Meningioma associated with subdural hematoma--case report.

The case of a 49-year-old female with a left parietal convexity meningioma associated with an acute subdural hematoma is described. She was admitted because of sudden onset of severe headache accompanied by nausea and vomiting. She was also confused, and 6 hours after admission she developed lethargy, right hemiplegia, and left mydriasis with no pupillary reaction to light. Computed tomography disclosed a round, extra-axial mass in the left parietal region; it was heterogeneously enhanced. Emergency craniotomy, performed after carotid angiography, revealed a tumor with a massive underlying subdural hematoma. The histological diagnosis was meningotheliomatous meningioma, and there were many meningothelial cells within the hematoma.     

Nontraumatic chronic subdural hematoma due to dural metastases of breast cancer. Case report

A case of nontraumatic chronic subdural hematoma due to obstruction of dural vessels by tumor cells is presented and 25 reported cases are reviewed. A 39-year-old female was referred for headache, vomiting, disturbance of consciousness and right homonymous hemianopia with macular sparing. She had undergone mammectomy for medullary nodular carcinoma of the left breast five years before. She had been treated with combined hormonal therapy and chemotherapy for the cancer metastases to the liver in preceeding six months. Hematological examination revealed drug-induced thrombocytopenia, increase of FDP in blood (80 micrograms/ml), but no abnormality of prothrombin time and fibrinogen content. Therefore in the present case there was no evidence of disseminated intravascular coagulation (DIC) after Colman's criteria. However, it was suggested that this case had compensated DIC after Cooper's criteria. CT scan showed a biconvex-shaped low and partially iso-density area over the left fronto-temporal convexity, indicative of chronic subdural hematoma, and no abnormal findings in the occipital area. After removal of the hematoma she became alert without headache and vomiting. However, seven days later she complained of headache and vomiting again. Repeated CT scan showed a larger biconvex-shaped low density area over the left hemisphere extending to the parietal region at that time. Second operation was performed, but she expired four days later. Autopsy showed systemic metastases of the medullary nodular carcinoma in the scalp, temporal muscle and dura as well as lungs, adrenal glands, ovaries and bone marrow.(ABSTRACT TRUNCATED AT 250 WORDS)     

Organized chronic subdural hematoma; report of two cases

Two cases of organized chronic subdural hematoma were presented. The first case had a one-year history of disorientation and right hemiparesis. CT scan revealed a low density area with linear high density in its medial margin, suggesting chronic subdural hematoma on the left frontal convexity. Surgery was performed expecting to remove the hematoma. There was, however, only a little fluid inside with thick membranous tissue. The second case, who has Crouzon disease, presented a one-year history of pseudobulbar palsy and tetraparesis after surgery for chronic subdural hematoma and hydrocephalus. The diagnosis of organized subdural hematoma was made at the time of reoperation which was performed expecting to remove the recurrent chronic subdural hematoma. Plain CT, done after admission to our hospital, showed homogeneous low density area remaining in the bilateral frontal convexity. Infusion scan revealed marked enhancement of the medial margin of the low density area. The lesion was demonstrated as a low intensity area by T1-weighted magnetic resonance images (MRI). Marked enhancement was noted around the low intensity area after the infusion of Gd-DTPA. Although it is very hard to make a diagnosis of organized chronic subdural hematoma using only the CT scan preoperatively, combination of the CT scan and MRI with Gd-DTPA enhancement seemed to be very useful for this purpose.     

Three cases of acute interhemispheric subdural hematoma

Traumatic acute subdural hematomas over the convexity of the cerebral hemispheres are often encountered, but acute interhemispheric subdural hematomas are rare. Fourty-eight cases of acute subdural hematomas was admitted to our hospital between 1977 and 1986, and three cases of them (6%) were located in the interhemispheric subdural space. In this paper, these three cases are reported with 20 documented cases. Case 1: an 81-year-old female was admitted to our hospital because of headache, nausea and vomiting. She hit her occiput a week ago. CT scan demonstrated contusion in the right frontal lobe and a high density in the interhemispheric space of the right frontal region. Her complaints disappeared gradually by conservative therapy and she returned to her social life. Case 2: a 50-year-old male fell downstairs and hit his vertex. As he lost consciousness, he was admitted to our hospital. He was stuporous and had left-hemiparesis. Skull X-ray film showed fracture line extending from the right temporal bone to the left parietal bone across the midline. CT scan revealed intracerebral hematoma in both frontal lobe and right parietal lobe and subarachnoid hemorrhage in the basal cistern and Sylvian fissure of the right side. And interhemispheric subdural hematoma in the right parietal region was visualized. Angiography demonstrated a lateral displacement of the right callosomarginal artery and an avascular area between the falx and the callosomarginal artery. After admission his consciousness recovered and convulsion was controlled by drug. Left-hemiparesis was improved by conservative therapy and he was discharged on foot.(ABSTRACT TRUNCATED AT 250 WORDS)     

Subacute subdural hematoma associated with moyamoya phenomenon--a case report

A case of subacute subdural hematoma associated with moyamoya phenomenon is reported. On May 8, 1986, a 61-year-old female was referred to Mito National Hospital for evaluation of a left-sided hemiparesis and headache 8 days after minor head injury. Seventeen years ago she experienced the sudden onset of a left-sided hemiparesis which improved by rehabilitation. CT scans showed a thin high density area on the right cerebral convexity and a small low density area in the right semiovale center. On May 12, she was admitted because of aggravation of her symptoms. A repeat CT scan showed an enlarged right temporoparietal subdural hematoma with significant mass effect. Cerebral angiograms revealed the occlusion of right internal carotid artery. There were so-called moyamoya vessels bilaterally and transdural anastomosis on the right side. Avascular area confirmed subdural hematoma. The hematoma was evacuated via two burr holes with preservation of the middle meningeal and superficial temporal arteries. By the time of discharge two months postoperatively, she was walking well without assistance. We reviewed four cases of acute or subacute subdural hematoma associated with moyamoya phenomenon and emphasized the possibility of occurrence of acute or subacute subdural hematoma due to rupture of vault moyamoya vessels.     

A case of acute subdural hematoma associated with convexity meningioma

A 61-year-old normotensive woman was admitted to our hospital with complaints of severe headache and nausea. She has had a limp due to the poliomyelitis in her childhood. Three days before admission, she had a headache without unconsciousness. On admission, she was almost alert. Her vital signs were normal. A mild monoparesis of the atrophic right lower extremity was evident. This impairment was due to her past poliomyelitis. There were no other motor palsy, sensory loss, nuchal rigidity, and papilledema. A plain CT scan showed a crescent high density zone adjacent to a round high density mass in the left convexity. A cerebral angiogram showed a vascular left temporoparietal mass supplied by a middle meningeal artery. A craniotomy was then immediately performed. The well encapsulated tumor was totally resected, and the adjacent subdural hematoma was also evacuated. Histologically, the tumor was transitional meningioma with areas containing thin-walled vessels and focal necrosis. Postoperative course was uneventful. The origin of hemorrhage in this case would seem to be the thin-walled blood vessel with loss of vessel support. The clinical significance and the mechanism of the hemorrhage from the meningioma were discussed.     

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.     

A case of small meningioma with acute subdural hematoma

A 46-year-old female was transported to our clinic 4 hours after the onset of sudden headache and transient loss of consciousness. On admission, she was drowsy with slight left hemiparesis and anisocoria (left greater than right). The CT scan revealed a right subdural neurological deficit one month after the operation. the operation, we found that the hematoma was derived from a small meningioma attached to the dura at the middle temporal fossa. The meningioma was 1.5 cm in diameter. The patient was discharged without neurological deficit one month after the operation. Although glioblastoma and metastatic brain tumor are most common, meningioma is rare as a cause of intracranial bleeding. Among 69 cases of meningioma with intracranial bleeding reported previously, only 4 cases were accompanied with acute subdural hematoma.     

Acute spontaneous subdural hematoma associated with multiple aneurysms--a case report

A case of acute spontaneous subdural hematoma associated with three aneurysms is reported. On March 12, 1984, a 47-year-old woman experienced the sudden onset of severe headache over the bilateral frontal region and vomiting. Three hours later, she was transferred to our hospital by ambulance car because of continuous headache and vomiting. She had no history of head trauma. She had been medicated hypertension for five years. On admission she suffered from headache and nausea. But there was no clinical sign in physical and neurological examinations. The meningeal irritation was not present, but lumbar puncture showed slightly pinky CSF with normal pressure. A plain computed tomographic scan showed a thin high density mass in the left temporal extra-axial region and the slight deviation of the midline structures to the right. Left carotid arteriogram showed an avascular region over the left cerebral convexity, an aneurysm of the left A2-A3 junction and a questionable aneurysm of the bifurcation of left middle cerebral artery. Right carotid arteriogram showed an aneurysm of the bifurcation of right middle cerebral artery. We diagnosed this case as an acute subdural hematoma by CT scan and arteriogram. We were perplexed preoperatively whether this bleeding was spontaneous or secondary to the rupture of aneurysm, and we could not deny the possibility of a ruptured aneurysm. On March 15, 1984, three days after onset, operation was performed. At operation, a small subdural hematoma was removed, and the underlying cortex was normal.(ABSTRACT TRUNCATED AT 250 WORDS)     

Rapid resolution of acute subdural hematoma; report of two cases]

We reported two cases of rapid resolution of acute subdural hematoma. Case 1, a 21-year-old female, sustained head trauma and became unconscious for about 15 min. Probably she was suffering from posttraumatic amnesia for about 1 day. On admission J.C.S and G.C.S were 20 and 9 (2 + 2 + 5) points, respectively. Neurological examination showed no abnormalities. An initial computed tomography (CT) scan taken 2 hours after the injury showed a high dense subdural hematoma on the left cerebral hemisphere and hemispheric swelling. She was conservatively treated. A follow up CT scan taken 8 hours after the injury disclosed rapid disappearance of the hematoma and cerebral swelling. Case 2a 23-year-old male, sustained head trauma and became unconscious for about 30 min. On admission J.C.S and G.C.S were 1 and 14 (4 + 4 + 6) points, respectively, and slight right hemiparesis was noted. An initial CT scan taken 2 hours after the injury showed subdural hematoma of the left cerebral hemisphere and hemispheric swelling. He was conservatively treated. A follow up CT scan taken 24 hours after the injury revealed almost complete disappearance of the subdural hematoma and cerebral swelling. It was suggested that the rapid resolution of acute subdural hematoma was attributable to redistribution due to decrease of ICP, and washing out by cerebrospinal fluid.     

A case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography

One case of chronic subdural hematoma associated with an unruptured cerebral aneurysm detected by cerebral computed angiotomography is reported. A 44-year-old female slipped and hit her head without loss of consciousness, one month ago. Recently she complained of headaches and visited the department of Neurosurgery, Washokai Sadamoto Hospital on May 21, 1985. There were no physical and neurological signs on examination. Plain CT scans showed a crescent-shaped high density area in the left frontal region with a slight mass sign. She was diagnosed as having a possible chronic subdural hematoma and further examination was recommended. Biplane ultrafast overlapping cerebral computed angiotomograms clearly demonstrated a so-called avascular area delineated by enhanced superficial cerebral vessels with contrast medium. Furthermore, a marked high density mass measuring 8 mm X 10 mm X 6 mm in diameters was simultaneously demonstrated around the right anterior clinoid process on the same image, suggesting a cerebral aneurysm. Right carotid angiograms showed a right internal carotid-posterior communicating junction aneurysm. The irrigation of the left chronic subdural hematoma was carried out on May 24 and the neck clipping of the right IC-PC junction aneurysm was done two weeks later. During the operation, there were no findings suggesting a previous subarachnoid hemorrhage from the aneurysm, but a bleb was found on the aneurysm. The post-operative course was uneventful. Since the introduction of the CT scanner, chronic subdural hematomas are usually operated without cerebral angiograms.(ABSTRACT TRUNCATED AT 250 WORDS)     

A case of infant epidural hematoma treated by continuous drainage of cephalohematoma

A female infant was born at 36 weeks with vacuum extraction. Her weight was 2.216 g and Apgar score was 9. She had a cephalohematoma at right parietal region. The cephalohematoma grew during 6 days after birth, then she came to our hospital. On arrival, her consciousness was alert and there were no neurological deficits. Her head circumference was 22.5 cm, and she had a pulsatile soft cephalohematoma, 7 cm in diameter, at right parietal region. Ultrasound examination showed a midline shift of the brain and CT scan revealed an epidural hematoma with bone fracture and cephalohematoma. We chose the puncture and continuous drainage of cephalohematoma as a primary therapy, because cephalohematoma was considered to be liquified and to be continuous to the epidural hematoma. The reason was that the pulsatile cephalohematoma became harder when she cried. The epidural hematoma was completely reduced on the next day's CT and then drainage was removed. She discharged on 15th post-operative day. We conclude that the puncture and continuous drainage of cephalohematoma may be one of the good therapeutic methods for the mild symptomatic neonate who has epidural hematoma with the cephalohematoma and bone fracture.     

A case of multiple mycotic intracranial aneurysms presenting with subdural hematoma]

A patient with subdural hematoma associated with multiple mycotic intracranial aneurysms is reported. A 22-year-old woman presented with headache and disturbance of consciousness. A CT showed subdural hematoma at the tentrium and the left cerebral convexity. Conservative treatment and was used and she was discharged 10 days later. However, follow-up CT demonstrated a parenchymal hematoma in the right posterior temporal lobe. Cerebral angiography demonstrated a large right posterior cerebral aneurysm and multiple right middle cerebral aneurysms. A cardiac ultrasonography showed a verruca at the mitral valve. The posterior cerebral aneurysms increased in size and one new middle cerebral aneurysm appeared at follow-up angiography one week later. Endovascular treatment with coils was applied for the right posterior cerebral aneurysm, and others were treated with antibiotic therapy under serial observation, using MR angiography. She was discharged without any symptoms two months after embolization. Follow-up angiography at one year after embolization showed disappearance of the aneurysms. The possibility of mycotic aneurysm should be considered in the differential diagnosis of non-traumatic acute subdural hematoma.     

Acute epidural hematoma developing during twist-drill craniostomy: a complication of percutaneous subdural tapping for the treatment of chronic subdural hematoma

BACKGROUND

This case illustrates that although percutaneous subdural tapping for patients with chronic subdural hematoma (CSDH) is successful and minimally invasive, it can be complicated by acute epidural hematoma.

CASE PRESENTATION

A 62-year-old woman presented with headache two months after minor head trauma. Computed tomography (CT) scanning revealed CSDH with mixed density on the right side. Prior to percutaneous subdural tapping, twist-drill craniostomy was performed at the parietal tuber. When the drill-needle reached the dura mater, the patient began to complain of headache, which was followed by altered consciousness. CT scanning disclosed acute epidural hematoma abutting the CSDH; both hematomas were evacuated by emergency craniotomy. At surgery, no definite bleeding source was identified apart from oozing on the dura mater.

CONCLUSION

Hemorrhagic complications after percutaneous subdural tapping are rare. The formation of acute epidural hematoma during twist-drill craniostomy has not been reported in the literature. This complication can occur when the blunt tip of the drill-needle remains on the dura mater without penetrating into the subdural hematoma cavity.     

Familial occurrence of intracerebral cavernous angioma

This article reported a familial occurrence of intracerebral cavernous angioma in four members of one generation diagnosed by X-ray CT, MRI or operative specimen. Case 1, a 34-year-old female, was examined just after an episode of sudden convulsive seizure. On examination, she had a cutaneous angioma without any neurological deficit. X-ray CT revealed a high density mass lesion in the left frontal lobe, and MRI demonstrated a mass lesion in the chronic stage with an old hematoma circumscribed by hypointensity ring indicating peripheral hemosiderosis. Complete excision was carried out and a diagnosis of cavernous angioma was made after histological examination. Case 2, the 37-year-old brother of Case 1, suddenly developed left hemiparesis and hypesthesia with severe headache. X-ray CT revealed a high density mass in the right parietal lobe and two other calcifications. The right parietal lesion was excised and a histopathological diagnosis of cavernous angioma with intracerebral hematoma was made. Case 3, the 49-year-old sister of Case 1, suddenly fell into a coma and was admitted immediately. X-ray CT revealed a large pontine hemorrhage. She died on the 4th day of hospitalization without operative treatment. Necropsy was not carried out. Case 4, the 39-year-old sister of Case 1, was asymptomatic, however, she was examined on the supposition of a familial occurrence of intracerebral cavernous angioma. On examination, it was found she had multiple cavernous angioma without any neurological deficit. X-ray CT revealed parietal intracerebral calcification. MRI demonstrated a mass lesion with peripheral hypointensity ring in the right parietal lobe, and another small lesion in the pons.(ABSTRACT TRUNCATED AT 250 WORDS)     

Three cases of non-traumatic acute subdural hematoma]

The authors present three cases of non-traumatic acute subdural hematoma showing interesting clinical features and operative findings. Case 1: A-50-year-old male was admitted because of sudden headache and epileptic seizure. Computed tomographic (CT) scan showed a right thin subdural hematoma, but cerebral angiography demonstrated no pathological findings, that might cause acute subdural hematoma on the follow-up CT scans. The hematoma changed to a chronic one within only 15 days, which was proved by the operation. Case 2: A 52-year-old male was hospitalized because of loss of consciousness. CT scan revealed a right subdural hematoma without subarachnoid hemorrhage and cerebral angiography demonstrated a right middle cerebral artery aneurysm. The hematoma was surgically proved to be due to rupture of the aneurysm. Case 3: A 52-year-old male was admitted because of headache, vomiting and left motor weakness. CT scan showed a thick right subdural hematoma and right carotid angiography revealed two internal carotid artery aneurysms. It was surgically certified that the subdural hematoma was caused by a tear in a cortical artery attached to the dura, not by the rupture of the aneurysms. Clinical cause and pathogenesis of so-called "non-traumatic" or "spontaneous" acute subdural hematomas were discussed, and the importance of emergency angiography for this condition is stressed.     

Posterior fossa subdural hematoma in neonates: report of two cases and review of the literature

Posterior fossa subdural hematoma in neonates caused by birth trauma is rare; only 30 clinical cases can be found in the literature so far. Here we experience two similar cases and review that literature. Case #1 is that of a full-term female born in the pelvic position. At 21 hours after birth she developed convulsions and a CT scan revealed a high-density area, mainly in the right posterior fossa. On the fourth day, a right suboccipital craniectomy was performed and about 15 ml of hematoma was removed. At present her mental and somatic development is appropriate for her age (5 months), despite the fact that moderate brain atrophy was seen in the CT scan taken at 4 months. Case #2 is that of a full-term female also born in the pelvic position. At 38 hours she became convulsive and opisthotonic; a CT scan revealed a high-density area in the posterior fossa. No neurological abnormality was seen thereafter, however, and she was treated conservatively. On the 18th day, the high-density area in the CT scan had almost disappeared. In the CT scan taken at 6 months moderate brain atrophy was seen, but at the present age of two she evidences quite normal development both mentally and somatically. These cases lead us to emphasize the importance of prompt diagnosis followed by removal of hematoma, and the usefulness of CT scan as a diagnostic method in clinical manifestations of this sort.     

Acute subdural hematoma after aneurysmal rupture; evacuation with aneurysmal clipping after emergent infusion computed tomography: case report.

A 74-year-old woman sought treatment after an initial subarachnoid hemorrhage verified on computed tomographic scan with no focal neurological deficit. Shortly after admission, she sustained a second subarachnoid hemorrhage with acute neurological decompensation. A repeat computed tomographic scan revealed increased blood along the right medial temporal region, as well as in the interhemispheric fissure and bilateral sylvian cisterns. Also evident was a right hemispheric acute subdural hematoma. The patient's rapidly deteriorating neurological status precluded a cerebral angiogram; therefore, a double-dose infusion computed tomographic scan was performed. This revealed a cerebral artery aneurysm adjacent to the right medial temporal hematoma. She was taken to the operating room on the basis of this study. After evacuation of the right hemispheric subdural hematoma and clipping of the right posterior communicating artery aneurysm, the patient made a rapid, full neurological recovery.     

Successful surgical treatment of subdural hematoma following mitral valve replacement]

A 56-year-old woman, followed after mitral commissurotomy, was admitted to the hospital because of congestive heart failure of NYHA IV. Cardiac catheterization demonstrated severe MSR and TR. MVR using a SJM prosthetic valve and TAP with DeVega's method were performed under cardiopulmonary bypass with moderate hypothermia (25 degrees C). Postoperative hemodynamic condition was good with a uneventful convalescence. But disturbance of consciousness was seen with gradual deterioration and anisocoria developed on the 4th postoperative day. CT scan revealed a subdural hematoma in the right frontal and parietal region. Irrigation of the hematoma was performed immediately by neurosurgeons. She resumed full consciousness and was discharged from the hospital without any sequelae on the 49th postoperative day. The importance of the early diagnosis and the immediate treatment for the subdural hematoma following open heart surgery was emphasized.     

A case of petrotentorial meningioma presented as an acute subdural hemorrhage

The authors report a rare case of petrotentorial meningioma presenting as acute subdural hematoma. A 60-year-old female was introduced to our hospital complaining of sudden headache and gait disturbance. CT and MRI demonstrated a petrotentorial tumor with a subdural hematoma in the posterior fossa. The tumor was enhanced intensively on MRI and showed the dural tail sign. The patient developed progressive impairment of consciousness along with hydrocephalus. After ventricular drainage, emergency intracranial decompression through hematoma evacuation and partial tumor resection was performed. One month later, she improved clinically and the tumor resected totally in the second craniotomy. Histological examination showed a meningothelial meningioma with high vascularity in part. She recovered uneventfully and was discharged on foot. We discussed the etiology of an acute subdural hematoma caused by intratumoral hemorrhage and reviewed past literatures.