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PubMed1986

[Postoperative tension pneumocephalus--report of 3 cases].

Three cases of tension pneumocephalus are reported and pathogenesis, clinical features and management of this complication is discussed. Case 1: A 12-year-old female underwent a craniotomy for a suprasellar tumor following V-P shunting. At that time, Mayfield's pin fixing head holder was used and a CSF leak from a puncture wound caused by the head holder was noted postoperatively. Although she showed uneventful recovery from the anesthesia, several hours after surgery, she developed general convulsions and deteriorated. CT scan revealed a huge bifrontal accumulation of air compressing the entire brain postero-caudally. No active measures were taken to treat the intracranial air and a follow-up CT scan revealed a hemorrhagic infarction in the right occipital lobe possibly caused by transtentorial herniation. The patient remained in a vegetative state until her death three years later. Case 2: A 55-year-old man had a pansinectomy for sinusitis. Seven days later he developed CSF rhinorrhea and a severe headache. A CT scan revealed air in the subarachnoid space as well as in the ventricles. After repeated spinal taps, he became stuporous. An emergency repair of the CSF leak was performed. Intraoperatively, the accumulation of air was noted in the subarachnoid space under extreme tension. He made a full recovery. Case 3: A 69-year-old woman underwent a neck clipping for a ruptured anterior communicating aneurysm 2 days after the onset. Shortly before the craniotomy, a continuous spinal drainage system was installed. Postoperatively she did not recover from the anesthesia and a CT scan showed an accumulation of air in the bifrontal subdural space compressing the brain posteriorly.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1986

[A case of chronic subdural hematoma in a hemodialyzed patient].

In proportion to a rapid increase of dialysis patient, death caused by neurological complications is increasing annually among long-term hemodialyzed patients. A case of chronic subdural hematoma during long-term hemodialysis is presented. A 35-year-old male had undergone hemodialysis three times weekly for four years. He had marked changes in body-weight and blood pressure between hemodialysis. In March 1983, he had a headache, vomiting, and left hemiparesis. The CT scan showed a right subdural hematoma. He was admitted to our hospital 10 days later because of progressive hemiparesis and speech disturbance. The neurological examination showed left hemiparesis with sensory deficit and dysarthria. The CT scan showed an increase in the size of the subdural hematoma. Bleeding time was over 10 minutes. A right-sided burr hole was made and altered blood was removed and irrigated. After operation, headache and weakness rapidly subsided, but the next morning, attacks of convulsion occurred. The CT scan showed the rebleeding in the subdural space. After correcting the level of serum potassium by hemodialysis, a right parietal craniotomy was performed. Hematoma of about 100 g was removed and the capsule of the hematoma showed organized tissue histologically. Postoperatively, although attacks of convulsion occurred temporarily, he gradually improved. The levels of serum potassium and BUN were controlled by several treatments of hemodialysis. He was discharged with only mild hemiparesis. Subdural hematoma caused by hemodialysis is a very important complication. Chronic subdural hematoma is sometimes very difficult to differentiate from dysequilibrium syndrome or dialysis dementia. The CT scan is a very valuable examination to rule out subdural hematoma.

Adult↗
PubMed2004

Rapid natural resolution of intracranial hematoma.

OBJECTIVE: To investigate the clinical characteristics of intracranial hematoma and the mechanism involved in its rapid natural resolution. METHODS: Seventeen cases of intracranial hematoma with typical clinical and CT manifestations were retrospectively studied. RESULTS: Intracranial hematoma was found obviously decreased in size within 72 h after its occurrence in 8 cases. The rest 9 cases presented complete resolution. CONCLUSIONS: Rapid natural resolution of acute epidural hematoma is mostly found in teenagers and the resolution is correlated with cranial fracture at the hematoma site. As for acute subdural hematoma, its rapid resolution is associated with the transfer of cerebrospinal fluid toward subdural space, the lavage effect, and the compression caused by the increased intracranial pressure or the space left resulting from redistribution of the hematoma in brain atrophy.

Adolescent↗
PubMed1994

The single burr hole technique for the evacuation of non-acute subdural hematomas.

A 4-year retrospective study was made of 111 consecutive surgically treated patients with chronic or subacute subdural hematomas. All underwent single burr hole evacuation with accompanying saline irrigation of the subdural space. Postoperative outcomes at 6 weeks were 90% excellent, 5.5% fair, and 4.5% poor. Postoperative re-evacuation was performed either by needle aspiration or reoperation via the burr hole on 12 patients; one required a craniectomy and neomembrane stripping. These results compare favorably with previous data and support the use of the single burr hole technique as a simple and effective treatment of subacute and chronic subdural hematomas. This addresses the decompression of the brain parenchyma, the removal of the residual semisolid subdural hematoma component, and the removal, dilution, and inactivation of endogenous fibrinolytic agents.

Chronic Disease↗
PubMedDate not supplied

Posttraumatic cerebellar hematoma.

A posttraumatic cerebellar hematoma in a 12-year-old boy is reported. It was observed by CT scan that the hematoma is discharged incompletely into the subdural space. The surgical treatment was successful with complete recovery. It is suggested that CT scan should be performed as soon as possible in cranial trauma with cerebellar signs.

Brain Injuries↗
PubMed1999

Lumbar spinal subdural hematoma following craniotomy--case report.

A 52-year-old female complained of lumbago and weakness in the lower extremities 6 days after craniotomy for clipping an aneurysm. Neurological examination revealed symptoms consistent with lumbosacral cauda equina compression. The symptoms affecting the lower extremities spontaneously disappeared within 3 days. Magnetic resonance (MR) imaging 10 days after the operation demonstrated a lumbar spinal subdural hematoma (SSH). She had no risk factor for bleeding at this site, the symptoms appeared after she began to walk, and MR imaging suggested the SSH was subacute. Therefore, the SSH was probably due to downward movement of blood from the cranial subdural space under the influence of gravity. SSH as a complication of cranial surgery is rare, but should be considered if a patient develops symptoms consistent with a lumbar SSH after craniotomy.

Brain↗
PubMed1985

Subdural collection of intravenous fat emulsion in a neonate. Complication of central venous catheterization for total parenteral nutrition.

An infected subdural collection of intravenous fat emulsion (Intralipid) was diagnosed in a 5-week-old premature infant who was receiving total parental nutrition (TPN) through a facial vein cutdown. This fluid was successfully drained and the infection, due to Staphylococcus epidermidis, was treated with vancomycin. We postulate that the subdural collection occurred as a result of septic thrombosis of the internal jugular vein with subsequent retrograde flow and infiltration of Intralipid from the bridging veins into the subdural space. This complication of central TPN has not been reported previously.

Catheterization↗
PubMed1992

Transient glucose hypermetabolism after acute subdural hematoma in the rat.

Ischemic brain damage occurs in most patients with acute subdural hematoma, yet many aspects of the distribution and extent of this damage remain unexplained. Previous studies in rat model, which produces a region of infarction under the hematoma, have implicated an "excitotoxic" mechanism, suggesting that high concentrations of excitatory amino acids may exacerbate ischemic damage. A study is described in which local glucose utilization is measured 2 or 4 hours after induction of acute subdural hematoma in the rat. These changes are compared to those produced by introducing the same volume of inert silicone gel into the subdural space. Massive increases (up to 142%) in glucose utilization occurred throughout both hippocampi and in a variable zone around the ischemic core, but these had normalized by 4 hours after blood injection. Hippocampal hypermetabolism was not seen after introduction of the silicone mass, suggesting that diffusible substances from the clotted blood may be responsible for these changes. This transient hypermetabolism accords with an excitotoxic process, which may amplify brain damage after acute subdural hematoma.

Acute Disease↗
PubMed1994

[Nontraumatic subdural hematoma secondary to dural metastasis of lung cancer: case report and review of the literature].

In this paper, a case of nontraumatic subdural hematoma secondary to dural metastasis of lung cancer was presented and 43 cases in the literature were reviewed. A 75-year-old man who had been affected with lung tuberculosis for the previous 7 years was admitted to our hospital because of right hemiparesis and aphasia. No history of head injury was discovered. On admission, he was fully conscious and no other neurological abnormalities were noticed except for right hemiparesis and motor aphasia. The chest X-ray revealed abnormal shadows on the right lung, which were most suggestive of tuberculosis. Laboratory studies including prothrombin time, platelet count and fibrinogen were normal. The CT scans taken at that time demonstrated a large subdural hematoma over the left hemisphere. Under a diagnosis of chronic subdural hematoma, emergency evacuation through a small burr hole was performed. However, because of its low liquidity, the hematoma was insufficiently removed. Postoperatively, hemiparesis gradually disappeared. On the 20th hospital day, he suddenly became unconscious and CT scans showed recurrence of the subdural hematoma. Temporo-parietal craniotomy was immediately carried out. The dura was thickened and hyperemic. Although the underlying brain was apparently normal, the exploration performed after removal of the hematoma revealed a soft grayish mass extruding into the subdural space from the dura. The bleeding point was not identified. Both the dura and the abnormal tissue were biopsied for histological examination.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1984

Ultrasonic assessment of infectious meningitis.

Real-time ultrasonography was performed, utilising the patent anterior fontanelle, on 82 infants with viral or bacterial meningitis. One third of the cases had normal ultrasonic appearances. The other two thirds demonstrated abnormalities of the subdural space, parenchyma and ventricles. Ventricular dilatation was the commonest abnormality and was present in 57% of the infants; ultrasonic evaluation was used to monitor the progress of treatment of these patients.

Cerebral Ventricles↗
PubMed1994

[Reduction cranioplasty for a case of intractable chronic subdural hematoma in infancy].

Although almost all infants suffering chronic subdural hematomas (CSDH) are successfully treated by established methods such as a subdural puncture, burr holes and shunting procedures, infantile CSDH with progressive craniocerebral disproportion requires a special therapeutical regimen. Clinical efforts such as reduction cranioplasty have been made as a treatment for these cases. This is a case report of a 9-month-old male infant with an intractable CSDH, bilateral and large, and subsequent brain atrophy caused by traumatic head injury. Excellent results were obtained by a modified reduction cranioplasty. In brief, the patient was supine-positioned with a 20-degree flexion of the head in an attempt to obtain a large operative field. Bicoronal skin incision was combined with an additional linear one on the midline (T-shaped incision). Bilateral frontoparietal craniotomy with periosteum was made to keep the midline bony bridge overlying the superior sagittal sinus (SSS). The resulting extensive dural opening allowed complete evacuation of the subdural hematoma. Thereafter, the anterior part, ca. 4cm in width, of the bony bridge was removed in order to make the remaining bone able to be manipulated and connected to the frontal bone. Prior to this stage, SSS close to the crista galli was ligated and cut with the falx to avoid postoperative kinking. The dura mater was sutured so as not to leave an excessive subdural space. The bone flaps were trimmed to complete a good-shaped reconstruction. Finally, the excessive scalp was removed because the original scalp was too large for the reconstructed skull.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic Disease↗
PubMed1992

Arachnoid cysts of the middle cranial fossa.

In 18 cases of temporal arachnoid cysts the etiology, clinical and radiographic findings, surgical treatment, and outcome are reviewed. Cysts of the middle cranial fossa are susceptible to trauma, which may cause bleeding either into the cyst or into the subdural space. CT or MRI scans are diagnostic in arachnoid cysts. In cases of intracranial mass lesion with displacement of the midline structures and increasing ICP, osteoplastic craniotomy is performed and the medial wall of the cyst is resected down to the tentorial notch, with opening into the basal cisterns. There were no operative or postoperative complications in 18 consecutive cases. However, one boy required a cystoperitoneal shunt 3 months later as a result of hydrocephalus following subdural hematoma and two other patients were also subsequently shunted. Asymptomatic arachnoid cysts are discussed with the respect to brain function and potential risks.

Arachnoid↗
PubMed1999

[Methicillin-resistant Staphylococcus aureus subdural abscess in an elderly patient with dementia].

A 74-year-old man was admitted to our hospital because of a fever of 38.2 degrees C and drowsiness. Two months before admission, he was admitted to another hospital with the diagnosis of Alzheimer's disease. One week before admission, he had a fever which was judged to be due to pyelonephritis. Because imipenem cilastatin and minocycline were not effective in relieving symptoms, he was transferred to our hospital. Methicillin-resistant Staphylococcus aureus (MRSA) was cultured from the blood, and vancomycin was started on the 5th hospital day. Because of the persistent fever and signs of inflammation, Gallium-scintigraphy was performed, showing abnormal accumulation in the left fronto-parietal region of the brain and the sacral region. Enhanced brain CT revealed a crescentic low density area and a fine, intense line of enhancement in the left fronto-parietal region. An emergency drainage of abscess was performed via single left fronto-parietal burr hole. A slightly yellowish, bloody, purulent fluid was obtained. The subdural space was irrigated with saline containing antibiotics and a drain was inserted. MRSA was cultured from the obtained fluid. The fever gradually subsided and drowsiness disappeared. He had had decubitus ulcer, stage I on the surface, in the sacral region, which later turned out to have unexpectedly deep undermining lesion reaching to periosteum. MRSA was cultured from this decubitus lesion. MRSA which entered into blood stream from the decubitus site might have been implanted in the subdural hematoma. Thus, subdural abscess should be kept in mind as an active differential diagnosis in elderly patients with fever and drowsiness.

Aged↗
PubMed2001

Organized chronic subdural hematoma requiring craniotomy--five case reports.

Two child and three elderly patients underwent craniotomy for organized and/or partially calcified chronic subdural hematomas (CSHs). The characteristic feature of magnetic resonance imaging was a heterogeneous web-like structure in the hematoma cavity. Both children had undergone one side subduroperitoneal shunt for bilateral CSHs when infants. As a result, the opposite hematoma cavities persisted and developed into calcified CSHs after a couple of years. All three elderly patients with senile brain atrophy showed various systemic complications such as cerebral infarction, diabetes mellitus, leg ulceration, cirrhosis, and bleeding tendency. Craniotomy for removal of the hematoma and calcification achieved good results in all patients. Subdural space created by shunt, craniotomy, or brain atrophy and persisting for a certain period, and additional various brain damage such as microcirculatory disorder, meningitis, encephalitis, or premature delivery may be important in generating calcified or organized CSH.

Aged↗
PubMedDate not supplied

[A postmortem view on "pure" subdural hemorrhages in infants and toddlers].

In the last years, the discussion concerning the causes of infantile subdural hemorrhages became controversial. Many authors still suppose that child abuse is the predominant cause of such cases. On the other hand, reports presenting series of accidental cases were published, and the fear of an overdiagnosis of the shaken baby syndrome has been expressed. Our autopsy material concerning all lethal head injuries of infants and toddlers from 2 decades was reviewed. 17 of these 64 cases were characterized by the following: history of no trauma or only an insignificant event; children found dead or apnoic or in coma; no skull fractures; no focal brain injury; ruptures of several bridging veins but only minimal subdural bleeding. 11 victims were infants (1st year of life) and either 3 were 2 years resp. 3 - 6 years old; 50 % off all lethal head injuries of infants were of this type, while only 25 % resp. 10 % of the following age groups. None of these 17 cases was a result of a minor accident witnessed by unrelated persons. Abuse could be ascertained with a high degree of probability in most cases and remained quite likely in the others. Two different types of subdural hemorrhages should be kept from another: a) patients suffering a moderate head injury from a minor accident which results in a subdural bleeding (from a small intracranial lesion) often do not deteriorate soon after the impact, develop a hemorrhage of significant volume, respond well to therapy and have a good prognosis. b) cases with a history of no or only of an insignificant trauma, infants dead or nearly dead on clinical presentation, often a poor outcome in cases of survival. There is typically no significant subdural bleeding despite multiple bridging vein ruptures in the majority of these cases: the subdural hemorrhage is here only a visible sign of a much more serious and general cerebral alteration, resulting in a rapid increase of intracranial pressure (often complicated by respiratory arrest) which prevents a signifant bleeding into the subdural space. This combination of findings is typically found in victims of massive events (car occupants in high-velocity crashes) and not compatible with a supposition of a minor fall causing this.

Accidental Falls↗
PubMed2002

[Rapid spontaneous resolution of acute subdural hematoma].

Acute subdural hematomas are usually neurosurgical emergencies, although a conservative therapy is indicated in selected cases. In some of these patients a progressive resolution is appreciated. However, rapid spontaneous resolution of an acute suddural hematoma is seldom reported. A patient with antecedent of chronic alcoholism and spontaneous resolution of acute subdural hematoma in less than 18 hours after the head injury is described. The possible mechanisms of this rapid resolution are discussed. A tear in the arachnoid with spilling of CSF into the subdural space and the effect of intracranial antihypertensive measures together with cerebral atrophy, are factors that possibly contribute to dilution and redistribution of blood with hematoma disappearing in CT scan.

Atrophy↗
PubMed2005

[Craniotomy for organized subdural hematoma].

We reported 3 cases of organized chronic subdural hematoma (CSDH), which required radical treatment by craniotomy. All patients were in the 70s (male, two; female, one). Two cases had previously received craniotomy and neck clipping for intracranial aneurysm. All of them received trephine evacuation of hematoma more than two times, although the hematoma was not removed due to organization. Because of this, we performed craniotomy and removal of the hematoma with its thick outer membrane. In order to obliterate the subdural space completely, we stripped the dura mater from the skull and attached it to the inner membrane with fibrine glue. After a period of more than two years of followed-up, no recurrences had been discovered.

Aged↗
PubMed2002

Arachnoid cyst rupture with subdural hygroma: report of three cases and literature review.

INTRODUCTION: Arachnoid cysts are believed to account for about 1% of all intracranial expansive lesions, some remain inactive throughout life, others lie dormant for many years before clinical manifestation. In a few cases, arachnoid cysts have ruptured after cranial trauma or more rarely, spontaneously, with resultant subdural haemorrhage or CSF collection. CASE REPORT: We report three cases with traumatic rupture of arachnoid cyst into the subdural space in children, which is an extremely unusual complication. DISCUSSION: A review of the literature revealed only 18 previously reported cases.

Adolescent↗