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Früh A, Schaller SJ, Faust K. [Neurosurgical Management of Traumatic Brain Injury]. Anasthesiol Intensivmed Notfallmed Schmerzther 2024; 59:438-449. [PMID: 39074789 DOI: 10.1055/a-2075-9315] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2024]
Abstract
The neurosurgical management of traumatic brain injury (TBI) plays a critical role in ensuring acute survival and mitigating secondary brain damage, which significantly impacts patients' quality of life. TBI is defined as an external force impacting the skull, leading to brain injuries and subsequent functional impairments. It is a leading cause of mortality and morbidity, particularly among young individuals. The initial clinical examination is crucial, with external signs like scalp injuries, hematomas, nasal fluid leakage, skull deformities, and neurological deficits providing important clues to injury patterns. Pupil examination is particularly critical, as mydriasis coupled with reduced consciousness may indicate an acute life-threatening increase in intracranial pressure (ICP), necessitating immediate neurosurgical intervention. TBI assessment often utilizes the Glasgow Coma Scale (GCS), classifying injuries as mild (GCS 13-15), moderate (GCS 9-12), or severe (GCS < 9). Even mild TBI can lead to long-term complications. TBI should be viewed as a disease process rather than a singular event. Primary brain damage results from shearing forces on the parenchyma, manifesting as contusions, hematomas, or diffuse axonal injury. Secondary brain damage is driven by mechanisms such as inflammation and spreading depolarizations. Treatment aims not only to secure immediate survival but also to reduce secondary injuries, with ICP management being crucial. Neurosurgical interventions are guided by cranial pathologies, with options including ICP monitoring, burr hole trepanation, craniotomy. In severe TBI cases with refractory ICP elevation, decompressive craniectomy may be performed as a last resort, significantly reducing mortality but often resulting in high morbidity and vegetative states, necessitating careful consideration of indications.
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Awwad A, Daraghma RA, Hajhamad MM, Asad DM, Khalil OR. The Delayed Presentation of Bilateral Subdural Hematoma Secondary to Epidural Anesthesia for Elective Vaginal Delivery: A Case Report and Review of the Literature. Cureus 2024; 16:e59041. [PMID: 38800238 PMCID: PMC11128062 DOI: 10.7759/cureus.59041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2024] [Indexed: 05/29/2024] Open
Abstract
Epidural anesthesia (EA) involves reaching the spinal epidural space with an anesthetic drug injection. This procedure provides pain relief during labor. Although EA can lead to some complications, subdural hemorrhage (SDH) is a rare adverse event associated with it. We report the case of a 25-year-old female patient who presented to our emergency department with a one-month history of headaches and associated blurred vision following a normal vaginal delivery with EA. She was initially treated as a case of post-dural puncture headache (PDPH), with no improvement. Finally, the diagnosis of bilateral SDH was made based on a brain MRI. She required surgical intervention, which led to a positive prognosis and a full return of normal baseline neurological functions. Only a few reports in the literature have indicated the possibility of cranial subdural hematoma formation associated with spinal or epidural analgesia. Our patient experienced a delay in her diagnosis and treatment, as SDH following EA is a rare entity. It is important to follow up with such patients and consider other possibilities when symptoms fail to resolve. Also, reporting these cases is crucial to assist clinicians in early diagnosis and treatment, and to avoid disastrous outcomes.
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Affiliation(s)
- Ahmad Awwad
- Surgery Department, Rafidia Governmental Hospital, Nablus, PSE
| | | | | | - Diya M Asad
- Faculty of Medicine, Al-Quds University, Jerusalem, PSE
| | - Omar R Khalil
- Internal Medicine, Al-Quds University, Jerusalem, PSE
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Zhuang D, Li T, Xie H, Sheng J, Chen X, Li X, Li K, Chen W, Wang S. A dynamic nomogram for predicting intraoperative brain bulge during decompressive craniectomy in patients with traumatic brain injury: a retrospective study. Int J Surg 2024; 110:909-920. [PMID: 38181195 PMCID: PMC10871569 DOI: 10.1097/js9.0000000000000892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 10/26/2023] [Indexed: 01/07/2024]
Abstract
OBJECTIVE The aim of this paper is to investigate the risk factors associated with intraoperative brain bulge (IOBB), especially the computed tomography (CT) value of the diseased lateral transverse sinus, and to develop a reliable predictive model to alert neurosurgeons to the possibility of IOBB. METHODS A retrospective analysis was performed on 937 patients undergoing traumatic decompressive craniectomy. A total of 644 patients from Fuzong Clinical Medical College of Fujian Medical University were included in the development cohort, and 293 patients from the First Affiliated Hospital of Shantou University Medical College were included in the external validation cohort. Univariate and multifactorial logistic regression analyses identified independent risk factors associated with IOBB. The logistic regression models consisted of independent risk factors, and receiver operating characteristic curves, calibration, and decision curve analyses were used to assess the performance of the models. Various machine learning models were used to compare with the logistic regression model and analyze the importance of the factors, which were eventually jointly developed into a dynamic nomogram for predicting IOBB and published online in the form of a simple calculator. RESULTS IOBB occurred in 93/644 (14.4%) patients in the developmental cohort and 47/293 (16.0%) in the validation cohort. Univariate and multifactorial regression analyses showed that age, subdural hematoma, contralateral fracture, brain contusion, and CT value of the diseased lateral transverse sinus were associated with IOBB. A logistic regression model (full model) consisting of the above risk factors had excellent predictive power in both the development cohort [area under the curve (AUC)=0.930] and the validation cohort (AUC=0.913). Among the four machine learning models, the AdaBoost model showed the best predictive value (AUC=0.998). Factors in the AdaBoost model were ranked by importance and combined with the full model to create a dynamic nomogram for clinical application, which was published online as a practical and easy-to-use calculator. CONCLUSIONS The CT value of the diseased lateral transverse is an independent risk factor and a reliable predictor of IOBB. The online dynamic nomogram formed by combining logistic regression analysis models and machine learning models can more accurately predict the possibility of IOBBs in patients undergoing traumatic decompressive craniectomy.
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Affiliation(s)
- Dongzhou Zhuang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou
| | - Tian Li
- Department of Microbes and Immunity, Shantou University Medical College, Shantou, Guangdong
| | - Huan Xie
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong
| | - Jiangtao Sheng
- Department of Microbes and Immunity, Shantou University Medical College, Shantou, Guangdong
| | - Xiaoxuan Chen
- Department of Microbes and Immunity, Shantou University Medical College, Shantou, Guangdong
| | - Xiaoning Li
- Department of Orthopaedics, The Third Xiangya Hospital, Central South University, Changsha, Hunan, People’s Republic of China
| | - Kangsheng Li
- Department of Microbes and Immunity, Shantou University Medical College, Shantou, Guangdong
| | - Weiqiang Chen
- Department of Neurosurgery, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong
| | - Shousen Wang
- Department of Neurosurgery, Fuzong Clinical Medical College of Fujian Medical University, Fuzhou
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Evbayiro U, Delmas T, Lat T. Non-traumatic Acute Subdural Hematoma in a Patient With Scleroderma Complicated by Pulmonary Arterial Hypertension: A Case Report. Cureus 2023; 15:e38769. [PMID: 37303401 PMCID: PMC10250107 DOI: 10.7759/cureus.38769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Non-traumatic acute subdural hematoma (SDH) in patients with scleroderma is infrequently described in literature reviewing the neurologic disorders in scleroderma. We report a case of a patient with scleroderma complicated by severe pulmonary arterial hypertension (PAH), and a history of pulmonary embolism on warfarin who developed an SDH, requiring hemicraniectomy after initiating therapy with IV epoprostenol. The proposed mechanisms for SDH development and management strategy are discussed.
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Affiliation(s)
- Uyioghosa Evbayiro
- Pulmonary and Critical Care Medicine, Texas A&M University School of Medicine, Temple, USA
| | - Thomas Delmas
- Neurocritical Care, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Tasnim Lat
- Pulmonary and Critical Care Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
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Li Z, Feng Y, Wang P, Han S, Zhang K, Zhang C, Lu S, Lv C, Zhu F, Bie L. Evaluation of the prognosis of acute subdural hematoma according to the density differences between gray and white matter. Front Neurol 2023; 13:1024018. [PMID: 36686517 PMCID: PMC9853902 DOI: 10.3389/fneur.2022.1024018] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/21/2022] [Indexed: 01/07/2023] Open
Abstract
Objective Acute subdural hematoma (ASDH) is a common neurological emergency, and its appearance on head-computed tomographic (CT) imaging helps guide clinical treatment. To provide a basis for clinical decision-making, we analyzed that the density difference between the gray and white matter of the CT image is associated with the prognosis of patients with ASDH. Methods We analyzed the data of 194 patients who had ASDH as a result of closed traumatic brain injury (TBI) between 2018 and 2021. The patients were subdivided into surgical and non-surgical groups, and the non-surgical group was further subdivided into "diffused [hematoma]" and "non-diffused" groups. The control group's CT scans were normal. The 3D Slicer software was used to quantitatively analyze the density of gray and white matter depicted in the CT images. Results Imaging evaluation showed that the median difference in density between the gray and white matter on the injured side was 4.12 HU (IQR, 3.91-4.22 HU; p < 0.001) and on the non-injured side was 4.07 HU (IQR, 3.90-4.19 HU; p < 0.001), and the hematoma needs to be surgically removed. The median density difference value of the gray and white matter on the injured side was 3.74 HU (IQR, 3.53-4.01 HU; p < 0.001) and on the non-injured side was 3.71 HU (IQR, 3.69-3.73 HU; p < 0.001), and the hematoma could diffuse in a short time. Conclusion Quantitative analysis of the density differences in the gray and white matter of the CT images can be used to evaluate the clinical prognosis of patients with ASDH.
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Affiliation(s)
- Zean Li
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Yan Feng
- Department of Radiology of the First Clinical Hospital, Jilin University, Changchun, China
| | - Pengju Wang
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Shuai Han
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Kang Zhang
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Chunyun Zhang
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Shouyong Lu
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Chuanxiang Lv
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Fulei Zhu
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China
| | - Li Bie
- Department of Neurosurgery of the First Clinical Hospital, Jilin University, Changchun, China,*Correspondence: Li Bie
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Fadzil F, Mei AKC, Mohd Khairy A, Kumar R, Mohd Azli AN. Value of Repeat CT Brain in Mild Traumatic Brain Injury Patients with High Risk of Intracerebral Hemorrhage Progression. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14311. [PMID: 36361190 PMCID: PMC9658041 DOI: 10.3390/ijerph192114311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/11/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Abstract
UNLABELLED Patients with mild traumatic brain injury (MTBI) with intracerebral hemorrhage (ICH), particularly those at higher risk of having ICH progression, are typically prescribed a second head Computer Tomography (CT) scan to monitor the disease development. This study aimed to evaluate the role of a repeat head CT in MTBI patients at a higher risk of ICH progression by comparing the intervention rate between patients with and without ICH progression. METHODS 192 patients with MTBI and ICH were treated between November 2019 to December 2020 at a single level II trauma center. The Glasgow Coma Scale (GCS) was used to classify MTBI, and initial head CT was performed according to the Canadian CT head rule. Patients with a higher risk of ICH progression, including the elderly (≥65 years old), patients on antiplatelets or anticoagulants, or patients with an initial head CT that revealed EDH, contusional bleeding, or SDH > 5 mm, and multiple ICH underwent a repeat head CT within 12 to 24 h later. Data regarding types of intervention, length of stay in the hospital, and outcome were collected. The risk of further neurological deterioration and readmission rates were compared between these two groups. All patients were followed up in the clinic after one month or contacted via phone if they did not return. RESULTS 189 patients underwent scheduled repeated head CT, 18% had radiological intracranial bleed progression, and 82% had no changes. There were no statistically significant differences in terms of intervention rate, risk of neurological deterioration in the future, or readmission between them. CONCLUSION Repeat head CT in mild TBI patients with no neurological deterioration is not recommended, even in patients with a higher risk of ICH progression.
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Affiliation(s)
- Farizal Fadzil
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Amy Khor Cheng Mei
- Department of Surgery, Hospital Tengku Ampuan Rahimah, Klang 41200, Selangor, Malaysia
| | - Azudin Mohd Khairy
- Department of Surgery, Hospital Tengku Ampuan Rahimah, Klang 41200, Selangor, Malaysia
| | - Ramesh Kumar
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
| | - Anis Nabillah Mohd Azli
- Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras, Kuala Lumpur 56000, Malaysia
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Plowman K, Lindner D, Valle-Giler E, Ashkin A, Bass J, Ruthman C. Subdural hematoma expansion in relation to measured mean and peak systolic blood pressure: A retrospective analysis. Front Neurol 2022; 13:1026471. [PMID: 36324382 PMCID: PMC9618657 DOI: 10.3389/fneur.2022.1026471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Subdural hematomas (SDH) account for an estimated 5 to 25% of intracranial hemorrhages. Acute SDH occur secondary to rupture of the bridging veins leading to blood collecting within the dural space. Risk factors associated with SDH expansion are well documented, however, there are no established guidelines regarding blood pressure goals in the management of acute SDH. This study aims to retrospectively evaluate if uncontrolled blood pressure within the first 24 h of hospitalization in patients with acute SDH is linked to hematoma expansion as determined by serial CT imaging. Methods A single center, retrospective study looked at 1,083 patients with acute SDH, predominantly above age 65. Of these, 469 patients met the inclusion criteria. Blood pressure was measured during the first 24 h of admission along with PT, INR, platelets, blood alcohol level, anticoagulation use and antiplatelet use. Follow-up CT performed within the first 24 h was compared to the initial CT to determine the presence of hematoma expansion. Mean systolic blood pressure (SBP), peak SBP, discharge disposition, length of stay and in hospital mortality were evaluated. Results We found that patients with mean SBP <140 in the first 24 h of admission had a lower rate of hematoma expansion than those with SBP > 140. Patients with peak SBP > 200 had an increased frequency of hematoma expansion with the largest effect seen in patients with SBP > 220. Other risk factors did not contribute to hematoma expansion. Conclusions These results suggest that blood pressure is an important factor to consider when treating patients with SDH with medical management. Blood pressure management should be considered in addition to serial neurological exams, repeat radiological imaging, seizure prophylaxis and reversal of anticoagulation.
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Affiliation(s)
- Keegan Plowman
- Graduate Medical Education Internal Medicine Residency, NCH Healthcare System, Naples, FL, United States
- *Correspondence: Keegan Plowman
| | - David Lindner
- Division of Pulmonary Critical Care Medicine, NCH Healthcare System, Naples, FL, United States
| | - Edison Valle-Giler
- Division of Neurological Surgery, NCH Healthcare System, Naples, FL, United States
| | - Alex Ashkin
- Graduate Medical Education Internal Medicine Residency, NCH Healthcare System, Naples, FL, United States
| | - Jessica Bass
- Graduate Medical Education Internal Medicine Residency, NCH Healthcare System, Naples, FL, United States
| | - Carl Ruthman
- Division of Pulmonary Critical Care Medicine, NCH Healthcare System, Naples, FL, United States
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Lee CH, Kim YH, Oh BK, Lee CH, Kim CH, Sung SK, Lee SW, Song GS. Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? Korean J Neurotrauma 2022; 18:198-207. [PMID: 36381433 PMCID: PMC9634325 DOI: 10.13004/kjnt.2022.18.e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has affected all medical fields, including neurosurgery. Particularly, performing preoperative screening tests has become mandatory, potentially extending the time from admission to the emergency room and operating room, thus possibly affecting patients' prognosis. This study aimed to determine the influence of COVID-19 screening time on patients' postoperative prognosis. Methods From September 10, 2020, to May 31, 2021, we retrospectively evaluated 54 patients with cerebral hemorrhage who underwent emergency surgery in the emergency room after the screening test. The control group included 89 patients with cerebral hemorrhage who underwent emergency surgery between January 2019 and March 2020, i.e., the period before the COVID-19 pandemic. Prognosis was measured using the Glasgow Coma Scale scores, which were obtained preoperatively, postoperatively, and at discharge, and the modified Rankin Scale (mRS). Additionally, unfavorable outcomes (mRS score 3-6) and in-hospital mortality rates were investigated for postoperative prognostic assessments. Results No remarkable differences were observed in the time to surgical intervention and prognostic evaluation scores between patients with cerebral hemorrhage who underwent COVID-19 screening tests and subjects in the control group. Conclusion This study confirmed that patient treatment and prognosis were not significantly affected by additional preoperative screening testing times during the pandemic. We believe that our results are informative for the evaluation and performance of emergency neurosurgery during the pandemic.
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Affiliation(s)
- Chang Ho Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Bu Kwang Oh
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
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Xiang T, Zhang X, Wei Y, Feng D, Gong Z, Liu X, Yuan J, Jiang W, Nie M, Fan Y, Chen Y, Feng J, Dong S, Gao C, Huang J, Jiang R. Possible mechanism and Atorvastatin-based treatment in cupping therapy-related subdural hematoma: A case report and literature review. Front Neurol 2022; 13:900145. [PMID: 35937065 PMCID: PMC9354981 DOI: 10.3389/fneur.2022.900145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Subdural hematoma (SDH) is one of the most lethal types of traumatic brain injury. SDH caused by Intracranial Pressure Reduction (ICPR) is rare, and the mechanism remains unclear. Here, we report three cases of SDH that occurred after substandard cupping therapy and are conjected to be associated with ICPR. All of them had undergone cupping treatments. On the last cupping procedure, they experienced a severe headache after the cup placed on the occipital-neck junction (ONJ) was suddenly removed and were diagnosed with SDH the next day. In standard cupping therapy, the cups are not usually placed on the ONJ. We speculate that removing these cups on the soft tissue over the cisterna magna repeatedly created localized negative pressure, caused temporary but repeated ICPR, and eventually led to SDH development. The Monro-Kellie Doctrine can explain the mechanism behind this - it states that the intracranial pressure is regulated by a fixed system, with any change in one component causing a compensatory change in the other. The repeated ICPR promoted brain displacement, tearing of the bridging veins, and development of SDH. The literature was reviewed to illustrate the common etiologies and therapies of secondary ICPR-associated SDH. Despite the popularity of cupping therapy, its side effects are rarely mentioned. This case is reported to remind professional technicians to fully assess a patient's condition before cupping therapy and ensure that the cups are not placed at the ONJ.
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Affiliation(s)
- Tangtang Xiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xinjie Zhang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yingsheng Wei
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Dongyi Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Zhitao Gong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Xuanhui Liu
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiangyuan Yuan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Weiwei Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Meng Nie
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yibing Fan
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Yupeng Chen
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jiancheng Feng
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Shiying Dong
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Chuang Gao
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Jinhao Huang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
| | - Rongcai Jiang
- Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China
- Key Laboratory of Post Neuro-injury Neuro-repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin, Tianjin, China
- *Correspondence: Rongcai Jiang
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Nguyen A, Reed L, Daly SR, Keith K, Garrett D. Spontaneous Atraumatic Subdural Hematoma Related to Methamphetamine Use. Cureus 2021; 13:e18383. [PMID: 34729264 PMCID: PMC8555929 DOI: 10.7759/cureus.18383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022] Open
Abstract
There are multiple risk factors associated with spontaneous subdural hematoma (SDH), including substance abuse, hypertension, vascular abnormalities, and neoplasms. The illicit drugs typically cited as risk factors for spontaneous SDH are alcohol and cocaine. We report a rare case of spontaneous, significant SDH associated exclusively with methamphetamine. Although it is unclear whether the underlying pathophysiology involves vasculitis, sympathomimetic-induced hypertension, or a combination of both, this case further illustrates the risks of methamphetamine abuse.
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Affiliation(s)
| | - Laura Reed
- Neurosurgery, Baylor Scott & White Health, Temple, USA
| | - Samuel R Daly
- Neurosurgery, Baylor Scott & White Health, Temple, USA
| | - Kristin Keith
- Neurosurgery, Baylor Scott & White Health, Temple, USA
| | - David Garrett
- Neurosurgery, Baylor Scott & White Health, Temple, USA
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Pastor IS, Dumbravă LP, Siserman C, Stan H, Para I, Florian IȘ. Predictive factors of 30-day mortality in patients with traumatic subdural hematoma. Exp Ther Med 2021; 22:757. [PMID: 34035854 DOI: 10.3892/etm.2021.10189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 11/05/2022] Open
Abstract
In the present study, we aimed to assess and analyze the predictive factors of 30-day mortality in patients with acute subdural hematoma (ASDH) who underwent surgical intervention after traumatic brain injury (TBI). We conducted a retrospective study, which included a cohort of 135 consecutive patients diagnosed with ASDH who required surgical evacuation. We assessed the demographic and clinical data, the imaging data of the hematoma described by preoperative computed tomography (CT) and the type of neurosurgical intervention for hematoma evacuation via either craniectomy or craniotomy. The patients were followed up for 30 days after head trauma and the occurrence of death was noted. Death was recorded in 63 (46.6%) patients at 30 days after TBI. There was a significant number of deceased patients who underwent craniectomy (71.4%). The Glasgow Coma Scale (GCS) was statistically significantly lower in patients who died (P<0.001), with a cut-off value of ≤12, under which the probability of death increased [AUC 0.830 (95% CI, 0.756-0.889); Se 90.48% (95% CI, 80.4-96.4); Sp 66.7% (95% CI, 54.6-77.3); P<0.001]. The midline shift was statistically significantly higher in deceased patients (P=0.005), with a cut-off value of >7 mm, over which the probability of death increased [AUC 0.637 (95% CI, 0.550-0.718); Se 38.1% (95% CI, 26.1-51.2); Sp 86.1% (95% CI, 75.9-93.1); P=0.003]. There were significantly more deceased patients with intracranial hypertension, brain herniation, brain swelling, intraparenchymal hematoma and cranial fracture. In multivariate analysis only a Glasgow score ≤12 and a midline shift >7 mm were independently linked to mortality. Brain herniation and intraparenchymal hematoma were associated with a higher probability of dying, but the statistical threshold was slightly exceeded. The type of neurosurgery performed for patients with ASDH was not an independent predictive factor for 30-day mortality. However, craniectomy was associated with a higher mortality in patients with ASDH.
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Affiliation(s)
- Iulia-Sevastiana Pastor
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Lăcrimioara Perju Dumbravă
- First Department of Neurology, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Costel Siserman
- Department of Legal Medicine, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Horațiu Stan
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioana Para
- Department of Internal Medicine, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Ioan Ștefan Florian
- Department of Neurosurgery, Faculty of Medicine, 'Iuliu Hațieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Koppen H, Arkink E, Nordbeck A, Sie L, van der Gaag N. Swift Spontaneous Regression of a Pediatric Traumatic Acute Subdural Hematoma. Case Rep Neurol 2019; 11:351-356. [PMID: 31966032 PMCID: PMC6959089 DOI: 10.1159/000504468] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 10/30/2019] [Indexed: 11/23/2022] Open
Abstract
We report the case of a 4-year-old girl with acute subdural hematoma who presented to the emergency department after an unwitnessed fall of the balcony. The hematoma was hyperdense along the left convexity of 9 mm thickness with a consequent mass effect with obliteration of the adjacent sulci, left lateral ventricle compression and a midline shift of 7 mm. During her stay in the emergency department while waiting for transfer to the children intensive care unit elsewhere she slightly deteriorated neurologically. Repeat CT scan of the brain 4 h after initial presentation remarkably showed that the subdural hematoma had now largely disappeared, with a decrease in volume and density. Consequently, the mass effect diminished with a near normalization of the midline shift.
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Affiliation(s)
- Hille Koppen
- Hagaziekenhuis, Department of Neurology, The Hague, The Netherlands.,Leiden University Medical Center, Department of Neurology, Leiden, The Netherlands
| | - Enrico Arkink
- Landspitali University Hospital, Department of Radiology, Reykjavik, Iceland
| | - Anna Nordbeck
- Hagaziekenhuis, Department of Neurology, The Hague, The Netherlands
| | - Lilian Sie
- Hagaziekenhuis, Department of Pediatric Neurology, The Hague, The Netherlands
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13
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Alhillo HT, Sadik HA, Gheni TN, Hoz SS. Rare occurrence of a huge traumatic extradural haematoma in a patient with an ipsilateral sylvian arachnoid cyst. BMJ Case Rep 2018; 11:11/1/bcr-2018-227525. [PMID: 30567181 DOI: 10.1136/bcr-2018-227525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A man, a teenage victim of an assault to the head, presented to the emergency department, in Baghdad, with a Glasgow Coma Score of 4/15 (E1 M2 V1) and total right-sided paralysis. CT of the brain revealed a large-left sided frontotemporoparietal extradural haematoma with the presence of an ipsilateral sylvian arachnoid cyst deep to the haematoma. Urgent surgical evacuation of the haematoma was performed, leaving the arachnoid cyst intact. The patient improved and gained full consciousness within 4 days.Three years after the initial trauma, the patient has remained well. This case required a thorough discussion of the surgical options, in particular whether to intervene with the associated cyst, and whether any intervention with the cyst should be performed in the same or future operations. This dilemma forms the basis of the discussion in the following report.
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Affiliation(s)
| | - Hatem Azet Sadik
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Teeba N Gheni
- College of Medicine, Al-Anbar University, Anbar, Iraq
| | - Samer S Hoz
- Department of Neurosurgery, Neurosurgical Teaching Hospital, Baghdad, Iraq
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14
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Repair of damaged cortical artery by direct micro-suture in surgical treatment of acute subdural hematoma: technical note. Acta Neurochir (Wien) 2018; 160:1931-1937. [PMID: 30066190 DOI: 10.1007/s00701-018-3634-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 07/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In surgical treatment of acute subdural hematoma (ASDH), neurosurgeons frequently encounter bleeding from cortical arteries, which is usually controlled with bipolar coagulation. However, bipolar coagulation is associated with a risk of sacrificing the cortical artery, which may affect the prognosis of neurological symptoms when these cortical arteries supply critical areas. In this article, we describe microsurgical repair of damaged cortical arteries using a 10-0 nylon micro-suture in patients with arterial-origin ASDH. METHODS After removal of the subdural hematoma, the exact bleeding point of the cortical artery was identified, and the 10-0 nylon suture stitches were placed on the arterial tear under a microscope. After completion of the micro-suture, vascular patency was confirmed by indocyanine green (ICG) videoangiography. RESULTS From June 2015 through February 2017, microsurgical repair was performed for seven cortical arteries in six patients. All damaged arteries were located near the Sylvian fissure, and all tears were pinhole tears. The average blood flow occlusion time was 8 min (range, 0-15 min). The patency of all seven repaired arteries was successfully confirmed by ICG videoangiography. Postoperative cerebral infarction was not observed except in one patient with cerebral contusion and a history of severe head trauma. CONCLUSIONS The present report demonstrates that repair of a cortical artery by the 10-0 nylon micro-suture is a simple and safe method with a low risk of sacrificing the artery. This technique may be a good option in the surgical treatment of arterial-origin ASDH, especially when the accompanying cerebral contusion is minimal.
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15
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Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. [PMID: 31179908 PMCID: PMC6135040 DOI: 10.1186/s12245-018-0199-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 08/26/2018] [Indexed: 12/26/2022] Open
Abstract
Background Intracranial subdural hematoma occurring as a result of a procedure that causes a puncture of the spinal dura mater is extremely rare, with less than 100 cases reported. Often, this condition is initially misdiagnosed and treated as a post dural puncture headache. Case presentation A woman presented to our emergency department complaining of a headache 4 days after receiving epidural anesthesia during uncomplicated childbirth. The headache’s characteristics were consistent with a post dural puncture headache, and the patient was initially treated as such. Computed tomography later revealed the presence of bilateral intracranial subdural hematomas. In light of the patient’s clinical status, treatment involved cautious observation only. Repeat imaging revealed spontaneous resolution of the hematomas, and the patient had a benign clinical course. Conclusions Headaches are common in the postpartum period, often after receiving epidural or spinal anesthesia. While exceptionally rare, intracranial subdural hematoma may occur as a complication of any procedure that results in spinal dural puncture. The possibility of this potentially life-threatening complication must be kept in mind when evaluating these patients.
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Affiliation(s)
- Victor Szeto
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA
| | - Justin Kosirog
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA
| | - Wesley Eilbert
- Department of Emergency Medicine, University of Illinois College of Medicine, 1819 West Polk St., Room 469 COME, Chicago, IL, 60612, USA.
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Alliez JR, Kaya JM, Leone M. Ematomi intracranici post-traumatici in fase acuta. Neurologia 2017. [DOI: 10.1016/s1634-7072(17)86804-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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17
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Moussa WMM, Khedr WM, Elwany AH. Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study. Neurosurg Rev 2017; 41:483-488. [DOI: 10.1007/s10143-017-0873-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
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18
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A glimmer of hope for a devastating complication. Blood 2017; 129:2952-2953. [DOI: 10.1182/blood-2017-04-777771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lucke-Wold BP, Turner RC, Josiah D, Knotts C, Bhatia S. Do Age and Anticoagulants Affect the Natural History of Acute Subdural Hematomas? ARCHIVES OF EMERGENCY MEDICINE AND CRITICAL CARE 2016; 1. [PMID: 27857999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/28/2022]
Abstract
Acute subdural hematoma is a serious complication following traumatic brain injury. Large volume hematomas or those with underlying brain injury can cause mass effect, midline shift, and eventually herniation of the brain. Acute subdural hematomas in the young are associated with high-energy trauma and often have underlying contusions, while acute subdural hematomas in the elderly are associated with minor trauma and an absence of underlying contusions, even though the elderly are more likely to be on anticoagulants or anti-platelet therapy. In the young patients with high impact injuries the hematomas tend to be small and the underlying brain injury and swelling is responsible for the increased intracranial pressure and midline shift. In the elderly, the injuries are low impact (e.g fall from standing), the underlying brain is intact, and the volume of the hematoma itself produces symptoms. In addition the use of anticoagulants and antiplatelet agents in the elderly population has been thought to be a poor prognostic indicator and is considered to be responsible for larger hematomas and poor outcome. When managed conservatively, acute subdural hematomas can sometimes progress to chronic subdural hematoma formation, further enlargement, seizures, and progressive midline shift. Another potential difference in the young and the elderly is brain atrophy, which increases the potential space to accommodate a larger hematoma. It is not known if these two groups differ in other ways that might have implications for treatment or prognosis. In this paper, we investigate the clinical course of 80 patients admitted to our institution with acute subdural hematomas, to identify differences in patients above or below the age of 65 years. The natural progression/resolution of acute subdural hematomas was mapped by measuring volume expansion/regression over time. In this retrospective chart review, we investigated clinical baseline metrics and subsequent volumetric expansion outcomes between patients < 65 years old (N=44) and those > 65 years old (N=36). Volume was estimated by the ABC/2 method. We observed a statistically significant difference between groups in use of anticoagulants χ2 =40.305 with p < 0.001, corrective platelet administration χ2 =19.380 with p < 0.001, gender χ2 =14.573 with p < 0.001, and Glasgow Coma Scale with χ2 =23.125 (p=0.026). Overall outcomes were similar in the two groups. Younger patients on average had worse presenting GCS scores, but recovered comparable to older patients. No significant difference in rate of volume expansion, resolution time, or need for surgical treatment was seen between these two groups. We conclude that the initial volume, size, and severity of subdural hematoma determined by the Glasgow Coma Scale score is more likely to predict surgery or future expansion than age of the patient. Patients on oral anti-coagulants that are given appropriate medical reversal agents early do quite well and no impact on the eventual outcome could be demonstrated. Further work is needed to establish better predictors of future volume expansion, and progression to chronic subdural hematoma based on improved severity scales.
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Affiliation(s)
| | - Ryan C Turner
- Department of Neurosurgery, West Virginia University, USA
| | - Darnell Josiah
- Department of Neurosurgery, West Virginia University, USA
| | - Chelsea Knotts
- Department of Neurosurgery, West Virginia University, USA
| | - Sanjay Bhatia
- Department of Neurosurgery, West Virginia University, USA
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Han J, Lim DJ, Kim SD, Ha SK, Lee SH, Kim SH. Subdural Hematoma without Subarachnoid Hemorrhage Caused by the Rupture of Middle Cerebral Artery Aneurysm. J Cerebrovasc Endovasc Neurosurg 2016; 18:315-321. [PMID: 27847781 PMCID: PMC5104862 DOI: 10.7461/jcen.2016.18.3.315] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/30/2016] [Accepted: 08/31/2016] [Indexed: 11/23/2022] Open
Abstract
Pure subdural hematomas caused by a ruptured intracranial aneurysm are extremely rare. We describe the case of a 42-year-old woman who presented with headache without evidence of head trauma. Magnetic resonance angiography and conventional cerebral angiography revealed a ruptured aneurysm at the right middle cerebral artery bifurcation. The patient underwent surgical treatment and had a good outcome without any neurological deficit. The mechanisms and clinical characteristics of this condition are discussed.
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Affiliation(s)
- Jinsol Han
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dong-Jun Lim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sang-Dae Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung-Kon Ha
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Seung-Hwan Lee
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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21
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Amrhein TJ, Mostertz W, Matheus MG, Maass-Bolles G, Sharma K, Collins HR, Kranz PG. Reformatted images improve the detection rate of acute traumatic subdural hematomas on brain CT compared with axial images alone. Emerg Radiol 2016; 24:39-45. [DOI: 10.1007/s10140-016-1440-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 09/01/2016] [Indexed: 02/03/2023]
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22
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Albertine P, Borofsky S, Brown D, Patel S, Lee W, Caputy A, Taheri MR. Small subdural hemorrhages: is routine intensive care unit admission necessary? Am J Emerg Med 2016; 34:521-4. [DOI: 10.1016/j.ajem.2015.12.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 12/16/2015] [Accepted: 12/17/2015] [Indexed: 11/16/2022] Open
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Sweis RT, Ouyang B, Lopez GA, Bleck TP, Busl KM. Falcine and Tentorial Subdural Hematomas May Not Routinely Require Transfer to a Tertiary Care Center. J Emerg Med 2015; 49:679-85. [PMID: 26279513 DOI: 10.1016/j.jemermed.2015.06.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 06/16/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with subdural hematomas (SDH) are frequently transferred to tertiary care centers. Although many prognostic factors, treatment strategies, and outcomes for convexity SDH have been reported, little is known about falcine and tentorial SDH. OBJECTIVES To describe features and outcomes of isolated falcine and tentorial SDH. METHODS We reviewed clinical/radiographic findings, treatment, length of stay (LOS), and outcome of adult patients transferred to a tertiary care center for acute SDH. Characteristics of patients with isolated falcine/tentorial SDH and outcomes (favorable [discharge to home/acute rehabilitation] vs. unfavorable [death/hospice/skilled nursing facility/long term care]) were assessed with univariate analyses. RESULTS Of 210 patients with SDH, mean age was 69.5 years; 117 were male; 98 (47%) underwent surgical SDH evacuation. Twenty-seven patients had isolated falcine or tentorial SDH, with known traumatic etiology in 23. None of the falcine/tentorial SDH patients required surgery or intubation. Compared with convexity SDH, patients with falcine/tentorial SDH were younger (59.7 vs. 70.9 years, p = 0.01), had higher admission Glasgow Coma Scale scores at the referring (p = 0.01) and receiving facility (p = 0.004), and shorter median intensive care unit LOS (1 vs. 3, p < 0.0001). All patients (100%) with falcine/tentorial SDH had favorable outcome vs. 68% with convexity SDH (p = 0.0005). CONCLUSION Isolated tentorial/falcine SDH without associated neurological deficits represent a benign entity among acute SDH, with no need for surgical intervention, short LOS, and favorable outcome. Our data indicate that for these patients, in the absence of complicating factors, transfer to a tertiary care center may not be routinely indicated.
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Affiliation(s)
- Rochelle T Sweis
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Bichun Ouyang
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - George A Lopez
- Department of Neurological Sciences, Section of Neurocritical Care, Rush University Medical Center, Chicago, Illinois
| | - Thomas P Bleck
- Departments of Neurological Sciences, Neurosurgery, Internal Medicine, and Anesthesiology, Rush Medical College, Chicago, Illinois; Critical Care, Rush University Medical Center, Chicago, Illinois
| | - Katharina M Busl
- Department of Neurological Sciences, Section of Neurocritical Care, Rush University Medical Center, Chicago, Illinois
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