Combined chronic subdural and acute epidural hematoma secondary to metastatic hepatocellular cancer: case report]

We report a case of combined chronic subdural and acute epidural hematoma caused by metastatic hepatocellular cancer of the dura mater. A 44-year-old woman, who had been under treatment for hepatic cancer for one year, presented with right hemiparesis. MRI revealed a chronic subdural hematoma on the left fronto-parietal region with subgaleal and epidural metastasis. The patient was found comatose 7 days later. A huge epidural hematoma in the left parietal region was disclosed with CT scan. She died of hepatic failure despite the evacuation of the hematoma. This is the first reported case with a combined subdural and epidural hematoma secondary to metastatic brain tumor of the dura mater.     

Long-term prognosis of nonoperative acute epidural hematoma in children]

Computed tomography(CT) scan has revealed that certain acute epidural hematomas(AEH) don't need operative therapies. But, it is difficult to determine especially in childhood, whether AEH compressing the brain for a short-term would or would not effect the function of the central nervous system in the future. For this reason, the authors report the long-term prognosis of nonoperative AEH in children. Twelve children suffering from AEH were transported to our clinic. On admission, they had no neurological deficits and CT scan revealed hematomas that had maximum thickness of 5-19 mm without midline shift. With nonoperative therapy they were discharged and the hematomas disappeared within 3-12 weeks. After long-term follow-up (3-10 years), it was shown that they had no epileptic episodes, and no changes in their school study records. Also, the Yatabe-Guilford personality test revealed no abnormal data. These data suggest that children can be cured who suffer from AEH with no neural deficits, and in whom the maximum thickness of the AEH is less than 20 mm, and in whom there is no midline shift in CT scan, can be cured without undergoing an operation, and will have a good long-term prognosis.     

Acute epidural hematoma following evacuation of chronic subdural hematoma with continuous closed system drainage]

The authors report a case of acute epidural hematoma occurring after evacuation of chronic subdural hematoma with continuous closed system drainage. Laboratory data of the patient including bleeding time were within normal limits. The cause of the postoperative intracranial hematoma was the rapid surgical decompression of the initial lesion, and we considered that it could be prevented if chronic subdural hematoma was treated using closed system drainage and slow decompression. But acute epidural hematoma occurred after this operative procedure and it was accelerated by evacuation of the chronic subdural hematoma through the drain. An emergent craniotomy and removal of the hematoma was performed, so the patient was discharged from hospital with satisfactory neurological recovery. A careful check of the evacuated hematoma volume is very important, and CT scanning should be immediately performed if postoperative hematoma is suspected.     

急性硬膜外血肿的手术治疗体会

【摘要】 目的 总结急性硬膜外血肿的临床诊治经验。方法 回顾性分析自2005年至2012年间在我院住院治疗的75例急性硬膜外血肿患者的临床资料的临床资料;所有患者均行骨瓣开颅血肿清除手术治疗。结果 75例患者中59例治愈,8例好转,2例重残,6例死亡,总有效率为89.33%。结论 急性硬膜外血肿是临床上的急重症,通过早期积极的手术治疗,可以取得满意的疗效。     

Multilevel acute spinal epidural hematoma in a patient with chronic renal failure--case report

A 47-year-old female with diabetic nephropathy presented with acute onset of severe back pain and progressive weakness in both lower extremities. Neuroimaging revealed a spinal epidural hematoma extending from the T-3 vertebra to the sacrum. Removal of all or every other lamina on levels with epidural hematoma and emergent evacuation of the hematoma were planned. T-9 and T-10 laminectomies were performed, but excessive bleeding during the operation prompted us to abandon the procedure. Plasma and desmopressin administration controlled the bleeding from the drain 8 hours after the operation. Follow-up neuroimaging one month later revealed total resolution of the hematoma with improved neurological status. Acute spinal epidural hematomas extending over more than 15 segments are extremely rare and the surgical treatment is still challenging. Coexisting hemorrhagic diathesis creates more problems. Conservative treatment may be the best option.     

Computerized tomography findings of acute traumatic epidural hematoma

During four year period from April, 1977 to March, 1981, 53 cases with acute traumatic epidural hematoma had been encountered out of 430 acute head injured patients examined by computerized tomography (CT) within 24 hours after incurring the trauma at the Department of Neurosurgery and Critical Care Medicine of Nippon Medical School, Sendagi, Tokyo, Japan. Besides the initial CT, the authors performed contrast enhanced CT (41 cases) and serial CT scanning (31 cases). There were 49 cases of epidural hematoma existing in the supratentorial region, Two cases infratentorial region and 2 cases in the both regions. Two cases of vertex epidural hematoma had been encountered, one of them required vertical scan technique. In 22 (41%) of the 53 patients, the initial CT showed evidence of other cerebral lesions. The most frequent lesion was pneumocephalus (11 cases), 3 cases of them existed in the epidural hematoma. There were also intracerebral hematoma (6 cases), subdural hematoma (4 cases), cerebral contusion (2 cases), intraventricular hemorrhage (2 cases) and 2 cases of them demonstrated "diffuse traumatic cerebral injury" (Zimmerman, 1979). During contrast enhanced CT, 11 cases out of 41 cases indicated several enhancement pattern. There were total enhancement of epidural hematoma (2 cases), partial enhancement of hematoma (2 cases) and enhancement of internal margin of hematoma (2 cases). Serial CT scans was performed in 36 out of the 53 patients. Common findings on the serial CT scans were decreased density collection in the subdural space such as subdural effusions or chronic subdural hematomas (8 cases) and enlargement of small epidural hematomas (3 cases).(ABSTRACT TRUNCATED AT 250 WORDS)     

Rapid disappearance of acute posterior fossa epidural hematoma

A 34-year-old man presented with an acute epidural hematoma that resolved within 24 hours after a fall. On admission, neurological examination found no abnormalities. Computed tomography (CT) indicated a linear fracture in the occiput. Four hours after the injury, the patient's condition worsened and repeat CT showed a bilateral epidural hematoma in the posterior fossa extending over the bilateral transverse sinuses and severe brain swelling. The patient's family refused surgery. Conservative management with pentothal was performed in the intensive care unit. Follow-up CT 21 hours after the initial injury showed complete resolution of the hematoma and an increase in the CT density of the pericranial soft tissue near the hematoma. The pressure gradient between the subgaleal and epidural space may have been important in the rapid disappearance of this epidural hematoma.     

Abrupt exacerbation of acute subdural hematoma mimicking benign acute epidural hematoma on computed tomography--case report

A 75-year-old male was hit by a car, when riding a bicycle. The diagnosis of acute epidural hematoma was made based on computed tomography (CT) findings of lentiform hematoma in the left temporal region. On admission he had only moderate occipitalgia and amnesia of the accident, so conservative therapy was administered. Thirty-three hours later, he suddenly developed severe headache, vomiting, and anisocoria just after a positional change. CT revealed typical acute subdural hematoma (ASDH), which was confirmed by emergent decompressive craniectomy. He was vegetative postoperatively and died of pneumonia one month later. Emergent surgical exploration is recommended for this type of ASDH even if the symptoms are mild due to aged atrophic brain.     

Thoracic epidural anesthesia and epidural hematoma

This report involves a 74-year-old-male who developed a thoracic epidural hematoma with paraparesis on the second postoperative day in conjunction with thoracic epidural anesthesia established before surgery for acute abdominal aortic dissection. The finding indicates that laminectomy can be performed successfully as late as three days after diagnosis of the hematoma, with a complete restitution of neurological function. High-dose steroid treatment may have been a contributing factor for the positive outcome.     

急性自发性椎管内硬膜外血肿的临床特征及治疗

目的:总结急性自发性椎管内硬膜外血肿(acute spontaneous spinal epidural hematoma,ASSEH)的临床和影像学特征,探讨其治疗方法及预后.方法:收集我院2005年1月～2020年12月收治的27例ASSEH患者的临床和影像学资料,回顾性分析病因、临床表现、影像学特征、治疗过程、手...     

Spinal epidural hematoma

Three cases of spinal epidural hematoma are reported, one lumbar, another cervical, and the third thoracic. All were dorsolaterally localized, the first and the third were dependent on anticoagulant therapy, and the second was spontaneous. In addition to the symptoms of sudden onset, acute spinal pain, flaccid paralysis, and loss of sphincter control, the second case had the exceptional picture of a cervical anterior spinal cord syndrome with preoperative transient improvement, followed by the development of Brown-Séquard syndrome with subsequent deterioration. This case was diagnosed by means of computed tomography. The postoperative course has been satisfactory in all patients, with complete recovery in two.     

Bilateral epidural hematoma

Bilateral epidural hematomas are very rare and are associated with high mortality. The purpose of this study is to identify the clinical features, mechanisms, and outcomes of bilateral epidural hematomas. This report considers 19 cases of bilateral epidural hematoma hospitalized between 1987 and 1997. All of the cases, with the exception of three, were diagnosed within the first 6 h. The neurologic evaluations on admission and during hospital stay were based on the Glasgow Coma Scale. Hematomas were determined by CT scans in all cases. The patients were evaluated using the Glasgow Outcome Scale after 6 months. In 13 patients, the bilateral epidural hematoma was in the midline. In six patients, hematomas were at different locations on either side. Surgical approach was chosen as the primary treatment modality in 18 patients. One was treated conservatively. The mortality rate was 15.7% in this series. With the widespread use of CT scan, diagnosis before deterioration of the neurological status affects the results of surgery and prognosis or even presents the possibility of a conservative treatment. Received: 2 June 1998 / Accepted: 15 April 1999