Conservative treatment of subdural hematoma

The authors report the results of conservative treatment of subdural hematomas in 8 cases. In 6 of them the treatment was begun 1 to 7 days after head trauma, the other two with no history of trauma had complained of intracranial disease for two to four weeks before admission to hospital. All patients were treated with dexamethasone and 6 of them with Lasix, and two with mannitol. In 7 cases a quick improvement was observed, one patient, after 7 days treatment without good result was operated on. Control CT-scan, performed 2 weeks to 6 months after conservative treatment revealed the resolution of previously detected subdural hematomas.     

慢性硬膜下血肿96例诊治体会

目的探讨慢性硬膜下血肿的诊断、治疗及提高疗效的注意事项。方法选择我科96例慢性硬膜下血肿患者,全部病例均经头颅CT扫描证实诊断、判断出血量;采用单侧或双侧钻孔、冲洗、引流的治疗方法。结果术后血肿腔引流量最少50ml,最多450ml;头颅CT复查,90例(93.8%)仅见少量残存血肿(<10ml);创腔积气2例;4例症状加重,CT示血肿量较大,行开颅手术清除血肿;双侧血肿病例单侧钻孔的3例对侧血肿增多,行对侧钻孔引流。结论钻孔引流术是治疗慢性硬膜下血肿的首选最佳治疗方法,它创伤小、疗效显著、恢复快,对老年患者大大降低了手术风险;正确的操作是提高疗效的保证。     

Abusive Head Trauma in Infants and Children in Japan

Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.     

Intrauterine chronic subdural hematoma with postoperative tension pneumocephalus

A newborn infant demonstrated prenatal, bilateral chronic subdural hematomas with recent hemorrhage, internal hydrocephalus, and macrocephaly at birth. Serial cranial ultrasound and computed tomography evaluations revealed progressive hydrocephalus and subdural hematomas. Following surgical evacuation of subdural hematomas the child developed tension pneumocephalus with clinical deterioration. The pathogenesis of congenital subdural hematoma and rare postoperative complication of tension pneumocephalus are discussed.     

Acute Spontaneous Spinal Subdural Hematoma with Vague Symptoms

Spinal subdural hematoma is a rarely reported disease and spontaneous spinal subdural hematomas (SSDH) without underlying pathological changes are even rarer. The patients usually show typical symtoms such as back pain, quadriplegia, paraplegia or sensory change. But rarely, patients may show atypical symptoms such as hemiparesis and misdiagnosed to cerebrovascular accident. We recently experienced a case of SSDH, where the patient initially showed vague symptoms, such as the sudden onset of headache which we initially misdiagnosed as subarachnoid hemorrhage. In this case, the headache of patient improved but the neck pain persisted until hospital day 5. Therefre, we conducted the MRI of cervical spine and finally confirmed SSDH. The patient was managed conservatively and improved without recurrence. In this case report, we discuss the clinical features of SSDH with emphasis on the importance of an early diagnosis.     

颅脑损伤术后并发迟发性颅内血肿分析（附22例报告）

本文报告了２２例颅脑损伤开颅术后并发２５个迟发性颅内血肿。发生在幕上２２个，幕下３个。脑实质内１１个，硬膜下４个，硬膜外１０个。并对其发生机理进行探讨，认为脑血管舒缩机制障碍、手术前后颅内压急骤变化、以及凝血机制障碍是术后发生迟发性颅内血肿的重要因素。对其诊断和治疗提出建议。     

自发性低颅压综合征伴双侧硬膜下血肿二例

目的探讨自发性低颅压综合征的临床表现及影像学特征,以及其并发症慢性硬膜下血肿的处理。方法收集河北医科大学第二医院就诊的2例自发性低颅压综合征伴慢性硬膜下血肿的临床资料。分析该病的主要临床表现及影像学特征,及其慢性硬膜下血肿的处理。结果自发性低颅压综合征伴慢性硬膜下血肿,若有血肿进展或意识改变应及时外科治疗。结论自发性低颅压综合征伴慢性硬膜下血肿应密切观察患者病情,随访CT/MRI,了解有无血肿的进展,以便及早给予相应的治疗。     

Reversible parkinsonism due to chronic bilateral subdural hematomas

Subdural hematoma is a rare cause of secondary parkinsonism. We report a 65-year-old woman with reversible parkinsonism due to bilateral chronic subdural hematomas. Symmetrical parkinsonism evolved acutely 45 days after a trivial head injury. Mild pyramidal signs were also present on her left side. MRI revealed bilateral chronic subdural hematomas. The patient’s parkinsonism was completely abolished one month after successful neurosurgical evacuation of the hematomas.     

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.     

Computed tomography of extracerebral hematoma.

The appearance on C.T. of 30 extracerebral hematomas is described. Acute subdural hematomas were seen as bandlike lesions with markedly increased, homogenous density. Epidural hematomas demonstrated a high density and a biconvex, lenticular shape. During the process of liquefaction the density decreases and three hematomas appeared as isodense lesions. The majority of chronic subdural hematomas presented a mildly to moderately decreased, nonhomogenous density, the clearly identifiable inner wall of the lesion being either convex or concave. Subdural hygromas showed a homogeneous, markedly decreased density. Almost all the hematomas caused compression of the homolateral lateral ventricle and displacement of midline structures, particularly of the septum pellucidum. In 60% of the hematomas a dilatation of the contralateral lateral ventricle, predominantly of the posterior part was seen. Acute hematomas presented oedema in varying degrees, in chronic hematomas oedema was usually absent. In the original interpretation extracerebral hematomas were recognized as a lesion on C.T. in 97% (1 false negative result), in 90%, the lesion was correctly diagnosed as an extracerebral hematoma (1 false negative and 2 incorrect). The series contained one false positive C.T. scan and 2 intracerebral hematomas were interpreted incorrectly as subdural hematomas. The review C.T. diagnosis proved to be correct in 100%. C.T. and angiography appeared to have about the same diagnostic accuracy. However, C.T. is a non invasive investigation and it provides valuable additional information with regard to all the intracranial contents. Therefore C.T. should be the method of first choice in the diagnosis of extracerebral hematomas.     

Visualization of an actively bleeding cortical vessel into the subdural space by CT angiography

Spontaneous subdural hematomas of arterial origin are rare with only a few published case reports in the literature. In the CT era, vessel imaging of extra-axial hematomas is not commonly performed. In this case report we present a patient with a large, spontaneous acute subdural hematoma that demonstrated active contrast extravasation from a small cortical vessel on CT angiography. During surgical evacuation the vessel was confirmed to be a small cortical artery that was bulging through the arachnoid membrane and bleeding into the subdural space. The historical, radiographic, and clinical aspects of this unusual cause of subdural hematoma are discussed.     

Subdural hematoma in a case of hydrocephalus and macrocrania

A child with hydrocephalus and macrocrania was treated by a shunt procedure. After placement of a bilateral ventriculo-atrial shunt subdural hematomas developed on both sides. Burr hole drainage and insertion of a pressure-adjustable valve were used to obliterate the subdural hematomas and to influence the outflow resistance of the shunt.     

Computed tomography of extracerebral hematoma

The appearance on C.T. of 30 extracerebral hematomas is described. Acute subdural hematomas were seen as bandlike lesions with markedly increased, homogeneous density. Epidural hematomas demonstrated a high density and a biconvex, lenticular shape. During the process of liquefaction the density decreases and three hematomas appeared as isodense lesions. The majority of chronic subdural hematomas presented a mildly to moderately decreased, nonhomogeneous density, the clearly identifiable inner wall of the lesion being either convex or concave. Subdural hygromas showed a homogeneous, markedly decreased density.

Almost all the hematomas caused compression of the homolateral lateral ventricle and displacement of midline structures, particularly of the septum pellucidum. In 60% of the hematomas a dilatation of the contralateral lateral ventricle, predominantly of the posterior part was seen. Acute hematomas presented oedema in varying degrees, in chronic hematomas oedema was usually absent.

In the original interpretation extracerebral hematomas were recognized as a lesion on C.T. in 97% (1 false negative result), in 90%, the lesion was correctly diagnosed as an extracerebral hematoma (1 false negative and 2 incorrect). The series contained one false positive C.T. scan and 2 intracerebral hematomas were interpreted incorrectly as subdural hematomas. The review C.T. diagnosis proved to be correct in 100%.

C.T. and angiography appeared to have about the same diagnostic accuracy. However, C.T. is a non invasive investigation and it provides valuable additional information with regard to all the intracranial contents. Therefore C.T. should be the method of first choice in the diagnosis of extracerebral hematomas.     

单、双颅骨钻孔治疗慢性硬膜下血肿201例效果比较

目的分析颅骨钻孔数量对治疗慢件硬膜下血肿效果的影响。方法20l例慢性硬膜下血肿患者按单、双颅骨钻孔分为两组，以是否须再次手术为标准，比较两者间疗效的差异结果颅骨钻孔数量不影响治疗效果。结论该部位血肿的手术治疗颅骨钻单孔即可。     

Generalized chorea associated with chronic subdural hematomas

Two patients with chronic bilateral subdural hematomas developed symmetrical generalized choreiform movements. In one patient the chorea disappeared after evacuation of the hematomas, and in the other the movements improved. The latter patient has a family history of Huntington's disease.     

Subdural hematoma in a case of hydrocephalus and macrocrania. Experience with a pressure-adjustable valve

A child with hydrocephalus and macrocrania was treated by a shunt procedure. After placement of a bilateral ventriculo-atrial shunt subdural hematomas developed on both sides. Burr hole drainage and insertion of a pressure-adjustable valve were used to obliterate the subdural hematomas and to influence the outflow resistance of the shunt.     

慢性硬脑膜下血肿与癫痫

以癫痫为首发症状的慢性硬脑膜下血肿１２例，男９例，女３例。大发作３例，局灶性发作９例。对以癫痫为首发的临床症状、体征、脑电图、ＣＴ等资料作了分析；对慢性硬脑膜下血肿所致癫痫发作的病因、血肿包膜的病理生理及临床处理作了讨论，认为早期手术术后继服用抗癫痫药物治疗效果良好。     

急性硬膜下血肿术中脑膨出的原因分析与综合治疗

目的探讨急性硬膜下血肿术中脑膨出形成原因及综合治疗措施。方法回顾分析45例术中出现脑膨出的急性硬膜下血肿病人的受伤机制、临床表现、CT扫描结果,总结脑膨出形成原因。结果按GOS标准,治疗后6个月评定治疗结果,恢复良好24例,中残4例,植物生存1例,死亡16例。急性脑肿胀、迟发性颅内血肿、低血压、脑缺氧、长时间脑疝是颅脑术中急性脑膨出的主要原因,采取综合治疗是防治术中脑膨出的有效措施。结论结合临床和CT扫描可判定术中脑膨出发生的可能性,对各种原因所致术中急性脑膨出及时采取相应综合措施可获良效。     

Generalized chorea associated with bilateral chronic subdural hematoma

A variety of acquired disorders cause chorea, such as hypoxia-ischemia injury, drugs, toxins, infections, autoimmune disorders, and endocrine and electrolyte abnormalities, but rarely subdural hematoma. We report the case of a 76-year-old woman who presented with sudden onset of generalized choreiform movements 1 day prior to admission. Computed tomography revealed a bilateral lateral convexity subdural effusion, which was later confirmed by magnetic resonance imaging as a chronic subdural hematoma. After surgical evacuation of the subdural hematoma, the choreoathetoid movements ceased completely. We propose that transient ischemia in the bilateral subcortical regions was from compression and distortion of the brain by the bilateral hematomas and resulted in generalized chorea.     

Spontaneous concomitant intracranial and spinal subdural hematomas in association with anticoagulation therapy

Simultaneous intracranial and spinal subdural hematomas are extremely rare. In most cases, they are attributed to major or minor trauma and iatrogenic causes, such as those resulting from spinal puncture. To the best of the authors' knowledge, there has been only two reports of spontaneous concomitant intracranial and spinal subdural hematomas in a patient receiving anticoagulant therapy who had an absence of evident trauma history. We report on a case of spontaneous concomitant intracranial and spinal subdural hematomas that occurred in association with anticoagulant therapy and present a review of the relevant literature.