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Boukobza M, Laissy JP. The "zebra sign" after a lumbar puncture. Rev Neurol (Paris) 2024:S0035-3787(24)00515-0. [PMID: 38744570 DOI: 10.1016/j.neurol.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 03/17/2024] [Indexed: 05/16/2024]
Affiliation(s)
- M Boukobza
- Department of Radiology, Bichat-Claude-Bernard University Hospital, Assistance publique-Hôpitaux de Paris, 46, rue Henri-Huchard, 75018 Paris, France.
| | - J-P Laissy
- Department of Radiology, Bichat-Claude-Bernard University Hospital, Assistance publique-Hôpitaux de Paris, Paris, France; Inserm U1148, Paris University, Paris, France
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Jagtap SA, Dole S, Thakor B, Joshi A. Ruptured Cerebellopontine Angle Dermoid Cyst Presenting As Young Stroke. Neurol India 2022; 70:2241-2242. [PMID: 36352661 DOI: 10.4103/0028-3886.359186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Sujit A Jagtap
- Assistant Professor in Neurology, Bharati Vidyapeeth Medical College; Consultant Neurologist and Epileptologist, Bajaj Allianz Comprehensive Center for Epilepsy Care, Pune, Maharashtra, India
| | - Shreya Dole
- Senior Resident in Neurology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
| | - Bina Thakor
- Fellow in Pediatric Neurology, Bharati Vidyapeeth Medical College, Pune, Maharashtra, India
| | - Aniruddha Joshi
- Consultant Radiologist, Department of Radiology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
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Remote cerebral and cerebellar hemorrhage after removal of supratentorial Ganglioglioma: A case report and review of the literature. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101470] [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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Liu F, Li D, Yang T, Li C, Luo X, Li M, Wang S, Jin T, Zhang C, Luo C. Remote cerebellar hemorrhage after supratentorial craniotomy: illustrative cases. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21687. [PMCID: PMC9379697 DOI: 10.3171/case21687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND
Remote cerebellar hemorrhage (RCH) is an extremely rare and potentially fatal complication after supratentorial craniotomy. However, the exact pathophysiological mechanism of RCH remains unclear, so clinicians often lack clinical experience in prevention, early diagnosis, and standardized treatment.
OBSERVATIONS
The authors retrospectively analyzed data of patients who underwent surgery for supratentorial lesions at their center between 2012 and 2021. They identified 4 patients who developed RCH among 4,075 patients who underwent supratentorial craniotomy. All 4 patients were male, with an average age of 57.5 years. One RCH occurred after tumor resection, and the other 3 occurred after aneurysm clipping. One patient was asymptomatic and received conservative treatment with a favorable outcome. The remaining 3 patients underwent lateral ventricular drainage and/or suboccipital decompression; 2 died, and 1 recovered well.
LESSONS
The authors believe that RCH should be considered as a multifactorial cause, and massive cerebrospinal fluid loss plays a key role in the development and progression of RCH. Asymptomatic RCH can be treated conservatively. However, in the case of conscious disturbance, hydrocephalus, and brain stem compression, surgery should be performed immediately. Early detection and individualized treatment would be helpful to avoid potentially fatal outcomes caused by RCH.
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Affiliation(s)
- Feng Liu
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Dongbo Li
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Tao Yang
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Congjin Li
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Xianhua Luo
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Minghui Li
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Songlin Wang
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Tao Jin
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Chunhua Zhang
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
| | - Changwen Luo
- Department of Neurosurgery, Ankang Central Hospital, Ankang, People’s Republic of China
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Wang J, Chong Y, Jiang C, Dai Y, Liang W, Ding L. Supratentorial subdural hematoma following microvascular decompression. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2021.101403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Wen P, Xu W, Chen H. Intracranial hemorrhage following drainage of chronic subdural effusion and hematoma: A case report and review of the literature. IBRAIN 2022; 8:68-77. [PMID: 37786413 PMCID: PMC10528771 DOI: 10.1002/ibra.12022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 12/20/2021] [Accepted: 12/27/2021] [Indexed: 10/04/2023]
Abstract
Acute intracranial hemorrhage (AIH) after drainage of chronic subdural hematoma is a rare but serious complication. An 86-year-old man with bilateral frontotemporal subdural effusion, hematoma, and cerebral hernia was admitted to our department and treated with bilateral burr hole surgery and closed-system drainage under local anesthesia. After the operation, computed tomography (CT) showed AIH in the left temporal and occipital lobe, and then a series of head CT showed that the hematoma gradually increased day by day. This patient had a medical history of hypertension, diabetes, atrial fibrillation, and taking warfarin. He was treated conservatively, but had not recovered at discharge after 1 month. We reviewed the relevant literature and analyzed the operation opportunity, causes of cerebral hemorrhage, and preventive measures in similar patients. We suppose that the coagulation abnormality and rapid fluctuations of intracranial pressure were the main causes of development of AIH in our patient. Several possible reasons such as brain shift and impaired vascular autoregulation are also associated with postoperative AIH. We must be aware of this complication and keep some preventive measures in our mind.
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Affiliation(s)
- Peng Wen
- Department of NeurosurgeryXuanwu Hospital Capital Medical UniversityBeijingChina
- Department of NeurosurgeryThe First People's Hospital of ZunyiZunyiGuizhouChina
| | - Wen‐Long Xu
- Department of NeurosurgeryXuanwu Hospital Capital Medical UniversityBeijingChina
| | - Huan Chen
- Clinical Pharmacy DepartmentThe First People's Hospital of ZunyiZunyiGuizhouChina
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Singh A, Wadhwa C, Karthigeyan M, Salunke P, Bansal H, Chaudhary AK. Spectrum of remote site extradural hematomas following decompressive craniectomy: Does fracture always co-exist? Surg Neurol Int 2021; 12:443. [PMID: 34621559 PMCID: PMC8492426 DOI: 10.25259/sni_484_2021] [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: 05/15/2021] [Accepted: 07/23/2021] [Indexed: 11/04/2022] Open
Abstract
Background Remote-site extradural hematomas (EDHs) after decompressive-surgeries for traumatic brain injury (TBI) are rarely encountered. Typically, they form contralateral to the injured side, with an overlying fracture. We present a subset which developed EDH immediately after decompressive-hemi-craniectomy for TBI, most without an evidence of fracture, and not limited to contralateral location. Methods Nine such patients were retrospectively identified. Plausible mechanisms, management issues and outcomes have been discussed. Results All nine patients were victims of severe-TBI. Six did not have any skull-fractures. Eight showed hemispheric-injuries while one had bifrontal-contusions. In hemispheric-injuries, midline-shift was at least 8 mm except one with midline-shift of 6 mm. The EDH was straddling the midline in 2 (bifrontal-1, bi-occipital-1), and juxtaposed to the previous craniectomy in 1, apart from a contralateral-bleed in 6; all, except one, needed evacuation. In most patients, venous-source of bleed was identified. All had improved from their preoperative Glasgow coma scale (GCS) at follow-up. Conclusion A fracture need not always co-exist in EDH following decompressive craniectomy. However, an extra-caution is suggested in its presence. Given the need for surgical-evacuation in most patients and an inability to assess immediate postoperative-GCS in severely head-injured, a routine postoperative-computed tomography is recommended to avoid overlooking such potentially treatable condition.
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Affiliation(s)
- Apinderpreet Singh
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chetan Wadhwa
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Madhivanan Karthigeyan
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pravin Salunke
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Hanish Bansal
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Oktay K. Subdural Hematoma Related to Dural Tear During Lumbar Spine Surgery: A Case Report and Review of the Literature. Neurol India 2020; 68:903-905. [PMID: 32859839 DOI: 10.4103/0028-3886.293459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Subdural hematoma is a rare complication after lumbar spine surgeries. Most of the time, the reason for this complication is intracranial hypotension related to an unintended durotomy, and the main symptom is persistent orthostatic headache. The authors present the case of a-38-year-old woman who underwent lumbar discectomy. Three weeks after the surgery, she developed subdural hematoma related to dural tear during the procedure. Emergent hematoma evacuation with craniotomy and dural tear repair was performed simultaneously because of the herniation symptoms of the patient. Clinical findings, radiological assessments, and treatment modalities have been discussed in the presence of a literature review in this case report.
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Affiliation(s)
- Kadir Oktay
- Department of Neurosurgery, Gaziantep Medical Park Hospital, Gaziantep, Turkey
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Lee I, Park CW, You CJ, Choi DH, Park K, Kim YB, Kim WK, Yee GT, Kim MJ, Kim EY. Risk factors of postoperative remote intracerebral hemorrhage after craniotomy for ruptured cerebral aneurysms. J Cerebrovasc Endovasc Neurosurg 2020; 22:53-64. [PMID: 32665912 PMCID: PMC7329564 DOI: 10.7461/jcen.2020.22.2.53] [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: 01/07/2020] [Revised: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 11/30/2022] Open
Abstract
Objective We aimed to identify the relation between perioperative cerebrospinal fluid (CSF) drain through lumbar drainage (LD) and development of postoperative (POP) remote intracerebral hemorrhage (rICH) in craniotomy to treat ruptured intracranial aneurysms. Methods We retrospectively reviewed consecutive patients who underwent craniotomy for ruptured cerebral aneurysms at the authors’ institution between 1998 and 2004. We subsequently compared the incidence and characteristics of POP rICH between the patients who had a perioperative LD and those who did not. All statistical analyses were conducted using the software package SPSS 19.0 (SPSS Inc., Chicago, IL, USA). A p value of <0.05 was considered statistically significant. Results We enrolled 688 patients, of which 80 patients (11.6%) received perioperative LD, and 608 did not. LD and non-LD groups were comparable because although clinical characteristics of the two groups were significantly different considering history of hypertension, timing of surgery, and closed system negative pressure suction drain (SD) placement, none of these three variables was an independent risk factor associated with POP rICH in multivariate analysis. POP rICH incidence was significantly higher in the LD goup (12.5%) than non-LD group (0.8%) (p=0.000) in univariate analysis. LD placement was the only independent risk factor associated with the development of rICH in multivariate logistic regression analysis. Conclusions POP rICH incidence was significantly higher in patients who were managed with perioperative LD than in those who did not. LD insertion in craniotomy for ruptured intracranial aneurysm, should be closely monitored to address the occurrence of POP rICH.
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Affiliation(s)
- Insu Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Cheol Wan Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Chan Jong You
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Dae Han Choi
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Kwangwoo Park
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea.,Department of Emergency Medicine, Section of Critical Care Medicine, Gil Medical Center, Gachon University, Incheon, Korea
| | - Young Bo Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Woo Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Gi-Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Myeong-Jin Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
| | - Eun Young Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
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