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PubMed1991

Correlative pathology of subdural hematoma with computerized tomography.

Subdural hematoma (SDH) develops as a result of bleeding in the subdural space. According to nowadays accepted division, three groups of subdural hematomas can be differentiated: acute, subacute and chronic. The time elapsed from the moment of the occurrence of the hematoma to the moment when it was diagnosed is the main factor for determining the stage of SDH. However, for the above-mentioned types of SDH, this time differs depending on the author reporting it. Subdural hematoma is most often diagnosed by means of computerized tomography (CT). This method is safe and reliable, giving the exact diagnosis in more than 90% of cases. According to the basic principle of the concept of "living pathology", the knowledge of histological appearance of an investigated lesion is essential for the diagnostic interpretation of this lesion in neuroimaging methods. Very few authors studied the histological picture of subdural hematoma. The only structure which was histologically examined in details was the subdural neomembrane. Studies correlating histological picture of SDH and its appearance on CT scans have not been carried out until now. In this work such a correlation was made, and some regularities connecting these two methods were pointed out. Hyperdense picture of SDH on CT scans represents a hematoma containing almost only erythrocytes and erythrocyte-fibrin component being formed. Hypodense picture of SDH on CT scans represents a hematoma containing fibrin and inflammatory cells. Hematomas of mixed density on CT scan in all cases contained a neomembrane. Obvious histological differences between the mentioned types of subdural hematoma have led to the conclusion that chronic subdural hematoma is not the last stage of an "old" acute SDH. Chronic and acute subdural hematomas are different entities, considering their etiopathogenetic and clinical picture, and especially their CT and histopathological appearances.

Adolescent↗
PubMed1995

Acute subdural hemorrhage complicating embolization of a cerebral arteriovenous malformation.

We present a case of a young adult in whom acute subdural hemorrhage developed immediately after embolization of a cerebral arteriovenous malformation with glue. Inadvertent venous outlet obstruction with glue was implicated in the production of the hemorrhage. Possible mechanisms of spread of blood to the subdural space are discussed. Awareness of the possibility of iatrogenic subdural hemorrhage is necessary before undertaking embolization procedures.

Adolescent↗
PubMed2001

Ruptured middle cerebral artery aneurysm and bilateral chronic subdural hematomas.

BACKGROUND: While rupture of a cerebral aneurysm into the subdural space is rare, aneurysmal subarachnoid hemorrhage in the presence of subdural hematoma(s) is much more uncommon. Such a patient requires changes in routine perioperative management. CASE DESCRIPTION: A patient with a ruptured middle cerebral artery bifurcation aneurysm and bilateral subdural hematomas is presented. He underwent successful aneurysm clipping and subdural hematoma evacuations. At the time of surgery, measures commonly used to obtain brain relaxation were avoided. The patient was kept normovolemic, normocarbic, and normotensive. He recovered completely and resumed his prior occupation. CONCLUSIONS: Changes in standard techniques for a patient undergoing a pterional craniotomy for a ruptured cerebral aneurysm are required when bilateral extra-axial mass lesions are present.

Aneurysm, Ruptured↗
PubMed1999

Spontaneous spinal subdural hematoma in a young adult with hemophilia.

Spontaneous spinal subdural hemorrhage is a rare clinical problem that usually manifests with a sudden onset of pain and paralysis. This article reports on an 18-year-old male with hemophilia A and cerebral palsy, who experienced a several month history of transient back, hip, and leg pain accompanied by gait difficulties that ultimately culminated in a more striking episode of lower extremity weakness, irritability, and diffuse pain involving the neck, back, and legs. In the absence of any clinical or radiographic evidence of hemarthrosis, osteomyelitis, or intracranial hemorrhage, imaging of the spine disclosed a large, apparently multicompartmentalized intraspinal lesion, consistent with old hemorrhage. This extended from the thoracic to the sacral region, with the largest extent at the lumbosacral junction. Following correction of factor VIII levels, surgical exploration was undertaken and demonstrated liquefied blood within the subdural space without violation of the underlying arachnoid. Because the chronic subdural blood flowed quite easily through the dural opening by simply angling the operating table, a limited exposure was required to achieve a substantial evacuation of the clot. This case calls attention to the often protean manifestations of this process, the potential for a chronic course to the clinical symptoms, and the possibility of achieving substantial clot evacuation and clinical recovery with a limited operative approach.

Adolescent↗
PubMed1991

[A case of hydrocephalus with hypacusis due to hemangioblastoma].

A case of a brain stem hemangioblastoma with recurrent episodes of hypacusis due to progression of hydrocephalus is reported. The patient was a 25-year-old female, admitted to the department of otorhinolaryngology with complaints of hearing difficulty, headache and blurred vision. Neuroradiological studies showed a tumor from the medulla oblongata, obliterating the IVth ventricle, and a secondary hydrocephalus. Hearing loss fluctuated as hydrocephalus progressed. Multiple V-P shunting procedures relieved episodic hypacusis. The patient remains asymptomatic at present and has resumed normal activity. The mechanism of episodic hearing loss due to hydrocephalus is though to be due to the fact that through the ductus perilymphaticus and the ductus endolymphaticus, especially the former, increased intracranial pressure is transmitted to the inner ear. Through the ductus perilymphaticus there is communication between the perilymphatic space and the intracranial subarachnoid space. Through the ductus endolymphaticus there is communication with the subdural space. Increased ICP effects the inner ear. It is suspected that, in this particular case, the progression of hydrocephalus effected the patient's hearing.

Adult↗
PubMed2004

Chronic subdural hematoma: results of a homogeneous series of 159 patients operated on by residents.

AIMS: A series of cases with chronic subdural hematoma operated upon by residents in neurosurgery is analysed. MATERIALS AND METHODS: 159 patients treated between 1998 and 2001 were included in the study. Mean age was 76.4 years and male/female ratio was 1.7/1. The patients were classified both on admission and at discharge according to the Markwalder scale. The standard operative procedure consisted of an enlarged single burr-hole, rinsing the subdural space with iso-osmotic saline solution and insertion of a subdural drain. CONCLUSION: In CSDH, operation by the residents is safe and the results are comparable to those of the major series of the literature as the surgical procedure is standardized.

Adult↗
PubMed1996

[Bilateral chronic subdural hematomas presented with subarachnoid hemorrhage: report of two cases].

Computed tomography (CT) findings of chronic subdural hematomas are usually diagnostic, unless hematomas are isodense and bilateral. The authors report two cases of bilateral chronic subdural hematomas, in which CT scans on admission were both misdiagnosed as delayed subarachnoid hemorrhage (SAH). The first case was a 43-year-old woman who suffered from a sudden onset of headache and nausea. She had no past history of head injury. CT scans on admission did not clearly reveal the Sylvian fissures and the mesencephalic cistern, without any mass effects. A lumbar puncture demonstrated xanthochromic cerebrospinal fluid (CSF), which was considered to be responsible for her headache. Cerebral angiography performed on day 4 failed to demonstrate any cerebral vascular disorders. Follow-up CT scans on day 7 demonstrated a high density lesion in the left subdural space. Magnetic resonance images (MRIs) confirmed a diagnosis of bilateral chronic subdural hematomas. Removal of the hematomas cleared all signs and symptoms smoothly. The second case was a 44-year-old man who was referred from another hospital because of xanthochromic CSF found by lumbar puncture. He began to suffer headache and be subject to vomiting 6 weeks earlier and these symptoms were still present on the day of admission. CT scans did not clearly show the cerebral cisterns without mass effects. Because the second lumbar puncture showed xanthochromic CSF again, SAH from aneurysm was suspected. However, emergency cerebral angiography failed to demonstrate cerebral aneurysms. MRI performed two days later demonstrated bilateral chronic subdural hematomas. Following surgery, the patient improved immediately and was discharged from hospital without any complications. In both cases, a retrospective study of the angiograms revealed the evidence of bilateral avascular areas over the convexities in the venous phase. The reason why these subdural hematomas were missed at the time of angiography was due to too much attention being paid to the arterial phase in an effort aimed only at identifying cerebral aneurysms. There are no reports of chronic subdural hematoma which demonstrated sudden onset of headache associated with xanthochromic CSF.

Adult↗
PubMed1997

[A case of cranial osteomyelitis after head injury with exaggeration and remission for thirty years].

We report a case of cranial osteomyelitis after head injury with exaggeration and remission for 30 years. A 41-year-old man was referred to our hospital with redness, swelling and pain in the left frontal region. He had noted a hard mass in the same region after an injury at the age of 12 years, and local heat and redness again in the same region which had disappeared without definite treatment at the age of 20 years. Presently, skull roentogenogram showed an erosive lesion in the left frontal bone. Plain CT revealed bone defect, epidural mass lesion, calcification of the dura mater and thickness of the extracranial soft tissue in the left frontal region. T1-weighted MR images showed an isointense lesion and T2-weighted MR images showed a high intensity lesion in the inner table and a diploic layer in the left frontal bone. 99thTc MDP bone scinntigram showed abnormal uptake in the same region. Operation performed through a left frontotemporal craniotomy revealed a degeneration of temporal muscle and frontal bone, and granulation tissue and pus in the subcutaneous and epidural spaces. These were removed together with the calcified dura mater. The subdural space was intact. Dural plasty was performed using fascia lata, but the craniotomied bone was replaced. Histological examination revealed typical findings of osteomyelitis. Postoperative course was uneventful, and he was discharged without neurological deficit. Cranioplasty was performed 8 months after the first surgery. The mechanism by which osteomyelitis continued over a long course of time was suspected to be the formation of a focus of recurrent inflammation due to the head injury 30 years earlier.

Adult↗
PubMed1997

Subdural sarcoma associated with chronic subdural hematoma. Report of two cases and review of the literature.

The authors report the cases of two children who presented in the first months of life with progressive macrocrania related to chronic pericerebral fluid collection. This condition resolved spontaneously without treatment after a few months in the first case, whereas it required several aspirations of blood-stained fluid via the fontanel in the second case. Both patients developed normally without evidence of disease in the earliest years of life and presented at the ages of 3 1/2 and 4 1/2 years, respectively, with symptoms and signs of rapidly progressing intracranial hypertension. In both cases contrast-enhanced computerized tomography and magnetic resonance imaging revealed masses in the subdural space of the skull base and the cranial vault associated with significant subdural fluid collections. In the first case the lesion was misdiagnosed in the initial phase and treated, by means of multiple craniotomies, as an organized subdural hematoma. After a diagnosis of liposarcoma had been made, the patient was treated with chemotherapy, which resulted in a good resolution of the lesions at 3-month follow-up review. In the second case a biopsy allowed the diagnosis of fibrohistiocytic sarcoma and the patient was treated with chemotherapy. The authors review the literature of the few reported cases and discuss the possible pathophysiological association between pericerebral fluid collection and the subsequent development of a subdural sarcoma.

Biopsy↗
PubMed2005

[Subdural empyema complicating acute frontal sinusitis. Four cases report].

OBJECTIVE: Subdural empyema is a collected cranioencephalic suppuration between arachnoid and dura meninge space. Subdural empyema occurring after sinusitis is an uncommon but serious complication of paranasal sinus infections. The purpose of this study is to aware the clinician about this condition. MATERIAL ET METHOD: Four young male children had been admitted with expressed fronto-ethmoid sinusitis. The intracranial infection was confirmed by computed tomography scan of brain and sinus. Both drainage of the sinus and intracranial suppuration was performed at the same time surgical procedure and antibiotics administered during 4 weeks. RESULTS: The subdural empyema was localized in the right temporoparietal region in 1 case, in the frontal lobe in the others cases. In 1 case, the frontal subdural empyema was associated with an inerhemispherique collection. One patient underwent a second drainage. Immediate post-operative outcomes were temporally complicated with convulsions and focal neurological deficit, in 1 case. This symptoms had regressed spontaneously. There was no case of death. The functional prognosis was bad, marked by lost vision in 2 cases, which was bilateral in 1 case. CONCLUSION: A high index of suspicion of intracranial extension of sinus infection must recommended neuroradiological investigations. When suppurative collection is confirmed, an appropriated management of the infection between otorhinolaryngologists and neurosurgeons is necessary.

Acute Disease↗
PubMedDate not supplied

[Incidence and treatment of subdural hygroma in severe head injuries].

In a population of 109 subjects with severe head injury (Liège score less than or equal to 12) we observed secondary development of subdural hygroma in sixteen patients. These liquefying processes were mostly secondary to the entry of CSF in the subdural space from tears in the arachnoid. Half the accumulations were accompanied by increased subdural pressure. Drainage of the subdural fluid brought clinical improvement in patients with elevated subdural pressure (greater than 15 torr).

Adolescent↗
PubMed1994

[Subdural hemorrhage of aneurysmal origin].

Although most subdural hematomas are considered to be venous in origin, they may also be of arterial origin. When subdural bleeding is due to the rupture of an intracranial aneurysm, most commonly at the middle cerebral or internal carotid arteries, the amount of subdural blood is usually small and of no clinical importance. We describe two patients with subdural hematomas secondary to rupture of an intracranial aneurysm, who needed prompt surgical treatment. The first patient had a left internal carotid artery aneurysm at the origin of the ophthalmic artery. In the second patient the aneurysm was at the anterior communicating artery and rebled into the subdural space directly through a right intraparenchymatous frontobasal hematoma. The most probable mechanism of subdural bleeding in our two patients was the existence of adhesions between the aneurysm and the arachnoid due to previous minor hemorrhages. The indication of cerebral angiography in a patient with subdural hematoma is based mainly upon the existence of meningeal signs, the presence of blood in more than one intracranial compartment or the rapid progression of bleeding.

Aged↗
PubMed1989

Use of intraoperative ultrasonography to improve the diagnostic accuracy of exploratory burr holes in patients with traumatic tentorial herniation.

Seventeen head-injured patients with signs of brain stem compression at admission underwent emergency bilateral burr-hole exploration before computerized tomographic (CT) scanning. After exploration of the epidural and subdural spaces, real-time ultrasonography was performed intraoperatively to identify intraaxial hematomas. Epidural or subdural hematomas were identified surgically in 11 patients (65%) and immediately evacuated through a craniotomy; in 2 patients, bilateral subdural hematomas were removed. Ultrasonography showed no evidence of intracerebral mass lesions in 14 (82%) of the 17 patients, demonstrated extensive contusions of the temporal lobe in 2 patients (prompting partial lobectomy in both cases), and revealed a small intraparenchymal hematoma deep within the dominant hemisphere, which was not removed, in 1 patient. The sensitivity of ultrasound images for identifying intraparenchymal lesions was evaluated postoperatively by CT or autopsy. In 15 patients (88%), the results of ultrasonography were confirmed. In 2 (12%), CT scans showed small but significant lesions at the frontal pole missed by ultrasonography; one patient had a residual subdural hematoma, and the other a small intraparenchymal hemorrhage. These results confirm that patients with clinical evidence of brain stem compression soon after head injury often have extraaxial hematomas that can be readily identified by burr-hole exploration. Although intraparenchymal hematomas are rare immediately after head injury, they can usually be identified by intraoperative ultrasonography. This simple technique can reduce the risk of missing intracranial hematomas during emergency burr-hole exploration and improve intraoperative decision making in this population of severely head-injured patients.

Adolescent↗
PubMed1977

Intracranial extravasation of contrast medium during carotid angiography.

The results of 5184 carotid angiograms were reviewed and five cases of intracranial extravasation of contrast medium were found. In two cases an aneurysm ruptured during angiography and extravasation into the subarachnoid space was seen. In one case medium leaked from an angiomatous malformation into the subdural space. The fourth case was a patient who had suffered closed head trauma. Here extravasation was seen deep within the brain. The fifth case illustrates two forms which extravasation from meningeal arteries may take. The incidence and prognostic significance of this finding in different conditions are discussed.

Adolescent↗
PubMed2004

Supra- and infratentorial subdural empyema secondary to septicemia in a patient with liver abscess--case report.

An 81-year-old man presented with subdural empyema in the left parietotemporal convexity 2 months after treatment under diagnoses of liver abscess and septicemia. Systemic investigation found no evidence of otorhinological or other focal infection except for liver abscess. Emergency drainage of pus was performed via a single burr hole and additional intravenous antibiotics were administered. Six weeks later, magnetic resonance imaging revealed subdural empyema in the right cerebellopontine angle in addition to recurrence of pus in the left parietotemporal subdural space. Ischemic changes were also shown in the right cerebellar hemisphere and brainstem. Although subdural empyema secondary to septicemia is rare, the possibility of this type of intracranial infection must be kept in mind, especially in compromised patients with septicemia.

Aged↗
PubMed1981

The course of chronic subdural hematomas after burr-hole craniostomy and closed-system drainage.

A consecutive series of 32 adult patients with chronic subdural hematoma was studied in respect to postoperative cerebral reexpansion (reduction in diameter of the subdural space) after burr-hole craniostomy and closed-system drainage. Patients with high subdural pressure showed the most rapid brain expansion and clinical improvement during the first 2 days. Nevertheless, a computerized tomography (CT) scan performed on the 10th day after surgery demonstrated persisting subdural fluid in 78% of cases. After 40 days, the CT scan was normal in 27 of the 32 patients. There was no mortality and no significant morbidity. Our study suggests that well developed subdural neomembranes are the crucial factors for cerebral reexpansion, a phenomenon that takes at least 10 to 20 days. However, blood vessel dysfunction and impairment of cerebral blood flow may participate in delay of brain reexpansion. It may be argued that additional surgical procedures, such as repeated tapping of the subdural fluid, craniotomy, and membranectomy or even craniectomy, should not be evaluated earlier than 20 days after the initial surgical procedure unless the patient has deteriorated markedly.

Adult↗
PubMedDate not supplied

[Ultrastructure of the cellular patches of the arachnoid membrane of the human brain (concerning the origin of the arachnoid-endothelial cleavages of the cerebral dura mater). Electron microscopic study].

The ultrastructure of cellular spots was studied--growths of the external arachnoidendothelial layer of the arachnoid membrane of the human cerebral hemispheres. The peculiarities of their ultrastructure depending on the stage of their development were revealed. "Young", cellular spots were formed by accumulations of osmiophobic round-shaped cells that are lined from the outside by osmiophilic cells like the whole of the arachnoid membrane surface. "Mature" cellular spots contain great number of oxmiophobic (viable) cells located in a immediate proximity of the subdural space, and they form the main source of viable arachnoidenodthelial cells found in the subdural fluid. The author believes that these cells penetrate together with the subdural fluid flow into the dura mater where, under specific conditions, they may become a source of arachnoidendothelial chippings.

Adult↗
PubMed1996

Neurosurgical care of spinal epidural, subdural, and intramedullary abscesses and arachnoiditis.

Epidural abscess of the spinal column is a rare but potentially devastating disease. When recognized early and treated appropriately, the outcome can be excellent. Abscesses in the spinal subdural space or in the spinal cord proper are even more unusual but can also lead to complete and irreversible loss of neurologic function if not diagnosed and treated rapidly. Although infection frequently can result in arachnoiditis, there are other more common causes, such as surgery and chemical irritants. It remains a difficult condition to treat, and long-term therapeutic results are mediocre. Newer technology with spinal cord stimulation seems to show improved results but pain relief is incomplete, and the percentage of patients with poor results remains high.

Abscess↗