应用Subdural专用引流管治疗慢性硬膜下血肿

目的比较钻孔闭式引流和Subdural专用引流管穿刺引流在慢性硬膜下血肿(CSDH)中的疗效。方法回顾分析我院收治的88例CSDH患者,46例行钻孔闭式引流(A组),42例行Subdural专用引流管穿刺引流术(B组),比较两组治疗效果。结果A组40例一次钻孔引流成功,6例因继发颅内血肿而改行开颅手术,再手术率13.04%,癫发作3例;B组41例一次性引流成功,1例因继发血肿再次手术,再手术率2.38%,无癫发作。结论Subdural引流术较钻孔冲洗闭式引流术更微创、更安全有效,并发症少,宜作为治疗CSDH的首选方法。     

应用Subdural引流管及尿激酶治疗慢性硬膜下血肿

我院自2004年1月～2010年9月采用Subdural引流管治疗慢性硬膜下血肿119例,术后24h复查头颅CT,根据血肿残留情况注入尿激酶溶解血肿,取得满意疗效,报告如下。1资料与方法1.1一般资料男96例,女23例;年龄44～86岁,平均64.5岁,有明确头部外伤史108例,病程20～180d,平均41.5d。1.2临床表现头痛、头晕78例,恶心、呕吐20例,肢体轻偏瘫32例,锥体束征阳性8例,精神障碍9例,癫痫发作6例,嗜睡11例,神志朦胧5例,昏迷2例。     

What Determines the Laterality of the Chronic Subdural Hematoma?

Objective

Chronic subdural hematomas (CSDH) are more common on the left hemisphere than on the right. We verified this left predilection of CSDH and tried to explain the reason for this discrepancy.

Methods

We investigated the laterality of CSDH in 182 patients who were treated from January 2005 to December 2009. We examined the symmetry of the cranium and the location of the lesion.

Results

CSDH was more common on the left-side. The cranium was symmetric in 63 patients, asymmetric in 119 patients. The asymmetric crania were flat on the right-side in 77 patients, on the left-side in 42 patients. The density of the CSDHs was hypodense in 29 patients, isodense 132 patients, and the others in 21 patients. Bilateral hematomas were more common in the hypodense group. In the right flat crania, the hematoma was more commonly located on the opposite side of the flat side. While in the left flat crania, the hematoma was more common on the same side.

Conclusion

CSDHs occurred more frequently on the left side. The anatomical asymmetry of the cranium influences the left predilection of CSDH.     

Can Subdural Hematoma Be a Trigger for Guillain–Barré Syndrome?

Guillain–Barré syndrome (GBS) is an acute inflammatory polyneuropathy which follows a precipitating event in approximately two thirds of cases. Although its pathogenesis is unclear, it is likely to be a consequence of an immune-mediated process. In the literature there are three case reports of GBS following subarachnoid hemorrhage, subdural hematoma, and facial bone fracture after head trauma.The unique feature of our case with GBS after subdural hematoma is the presence of cerebellar symptoms. We believe that GBS results from an aberrant immune response following trauma that somehow mistakenly attacks the nerve tissue of its host, and we discuss the effects of the trauma of head injury on cellular and humoral immunities and the absence of antiganglioside antibody (anti-GD1b IgG, which is accused of ataxia and cerebellar symptoms) in this case report.     

Wolf in Sheep’s Clothing: Acute Chloroma Disguised as a Subdural Hematoma

Background  

Subdural hematomas are not infrequent among patients with hematologic disorders as they are prone to thrombocytopenia from their disease and chemotherapy. However, rarely these patients can also have leukemic involvement of the subdural space.     

Subdural hematoma in infants: can it occur spontaneously? Data from a prospective series and critical review of the literature

Background

Subdural hematomas (SDH) in infants often result from nonaccidental head injury (NAHI), which is diagnosed based on the absence of history of trauma and the presence of associated lesions. When these are lacking, the possibility of spontaneous SDH in infant (SSDHI) is raised, but this entity is hotly debated; in particular, the lack of positive diagnostic criteria has hampered its recognition. The role of arachnoidomegaly, idiopathic macrocephaly, and dehydration in the pathogenesis of SSDHI is also much discussed.

Purpose

We decided to analyze apparent cases of SSDHI from our prospective databank.

Materials and methods

We selected cases of SDH in infants without systemic disease, history of trauma, and suspicion of NAHI. All cases had fundoscopy and were evaluated for possible NAHI. Head growth curves were reconstructed in order to differentiate idiopathic from symptomatic macrocrania.

Results

Sixteen patients, 14 males and two females, were diagnosed with SSDHI. Twelve patients had idiopathic macrocrania, seven of these being previously diagnosed with arachnoidomegaly on imaging. Five had risk factors for dehydration, including two with severe enteritis. Two patients had mild or moderate retinal hemorrhage, considered not indicative of NAHI. Thirteen patients underwent cerebrospinal fluid drainage. The outcome was favorable in almost all cases; one child has sequels, which were attributable to obstetrical difficulties.

Conclusion

SSDHI exists but is rare and cannot be diagnosed unless NAHI has been questioned thoroughly. The absence of traumatic features is not sufficient, and positive elements like macrocrania, arachnoidomegaly, or severe dehydration are necessary for the diagnosis of SSDHI.