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1.
I-Chang Su Kuo-Chuan Wang Shih-Hao Huang Chien-Hsun Li Lu-Ting Kuo Jin-Er Lee Ham-Min Tseng Yong-Kwang Tu 《Clinical neurology and neurosurgery》2010
Objectives
Acute subdural hematoma (SDH) normally appears as a panhemispheric collection of blood with a crescent configuration. However, a number of SDH show lentiform appearances, mimicking acute epidural hematoma (EDH). In this study, we reported our experiences with this special disease entity. Radiological features that aided in the accurate localization of the hematoma were also addressed.Patients and methods
From among 51 acute SDH cases who were surgically treated between July 2007 and April 2008, five cases whose SDH had a localized convex appearance were enrolled. Surgical records and CT images were retrospectively reviewed. Important CT features that could differentiate lentiform SDH from EDH were especially analyzed.Results
Subdural adhesions were major causes of localized SDH in four out of five patients, all of whom had previous neurosurgical interventions or radiotherapy. Though those hematomas appeared as biconvex on CT scans, four differential features could be identified in favor of SDH. These included a crescentic tail, an obtuse angle at the margin of the hematoma, a dural line above the hematoma and a direct connection to the underlying intracerebral hematomas.Conclusions
Biconvex localized SDH might be misinterpreted as acute EDH if the diagnosis is based on the shape of the hematoma alone. This study emphasized that a detailed evaluation of surgical histories and CT features are mandatory in differentiating lentiform SDH and EDH. 相似文献2.
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 subdural hematoma. Three days after surgery, weakness of the extremities developed, and contralateral acute subdural bleeding within the previous subdural hygroma was diagnosed by CT scan of the brain. The pathophysiological mechanism of this rare complication was discussed, and the relevant literature was also reviewed.Chronic subdural hematoma (SDH) is one of the most common entities managed in daily neurosurgical practice, and is known to have a good prognosis after minimal burr-hole craniostomy.1 Ipsilateral acute SDH or recurrence of hematoma is the most well-documented complication of this simple surgery.1-3 However, the development of a contralateral acute SDH following burr-hole craniostomy with closed-system drainage has been previously reported to be a rare but devastating postoperative complication.4,5 Herein, we report a case of contralateral acute SDH occurring after evacuation of chronic SDH with the coexistence of contralateral subdural hygroma. The relevant literature is also reviewed. Our objective in presenting this particular case is to highlight this rare but devastating complication in the management of this disease. 相似文献
3.
Hoya K Tanaka Y Uchida T Takano I Nagaishi M Kowata K Hyodo A 《Clinical neurology and neurosurgery》2012,114(3):211-216
Objective
The presence of a cerebrospinal fluid (CSF) shunt is a predisposing factor for the development of subdural hematoma (SDH) in patients with hydrocephalus. However, few reports have addressed how patients with a CSF shunt should be treated in the event of traumatic acute SDH. The purpose of this study was to show how post-traumatic management of CSF shunt affects acute SDH in adult patients with hydrocephalus.Methods
Twelve patients were studied retrospectively. Pressure settings of shunt valve prior to head injury (HI), severity of HI, treatment on admission, changes in SDH thickness and subsequent hydrocephalus were mainly analyzed.Results
Ten patients experienced mild HI, with nine showing neurological deterioration until admission. Five patients needed surgical hematoma removal soon after admission. SDH recurred in four cases where shunt pressure levels were kept relatively low. Shunt ligation or raising the pressure level in the programmable valve proved effective for controlling postoperative SDH in such cases. Six of the remaining seven patients underwent only shunt ligation or readjustment of pressure level in the programmable valve on admission. SDH thickness was reduced as ventricles dilated without major neurological complications. Four patients showed delayed development of SDH even though shunts were kept ligated.Conclusions
Hematoma removal alone may result in hematoma recurrence and require a second treatment comprising shunt management to effectively control hematoma. Using shunt management as the only initial treatment can reduce hematoma volume, but some patients may suffer delayed SDH development and require surgery. 相似文献4.
Lee KS Shim JJ Yoon SM Doh JW Yun IG Bae HG 《Journal of Korean Neurosurgical Society》2011,50(6):512-516
Objective
Patients with asymptomatic chronic subdural hematoma (SDH) are prone to fall or slip. Acute trauma on these patients may develop acute subdural bleeding over the chronic SDH. We recently experienced 9 patients with acute-on-chronic SDH. We report the clinical and radiological features of this lesion.Methods
We retrospectively examined the computed tomographic (CT) scans of 107 consecutive patients who diagnosed as chronic SDH from January 2008 to December 2010. All cases of CSDH were diagnosed on CT with or without MRI scan.Results
Acute-on-chronic SDH is not rare, being 8% of chronic SDH. The most common cause of trauma was a slip in drunken state. Alcoholism with multiple episodes of trauma was one of the prominent histories. Acute-on-chronic SDH appeared as a hyperdense layer of clot with irregular blurred margin or lumps in liquefied hematoma. Single or two burr holes was usually effective to remove the hematoma.Conclusion
Repeated trauma may cause acute bleeding over the chronic SDH. It will be helpful to understand the role of repeated trauma as a mechanism of hematoma enlargement. 相似文献5.
Osman Fikret Sonmez Yasin Temel Veerle Visser-Vandewalle Bunyamin Sahin Ersan Odacı 《Clinical neurology and neurosurgery》2013
Objective
Endoscopic third ventriculostomy (ETV) is a procedure commonly applied in the treatment of non-communicating (obstructive) hydrocephalus. One of the rare complications that can occur following ETV is a subdural effusion, even though this procedure is considered to be a more controlled and natural method of cerebrospinal fluid drainage compared to external drainage. In this study, we evaluated the intracranial volume changes and subdural effusion of patients following ETV using Cavalieri method.Method
Volumes analysis of the cranial cavity, brain, ventricles and subdural effusions of two patients after ETV were performed on computed tomography images using the Cavalieri principle, one of the stereological methods.Results
The preoperative total intracranial volumes and the preoperative brain volumes decreased for both patients during the postoperative 3rd, 10th and 30th days. Following ETV, the volumes of the lateral ventricles of both patients initially decreased during the postoperative 3rd and 10th days, however, the volumes returned almost to their preoperative size by the end of the 30th day. The effusions were seen on the postoperative 3rd and 10th days resolved by the end of the 30th day.Conclusion
Our results show that the Cavalieri method can be used to unbiased prediction of intracranial volume changes and to follow the subdural effusion after the ETV surgery. 相似文献6.
Oskar P. Aspegren Ramona ÅstrandMaria I. Lundgren Bertil Romner 《Clinical neurology and neurosurgery》2013
Objective
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.Methods
We conducted a retrospective review of 239 patients undergoing surgery for CSDH over a period of six years (2006–2011). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, coagulation status, laterality, surgical method and recurrence.Results
Seventy-two percent of the patients were male and the mean age was 71.8 years (range 28–97 years). Previous fall with head trauma was reported in 60% of the patients while 16% were certain of no previous head trauma. The majority of patients (63%) in the non-trauma group were receiving anticoagulants and/or antiplatelet agent therapy prior to CSDH presentation, compared to 42% in the trauma group. Twenty-four percent experienced recurrence of the CSDH. There was no association between recurrence and anticoagulant and/or antiplatelet agent therapy.Conclusion
Anticoagulant and/or antiplatelet aggregation agent therapy is more prevalent among non-traumatic CSDH patients but does not seem to influence the rate of CSDH recurrence. 相似文献7.
Kawasaki Y Fujiki M Ooba H Sugita K Hikawa T Abe T Ishii K Kobayashi H 《Clinical neurology and neurosurgery》2012,114(7):976-980
Objective
To evaluate the cortical excitability in patients with mild cortical compression.Methods
The present study used short interval intracortical inhibition (SICI), intracortical facilitation (ICF), and short latency afferent inhibition (SAI) to evaluate motor cortex excitability in 16 chronic subdural hematoma (CSDH) patients with memory impairment and compared the data with those of 16 healthy controls.Results
SAI was reduced in patients compared with controls (99 ± 14 vs. 47 ± 11% of the test size; p < 0.0001, unpaired t-test). CSDH patients tended to have a high resting motor threshold and less pronounced SICI and ICF than controls, but these differences were not significant. Treatment of hematoma improved memory impairment and SAI in CSDH patients with wide individual variations that ranged from an increase of 74% to 17% of test size.Conclusion
These findings suggest that measuring SAI may provide a means of probing the integrity of cortical cholinergic networks in a compressed human brain. 相似文献8.
Sari A Sert B Dinc H Kuzeyli K 《Journal of neuroradiology. Journal de neuroradiologie》2006,33(1):67-69
We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma. 相似文献
9.
F. Siddiqi MD R. Hammond MD D. Lee MD N. Duggal MD 《Journal of clinical neuroscience》2005,12(8):949-953
Spontaneous chronic spinal subdural hematoma is rare. We describe a case of spontaneous chronic spinal subdural hematoma associated with arachnoiditis and syringomyelia in a 76-year old woman who presented with a 14-year history of progressive myelopathy. MRI scan revealed a thoraco-lumbar subdural cystic lesion and a thoracic syrinx. The patient underwent thoracic laminectomy and decompression of the lesion, which was a subdural hematoma. A myelotomy was performed to drain the syrinx. Pathological examination revealed features consistent with chronic subdural membrane. This report attempts to elucidate the pathogenesis of chronic spinal subdural hematoma. We discuss possible etiological factors in light of the current literature and pathogenesis of both spinal subdural hematoma and syrinx formation. 相似文献
10.
Tammam Abboud Lasse Dührsen Christina Gibbert Manfred Westphal Tobias Martens 《Neurocirugía (Asturias, Spain)》2018,29(2):86-92
Introduction
Chronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH.Methods
A cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6.Results
201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p = 0.001 and p = 0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence.Conclusion
Administration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort. 相似文献11.
Raimund Firsching Markus Heimann Reinhold Alexander Frowein 《Neurological research》2013,35(3):257-260
AbstractIn a retrospective study volumes of 42 extradural and 702 subdural traumatic hematomas were evaluated. Results were related with the time interval between injury and initial CT scan, outcome, coma grade and subject age. Mean volumes were found to increase with time after the injury. In the first bour volumes of 8 intracranial hematomas were hardly space consuming, while they became clearly space consuming in the second and in later hours after the injury. It was therefore concluded that it should not take longer than one hour until a CT scan be performed when an intracranial post-traumatic hematoma is suspected in the comatose patient. [Neural Res 1997; 19: 257–260] 相似文献
12.
Seong Son Chan Jong Yoo Sang Gu Lee Eun Young Kim Chan Woo Park Woo Kyung Kim 《Journal of Korean Neurosurgical Society》2013,54(3):211-219
Objective
The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression.Methods
Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors.Results
No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG.Conclusion
A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging. 相似文献13.
S. MoscoviciI. Paldor F. Ramirez de-NoriegaE. Itshayek Y. ShoshanS. Spektor M. Attia 《Journal of clinical neuroscience》2011,18(4):563-565
We report a patient with minor head trauma-related bilateral hemispheric subdural hematoma (SDH) and subsequent delayed spinal SDH or presumed migration to the lumbar spine. An acutely confused 88-year-old man presented to the Emergency Department after minor head trauma. Head CT scan revealed a small hemispheric SDH. The patient was admitted for observation. CT scan 6 hours later showed bilateral SDH with extension to the tentorium. Three days later SDH had resolved leaving bilateral subdural hygromas. Local leg weakness localized to the lumbar spine developed on day 6; spinal CT scan and MRI revealed a posterior L5-S1 collection. A pure subacute subdural hematoma compressing the cauda equina was drained after an L5 laminectomy. His lower leg weakness improved. The patient was discharged to rehabilitation two weeks after surgery. Patients with traumatic SDH who develop late-onset neurological deterioration attributable to any region of the spine should be evaluated for spinal SDH. 相似文献
14.
Park SH Kang DH Park J Hwang JH Hwang SK Sung JK Hamm IS 《Clinical neurology and neurosurgery》2011,113(4):272-276
Objective
We investigated the relationship between fibrinolytic factors and computed tomography (CT) findings in patients with chronic subdural hematomas (CSDHs).Methods
Thirty-one patients with CSDHs were divided on the basis of CT findings into heterogeneous and homogeneous groups. A sample from the subdural hematoma was obtained at surgery to measure the concentrations of fibrinogen and D-dimer.Results
The mean level of fibrinogen in the heterogeneous group, including the layering (n = 4) and mixed (n = 10) type, was 88.2 ± 121.2 mg/dL, whereas in the homogeneous group, including high density (n = 2), isodensity (n = 9), and low density (n = 6) types, it was <25 mg/dL. The concentration of fibrinogen was significantly higher in the heterogeneous group than in the homogeneous group (p = 0.006). The mean level of D-dimer in the heterogeneous group was 35,407.9 ± 16,325.5 μg/L, whereas for the homogeneous group it was 1476.4 ± 2091.4 μg/L. The concentration of D-dimer was significantly higher in the heterogeneous group than in the homogeneous group (p < 0.001).Conclusions
The layering and mixed types of CSDH exhibited higher concentrations of fibrinogen and D-dimer in subdural hematoma than the homogeneous types. These fibrinolytic factors appear to be associated with evolution in CSDHs with heterogeneous density. 相似文献15.
Thomas Arjan van Essen Jorn Jesse HeeringaJan-Paul Muizelaar 《Clinical neurology and neurosurgery》2010
Objectives
Whether or not a patient could benefit from a computed tomography (CT) scan and/or the evaluation by a neurosurgeon requires judgment by a clinician of the risk of clinical deterioration. To assess this clinical process we aimed to determine how many of the consultations to the Neurosurgical department (NSG) of UC Davis are appropriately indicated for neurosurgical input or management. Secondly, we investigated how CT is used in the University of California Davis Medical Center (UCDMC) in NSG consults of head injured patients compared to a validated and highly sensitive decision making tool, the Canadian CT Head Rule (CCHR).Patients and methods
Patients were enrolled in this prospective study if they presented to a department of UCDMC other than neurosurgery and when, consequently, the NSG was consulted. The emergency consultations were categorized into three groups: head injury, spine injury and others. Subsequently, the appropriateness of the consultations was evaluated based on the need for evaluation determined by the likelihood of clinically important intracranial lesions for head injury and by the likelihood of clinically important spinal cord injury or spinal cord instability for spine injury. Of the head injured patients with a CT scan the appropriateness of the scan was determined by way of the CCHR.Results
Between 21 July and 15 August 2008 99 consultations were included: 32 patients with head injuries, 29 with spine injuries, 34 with other diseases and 4 not sufficiently documented patients. 23 classified inappropriate, 69 appropriate and 7 remained unclassified. Of the head injured patients, 10 (31.2%) had gotten a CT scan that was classified inappropriate.Conclusion
NSG receives 3–4 requests for consultations per day from the other services of UCDMC, of which one is of questionable validity and one of the three CT scans for head injury is not necessary. These results suggest the use of the CCHR in UCDMC would improve patient care and could result in large health-care savings, while there would also be less radiation exposure. 相似文献16.
Background
Surgery for medically resistant epilepsy is safe and effective. However, when noninvasive techniques are insufficient, then consideration is given to invasive electrocorticography (EcoG).Objective
The aim of the study was to analyze results and complications of subdural electrodes placement in the treatment of intractable epilepsy.Methods
Ninety-one consecutive patients who underwent placement of subdural electrodes (1999-2010) were considered for this study. All patients underwent a standardized pre-operative evaluation. Invasive subdural electrode placement was considered when there were inadequate ictal recordings, there was discordance between EEG and neuroimaging or the epileptogenic zone was localized near eloquent cortex.Results
Resective epilepsy surgery was performed in 70/91 patients (76.9%). Twenty-four out of seventy (34.3%) who underwent surgical resection were seizure-free (CL-I) at last follow-up. A statistical evaluation revealed a very strong trend for patients with positive lesional pre-operative MRI to have improved outcomes compared to normal brain MRI population (p = .028). There were 10 surgical related complications (11%), but no mortality or permanent morbidity. Statistical analysis demonstrated that placement of a subdural grid in any combination was statistically significant (p = .01) for surgical complications.Conclusions
Invasive monitoring is a useful and necessary technique for the surgical treatment of intractable epilepsy. Careful surveillance is required during the monitoring period especially when the patient has undergone large subdural grid placement. A good working hypothesis can minimize complications and achieve better outcomes. 相似文献17.
Introduction
High intracranial compliance states requiring negative pressure drainage, otherwise known as low-pressure hydrocephalus syndromes, are rare conditions. The use of siphoning, enabled by revision to an adjustable shunt without an anti-siphon device, has been largely unexplored in low-pressure hydrocephalus.Methods
Three patients with presumed normal pressure hydrocephalus (NPH) presented with unresolved symptoms, including urinary incontinence, disturbed gait, and cognitive dysfunction. Each was inadequately treated despite confirmed functioning Strata II valves (with built-in siphon control device) calibrated to the lowest pressure setting for maximum drainage. Surgical revision to Strata non-siphon control (NSC) valves was performed to allow for additional drainage via siphoning.Results
Following revision to a shunt with a “siphoning” device, each patient achieved improved neurological function. Each differential pressure valve was initially set to a higher setting than with the Strata II valve. One of our patients experienced the formation of a subdural hematoma after shunt revision; resolution following adjustment of the valve to a higher setting suggests that siphoning may be of less importance to overdrainage syndromes when compared with valve opening pressure.Conclusion
Our findings indicate that intermittent intracranial hypotension achieved by siphoning is effective in the treatment of a subset of patients presenting clinically with NPH. Direct conversion to a shunt system without an anti-siphon device allows reduction of ventricular size without the risk associated with external ventricular drainage (EVD). With conversion to the Strata NSC valve, our patients had sustained clinical improvement, even at higher valve settings. 相似文献18.
Background
Intracranial subarachnoid hemorrhage (SAH) and spinal subdural hematoma (SDH) are rare complications of spine surgery, thought to be precipitated by cerebrospinal fluid (CSF) hypotension in the setting of an intraoperative durotomy or postoperative CSF leak. Considerable clinical variability has been reported, requiring a high level of clinical suspicion in patients with a new, unexplained neurologic deficit after spine surgery.Methods
Case report.Results
An 84-year-old man developed symptomatic spinal stenosis with bilateral lower extremity pseudoclaudication. He underwent L3-5 laminectomy at an outside institution, complicated by a small, incidental, unrepairable intraoperative durotomy. On postoperative day 2, he became confused; and head CT demonstrated intracranial SAH with blood products along the superior cerebellum and bilateral posterior Sylvian fissures. He was transferred to our neurosciences ICU for routine SAH care, with improvement in encephalopathy over several days of supportive care. On postoperative day 10, the patient developed new bilateral lower extremity weakness; MRI of the lumbar spine demonstrated worsening acute spinal SDH above the laminectomy defect, from L4-T12. He was taken to the OR for decompression, at which time a complex 1.5-cm lumbar durotomy was identified and repaired primarily.Conclusions
We report the first case of simultaneous intracranial SAH and spinal SDH attributable to postoperative CSF hypotension in the setting of a known intraoperative durotomy. Although rare, each of these entities has the potential to precipitate a poor neurologic outcome, which may be mitigated by early recognition and treatment.19.
Paul M. Arnold Heather E. Floyd Karen K. Anderson Kathy L. Newell 《Clinical neurology and neurosurgery》2010
Background
Carcinoid tumors are rare, slow-growing neuroendocrine tumors that most frequently arise from the gastrointestinal tract or the lungs. Common sites of carcinoid metastases include lymph nodes, liver, lungs, and bone, with rare metastasis to the spine. We report three patients who presented with spinal cord compression secondary to carcinoid metastases to the spine.Methods
Three patients presented with symptoms characteristic of spinal cord compression, including neck pain, radiculopathy, thoracic pain, weakness and numbness. All three patients underwent radiographic work-up and surgical treatment.Results
One patient continued to have decreased strength in her right upper extremity, but was able to participate in physical therapy; another patient's numbness eventually resolved after completion of physical therapy; and the third patient's pain dramatically improved after surgery. One patient died more than two years post-surgery due to widespread metastasis; the other two remain alive more than two years post-surgery.Conclusions
Carcinoid tumor metastases rarely cause spinal cord compression, but should be considered when patients present with neurological symptoms consistent with cord compression. Work-up should include magnetic resonance imaging (MRI), computed tomography (CT) of the spine, and perhaps CT-guided biopsy. Surgery is indicated for symptomatic spinal cord compression in patients with carcinoid tumors. 相似文献20.
Se-Yang Oh Jeong-Taik Kwon Yong-Sook Park Taek-Kyun Nam Seung-Won Park Sung-Nam Hwang 《Journal of Korean Neurosurgical Society》2011,50(1):6-10