Subdural haematoma presenting with transient neurological deficits.

OBJECTIVE: To stress that transient neurological deficits do not always imply transient cerebral ischaemia, and may be produced by subdural haematoma. CLINICAL FEATURES: An 80-year-old man was seen for intermittent gait disturbance, with normal findings on initial examination. He was then admitted after the onset of a fixed neurological deficit which worsened. Subdural haematoma was diagnosed by computed tomography (CT). An 80-year-old woman was seen after she had experienced left hemisphere transient neurological deficits. A CT scan showed a left-sided subdural haematoma. INTERVENTION AND OUTCOME: Both patients underwent successful surgery with complete resolution of their symptoms and signs. CONCLUSION: Subdural haematoma is relatively common and must be considered in those with unexplained transient neurological deficits. Magnetic resonance imaging or CT are the diagnostic procedures of choice. Antiplatelet or anticoagulant therapy must not be instituted until subdural haematoma is excluded.     

老年人慢性硬脑膜下血肿的手术治疗

慢性硬脑膜下血肿的治疗重点及预防复发的关键，在于选择恰当的手术时机和方法，术中将血肿液中纤维蛋白降解产物（ＦＤＰ）尽可能冲洗干净，以达到充分止血目的；老年人常合并心血管疾病，对手术耐受力差，不适合采用骨皮瓣开颅血肿清除术。本文介绍３０例老年人慢性硬脑膜下血肿，采用颅骨钻孔冲洗和术后持续引流治疗，除１例因高龄合并心血管疾病，术后死于并发外症，其余均治愈。     

标准大骨瓣开颅术治疗急性硬膜下血肿35例临床分析

目的探讨标准大骨瓣开颅术治疗急性硬膜下血肿的手术方法及临床效果。方法回顾性分析3年来该院采用标准大骨瓣开颅术治疗的35例急性硬膜下血肿患者的病例资料。结果按格拉斯哥标准（GOS）对预后进行评估，全组35例中，治愈16例，中残7例，重残4例，死亡8例。术后并发症：迟发性血肿3例，外伤性脑梗塞1例，硬膜下积液3例，皮片坏死1例，减压区脑软化灶2例，颅内感染2例，外伤性癫痫3例。结论标准大骨瓣开颅术暴露良好、止血方便，能迅速清除血肿、缓解颅压，是治疗急性硬膜下血肿的有效手段。     

Epidural haematoma after evacuation of contralateral subdural haematoma

Background Sequentially evolving intracranial bilateral haematomas, where the second haematoma develops after the surgical removal of the first one is rarely reported. Aim To report a patient who developed an epidural haematoma after evacuation of a contralateral subdural haematoma. Methods A 49-year-old male was admitted to our department after head injury. A brain computerized tomography (CT) scan revealed an acute subdural haematoma in the right temporal area which was evacuated. During his stay in the intensive care unit, he was submitted to intracranial pressure monitoring, which soon rose. Results A new CT scan showed an acute epidural haematoma in the contralateral parietal area that was also evacuated. Conclusions While rising intracranial pressure after the evacuation of a traumatic haematoma is usually attributed to brain oedema or recurrent haematoma at the craniotomy site, the development of a contralateral epidural haematoma requiring surgical treatment should not be overlooked.     

创伤性急性硬膜下血肿术后并发对侧硬膜外血肿的诊疗

目的：分析颅脑创伤性急性硬膜下血肿患者开颅减压术后并发对侧硬膜外血肿的临床、生化、影像学资料。探讨其形成机制,总结其临床诊断及治疗要点。方法：对27例颅脑创伤性急性硬膜下血肿病例行开颅血肿清除减压术,术后并发对侧硬膜外血肿进行再次手术,对所有病例的临床、生化、影像资料以及治疗、预后进行回顾性分析。结果：27例患者术前均有D二聚体水平异常增高出现,术后4例死亡,余23例病人随访6个月行COS评分,恢复良好及轻度残疾者11例,重残及植物生存者12例。结论：该类病例颅脑损伤重、手术减压迅速解除损伤血管受压、纤溶功能亢进等可能是其发生的主要机制。术前、术中、术后密切观察病情变化及动态CT检查是及早发现并处理这种比较少见的对侧硬膜外血肿的主要手段。     

硬膜悬吊在慢性硬膜下血肿钻孔引流术中的应用

目的:探讨硬膜悬吊在慢性硬膜下血肿钻孔引流术(BHID)中的作用,减少术后硬膜外血肿的发生。方法:回顾性分析我院2005年至2009年收治的80例慢性硬膜下血肿患者的诊疗资料。结果:所有患者均行颅骨钻孔引流术,术中行硬膜悬吊者50例,术后1例出现硬膜外血肿,未行硬膜悬吊者30例,术后6例出现硬膜外血肿,应用连续性校正卡方检验结果 P<0.05。结论:硬膜悬吊可有效预防慢性硬膜下血肿钻孔引流术后硬膜外血肿的发生。     

Subdural haematoma: presentation and diagnosis on medical wards

The twenty-two adult patients with subacute and chronic subdural haematoma seen in Leicester during the last 7 years have been reviewed. The clinical manifestations and results of investigations are described. The diagnostic difficulties which may confront physicians are discussed, with special reference to cases with no history of head injury masquerading as strokes. Stress is laid on the points which help with the differentiation.     

Transient cortical blindness post angiography--a case report

A 56-year old female reported having had a fall two weeks prior to presentation. Computed Tomography (CT) scan showed an acute right-sided convexity subdural haematoma. A computed tomography angiogram revealed no vascular anomaly. One hour post procedure she had bilateral cortical blindness. Her vision subsequently was fully restored. A diagnosis of transient cortical blindness was made. Transient cortical blindness is a rare but recognized complication ofintra-arterial injection of iodinated contrast agents.     

Spontaneous acute subdural haemorrhage, cerebral and pulmonary metastases in a complete mole

Complete and partial moles remit spontaneously in most cases, following evacuation of the uterine cavity. However, either persistent trophoblastic disease or a frank trophoblastic tumour can follow a complete hydatidiform mole. To our knowledge, acute subdural haematoma, as a complication of cerebral metastases, following treatment for hydatidiform mole has not been reported. We describe a 29-year-old woman who presented with spontaneous acute subdural haemorrhage and pulmonary metastases, eight months after evacuation of a complete hydatidiform mole, with a fatal outcome.     

Spinal subdural haematoma: a rare complication of low-molecular-weight heparin therapy.

A 52-year-old man presented with chest pain, diarrhoea, rash, and arthritis. The use of low-molecular-weight heparin for suspected pulmonary embolism or angina led to a spinal subdural haematoma 3 days later. He was retrospectively confirmed to have Salmonella paratyphi infection. The clinical presentation and management of spinal subdural haematomas, and the incidence and manifestations of reactive arthritis related to Salmonella infections are briefly discussed.     

Chronic subdural haematoma in the elderly

Chronic subdural haematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half the cases. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.     

颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析

目的 探讨颅脑损伤去骨瓣减压术后硬膜下积液的临床特点,分析其影响因素,为早期进行积极预防和干预提供临床依据.方法 选择嘉兴学院附属第二医院2010年1月—2019年11月收治的颅脑损伤去骨瓣减压术后患者608例为观察对象,根据术后是否继发硬膜下积液分为硬膜下积液组(120例)和无硬膜下积液组(488例),分析硬膜下积液...     

微创术治疗颅内血肿52例报告

目的 :总结微创术对各种颅内血肿的治疗效果。方法 :CT定位下用 YL- 1型一次性使用颅内血肿穿刺针对 5 2例各类颅内血肿进行穿刺抽吸引流。结果 :高血压性脑出血42例 ,30 d内死亡 6例 ,病死率 1 4.3% ,3个月后存活 36例 ,按日常生活能力评定 ADL11 0例 ,ADL2 1 3例 ,ADL31 1例 ,ADL4 2例。慢性硬膜下血肿及外伤性硬膜下血肿 1 0例 ,全部恢复正常。结论 :微创术是治疗各种颅内血肿的有效方法 ,值得推广     

Delirium Tremens

The varied clinical manifestations and management of 14 male patients with delirium tremens (DT) have been studied. Eight patients were initially hospitalised for diseases unrelated to ethanol abuse i.e. 2 each for gun shot wound, myocardial infarction and stroke, and one each for pneumonia and gastroenteritis. One patient was going through withdrawal because of prodrome of viral hepatitis before he was hospitalised for uncontrolled agitation and delirium. Two known cases of mild essential hypertension on dietary therapy reported for agitation, abnormal behaviour, a single episode of tonic clonic seizure and hypertensive encephalopathy as they could not/did not get alcohol for 3 days. Three patients presented denovo with DT without concomitant illness. The other features besides delirium and hallucinations were tremulousness in 10, tachycardia in 12, fever in 3, diaphoresis in 2 and tonic clonic seizures in 4 patients. The symptoms fluctuated markedly at short intervals and 2 patients did not have any features of sympathetic overactivity. Altered hepatic biochemical parameters and ketonuria with normal blood sugar were noted in 4 and one patients respectively. Other biochemical parameters including serum electrolytes were normal. CT scan brain done for 5 patients revealed subdural haematoma in one. Cerebro spinal fluid (CSF) and EEG findings were noncontributory. All made good recovery with heavy doses of intravenous vitamin B complex, glucose and oral benzodiazepine. Short course of haloperidol was used in 2 patients. Two patients developed pancreatitis during follow up. All patients made complete recovery, and 8 patients have been followed for 8 to 12 months without relapse. The reason for hospitalisation in such cases is often unrelated to alcohol abuse; hence a detailed history of alcoholism is mandatory to identify those at risk as well as for prompt treatment and decreasing the mortality.Key Words: Alcohol withdrawal, Concomitant illnesses, Delirium, Precipitating events     

Maurice Ravel's illness: a tragedy of lost creativity

Maurice Ravel had been subject to psychiatric disorder for many years when signs of organic brain disease appeared at the age of 52. Aphasia, apraxia, agraphia, and alexia became established some five years later. Musical creativity was lost. Alajouanine diagnosed cerebral atrophy with bilateral ventricular enlargement. Though Ravel's condition deteriorated progressively, generalised dementia was not apparent. He died in December 1937, after a craniotomy performed by Clovis Vincent, possibly from a subdural haematoma. Vincent's operative findings are described here. The likely cause of Ravel's illness was a restricted form of cerebral degeneration.     

Computerised tomographic scan of the head in evaluation of stroke in Ghanaians

One thousand and three patients clinically diagnosed as stroke cases were investigated using computerised tomographic (CT) scan. No diagnosis was made in 56 (5.58%) of the patients. While 56 cases had the CT scans reported as normal, in 40 (4.99%) of the patients disorders other than stroke were diagnosed. They included remediable causes like subdural haematoma (ten cases), cerebral abscess (eight cases), meningioma (four cases), other brain tumours (eighteen cases). Nine hundred and seven of the patients were proven to have suffered a stroke; 547 (60.3%) were haemorrhagic and 360 (39.7%) were infarctive. These results are at variance with previous studies from West Africa which made infarcts the commoner stroke type, but reflect those found in Blacks elsewhere in South Africa and America. Our results were achieved through the use of the CT scan as opposed to the earlier clinically-diagnosed West African studies. The larger number of haemorrhagic strokes had therapeutic implications. Trepidation in the use of anticoagulants, thrombolytics and fibrinolytics before proof of the pathological type is advised. Although clinical evaluation may be more cost-effective in the management of stroke, brain imaging techniques are recommended for accuracy in diagnosis and appropriate management.     

Pupillary evaluation for differential diagnosis of coma

Objectives: To determine the usefulness of bedside evaluation of pupils in determining the aetiology of coma by adopting a probabilistic approach. Patients and methods: One hundred and fifteen consecutive patients presenting with coma were enrolled in this prospective cohort during the 12 month study period in the emergency room of a community teaching hospital. Patients underwent structured clinical examinations and laboratory and imaging tests. Assignment of aetiology of coma was based on strict adherence to predetermined criteria and achieved by consensus of the two physician investigators. One year follow up was obtained in all patients. Results: Aetiology of coma was determined in 98% of the patients. It was metabolic in 69 patients (60%) and structural in 46 patients (40%). Metabolic causes included drug overdose, acute alcohol intoxication, hypoglycaemia, sepsis, and pneumonia. Structural causes included intracerebral haemorrhage, subarachnoid haemorrhage, cerebral infarction, subdural haematoma, and epidural haematoma. Multivariate logistic regression analysis showed light reflex loss (likelihood ratio for positive test result 3.59) and anisocoria (likelihood ratio for positive test result 9.0) as independent predictors of structural origin. Conclusions: In this prospective study of patients presenting to the emergency room of a community based teaching hospital with coma, in about 60% the coma is of metabolic origins and in about 40% of structural origins. Light reflex loss and anisocoria suggest a structural aetiology.     

Profile of compressive myelopathy as evaluated by magnetic resonance imaging

To evaluate spectrum of diseases causing compressive myelopathy and accuracy of magnetic resonance imaging in diagnosing these conditions, a total of 69 clinically diagnosed cases of compressive myelopathy were evaluated by magnetic resonance imaging and results were tabulated. Caries spine was the commonest condition (24.6%) followed by metastasis spine (17.4%), ossified posterior longitudinal ligament (7.8%), primary bone tumours, nerve sheath tumours, intramedullary tumours and rare conditions like epidural abscess, spontaneous epidural haematoma, subdural haematoma, epidural lipomatosis, etc. Sensitivity, specificity and accuracy for diagnosing caries by magnetic resonance imaging was found to be 94%, 98% and 97% while that of metastasis spine was 91%, 98% and 97% respectively. Magnetic resonance imaging is the modality of choice for diagnosing compressive myelopathy.     

Electrocardiographic changes in craniocerebral trauma--could they serve as prognostic indicators?

Electrocardiographic (ECG) changes were analysed in one hundred patients of craniocerebral injuries irrespective of age and sex. Males comprised 82% of patients and most vulnerable age group was 15-40 years (66%). Although the overall mortality was 17%, the maximum mortality (44.44%) was observed in the age group of 41-60 years. Computed tomographic scan proved lesions in intracerebral haemorrhage, subdural haematoma, mixed lesions and extradural haematoma were associated with mortality rates in 66.66, 33.33, 20 and 11.11 per cent respectively. ECG changes of some or the other type were present in almost all patients (99%) but ST-segment shift, sinus tachycardia/bradycardia, T-wave changes and prolonged QTc-interval (> 440 msec) carried high mortality rates of 60, 34.6/27.3, 19.6 and 17.3 per cent respectively, especially if these changes persisted for long duration. Occurrence of supraventricular tachycardia and nodal arrhythmia, although associated with high (50%) mortality rates, were probably terminal events rather than the cause of increased mortality. There was, however, no direct correlation between the type of craniocerebral injury and specific ECG changes.