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Vilcinis, Rimantas, and Juozas Šidiškis. "Poūmių trauminių intrakranijinių hematomų vėlyvas chirurginis gydymas." Lietuvos chirurgija 2, no. 3 (2004): 0. http://dx.doi.org/10.15388/lietchirur.2004.3.2360.
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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
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Entezami, Pouya, Alan Boulos, Alexandra Paul, Emad Nourollahzadeh, and John Dalfino. "Contrast enhancement of chronic subdural hematomas after embolization of the middle meningeal artery." Interventional Neuroradiology 25, no. 5 (2019): 596–600. http://dx.doi.org/10.1177/1591019919843354.
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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.
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Caramanti, Ricardo, Ronaldo Fernandes, Eduardo Abib, et al. "Clival Subdural Hematoma after Drainage of Concomitant Intracranial and Spinal Cord Subdural Hematomas – Rare Case Report." Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 38, no. 01 (2017): 060–63. http://dx.doi.org/10.1055/s-0036-1593976.
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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.
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Dampeer, Rebecca Anne. "Spontaneous Spinal Subdural Hematoma: Case Study." American Journal of Critical Care 19, no. 2 (2010): 191–93. http://dx.doi.org/10.4037/ajcc2009982.
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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.
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Meguro, Kotoo, Eiki Kobayashi, and Yutaka Maki. "Acute Brain Swelling during Evacuation of Subdural Hematoma Caused by Delayed Contralateral Extradural Hematoma: Report of Two Cases." Neurosurgery 20, no. 2 (1987): 326–28. http://dx.doi.org/10.1227/00006123-198702000-00023.
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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.
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SÜRME, Mehmet Beşir, Ömer Batu HERGÜNSEL, Bilal ERTUĞRUL, and Metin KAPLAN. "Ossified Chronic Subdural Hematoma: Case Report." Turkiye Klinikleri Journal of Neurology 12, no. 2 (2017): 44–48. http://dx.doi.org/10.5336/neuro.2017-55840.
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Cornelio Rodríguez, Georgina, Rafael Flores Suárez, Lorena Moreno Ordaz, and José Luis Ramírez-Arias. "Subdural hematome." Revista de la Facultad de Medicina 61, no. 6 (2018): 29–30. http://dx.doi.org/10.22201/fm.24484865e.2018.61.6.05.
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Jukovic, Mirela, Kosta Petrovic, and Viktor Till. "The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma." Medical review 67, no. 9-10 (2014): 277–81. http://dx.doi.org/10.2298/mpns1410277j.
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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.
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Aoki, Nobuhiko, and Hideaki Masuzawa. "Bilateral Chronic Subdural Hematomas without Communication between the Hematoma Cavities: Treatment with Unilateral Subdural-Peritoneal Shunt." Neurosurgery 22, no. 5 (1988): 911–13. http://dx.doi.org/10.1227/00006123-198805000-00019.
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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.
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Benek, Huseyin Berk, and Emrah Akcay. "Concomitant chronic subdural hematomas and arachnoid cysts in young adults." F1000Research 10 (May 26, 2021): 421. http://dx.doi.org/10.12688/f1000research.53210.1.
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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.
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Melashenko, Tat’yana V., Maria Yu Fomina, Ivan N. Usenko, and Yuriy V. Rodionov. "Subdural hematomas in young children: clinical and electrophysiological features." Pediatrician (St. Petersburg) 10, no. 6 (2020): 93–99. http://dx.doi.org/10.17816/ped10693-99.
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Subdural hematoma is a sufficiently rare, but serious pathology of the brain in infants, which can lead to severe neurological deficit or result in death. Subdural hematomas are detected in 2025 per 100,000 children under 1 year. A retrospective analysis of autopsy material revealed that subdural hematomas were diagnosed in 72% of children who died before the age of 5 months from intracranial hemorrhage. According to localization, subdural hematomas are divided into supra- and subtentorial, mainly associated localization, which are located along the tent of cerebellum and sickle of the brain, mainly. The main mechanism of development of subdural hematomas is associated with the rupture of the bridge veins of the subdural space as a result of their tension, both traumatic etiology and nontraumatic brain damage, accompanied by progressive cerebral atrophy. It is believed that perinatal hypoxic-ischemic brain damage is one of the leading etiological factors of developed subdural hematomas in young children. In addition, the formation of subdural hematomas in young children can be observed with intraamniotic infections, congenital fermentopathies, and above all, in children with aciduria. In some infants, subdural hematomas occur without clinical manifestation, but in most cases are accompanied by the development of neurological disorders, both in acute and in distant periods. In the main, subdural hematomas in the acute period manifest with focal convulsions with secondary generalization of seizures, behavioral disturbances, respiration, and symptoms of intracranial hypertension. During the formation of chronic subdural hematoma, development of structural epilepsy (up to 20%), microcephaly, impaired psychomotor development is observed. In 55% of young children with acute subdural hematomas, the formation of chronic subdural hematomas is observed.
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Motiei-Langroudi, Rouzbeh, Ron L. Alterman, Martina Stippler, et al. "Factors influencing the presence of hemiparesis in chronic subdural hematoma." Journal of Neurosurgery 131, no. 6 (2019): 1926–30. http://dx.doi.org/10.3171/2018.8.jns18579.
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OBJECTIVEChronic subdural hematoma (CSDH) has a variety of clinical presentations, including hemiparesis. Hemiparesis is of the utmost importance because it is one of the major indications for surgical intervention and influences outcome. In the current study, the authors intended to identify factors influencing the presence of hemiparesis in CSDH patients and to determine the threshold value of hematoma thickness and midline shift for development of hemiparesis.METHODSThe authors retrospectively reviewed 325 patients (266 with unilateral and 59 with bilateral hematomas) with CSDH who underwent surgical evacuation, regardless of presence or absence of hemiparesis.RESULTSIn univariate analysis, hematoma loculation, age, hematoma maximal thickness, and midline shift were significantly associated with hemiparesis. Moreover, patients with unilateral hematomas had a higher rate of hemiparesis than patients with bilateral hematomas. Sex, trauma history, anticoagulant and antiplatelet drug use, presence of comorbidities, Glasgow Coma Scale score, hematoma density characteristics on CT scan, and hematoma signal intensity on T1- and T2-weighted MRI were not associated with hemiparesis. In multivariate analysis, the presence of loculation and hematoma laterality (unilateral vs bilateral) influenced hemiparesis. For unilateral hematomas, maximal hematoma thickness of 19.8 mm and midline shift of 6.4 mm were associated with a 50% probability of hemiparesis. For bilateral hematomas, 29.0 mm of maximal hematoma thickness and 6.8 mm of shift were associated with a 50% probability of hemiparesis.CONCLUSIONSPresence of loculations, unilateral hematomas, older patient age, hematoma maximal thickness, and midline shift were associated with a higher rate of hemiparesis in CSDH patients. Moreover, 19.8 mm of hematoma thickness and 6.4 mm of midline shift were associated with a 50% probability of hemiparesis in patients with unilateral hematomas.
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Han, Patrick P., Nicholas Theodore, Randall W. Porter, Paul W. Detwiler, MichaeL T. Lawton, and Robert F. Spetzler. "Subdural hematoma from a Type I spinal arteriovenous malformation." Journal of Neurosurgery: Spine 90, no. 2 (1999): 255–57. http://dx.doi.org/10.3171/spi.1999.90.2.0255.
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✓ The authors report a patient in whom a subdural hematoma developed from a Type I spinal arteriovenous malformation (AVM). The patient became symptomatic with back pain, and magnetic resonance imaging revealed a spinal subdural hematoma. Selective spinal angiography, however, failed to demonstrate a pathological process. The patient underwent exploratory laminoplasty that revealed a subdural extraarachnoid hematoma with an underlying Type I spinal AVM, which was surgically obliterated. The patient recovered completely. Subdural hematomas that affect the spine are rare. Although a negative result was obtained using selective spinal angiography, exploratory surgery should be considered for the evacuation of a subdural hematoma and possibly for the definitive treatment of a spinal AVM.
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ÖCAL, Ruhşen, Zafer SABANCILAR, and Tolga BAYAZIT. "Unilateral Calcified Chronic Subdural Hematoma: Case Report." Turkiye Klinikleri Journal of Case Reports 23, no. 3 (2015): 232–34. http://dx.doi.org/10.5336/caserep.2013-38264.
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Hrabovský, Dušan, Radim Jančálek, Markéta Hermanová, Petr Burkoň, and Jan Chrastina. "Chronic subdural haematoma associated with advanced malignant tumor." Neurologie pro praxi 17, no. 2 (2016): 123–27. http://dx.doi.org/10.36290/neu.2016.025.
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Jukovic, Mirela, and Viktor Till. "Chronic subdural hematoma - diagnosis, treatment and perspectives." Medical review 73, no. 9-10 (2020): 295–300. http://dx.doi.org/10.2298/mpns2010295j.
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Introduction. Chronic subdural hematoma has become an important entity in radiological, neurological and neurosurgery practice. Classification. The classification of chronic subdural hematoma is most often done in relation to the time of the disease onset (acute, subacute and chronic), whereas the second classification is based on hematoma density using computed tomography. Clinical presentation. The clinical presentation may mimic a spectrum of various diseases and chronic subdural hematoma can be easily overlooked without radiological verification. Diagnosis. The diagnosis of chronic subdural hematoma is partly clinical and partly radiological. In most cases, computed tomography is the initial diagnostic method for detection of this disease. Many studies point to different management strategies in the diagnosis and treatment of the disease. Therapy. The therapy of chronic subdural hematoma depends on the patient?s neurological deficit, but generally it is divided into conservative and surgical treatment. Conclusion. The aim of this paper is to review chronic subdural hematomas with reference to their clinical and radiological characteristics for better understanding of these phenomena.
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Li, Rong, Vishnu V. B. Reddy, and Cheryl Ann Palmer. "Extramedullary Hematopoiesis: An Unusual Finding in Subdural Hematomas." Case Reports in Pathology 2011 (2011): 1–3. http://dx.doi.org/10.1155/2011/718585.
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We present a case of a 59-year-old man who was found to have clusters of hyperchromatic, small, round nucleated cells within a subdural hematoma removed after a skull fracture. Immunohistochemistry study confirmed that the cells were hematopoietic components predominantly composed of normoblasts. In this paper, we describe the clinical and pathological findings. A brief review of published information on extramedullary hematopoiesis in subdural hematoma and the mechanisms of pathogenesis are also discussed. While extramedullary hematopoiesis is seen anecdotally by neuropathologists in chronic subdural hematomas, only a few cases are documented in the literature. Furthermore, extramedullary hematopoiesis in subdural hematoma can pose a diagnostic challenge for general pathologists who encounter subdural hematoma evacuations seldom in their surgical pathology practices.
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Gopinath, Shankar P., Claudia S. Robertson, Robert G. Grossman, and Britton Chance. "Near-infrared spectroscopic localization of intracranial hematomas." Journal of Neurosurgery 79, no. 1 (1993): 43–47. http://dx.doi.org/10.3171/jns.1993.79.1.0043.
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✓ Near-infrared spectroscopy (NIRS) of the cerebral hemispheres, applied transcranially through the intact scalp and skull, was evaluated for its ability to detect the presence of an intracranial hematoma in 46 head-injured patients. In 40 patients intracranial hematomas (22 subdural, 10 epidural, eight intracerebral) were identified on computerized tomography (CT); in all 40 cases, NIRS demonstrated greater absorption of light at 760 nm on the side of the hematoma. The mean difference in optical density (OD) between the hemisphere with the hematoma and the normal hemisphere was 0.99 ± 0.30 for epidural hematomas, 0.87 ± 0.31 for subdural hematomas, but only 0.41 ± 0.11 for intracerebral hematomas. In 36 patients, the asymmetry in OD resolved after surgical evacuation of the hematoma or with spontaneous resorption of the hematoma. Four patients who developed postoperative or delayed hematomas exhibited persistence of the asymmetry in OD. Six patients had only diffuse injuries and exhibited only minor differences in OD between the hemispheres, similar to 10 patients in the control group with no head injury. It appears that NIRS is useful in the initial examination of the head-injured patient, as an adjunct to CT, and in following patients postoperatively in the intensive care unit.
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Itani, Masahiko, Satoshi Shitara, and Yoshinori Akiyama. "A convexity meningioma presenting with an acute subdural hematoma." Surgical Neurology International 11 (August 29, 2020): 263. http://dx.doi.org/10.25259/sni_328_2020.
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Background: Meningiomas presenting with acute subdural hematomas are extremely rare. To the best of our knowledge, only 45 cases have been reported to date. We report on a case of a meningioma mimicking an acute subdural hematoma as well as a thorough literature review. Case Description: A 67-year-old man with no history of trauma was referred to our hospital with sudden onset of decreased level of consciousness and left hemiplegia. Computed tomography revealed an acute convexity subdural hematoma. Emergency surgery to remove the hematoma was performed. The hematoma was found to exist in the extra-axial space and the attached dura mater and pia mater remained intact. Pathological examination revealed a transitional meningioma, the World Health Organization Grade 1. Detailed medical history taken postoperatively revealed that a convexity meningioma had been diagnosed incidentally at another facility 1 year earlier. Conclusion: Acute subdural hematomas due to meningiomas are rare, and establishing the cause is challenging. Prompt and precise diagnosis of such entities may afford patients a better prognosis.
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Adam, D., D. Iftimie, Gina Burduşa, and Cristiana Moisescu. "Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma." Romanian Neurosurgery 31, no. 1 (2017): 8–16. http://dx.doi.org/10.1515/romneu-2017-0002.
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Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.
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Protzman, Nicole M., Jennifer Kapun, and Christopher Wagener. "Thoracic spinal subdural hematoma complicating anterior cervical discectomy and fusion: case report." Journal of Neurosurgery: Spine 24, no. 2 (2016): 295–99. http://dx.doi.org/10.3171/2015.5.spine141191.
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A spinal subdural hematoma is a rare clinical entity with considerable consequences without prompt diagnosis and treatment. Throughout the literature, there are limited accounts of spinal subdural hematoma formation following spinal surgery. This report is the first to describe the formation of a spinal subdural hematoma in the thoracic spine following surgery at the cervical level. A 53-year-old woman developed significant paraparesis several hours after anterior cervical discectomy and fusion of C5–6. Expeditious return to operating room for anterior cervical revision decompression was performed, and the epidural hematoma was evacuated without difficulty. Postoperative imaging demonstrated a subdural hematoma confined to the thoracic level, and the patient was returned to the operating room for a third surgical procedure. Decompression of T1–3, with evacuation of the subdural hematoma was performed. Postprocedure, the patient’s sensory and motor deficits were restored, and, with rehabilitation, the patient gained functional mobility. Spinal subdural hematomas should be considered as a rare but potential complication of cervical discectomy and fusion. With early diagnosis and treatment, favorable outcomes may be achieved.
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Jaiswal, Manish, Vijay Sundar, Ashok Gandhi, Devendra Purohit, and R. S. Mittal. "Traumatic acute posterior fossa subdural hematoma – A case report and review of literature." Romanian Neurosurgery 21, no. 4 (2014): 485–88. http://dx.doi.org/10.2478/romneu-2014-0066.
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Abstract 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].
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Zamora, Carlos A., and Doris D. Lin. "Enhancing subdural effusions mimicking acute subdural hematomas following angiography and endovascular procedures: report of 2 cases." Journal of Neurosurgery 123, no. 5 (2015): 1184–87. http://dx.doi.org/10.3171/2014.10.jns142172.
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Hyperdense enhancing subdural effusion due to contrast extravasation has been recently described as a potential mimicker of acute subdural hematoma following a percutaneous coronary procedure. Herein, the authors report on 2 patients who presented with subarachnoid hemorrhage from ruptured cerebral aneurysms and who developed enhancing subdural effusions mimicking acute subdural hematomas after angiography and endovascular coil placement. In 1 case, the subdural effusions completely cleared but recurred after a second angiography. CT attenuation values higher than expected for blood, as well as the evolution of the effusions and density over time, allowed for differentiation of enhancing subdural effusions from acute subdural hematomas.
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Hosoda, Kohkichi, Norihiko Tamaki, Michio Masumura, Satoshi Matsumoto, and Fumio Maeda. "Magnetic resonance images of chronic subdural hematomas." Journal of Neurosurgery 67, no. 5 (1987): 677–83. http://dx.doi.org/10.3171/jns.1987.67.5.0677.
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✓ Magnetic resonance imaging (MRI) and computerized tomography (CT) scans of 18 patients with 20 chronic subdural hematomas were compared. In many ways, MRI was superior to CT for demonstrating the hematomas. In general, chronic subdural hematomas were hyperintense on both T1- and T2-weighted MRI. The T1 values of chronic subdural hematomas were significantly shorter than gray matter values and significantly longer than white matter values. The T2 values were significantly longer than both gray matter and white matter values. These findings were consistent with previous reports. However, six hematomas (30%) were iso- or hypointense on T1-weighted images. Possible mechanisms responsible for the difference in intensity of chronic subdural hematoma on MRI are discussed, and the important role of methemoglobin formation is emphasized.
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Golubovic, Jagos, Djula Djilvesi, Tomislav Cigic, Vladimir Papic, Bojan Jelaca, and Petar Vulekovic. "Rare case of dural arteriovenous fistula presenting by spontaneous acute subdural hematoma: A case report and review of literature." Vojnosanitetski pregled 77, no. 2 (2020): 237–39. http://dx.doi.org/10.2298/vsp160522111g.
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Introduction. Dural arteriovenous fistulas represent pathological acquired bonds between the meningeal blood vessels (arteries) and drainage veins associated to them. These fistulas can vary in clinical presentations, from being asymptomatic to causing serious neurological deficits, depending mostly on the localization and size. Only one fourth of dural fistulas present themselves with intracranial bleeding. This hemorrhage is most frequently localized in subarachnoid space, occasionally intracerebrally, and seldom beneath the dura mater, ie subdurally. Case report. We presented a rare case of a patient with spontaneous acute subdural hematoma. After the initial treatment and consequent imaging methods, a diagnosis of a dural arteriovenous fistula was established. After the craniotomy for hematoma evacuation, the patient underwent an uneventful endovascular treatment. Despite the rarity of non-traumatic acute subdural hematoma caused by dural arteriovenous fistula, one should not overlook the possible pathogenesis and etiology in patients with spontaneous acute subdural hematoma. Even with the absence of the symptoms and signs of subdural bleeding, dural arteriovenous fistula, as a cause of it, should not be immediately ruled out. Conclusion. Despite the rarity of non-traumatic acute subdural hematoma being caused by dural arteriovenous fistulas, one should not immediately overlook the possible pathogenesis and etiology. Cautious approach is needed when treating such diseases even in the absence of typical symptoms.
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Nedugov, German V., and Tatyana A. Fedorina. "New pathomorphological classification of subdural hematomas." Science and Innovations in Medicine 5, no. 2 (2020): 130–35. http://dx.doi.org/10.35693/2500-1388-2020-5-2-130-135.
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Objective - to develop a pathomorphological classification of subdural hematomas, which reflects the aspects of their pathogenesis and time of occurrence that are important for forensic analysis. Materials and methods. The study is based on a prospective pathomorphological analysis of the qualitative evolution of 200 of subdural hematomas in closed and open non-penetrating craniocerebral trauma. Results. The new pathomorphological classification of subdural hematomas is developed. It takes into account a hierarchical sequence of hematoma characteristics: the presence and severity of organization; the genesis of encapsulation and resorption, and the mechanism of organization. Conclusion. The developed pathomorphological classification is recommended for use in the course of forensic or medical expert analysis of subdural hematomas.
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Ito, Haruhide, Shinjiro Yamamoto, Kenichi Saito, Kiyonobu Ikeda, and Kinichi Hisada. "Quantitative estimation of hemorrhage in chronic subdural hematoma using the 51Cr erythrocyte labeling method." Journal of Neurosurgery 66, no. 6 (1987): 862–64. http://dx.doi.org/10.3171/jns.1987.66.6.0862.
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✓ Red cell survival studies using an infusion of chromium-51-labeled erythrocytes were performed to quantitatively estimate hemorrhage in the chronic subdural hematoma cavity of 50 patients. The amount of hemorrhage was determined during craniotomy. Between 6 and 24 hours after infusion of the labeled red cells, hemorrhage accounted for a mean of 6.7% of the hematoma content, indicating continuous or intermittent hemorrhage into the cavity. The clinical state of the patients and the density of the chronic subdural hematoma on computerized tomography scans were related to the amount of hemorrhage. Chronic subdural hematomas with a greater amount of hemorrhage frequently consisted of clots rather than fluid.
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Sasikala, P., Bindu Menon, and Amit Agarwal. "Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma." Romanian Neurosurgery 21, no. 1 (2014): 109–12. http://dx.doi.org/10.2478/romneu-2014-0013.
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Abstract 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.
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Barro, Brett, Scott Kobner, and Ashkon Ansari. "Decompression of Subdural Hematomas Using an Intraosseous Needle in the Emergency Department: A Case Series." Clinical Practice and Cases in Emergency Medicine 4, no. 3 (2020): 312–15. http://dx.doi.org/10.5811/cpcem.2020.6.46069.
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Introduction: Traumatic subdural hematomas beget significant morbidity and mortality if not rapidly decompressed. This presents a unique challenge to the emergency physician without immediate neurosurgical support. Case Report: We report two cases of patients in Los Angeles County with traumatic subdural hematomas and clinical deterioration in the emergency department (ED) who were treated with decompression using an intraosseous needle drill. Discussion: We believe these cases represent the first use of this technique to temporize a subdural hematoma in the ED.
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Khosla, Virender K., Vijay K. Kak, and Suresh N. Mathuriya. "Chronic spinal subdural hematomas." Journal of Neurosurgery 63, no. 4 (1985): 636–39. http://dx.doi.org/10.3171/jns.1985.63.4.0636.
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✓ Two patients with chronic spinal subdural hematomas are described. Both had a fluctuating clinical course, not previously documented in the literature. Surgical evacuation resulted in almost complete recovery. The pathogenesis of spinal subdural hematoma is discussed and the pertinent literature is reviewed.
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Moskała, Marek, Igor Gościński, Józef Kałuża, et al. "Morphological Aspects of the Traumatic Chronic Subdural Hematoma Capsule: SEM Studies." Microscopy and Microanalysis 13, no. 3 (2007): 211–19. http://dx.doi.org/10.1017/s1431927607070286.
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The morphology of the outer and inner membranes of traumatic chronic subdural hematomas (CSDHs) surgically removed from eight patients was investigated by scanning electron microscopy (SEM). Hematomas were divided into three groups based on time that had passed from the initiation of trauma to surgery. Structure of the CSDHs showed gradual morphological changes of the developing hematoma capsule. They initially included angiogenic and aseptic inflammatory reactions followed by progressive involvement of fibroblasts—proliferating and producing collagen fibrils. Numerous capillaries suggesting formation of new blood vessels were observed mainly in young hematomas removed between 15 and 21 days after trauma. In “older” hematomas (40 days after trauma), more numerous capillaries and thin-walled sinusoids were accompanied by patent, larger diameter blood vessels. Within the fibrotic outer membrane of the “oldest” hematoma capsules (60 or more days after trauma), especially in the area over the hematoma cavity, blood vessels were frequently occluded by clots. The results suggest dynamic changes in cellular and vascular organization of traumatic CSDH capsules paralleling the progression in hematoma age.
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Djilvesi, Djula, Petar Vulekovic, Tomislav Cigic, Zeljko Kojadinovic, Igor Horvat, and Mladen Karan. "Treatment of recurrent chronic subdural hematoma in a patient with Arachnoid cyst." Medical review 62, no. 9-10 (2009): 469–72. http://dx.doi.org/10.2298/mpns0910469d.
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Introduction. Arachnoid cysts are congenital fluid-filled compartments within the cerebrospinal fluid cisterns and major cerebral fissure, between two layers of the arachnoid membrane. They can develop anywhere within the subarachnoid space, most frequently located within the Sylvian fissure in the middle fossa. In young patients with the arachnoid cyst and history od head trauma chronic subdural hemathoma is present up to 4.6%. Case report. This is a case report of a 21 year old male, with left temporal lobe arachnoid cyst. Three months after minor head injury the patient was admitted to our clinic with chronic subdural hematoma compressing the surrounding tissue. The scull burr-hole trepanation was performed and the hematoma was drained. The control CT scan showed a reduced size of the chronic subdural hematoma with the smaller subdural collection of the fresh blood. Three weeks after the intervention the new CT scan showed the recurrence of the chronic subdural hematoma. The second trepanation was performed and the hematoma was drained. After the second operation, the patient was with no neurological disorders and subjective complaints. Three months after the second intervention, the control CT scan visualized only the arachnoid cyst in the temporal lobe, without the presence of the subdural hematoma. Conclusion. We conclude that a chronic subdural hematoma and reccurrent chronic subdural hematoma in patients with the arachnoid cyst in the fossa media should be drained by applying the method of burr-hole trepanation. In the patient with no subjective complaints and neurological disorders, the operative treatment of the arachnoid cyst is not considered necessary.
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de Oliveira, Adilson, Wellingson da Silva Paiva, and Manoel Jacobsen Teixeira. "Rare acute idiopathic subdural hematoma: A case report and literature review." Surgical Neurology International 11 (January 17, 2020): 9. http://dx.doi.org/10.25259/sni_499_2019.
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Background: Acute spontaneous subdural hematoma is rare. For patients under 40 years of age, we found only five previous reports. Here, we have presented a sixth case study. Case Description: A 27-year-old male initially presented with a high-intensity headache without any neurological deficits. The brain computed tomography revealed a left frontoparietal lesion, consistent with an acute epidural hematoma. However, the bone window examination showed no fracture, and at surgery, this lesion proved to be an acute subdural hematoma. Additional studies, including cerebral angiography, brain magnetic resonance imaging, and a complete coagulation work-up, were all negative. Conclusion: This case report and literature review focused on the rarity of acute idiopathic/spontaneous subdural hematomas.
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GÜL, Mehmet, Mustafa Kürşat AYRANCI, Hakan GÜNER, Mohamed Refik MEDNI, and Başar CANDER. "Cranial Subdural Hematoma Following Spinal Anesthesia: Case Report." Turkiye Klinikleri Journal of Case Reports 25, no. 3 (2017): 132–34. http://dx.doi.org/10.5336/caserep.2017-55758.
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Fujitani, Shigeta, Osamu Ishikawa, Keisuke Miura, Yasuhiro Takeda, Haruo Goto, and Keiichiro Maeda. "Factors predicting contralateral hematoma growth after unilateral drainage of bilateral chronic subdural hematoma." Journal of Neurosurgery 126, no. 3 (2017): 755–59. http://dx.doi.org/10.3171/2016.1.jns152655.
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OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage with a recurrence rate of 9.2%–26.5% after bur hole surgery. Occasionally patients with bilateral CSDH undergo unilateral surgery because the contralateral hematoma is deemed to be asymptomatic, and in some of these patients the contralateral hematoma may subsequently enlarge, requiring additional surgery. The authors investigated the factors related to the growth of these hematomas. METHODS Ninety-three patients with bilateral CSDH who underwent unilateral bur hole surgery at Aizu Chuo Hospital were included in a retrospective analysis. Findings on preoperative MRI, preoperative thickness of the drained hematoma, and the influence of antiplatelet or anticoagulant drugs were considered and evaluated in univariate and multivariate analyses. RESULTS The overall growth rate was 19% (18 of 93 hematomas), and a significantly greater percentage of the hematomas that were iso- or hypointense on preoperative T1-weighted imaging showed growth compared with other hematomas (35.4% vs 2.3%, p < 0.001). Multivariate logistic regression analysis showed that findings on preoperative T1-weighted MRI were the sole significant predictor of hematoma growth, and other factors such as antiplatelet or anticoagulant drug use, patient age, patient sex, thickness of the treated hematoma, and T2-weighted MRI findings were not significantly related to hematoma growth. The adjusted odds ratio for hematoma growth in the T1 isointense/hypointense group relative to the T1 hyperintense group was 25.12 (95% CI 3.89–51.58, p < 0.01). CONCLUSIONS The findings of preoperative MRI, namely T1-weighted sequences, may be useful in predicting the growth of hematomas that did not undergo bur hole surgery in patients with bilateral CSDH.
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Aikawa, Hisashi, and Kinuko Suzuki. "Experimental chronic subdural hematoma in mice." Journal of Neurosurgery 67, no. 5 (1987): 710–16. http://dx.doi.org/10.3171/jns.1987.67.5.0710.
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✓ A new experimental model of chronic subdural hematoma in mice is described. A single intraperitoneal injection of 6-aminonicotinamide (25 mg/kg body weight) on the 5th postnatal day induced hydrocephalus in mice with almost 100% success. Approximately 60% of the mice spontaneously developed intracranial hemorrhage 20 days after the injection. About 1 week after the hemorrhage, a lens-shaped or spherical subdural hematoma was observed, accompanied by marked dilatation of the lateral ventricles and intraventricular hemorrhage. Histological examination revealed that the hematoma contained well-organized outer and inner membranes. Fresh hemorrhage surrounded by many hemosiderin-laden macrophages was seen at the margin of the hematoma adjacent to the organizing outer membrane, in which many fibroblasts and blood vessels were noted. The inner membrane of the hematoma was made up of several tiers of flattened cells with thin-walled blood vessels. The gross morphology and histology of these hematomas closely resembled those of human chronic subdural hematoma.
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Andrews, Brian T., Joshua B. Bederson, and Lawrence H. Pitts. "Use of Intraoperative Ultrasonography to Improve the Diagnostic Accuracy of Exploratory Burr Holes in Patients with Traumatic Tentorial Herniation." Neurosurgery 24, no. 3 (1989): 345–47. http://dx.doi.org/10.1227/00006123-198903000-00006.
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Abstract Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burrhole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. Ultrasonography showed no evidence of intracerebral mass lesions in 14 (82%) of the 17 patients, demonstrated extensive contusions of the temporal lobe in 2 patients (prompting partial lobectomy in both cases), and revealed a small intraparenchymal hematoma deep within the dominant hemisphere, which was not removed, in 1 patient. The sensitivity of ultrasound images for identifying intraparenchymal lesions was evaluated postoperatively by CT or autopsy. In 15 patients (88%), the results of ultrasonography were confirmed. In 2 (12%), CT scans showed small but significant lesions at the frontal pole missed by ultrasonography; one patient had a residual subdural hematoma, and the other a small intraparenchymal hemorrhage. These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can ususally be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intractranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.
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Vien, Christine, Paul Marovic, and Brendan Ingram. "Epidural Anesthesia Complicated by Subdural Hygromas and a Subdural Hematoma." Case Reports in Anesthesiology 2016 (2016): 1–4. http://dx.doi.org/10.1155/2016/5789504.
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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.
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Sato, Masaharu, Koichi Iwatsuki, Chihiro Akiyama, Eiji Kumura, and Toshiki Yoshimine. "Implantation of a Reservoir for Refractory Chronic Subdural Hematoma." Neurosurgery 48, no. 6 (2001): 1297–301. http://dx.doi.org/10.1097/00006123-200106000-00023.
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Abstract OBJECTIVE Recurrence of chronic subdural hematoma is not rare. Among patients who experience recurrence, severe background disease may adversely influence the prognosis of chronic subdural hematoma. We treated patients with these refractory hematomas with an Ommaya cerebrospinal fluid (CSF) reservoir and analyzed the effectiveness of the treatment. METHODS Sixteen patients with refractory chronic subdural hematoma were studied. These patients had severe diseases that adversely influenced the clinical course of chronic subdural hematoma, including cerebral infarction, liver cirrhosis, thrombocytopenia, severe Parkinsonism, severe heart disease, psychiatric disease, and spinocerebellar degeneration. All patients were treated initially in the standard fashion: evacuation of the hematoma followed by irrigation and drainage of the hematoma cavity. In each patient, an Ommaya CSF reservoir was implanted after the hematoma recurred. Whenever the volume of the hematoma either decreased very slowly or increased, the reservoir was punctured. RESULTS The hematoma size decreased to less than 3 mm a median of 60 days after introduction of the reservoir. Postoperatively, 13 patients returned to their condition before the onset of hematoma. One patient died of myocardial infarction, and two patients with Parkinson's disease could not maintain their previous functional level; both remained in a partially dependent state. Complications consisted of minor bleeding in two patients and occlusion of the reservoir in two other patients. CONCLUSION By use of this method, reoperation was avoided and the patients were mobile early in the postoperative period. This method was suitable for refractory chronic subdural hematoma accompanied by severe disease that adversely influenced the clinical course.
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Yoshino, Eiji, Tarumi Yamaki, Toshihiro Higuchi, Yoshiharu Horikawa, and Kimiyoshi Hirakawa. "Acute brain edema in fatal head injury: analysis by dynamic CT scanning." Journal of Neurosurgery 63, no. 6 (1985): 830–39. http://dx.doi.org/10.3171/jns.1985.63.6.0830.
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✓ Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p < 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.
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Farzaneh, Negar, Craig A. Williamson, Cheng Jiang, et al. "Automated Segmentation and Severity Analysis of Subdural Hematoma for Patients with Traumatic Brain Injuries." Diagnostics 10, no. 10 (2020): 773. http://dx.doi.org/10.3390/diagnostics10100773.
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Detection and severity assessment of subdural hematoma is a major step in the evaluation of traumatic brain injuries. This is a retrospective study of 110 computed tomography (CT) scans from patients admitted to the Michigan Medicine Neurological Intensive Care Unit or Emergency Department. A machine learning pipeline was developed to segment and assess the severity of subdural hematoma. First, the probability of each point belonging to the hematoma region was determined using a combination of hand-crafted and deep features. This probability provided the initial state of the segmentation. Next, a 3D post-processing model was applied to evolve the initial state and delineate the hematoma. The recall, precision, and Dice similarity coefficient of the proposed segmentation method were 78.61%, 76.12%, and 75.35%, respectively, for the entire population. The Dice similarity coefficient was 79.97% for clinically significant hematomas, which compared favorably to an inter-rater Dice similarity coefficient. In volume-based severity analysis, the proposed model yielded an F1, recall, and specificity of 98.22%, 98.81%, and 92.31%, respectively, in detecting moderate and severe subdural hematomas based on hematoma volume. These results show that the combination of classical image processing and deep learning can outperform deep learning only methods to achieve greater average performance and robustness. Such a system can aid critical care physicians in reducing time to intervention and thereby improve long-term patient outcomes.
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Kpelao, E., K. A. Beketi, A. K. Moumouni, et al. "Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma." Neurosurgical Review 39, no. 2 (2015): 237–40. http://dx.doi.org/10.1007/s10143-015-0669-4.
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Cenic, Aleksa, Mohit Bhandari, and Kesava Reddy. "Management of Chronic Subdural Hematoma: A National Survey and Literature Review." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 32, no. 4 (2005): 501–6. http://dx.doi.org/10.1017/s0317167100004510.
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ABSTRACT:Objective:To survey neurosurgical practices in the treatment of chronic and subacute subdural hematoma in the Canadian adult population.Methods:We developed and administered a questionnaire to Canadian Neurosurgeons with questions relating to the management of chronic and subacute subdural hematoma. Our sampling frame included all neurosurgery members of the Canadian Neurosurgical Society.Results:Of 158 questionnaires, 120 were returned (response rate = 76%). The respondents were neurosurgeons with primarily adult clinical practices (108/120). Surgeons preferred one and two burr-hole craniostomy to craniotomy or twist-drill craniostomy as the procedure of choice for initial treatment of subdural hematoma (35.5% vs 49.5% vs 4.7% vs 9.3%, respectively). Craniotomy and two burr-holes were preferred for recurrent subdural hematomas (43.3% and 35.1%, respectively). Surgeons preferred irrigation of the subdural cavity (79.6%), use of a subdural drain (80.6%), and no use of anti-convulsants or corticosteroids (82.1% and 86.6%, respectively). We identified a lack of consensus with keeping patients supine following surgery and post-operative antibiotic use.Conclusion:Our survey has identified variations in practice patterns among Canadian Neurosurgeons with respect to treatment of subacute or chronic subdural hematoma (SDH). Our findings support the need for further prospective studies and clinical trials to resolve areas of discrepancies in clinical management and hence, standardize treatment regimens.
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McKenzie, Clark R., Setti S. Rengachary, Douglas H. McGregor, Anita Y. Dixon, and Dana L. Suskind. "Subdural Hematoma Associated with Metastatic Neoplasms." Neurosurgery 27, no. 4 (1990): 619–25. http://dx.doi.org/10.1227/00006123-199010000-00019.
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Abstract Two cases of subdural hematoma, one acute and the other chronic, associated with cancer metastatic to the dura are reported. Various mechanisms of the association of hematomas with cancer are reviewed.
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Hacıyakupoğlu, Ersin, Derviş Mansuri Yılmaz, Burak Kınalı, Taner Arpacı, Tuğana Akbaş, and Sebahattin Hacıyakupoğlu. "Recurrent chronic subdural hematoma: Report of 13 cases." Open Medicine 13, no. 1 (2018): 520–27. http://dx.doi.org/10.1515/med-2018-0076.
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AbstractChronic subdural hematoma is a frequent type of hemorrhage, which terminates with mortality if not diagnosed and treated early. The aim of this clinical study is to evaluate the patients with unilateral and bilateral recurrent chronic subdural hematoma.The study group consisted of 13 cases with unilateral and bilateral recurrent chronic subdural hematomas who underwent aggressive wide craniotomy, duraectomy, inner and outer membranectomy, dural border coagulation, incision through cortical vein trace and hang up of dural edge, between 2009 - 2016. All of our patients were diagnosed by preoperative Magnetic Resonance Imaging. We evaluated the age, gender, complaints and neurologic signs, localization and thickness of the hematoma.We can estimate that wide craniotomy, duraectomy and membranectomy is a good option in preventing recurrent chronic subdural hematoma and complications.
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Balandina, Irina A., Anatoliy A. Balandin, and Mikhail K. Pankratov. "Effectiveness of managing patients with subdural hematoma with a volume of 60-100 cm3 of various localization." Курский научно-практический вестник «Человек и его здоровье», no. 2 (June 2020): 4–9. http://dx.doi.org/10.21626/vestnik/2020-2/01.
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The aim of the study was to determine the relationship between the effectiveness of treatment of patients with traumatic brain injury complicated by subdural hematoma and the localization of the hematoma. Materials and methods. The medical documentation of 52 patients with traumatic brain injury (TBI) complicated by acute subdural hematoma with a volume of 60-100 cm3 was retrospectively analyzed. Patients were divided into 3 groups depending on the location of the hematoma: group I consisted of 21 patients (40%) with hematoma localization in the frontotemporal region, group II - 18 patients (35%) with hematoma localization in the parietal - temporal region, group III - 13 patients (25%) with hematoma localization in the frontotemporal - occipital region. When patients are discharged from the hospital, their condition indicators are calculated according to the Rankin scale. Results. More often subdural hematomas were localized in the frontotemporal and parietal-temporal regions, less often in the frontotemporal-occipital region. The severity of the victims' condition, estimated at less than 10 points according to the Glasgow scale, prevailed in patients with TBI complicated by subdural hematoma localized in the frontal-parietal-occipital region. The volume of hematoma localized in the frontal-parietal-occipital region prevailed in comparison with the frontal-temporal and parietal-temporal regions (p<0.01). After completing treatment in a specialized department, the degree of independence and disability, less than 2 points according to the Rankin scale, was established in 31 (60%) of the 52 victims; of these, in 18 (35%) patients, the hematoma was localized in the frontotemporal region. Conclusion. The results of surgical treatment of patients with TBI complicated by subdural hematoma with a volume of 60-100 cm3 are interrelated with its localization. The best indicators of treatment effectiveness were found in patients with subdural hematoma localized in the frontotemporal region. The least effective treatment was observed when the hematoma was localized in the frontal-parietal-occipital region.
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Casey, David, Bedansh Roy Chaudhary, Paul A. Leach, Amit Herwadkar, and Konstantina Karabatsou. "Traumatic clival subdural hematoma in an adult." Journal of Neurosurgery 110, no. 6 (2009): 1238–41. http://dx.doi.org/10.3171/2008.9.jns17651.
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Retroclival hematomas are a rare entity. They are usually associated with significant trauma, and patients frequently have focal neurological deficits, especially cranial nerve palsies. Previous case reports of epidural clival hematomas have been described almost exclusively in the pediatric population. The authors report a unique case of traumatic clival subdural hematoma, which has never been described in an adult except in the context of hemophilia. An 18-year-old man presented with continuing nausea and headaches following a seemingly trivial head injury. He was found to have a posterior fossa retroclival hematoma extending into the spinal subdural space but without any neurological deficits. He was treated conservatively, with a good outcome. The authors discuss the possible mechanisms of injury, management, and complications related to this rare condition, and they review the pertinent literature.
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Papacocea, Toma, Danil Adam, Raisa Croitoru, Ionut Rusu, and Alexandru Papacocea. "Factors influencing the recurrence rate of operated chronic subdural hematomas." Romanian Neurosurgery 30, no. 2 (2016): 162–67. http://dx.doi.org/10.1515/romneu-2016-0026.
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AbstractIn this study we are trying to establish a correlation between the surgical technique used for the treatment of chronic subdural hematomas and the risk of recurrence. Between 01.06.2008 and 31.05.2014, 123 patients with 138 chronic subdural hematomas (CSDH) were operated on and followed-up in our department. Among them, 16 hematomas (11,6%) recurred. Factors related to the patients (gender, age, location of the hematoma) are analyzed as possible predictors of recurrence. Several surgical techniques were used in the treatment of chronic subdural hematomas. Each of them is analyzed to find possibly connections with the recurrence risk of the size of the approach, the reposition of the bone flap, the suture of the dura and other aspects. There are obvious, statistically significant correlations between the risk of recurrence and some elements of the surgical technique employed.
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Andrews, Brian T., Lawrence H. Pitts, Mary P. Lovely, and Henry Bartkowski. "Is Computed Tomographic Scanning Necessary in Patients with Tentorial Herniation?" Neurosurgery 19, no. 3 (1986): 408–14. http://dx.doi.org/10.1227/00006123-198609000-00012.
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Abstract Computed tomographic (CT) scans are performed on virtually all patients with severe head injury at the time of admission. Because of the time involved in obtaining these studies, the evacuation of significant intracranial mass lesions is delayed. To avoid such delays, the authors performed burr-hole exploration for the diagnosis of intracranial hematomas before CT scans were obtained in 100 consecutive head-injured patients with clinical signs of tentorial herniation or upper brain stem dysfunction upon admission to the emergency room. Patients in whom a hematoma was discovered had a craniotomy for evacuation of the clot: those in whom the exploration was negative had a CT brain scan immediately after operation. Burr-hole exploration revealed extracerebral mass lesions in 56 patients. In 38 patients, the exploration was negative, and postoperative CT scanning showed no significant hematoma. Of 6 patients in whom the CT scan demonstrated extraaxial hematomas requiring surgical evacuation, 4 had subdural hematomas that were missed because the exploration was incomplete: 1 patient had an epidural hematoma and 1 had a subdural hematoma contralateral to a craniotomy on the side of a positive initial burr-hole exploration. Our results indicate that the relatively small subgroup of head-injured patients with early tentorial herniation or upper brain stem compression have a high incidence of immediate extraaxial hematomas and a low incidence of intracerebral hematomas. This is particularly true of patients over 30 years of age and those who suffer low speed trauma, such as falls and vehicle-pedestrian accidents.
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Huntoon, Kristin, Umang Khandpur, David Dornbos, and Patrick P. Youssef. "Spinal dural arteriovenous fistula masquerading as subdural hematoma." Surgical Neurology International 11 (June 6, 2020): 142. http://dx.doi.org/10.25259/sni_160_2020.
Full textAbstract:
Background: This case highlights an angiographically occult spinal dural AVF presenting with a spinal subdural hematoma. While rare, it is important that clinicians be aware of this potential etiology of subdural hematomas before evacuation. Case Description: A 79-year-old female presented with acute lumbar pain, paraparesis, and a T10 sensory level loss. The MRI showed lower cord displacement due to curvilinear/triangular enhancement along the right side of the canal at the T12-L1 level. The lumbar MRA, craniospinal CTA, and multivessel spinal angiogram were unremarkable. A decompressive exploratory laminectomy revealed a subdural hematoma that contained blood products of different ages, and a large arterialized vein exiting near the right L1 nerve root sheath. The fistula was coagulated and sectioned. Postoperatively, the patient regained normal function. Conclusion: Symptomatic subdural thoracolumbar hemorrhages from SDAVF are very rare. Here, we report a patient with an acute paraparesis and T10 sensory level attributed to an SDAVF and subdural hematoma. Despite negative diagnostic studies, even including spinal angiography, the patient underwent surgical intervention and successful occlusion of the SDAVF.