Academic literature on the topic 'Subduralni hematom'

Rimantas Vilcinis, Juozas ŠidiškisKauno medicinos universiteto klinikųNeurochirurgijos klinikosGalvos smegenų traumų skyrius,Eivenių g. 2, LT–50009, KaunasEl. paštas Rimas.Vilcinis@kmu.lt Įvadas / tikslas Dalis trauminių intrakranijinių hematomų kliniškai pasireiškia po trijų dienų ar vėliau. Darbo tikslas – įvertinti poūmių trauminių intrakranijinių hematomų dažnį, rūšis, traumos mechanizmus, operacijos indikacijas ir jos terminą, gydymo komplikacijas ir rezultatus. Tuo remdamiesi pateikiame poūmių trauminių intrakranijinių hematomų gydymo rekomendacijas. Ligoniai ir metodai Retrospektyviai išanalizavome 1275 ligonius, operuotus nuo trauminių intrakranijinių hematomų (TIH) Kauno medicinos universiteto klinikų Galvos smegenų traumų skyriuje per 7 metus (1997–2002). Iš jų 50 ligonių išoperuotos poūmės intrakranijinės hematomos (PIH), kurios kliniškai pasireiškė ir buvo pašalintos tarp ketvirtos ir dvidešimt pirmos potrauminės paros. Hematoma pašalinta atliekant kraniotomiją 24 ligoniams. Kitiems 26 ligoniams pakako pašalinti suskystėjusią subduralinę hematomą uždaruoju būdu drenuojant subduralinį tarpą per trepanacinę frezinę angą. Rezultatai Iš 50 ligonių, kuriems pasireiškė poūmė intrakranijinė hematoma, 41-am nustatyta subduralinė hematoma, dviem – epiduralinė hematoma (iš jų vienam užpakalinėje kaukolės dauboje), vienam – smegenėlėse, vienam – smegenyse, ir penkiems – mišrios (subduralinė ir intracerebrinė) hematomos. Vidutinis hematomos storis, vertinant pagal kompiuterinę tomogramą (KT), – 1,12 ± 0,44 cm. Ligoniai buvo operuoti praėjus vidutiniškai 11,73 ± 5,46 paroms (4–21) po traumos. Operacijos indikacijos buvo: ilgalaikiai galvos skausmai, nepaisant skiriamo intensyvaus medikamentinio gydymo (27 ligoniams), didėjanti smegenų vidurinių struktūrų dislokacija KT (24-iems), stabilūs ar ryškėjantys židininiai neurologiniai simptomai (parezė – 14, disfazija – 10), dezorientacija (11), epilepsijos priepuoliai (6), stazė akių dugne (9), patologinis Babinskio refleksas (7), akių deviacija (4), bradikardija (3), anizokorija, šlapinimosi kontrolės sutrikimas, kraujosruvos akių dugne (po 1). Po kraniotomijos operacijos 3 ligoniams atsirado pooperacinės hematomos (2 epiduralinės ir 1 subduralinė), kurios sėkmingai pašalintos pakartotinės operacijos metu. Visi ligoniai po operacijos pasveiko, vienam ligoniui liko parezė ir dviem – daliniai kalbos sutrikimai. Išvados Traumines intrakranijines hematomas, nesukeliančias aiškių smegenų suspaudimo požymių, iš pradžių galima gydyti konservatyviai, įdėmiai stebint ligos eigą. Jei nėra ženklesnio būsenos pagerėjimo ar ji blogėja, tokius ligonius reikia operuoti, dažniausiai antrą savaitę po traumos. Jei kontrolinėse galvos KT matoma suskystėjusi subduralinė hematoma (izodensinė ir hipodensinė zona), pakanka ją drenuoti pro trepanacinę angą. Prasminiai žodžiai: poūmės trauminės intrakranijinės hematomos, kraniotomija, trepanacija, drenavimas Delayed surgical treatment of subacute traumatic intracranial hematomas Rimantas Vilcinis, Juozas Šidiškis Background / objective Some traumatic intracranial hematomas manifest clinically three and more days after injury. Our aim was to analyse their frequency, types, mechanisms of injury, indications for operation, surgical tactics and treatment results. Patients and methods We analysed retrospectively 50 (4%) patients with subacute intracranial hematoma among 1275 patients operated on for traumatic intracranial hematoma in Head Injury Department of Kaunas Medical University Hospital in 1997–2002. Craniotomy was done for 24 patients, and it was enough to drain liquid subdural hematoma through a burr hole in 26 cases. Results There were 41 subdural hematomas, 2 epidural (1 in posterior cranial fossa), 1 cerebellar, 1 intracerebral and 5 mixted (subdural and intracerebral) hematomas evacuated 3–21 days post injury. The average thickness of hematoma on CT was 1.12 ± 0.44 cm. The patients were operated on 4–21 (mean 11.73 ± 5.46) days post injury. The indications for surgery were: prolonged hypertensive headache (27 patients), the increase of midline dislocation on control CT (24 patients), stabile or deteriorating focal neurological deficit (paresis – 14, dysphasia – 10), disorientation (11), epileptic seizures (6), stasis in eye fundus (9), pathologic Babinski reflex (7), eye deviation (4), bradicardia (3), etc. There were 3 postoperative hematomas (2 epidural and 1 subdural), which were succesfully evacuated. All patients recovered, and the residual neurological deficit was paresis in 1 case and remnant disphasia in 2 patients. Conclusions Patients with traumatic intracranial hematoma, without clear signs of brain compression initially and treated conservatively, need surgery mainly on the second week after trauma. It is worthwhile to observe patients with small subdural hematoma, and if it does not resolve, liquid hematoma may be evacuated successfully through a burr hole the second week after injury. Keywords: subacute traumatic intracranial hematoma, craniotomy, burr hole, drainage

Chronic subdural hematomas are a common neurosurgical presentation. They are difficult to treat, and current interventions – namely surgical evacuation – are not without complications or recurrences. Embolization of the middle meningeal artery is a promising new treatment option for this pathology. We have noted an interesting phenomenon in our patients following endovascular embolization, which is that the subdural hematoma is stained with contrast following the procedure. This ties into the basic physiology of chronic subdurals, which parasitize the middle meningeal artery during the process of membrane formation and neovascularization, which has previously been reported.

AbstractConcomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma are very uncommon. Their pathophysiology is not totally elucidated, but one hypothesis is the migration of the hematoma from the head to the spine. In the present case report, the authors describe the case of a 51-year-old man presenting with headache, nauseas and back pain after a head trauma who presented with intracranial and spinal cord subdural hematomas. Drainage was performed but, 1 week later, a retroclival subdural hematoma was diagnosed. The present paper discusses the pathophysiology, the clinical presentation, as well as the complications of concomitant traumatic spinal cord and intracranial subdural hematomas associated with a retroclival hematoma, and reviews this condition.

Spinal cord hematomas are remarkably uncommon. Even more rare are spontaneous spinal subdural hematomas without underlying pathological changes. In some patients, compression of the spinal cord by spinal subdural hematoma has led to acute paraplegia. Spontaneous spinal subdural hematomas occur most often in the thoracic spine and are manifested by sudden back pain that radiates to the upper or lower extremities or to the trunk and variable degrees of motor, sensory, and autonomic disturbances. Clinicians should consider spontaneous spinal subdural hematoma when patients who are taking anticoagulants report back or radicular pain and the development of paraparesis, because early diagnosis is essential for preventing irreversible paralysis. Diagnosis of spontaneous spinal subdural hematoma requires prompt radiological assessment; magnetic resonance imaging is the preferred method. Treatment includes emergent decompressive laminectomy and evacuation of the hematoma to prevent or minimize permanent neurological damage caused by spinal cord compression, ischemia, and spinal cord injury.

Abstract Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.

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

Abstract Communication between bilateral subdural hematoma cavities was not demonstrated by metrizamide computed tomography subdurography in three patients with bilateral chronic subdural hematomas. Because unilateral subdural tapping yielded a slack fontanel without untoward neurological findings, patients were treated by the placement of unilateral subdural-peritoneal shunts, resulting in resolution of the bilateral hematomas.

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5–60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.