Rapid resolution of acute subdural hematoma and effects on the size of existent subdural hygroma: a case report

The diagnosis and management of acute subdural hematoma is important in neurosurgery practice. Rapid spontaneous resolution of acute subdural hematoma within a few hours is seen rarely on the CT scan. We present a case that enlarged the existent subdural hygroma showing rapid resolution of acute subdural hematoma with resolution in 9 hours after the trauma. Additionally, the follow-up CT scans in the 1st month showed the decrease of enlargement of subdural hygroma. The resolution of acute subdural hematoma and effect of acute subdural hematoma on subdural hygroma must be considered during management. The relation of acute subdural hematoma and subdural hygroma is important for the resolution and management of acute subdural hematoma.     

长时间应用甘露醇致硬膜下积液三例

目的对3例长时间应用甘露醇导致硬膜下积液的发生机制及治疗进行初步探讨。方法回顾性分析我院神经外科收治的因过度应用甘露醇出现硬膜下积液的3例颅脑损伤患者的临床资料,其中2例实行开颅手术,均应用甘露醇静点降颅压,半月后出现硬膜下积液。结果停用甘露醇后硬膜下积液不见好转,应用锥颅置管外引流术当时有效,拔除引流管后硬膜下积液又恢复原状,采用硬膜下积液腹腔分流术缓解。结论颅脑损伤后应用甘露醇时间太长易形成硬膜下积液,硬膜下积液腹腔分流术是治疗硬膜下积液的有效措施。     

Escherichia Coli Subdural Empyema Following Subdural Hygroma in Elderly Patient

Subdural empyema of the brain is an uncommon disorder that occurs more frequently in children than in adult. Authors report a very rare of subdural empyema following the subdural hygroma after mild head injury. The exact mechanism of infection is not known. However, we have to consider subdural infection as one of differential diagnosis in elderly patient with subdural hygroma when new abnormal density lesion is developed in the subdural space.     

Subdural empyema in infant meningitis: diagnosis,therapy, and prognosis

Collections of subdural fluid during the course of infant Hemophilus influenzae meningitis have been demonstrated in the past by routine subdural taps and, more recently, by computed tomography. While the fluid is usually a benign effusion, the clinical picture and CT pattern may suggest a subdural abscess (empyema) necessitating further subdural punctures. This is a review of nine infants with subdural empyema. As reported in the literature, a remarkably good prognosis is apparent following treatment with subdural taps and systemic antibiotics. Six of seven H. influenzae cases were ampicillin-resistant in this series.     

Calcified chronic subdural hematoma mimicking calvarial mass: a case report

Head trauma is a frequent cause of mortality and morbidity in the pediatric population. Chronic subdural hematoma is the most common traumatic lesion in head injury. Chronic subdural hematomas are rare in children older than 2 years old; they are more frequent during adolescence. Calcified or ossified chronic subdural hematoma is a rare entity that usually presents as a space-occupying lesion over the cerebral convexity. Chronic calcified subdural hematomas are reported less than chronic subdural hematomas. In this article, we report a successfully treated patient with surgical removal case of calcified chronic subdural hematoma mimicking calvarial mass.     

深静脉穿刺管在治疗婴儿硬膜下血肿及积液中的临床应用

目的 探讨深静脉穿刺管在治疗婴儿硬膜下血肿及积液中的应用疗效.方法 使用深静脉穿剌管治疗婴幼儿硬膜下血肿及积液19例,其中急性硬膜下血肿9例,慢性硬膜下血肿6例,硬膜下积液4例,经前囟穿剌置入深静脉穿剌管于硬膜下持续引流治疗硬膜下血肿及积液,持续引流3～7 d,观察疗效.结果 均穿刺置管成功,术后1～7 d复查头颅CT,硬膜下血及硬膜下积液均基本清除,全部病例均存活.结论 深静脉穿剌管治疗婴儿硬膜下血肿及积液中是安全有效的方法.     

外伤性硬膜下积液在向慢性硬膜下血肿转化过程中的相关因素配对回归分析

目的 回顾性研究外伤性硬膜下积液向慢性硬膜下血肿(CSDH)转化过程中相关因素的影响.方法 对22例慢性硬膜下血肿中明确有外伤性硬膜下积液(TSE)的患者根据性别、年龄、职业配对单纯外伤性硬膜下积液的患者(1∶2配对,共44例).多因素回归分析外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间在硬膜下积液CT值、积液部位、积液体积、凝血功能4种相关因素间有无差异.结果 外伤性硬膜下积液转化为慢性硬膜下血肿组与单纯外伤性硬膜下积液组间患者的伤后硬膜下积液CT值、积液部位间差异存在统计学意义.结论 外伤性硬膜下积液存在向慢性硬膜下血肿转化的趋势,患者硬膜下积液的CT值相对较高、积液位于额颞部患者这一趋势尤为明显.     

慢性硬膜下血肿钻孔引流术后硬膜下脓肿形成的治疗

目的慢性硬膜下血肿术后并发硬膜下脓肿极为罕见,治疗方式多为再次置管引流,而选择开颅治疗极少,本文将对其开颅治疗进行讨论。方法回顾报道开颅手术治疗的两例慢性硬膜下血肿钻孔引流术后并发硬膜下脓肿的病例。结果两例病人预后均较好,未残留明显的神经系统受损体征。结论硬膜下脓肿术前的影像学评估十分重要,手术方式是选择再次钻孔引流还是开颅手术需依据术前影像学特征来合理选择,静脉应用敏感抗生素一定要足量、全程。     

Infantile acute subdural hematoma

A retrospective analysis of the infantile acute subdural hematoma was made with special reference to its pathogenesis. In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. In 3 patients, a subdural membrane, as seen in adult chronic subdural hematoma, was found. In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with craniocerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury.     

Spontaneous chronic spinal subdural hematoma associated with spinal arachnoiditis and syringomyelia

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.     

A method for continuous external drainage in the management of infantile subdural collections

There is no consensus on the management of infantile chronic subdural collections. Subdural tapping, craniotomy and removal of membranes, and shunting from the subdural space have all been used. We performed continuous external subdural drainage (CESD) as a step prior to subdural-peritoneal shunt placement in the management of infantile chronic subdural fluid collections. A lumbar drainage set was used for CESD. The catheter was placed in the subdural space through the anterior fontanel with a Touhy needle. This percutaneous technique seems an easy and safe method for CESD in infants with chronic subdural collections.     

Subdural hygroma in association with middle fossa arachnoid cyst: acetazolamide therapy

Intracranial arachnoid cysts are cerebrospinal fluid-filled collections between arachnoid layers. While many are silent, arachnoid cysts can become symptomatic if there is sudden expansion, haemorrhage or rupture with the development of subdural hygroma or subdural hematoma. Several studies have demonstrated the association of arachnoid cysts with subdural hygroma and subdural hematoma. We describe a 9-year-old girl with a moderate-sized middle-fossa arachnoid cyst and bilateral frontal subdural hygroma presenting with raised intracranial pressure. She was treated with acetazolamide which resulted in resolution of the subdural hygroma and relief of symptomatology.     

Infected subdural hematoma

A case is presented in which Escherichia coli seeded a pre-existing chronic subdural hematoma. A 77-year-old woman was admitted to our hospital because of lethargy, left hemiparesis and fever. Drainage through a burr hole was performed with the diagnosis of bilateral chronic subdural hematoma. Operative findings revealed the infected subdural hematoma on the right side and non-infected subdural hematoma on the left side. Cultures of the subdural hematoma grew Escherichia coli. In view of the pyuria, the etiology of the infected subdural hematoma was postulated to be a urinary tract infection. In the majority of 14 reported cases, the causative organisms were Escherichia coli, Salmonella, and the systemic sources of infection included the urinary tract, gastrointestinal disease, or were unknown. The possibility of infected subdural hematoma should be considered when computed tomography findings suggestive of chronic subdural hematoma exist in a patient with signs of infection.     

Chronic subdural hematoma after transsphenoidal surgery.

Chronic subdural haematoma has not been reported as a complication of transsphenoidal surgery. We present a case of pituitary adenoma which was gross-totally removed by transsphenoidal surgery with the enlarged sellar opening. Postoperative serial imaging showed massive air accumulation in both frontal subdural spaces followed by subdural fluid collection and subsequent chronic subdural haematomas 2 months later. We conclude that close follow up imaging study is required to avoid overlooking chronic subdural haematoma when massive air is introduced into the subdural space by the transsphenoidal surgery.     

Primary brain tumor complicating subdural hematoma

A case of sphenoidal ridge meningioma complicating chronic subdural hematoma and a case of malignant astrocytoma producing not only intracerebral hematoma but also acute subdural hematoma were reported, and the mechanism of subdural hematoma formation was discussed according to the literature. Malignant glioma often produces intracranial hemorrhage, but scarcely produces subdural hematoma. On the other hand, meningioma scarcely produces intracranial hematomas, but among of them subdural hematoma is not unusual. The reason for it is probably due to the difference of the place where each tumor grows originally. Rupture of the bridging veins or the intratumoral abnormal vessels due to twisting of the brain from trivial head trauma or without trauma might produce subdural hematoma.     

硬膜下积液治疗经验总结（附27例临床分析）

目的总结不同类型硬膜下积液治疗经验。 方法对解放军总医院第六医学中心神经外科自2009年1月至2014年10月手术治疗并完整随访的27例硬膜下积液患者进行回顾性分析。根据术前影像学特征鉴别积液是否为血性,将患者分为血性硬膜下积液患者（9例）和非血性硬膜下积液患者（18例）。根据积液是否为血性选择个性化治疗方案,观察其疗法。 结果9例血性硬膜下积液患者接受钻孔外引流手术,8例积液消退,另外1例无效,之后接受硬膜下腹腔分流后治愈。非血性硬膜下积液患者中14例接受硬膜下腹腔分流,12例有效,2例术后出现脑积水,经脑室-腹腔分流术治愈;2例术前合并脑积水接受脑室-腹腔分流术,均有效;另外2例最初接受积液外引流,无效,之后行硬膜下腹腔分流后积液消退。 结论对于硬膜下积液患者,术前需仔细评估积液是否为血性,是否合并脑积水。血性积液采取钻孔外引流,非血性积液采取硬膜下腹腔分流,合并脑积水的积液采取脑室-腹腔分流手术方式,给予个体化治疗,可获得满意疗效。     

Lateralization of temporal lobe foci: depth versus subdural electrodes.

OBJECTIVES: Definitive localization of an epileptic focus correlates with a favorable outcome following epilepsy surgery. This study was undertaken to determine the incremental value of data yielded for surgical decision making when using subdural electrodes alone and in addition to depth electrodes for temporal lobe epilepsy. METHODS: Standardized placement for intracranial electrodes included: (1) longitudinal placement of bilateral temporal lobe depth electrodes; (2) bilateral subtemporal subdural strips; and (3) bilateral orbitofrontal subdural strips. Sixty-three events were randomly reviewed for: (1) subdural electrodes alone; and (2) depth electrodes in conjunction with subdural electrodes. RESULTS: Of the 63 seizures, 54 (85.7%) demonstrated congruent lateralization to ipsilateral subtemporal subdural strip electrodes (based on depth electrode localization) when subdural strip electrodes were utilized alone. In 3 of 22 patients, 7 seizures demonstrated 'false localization' on subdural electrode analysis alone when compared with depth recording and post-surgical outcome. For these 3 patients, retrospective review of neuroimaging demonstrated suboptimal ipsilateral placement of subtemporal subdural electrodes with the most mesial electrode lateral to the collateral sulcus. Four additional patients had suboptimal placement of subtemporal subdural electrodes. Two of these 4 patients had congruent localization with subdural electrodes to ipsilateral depth electrodes despite suboptimal placement. Subtemporal subdural electrodes accurately localized for all seizures from the mesial temporal lobe when the mesial electrodes of the subtemporal subdural strip recorded mesial to the collateral sulcus from the parahippocampal region. CONCLUSION: We conclude that although there are high concordance rates between subdural and depth electrodes, localization of seizure onset based on subdural strip electrodes alone may result in inaccurate focus identification with potential for possible suboptimal treatment of temporal lobe epilepsy. When subtemporal subdural electrodes provide recording from the parahippocampal region, there is accurate localization of the seizure focus. If suboptimal placement occurs lateral to the collateral sulcus, the electroencephalographer cannot make a definitive identification of the seizure focus.     

Spontaneous resolution of an acute subdural hematoma

Acute postraumatic subdural hematoma is known to have bad prognosis. Traditionally, its treatment consisted in urgent surgical evacuation. Rapid spontaneous resolution of the hematoma has been infrequently observed. We report a case of a patient with an acute traumatic subdural hematoma which disappeared without surgery. CT-scan showed a left-sided subdural hematoma with marked mass effect. A low density layer, which implied involvement of CSF in the subdural space, was observed between the hematoma and the inner wall of the skull. We think that the spontaneous resolution of the hematoma was due to the dilution and washing-out by the CSF through an arachnoid tear. Another suggested mechanism in the literature is blood redistribution in the subdural space. Selected patients with an acute subdural hematoma can be managed with conservative treatment.     

Subacute spinal subdural hematoma associated with intracranial subdural hematoma

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.     

Local alterations of hemostatic-fibrinolytic mechanisms in reforming subdural hematomas.

Multiple chemical and coagulation determinations were undertaken on the subdural hematoma fluid from the reformed effusions of two patients. It was found that plasma or blood repeatedly reentered the subdural cavity. Coagulation studies compared the in vitro effects of subdural fluid with those of cerebrospinal fluid, serum, and a buffer control. Despite some chemical differences, the subdural fluids from both patients behaved similarly by (1) accelerating the intrinsic clotting system, (2) producing defective clot formation, and (3) accelerating the fibrinolytic system. It is presumed that these continuous hemostatic-fibrinolytic alterations, acting in the subdural sac, may have important implications in the growth and reformation of subdural hematomas, and a hypothesis of the mechanisms involved is presented.