa subdural hematoma – A case report and review of literature

Directory of Open Access Journals (Sweden)

Jaiswal Manish

2014-12-01

Full Text Available Traumatic subdural hematomas of the posterior fossa are rare but dangerous neurosurgical emergencies that require prompt diagnosis and management to avoid the uniformly poor outcome. We present a case of a teenager with severe TBI and acute subdural hematoma of the posterior fossa that deteriorated rapidly before surgery but eventually made a good recovery. We also the review the literature concerning traumatic posterior fossa subdural hematomas [PFSDH].

Do Age and Anticoagulants Affect the Natural History of Acute Subdural Hematomas?

Science.gov (United States)

Lucke-Wold, Brandon P.; Turner, Ryan C.; Josiah, Darnell; Knotts, Chelsea; Bhatia, Sanjay

2016-01-01

Acute subdural hematoma is a serious complication following traumatic brain injury. Large volume hematomas or those with underlying brain injury can cause mass effect, midline shift, and eventually herniation of the brain. Acute subdural hematomas in the young are associated with high-energy trauma and often have underlying contusions, while acute subdural hematomas in the elderly are associated with minor trauma and an absence of underlying contusions, even though the elderly are more likely to be on anticoagulants or anti-platelet therapy. In the young patients with high impact injuries the hematomas tend to be small and the underlying brain injury and swelling is responsible for the increased intracranial pressure and midline shift. In the elderly, the injuries are low impact (e.g fall from standing), the underlying brain is intact, and the volume of the hematoma itself produces symptoms. In addition the use of anticoagulants and antiplatelet agents in the elderly population has been thought to be a poor prognostic indicator and is considered to be responsible for larger hematomas and poor outcome. When managed conservatively, acute subdural hematomas can sometimes progress to chronic subdural hematoma formation, further enlargement, seizures, and progressive midline shift. Another potential difference in the young and the elderly is brain atrophy, which increases the potential space to accommodate a larger hematoma. It is not known if these two groups differ in other ways that might have implications for treatment or prognosis. In this paper, we investigate the clinical course of 80 patients admitted to our institution with acute subdural hematomas, to identify differences in patients above or below the age of 65 years. The natural progression/resolution of acute subdural hematomas was mapped by measuring volume expansion/regression over time. In this retrospective chart review, we investigated clinical baseline metrics and subsequent volumetric expansion

Leptomeningeal metastasis mimicking Chronic Subdural Hematoma

Directory of Open Access Journals (Sweden)

Jain Saurabh

2017-12-01

Full Text Available The presentation of Leptomeningeal Metastasis varies widely. It can also present a condition very similar to Chronic Subdural Hematoma. One should have a low threshold for suspicion while diagnosing such conditions to avoid catastrophic events.

Intradural extramedullary spinal cord tumours: A retrospective study of sur­gical outcomes

Directory of Open Access Journals (Sweden)

Md. Kamrul Ahsan

2016-07-01

Full Text Available Background: Intradural extramedullary spinal cord tumours (IESCT accounts for approximately two thirds of all intraspinal neoplasm and are of important clinical consideration and surgery is the essence in cases with neurological deterioration.Objective: To share our experience on the outcome of surgical excision of intradural extramedullary spinal cord tumours. Methods: Results of 60 patients surgically treated intradural extramedullary spinal tumours between Octo­ber 2003 and October 2015 at Bangabandhu Sheikh Mujib Medical University and in our private settings, Dhaka, were analyzed retrospectively. There were 32 males, 28 females with an average age of 52.4 years (13-70 years and followed up for at least a year. The preoperative symptom with duration, tumours location and intradural space occupancy and the histopathological diagnosis were analyzed. Pain was evaluated by the visual analogue scale (VAS and the neurologic function was assessed by Nurick's grade.Results: The tumours were located as, thoracic 32 (53.33%, lumbar 16 (26.67%, cervical 04 (6.67%, and junctional 08 (13.33%, CervicoThoracic-01, Thoracolumbar-07. The histopathological diagnosis included schwannoma 35 (58.33%, meningiomas 14 (23.33%, neurofbroma 4 (6.67%, arachnoid cyst and myxopapillary ependymoma 03 (05.00% each and paraganglioma 01 (01.67%. The VAS score was reduced in all cases from 8.0 ± 1.2 to 1.2 ± 0.8 (p < 0.003 and the Nurick's grade was improved in all cases from 3.0 ± 1.3 to 1.0 ± 0.0 (p < 0.005. The preoperative neurological deficit improved within 8 postoperative weeks in most cases and within 1 postoperative year in all cases. Complications included cerebrospinal fluid leakage, parasthesia, dependant bedsore 02 (3.33% each and recurrence 03 (05.00%. and further neurological deterioration 1 (01.67% case.Conclusion: lntradural extramedullary tumors detected by MRI are mostly benign and good clinical results can be obtained when treated surgi

A Computer Navigation System Analysis of the Accuracy of the Extramedullary (Tibial Alignment Technique in Total Knee Arthroplasty (TKA

Directory of Open Access Journals (Sweden)

EK Chee

2010-07-01

Full Text Available In total knee arthroplasty, mechanical alignment guides have improved the accuracy of implant alignment, but errors are not uncommon. In the present study, an image-free computer-assisted navigation system was used to analyse the accuracy of an extramedullary (tibial alignment system, which is based on predetermined, fixed anatomical landmarks. Comparisons were made between two surgeons, with different levels of competency in order to determine if experience affected the accuracy of extramedullary tibial jig placement, in either the coronal and sagittal planes or both planes. The results showed that the accuracy of the extramedullary tibial alignment system, in the coronal plane (in up to 80-87% of cases was much better than for posterior slope, and sagittal plane. Surgeon experience was not a significant factor.

Adrenal extramedullary hematopoiesis associated with β-thalassemia major

OpenAIRE

Bijan Keikhaei; Ahmad Soltani Shirazi; Mahboob Mohammad Pour

2012-01-01

The presence of apparently normal hematopoietic tissue outside of bone marrow cavity is defined as extramedullary hema - topoiesis (EMH). EMH is a rare complication in thalassemia major (TM) and adrenal gland as well. This report describes a case of adrenal EMH in a 26-year-old man with β-TM. He has been transfused with regular blood transfusion since 9 months. During the routine physical examination he was incidentally found to have a hypoechoic mass at his abdominal ultrasonography. Abdomin...

[Extramedullary fixation combined with intramedullary fixation in the surgical reduction of sagittal mandibular condylar fractures].

Science.gov (United States)

Chuanjun, Chen; Xiaoyang, Chen; Jing, Chen

2016-10-01

This study aimed to evaluate the clinical effect of extramedullary fixation combined with intramedullary fixation during the surgical reduction of sagittal mandibular condylar fractures. Twenty-four sagittal fractures of the mandibular condyle in18 patients were fixed by two appliances: intramedullary with one long-screw osteosynthesis or Kirschner wire and extramedullary with one micro-plate. The radiologically-recorded post-operative stability-associated com-plications included the screw/micro-plate loosening, micro-plate twisting, micro-plate fractures, and fragment rotation. The occluding relations, the maximalinter-incisal distances upon mouth opening, and the mandibular deflection upon mouth opening were evaluated based on follow-up clinical examination. Postoperative panoramic X-ray and CT scans showed good repositioning of the fragment, with no redislocation or rotation, no screw/plate loosening, and no plate-twisting or fracture. Clinical examination showed that all patients regained normal mandibular movements, ideal occlusion, and normal maximal inter-incisal distances upon mouth opening. Extramedullary fixation combined with intramedullary fixation is highly recommended for sagittal condylar fractures because of the anti-rotation effect of the fragment and the reasonable place-ment of the fixation appliances.

Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

Science.gov (United States)

Mostofi, Keyvan; Marnet, Dominique

2011-01-01

Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

Do Age and Anticoagulants Affect the Natural History of Acute Subdural Hematomas?

Science.gov (United States)

Lucke-Wold, Brandon P; Turner, Ryan C; Josiah, Darnell; Knotts, Chelsea; Bhatia, Sanjay

2016-01-01

Acute subdural hematoma is a serious complication following traumatic brain injury. Large volume hematomas or those with underlying brain injury can cause mass effect, midline shift, and eventually herniation of the brain. Acute subdural hematomas in the young are associated with high-energy trauma and often have underlying contusions, while acute subdural hematomas in the elderly are associated with minor trauma and an absence of underlying contusions, even though the elderly are more likely to be on anticoagulants or anti-platelet therapy. In the young patients with high impact injuries the hematomas tend to be small and the underlying brain injury and swelling is responsible for the increased intracranial pressure and midline shift. In the elderly, the injuries are low impact (e.g fall from standing), the underlying brain is intact, and the volume of the hematoma itself produces symptoms. In addition the use of anticoagulants and antiplatelet agents in the elderly population has been thought to be a poor prognostic indicator and is considered to be responsible for larger hematomas and poor outcome. When managed conservatively, acute subdural hematomas can sometimes progress to chronic subdural hematoma formation, further enlargement, seizures, and progressive midline shift. Another potential difference in the young and the elderly is brain atrophy, which increases the potential space to accommodate a larger hematoma. It is not known if these two groups differ in other ways that might have implications for treatment or prognosis. In this paper, we investigate the clinical course of 80 patients admitted to our institution with acute subdural hematomas, to identify differences in patients above or below the age of 65 years. The natural progression/resolution of acute subdural hematomas was mapped by measuring volume expansion/regression over time. In this retrospective chart review, we investigated clinical baseline metrics and subsequent volumetric expansion

Intramedullary versus extramedullary alignment of the tibial component in the Triathlon knee

LENUS (Irish Health Repository)

Cashman, James P

2011-08-20

Abstract Background Long term survivorship in total knee arthroplasty is significantly dependant on prosthesis alignment. Our aim was determine which alignment guide was more accurate in positioning of the tibial component in total knee arthroplasty. We also aimed to assess whether there was any difference in short term patient outcome. Method A comparison of intramedullary versus extramedullary alignment jig was performed. Radiological alignment of tibial components and patient outcomes of 103 Triathlon total knee arthroplasties were analysed. Results Use of the intramedullary was found to be significantly more accurate in determining coronal alignment (p = 0.02) while use of the extramedullary jig was found to give more accurate results in sagittal alignment (p = 0.04). There was no significant difference in WOMAC or SF-36 at six months. Conclusion Use of an intramedullary jig is preferable for positioning of the tibial component using this knee system.

Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment

Science.gov (United States)

Balevi, Mustafa

2017-01-01

Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion

Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness

Directory of Open Access Journals (Sweden)

David I Bruner

2012-12-01

Full Text Available While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures,confusion, and focal arm weakness after a bout of sinusitis.

Subdural Empyema Presenting with Seizure, Confusion, and Focal Weakness

Science.gov (United States)

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

2012-01-01

While sinusitis is a common ailment, intracranial suppurative complications of sinusitis are rare and difficult to diagnose and treat. The morbidity and mortality of intracranial complications of sinusitis have decreased significantly since the advent of antibiotics, but diseases such as subdural empyemas and intracranial abscesses still occur, and they require prompt diagnosis, treatment, and often surgical drainage to prevent death or long-term neurologic sequelae. We present a case of an immunocompetent adolescent male with a subdural empyema who presented with seizures, confusion, and focal arm weakness after a bout of sinusitis. PMID:23358438

Life-threatening acute subdural haematoma after combined spinal–epidural anaesthesia in labour

Directory of Open Access Journals (Sweden)

Bulent Bakar

2015-09-01

Full Text Available Background and objectives: Only few reports in literature have pointed out to the possibility of a cranial subdural haematoma formation associated with dural puncture during spinal or epidural analgesia. We herein describe such a rare case who was diagnosed to have acute subdural haematoma after combined spinal–epidural anaesthesia used in labour. Case report: A 34-year-old, primigravid women with a gestation of 38 weeks underwent caesarean section under combined spinal–epidural anaesthesia and gave birth to a healthy boy. Thirty-two hours after delivery, her moderate headache progressed to a severe headache associated with nausea and vomiting and later was more complicated with a generalized tonic–clonic seizure and ensuing lethargy. Computed tomography of the brain demonstrated a right-sided fronto-temporo-parietal acute subdural haematoma with diffuse cerebral oedema. She underwent urgent FTP craniotomy and evacuation of the haematoma. Early postoperative cranial computed tomography showed a clean operative site. Eight days after subdural haematoma surgery, she became lethargic again, and this time cranial computed tomography disclosed an extradural haematoma under the bone flap for which she had to undergo surgery again. Two days later, she was discharged home with Karnofsky performance score of 90/100. At follow-up exam, she was neurologically intact and her cranial computed tomography and magnetic resonance were normal. Conclusions: As conclusion, with the use of this combined spinal–epidural anaesthesia, it should be kept in mind that headache does not always mean low pressure headache associated with spinal anaesthesia and that a catastrophic complication of subdural haematoma may also occur. Resumo: Justificativa e objetivos: Apenas alguns relatos na literatura mencionaram a possibilidade de formação de hematoma subdural craniano associada à punção durante a raquianestesia ou anestesia epidural. O presente relato descreve

Mixed phenotype (T/B/myeloid) extramedullary blast crisis as an initial presentation of chronic myelogenous leukemia.

Science.gov (United States)

Qing, Xin; Qing, Annie; Ji, Ping; French, Samuel W; Mason, Holli

2018-04-01

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder characterized by the Philadelphia (Ph) chromosome generated by the reciprocal translocation t(9,22)(q34;q11). The natural progression of the disease follows a biphasic or triphasic course. Most cases of CML are diagnosed in the chronic phase. Extramedullary blast crisis rarely occurs during the course of CML, and is extremely rare as the initial presentation of CML. Here, we report the case of a 32-year-old female with enlarged neck lymph nodes and fatigue. She was diagnosed with B-lymphoblastic leukemia/lymphoma with possible mixed phenotype (B/myeloid) by right neck lymph node biopsy at an outside hospital. However, review of her peripheral blood smear and her bone marrow aspirate and biopsy showed features consistent with CML, which was confirmed by PCR and karyotyping. An ultrasound-guided right cervical lymph node core biopsy showed a diffuse infiltrate of blasts, near totally replacing the normal lymph node tissue, admixed with some hematopoietic cells including megakaryocytes, erythroid precursors and maturing myeloid cells. By flow cytometry and immunohistochemistry, the blasts expressed CD2, cytoplasmic CD3, CD5, CD7, CD56, TdT, CD10 (weak, subset), CD19 (subset), CD79a, PAX-5 (subset), CD34, CD38, CD117 (subset), HLA-DR (subset), CD11b, CD13 (subset), CD33 (subset), and weak cytoplasmic myeloperoxidase, without co-expression of surface CD3, CD4, CD8, CD20, CD22, CD14, CD15, CD16 and CD64, consistent with blasts with mixed phenotype (T/B/myeloid). A diagnosis of extramedullary blast crisis of CML was made. Chromosomal analysis performed on the lymph node biopsy tissue revealed multiple numerical and structural abnormalities including the Ph chromosome (46-49,XX,add(1)(p34),add(3)(p25),add(5)(q13),-6,t(9;22)(q34;q11.2),+10,-15,add(17)(p11.2),+19, +der(22)t(9;22),+mar[cp8]). After completion of one cycle of combined chemotherapy plus dasatinib treatment, she was transferred to City of Hope

Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.

Science.gov (United States)

Soleman, Jehuda; Kamenova, Maria; Lutz, Katharina; Guzman, Raphael; Fandino, Javier; Mariani, Luigi

2017-08-01

To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies. Copyright © 2017 Elsevier Inc. All rights reserved.

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

DEFF Research Database (Denmark)

Schmidt, Linnea; Gørtz, Sanne; Wohlfahrt, Jan

2015-01-01

OBJECTIVES: To estimate the risks of and identify predictors for recurrent subdural haematoma in surgically and conservatively treated patients. METHODS: The cohort comprised all individuals diagnosed with a first-time subdural hematoma in Denmark 1996-2011. Information on potential predictors...... was retrieved from the Danish health registers. Cumulative recurrence risks were estimated using the Aalen-Johansen estimator. Rate ratios (RR) were estimated using Poisson regression. RESULTS: Among 10,158 individuals with a subdural hematoma, 1,555 had a recurrent event. The cumulative risk of recurrent...... subdural hematoma was 9% at 4 weeks after the primary bleeding, increasing to and stabilising at 14% after one year. Predictors associated with recurrence were: Male sex (RR 1.60, 95% CI:1.43-1.80), older age (>70 years compared to 20-49 years; RR 1.41, 95% CI: 1.21-1.65), alcohol addiction (RR 1.20, 95...

Magnetic resonance imaging of chronic subdural hematomas; Especially in recurrent cases

Energy Technology Data Exchange (ETDEWEB)

Yamagami, Tatsuhito; Higashi, Kenichiro; Handa, Hajime (Ijinkai Takeda General Hospital, Kyoto (Japan)) (and others)

1993-02-01

Sixty-two patients with chronic subdural hematomas (CSDH) were examined with magnetic resonance imaging (MRI). MRI was performed using 0.2 and 0.5 Tesla imagers. The MRI findings were then compared with the density patterns of X-ray CT. In many cases, the CSDHs were more hyperintense than the gray matter on the T[sub 1]-weighted image, though a few cases showed hypo- or isointensity. Most cases showed a high intensity on a proton-density-weighted image (PDW), while a low signal intensity was rarely seen on PDW. However, it always had a higher signal intensity than that of CSF in the lateral ventricle. Therefore, PDW was thought to be the most useful image for the diagnosis of CSDH with regard to differentiation from the subdural hydroma. All the cases of CSDH showed a very high intensity on a T[sub 2]-weighted image (T[sub 2]W), while, in a small number of cases, the hematoma contained a layered hypointensity near the hematoma capsule and demonstrated a heterogeneous appearance on T[sub 2]W. This was considered to indicate repeated hemorrhages. In 58 patients, an operation was performed by removing the hematoma through one or two burr holes and by then irrigating the hematoma cavity. A second operation was necessary in nine cases. Some of the recurrent cases showed heterogeneous intensity on MRI. Three of the six cases of bilateral CSDH, which showed different intensities on the two sides, had to be operated on again. MRI was superior to X-ray CT in demonstrating the postoperative residual hematomas. The disappearance of residual CSDH was confirmed by follow-up MRI in 19 of 40 postoperative cases. The residual hematoma was found by the MRI to have disappeared 158 days after the operation, on the average. On the other hand, the disappearance of the hematomas could not be ascertained before the operation in the recurrent cases. It is thus considered to be necessary to follow-up the post-operative MRI findings for at least five months in cases of CSDH. (author).

Postoperative intraspinal subdural collections after pediatric posterior fossa tumor resection: incidence, imaging, and clinical features.

Science.gov (United States)

Harreld, J H; Mohammed, N; Goldsberry, G; Li, X; Li, Y; Boop, F; Patay, Z

2015-05-01

Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection. Retrospective review of postoperative spine MRI in 243 children (5.5 ± 4.6 years of age) from our clinical data base postresection of posterior fossa tumors from October 1994 to August 2010 yielded 37 (6.0 ± 4.8 years of age) subjects positive for postoperative intraspinal subdural collections. Their extent and signal properties were recorded for postoperative (37/37), preoperative (15/37), and follow-up spine (35/37) MRI. Risk factors were compared with age-matched internal controls (n = 37, 5.9 ± 4.5 years of age). Associations of histology, hydrocephalus and cerebellar tonsillar herniation, and postoperative intracranial subdural collections with postoperative intraspinal subdural collections were assessed by the Fisher exact test or χ(2) test. The association between preoperative tumor volume and postoperative intraspinal subdural collections was assessed by the Wilcoxon rank sum test. The overall incidence of postoperative intraspinal subdural collections was 37/243 (15.2%), greatest ≤7 days postoperatively (36%); 97% were seen 0-41 days postoperatively (12.9 ± 11.0 days). They were T2 hyperintense and isointense to CSF on T1WI, homogeneously enhanced, and resolved on follow-up MR imaging (35/35). None were symptomatic. They were associated with intracranial subdural collections (P = .0011) and preoperative tonsillar herniation (P = .0228). Postoperative intraspinal subdural collections are infrequent and clinically silent, resolve spontaneously, and have a distinctive appearance. Preoperative tonsillar herniation appears to be a predisposing factor. In this series, repeat MR imaging by 4 weeks

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

Directory of Open Access Journals (Sweden)

Linnea Schmidt

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

Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

Science.gov (United States)

Rao, Murali Gundu; Khandelwal, Niranjan; Sharma, Suresh Kumar

2016-01-01

Introduction Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. Aim The purpose of this study was to determine the post-traumatic interval of Subdural Haemorrhage (SDH) based on Hounsfield Unit measurements (HU) on Computed Tomography (CT) in surviving victims of head injury. Materials and Methods The study included a total of 100 cases of closed head injury with subdural haemorrhage. The Post-traumatic Time Interval (PTI) varied from 0.5 hours to a maximum of 249 hours, with a mean of 54.2 hours. Results Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant. Conclusion The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past. We concluded that further sorting of cases could be done according to its age with additional research and uniformity in the methodology. PMID:27190831

[Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis].

Science.gov (United States)

Takayama, Motoharu; Terui, Keita; Oiwa, Yoshitsugu

2012-10-01

Chronic subdural hematoma is common in elderly individuals and surgical procedures are simple. The recurrence rate of chronic subdural hematoma, however, varies from 9.2 to 26.5% after surgery. The authors studied factors of the recurrence using univariate and multivariate analyses in patients with chronic subdural hematoma We retrospectively reviewed 239 consecutive cases of chronic subdural hematoma who received burr-hole surgery with irrigation and closed-system drainage. We analyzed the relationships between recurrence of chronic subdural hematoma and factors such as sex, age, laterality, bleeding tendency, other complicated diseases, density on CT, volume of the hematoma, residual air in the hematoma cavity, use of artificial cerebrospinal fluid. Twenty-one patients (8.8%) experienced a recurrence of chronic subdural hematoma. Multiple logistic regression found that the recurrence rate was higher in patients with a large volume of the residual air, and was lower in patients using artificial cerebrospinal fluid. No statistical differences were found in bleeding tendency. Techniques to reduce the air in the hematoma cavity are important for good outcome in surgery of chronic subdural hematoma. Also, the use of artificial cerebrospinal fluid reduces recurrence of chronic subdural hematoma. The surgical procedures can be the same for patients with bleeding tendencies.

The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique.

Science.gov (United States)

Berhouma, M; Jacquesson, T; Jouanneau, E

2014-12-01

Fibrin membranes and compartmentalization within the subdural space are a frequent cause of failure in the treatment of chronic subdural hematomas (CSH). This specific subtype of CSH classically requires craniotomy, which carries significant morbidity and mortality rates, particularly in elderly patients. In this work, we describe a minimally invasive endoscopic alternative. Under local scalp anesthesia, a rigid endoscope is inserted through a parietal burr hole in the subdural space to collapse fibrin septa and cut the internal membrane. It also allows cauterization of active bleedings and the placement of a drain under direct visualization. The endoscopic treatment of septated CSH represents a minimally invasive alternative to craniotomy especially for the internal membranectomy.

Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

Energy Technology Data Exchange (ETDEWEB)

Tavani, F.; Zimmerman, R.A. [Neuroradiology Dept., The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Clancy, R.R.; Licht, D.J. [Dept. of Neurology, The Children' s Hospital of Philadelphia, Philadelphia, PA (United States); Mahle, W.T. [Children' s Heart Hospital, Atlanta, GA (United States)

2003-04-01

We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

Incidental intracranial hemorrhage after uncomplicated birth: MRI before and after neonatal heart surgery

International Nuclear Information System (INIS)

Tavani, F.; Zimmerman, R.A.; Clancy, R.R.; Licht, D.J.; Mahle, W.T.

2003-01-01

We investigated the prevalence of intracranial hemorrhage (ICH) before and after neonatal heart surgery. We carried out pre- and postoperative MRI looking for brain lesions in 24 full-term new-borns with known congenital heart disease. They underwent heart surgery with cardiopulmonary bypass (CPB), usually with deep hypothermic circulatory arrest (DHCA). The first MRI was 1-22 days after birth. There were 21 children born after uncomplicated vaginal delivery and three delivered by cesarean section (CS). ICH was seen in 13 (62%) of the vaginal delivery group but in none of the CS group. We saw subdural bleeding along the inferior surface of the tentorium in 11 (52%) and supratentorially in six (29%) of the 21 children with ICH. Small hemorrhages were present in the choroid plexus in seven (33%), in the parenchyma in one (5%) and in the occipital horn in one (5%). There were 26 foci of bleeding in these 21 patients (1.2 per patient). None was judged by formal neurologic examination to be symptomatic from the hemorrhage. Follow-up MRI after cardiac surgery was obtained in 23 children, showing 37 foci of ICH (1.6 per patient), but all appeared asymptomatic. Postoperatively, ICH had increased in 10 children (43%), was unchanged in seven (30%) and was less extensive in six (26%). (orig.)

Extramedullary plasmacytoma of the testicle.

Science.gov (United States)

Carrion, Diego M; Álvarez-Maestro, Mario; Gómez Rivas, Juan; González-Peramato, Pilar; Cisneros Ledo, Jesús

2017-12-01

We present the case of a patient diagnosed with a testicular extramedullary plasmacytoma (EMP), and perform a brief review of the literature of this pathology. A 64 year-old male patient, with history of multiple myeloma successfully treated three years before, presented with left testicular swelling. Initial work-up was compatible with a testicular tumor and radical inguinal orchiectomy was performed. Histologic examination of the testis revealed extensive intertubular infiltration by CD138 and CD56 atypical plasma cells, with diffuse staining for IgA, compatible with EMP. Invasion of the testis in multiple myeloma patients as a recurrence of the disease is an extremely rare condition, as EMPs are more common in other organ systems. Initial treatment should be the same as a primary testicular tumor with radical inguinal orchiectomy, and definitive diagnosis is established in histologic analysis.

Extramedullary hematopoiesis presented as cytopenia and massive paraspinal masses leading to cord compression in a patient with hereditary persistence of fetal hemoglobin.

Science.gov (United States)

Katchi, Tasleem; Kolandaivel, Krishna; Khattar, Pallavi; Farooq, Taliya; Islam, Humayun; Liu, Delong

2016-01-01

Extramedullary hematopoeisis (EMH) can occur in various physiological and pathologic states. The spleen is the most common site of EMH. We report a case with hereditary persistence of fetal hemoglobin with extramedullary hematopoiesis presented as cord compression and cytopenia secondary to multi-paraspinal masses. Treatment can be a challenge. Relapse is a possibility.

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

Directory of Open Access Journals (Sweden)

Antonio Guevara Melcón

2012-03-01

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

Analysis of chronic subdural hematoma based on CT, 3

International Nuclear Information System (INIS)

Takahashi, Yoshio; Mikami, Junichi; Ueda, Mikiya; Ito, Kazunori; Sato, Hiroyuki

1984-01-01

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

Growth Potential of Subdural Hematomas Under Clinical Observation: Which Subdural Hematomas Tend to Grow and Why They Do.

Science.gov (United States)

Asan, Ziya

2018-05-01

To study the prognoses of patients with subdural hematoma (SDH) who were not operated on at the time of the first diagnosis and the causes of enlarged hematomas in some patients during the follow-up period. The records, service files, and radiologic examination results of the patients with diagnoses of SDH were reviewed. The SDH patients were recorded under 5 different categories: acute SDH (ASDH), subacute SDH (SSDH), chronic SDH (CSDH), acute component with chronic SDH (A-CSDH), and subacute component with chronic SDH (S-CSDH). The symptoms, clinical findings, and progression in the patients were correlated with radiologic examinations. A total of 291 patients received diagnoses of SDHs: 80 patients with acute, 29 patients with subacute, and 163 patients with chronic hematoma. Thirty-five patients had diagnoses of SDH with a combination of different components. It was determined that in the follow-up period, patients with A-CSDH showed the greatest increase in hematoma size over time and required surgical intervention the most often. SDHs reveal different prognoses in different age groups. Multicomponent SDHs are within the group that shows the greatest increase in size in the follow-up period. SDHs and CSDHs cause recurrent hemorrhages by sustaining the tension on the bridging veins. The greater the hematoma volume, the greater the growth potential of the hematoma tends to be. CSDHs that do not manifest changes in volume for a long time can be monitored without surgical intervention as long as the clinical picture remains stable. Copyright © 2018 Elsevier Inc. All rights reserved.

Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

Science.gov (United States)

Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R Shane; Moisi, Marc

2017-02-16

Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

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

Energy Technology Data Exchange (ETDEWEB)

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

1991-06-01

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

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

International Nuclear Information System (INIS)

Shinoura, Nobusada; Kondo, Tatsuya; Yamakawa, Kenta; Makiuchi, Tsuneo; Fujii, Kyoichi; Yoshioka, Masumi

1991-01-01

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

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

Science.gov (United States)

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

2015-10-01

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

'Subarachnoid cyst' after evacuation of chronic subdural hematoma: Case report of an unusual postoperative morbidity.

Science.gov (United States)

Sharon, Low Y Y; Wai Hoe, N G

2016-01-01

Burr-hole drainage of chronic subdural hematomas are routine operative procedures done by neurosurgical residents. Common postoperative complications include acute epidural and/or subdural bleeding, tension pneumocephalus, intracranial hematomas and ischemic cerebral infarction. We report an interesting post-operative complication of a 'subarachnoid cyst' after burr-hole evacuation of a chronic subdural hematoma. The authors hypothesize that the 'cyst' is likely secondary to the splitting of the adjacent neomembrane within its arachnoid-brain interface by iatrogenic irrigation of the subdural space. Over time, this 'cyst' develops into an area of gliosis which eventually causes long-term scar epilepsy in the patient. As far as we are aware, this is the first complication of such a 'subarachnoid cyst' post burr-hole drainage reported in the literature.

Intradural extramedullary Ewing's sarcoma: A case report and review of the literature.

Science.gov (United States)

Paterakis, Konstantinos; Brotis, Alexandros; Tasiou, Anastasia; Kotoula, Vasiliki; Kapsalaki, Eftychia; Vlychou, Marianna

Extra-skeletal Ewing's sarcomas are very rare lesions to the spine surgeon, with the intradural, extramedullary lesions being even rarer. Herein we present a patient with an intradural, extramedullary form of Ewing's sarcoma and review the relevant literature. The medical records, operative reports, radiographical studies and histological examinations of a single patient are retrospectively reviewed. A 31-year old male presented with back-pain, right-leg progressive paraparesis, and inability to walk. Both motor and sensory disturbances were revealed on the right leg at the clinical examination. Lumbar MRI showed two lesions. The first one was an intradural, extramedullary lesion at the L2-L3 level, while the second was smaller, located at the bottom of the dural sac. The patient underwent gross total resection of the L2-L3 lesion after a bilateral laminectomy. Histological examination was compatible with Ewing's sarcoma, and was verified by molecular analysis. No other extra-skeletal or skeletal lesion was found. A chemotherapy scheme was tailored to the patients' histological diagnosis. The patient presented with local recurrence and bone metastasis 2 years after his initial diagnosis. A second operation was performed and the follow up of the patient showed no disease progression 18 months after revision surgery. The spine surgeon should be aware of the existence of such rare entities, in order to timely fulfill the staging process and institute the proper therapy. The management of patients with extra-skeletal Ewing's sarcomas involves professionals as members of a multidisciplinary team, all of which should co-operate for the patient's optimal outcome. Copyright © 2016. Published by Elsevier Urban & Partner Sp. z o.o.

Subarachnoid Hemorrhage due to Spinal Cord Schwannoma Presenting Findings Mimicking Meningitis.

Science.gov (United States)

Zhang, Hong-Mei; Zhang, Yin-Xi; Zhang, Qing; Song, Shui-Jiang; Liu, Zhi-Rong

2016-08-01

Subarachnoid hemorrhage (SAH) of spinal origin is uncommon in clinical practice, and spinal schwannomas associated with SAH are even more rarely reported. We report an unusual case of spinal SAH mimicking meningitis with normal brain computed tomography (CT)/magnetic resonance imaging (MRI) and negative CT angiography. Cerebrospinal fluid examination results were consistent with the manifestation of SAH. Spinal MRI performed subsequently showed an intradural extramedullary mass. The patient received surgery and was finally diagnosed with spinal cord schwannoma. A retrospective chart review of the patient was performed. We describe a case of SAH due to spinal cord schwannoma. Our case highlights the importance of careful history taking and complete evaluation. We emphasize that spinal causes should always be ruled out in patients with angionegative SAH and that schwannoma should be considered in the differential diagnosis of SAH etiologies even though rare. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Extramedullary hematopoiesis presented as cytopenia and massive paraspinal masses leading to cord compression in a patient with hereditary persistence of fetal hemoglobin

OpenAIRE

Katchi, Tasleem; Kolandaivel, Krishna; Khattar, Pallavi; Farooq, Taliya; Islam, Humayun; Liu, Delong

2016-01-01

Background Extramedullary hematopoeisis (EMH) can occur in various physiological and pathologic states. The spleen is the most common site of EMH. Case presentation We report a case with hereditary persistence of fetal hemoglobin with extramedullary hematopoiesis presented as cord compression and cytopenia secondary to multi-paraspinal masses. Conclusion Treatment can be a challenge. Relapse is a possibility.

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

International Nuclear Information System (INIS)

Lusins, J.; Jaffe, R.; Bender, M.B.

1976-01-01

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

Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature.

Science.gov (United States)

Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V

2016-12-01

To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

Frontal and occipital horn ratio is associated with multifocal intraparenchymal hemorrhages in neonatal shunted hydrocephalus.

Science.gov (United States)

Oushy, Soliman; Parker, Jonathon J; Campbell, Kristen; Palmer, Claire; Wilkinson, Corbett; Stence, Nicholas V; Handler, Michael H; Mirsky, David M

2017-11-01

OBJECTIVE Placement of a cerebrospinal fluid diversion device (i.e., shunt) is a routine pediatric neurosurgical procedure, often performed in the first weeks of life for treatment of congenital hydrocephalus. In the postoperative period, shunt placement may be complicated by subdural, catheter tract, parenchymal, and intraventricular hemorrhages. The authors observed a subset of infants and neonates who developed multifocal intraparenchymal hemorrhages (MIPH) following shunt placement and sought to determine any predisposing perioperative variables. METHODS A retrospective review of the electronic medical record at a tertiary-care children's hospital was performed for the period 1998-2015. Inclusion criteria consisted of shunt placement, age hydrocephalus. Markers of severity of ventriculomegaly (FOR) and ventricular response to CSF diversion (∆FOR) were significantly associated with occurrence of MIPH. Choice of shunt and etiology of hydrocephalus were also significantly associated with MIPH. After adjusting for corrected age, etiology of hydrocephalus, and shunt setting, the authors found that ∆FOR after shunting was still associated with MIPH. A prospective study of MIPH prevention strategies and assessment of possible implications for patient outcomes is needed.

Reversible Parkinson-Like Symptoms in Patient with Bilateral Chronic Subdural Hematomas and Cervical Spinal Stenosis.

Science.gov (United States)

Guppy, Kern H; Khandhar, Suketu M; Ochi, Calvin

2018-01-01

Gait abnormalities have been seen in patients with Parkinson disease or Parkinson-like (P-L) disorders and cervical spinal stenosis. Acute presentation of P-L symptoms has been reported in 24 cases caused by chronic subdural hematomas with 11 cases due to bilateral chronic subdural hematomas. When a patient also presents with cervical spinal stenosis, the correct therapeutic decision between P-L disorders and myelopathy is challenging. An 80-year-old male presented with a 2-week history of weakness in his left leg. A few days before presentation, his gait had deteriorated quite dramatically. Neurologic examination showed mild leg weakness, hyperreflexia, and a gait that was slow and wide based, at times festinating but with relatively spared arm movement. He also had masked facial features with increased tone in his extremities. Magnetic resonance imaging of the cervical spine showed cervical stenosis at C5-6, and computed tomography of the head showed large bilateral subdural hematomas. The subdural hematomas were drained. Immediate improvement in his symptoms was observed with complete resolution by his third month of follow-up. The patient never had a history of Parkinson disease. This paper reports for the first time a patient who presented with acute P-L symptoms and cervical myelopathy with findings of both bilateral chronic subdural hematomas and cervical spinal stenosis. The decision to drain the subdural hematoma in our case resulted in full recovery of the patient's gait and other extrapyramidal symptoms. This paper reviews the literature on reversible P-L symptoms caused by bilateral chronic subdural hematomas. Copyright © 2017 Elsevier Inc. All rights reserved.

Subdural Effusions with Hydrocephalus after Severe Head Injury: Successful Treatment with Ventriculoperitoneal Shunt Placement: Report of 3 Adult Cases

Directory of Open Access Journals (Sweden)

N. Tzerakis

2010-01-01

Full Text Available Background. Subdural collections of cerebrospinal fluid (CSF with associated hydrocephalus have been described by several different and sometimes inaccurate terms. It has been proposed that a subdural effusion with hydrocephalus (SDEH can be treated effectively with a ventriculoperitoneal shunt (V-P shunt. In this study, we present our experience treating patients with SDEH without directly treating the subdural collection. Methods. We treated three patients with subdural effusions and hydrocephalus as a result of a head injury. All the patients were treated with a V-P shunt despite the fact that there was an extra-axial CSF collection with midline shift. Results. In all of the patients, the subdural effusions subsided and the ventricular dilatation improved in the postoperative period. The final clinical outcome remains difficult to predict and depends not only on the successful CSF diversion but also on the primary and secondary brain insult. Conclusion. Subdural effusions with hydrocephalus can be safely and effectively treated with V-P shunting, without directly treating the subdural effusion which subsides along with the treatment of hydrocephalus. However, it is extremely important to make an accurate diagnosis of an SDEH and differentiate this condition from other subdural collections which require different management.

Spinal cord compression secondary to extramedullary hematopoiesis in a dog.

Science.gov (United States)

Williams, Lindsay M; Skeen, Todd M

2013-03-15

An 11-year-old spayed female Siberian Husky was evaluated because of a 2-week history of progressive paraparesis. Results of neurologic examination were consistent with a T3-L3 myelopathy. There were no abnormalities on CBC, and hypercalcemia was noted on serum biochemical analysis. Several hypoechoic splenic nodules were evident on abdominal ultrasonography, and results of fine-needle aspiration cytology were consistent with splenic extramedullary hematopoiesis (EMH). Two compressive, extradural masses in the dorsal epidural space of the thoracolumbar region of the spinal cord were seen on MRI images. A dorsal laminectomy was performed to remove the extradural spinal masses. Results of histologic examination of tissue samples were consistent with EMH. Following surgery, clinical signs of paraparesis resolved, and there was no recurrence of the masses 24 months after surgery. Extramedullary hematopoesis should be considered as a differential diagnosis in dogs in which results of diagnostic imaging indicate a epidural mass. In human patients, spinal EMH usually occurs secondary to an underlying hematologic disease, but it can also occur spontaneously. Treatment options reported for humans include surgical decompression, radiation therapy, chemotherapy, and blood transfusion. The dog of this report responded favorably to surgical decompression and was clinically normal 2 years after surgery.

Extramedullary plasmacytoma: clinical and histopathologic study.

Science.gov (United States)

Strojan, Primoz; Soba, Erika; Lamovec, Janez; Munda, Anton

2002-07-01

To review the histories of extramedullary plasmacytoma patients diagnosed in Slovenia between 1969 and 1999, to determine the relationship between radiotherapy (XRT) dose and local tumor control, and to clarify the role of elective nodal XRT and the prognostic value of Bartl's histologic grading criteria (originally devised for multiple myeloma [MM]). The database of the Cancer Registry of Slovenia was used for the identification of patients. The inclusion criteria were as follows: bone marrow biopsy showing less than 10% plasma cells, normal skeletal survey, and immunohistochemically determined tumor monoclonality. Simulation/portal films were reviewed to assess the extent of elective nodal XRT. Twenty-six patients with 31 tumors fulfilled the inclusion criteria. In 4 patients, nine metachronously appearing solitary tumors were diagnosed. The head-and-neck region and other body sites were the sites of origin of primary tumors in 84% and 16% of patients, respectively, whereas in the two regions, regional disease was seen in 15% and 60% of patients, respectively. Therapy was as follows: XRT, 12 patients; surgery and postoperative XRT, 15 patients; and surgery, 4 patients. Ultimate local and regional control rates were 90% and 97%, respectively, and MM developed in 2 (8%) patients. The 10-year disease-specific and overall survival rates were 87% and 61%, respectively. The analysis of the dose-effect relationship showed that more conservative treatment is justified: for macroscopic disease, 40-50 Gy (2 Gy/day), adjusted to the bulk of disease; for microscopic disease, 36-40 Gy; after R0 surgery, no XRT is required, but close observation is needed. No attempts should be made to treat uninvolved nodal regions. Using Bartl's histologic grading criteria, trends were detected in patients with higher tumor grades: regional lymph node involvement (p = 0.04) and shorter disease-specific survival (p = 0.08). Extramedullary plasmacytoma is a highly curable disease when XRT is

Subdural hematoma and oral anticoagulant therapy

NARCIS (Netherlands)

Wintzen, A. R.; Tijssen, J. G.

1982-01-01

In a retrospective study of the period 1959 to 1978, the role of anticoagulant therapy (ACT) in the development of subdural hematoma (SH) was investigated. Of 212 cases, 46 were receiving ACT, a proportion highly in excess of the frequency of ACT in the general population of the Leiden area. In this

RI cisternography and CT cisternography in chronic subdural effusion in infancy

Energy Technology Data Exchange (ETDEWEB)

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

1980-10-01

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

Thalassemia, extramedullary hematopoiesis, and spinal cord compression: A case report

OpenAIRE

Bukhari, Syed Sarmad; Junaid, Muhammad; Rashid, Mamoon Ur

2016-01-01

Background: Extramedullary hematopoiesis (EMH) refers to hematopoiesis outside of the medulla of the bone. Chronic anemia states such as thalassemia can cause hematopoietic tissue to expand in certain locations. We report a case of spinal cord compression due to recurrent spinal epidural EMH, which was treated with a combination of surgery and radiotherapy. Pakistan has one of the highest incidence and prevalence of thalassemia in the world. We describe published literature on diagnosis and m...

A Rare Presentation of Extramedullary Hematopoiesis in Post-polycythemic Myelofibrosis

OpenAIRE

Konca Degertekin, Ceyla; Özkurt, Zübeyde Nur; Akyürek, Nalan; Yağcı, Münci

2012-01-01

Polycythemia vera is a clonal proliferative disorder of the bone marrow that could possibly evolve into myelofibrosis in its natural course. Progression to myelofibrosis is usually a late stage complication and presents clinically with refractory cytopenias and extramedullary hematopoiesis (EMH). EMH can occur in any tissue during the course of post-polycythemic myelofibrosis. However, skin and cardiac involvements seems to be very rare. We present a 56-year-old woman with post-polycythemic m...

Solitary extramedullary plasmacytomas of thyroid in Hashimoto's thyroiditis: Mimicking benign cystic nodule on ultrasonography

International Nuclear Information System (INIS)

Kwon, Yohan; Kim, Soo Jin; Hur, Joon Ho; Park, Sung Hee; Lee, Sun Jin; Lee, Tae Jin

2013-01-01

Solitary extramedullary plasmacytoma (SEP) of the thyroid is uncommon and mostly occur in patients with a Hashimoto's thyroiditis (82%). We present a case on SEP of thyroid in Hashimoto's thyroiditis, which mimics growing benign cystic masses on serial ultrasonography.

Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.

Science.gov (United States)

Ratilal, Bernardo O; Pappamikail, Lia; Costa, João; Sampaio, Cristina

2013-06-06

Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. To assess the effects of prophylactic anticonvulsants in patients with chronic subdural haematoma, in both the pre- and post-operative periods. We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), PubMed, LILACS, and the databases clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, and Current Controlled Trials. The search was through 27th March 2013. Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention. Three authors screened the search results to identify relevant studies. No studies met the inclusion criteria for the review. No randomised controlled trials were identified. No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. There are no randomised controlled trials on this topic, and non-controlled studies have conflicting results. There is an urgent need for well-designed randomised controlled trials.

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.)

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

DEFF Research Database (Denmark)

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

2013-01-01

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

Transjugular Intrahepatic Porto-Systemic Stent-Shunt for Therapy of Bleeding Esophageal Varices Due to Extramedullary Hematopoiesis in Primary Myelofibrosis: A Case Report

OpenAIRE

Phillip, Veit;Berger, Hermann;Straub, Melanie;Saugel, Bernd;Treiber, Matthias;Einwächter, Henrik;Schmid, Roland M.;Huber, Wolfgang

2016-01-01

Background: Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. Patient and Methods: We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Results: Therapy of variceal bleeding ...

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

Science.gov (United States)

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

2015-01-01

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

Computerized tomography of chronic subdural hematoma extending to the tentorium

International Nuclear Information System (INIS)

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

1987-01-01

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

Computerized tomography of chronic subdural hematoma extending to the tentorium

Energy Technology Data Exchange (ETDEWEB)

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

1987-06-01

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

Chronic Subdural Hematoma Associated with Arachnoid Cyst in Young Adults: A Case Report

Directory of Open Access Journals (Sweden)

Jun-Yeen Chan

2008-01-01

Full Text Available Inrracranial arachnoid cysts are believed to be congenital; they can become symptomatic in pediarric patients. Chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury a few months prior to the onset of symptoms. However, these two distinct clinical entities sporadically occur together in relatively young patients. We report a 29-year-old man who presented with headache and dizziness of 2 months' duration. Brain computed tomography revealed a huge chronic subdural hematoma over the left frontoparietal lobe, with an incidental finding of an arachnoid cyst over the left sylvian fissure. In light of a literature review, we discuss arachnoid cysts as a possible risk factor for subdural hematoma, especially in young adults.

MR imaging evaluation of subdural hematomas in child abuse

International Nuclear Information System (INIS)

Hay, T.C.; Rumack, C.M.; Horgan, J.G.; Hyden, P.; Krugman, R.

1988-01-01

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

[Metastasis of Hepatocellular Carcinoma to the Membrane of Chronic Subdural Hematomas:A Case Report].

Science.gov (United States)

Oshita, Jumpei; Ohba, Shinji; Itou, Yoko; Yonezawa, Koki; Hosogai, Masahiro

2017-10-01

An 81-year-old man presented with gait disturbance. Two months previously, he suffered from hepatocellular carcinoma and transarterial chemoembolization was performed. A head computed tomography(CT)scan revealed bilateral chronic subdural hematomas. The patient's gait disturbance was improved after achievement of bilateral burr hole drainage. A head CT two months after treatment revealed no recurrence of the hematomas. However, head CT images obtained four months after treatment revealed an abnormal mass in the right parietal region attached to the internal surface of the skull. The mass was located in the same region from where the chronic subdural hematomas were previously removed via burr hole drainage, and was suspected to have originated from the dura mater. We performed craniotomy and total removal of the mass. The dura mater was intact, and macroscopically, the mass originated from the organized membrane of the chronic subdural hematoma. A pathological examination revealed metastasis of hepatocellular carcinoma to the membrane of the chronic subdural hematomas. Head magnetic resonance imaging(MRI)performed 39 days after craniotomy presented a new lesion in the left parietal region attached to the internal surface of the skull. The patient subsequently died 46 days post-operation. When examining chronic subdural hematomas in cancer patients, histological examination of the dura mater, hematoma, and membrane of the hematoma are important. The possibility of metastasis to the capsule of the hematoma should be considered.

‘Subarachnoid cyst’ after evacuation of chronic subdural hematoma: Case report of an unusual postoperative morbidity

Science.gov (United States)

Sharon, Low Y. Y.; Wai Hoe, NG

2016-01-01

Burr-hole drainage of chronic subdural hematomas are routine operative procedures done by neurosurgical residents. Common postoperative complications include acute epidural and/or subdural bleeding, tension pneumocephalus, intracranial hematomas and ischemic cerebral infarction. We report an interesting post-operative complication of a ‘subarachnoid cyst’ after burr-hole evacuation of a chronic subdural hematoma. The authors hypothesize that the ‘cyst’ is likely secondary to the splitting of the adjacent neomembrane within its arachnoid-brain interface by iatrogenic irrigation of the subdural space. Over time, this ‘cyst’ develops into an area of gliosis which eventually causes long-term scar epilepsy in the patient. As far as we are aware, this is the first complication of such a ‘subarachnoid cyst’ post burr-hole drainage reported in the literature. PMID:27366276

A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

Science.gov (United States)

Singh, Amit Kumar; Suryanarayanan, Bhaskar; Choudhary, Ajay; Prasad, Akhila; Singh, Sachin; Gupta, Laxmi Narayan

2014-01-01

Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

Streptococcal Subdural Empyema as a Complication of Varicella

Directory of Open Access Journals (Sweden)

J Gordon Millichap

2005-01-01

Full Text Available A 3-month-old male infant who presented with a group A streptococcal subdural empyema on day 5 of a varicella skin rash is reported from the University of British Columbia, Vancouver, BC, Canada.

Superficial subarachnoid cerebrospinal fluid space expansion after surgical drainage of chronic subdural hematoma.

Science.gov (United States)

Tosaka, Masahiko; Tsushima, Yoshito; Watanabe, Saiko; Sakamoto, Kazuya; Yodonawa, Masahiko; Kunimine, Hideo; Fujita, Haruyasu; Fujii, Takashi

2015-07-01

The present study examined the computed tomography (CT) findings after surgery and overnight drainage for chronic subdural hematoma (CSDH) to clear the significance of inner superficial subarachnoid CSF space and outer subdural hematoma cavity between the brain surface and the inner skull. A total of 73 sides in 60 patients were evaluated. Head CT was performed on the day after surgery and overnight drainage (1st CT), within 3 weeks of surgery (2nd CT), and more than 3 weeks after surgery (3rd CT). Subdural and subarachnoid spaces were identified to focus on density of fluid, shape of air collection, and location of silicone drainage tube, etc. Cases with subdural space larger than the subarachnoid CSF space were classified as Group SD between the brain and the skull. Cases with subarachnoid CSF space larger than the subdural space were classified as Group SA. Cases with extremely thin (<3 mm) spaces between the brain and the skull were classified as Group NS. Group SA, SD, and NS accounted for 31.9, 55.6 and 12.5% of cases on the 1st CT. No statistical differences were found between Groups SA, SD, and NS in any clinical factors, including recurrence. Group SA were found significantly more on 1st CT than on 2nd and 3rd CT. Subarachnoid CSF space sometimes expands between the brain and skull on CT after surgical overnight drainage. Expansion of the arachnoid space may be a passive phenomenon induced by overnight drainage and delayed re-expansion of the brain parenchyma.

Spontaneous subdural hematoma of the thoracolumbar region with massive recurrent bleed

Directory of Open Access Journals (Sweden)

Cincu Rafael

2009-01-01

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

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

International Nuclear Information System (INIS)

Pollo, C.; Porchet, F.; Meuli, R.

2003-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

Pollo, C.; Porchet, F. [Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland); Meuli, R. [Department of Radiology, Centre Hospitalier Universitaire Vaudois, 1011, Lausanne (Switzerland)

2003-08-01

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

Development of Guidelines for Skeletal Survey in Young Children With Intracranial Hemorrhage.

Science.gov (United States)

Paine, Christine Weirich; Scribano, Philip V; Localio, Russell; Wood, Joanne N

2016-04-01

As evidenced by the variation and disparities in evaluation, there is uncertainty in determining which young children with intracranial hemorrhage (ICH) should undergo evaluation with skeletal survey (SS) for additional injuries concerning for abuse. We aimed to develop guidelines for performing initial SS in children <24 months old presenting with ICH by combining available evidence from the literature with expert opinion. Using the RAND/UCLA Appropriateness Method, a multispecialty panel of 12 experts used the literature and their own clinical expertise to rate the appropriateness of performing SS for 216 scenarios characterizing children <24 months old with ICH. After a moderated discussion of initial ratings, the scenarios were revised. Panelists re-rated SS appropriateness for 74 revised scenarios. For the 63 scenarios in which SS was deemed appropriate, the panel rated the necessity of SS. Panelists concluded that SS is appropriate for 85% (63), uncertain for 15% (11), and inappropriate for 0% of scenarios. Panelists determined that SS is necessary in all scenarios deemed appropriate. SS was deemed necessary for infants <6 months old and for children <24 months old with subdural hemorrhage that is not tiny and under a skull fracture. For children 6 to 23 months old with epidural hemorrhage, necessity of SS depended on the child's age, history of trauma, signs/symptoms, and ICH characteristics. The resulting clinical guidelines call for near-universal evaluation in children <24 months old presenting with ICH. Detailed, validated guidelines that are successfully implemented may decrease variation and disparities in care. Copyright © 2016 by the American Academy of Pediatrics.

Evaluation of Intraventricular Hemorrhage in Pediatric Intracerebral hemorrhage

Science.gov (United States)

Kleinman, Jonathan T; Beslow, Lauren A; Engelmann, Kyle; Smith, Sabrina E; Licht, Daniel J; Ichord, Rebecca N; Jordan, Lori C

2012-01-01

Previous studies of pediatric intracerebral hemorrhage have investigated isolated intraparenchymal hemorrhage. We investigated whether detailed assessment of intraventricular hemorrhage enhanced outcome prediction after intracerebral hemorrhage. We prospectively enrolled 46 children, full-term to 17 years, median age 2.7 years with spontaneous intraparenchymal hemorrhage and/or intraventricular hemorrhage. Outcome was assessed with the King’s Outcome Scale for Childhood Head Injury. Twenty-six (57%) had intraparenchymal hemorrhage, 10 (22%) had pure intraventricular hemorrhage, and 10 (22%) had both. There were 2 deaths, both with intraparenchymal hemorrhage + intraventricular hemorrhage volume ≥4% of total brain volume. Presence of intraventricular hemorrhage was not associated with poor outcome, but hydrocephalus showed a trend (p=0.09) toward poor outcome. In receiver operating characteristic curve analysis, combined intraparenchymal hemorrhage + intraventricular hemorrhage volume also showed a trend toward better outcome prediction than intraparenchymal hemorrhage volume alone. Although not an independent outcome predictor, future studies should assess intraventricular hemorrhage qualitatively and quantitatively. PMID:22068828

Transjugular intrahepatic porto-systemic stent-shunt for therapy of bleeding esophageal varices due to extramedullary hematopoiesis in primary myelofibrosis: a case report.

Science.gov (United States)

Phillip, Veit; Berger, Hermann; Straub, Melanie; Saugel, Bernd; Treiber, Matthias; Einwächter, Henrik; Schmid, Roland M; Huber, Wolfgang

2012-01-01

Primary myelofibrosis belongs to the group of myeloproliferative syndromes. Extramedullary hematopoiesis in the liver can lead to portal hypertension. We report a case of a patient with life-threatening, endoscopically not treatable bleeding from esophageal varices due to extramedullary hematopoiesis of the liver that was successfully treated with placement of a transjugular intrahepatic porto-systemic stent-shunt (TIPS). Therapy of variceal bleeding by TIPS insertion was successful. During a 29-month follow-up, no hepatic failure, hepatic encephalopathy, or further variceal bleeding episode occurred. TIPS placement is a well-established procedure for the treatment of complications due to portal hypertension mainly due to liver cirrhosis. This report illustrates that TIPS placement can also be a promising treatment option in patients with primary myelofibrosis and portal hypertension due to extramedullary hematopoiesis. Copyright © 2012 S. Karger AG, Basel.

The role of T2*-weighted gradient echo in the diagnosis of tumefactive intrahepatic extramedullary hematopoiesis in myelodysplastic syndrome and diffuse hepatic iron overload: a case report and review of the literature.

Science.gov (United States)

Belay, Abel A; Bellizzi, Andrew M; Stolpen, Alan H

2018-01-15

Extramedullary hematopoiesis is the proliferation of hematopoietic cells outside bone marrow secondary to marrow hematopoiesis failure. Extramedullary hematopoiesis rarely presents as a mass-forming hepatic lesion; in this case, imaging-based differentiation from primary and metastatic hepatic neoplasms is difficult, often leading to biopsy for definitive diagnosis. We report a case of tumefactive hepatic extramedullary hematopoiesis in the setting of myelodysplastic syndrome with concurrent hepatic iron overload, and the role of T2*-weighted gradient-echo magnetic resonance imaging in differentiating extramedullary hematopoiesis from primary and metastatic hepatic lesions. To the best of our knowledge, T2*-weighted gradient-echo evaluation of extramedullary hematopoiesis in the setting of diffuse hepatic hemochromatosis has not been previously described. A 52-year-old white man with myelodysplastic syndrome and marrow fibrosis was found to have a 4 cm hepatic lesion on ultrasound during workup for bone marrow transplantation. Magnetic resonance imaging revealed diffuse hepatic iron overload and non-visualization of the lesion on T2* gradient-echo sequence suggesting the presence of iron deposition within the lesion similar to that in background hepatic parenchyma. Subsequent ultrasound-guided biopsy of the lesion revealed extramedullary hematopoiesis. Six months later, while still being evaluated for bone marrow transplant, our patient was found to have poor pulmonary function tests. Follow-up computed tomography angiogram showed a mass within his right main pulmonary artery. Bronchoscopic biopsy of this mass once again revealed extramedullary hematopoiesis. He received radiation therapy to his chest. However, 2 weeks later, he developed mediastinal hematoma and died shortly afterward, secondary to respiratory arrest. Mass-forming extramedullary hematopoiesis is rare; however, our report emphasizes that it needs to be considered in the initial differential

Bilateral Biconvex Frontal Chronic Subdural Hematoma Mimicking ...

African Journals Online (AJOL)

Chronic subdural hematoma (CSDH) is one of the most common clinical entities encountered in daily neurosurgical practice.[1] CSDH is an encapsulated collection of old blood, mostly or totally liquefied and located between the dura mater and arachnoid.[2] We discuss the clinical and radiological findings in a case of ...

Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

Directory of Open Access Journals (Sweden)

Sasikala P.

2014-03-01

Full Text Available Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.

Leakage of contrast into a postmeningitic subdural effusion

International Nuclear Information System (INIS)

Scotti, G.; Harwood-Nash, D.C.

1980-01-01

The CT findings in a 6-month-old boy with hemophilus influenzae meningitis, complicated by the occurrence of bilateral subdural effusions, are described. The effusions were hypodense and the contents markedly enhanced (increase of 40 Hounsfield units) after contrast injection. (orig.)

Growth-mechanism of giant intracranial aneurysms; demonstration by CT and MR imaging

Energy Technology Data Exchange (ETDEWEB)

Schubiger, O.; Valavanis, A.; Wichmann, W.

1987-05-01

In four cases of giant intracranial aneurysm, CT demonstrated a hyperdense open-, or closed-ring structure at the periphery of the aneurysm. Surgery in two of the cases demonstrated that this peripheral hyperdensity represents fresh clot inside the wall of the thrombosed mass. An analogy is established between giant intracranial aneurysms, chronic subdural hematomas and growing encapsulated intracerebral hematomas. The common feature of the three entities is slow growth by recurrent hemorrhages into the lesion. It is proven that growth of chronic subdural hematomas and of growing encapsulated hematomas is related to recurrent hemorrhage from capillaries sprouting within the membrane of the lesion. The highly vascularized membranous wall of a giant intracranial aneurysm seems to behave like the membrane of a chronic subdural hematoma. It is suggested that the giant intracranial aneurysm grows by recurrent hemorrhage into its wall and behaves like growing encapsulated hematomas.

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

OpenAIRE

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

2013-01-01

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

Extramedullary plasmacytoma: clinical and histopathologic study

International Nuclear Information System (INIS)

Strojan, Primoz; Soba, Erika; Lamovec, Janez; Munda, Anton

2002-01-01

Purpose: To review the histories of extramedullary plasmacytoma patients diagnosed in Slovenia between 1969 and 1999, to determine the relationship between radiotherapy (XRT) dose and local tumor control, and to clarify the role of elective nodal XRT and the prognostic value of Bartl's histologic grading criteria (originally devised for multiple myeloma [MM]). Methods and Materials: The database of the Cancer Registry of Slovenia was used for the identification of patients. The inclusion criteria were as follows: bone marrow biopsy showing less than 10% plasma cells, normal skeletal survey, and immunohistochemically determined tumor monoclonality. Simulation/portal films were reviewed to assess the extent of elective nodal XRT. Results: Twenty-six patients with 31 tumors fulfilled the inclusion criteria. In 4 patients, nine metachronously appearing solitary tumors were diagnosed. The head-and-neck region and other body sites were the sites of origin of primary tumors in 84% and 16% of patients, respectively, whereas in the two regions, regional disease was seen in 15% and 60% of patients, respectively. Therapy was as follows: XRT, 12 patients; surgery and postoperative XRT, 15 patients; and surgery, 4 patients. Ultimate local and regional control rates were 90% and 97%, respectively, and MM developed in 2 (8%) patients. The 10-year disease-specific and overall survival rates were 87% and 61%, respectively. The analysis of the dose-effect relationship showed that more conservative treatment is justified: for macroscopic disease, 40-50 Gy (2 Gy/day), adjusted to the bulk of disease; for microscopic disease, 36-40 Gy; after R0 surgery, no XRT is required, but close observation is needed. No attempts should be made to treat uninvolved nodal regions. Using Bartl's histologic grading criteria, trends were detected in patients with higher tumor grades: regional lymph node involvement (p=0.04) and shorter disease-specific survival (p=0.08). Conclusions: Extramedullary

A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy

OpenAIRE

Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Ozaki, Makoto; Muragaki, Yoshihiro; Okada, Yoshikazu

2014-01-01

We are reporting the case of a 56-year-old woman who developed loss of consciousness during awake craniotomy. A thin subdural haematoma in the contralateral side of the craniotomy was identified with intraoperative magnetic resonance imaging and subsequently removed. Our case indicates that contralateral acute subdural haematoma could be a cause of deterioration of the conscious level during awake craniotomy.

A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy

Science.gov (United States)

Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Ozaki, Makoto; Muragaki, Yoshihiro; Okada, Yoshikazu

2014-01-01

We are reporting the case of a 56-year-old woman who developed loss of consciousness during awake craniotomy. A thin subdural haematoma in the contralateral side of the craniotomy was identified with intraoperative magnetic resonance imaging and subsequently removed. Our case indicates that contralateral acute subdural haematoma could be a cause of deterioration of the conscious level during awake craniotomy. PMID:25301378

Successful radiotherapy at the rare extramedullary localization of a chemotherapy refractory relapse Burkitt-All

International Nuclear Information System (INIS)

Menschel, E.; Koller, E.; Bernhart, M.; Noesslinger, T.; Pfeilstoecker, M.

2003-01-01

The intensive therapy of the Burkitt-All achieved higher remission rates in the last years. Relapses and therapy refractory are a big medial problem. Radiotherapy in contribution with radiosensitizer used by an extramedullary large relapse of Burkitt-All is documented in this article as a successful therapy method. (boteke)

Radiotherapy of extramedullary plasmacytoma of the head and neck

International Nuclear Information System (INIS)

Harwood, A.R.; Knowling, M.A.; Bergsagel, D.E.

1981-01-01

The purpose of this study is to report the results of megavoltage irradiation with cobalt-60 in 23 previously unreported cases of extramedullary plasmacytoma of the head and neck. It has been found that 3500 cGy (rad) in three weeks provides good local control of disease with minimal morbidity and a significant proportion do not go on to multiple myeloma. Prognostic factors of significance with respect to subsequent development of multiple myeloma include site and presence or absence of bone destruction. The presence or absence of an M protein peak appears to be of no significance. (author)

Incidence and prognostic significance of postoperative complications demonstrated on CT after brain tumor removal

Energy Technology Data Exchange (ETDEWEB)

Fukamachi, Akira; Koizumi, Hidehito; Kimura, Ryoichi; Nukui, Hideaki; Kunimine, Hideo

1987-06-01

We surveyed the computed tomographic (CT) findings in 273 patients who had undergone 301 craniotomies for brain tumors to determine the incidence and clinical outcome of the postoperative complications demonstrated on CT. The frequencies of medium-sized or large postoperative lesions were as follows: intracerebral hemorrhage, 11% of 301 operations; subdural fluid collection, 8%; brain edema, 6%; extradural hemorrhage, 4%; cerebral infarction, 3%; ventricular enlargement, 3%; intraventricular hemorrhage, 2%; chronic subdural hematoma, 1%; porencephalic cyst, 0.7%; tension pneumocephalus, 0.7%. In association with these complications, poor outcomes (deaths) developed with the following frequencies: intracerebral hemorrhage including an association with other types of hemorrhage, 4% (deaths, 2%) of 301 operations; cerebral infarction, 1% (deaths, 0.7%); brain edema, 0.7% (deaths, 0.7%); simple intraventricular hemorrhage, 0.3% (no deaths); tension pneumocephalus, 0.3% (no deaths). From these results, we conclude that medium-sized or large intracerebral hemorrhage, massive cerebral infarction and edema have a grave clinical significance in the postoperative course of patients with brain tumors.

The Pathogenesis of Subacute Subdural Hematoma: A Report of 3 Cases and Literature Review.

Science.gov (United States)

Tao, Zhi-Qiang; Ding, Sheng-Hong; Huang, Jian-Yue; Zhu, Zhi-Gang

2018-06-01

To discuss the pathologic mechanism of subacute subdural hematoma (sASDH). Three typical cases of sASDH were reported, and related literature in Chinese published in the past 15 years was reviewed. Intervals from onset of acute subdural hematoma to surgery or symptom deterioration resulting in sASDH were 12.5-15.5 days (mean 14.1 days). Delayed liquefaction of hematoma clots occurred in all 3 reported cases. One patient achieved good curative effect after administration of dexamethasone, and another patient relapsed owing to poor drainage after evacuation of hematoma. The conversion of acute subdural hematoma to sASDH is an inflammatory reaction process with very regular in time, and it is speculated that the pathologic mechanism may be a delayed hypersensitivity reaction. Antigen released during the liquefaction process of blood clot, with subdural neomembrane cells as antigen-presenting cells, is presented to the T lymphocytes released from the capillaries in the neomembrane and forms sensitized T lymphocytes. When the subsequent antigen is released from the blood clots with a delayed liquefaction and is exposed to sensitized T lymphocytes, the delayed hypersensitivity process occurs. Copyright © 2018 Elsevier Inc. All rights reserved.

CT findings and outcome in head injury

Energy Technology Data Exchange (ETDEWEB)

Yamaura, Akira

1984-12-01

CT findings and outcome were discussed in head injuries. Parenchymal findings were classified into 5 categories; ''normal'', ''hemispheric (isodense) swelling'', ''hemorrhagic lesions'', ''diffuse cerebral swelling'', and ''low density''. The worst outcome (73% mortality) was seen in ''hemispheric swelling''. This abnormality was quite often associated with acute subdural hematoma. Multiple ''hemorrhagic lesions'' were associated with much poorer outcome than single lesions. The older groups had more acute subdural hematomas and more ''hemorrhagic lesions''. And ''hemorrhagic lesions'' were more often multiple and larger in the older group. (author).

Membranectomy in Chronic Subdural Hematoma: Meta-Analysis.

Science.gov (United States)

Sahyouni, Ronald; Mahboubi, Hossein; Tran, Peter; Roufail, John S; Chen, Jefferson W

2017-08-01

Initial management strategies of chronic subdural hematoma (cSDH) are controversial and range from bedside twist-drill or burr-hole drainage to craniotomy with membranectomy (CWM). We aim to 1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature and 2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates. A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using key words ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence intervals (CIs) were calculated for all outcomes using a random-effects model. Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1-30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2-5.4% and 2.1-11.6%; P < 0.001 and P = 0.004). The collective mean recurrence rate was 7.6% (95% CI: 5%-10.2%; P < 0.001). Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable with the 5% mortality and 3%-12% morbidity rates and lower than the 10%-21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Fifteen-year follow-up of a patient with beta thalassaemia and extramedullary haematopoietic tissue compressing the spinal cord

International Nuclear Information System (INIS)

Niggemann, P.; Krings, T.; Thron, A.; Hans, F.

2005-01-01

A long-term follow-up of a patient with beta thalassaemia with intra- and extraspinal extramedullary haematopoietic tissue compressing the spinal cord is presented. Extramedullary haematopoietic nodules are a rare cause of spinal cord compression and should be included in the differential diagnosis, especially in patients from Mediterranean countries. Treatment with radiation therapy solely failed, giving rise to the need of surgical intervention. Surgical decompression of the spine and the removal of the culprit lesion compressing the spine were performed. Postinterventional radiation therapy was applied to the spine. A relapse had to be treated again by surgical means combined with postinterventional radiation therapy. A complete relief of the symptoms and control of the lesion could be obtained

Fifteen-year follow-up of a patient with beta thalassaemia and extramedullary haematopoietic tissue compressing the spinal cord

Energy Technology Data Exchange (ETDEWEB)

Niggemann, P.; Krings, T.; Thron, A. [Dept. of Neuroradiology, RWTH-Aachen Hosital (Germany); Hans, F. [Dept. of Neurosurgery, RWTH Aachen Hospital (Germany); 1

2005-04-01

A long-term follow-up of a patient with beta thalassaemia with intra- and extraspinal extramedullary haematopoietic tissue compressing the spinal cord is presented. Extramedullary haematopoietic nodules are a rare cause of spinal cord compression and should be included in the differential diagnosis, especially in patients from Mediterranean countries. Treatment with radiation therapy solely failed, giving rise to the need of surgical intervention. Surgical decompression of the spine and the removal of the culprit lesion compressing the spine were performed. Postinterventional radiation therapy was applied to the spine. A relapse had to be treated again by surgical means combined with postinterventional radiation therapy. A complete relief of the symptoms and control of the lesion could be obtained.

Temporal bone extramedullary hematopoiesis as a causeof pediatric bilateral conductive hearing loss:Case report and review of the literature.

Science.gov (United States)

Lanigan, Alexander; Fordham, M Taylor

2017-06-01

Extramedullary hematopoiesis occurs in children with hemoglobinopathy and chronic anemia. The liver and spleen are often affected first, but other foci can develop to support erythrocyte demand. We report a case of a nine-year-old with beta thalassemia and temporal bone extramedullary hematopoiesis causing ossicular fixation and bilateral conductive hearing loss. There is only one case in the literature describing this phenomenon in pediatric patients, and this is the first case report of bilateral hearing loss from this physiologic phenomenon. Otolaryngologists should consider this etiology in patients with chronic anemia and conductive hearing loss in the absence of otitis media. Published by Elsevier B.V.

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.

Nasal septum extramedullary plasmacytoma

Directory of Open Access Journals (Sweden)

Belić Branislav

2013-01-01

Full Text Available Introduction. Plasmacytomas are malignant tumors characterized by abnormal monoclonal proliferation of plasma cells. They originate in either bone - solitary osseous plasmacytoma, or in soft tissue - extramedullary plasmacytoma (EMP. EMP represents less than 1% of all head and neck malignancies. Case report. We presented a case of EMP of the nasal septum in a 44-year-old male who had progressive difficulty in breathing through the nose and frequent heavy epistaxis on the right side. Nasal endoscopy showed dark red, soft, polypoid tumor in the last third of the right nasal cavity arising from the nasal septum. The biopsy showed that it was plasmacytoma. Bence Jones protein in the urine, serum electrophoresis, bone marrow biopsy, skeletal survey and other screening tests failed to detect multiple myeloma. This confirmed the diagnosis of EMP. The mass was completely removed via an endoscopic approach, and then, 4 week later, radiotherapy was conducted with a radiation dose of 50 Gray. No recurrence was noted in a 3-year follow- up period. Conclusion. EMP of the nasal cavity, being rare and having long natural history, represents a diagnostic and therapeutic challenge for any ear, nose and throat surgeon. Depending on the resectability of the lesion, a combined therapy is the accepted treatment.

Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera

Directory of Open Access Journals (Sweden)

Shuhei Ito

2017-01-01

Full Text Available Extramedullary hematopoiesis (EMH occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera.

Science.gov (United States)

Ito, Shuhei; Fujita, Nobuyuki; Hosogane, Naobumi; Nagoshi, Narihito; Yagi, Mitsuru; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

2017-01-01

Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

Myelopathy due to Spinal Extramedullary Hematopoiesis in a Patient with Polycythemia Vera

OpenAIRE

Ito, Shuhei; Fujita, Nobuyuki; Hosogane, Naobumi; Nagoshi, Narihito; Yagi, Mitsuru; Iwanami, Akio; Watanabe, Kota; Tsuji, Takashi; Nakamura, Masaya; Matsumoto, Morio; Ishii, Ken

2017-01-01

Extramedullary hematopoiesis (EMH) occasionally occurs in patients exhibiting hematological disorders with decreased hematopoietic efficacy. EMH is rarely observed in the spinal epidural space and patients are usually asymptomatic. In particular, in the patients with polycythemia vera, spinal cord compression due to EMH is extremely rare. We report a case of polycythemia vera, in which operative therapy proved to be an effective treatment for myelopathy caused by spinal EMH.

Bilateral Pleural Effusion in a Patient with an Extensive Extramedullary Hematopoietic Mass

OpenAIRE

Yun Luo; Ying Zhang; Shi-feng Lou

2013-01-01

We present a 56-year-old woman with bilateral pleural effusions, widespread enlarged lymph nodes, and soft tissue masses located within the renal pelvis. The initially working diagnosis was tuberculosis and lymphoma. Further pathological examination of the lymph node biopsy confirmed a diagnosis of extramedullary hematopoiesis, and a bone marrow biopsy revealed myelofibrosis. Unlike common treatment options such as radiotherapy and/or surgery, intrathoracic cisplatin and dexamethasone for the...

Evaluation of Intraventricular Hemorrhage in Pediatric Intracerebral hemorrhage

OpenAIRE

Kleinman, Jonathan T; Beslow, Lauren A; Engelmann, Kyle; Smith, Sabrina E; Licht, Daniel J; Ichord, Rebecca N; Jordan, Lori C

2011-01-01

Previous studies of pediatric intracerebral hemorrhage have investigated isolated intraparenchymal hemorrhage. We investigated whether detailed assessment of intraventricular hemorrhage enhanced outcome prediction after intracerebral hemorrhage. We prospectively enrolled 46 children, full-term to 17 years, median age 2.7 years with spontaneous intraparenchymal hemorrhage and/or intraventricular hemorrhage. Outcome was assessed with the King’s Outcome Scale for Childhood Head Injury. Twenty-si...

Age related outcome in acute subdural haematoma following traumatic head injury.

LENUS (Irish Health Repository)

Hanif, S

2009-09-01

Acute subdural haematoma (ASDH) is one of the conditions most strongly associated with severe brain injury. Reports prior to 1980 describe overall mortality rates for acute subdural haematomas (SDH\\'s) ranging from 40% to 90% with poor outcomes observed in all age groups. Recently, improved results have been reported with rapid diagnosis and surgical treatment. The elderly are predisposed to bleeding due to normal cerebral atrophy related to aging, stretching the bridging veins from the dura. Prognosis in ASDH is associated with age, time from injury to treatment, presence of pupillary abnormalities, Glasgow Coma Score (GCS) or motor score on admission, immediate coma or lucid interval, computerized tomography findings (haematoma volume, degree of midline shift, associated intradural lesion, compression of basal cisterns), post-operative intracranial pressure and type of surgery. Advancing age is known to be a determinant of outcome in head injury. We present the results of a retrospective study carried out in Beaumont Hospital, Dublin, Ireland\\'s national neurosurgical centre. The aim of our study was to examine the impact of age on outcome in patients with ASDH following severe head injury. Only cases with acute subdural haematoma requiring surgical evacuation were recruited. Mortality was significantly higher in older patients (50% above 70 years, 25.6% between 40 and 70 years and 26% below 40 years). Overall poor outcome (defined as Glasgow outcome scores 3-5) was also higher in older patients; 74.1% above 70 years, 48% between 40 and 70 years and 30% below 40 years. Poor outcome in traumatic acute subdural haematoma is higher in elderly patients even after surgical intervention.

Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift

Directory of Open Access Journals (Sweden)

Joji Inamasu

2015-04-01

Full Text Available Spontaneous intracranial hypotension (SIH is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma. When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery.

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

International Nuclear Information System (INIS)

Hahm, Chang Kok; Lee, Seung Ro; Park, Dong Woo; Joo, Kyung Bin; Lee, Sang Gil

1989-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1989-08-15

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

Solitary extramedullary plasmacytomas of thyroid in Hashimoto's thyroiditis: Mimicking benign cystic nodule on ultrasonography

Energy Technology Data Exchange (ETDEWEB)

Kwon, Yohan; Kim, Soo Jin; Hur, Joon Ho; Park, Sung Hee; Lee, Sun Jin; Lee, Tae Jin [Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul (Korea, Republic of)

2013-11-15

Solitary extramedullary plasmacytoma (SEP) of the thyroid is uncommon and mostly occur in patients with a Hashimoto's thyroiditis (82%). We present a case on SEP of thyroid in Hashimoto's thyroiditis, which mimics growing benign cystic masses on serial ultrasonography.

Adrenal extramedullary hematopoiesis associated with β-thalassemia major.

Science.gov (United States)

Keikhaei, Bijan; Shirazi, Ahmad Soltani; Pour, Mahboob Mohammad

2012-05-10

The presence of apparently normal hematopoietic tissue outside of bone marrow cavity is defined as extramedullary hematopoiesis (EMH). EMH is a rare complication in thalassemia major (TM) and adrenal gland as well. This report describes a case of adrenal EMH in a 26-year-old man with β-TM. He has been transfused with regular blood transfusion since 9 months. During the routine physical examination he was incidentally found to have a hypoechoic mass at his abdominal ultrasonography. Abdominal computed tomography scan revealed a right well-defined suprarenal mass 7.7×7.3×5.8 cm in size. The diagnosis of EMH was confirmed with ultrasonographic-guided fine needle biopsy. Treatment options which include intensified regular blood transfusion and hydroxyurea have been started.

Paraspinal extramedullary hematopoiesis in patients with thalassemia intermedia.

Science.gov (United States)

Haidar, Rachid; Mhaidli, Hani; Taher, Ali T

2010-06-01

Ineffective erythropoiesis in patients with thalassemia intermedia drives extramedullary hematopoietic tumor formation in several parts of the body. Paraspinal involvement has received increasing attention due to the associated morbidity secondary to spinal cord compression. Although the history and physical examination may help narrow the differential diagnosis, radiographic imaging remains essential to confirm the existence of hematopoietic tissue. Characteristic appearance has been observed mainly on magnetic resonance imaging. Several treatment options have been described, including transfusion therapy, laminectomy, radiotherapy, and the use of fetal hemoglobin inducing agents that decrease the hematopoietic drive. However, the ideal management scheme remains controversial. Until large prospective trials evaluate the efficacy and safety of the available treatment options, both in single and in combination therapy, an individualized approach should be entertained.

Enhancement of intracranial meningeal lesions with Gd-DTPA MR imaging

International Nuclear Information System (INIS)

Brown, E.; De La Paz, R.

1989-01-01

Pathologic intracranial meningeal enhancement on Gd-DTPA MR images (T1-weighted spin-echo sequence, 800/20 [repetition time msec/echo time msec] 1.5 T) was evaluated in 23 patients. Diagnoses included metastatic neoplasm (13 cases), benign neoplasm (four), infection (one), subarachnoid hemorrhage (three), and subdural hematoma (two). Eleven patients had undergone previous surgery. Diffuse enhancement occurred in 11 patients: eight with malignant infiltration, two with postoperative inflammation, and one with meningitis. Focal enhancement occurred in 12 patients, equally divided between those with malignant and benign processes: six cases were adjacent to intra- or extra-axial malignancy; three were at sites of recent (1--3 weeks) subarachnoid hemorrhage; and three were postoperative, adjacent to a craniotomy or subdural hematoma. Meningeal lesions were rarely diagnosed on the precontrast images, and Gd-DTPA enhancement was needed to distinguish between thickened meninges and thin fluid collections. Precontrast T1- and T2-weighted images were needed to discriminate high-signal meningeal enhancement from subacute subdural or subarachnoid hemorrhage, diploic marrow, normal vascular structures, and benign dural plaques. Meningeal enhancement was not pathology specific, and precontrast images are recommended to avoid misdiagnosis of subacute hemorrhage and misinterpretation of normal anatomy

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

Directory of Open Access Journals (Sweden)

B Vijayakumar

2012-01-01

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

Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

International Nuclear Information System (INIS)

Hayakawa, Isao; Fukui, Mitsufumi; Furuhashi, Norihisa; Kanda, Tadashi; Tazaki, Yoshiaki

1981-01-01

A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H 2 O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan. (author)

Interhemispheric subdural empyema diagnosed by CT and cured by antibiotic therapy

Energy Technology Data Exchange (ETDEWEB)

Hayakawa, I.; Fukui, M.; Furuhashi, N.; Kanda, T.; Tazaki, Y. (Kitasato Univ., Sagamihara, Kanagawa (Japan). School of Medicine)

1981-09-01

A case of interhemispheric subdural empyema cured by high doses of antibiotics was reported. A 23-year-old man was admitted with complaints of headache, fever and motor weakness of the left lower leg of 2 days' duration. The neurological examination revealed neck stiffness, motor weakness and sensory disturbance of left lower leg. The WBS count was 26,000/cumm, and ESR was 74 mm/hour. The CSF showed a pressure of 230 mm H/sub 2/O and contained 1001/3 cells (63% polymorphonuclears, 37% lymphocytes) in association with slight elevation of protein but with normal sugar content. The CSF culture was negative. Administration of high doses of antibiotics was started on the first hospital day. On the fourth hospital day, Jacksonian seizures occurred in the left lower extremity, and were controlled by anticonvulsants. CT scans with contrast enhancement revealed an area of low density in the right interhemispheric space with irregular marginal enhancement. Right carotid arteriography demonstrated a small oval avascular space along the interhemispheric cistern. The abnormalities on CT scan disappeared after one month, when the patient was discharged without neurological deficit. Unlike the previously reported cases with interhemispheric subdural empyema commonly associated with a collection of pus over the cerebral convexities, a localized interhemispheric subdural empyema as was found in the present case appears to be a very rare condition. The interhemispheric subdural empyema has been thought to be exclusively surgical indication and, to the best of our knowlage, there is no report in the literature of a case with successful medical treatment. However, successful treatment by antibiotics alone may become more practical if the diagnoses could be made in the early stage with the aid of CT scan.

Post meningitis subdural hygroma: Anatomical and functional evaluation with (99m)Tc-ehylene cysteine dimer single photon emission tomography/computed tomography.

Science.gov (United States)

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

2013-01-01

Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. (99m)Tc-ehylene cysteine dimer ((99m)Tc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If (99m)Tc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management.

Post meningitis subdural hygroma: anatomical and functional evaluation with 99mTc-ethylene cysteine dimer single photon emission tomography/computed tomography

International Nuclear Information System (INIS)

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

2013-01-01

Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most often these resolve spontaneously. However, in cases with neurological complications surgical drainage may be needed. We here, present the case of an 8-year-old boy with post meningitis subdural hygroma. 99m Tc-ethylene cysteine dimer ( 99m Tc-ECD) hybrid single photon emission tomography/computed tomography (SPECT/CT) carried out in this patient, demonstrated the subdural hygroma as well as the associated cerebral hypoperfusion. If 99m Tc-ECD SPECT/CT is integrated into management of these patients, it can help in decision making with respect to conservative versus surgical management. (author)

Optimal perioperative management of antithrombotic agents in patients with chronic subdural hematoma.

Science.gov (United States)

Amano, Toshiyuki; Takahara, Kenta; Maehara, Naoki; Shimogawa, Takafumi; Mukae, Nobutaka; Sayama, Tetsuro; Arihiro, Shoji; Arakawa, Shuji; Morioka, Takato; Haga, Sei

2016-12-01

The use of antithrombotic agents such as anticoagulants and antiplatelet agents is widespread, and the opportunities to treat patients with chronic subdural hematoma (CSDH) under antithrombotic therapy are growing. However, whether antithrombotic therapy contributes to postoperative complications and recurrences of CSDH and how these agents should be managed in the surgical treatment of CSDH remains unclear. We retrospectively analyzed 150 consecutive patients with CSDH who underwent neurosurgical interventions at Kyushu Rosai Hospital from 2011 to 2015 and followed them for more than 3 months. Of the 150 study patients, 44 received antithrombotic therapy. All anticoagulants and 76% of the antiplatelet agents were discontinued before surgical treatment of CSDH and resumed within 1 week except in 4 patients whose treatment was terminated and 7 patients who developed postoperative complications or underwent reoperations before resumption of these agents. Postoperative hemorrhagic complications associated with surgical treatment of CSDH occurred in 8 patients (5.3%), and there was no significant difference in the incidence of these complications between patients with and without antithrombotic therapy (6.8% vs. 4.7%, respectively; p=0.90). Postoperative thromboembolic complications occurred in 5 patients (5.4%), including 4 patients with antithrombotic therapy; these complications developed before resumption of antithrombotic agents in 2 patients. There was a significant difference in the incidence of postoperative thromboembolic complications between patients with and without antithrombotic therapy (9.1% vs. 0.9%, respectively; p=0.04). There were no significant differences in the incidence of radiographic deterioration or reoperation of ipsilateral or contralateral hematomas between patients with and without antithrombotic therapy after surgical treatment of unilateral CSDH. A history of antithrombotic therapy was significantly correlated with the incidence of

Incidence and prognostic significance of postoperative complications demonstrated on CT after brain tumor removal

International Nuclear Information System (INIS)

Fukamachi, Akira; Koizumi, Hidehito; Kimura, Ryoichi; Nukui, Hideaki; Kunimine, Hideo.

1987-01-01

We surveyed the computed tomographic (CT) findings in 273 patients who had undergone 301 craniotomies for brain tumors to determine the incidence and clinical outcome of the postoperative complications demonstrated on CT. The frequencies of medium-sized or large postoperative lesions were as follows: intracerebral hemorrhage, 11 % of 301 operations; subdural fluid collection, 8 %; brain edema, 6 %; extradural hemorrhage, 4 %; cerebral infarction, 3 %; ventricular enlargement, 3 %; intraventricular hemorrhage, 2 %; chronic subdural hematoma, 1 %; porencephalic cyst, 0.7 %; tension pneumocephalus, 0.7 %. In association with these complications, poor outcomes (deaths) developed with the following frequencies: intracerebral hemorrhage including an association with other types of hemorrhage, 4 % (deaths, 2 %) of 301 operations; cerebral infarction, 1 % (deaths, 0.7 %); brain edema, 0.7 % (deaths, 0.7 %); simple intraventricular hemorrhage, 0.3 % (no deaths); tension pneumocephalus, 0.3 % (no deaths). From these results, we conclude that medium-sized or large intracerebral hemorrhage, massive cerebral infarction and edema have a grave clinical significance in the postoperative course of patients with brain tumors. (author)

Intracerebral Hemorrhage

Science.gov (United States)

... Home » Patients & Families » About Stroke » Intracerebral Hemorrhage Intracerebral Hemorrhage What is a Stroke? Ischemic Stroke Intracerebral Hemorrhage Subarachnoid Hemorrhage Pediatric Stroke Warning Signs Stroke Statistics ...

A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography.

Science.gov (United States)

Inokuchi, Go; Makino, Yohsuke; Yajima, Daisuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

2016-03-01

Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.

Extramedullary plasmocytoma of the rhino pharynx associated to intrathoracic mass - a case report

International Nuclear Information System (INIS)

Souza, Andrea Silveira de; Fernandes, Artur da Rocha Correa; Yamashita, Helio Kiitiro

1996-01-01

The authors report a case of a 56-year-old while male, who had occipital headache, libido and visual acuity (bitemporal field) reduction as the clinical picture, with progressive evolution within a four years period. The image diagnosis methods (roentgenologic studies, (MRI) demonstrated extensive mass involving the sella, clivus and sphenoid sinus, and an intrathoracic mass on the right. The final diagnosis was extramedullary plasmocytoma with rhinopharynx origin. (author)

Renal Bleeding Due to Extramedullary Hematopoiesis in a Patient With Chronic Myelogenous Leukemia

OpenAIRE

Stephanie Zettner; Sandeep G. Mistry

2014-01-01

Chronic myelogenous leukemia (CML) is a myeloproliferative disorder that normally presents in middle-aged adults. Renal infiltration and extramedullary hematopoiesis in renal tissue has been rarely reported. This case report presents a patient with CML and renal insufficiency who developed gross hematuria. Efforts at controlling the hematuria led to a cascade of events propelled by the underlying disorder that ultimately led to a radical nephrectomy, multiorgan failure, and prolonged hospital...

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

Directory of Open Access Journals (Sweden)

Yan Song

2013-01-01

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

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

Adrenal extramedullary hematopoiesis associated with β-thalassemia major

Directory of Open Access Journals (Sweden)

Bijan Keikhaei

2012-01-01

Full Text Available The presence of apparently normal hematopoietic tissue outside of bone marrow cavity is defined as extramedullary hema - topoiesis (EMH. EMH is a rare complication in thalassemia major (TM and adrenal gland as well. This report describes a case of adrenal EMH in a 26-year-old man with β-TM. He has been transfused with regular blood transfusion since 9 months. During the routine physical examination he was incidentally found to have a hypoechoic mass at his abdominal ultrasonography. Abdominal computed tomography scan revealed a right well-defined suprarenal mass 7.7¥7.3¥5.8 cm in size. The diagnosis of EMH was confirmed with ultrasonographic-guided fine needle biopsy. Treatment options which include intensified regular blood transfusion and hydroxyurea have been started.

Accidental deposition of local anaesthetic in the subdural space ...

African Journals Online (AJOL)

The incidence of accidental injection of local anaesthetic into the subdural space during neuraxial blockade is rare. The presentation of unexplainable clinical signs that do not match the clinical picture of subarachnoid or intravascular injection of the local anaesthetic agent should invoke high suspicion of unintentional ...

Hypothalamo-Pituitary Dysfunction in Patients With Chronic Subdural Hematoma

Czech Academy of Sciences Publication Activity Database

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

2012-01-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

1987-12-15

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

Intracranial hypotension - a look beyond “bilateral subdural hematomas”

International Nuclear Information System (INIS)

Penev, B.

2015-01-01

Full text: The intracranial hypotension (ICH) is a disorder due to spontaneous or iatrogenic CSF leak and a low intracranial pressure. The clinical presentation is characterized by drug resistant orthostatic headache, nausea, vomiting, dizziness, neck pain and etc. The intracranial hypotension is defined as a benign disorder and the treatment is predominantly conservative. Due to this fact it is very important to differentiate this entity from subdural hematomas and hygromas which are treated surgically. Magnetic resonance imaging has revolutionized the diagnosis of ICH. Nowadays there are a lot of clinical and imaging features of this disorder. Regardless of clinical varieties and atypical forms, MRI gives enough information for the correct or probable diagnosis in the vast majority of the cases. The initial imaging resemblance with posttraumatic subdural hematomas and hygromas can result in giving the wrong diagnosis and therefore performing unneeded surgical interventions. the aim of this presentation is to discuss the contemporary criteria, algorithm and imaging features of ICH

Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma.

Science.gov (United States)

Shimizu, Kiyoharu; Sadatomo, Takashi; Hara, Takeshi; Onishi, Shumpei; Yuki, Kiyoshi; Kurisu, Kaoru

2018-05-17

The present study aimed to clarify the relationship between frailty and prognosis of patients with chronic subdural hematoma. This retrospective study involved 211 patients aged ≥65 years with chronic subdural hematoma, who underwent surgery at Higashihiroshima Medical Center, Hiroshima, Japan, between July 2011 and May 2017. The study outcome was the patient's modified Rankin Scale score at 3 months after surgery. A logistic regression analysis was carried out to analyze factors that influenced the outcome. Chronic subdural hematoma patients with frailty had a poorer prognosis than those without (median modified Rankin Scale: 4 and 2, P < 0.001; proportions of patients discharged to home: 35% and 91%, P < 0.001, respectively). After adjusting for patients' background, the patients' modified Rankin Scale scores at 3 months after surgery were found to be associated with age, controlling nutritional status score and recurrence, but not with frailty. However, receiver operating characteristic curves of the model with the Clinical Frailty Scale were more accurately correlated with prognosis than those of the model without this scale (area under the curve 0.98, 95% confidence interval 0.96-0.99; and 0.87, 95% confidence interval 0.82-0.91, respectively.) CONCLUSIONS: Chronic subdural hematoma patients with frailty had poorer prognosis than those without. The evaluation of the presence of frailty on admission can be an important factor in the prediction of the prognosis of chronic subdural hematoma patients. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

Extramedullary haematopoiesis in Thalassaemia: results of radiotherapy: a report of three patients

International Nuclear Information System (INIS)

Pistevou-Gompaki, K.; Paraskevopoulos, P.; Kotsa, K.; Skaragas, G.; Repanta, E.

1996-01-01

Extramedullary haematopoiesis is sometimes encountered in serve anaemia. Rarely, it may cause neurological symptoms, leading to spinal cord or cauda equina compression. Three patients with thalassaemia intermedia, who developed neurological complications, are described. The diagnoses were based on the clinical findings, computed tomography and magnetic resonance imaging. Small doses of radiotherapy (10-20 Gy in 5-10 fractions) relieved symptoms in all of these patients. Our experience supports the role of radiation therapy as a treatment for this complication. (Author)

Pathological Fingerprints, Systems Biology and Biomarkers of Blast Brain Injury

Science.gov (United States)

2010-06-01

changes after blast injury. J. Trauma 56, 393–403. Murthy, J.M., Chopra, J.S., and Gulati, D.R. (1979). Subdural hematoma in an adult following a blast...neuronal damage), diffuse brain injury, and subdural hemorrhage. It is still controversial whether primary blast forces directly damage the brain, and if...emboli, leading to infarction (Guy et al., 2000a; Guy et al., 2000b). The most common types of TBI are diffuse axonal injury, contusion, and subdural

Iatrogenic Spinal Subdural Hematoma due to Apixaban: A Case Report and Review of the Literature

Directory of Open Access Journals (Sweden)

Alba Colell

2018-01-01

Full Text Available In the last decade, the clinical relevance for developing safer oral anticoagulants prompted the development of new classes of drugs that have shown a lower risk of life-threatening bleeding events as compared to standard warfarin. Nontraumatic spinal subdural hematoma is an uncommon urgent complication that can be associated with the use of these agents. An unusual case of spinal subdural hematoma related to apixaban treatment for nonrheumatic atrial fibrillation is reported here.

Extramedullary hematopoiesis: A report of two cases.

Science.gov (United States)

Zhang, Huan-Zhu; Li, Ying; Liu, Xin; Chen, Bao-Rong; Yao, Guo-Hua; Peng, Yu-Na

2016-12-01

Extramedullary hematopoiesis (EMH) is defined as hematopoiesis occurring in organs outside of the bone marrow. The present report describes two cases of thalassemic patients with paraspinal medullary hematopoiesis and analyzes the clinical manifestations, imaging, pathology, diagnosis and treatment of EMH. In addition, a supplementary review of previously published cases is provided along with a review of the related literature. Computed tomography (CT) of the first case revealed multiple paraspinal masses, and the largest was 6.2×8.0 cm in diameter. Likewise, CT of the second patient revealed multiple paraspinal masses in the bottom of the left thoracic cavity, and the largest was measured 10.1×10.5 cm. The two cases underwent surgical biopsy and the findings were compatible with a diagnosis of EMH. In conclusion, EMH is a compatible and rare disease, and should be distinguished from other neoplasms. EMH must considered when masses with characteristic radiologic appearance are detected in patients with thalassemia intermedia.

Management of Chronic Subdural Haematoma in a Case of ...

African Journals Online (AJOL)

and multilobate forms. CT scan of the brain showed a hypodense lesion at left posterior parietal and occipital region suggestive of chronic subdural haematoma with significant mass affect with effacement of ipsilateral ventricles [Figure 1]. She was given two units of platelet rich plasma (PRP) and three units of single donor.

Surgery for chronic subdural hematoma in nonagenarians

DEFF Research Database (Denmark)

Bartek, J; Sjåvik, K; Ståhl, F

2017-01-01

OBJECTIVE: Chronic subdural hematoma (cSDH) is a prevalent condition often seen in the elderly, with surgery being the treatment of choice when symptomatic. So far, few have explored the surgical outcomes in patients 90 years or older. The aim of this study was to investigate outcome after c...... neurosurgical centers. In a comparative analysis, the primary end-point was difference in hematoma recurrence rates between the ≥90 y/o and

Daunorubicin, Cytarabine, and Cladribine Regimen Plus Radiotherapy and Donor Lymphocyte Infusion for Extramedullary Relapse of Acute Myeloid Leukemia after Hematopoietic Stem Cell Transplantation

Directory of Open Access Journals (Sweden)

Marco Sanna

2013-01-01

Full Text Available Myeloid sarcoma is a rare tumor consisting of myeloid blasts that involve anatomic sites outside the bone marrow. Fatal prognosis is inevitable in patients with extramedullary relapse after hematopoietic stem cell transplantation (HSCT, and no standard treatments are available yet. We report the first case of extramedullary relapse after HSCT treated with a combination of daunorubicin, cytarabine, and cladribine (DAC regimen plus radiotherapy and donor lymphocyte infusion (DLI. This treatment induced a new and durable remission in our patient. The favorable toxicity profile and the reduced cost make this combination worthy of further investigations.

Extramedullary spinal teratoma presenting with recurrent aseptic meningitis.

Science.gov (United States)

Mpayo, Lucy L; Liu, Xiao-Hong; Xu, Man; Wang, Kai; Wang, Jiao; Yang, Li

2014-06-01

Spinal teratomas are extremely rare; they constitute meningitis. A 7-year-old boy presented with paroxysmal abdominal pain and a history of recurrent aseptic meningitis. Kernig and Brudzinski signs were present. Lumber puncture revealed pleocytosis with no evidence of bacteria growth. Imaging of the spine revealed a cystic lesion in spinal cord at thoracic level 9-11. Endoscopic excision of the cyst was successfully performed. Surgical and histopathological findings confirmed extramedullary matured teratoma. As the symptomatic attacks of spontaneous rupture of spinal teratoma resemble presentations of Mollaret meningitis, spinal teratoma should be considered in the differential diagnosis of Mollaret meningitis. We describe a rare example of spinal teratoma causing recurrent meningitis. Spine imaging should be considered in individuals with recurrent aseptic meningitis as this promotes earlier diagnosis, more appropriate treatment, and improved neurological outcome. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Carlos Fernando Lozano-Tangua

2009-01-01

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

The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma.

Science.gov (United States)

Santarius, Thomas; Qureshi, Hammad U; Sivakumaran, Ram; Kirkpatrick, Peter J; Kirollos, Ramez W; Hutchinson, Peter J

2010-06-01

A considerable body of evidence supporting the use of external drainage after evacuation of primary chronic subdural hematoma (CSDH) exists in the literature. However, no systematic study of the value of postoperative drainage in the treatment of recurrent CSDH has been published. The aim of the study was to investigate external drains and subdural-to-peritoneal conduit in the treatment of recurrent CSDH. A retrospective review of cases of CSDH treated in our institution between October 2002 and October 2006 was conducted. During the study period, 408 patients had burr hole evacuation. Sixty-four patients (15.9%) had treatment for recurrence. One patient had craniotomy, and the remaining 63 had another burr hole evacuation: 36 without placement of a drain (BHO), 14 with external drainage (SED), and 13 with placement of subdural-peritoneal catheter (SPC). Fifteen patients (24%) developed a secondary recurrence requiring a third drainage procedure. Postoperative drainage (SED or SPC) was associated with a significantly lower secondary recurrence rate when compared to BHO: 3/27 (11%) versus 12/36 (33%) (χ(2), P=.040). There was no significant difference in recurrence rates between SED and SPC. Postoperative complications included acute subdural hematoma (2), subdural empyema (2), brain edema (2), pneumonia (3), and in-hospital death (2). None of the complications was associated with the use of a specific technique. The results indicate that, as in the treatment of primary CSDHs, the use of drain (SED or SPC) with burr hole evacuation is safe and is associated with lower recurrence rate. Further investigation is needed to clarify the indications of currently available surgical techniques in the treatment of recurrent CSDH. Copyright © 2010 Elsevier Inc. All rights reserved.

Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study.

Science.gov (United States)

Kayaci, Selim; Kanat, Ayhan; Koksal, Vaner; Ozdemir, Bulent

2014-01-01

The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p subdural effusion and pneumocephalus, and shorter hospital stays.

Delayed intracranial subdural empyema following burr hole drainage: Case series and literature review.

Science.gov (United States)

Kim, You-Sub; Joo, Sung-Pil; Song, Dong-Jun; Kim, Sung-Hyun; Kim, Tae-Sun

2018-05-01

A subdural empyema (SDE) following burr hole drainage of a chronic subdural hematoma (CSDH) can be difficult to distinguish from a recurrence of the CSDH, especially when imaging data is limited to a computed tomography (CT) scan. All patients underwent burr hole drainage of the CSDH at first, and the appearance of the SDE occurred within one month. A contrast-enhanced magnetic resonance imaging (MRI) scan, with diffusion-weighted imaging (DWI), revealed both the SDE and diffuse meningitis in all patients. In Case 1, because the patient was very young, burr hole drainage of the SDE, rather than craniotomy, was performed. However, subsequent craniotomy was required due to recurrence of the SDE. In Cases 2 and 3, an initial craniotomy was performed without burr hole drainage. Symptoms improved for all patients, and each was discharged without any neurologic deficits or subsequent recurrence. Neurosurgeons should consider the possibility of infection if recurrence of CSDH occurs within 1 month following drainage of a subdural hematoma. A contrast-enhanced MRI with DWI should be performed to differentiate SDE from CSDH. In addition, surgical evacuation of the empyema via wide craniotomy is preferred to burr hole drainage.

Cortical gluing and Ringer lactate solution inflation to avoid cortical mantle collapse and subdural fluid collections in pediatric neurosurgery: safety and feasibility.

Science.gov (United States)

Mirone, Giuseppe; Ruggiero, Claudio; Spennato, Pietro; Aliberti, Ferdinando; Trischitta, Vincenzo; Cinalli, Giuseppe

2015-06-01

Subdural fluid collections following intraventricular and/or paraventricular procedures in pediatric neurosurgery are common and can be hard to treat. We describe our technique to close cortical defects by the aid of a fibrin adhesive and subsequent Ringer inflation with the aim to avoid cortical mantle collapse and to prevent the development of subdural fluid collections. We report the preliminary results of a prospective study on a consecutive series of 29 children who underwent 37 transcortical or transcallosal surgical procedures since 2008 in our department. In 17 procedures, we performed a transcortical approach on lesions, and in other 19 operations, we operated by a transcallosal. In 5/17 transcortical approaches (29%) and in 3/20 transcallosal approaches (15%), we observed a 5-mm-thick subdural fluid collection of the 5 patients with subdural fluid collections in the transcortical group, 3 patients (17%) underwent surgery for symptomatic or progressive subdural fluid collections. Of the 3 patients in the transcallosal group, a subduro-peritoneal shunt was necessary only for 1 patient (5%). At the very end of the treatment (including chemotherapy and radiotherapy), it was possible to remove the subduro-peritoneal shunt in all these patients because of disappearance of the subdural fluid collections. In pediatric patients after transcortical or transcallosal procedures, the use of a fibrin adhesive to seal surgical opening and subsequent inflation of the residual cavity with Ringer lactate solution to avoid cortical mantle collapse seems safe and appears to prevent the development of subdural fluid collections.

Cord Compression due to Extramedullary Hematopoiesis in an Adolescent with Known Beta Thalassemia Major

OpenAIRE

Soman, Salil; Rosenfeld, David L; Roychowdhury, Sudipta; Drachtman, Richard A; Cohler, Alan

2009-01-01

We describe a 16 year-old male with ß thalassemia major and gait disturbances that had not been given blood transfusions due to a severe childhood transfusion reaction. Thoracic spine MRI demonstrated hematopoietic marrow throughout the spine and epidural masses causing cord compression consistent with extramedullary hematopoiesis (EMH). After treatment with steroids, radiotherapy and monitored blood transfusions, the patient demonstrated significant improvement of his paraspinal lesions a...

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

International Nuclear Information System (INIS)

Clar, H.E.; Bock, W.J.; Wiechert, H.C.

1978-01-01

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

Rapid spontaneous resolution of acute subdural haematoma in a patient with chronic alcoholism.

Science.gov (United States)

Hadjigeorgiou, Georgios; Chamilos, Christos; Petsanas, Adamantios; Vranos, Georgios; Foteas, Pavlos; Spiridakis, Filokypros

2012-06-01

Acute subdural haematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery. There are only several reports that show the rapid disappearance of ASDH without surgical intervention. We report a case of a 64-year-old alcoholic man who had a traumatic subdural haematoma after a fall from a height of about eight meters on level ground. The computed tomography (CT) of the brain on admission demonstrated a left parietooccipital ASDH. A follow-up CT scan after 8 hours showed resolution of the hematoma. The patient was discharged 9 days later with no neurological deficit. We discuss the possible mechanisms of the rapid resolution of the ASDH.

The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: a case series.

Science.gov (United States)

McClelland, S; Mackey, S J; Kim, S S

2014-01-01

In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.

Subdural Hematoma in Grave’s Disease Induced Thrombocytopenia.

OpenAIRE

Kumar, S; Diwan, S; Chandek, S; Nitey, PO; Kakani, A

2013-01-01

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

Intra- and Extramedullary Dumbbell-Shaped Schwannoma of the Medulla Oblongata: A Case Report and Review of the Literature.

Science.gov (United States)

Zhang, Qing; Ni, Ming; Liu, Wei-Ming; Jia, Wang; Jia, Gui-Jun; Zhang, Jun-Ting

2017-02-01

Brainstem intramedullary schwannomas (ISs) are extremely rare. Various theories have been suggested to explain its origin. It was first speculated that ISs arise from the region where the nerve roots lose their sheaths on penetrating the pia mater. Later, it was further predicted that ISs would contain both intra- and extramedullary parts and would be shaped like a dumbbell. However, no cases reported previously can support this assumption adequately. A 40-year-old woman presented with constant cervical pain, accompanied by progressive weakness of upper extremities and glove distribution numbness. Magnetic resonance imaging of the brain revealed a rare intra- and extramedullary dumbbell-shaped lesion of the medulla oblongata, which was partially removed via a midline suboccipital craniectomy. Histologic and immunohistochemical examinations confirmed the diagnosis of schwannoma. Routine imaging performed 20 months after the initial resection revealed a regrowth of the intramedullary part, which was subsequently partially removed through a far-lateral approach, with symptoms alleviated. At 2-year follow-up, there continued to be no radiologic or clinical evidence of regrowth. To date and to our knowledge, there are only 16 reported cases of brainstem ISs, none of which contained both intra- and extramedullary components. We believe this is the first report of dumbbell schwannoma of the medulla oblongata with adequate radiologic evidence. The relevant literature is reviewed, and an assumption has been proposed that dumbbell or surfacing ISs arising near entry zones of sensory nerves, mixed cranial nerves, or ventral root may originate from the aberrant Schwann cells. Copyright © 2016 Elsevier Inc. All rights reserved.

The Swedish study of Irrigation-fluid temperature in the evacuation of Chronic subdural hematoma (SIC!)

DEFF Research Database (Denmark)

Bartley, Andreas; Jakola, Asgeir S; Bartek, Jiri

2017-01-01

BACKGROUND: Chronic subdural hematoma (cSDH) is one of the most common conditions encountered in neurosurgical practice. Recurrence, observed in 5-30% of patients, is a major clinical problem. The temperature of the irrigation fluid used during evacuation of the hematoma might theoretically...... and health-related quality of life. DISCUSSION: Irrigation-fluid temperature might influence recurrence rates in the evacuation of chronic subdural hematomas. We present a study protocol for a multicenter randomized controlled trial investigating our hypothesis that irrigation fluid at body temperature...

Intracranial involvement in extramedullary hematopoiesis: case report and review of the literature

Energy Technology Data Exchange (ETDEWEB)

Haidar, Salwa; Ortiz-Neira, Clara; Shroff, Manohar; Gilday, David; Blaser, Susan [Hospital for Sick Children, Department of Diagnostic Imaging, Toronto, ON (Canada)

2005-06-01

Intracranial involvement in extramedullary hematopoiesis (EMH) is rare, but it should be suspected in patients with myelofibrosis presenting with chronic severe headache. We present a 9-year-old girl with known myelofibrosis whose headaches were unresponsive to routine treatment. CT and MRI studies of the brain showed diffuse pachymeningeal thickening. CT examinations of the chest and abdomen had demonstrated bilateral thoracic paraspinal masses caused by EMH, suggesting the possibility that the intracranial involvement might also be related to EMH. The diagnosis was confirmed by sulfur colloid isotope scan. (orig.)

Intracranial involvement in extramedullary hematopoiesis: case report and review of the literature

International Nuclear Information System (INIS)

Haidar, Salwa; Ortiz-Neira, Clara; Shroff, Manohar; Gilday, David; Blaser, Susan

2005-01-01

Intracranial involvement in extramedullary hematopoiesis (EMH) is rare, but it should be suspected in patients with myelofibrosis presenting with chronic severe headache. We present a 9-year-old girl with known myelofibrosis whose headaches were unresponsive to routine treatment. CT and MRI studies of the brain showed diffuse pachymeningeal thickening. CT examinations of the chest and abdomen had demonstrated bilateral thoracic paraspinal masses caused by EMH, suggesting the possibility that the intracranial involvement might also be related to EMH. The diagnosis was confirmed by sulfur colloid isotope scan. (orig.)

Intracranial extramedullary hematopoiesis in patients with thalassemia: a case report and review of the literature.

Science.gov (United States)

Eskazan, Ahmet Emre; Ar, Muhlis Cem; Baslar, Zafer

2012-08-01

Extramedullary hematopoiesis (EH) is a compensatory phenomenon that results in the production of blood cell precursors outside the marrow in patients with chronic hemolytic anemia and ineffective erythropoiesis. EH usually involves the liver, spleen, and lymph nodes. It can also be found at paravertebral, intrathoracic, or pelvic locations. Intracranial EH is a rare entity and often asymptomatic but can sometimes lead to symptomatic tumor-like masses. Treatment options are controversial and include hypertransfusion, surgical excision, radiotherapy, and hydroxyurea (HU). Successful treatment of an intracranial EH mass with HU and blood transfusions in a beta-thalassemia major patient was discussed along with a review of the published literature on intracranial EH in thalassemia. In our patient, the extramedullary hematopoietic mass in the interhemispheric fissure showed a marked improvement after 6 months of HU and hypertransfusion therapy. In the English literature, there are a few cases with intracranial EH and thalassemia, which were treated with different treatment modalities, with different outcomes. There is no standard treatment approach in patients with symptomatic EH. HU with hypertransfusion regimen is a reasonable first-choice modality in treating intracranial EH masses. © 2012 American Association of Blood Banks.

Hematopoietic stem cell transplantation for isolated extramedullary relapse of acute lymphoblastic leukemia in children.

Science.gov (United States)

Gabelli, Maria; Zecca, Marco; Messina, Chiara; Carraro, Elisa; Buldini, Barbara; Rovelli, Attilio Maria; Fagioli, Franca; Bertaina, Alice; Lanino, Edoardo; Favre, Claudio; Rabusin, Marco; Prete, Arcangelo; Ripaldi, Mimmo; Barberi, Walter; Porta, Fulvio; Caniglia, Maurizio; Santarone, Stella; D'Angelo, Paolo; Basso, Giuseppe; Locatelli, Franco

2018-06-13

Relapse of acute lymphoblastic leukemia (ALL) may occur in extramedullary sites, mainly central nervous system (CNS) and testis. Optimal post-remissional treatment for isolated extramedullary relapse (IEMR) is still controversial. We collected data of children treated with hematopoietic stem cell transplantation (HSCT) for ALL IEMR from 1990 to 2015 in Italy. Among 281 patients, 167 had a relapse confined to CNS, 73 to testis, 14 to mediastinum, and 27 to other organs. Ninety-seven patients underwent autologous HSCT, 79 received allogeneic HSCT from a matched family donor, 75 from a matched unrelated donor, and 30 from an HLA-haploidentical donor. The 10-year overall survival was 56% and was not influenced by gender, ALL blast immune-phenotype, age, site of relapse, duration of first remission, and type of HSCT. In multivariable analysis, the only prognostic factors were disease status at HSCT and year of transplantation. Patients transplanted in third or subsequent complete remission (CR) had a risk of death 2.3 times greater than those in CR2. Children treated after 2000 had half the risk of death than those treated before that year. Our results suggest that both autologous and allogeneic HSCT may be considered for the treatment of pediatric ALL IEMR after the achievement of CR2.

A Rare Presentation of Extramedullary Hematopoiesis in Post-polycythemic Myelofibrosis.

Science.gov (United States)

Konca Degertekin, Ceyla; Ozkurt, Zübeyde Nur; Akyürek, Nalan; Yağcı, Münci

2014-09-01

Polycythemia vera is a clonal proliferative disorder of the bone marrow that could possibly evolve into myelofibrosis in its natural course. Progression to myelofibrosis is usually a late stage complication and presents clinically with refractory cytopenias and extramedullary hematopoiesis (EMH). EMH can occur in any tissue during the course of post-polycythemic myelofibrosis. However, skin and cardiac involvements seems to be very rare. We present a 56-year-old woman with post-polycythemic myelofibrosis refractory to treatment, developing EMH after splenectomy in various organs, exceptionally the skin and the heart. Along with the case, the clinical presentations, treatment options, prognostic significance of EMH and the role of cytogenetics is discussed in the light of the literature.

Computed tomography in epidural abscess, subdural empyema, meningitis, and brain abscess

International Nuclear Information System (INIS)

Schadel, A.; Boettcher, H.D.; Haverkamp, U.; Wagner, W.; Schmilowski, G.M.; Muenster Univ.

1983-01-01

Computerised tomography cannot be of great help in diagnosing meningitis. Examination of the cerebrospinal fluid remains essential. After the inflammation of the meninges has progressed to some stage of encephalitis, the formation of an abscess can be located via computed tomography. It is characterised by the ring-type abscess capsule. Computed tomography for diagnostic purposes is superior to cerebral scanning, which demonstrates enhanced activity, but does not show the formation of a membrane, so essential for differential diagnosis. Furthermore, computed tomography shows the adjacent anatomical structures and answers the questions of displacements and threatening invasion of the ventricle system. Epidural and subdural abscesses can also be located by computed tomography. Therapy can begin directly after computerised tomography, whereas in scintigraphy only a non-specific enhanced activity is present, which often does not allow differentiation between epidural and subdural location. (orig.) [de

Encapsulated subdural empyema. A case report with special reference to CT findings and operative indications

Energy Technology Data Exchange (ETDEWEB)

Tokunaga, Yoshiharu; Inoue, Masaru; Ishizaka, Hiroaki; Koga, Hiroaki; Kawano, Teruaki; Mori, Kazuo

1985-04-01

A case of encapsulated subdural empyema was reported. This 1.5-year-old boy was admitted with the increasing confusion and convulsion. Eight months prior to admission, he had craniotomy for traumatic acute epidural hematoma on the left side. Following a coagulation of the middle meningeal artery which was the bleeding source, the dura was opened but no cortical damage was noted at that time. The computed tomographic (CT) scan on admission revealed a large subdural collection with a thin enhancing rim on the left side. Emergency craniotomy revealed a collection of subdural pus, which was irrigated and a catheter was put for continuous drainage. Postoperatively, the patient did well, however, following removal of the catheter, three weeks after the first operation, the subdural empyema was reexpanded with a very thick enhancing rim on CT scan. Ultrasonography also clearly demonstrated the formation of the thick membranes. The large craniotomy was performed and empyema with the outer and inner memberanes of 8mm thick was totally excised. Post-operative CT scan did not show any enhancing rim, indicating that enchancement was caused by newly formed vessels within the membranes per se. This findings are totally different from those observed in the brain abscess in which ring enhancement on CT continues months to years following so-called extracapsular excision of abscess. In the brain abscess, surrounding glial tissue with plenty neovascularization is left intact, even after the operation. (author).

A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a Pourfour du Petit syndrome and review of the literature.

Science.gov (United States)

Balik, Vladimir; Kolembus, Petr; Svajdler, Marian; Sulla, Igor; Vaverka, Miroslav; Hrabalek, Lumir

2013-07-01

This report illustrates the rare rapid spontaneous redistribution of an acute intracranial supratentorial subdural hematoma (AISSDH) to the entire spinal subdural space (SSS). The study is also unique in that the spinal subdural hematoma (SSH) manifested by the extremely rare Pourfour du Petit Syndrome (PPS). A 66-year-old man sustained blunt head trauma. On admission to the regional hospital, he scored 6 on GCS and his pupils were of equal size reacting to light. Initial computed tomography (CT) scan showed a unilateral AISSDH. The patient was referred to our department and arrived 16 h following the accident, at which time a repeat CT scan revealed almost complete resolution of the AISSDH without clinical improvement. On the 9th postinjury day transient anisocoria and tachycardia without spinal symptomatology developed. Since neither neurological examination nor follow-up CT scans showed intracranial pathology explaining the anisocoria, the patient was treated further conservatively. During the next 3 days circulatory instability developed and the patient succumbed to primary traumatic injury. Autopsy revealed a SSH occupying the entire SSS. This case calls attention to the unique combination of the displacement of an AISSDH to the SSS and the presentation of this clinical entity by the PPS. Copyright © 2012 Elsevier B.V. All rights reserved.

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

Energy Technology Data Exchange (ETDEWEB)

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

2000-10-01

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

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

International Nuclear Information System (INIS)

Tsui, Edmund Yik Kong.; Fai Ma, Ka; Cheung, Yu Keung; Chan, Jimmy Hon Mo; Yuen, Ming Keung

2000-01-01

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

Extramedullary hematopoiesis: a rare occurrence in the sinonasal tract.

Science.gov (United States)

Bizzoni, Andrea; Lombardi, Davide; Maroldi, Roberto; Incardona, Paolo; Nicolai, Piero

2010-04-01

Extramedullary hematopoiesis (EMH) is a systemic reaction to inadequate hematopoiesis. We report two exceedingly rare cases of EMH involving the paranasal sinuses. The first patient, a 30-year-old man, presented with a maxillary sinus mass. The lesion was excised by endoscopic surgery: definitive histology identified foci of EMH within an inflammatory fibromyxoid pseudotumor. The second case occurred in a 29-year-old man affected by intermediate beta-thalassemia. He was hospitalized with a diagnosis of sphenoid sinus mucocele secondary to an ethmoid lesion. The patient underwent endoscopic excision of the mass and drainage of the sphenoid mucocele. At definitive histology, a diagnosis of EMH was established. Herein, the presenting modalities, imaging profile, and treatment options of this rare EMH localization are reviewed. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Subdural Hematoma in Grave’s Disease Induced Thrombocytopenia.

Directory of Open Access Journals (Sweden)

Sunil Kumar

2013-01-01

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

Spinal Subdural Staphylococcus Aureus Abscess: case report and review of the literature

Directory of Open Access Journals (Sweden)

Fligou Fotini

2009-08-01

Full Text Available Abstract Background Only 65 cases (including our case of spinal subdural abscesses have been reported to the literature, mostly to the lumbar spine. Staphylococcus aureus is the most common bacterial. The symptoms are not caracteristic and contrast – enhanced magnetic resonance imaging scan (MRI is the imaging method of choice. The early diagnosis is crucial for the prognosis of the patient. Case presentation We present a patient 75 years old who had a history of diabetes and suffered acute low back pain in the region of the lumbar spine for the last 4 days before his admission to the hospital. He also experienced lower leg weakness, fever and neck stiffness. After having a brain CT scan and a lumbar puncture the patient hospitalized with the diagnosis of meningitis. Five days after his admission the diagnosis of subdural abscess secured with contrast – enhanced MRI but meanwhile the condition of the patient impaired with respiratory failure and quadriplegia and he was admitted to the ICU. A laminectomy was performed eight days after his admission into the hospital but unfortunately the patient died. Conclusion Early diagnosis and treatment are very important for the good outcome in patients with subdural abscess. Although morbidity and mortality are very high, surgical and antibiotic treatment should be established as soon as possible after the diagnosis has secured.

[A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

Science.gov (United States)

Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

2016-06-01

A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events.

Splinter hemorrhages

Science.gov (United States)

Fingernail hemorrhage ... Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth. They are named splinter hemorrhages because they look like a splinter under the ...

Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study).

Science.gov (United States)

Chih, Adrian Ng Wei; Hieng, Albert Wong Sii; Rahman, Noor Azman A; Abdullah, Jafri Malin

2017-03-01

Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, post-operative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.

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

Energy Technology Data Exchange (ETDEWEB)

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

1994-11-01

Epidural und subdural spinal hematomas were previously diagnosed by myelography and computed tomography (CT). Recent reports indicate that noninvasive detection is possible with magnetic resonance imaging. We report on nine patients who were investigated by magnetic resonance imaging (MR) prior to surgery for epidural and subdural spinal hematoma. The MR examinations were performed on 1.5-T and 1-T units. We used surface coils and employed T1-, PD- and T2-weighted spin echo sequences and a T2*-weighted gradient echo sequence. CT was available in four patients and myelography in two patients. Surgical correlation was available in all patients. The hematomas were located in the cervical spine (n=2), thoracic spine (n=6) and lumbar spine (n=2). They were epidural in five patients and subdural in four. Blinded reading correctly indentified all five epidural hematomas and three of the subdural hematomas; one subdural hematoma was misjudged as epidural. Peracute hematomas (<24 h) in three patients appeared isointense or slightly hyperintense on T1-weighted images and had mixed signal intensity on T2- and T2*-weighted images. Acute hematomas (1-3 days) in four patients were also isointense on T1-weighted images but were more hypointense on T2- and T2*-weighted images. Chronic heamatomas in two patients (7 days and 14 days) were hyperintense on all sequences. Differentiation between epi- and subdural hematomas required transverse T2*-weighted gradient echo sequences. Our results underline that MRI at 1 and 1.5 T is capable of identifying epidural and subdural spinal hematoma in the acute and peracute stage. MRI is superior to CT and myelography for the delineation of the craniocaudal extension in epidural and subdural spinal hematomas and should be the primary preoperative diagnostic method. (orig.) [Deutsch] Epidurale und subdurale spinale Haematome sind neurochirurgische Notfaelle, deren Diagnose bisher vorwiegend mittels Myelographie und Computertomographie gestellt

[Subdural empyema due to gemella morbillorum as a complication of acute sinusitis].

Science.gov (United States)

Boto, Leonor Reis; Calado, Cláudia; Vieira, Marisa; Camilo, Cristina; Abecasis, Francisco; Campos, Alexandre R; Correia, Manuela

2011-01-01

Subdural empyema is a life-threatening infection that may complicate acute sinusitis. The authors report the case of a previously healthy 10 year-old girl who presented with subdural empyema due to Gemella morbillorum after an untreated maxillary, ethmoidal and esphenoidal sinusitis. Despite immediate drainage of the empyema and underlying primary infection and treatment with broad spectrum antibiotics, she later developed frontal cerebritis and refractory intracranial hypertension, needing urgent decompressive craniectomy. She recovered gradually, maintaining to date slight right hemyparesis and aphasia. Even though it is considered a low virulence organism, G. morbillorum has been increasingly described in central nervous system infection. In this case, the prompt institution of broad spectrum antibiotics and surgical drainage, as well as the agressive treatment of complications, including decompressive craniectomy, were crucial to the patient's recovery.

Intra-extramedullary drainage as an effective option for treatment of intramedullary ependymal cyst of thoracic spine: technical note.

Science.gov (United States)

Landi, Alessandro; Pietrantonio, Andrea; Marotta, Nicola; Mancarella, Cristina; Delfini, Roberto

2014-03-01

Intramedullary neuroepithelial cysts are extremely rare and only 15 cases have been reported in the literature. Clinico-radiological features are not indicative of a specific diagnosis; for this reason, diagnosis is based mainly on the histological features. In the literature, total surgical removal is considered the treatment of choice. The risk of recurrence is higher after partial removal and in cases of occlusion of intra-extramedullary shunt. For this reason, a surgical strategy that ensures the shunt patency in case of incomplete removal of the cyst becomes a very safe option for treatment of this pathology. We report the case of a 51-year-old woman who was found to have a dorsal (D9) intramedullary neuroepithelial cyst. She underwent surgical treatment with partial removal and placement of a Nelaton drainage device (8 French) inside the intra-extramedullary shunt. The patient experienced a complete regression of preoperative symptoms and magnetic resonance imaging (MRI) follow-up showed no radiological evidence of recurrence 24 months after surgical treatment. Spinal ependymal cysts show a high frequency of recurrence, especially in cases of partial removal of the cyst wall. Unfortunately, the cyst walls are often closely adherent to the spinal cord, making total removal impossible. Intra-extramedullary shunting is a viable option, although there is a high frequency of recurrence in cases of obstruction of the shunt. Placing an 8 Ch Nelaton drain between the dorsal columns is a reliable technique, especially in cases of partial removal. In fact, it allows continuous drainage of cyst fluid and subsequent resolution of symptoms, and it decreases the incidence of recurrences due to obstruction of the shunt. Georg Thieme Verlag KG Stuttgart · New York.

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

DEFF Research Database (Denmark)

Byard, Roger W; Blumbergs, Peter; Rutty, Guy

2013-01-01

It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to ...

Ischaemic colitis and lung infiltrates caused by extramedullary haematopoiesis in a patient with an acute erythroid leukaemia following polycythaemia vera

NARCIS (Netherlands)

Brada, SJL; de Wolf, JTM; Poppema, S; Vellenga, E

A patient with 'spent' polycythaemia vera showed extensive extramedullary haematopoiesis (EMH) in non-haematopoietic tissue clinically resulting in an ischaemic colitis and respiratory symptoms due to lung infiltrates. On laboratory investigation, the EMH also included immature erythroblasts due to

Paraplegia due to extramedullary hematopoiesis in thalassemia treated successfully with radiation therapy.

Science.gov (United States)

Malik, Monica; Pillai, Lakshmi S; Gogia, Nidhi; Puri, Tarun; Mahapatra, M; Sharma, Daya Nand; Kumar, Rajat

2007-03-01

Spinal cord compression due to extramedullary hematopoiesis (EMH) is a rare complication of thalassemia and generally presents as paraparesis with sensory impairment. Complete paraplegia is extremely rare in EMH due to thalassemia although it is known to occur in polycythemia vera and sickle cell anemia. Treatment options mostly include surgery and/or radiotherapy. Whereas cases presenting with paraparesis have been treated with either surgery or radiotherapy with equal frequency and efficacy, almost all reported cases with paraplegia have been treated with surgery with or without radiation therapy. We hereby report a case of thalassemia intermedia with paraplegia treated successfully with radiotherapy.

Occurrence of subdural hematomas in Dutch glutaric aciduria type 1 patients

NARCIS (Netherlands)

Vester, Marloes E M; Visser, Gepke; Wijburg, Frits A.; van Spronsen, Francjan J.; Williams, Monique; van Rijn, Rick R.

2016-01-01

Patients with glutaric aciduria type 1 (GA1), a rare inherited metabolic disorder, have an increased risk for subdural hematomas (SDHs). GA1 is therefore generally included in the differential diagnosis of children presenting with SDHs. This retrospective cohort study reviews all 25 registered, in

Occurrence of subdural hematomas in Dutch glutaric aciduria type 1 patients

NARCIS (Netherlands)

Vester, Marloes E. M.; Visser, Gepke; Wijburg, Frits A.; van Spronsen, Francjan J.; Williams, Monique; van Rijn, Rick R.

Patients with glutaric aciduria type 1 (GA1), a rare inherited metabolic disorder, have an increased risk for subdural hematomas (SDHs). GA1 is therefore generally included in the differential diagnosis of children presenting with SDHs. This retrospective cohort study reviews all 25 registered, in

Occurrence of subdural hematomas in Dutch glutaric aciduria type 1 patients

NARCIS (Netherlands)

Vester, M.E.M. (Marloes E.M.); G. Visser (G.); F.A. Wijburg (Frits); F.J. van Spronsen; M. Williams (Martine); R.R. van Rijn (Rick)

2016-01-01

textabstractPatients with glutaric aciduria type 1 (GA1), a rare inherited metabolic disorder, have an increased risk for subdural hematomas (SDHs). GA1 is therefore generally included in the differential diagnosis of children presenting with SDHs. This retrospective cohort study reviews all 25

Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.

Science.gov (United States)

Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J

2012-10-01

A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition.

Spinal cord compression secondary to extramedullary hematopoiesis: A rareness in a young adult with thalassemia major.

Science.gov (United States)

Fareed, Shehab; Soliman, Ashraf T; De Sanctis, Vincenzo; Kohla, Samah; Soliman, Dina; Khirfan, Diala; Tambuerello, Adriana; Talaat, Mohamed; Nashwan, Abdulqadir; Caparrotti, Palmira; Yassin, Mohamed A

2017-08-23

We report a case of a thalassemia major male patient with back pain associated to severe weakness in lower extremities resulting in the ability to ambulate only with assistance. An urgent magnetic resonance imaging (MRI) of  thoracic and lumbosacral spine was requested. A posterior intraspinal extradural mass lesion compressing the spinal cord at the level of thoracic T5-8 was present, suggesting an extramedullary hematopoietic centre, compressing the spinal cord. He was treated successfully with thalassemia major alone. The patient was treated with blood transfusion, dexamethasone, morphine and paracetamol, followed by radiotherapy in 10 fractions to the spine (daily fraction of 2Gy from T3 to T9, total dose 20 Gy). His pain and neurologic examination quickly improved. A new MRI of the spine, one week after radiotherapy, showed an improvement of the extramedullary hematopoietic mass compression. In conclusion, EMH should be considered in every patient with ineffective erythropoiesis and spinal cord symptoms. MRI is the most effective method of demonstrating EMH. The rapid recognition and treatment can dramatically alleviate symptoms. There is still considerable controversy regarding indications, benefits, and risks of each of modality of treatment due to the infrequency of this disorder.

Incidence, clinical features, laboratory findings and outcome of patients with multiple myeloma presenting with extramedullary relapse.

Science.gov (United States)

Papanikolaou, Xenofon; Repousis, Panagiotis; Tzenou, Tatiana; Maltezas, Dimitris; Kotsopoulou, Maria; Megalakaki, Katerina; Angelopoulou, Maria; Dimitrakoloulou, Elektra; Koulieris, Efstathios; Bartzis, Vassiliki; Pangalis, Gerasimos; Panayotidis, Panagiotis; Kyrtsonis, Marie-Christine

2013-07-01

Extramedullary plasmacytomas constitute a rare and not well studied subset of multiple myeloma (MM) relapses. We report the incidence, clinical-laboratory features and outcome of patients with MM and extramedullary relapse (ExMeR). A total of 303 patients with symptomatic MM were recorded in a 13-year period in two institutions. Twenty-eight cases of ExMeR (9%) were recorded. There was an increased frequency of elevated lactate dehydrogenase (LDH) (p = 0.026), bone plasmacytomas (p = 0.001) and fractures (p = 0.002) at diagnosis, in patients with ExMeR compared to the others. ExMeR was associated with an ominous outcome, high LDH, constitutional symptoms and a statistically significant decrease of monoclonal paraprotein compared to levels at diagnosis (p = 0.009). Prior treatment with bortezomib was associated with a decreased hazard of ExMeR (p = 0.041). Overall survival (OS) was decreased in patients with ExMeR compared to the others (38 vs. 59 months, p = 0.006). Patients with MM with ExMeR have a lower OS and their clinical and laboratory features differ from those without.

Predictors for Recurrence of Chronic Subdural Hematoma.

Science.gov (United States)

Hammer, Alexander; Tregubow, Alexander; Kerry, Ghassan; Schrey, Michael; Hammer, Christian; Steiner, Hans-Herbert

2017-01-01

This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment. Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH. In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037). Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.

Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: case report.

Science.gov (United States)

Wong, Sui To; Yuen, Ming Keung; Fok, Kam Fuk; Yuen, Shing Chau; Yam, Kwong Yui; Fong, Dawson

2009-01-01

Rapid spontaneous resolution of posttraumatic intracranial ASDH has been reported in the literature since 1986. We report a case to demonstrate that redistribution of hematoma to the spinal subdural space is a mechanism for the rapid spontaneous resolution of posttraumatic intracranial ASDH. A 73-year-old woman with a slipped-and-fell injury had a worst GCS score of 8/15. Computerized tomography of the brain demonstrated a large intracranial ASDH with mass effect. Conservative management was decided because of her poor premorbid general condition. Rapid clinical improvement was observed within 5 hours after the CT. Progress CT of the brain at 45 hours postinjury showed that the size of the intracranial ASDH was markedly diminished. The CT findings apparently demonstrated a caudal distribution of the intracranial ASDH over the tentorium and then into the posterior fossa. To investigate this further, an MRI of the spine was performed, which showed that there was spinal SDH in the cervical and thoracic spine. This is the first report demonstrating that redistribution of posttraumatic intracranial ASDH to the spinal subdural space is one of the mechanisms behind the rapid spontaneous resolution of posttraumatic intracranial ASDH in the acute phase.

Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

Energy Technology Data Exchange (ETDEWEB)

Tong, Wu-song; Zheng, Ping; Xu, Jun-fa; Guo, Yi-jun; Zeng, Jing-song; Yang, Wen-jin; Li, Gao-yi; He, Bin; Yu, Hui [Pudong New Area People' s Hospital, Department of Neurosurgery, Shanghai (China)

2011-05-15

Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation. To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI. A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01). For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time. (orig.)

Early CT signs of progressive hemorrhagic injury following acute traumatic brain injury

International Nuclear Information System (INIS)

Tong, Wu-song; Zheng, Ping; Xu, Jun-fa; Guo, Yi-jun; Zeng, Jing-song; Yang, Wen-jin; Li, Gao-yi; He, Bin; Yu, Hui

2011-01-01

Since progressive hemorrhagic injury (PHI) was introduced in neurosurgical literatures, several studies have been performed, the results of which have influenced doctors but do not define guidelines for the best treatment of PHI. PHI may be confirmed by a serial computerized tomography (CT) scan, and it has been shown to be associated with a fivefold increase in the risk of clinical worsening and is a significant cause of morbidity and mortality as well. So, early detection of PHI is practically important in a clinical situation. To analyze the early CT signs of progressive hemorrhagic injury following acute traumatic brain injury (TBI) and explore their clinical significances, PHI was confirmed by comparing the first and repeated CT scans. Data were analyzed and compared including times from injury to the first CT and signs of the early CT scan. Logistic regression analysis was used to show the risk factors related to PHI. A cohort of 630 TBI patients was evaluated, and there were 189 (30%) patients who suffered from PHI. For patients with their first CT scan obtained as early as 2 h post-injury, there were 116 (77.25%) cases who suffered from PHI. The differences between PHIs and non-PHIs were significant in the initial CT scans showing fracture, subarachnoid hemorrhage (SAH), brain contusion, epidural hematoma (EDH), subdural hematoma (SDH), and multiple hematoma as well as the times from injury to the first CT scan (P < 0.01). Logistic regression analysis showed that early CT scans (EDH, SDH, SAH, fracture, and brain contusion) were predictors of PHI (P < 0.01). For patients with the first CT scan obtained as early as 2 h post-injury, a follow-up CT scan should be performed promptly. If the initial CT scan shows SAH, brain contusion, and primary hematoma with brain swelling, an earlier and dynamic CT scan should be performed for detection of PHI as early as possible and the medical intervention would be enforced in time. (orig.)

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

Energy Technology Data Exchange (ETDEWEB)

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

1994-04-01

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

A STUDY ON MANAGEMENT OF CHRONIC SUBDURAL HAEMATOMA- BURR HOLE EVACUATION AND MINI CRANIOTOMY

Directory of Open Access Journals (Sweden)

Nandigama Pratap Kumar

2016-11-01

Full Text Available BACKGROUND Chronic SDH is one of the common neurosurgical conditions requiring surgical treatment. The incidence of chronic SDH is 1.7- 18 per 1,00,000 population. The incidence is higher in the elderly patients, i.e. 58 per 1,00,000. Various treatment modalities available for the treatment of chronic SDH indicate that there is no gold standard for the treatment of chronic SDH. Recurrence is the major problem following treatment and can be as high as 30%. Mini craniotomy is one of the surgical options that can offer better view of the subdural space and may allow us to efficiently clear the loculations and haematoma fluid and thereby decreasing the incidence of recurrences and the need for reoperations. Small craniotomies have not been studied well in the literature except for a few publications. In this study, we are comparing mini craniotomy and burr hole evacuation for the treatment of chronic SDH. MATERIALS AND METHODS All the patients with chronic subdural haematoma operated between August 2013 and January 2016. Patients with recurrent SDH on the same side and patients who underwent different procedures on either side (in case of bilateral haematomas were excluded from the study. The patients were operated by two senior surgeons with one surgeon doing burr hole evacuation and another doing mini craniotomy. Preoperative status and postoperative status was analysed. RESULTS All the patients were analysed both preoperatively and postoperatively. In both the groups, most of the patients shown improvement following surgery, but recurrences are more in burr hole group when compared to mini craniotomy. CONCLUSION Mini craniotomy allows better view of the subdural space and better evacuation of chronic subdural haematoma. Cure rate is higher with mini craniotomy compared to burr hole evacuation.

Surgical evacuation of neonatal intracranial hemorrhage due to vitamin K deficiency bleeding.

Science.gov (United States)

Zidan, Ashraf Shaker; Abdel-Hady, Hesham

2011-03-01

Although the incidence of vitamin K deficiency bleeding (VKDB) in neonates has dramatically decreased in the developed world since the adoption of routine vitamin K prophylaxis, in developing countries the incidence is still high. Intracranial hemorrhage (ICH) is the most dangerous complication. Early recognition and management are important to decrease the mortality rate and neurological sequelae. The authors conducted a prospective study between January 2008 and June 2010. They included all full-term neonates referred to the Department of Neurosurgery at Mansoura University Children's Hospital with ICH complicating VKDB and necessitating surgical evacuation. The objective was to evaluate the clinical presentation, diagnosis, hospital course, and outcome of ICH in full-term neonates with VKDB after surgical evacuation. Thirty-two neonates with ICH due to VKDB were included. Diagnosis and classification of ICH were based on detailed history, physical examination, and the interpretation of CT or MR imaging studies. The diagnosis of VKDB was based on pretreatment coagulation studies (prothrombin time [PT] and partial thromboplastin time [PTT]), which are grossly abnormal, together with a normal platelet count and correction of coagulation results to normal after vitamin K administration. The mean age (± SD) at onset of symptoms was 20.4 ± 4.9 days. Two neonates (6.25%) had early VKDB, 7 (21.9%) had classic VKDB, and 23 (71.9%) had late VKDB. The most common neurological manifestations included focal seizures, disturbed consciousness level, and tense anterior fontanel. The most common general manifestations included pallor, respiratory distress, and bleeding from other sites. Radiological findings varied from acute subdural hemorrhage (SDH) in 18 cases (56.3%), intracerebral hemorrhage in 10 (31.3%), and acute SDH with underlying intracerebral hemorrhage, intraventricular hemorrhage, and/or subarachnoid hemorrhage in 4 (12.5%). Before administration of vitamin K

Chronic subdural hematoma : a systematic review and meta-analysis of surgical procedures

NARCIS (Netherlands)

Liu, Weiming; Bakker, Nicolaas A.; Groen, Rob J. M.

Object. In this paper the authors systematically evaluate the results of different surgical procedures for chronic subdural hematoma (CSDH). Methods. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other databases were scrutinized according to the PRISMA (Preferred Reporting

Isolated Extramedullary Relapse of Acute Leukemia after Allogeneic Stem Cell Transplantation: Different Kinetics and Better Prognosis than Systemic Relapse.

Science.gov (United States)

Shem-Tov, Noga; Saraceni, Francesco; Danylesko, Ivetta; Shouval, Roni; Yerushalmi, Ronit; Nagler, Arnon; Shimoni, Avichai

2017-07-01

Allogeneic stem cell transplantation (SCT) is curative treatment in patients with acute leukemia and myelodysplastic syndrome. However, recurrent disease is the major cause of treatment failure. Isolated extramedullary relapse (iEMR) after SCT is relatively rare and not well characterized. We performed a retrospective analysis of 566 consecutive patients with acute myeloid leukemia (n = 446) and acute lymphoblastic leukemia (ALL; n = 120) after SCT to study the incidence, risk factors, treatment options, and outcome of iEMR. The 5-year cumulative incidence of bone marrow relapse (BMR) and iEMR was 41.0% and 5.8%, respectively. iEMR occurred significantly later than BMR at 10 and 4 months, respectively (P BMR but did not protect against iEMR. Most patients with iEMR received systemic treatment combined with local radiation and donor lymphocyte infusions when feasible. The 3-year survival after relapse was 8.5% and 30.1% after BMR and iEMR, respectively (P = .002). Patients with a first iEMR continued to have recurrent EMRs, and only a minority progressed to BMR. Second iEMR was also common after first BMR and associated with longer survival than second BMR. iEMR is more frequent in patients with ALL and prior extramedullary disease. It occurs later than BMR and more commonly in patients with chronic GVHD, suggesting less effective graft-versus-leukemia effect in extramedullary sites. Second iEMR is common after a first iEMR but also after a first BMR. Long-term survival is feasible with aggressive treatment. Copyright © 2017 The American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

A case report of craniovertebral junction intradural extramedullary neurenteric cyst

Directory of Open Access Journals (Sweden)

Rajeshwari S Vhora

2014-01-01

Full Text Available A neurenteric cyst of the craniocervical (CV junction, as a cause of bulbomedullary compression, is very rare. An abnormal communication between the endoderm and neuroectoderm during the third week of embryogenesis may be responsible for its formation. It is a rare spinal condition. The most frequent location is at the lower cervical and higher thoracic spine. Neurenteric cysts of the craniocervical junction are even rarer. We report the case of a CV junction intradural neurenteric cyst. Magnetic Resonance Imaging (MRI of our patient demonstrated an intradural extramedullary process of the craniocervical junction. A surgical posterior approach allowed gross total resection of the lesion. The histopathology of the surgical specimen showed that the cyst wall was made up of fibrocollagen walls lined with a partially ciliated columnar epithelium.

Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

Science.gov (United States)

Cariati, Paolo; Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

2016-10-01

Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words: Meningitis, subdural empyema, odontogenic infections.

Incomplete paraplegia caused by extramedullary hematopoiesis in a patient with thalassemia intermedia.

Science.gov (United States)

Hisamud-Din, Nurhasyimah; Mustafah, Nadia Mohd; Fauzi, Aishah Ahmad; Hashim, Natiara Mohamad

2017-01-01

Extramedullary hematopoiesis (EMH) is the production of blood cell precursors outside the bone marrow that occur in various hematological diseases. In patients with thalassemia intermedia, ineffective erythropoiesis drives compensatory EMH in the liver, pancreas, pleura, spleen, ribs and spine. We describe a patient with thalassemia intermedia who presented with acute neurological symptoms caused by paraspinal EMH, which responded well to combination therapy of steroid, hypertransfusion, laminectomy and excision of pseudotumor and hydroxyurea therapy to boost the formation of fetal haemoglobin. Prompt recognition of EMH based on clinical presentation and typical radiological findings should be made. Early treatment is recommended to prevent irreversible damage to the spinal cord.

Ultrasound-guided catheterization of the left subclavian vein without recognition of persistent left superior vena cava

OpenAIRE

Park, Sun Young; Yoo, Jae Hwa; Kim, Mun Gyu; Kim, Sang Ho; Park, Byoung-Won; Oh, Hong Chul; Kim, Hojoon

2017-01-01

Abstract Rationale: A persistent left superior vena cava (PLSVC) is rare, but the most common thoracic venous anomaly. We report a case of PLSVC unrecognized during left subclavian vein catheterization using real-time ultrasound-guided supraclavicular approach. Patient concerns: A 79-year-old man with history of hypertension presented with traumatic subdural hemorrhage, subarachnoid hemorrhage, and epidural hemorrhage. Before the operation, a central venous catheter (CVC) was placed into the ...

Preretinal hemorrhage

Directory of Open Access Journals (Sweden)

Eduardo Felippe

2004-12-01

Full Text Available A case of Valsalva hemorrhagic retinopathy treated with Nd:YAGlaser indescribed. The patient presented decreased visual acuityafter coughing, and a preretinal hemorrhage was diagnosed in theposterior pole; puncturing the posterior hyaloid face was performedwith Nd:Yag laser. Rapid hemorrhage absorption was observedafter the therapy proposed and visual acuity was recovered. Nd:Yaglaser proved to be safe and efficient in the management of preretinalhemorrhage.

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

Science.gov (United States)

Ma, Xuexiao; Zhang, Yan; Wang, Ting; Li, Guizhi; Zhang, Guoqing; Khan, Hassan; Xiang, Hongfei; Chen, Bohua

2014-01-01

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

Apparently Ipsilateral Parkinsonism in a Patient with Chronic Subdural Hematoma

Directory of Open Access Journals (Sweden)

Tae Hwan Roh

2012-05-01

Full Text Available Symptomatic parkinsonism secondary to ipsilateral lesion is rarely reported. Although the contribution of the contralateral lesions was assumed in some cases, the pathomechanism remains undetermined. Herein we report a patient with a subdural hematoma, who developed parkinsonism in the ipsilateral hemibody. Structural and functional imaging suggests the contralateral dopaminergic dysfunction as the major culprit of apparently ipsilateral parkinsonism.

Mechanism of subdural effusion evolves into chronic subdural hematoma: IL-8 inducing neutrophil oxidative burst.

Science.gov (United States)

Tao, Zhiqiang; Lin, Yingying; Hu, Maotong; Ding, Shenghong; Li, Jianwei; Qiu, Yongming

2016-01-01

Chronic subdural hematoma (CSDH) is still a mysterious disease. Though great success has been has achieved by neuro-surgery treatment, the origin and development of CSDH remains unknown. Tremendous clinical observations have found the correlation of subdural effusion (SDE) and CSDH. However, systematic elucidation of CSDH's origin and progression is lacking while almost all the current hypothesis only explained partial phenomenon. This hypothesis proposes Interleukin (IL)-8 inducing neutrophil respiratory burst is the crucial impact when SDE evolves into CSDH. IL-8 initially secreted by dural border layer cells, accumulates and the concentration of IL-8 rises in the SDE cavity. Accompanied by the formation of neo-membrane under the dura meninges, IL-8 firstly prompts to establish the neo-vasculature in it, and then attracts lymphocytes aggregation in the neo-membrane. Both the newly recruited lymphocytes and endothelial cells assist the further elevation of local IL-8 concentration. When the IL-8 concentration elevated to a particular level, it attracts neutrophils to the inner wall of neo-vessels and primes them to oxidative burst. Lysosomes and superoxide released by these neutrophils make the fragile neo-capillary became leaky, and subsequently the plasma and blood cells run into SDE. However, as long as the erythrocytes come into the cavity, they shall bind large quantity of IL-8 and decrease IL-8 concentration to a lower level relatively that reduce the neutrophils recruit. When this negative feedback is stagnancy, for example, the SDE space is so large in elder man who is experiencing brain atrophy, the neo-vessels have to release more erythrocytes to bind IL-8, the liquid cavity will expand and the high intracranial pressure symptoms appeared. Our hypothesis holds potential for the proper therapeutic intervention of CSDH. IL-8 antagonist and other anti-inflammation drugs like macrolides antibiotics, glucocorticoid and atorvastatin might be optional to resist

Clinical and computerized tomographic studies of chronic subdural hematomas

International Nuclear Information System (INIS)

Naito, Takahiro; Maegawa, Mototsugu; Morimoto, Tetsuya; Sakaki, Toshisuke; Tanikake, Tatsuo

1981-01-01

The authors' experience is based on 84 patients with chronic subdural hematomas verified by surgery. Analysis of CT findings of the chronic subdural hematoma led to a classification of four different types: low, iso-, mixed and high density. The mixed density type was classified into two subdivisions: Type I characterized by the sharp border between two compartments and Type II characterized by high density around the hematoma capsule. There was tendency in the high density type group for the clinical course from onset to be the most rapid, the mass effect for the brain the strongest and the period from onset to surgical intervention the shortest. They were slower, weaker and longer in order of the mixed, iso- and low density types. As a result of analysis of hematoma content, there was no correlation among Ca ion concentration, total protein volume and types of hematoma, but there were some significant correlations among hemoglobin, hematocrit and types of hematoma. Hemoglobin and hematocrit were highest in hematoma content of the high density type and were lower in the order of the high density part of the mixed density type, isodensity type and low density type. However, the hematoma content in the low density type showed the highest value of LDH. (author)

Spontaneous rapid reduction of a large acute subdural hematoma.

Science.gov (United States)

Lee, Chul-Hee; Kang, Dong Ho; Hwang, Soo Hyun; Park, In Sung; Jung, Jin-Myung; Han, Jong Woo

2009-12-01

The majority of acute post-traumatic subdural hematomas (ASDH) require urgent surgical evacuation. Spontaneous resolution of ASDH has been reported in some cases. We report here on a case of a patient with a large amount of ASDH that was rapidly reduced. A 61-yr-old man was found unconscious following a high speed motor vehicle accident. On initial examination, his Glasgow Coma Score scale was 4/15. His pupils were fully dilated and non-reactive to bright light. Brain computed tomography (CT) showed a massive right-sided ASDH. The decision was made to treat him conservatively because of his poor clinical condition. Another brain CT approximately 14 hr after the initial scan demonstrated a remarkable reduction of the previous ASDH and there was the new appearance of high density in the subdural space adjacent to the falx and the tentorium. Thirty days after his admission, brain CT revealed chronic SDH and the patient underwent surgery. The patient is currently able to obey simple commands. In conclusion, spontaneous rapid resolution/reduction of ASDH may occur in some patients. The mechanisms are most likely the result of dilution by cerebrospinal fluid and the redistribution of hematoma especially in patients with brain atrophy.

Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report.

Science.gov (United States)

Benedetto, Nicola; Cagnazzo, Federico; Gambacciani, Carlo; Perrini, Paolo

2016-12-01

The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.

Prognosis on follow-up CT of chronic subdural hematomas treated by burr hole evacuation

International Nuclear Information System (INIS)

Higeta, Toshiaki; Yamada, Hiroshi; Itoh, Hakuji

1986-01-01

A consecutive series of 47 adult patients with chronic subdural hematoma was studied in respect to postoperative follow-up CT after burr hole evacuation. In 15 of our patients, the CT scan was normalized within 60 days. Six patients required reoperation because of reaccumulation or of poor re-expansion, and in 13 patients the follow-up CT showed a persisting subdural fluid collection even after 60 postoperative days. Further studying the correlation between the prognosis on follow-up CT and various factors, such as patient's age, preoperative neurological condition and CT findings or others, authors found that the elderly, especially older than 70 years, had a poor prognosis, and that the prognosis was correlated to the density and the thickness of hematoma on preoperative CT scan. (author)

Extramedullary hematopoiesis within the clivus: an unusual cause of lower cranial nerve palsy.

Science.gov (United States)

Reames, Davis L; Lindstrom, Katherine; Raghavan, Prashant; Jane, John

2010-12-01

We report one year follow up of a case of extramedullary hematopoiesis within the clivus. The imaging findings, brief clinical course, and endoscopic transphenoidal approach are described. A 29-year-old female with thalassemia developed worsening cranial nerve signs. After imaging studies discovered a large clival mass, she underwent endoscopic transphenoidal biopsy of the lesion. Neural compression from exuberant erythrogenesis within tissue normally quiescent of red blood cell production was found to be the etiology of her neural deficit. Treatment for this condition is generally non-operative unless significant neural compression is present. Radiotherapy and anti-neoplastic agents have been used with success.

Venous injury in abusive head trauma

Energy Technology Data Exchange (ETDEWEB)

Choudhary, Arabinda K. [Nemours A. I. duPont Hospital for Children, Department of Radiology, Wilmington, DE (United States); Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B. [Hershey Medical Center, Department of Radiology, Hershey, PA (United States); Dias, Mark S. [Hershey Medical Center, Department of Neurosurgery, Hershey, PA (United States)

2015-11-15

Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

Venous injury in abusive head trauma

International Nuclear Information System (INIS)

Choudhary, Arabinda K.; Bradford, Ray; Thamburaj, K.; Boal, Danielle K.B.; Dias, Mark S.

2015-01-01

Abusive head trauma (AHT) is an important cause of serious brain injury in infants and young children who have characteristic clinical and imaging findings that are discordant with the clinical history provided. Recent attention has focused on abnormalities of the cranial venous sinuses and cortical veins, both on MRI and at autopsy. Although many have interpreted these to be secondary to the AHT, some have recently argued that these venous abnormalities represent primary cortical sinus and venous thrombosis that leads secondarily to subdural hemorrhage and secondary brain injury. Direct trauma to the veins and sinuses has been reported at autopsy in AHT, but there has been no systematic study of venous abnormalities in cases of AHT. The purpose of this study was to define the incidence and characteristics of venous and sinus abnormalities in AHT. We included all children <36 months of age who were diagnosed with abusive head trauma between 2001 and 2012 and who had MRI and magnetic resonance (MR) venography as part of their diagnostic workup. We analyzed age, gender and clinical findings. MRI and MR venography were analyzed independently by two neuroradiologists with a focus on abnormalities involving the intracranial veins and venous sinuses. A total of 45 children were included. The median age was 3 months (range 15 days to 31 months) and 28 were boys (62%). Clinical findings included retinal hemorrhage in 71% and extracranial fractures in 55%. CT or MRI demonstrated subdural hemorrhage in 41 (91%); none had subdural effusions. In 31 cases (69%) MR venography demonstrated mass effect on the venous sinuses or cortical draining veins, with either displacement or partial or complete effacement of the venous structures from an adjacent subdural hematoma or brain swelling. We also describe the lollipop sign, which represents direct trauma to the cortical bridging veins and was present in 20/45 (44%) children. Evidence of displacement or compression of cortical veins

Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma.

Science.gov (United States)

Han, Myung-Hoon; Ryu, Je Il; Kim, Choong Hyun; Kim, Jae Min; Cheong, Jin Hwan; Yi, Hyeong-Joong

2017-11-01

OBJECTIVE Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals. METHODS Kaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up. RESULTS This study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03-2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m 2 ), and a bilateral operation. CONCLUSIONS This study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

Incidence of Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus in Preterm Infants

Directory of Open Access Journals (Sweden)

Negar Sajjadian

2010-07-01

Full Text Available "nGerminal matrix-intraventricular hemorrhage (IVH is the most common variety of neonatal intracranial hemorrhage and is characteristics of the premature infant. The importance of the lesion relates not only to its high incidence but to their attendant complications (IC: hydrocephalus. Brain sonography is the procedure of choice in diagnosis of germinal matrix- intraventricular hemorrhage and hydrocephalus. In this study we have used brain sonography for detection of intraventricular hemorrhage and post hemorrhagic hydrocephalus and their incidences. The studied population was consisted of premature neonate (birth weight equal or less than 1500g and gestational age equal or less than 37 weeks who admitted in Mofid Hospital NICU (Tehran, Iran during a one year period. For all neonate (including criteria brain sonography in first week of life was done and in presence of IVH, serial Brain sonography was done weekly for detection of hydrocephalus. A total of 57 neonate entered the study. Intraventicular-germinal matrix hemorrhage was seen in 64.4% (35 patients. Forty percent of patients with intraventricular-germinal matrix hemorrhage had grade I, 11% grade II, 25.7% grade III, 2.8% grade VI. Hydrocephalus was detected in 20 percent of patients who had intraventricular-germinal matrix hemorrhage. That incidence of IVH in our study in comparison with other area and situation is higher. Hydrocephaly had direct relation with severity of IVH. This shows that with control of risk factor of IVH, we can control Post hemorrhagic hydrocephalus.

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

International Nuclear Information System (INIS)

Park, Young-Soo; Hironaka, Yasuhiro; Motoyama, Yasushi; Asai, Hideki; Watanabe, Tomoo; Nishio, Kenji; Nakase, Hiroyuki; Okuchi, Kazuo

2010-01-01

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

CT differential diagnosis between hypertensive putaminal hemorrhage and hemorrhagic infarction localized in basal ganglia

International Nuclear Information System (INIS)

Tazawa, Toshiaki; Mizukami, Masahiro; Kawase, Takeshi.

1984-01-01

The symptoms of hypertensive putaminal hemorrhage and of middle cerebral artery occlusion are sometimes similar to each other. Hemorrhage sometimes occurs following cerebral infarction. We experienced 7 patients with hemorrhages localized in the basal ganglia following cerebral infarction. The CT findings of 55 patients with putaminal hemorrhage and 7 patients with hemorrhagic infarction localized at the basal ganglia were investigated retrospectively in order to discuss their characteristics. The high-density area (HD) of a putaminal hemorrhage was homogeneous on a plain CT within a week of the onset. There was a close correlation between the size of the HD and the timing of its disappearance. The HD with a maximum diameter of A cm generally disappeared A weeks after. On the other hand, the HD of a hemorrhagic infarction was lower in density than that of the putaminal hemorrhage. The HD of a hemorrhagic infarction generally disappeared earlier than that of a putaminal hemorrhage. Ring enhancement was visualized on contrast-enhanced CT (CECT) from 2 or 3 weeks after the onset in patients with putaminal hemorrhages except in the case of small hemorrhages (less than 1 cm diameter). Ring enhancement was also visualized in 6 out of 7 patients with hemorrhagic infarction; one of them was recognized within a week of the onset. Contrast enhancement of the cortex in the territory of the middle cerebral artery was visualized in 4 out of 7 patients with hemorrhagic infarction. This finding seems to indicate one characteristic of hemorrhagic infarction. (author)

Local brain herniation after partial membranectomy for organized chronic subdural hematoma in an adult patient: case report and review of the literature.

Science.gov (United States)

Kusano, Yoshikazu; Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Kakizawa, Yukinari; Tanaka, Yuichiro; Hongo, Kazuhiro

2010-01-01

Local brain herniation after removal of chronic subdural haematoma is extremely rare, especially in adult patients. This study reports a case of local brain herniation after partial membranectomy for organized chronic subdural haematoma. A 77-year-old man presented with dysarthria and dysphasia caused by local brain herniation of the right frontal lobe through a defect of the inner membrane. The herniated brain was detected by magnetic resonance (MR) imaging. The patient underwent a craniotomy to release the herniated and strangulated brain, which were consistent with the MR imaging findings. The patient recovered fully within 1 month after surgery. To date, five cases of brain herniation through the internal subdural membrane have been reported as complications of chronic subdural haematomas. All but one case occurred in the paediatric population. Urgent surgery should be performed, even if an adult patient suffers from local brain herniation, for preservation of brain function. This is the sixth reported case of brain herniation through a defect of the inner membrane and the second reported case in the adult population.

Extramedullary plasmacytoma in the carotid space: Expanding the differential diagnosis

International Nuclear Information System (INIS)

Deshpande, Sneha Satish; Kane, Shubhada; Arya, Supreeta

2014-01-01

Plasma cell neoplasms have been classified into various types, with a range of clinical and radiological presentations. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms which presents as an isolated non-osseous soft tissue mass. Though carotid space neoplasms are commonly encountered, EMP in the carotid space is rare and seldom considered in the initial differential diagnosis of a carotid space mass. These tumors can be treated by surgery or radiotherapy. On the other hand, the commonly encountered tumors in the carotid space are treated surgically. Also, it is mandatory to exclude multiple myeloma in the patients presenting with EMP. Hence, accurate and early diagnosis has therapeutic and prognostic implications. We report a rare case of EMP of the carotid space, describing the imaging features and the differential diagnoses with clues pointing to this rare entity

Chronic subdural hematoma: A survey of neurosurgeons’ practices in Nigeria

Science.gov (United States)

Rabiu, Taopheeq B.

2013-01-01

Background: Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons’ practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. Methods: An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July–December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Results: Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of

Chronic subdural hematoma: A survey of neurosurgeons' practices in Nigeria.

Science.gov (United States)

Rabiu, Taopheeq B

2013-01-01

Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons' practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July-December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of the 14 neurosurgeons taking part in

Blood Pressure Guideline Adherence in Patients with Ischemic and Hemorrhagic Stroke in the Neurointensive Care Unit Setting.

Science.gov (United States)

Porto, Guilherme B F; Spiotta, Alejandro M; Chalela, Julio A; Kellogg, Ryan T; Jauch, Edward C

2015-12-01

Patients with acute brain injuries require strict physiologic control to minimize morbidity and mortality. This study aimed to assess in-hospital compliance to strict physiologic parameters (BP, HR, ICP, SpO2) in these populations. Patients with severe cerebrovascular events were admitted to the neurointensive care unit (NSICU) and were continuously monitored using the BedMasterEX (Excel Medical Electronics Inc, FL) system, which recorded hemodynamic data via an arterial catheter continuously in 5-s intervals. Furthermore, we investigated the impact of healthcare provider shift changes (6-8 a.m./p.m) and of day (6 a.m.-6 p.m.) versus night (6 p.m-6 a.m) shifts in hemodynamic control. Fifty patients admitted to the NSICU, 50 % male, mean age 59.7 ± 13.9 years with subarachnoid hemorrhage (23), ischemic stroke (8), subdural hematoma (4), intracerebral hemorrhage (3), intraventricular hemorrhage (2), and miscellaneous injuries (10) were enrolled. Data represented 2,337 total hours of continuous monitoring. Systolic BPs (SBP) were on average outside of recommended ranges 32.26 ± 30.46 % of the monitoring period. We subdivided adherence to ideal SBP range: optimal (≥99 % of time spent in NSICU within range) was achieved in 12 %, adequate (90 %) in 16 %, suboptimal (80 %) in 20 %, inadequate I (70 %) in 12 %, and inadequate II (<70 %) in 40 % of patients. Comparison of shift change %time and day versus night %time out of parameter yielded no statistically significant differences across SAH patients. Hemodynamic management of patients with cerebrovascular injuries, based on targeted thresholds in the NSICU, yielded optimal control of SBP in only 28 % of our patients (within parameters ≥90 % of time).

Age determination of subdural hematomas with CT and MRI: a systematic review

NARCIS (Netherlands)

Sieswerda-Hoogendoorn, Tessa; Postema, Floor A. M.; Verbaan, Dagmar; Majoie, Charles B.; van Rijn, Rick R.

2014-01-01

To systematically review the literature on dating subdural hematomas (SDHs) on CT and MRI scans. We performed a systematic review in MEDLINE, EMBASE and Cochrane to search for articles that described the appearance of SDHs on CT or MRI in relation to time between trauma and scanning. Two researchers

Intracranial Hemorrhage

Science.gov (United States)

2011-01-01

Intracranial hemorrhage is a life-threatening condition, the outcome of which can be improved by intensive care. Intracranial hemorrhage may be spontaneous, precipitated by an underlying vascular malformation, induced by trauma, or related to therapeutic anticoagulation. The goals of critical care are to assess the proximate cause, minimize the risks of hemorrhage expansion through blood pressure control and correction of coagulopathy, and obliterate vascular lesions with a high risk of acute rebleeding. Simple bedside scales and interpretation of computed tomography scans assess the severity of neurological injury. Myocardial stunning and pulmonary edema related to neurological injury should be anticipated, and can usually be managed. Fever (often not from infection) is common and can be effectively treated, although therapeutic cooling has not been shown to improve outcomes after intracranial hemorrhage. Most functional and cognitive recovery takes place weeks to months after discharge; expected levels of functional independence (no disability, disability but independence with a device, dependence) may guide conversations with patient representatives. Goals of care impact mortality, with do-not-resuscitate status increasing the predicted mortality for any level of severity of intraparenchymal hemorrhage. Future directions include refining the use of bedside neuromonitoring (electroencephalogram, invasive monitors), novel approaches to reduce intracranial hemorrhage expansion, minimizing vasospasm, and refining the assessment of quality of life to guide rehabilitation and therapy. PMID:22167847

MR imaging of experimental subdural bleeding. Correlates of brain deformation and tissue water content, and changes in vital physiological parameters

International Nuclear Information System (INIS)

Orlin, J.R.; Thuomas, K.Aa.; Ponten, U.; Bergstroem, K.; Zwetnow, N.N.

1997-01-01

Purpose: To evaluate morphological and physiological changes during acute lethal subdural bleeding in 2 models of anaesthetized dogs. Material and Methods: In model I, blood from the aorta was led into a collapsed subdural rubber balloon while in model II, the blood was directed into the subdural compartment over the left cerebral frontoparietal lobe. Eight vital physiological parameters were continuously registered. MR imaging visualized the compression and displacement of cerebral tissue, and assessed the dynamic changes in cerebral tissue water. Results: In model I, tissue herniation and compression of cerebral ventricles led to death at a haematoma volume corresponding to 8% of the intracranial volume. In model II, the extravasated blood progressed infratentorially and into the spinal sac with a volume that was 3 times larger than that of the lethal haematoma. Tissue water increased almost linearly during bleeding in both models. (orig.)

Perindopril and residual chronic subdural hematoma volumes six weeks after burr hole surgery

DEFF Research Database (Denmark)

Poulsen, Frantz Rom; Munthe, Sune; Søe, Morten