Chronic encapsulated intracerebral haematoma.

We report a rare chronic encapsulated intracerebral haematoma (CEICH). A 52-year-old man had two seizures. Unenhanced computed tomography scanning of the head revealed a hypodense tumour with clusters of calcification in the left temporal lobe. Magnetic resonance imaging of the brain showed a left temporal tumour with a hypointense centre and hyperintense periphery on T(1)-weighted imaging and heterogeneous hypointensity on T(2)-weighted imaging. The tumour was heterogeneously enhanced after gadolinium injection. Craniotomy was carried out and a CEICH in the left temporal lobe was completely excised. No vascular anomaly was found. The tumour was histologically confirmed to be a CEICH. The patient recovered well after the operation. In this report, we describe this rare case and discuss the characteristics of CEICH.     

Chronic encapsulated intracerebral haematoma: pathogenetic and diagnostic considerations.

Two cases of chronic encapsulated intracerebral haematoma are reported. The patients presented with progressive neurological deficits. Computed tomography scan showed a roundish, intracerebral lesion, that revealed ring blush after contrast infusion, with mass effect. At operation a thick, fibrous, brownish capsule, containing clots in different states of formation, was removed. The hypothesis of capsule formation due to an exuberant proliferation of arachnoidal fibroblasts, is discussed. Differentiation between encapsulated intracerebral haematoma and other chronic intracerebral blood collections is considered mandatory for appropriate treatment.     

Ruptured chronic encapsulated intracerebral hematoma in infancy: review of the literature with a case report

Objectives We report a case of a 2-month-old boy with chronic encapsulated intracerebral hematoma (EICH) and discuss clinical, radiological and pathological features of the case.Conclusions Chronic EICH in infants is extremely rare in the literature. Only two cases have been previously reported. One of the cases reported in the literature was supratentorial and the other was infratentorial.     

Uncoupling between CBF and oxygen metabolism in a patient with chronic subdural haematoma: case report.

The regional cerebral blood flow (rCBF) and oxygen metabolism of a patient with a chronic subdural haematoma were examined quantitatively, using positron emission tomography (PET). Before operation, the rCBF was decreased slightly throughout the brain, whereas the regional oxygen extraction fraction (rOEF) was increased throughout the brain, with values ranging from 0.36 to 0.60. One month after operation, the rCBF had recovered remarkably in almost all regions and rOEF had decreased to within the normal range.     

Stereotactic aspiration of intracerebral haematoma: significance of surgical timing and haematoma volume reduction.

We reviewed 63 patients with primary intracerebral haemorrhage (PICH) in basal ganglia treated by computed tomography (CT)-guided stereotactic aspiration to evaluate the impact of surgical timing and degree of haematoma volume reduction on neurological outcome evaluated with Glasgow Outcome Score (GOS). In 19 patients operation was performed within 24h from the symptom onset with more than 60% of haematoma volume reduction. At 3 weeks 11 patients (58%) achieved a favorable outcome (GOS 4 or 5). In the other 44 patients only 10 (23%) recovered to GOS 4 or 5. These differences were statistically significant. At 6 months a still larger proportion of patients with early radical decompression showed favorable outcome, however, the difference was not statistically significant. The results demonstrate that early and radical stereotactic aspiration provided a better neurological outcome at the early recovery phase, though the beneficial effect on the final outcome was not significant statistically.     

Chronic encapsulated intracerebral hematoma in thalamus with incongruous right homonymous hemianopia: a case report]

We presented a patient with chronic encapsulated intracerebral hematoma. This 49-year-old woman suffered from visual disturbance, and slowly progressive right hemiparesis, sensory disturbance of the right extremities and incongruous right homonymous hemianopia over 2 months. Computed tomography scanning showed high density area and ring enhancement, and magnetic resonance imaging revealed mixed intensity on T1 and T2-weighted images in her left thalamus and internal capsule. Angiographic studies revealed no vascular anomaly or tumor stain. The pathologic pictures indicated well-encapsulated hematoma containing fresh and old hematomas in the left thalamus. Most reported cases of this disease had hematomas in the subcortex and no cases had similar visual disturbance. This report was prepared because this condition is uncommon and may remain unrecognized.     

Posterior longitudinal ligament ossification: case report

Posterior longitudinal ligament ossification of cervical spine is a rare condition among caucasians. A 42 years old japanese patient with progressive walking difficulty was diagnosed with this pathology by CT scan and MRI and treated surgically by an anterior approach with arthrodesis. Pathophysiology, racial prevalence, clinical picture, radiological characteristics and surgical approaches options are revised.     

Thalamic intracerebral schwannoma: case report

The intracranial schwannomas cover about 8% of all the brain tumors, although, those localized inside the encephalic parenchyma are rare only 55 cases being reported in the literature. The histopathologic diagnosis is based on the cellular type and arrangement common to the nervous sheath tumors, the immunohistochemical findings (GFAP, S-100 protein, EMA) and electronmicroscopic findings as well. The clinical presentation related to the intraparenchimatous schwannoma is variable, depending on its localization, the image diagnosis does not show any typical aspect. The surgical treatment is curative once a complete extirpation is obtained. These tumors are benign but one case reported presented malignant signs. We present a patient that had a thalamic schwannoma with histological confirmation. We found no case with this localization in the literature.     

Mesencephalic haematoma: case report with autopsy study

Summary A 70-year-old hypertensive woman suffered sudden onset of bilateral blepharoptosis. Within a few hours she developed focal signs attributable to a lesion of the mesencephalon, and a stuporous state, from which she did not recover. Neuropathological examination showed a mesencephalic haematoma, but no arteriovenous malformation. A review of reported cases suggests that mesencephalic haematomas have a worse prognosis when they occur in aged hypertensive patients, as compared with younger normotensive patients, in whom they are probably related to arteriovenous malformations.     

Meningioma associated with contralateral chronic subdural haematoma: a short report.

Two unusual cases of meningiomas associated with opposite chronic subdural haematoma are presented.     

Neuroimaging characteristics of intracerebral haematoma

The objective of brain imaging is to identify the hematoma according to its different stages and to find a potential underlying cause because of the risk of recurrence and the possibilities of treatment. In emergency, the diagnosis of hematoma is often obtained by CT scan, however today MRI has proved to be more accurate than CT to detect hemorrhage and to identify an underlying etiology. In some cases, according to the patient age, the medical history and the location of the hematoma, it may be necessary to perform a conventional angiography in order to exclude an intracranial vascular malformation. The aim of this review is to detail the different aspects of intracerebral hemorrhages according to the sequences and the temporal evolution, and to describe special findings which can help to identify an underlying etiology.     

Prognostic factors in patients with intracerebral haematoma.

In a prospective study, the prognostic value of clinical characteristics in 157 consecutive patients with spontaneous supratentorial intracerebral haemorrhage were examined by means of multivariate analysis. Two days after the event 37 (24%) patients had died. Factors independently contributing to the prediction of two day mortality were pineal gland displacement on CT of 3 mm or more (p less than 0.001), blood glucose level on admission of 8.0 mmol/l or more (p = 0.01), eye and motor score on the Glasgow Coma Scale of eight out of 10 or less (p = 0.022) and haematoma volume of 40 cm3 or more (p = 0.037). Between the third day and one year after the event another 46 of the 120 two day survivors had died; the independent prognostic indicators for death during that period were: age 70 years or more (p less than 0.001) and severe handicap (Rankin grade five) on the third day (p less than 0.001). Functional independence (Rankin grade two or less) at one year was most common not only with the converse features of age less than 70 years (p less than 0.01) and Rankin grade four or less on the third day (p = 0.002), but also with an eye and motor score on the Glasgow Coma Scale of nine or 10 on the third day (p less than 0.001). The 120 patients with intracerebral haemorrhage who were still alive two days after the event were matched with 120 patients with cerebral infarction, according to age, level of consciousness on the third day after stroke (Glasgow Coma Scale) and handicap (Rankin grade). Survival and handicap after one year did not differ between these two groups. The conclusion drawn is that it is not the cause (intracerebral haemorrhage or cerebral infarction) but the extent of the brain lesion that determines the outcome in patients who survive the first two days.     

Primary intracerebral Hodgkin's disease: a case report

The authors report a case of primary intracerebral Hodgkin's disease in an 84-year-old woman who presented with a solitary intraparenchymal parieto-occipital lesion and absence of extracranial disease. The histologic diagnosis of Hodgkin's disease was further confirmed with positive immunohistochemical staining of Hodgkin's mononuclear cells and Reed-Sternberg cells and electron microscopy. Such an initial presentation of a solitary intracerebral tumor is extremely rare in Hodgkin's disease. This case helps establish primary intracerebral Hodgkin's disease as a true entity.     

99TCm-HMPAO SPECT studies in traumatic intracerebral haematoma.

Traumatic intracerebral haematomas are a common neurosurgical emergency. Their management, particularly the role of surgical removal, is controversial. Deterioration often occurs late, and is unpredictable. Eight patients with traumatic intracerebral haematomas were admitted to the neurosurgical unit to monitor their clinical state. All were studied within 48 hours of admission with single photon emission computerised tomography (SPECT), using the recently introduced radionuclide 99Technetiumm-Hexamethyl propylene amine oxime (99Tcm-HMPAO). At the time of the SPECT study, all the patients had been clinically stable. Three patients remained so; in the other five, the conscious level deteriorated, necessitating craniotomy and evacuation of the haematoma. In all the patients, the SPECT studies demonstrated perfusion defects that corresponded to the location of the haematoma, as demonstrated by computerised tomography (CT). However, in the five patients who subsequently deteriorated, the perfusion defects seen on the SPECT scan appeared larger than the haematoma, as seen on the CT scan. In addition, there was widespread poor retention of 99Tcm-HMPAO in the ipsilateral hemisphere. These differences were quantifiable. Interestingly, these differences were present at a time when the patients were clinically stable, before their deterioration. It is concluded that SPECT studies with 99Tcm-HMPAO are of possible use as predictors of late deterioration in the management of traumatic intracerebral haematomas.     

Subdural haematoma after endoscopic skull base surgery: case report and lesson learned

We report a case of a left fronto-temporo-parietal subdural haematoma that emerged as a complication of an endonasal endoscopic resection of a sinonasal adenocarcinoma of the left ethmoidal region. During the first surgical intervention, following oncological principles, the dura mater above the ethmoidal plate was removed and a skull base plasty was performed. In the post-operative phase a massive cerebrospinal fluid leak was observed and a revision duraplasty was performed the following day. Subsequently the patient was discharged on day 8 with no signs of CSF leakage. At the three month follow-up MR examination a subdural haematoma was observed and then treated by the neurosurgeon in a standard fashion. The collection was quite asymptomatic and discovered accidentally. We strongly advise the role of early post-op neuroimaging in every patient undergoing skull base procedures. We maintain that a massive CSF leak, that causes a significant reduction of intracranial pressure, should be managed as a surgical emergency, in order to reduce the risk of subdural haematoma.