Subdural effusion associated with COVID-19 encephalopathy: A case report

BACKGROUND The precise mechanism by which severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)impacts the central nervous system remains unclear,with manifestations spanning from mild symptoms(e.g.,olfactory and gustatory deficits,hallucinations,and headache)to severe complications(e.g.,stroke,seizures,encephalitis,and neurally demyelinating lesions).The occurrence of single-pass subdural effusion,as described below,is extremely rare.CASE SUMMARY A 56-year-old male patient presented with left-sided limb weakness and slurred speech as predominant clinical symptoms.Through comprehensive imaging and diagnostic assessments,he was diagnosed with cerebral infarction complicated by hemorrhagic transformation affecting the right frontal,temporal,and parietal regions.In addition,an intracranial infection with SARS-CoV-2 was identified during the rehabilitation process;consequently,an idiopathic subdural effusion developed.Remarkably,the subdural effusion underwent absorption within 6 d,with no recurrence observed during the 3-month follow-up.CONCLUSION Subdural effusion is a potentially rare intracranial complication associated with SARS-CoV-2 infection.

A Rare Etiology of a Life-Threatening Subdural Hematoma: Case Report and Literature Review

Background: Life-threatening subdural hematoma is commonly related to trauma and rarely revealed by neoplasm. Observation: We report a case of a 53-year-old suffering from mild headache and without a history of trauma, was admitted unconscious due to a subdural hematoma on radiological investigations. Beside the left subdural hematoma, there was also alytic lesion of the sphenoid wing and the temporal bone on the same side. An emergent removal of the subdural hematoma and an excision of the bone lesion were performed. Pathological examination diagnosed a cavernous hemangioma of the skull. The postoperative period was uneventful with a dramatic recovery of the patient. Conclusion: A quick worsening of a chronic headache, acute impairment of an uncommon headache deserve prompt investigation and emergent surgical management in case of intracranial hematoma. Any bone and dural abnormalities at the vicinity of a subdural hematoma require total excision with clean border and pathological examination.

Chronic Subdural Hematoma Associated with an Arachnoid Cyst in Elderly, an Intraoperative Finding after Re-Bleeding: Case Report

Intracranial arachnoid cysts (AC) are believed to be congenital and chronic subdural hematomas tend to occur in elderly patients with a history of mild head injury. The association between these two entities sporadically occur in relatively young patients but rare in elderly patients. We report a 65-year-old man who presented with headache and dizziness of 2 months’ duration with a history of head injury. Brain computed tomography (CT) a CSDH in right side and a hygroma in left side. After first operation with burr holes in both sides, the patient underwent an early recurrence of acute subdural hematoma in the right side. The evacuation of this hematoma by a craniotomy allowed seeing an AC that we resected partially with complete recovery of the patient. The association CSDH/AC is rare and possible in elderly patients and there is no consensus on treatment.

Left Hemispherical Subdural Hematoma on the Same Side as the Motor Deficit (Kernohan)

Chronic subdural hematoma represents 25% of traumatic subdural collections;common in elderly subjects with a clear male predominance. It occurs over the age of 50 in more than 90% of cases and 50% of patients have no history of head trauma even if the latter remains the main risk factor with others such as coagulopathy, anticoagulant treatment, chronic alcoholic poisoning. Its discovery is rarely fortuitous and has an important clinical polymorphism including an intracranial hypertension syndrome (complete or incomplete). We report a clinical case of a left hemispheric subacute subdural hematoma with post-traumatic falcorial involvement in a 70-year-old patient admitted with a picture of impaired consciousness and weakness of the left hemibody. The objective of this work is to draw the attention of neurosurgeons and neurologists to the paradoxical existence of the neurological deficit on the same side as the causal brain lesion.

Development of subdural empyema from subdural effusion after suppurative encephalitis:A case report

BACKGROUND Chronic subdural effusion is very common in the cranial imaging of middle-aged and older people.Herein,we report a patient misdiagnosed with subdural effusion,who was eventually diagnosed with chronic subdural empyema(SDE)caused by Streptococcus pneumoniae.CASE SUMMARY A 63-year-old man was brought to our emergency room with a headache,vomiting,and disturbed consciousness.Computed tomography(CT)revealed a bilateral subdural effusion at the top left side of the frontal lobe.Cerebrospinal fluid examination after lumbar puncture indicated suppurative meningitis,which improved after anti-infective therapy.However,the patient then presented with acute cognitive dysfunction and right limb paralysis.Repeat CT showed an increase in left frontoparietal subdural effusion,disappearance of the left lateral ventricle,and a shift of the midline to the right.Urgent burr hole drainage showed SDE that was culture-positive for Streptococcus pneumoniae.His condition improved after adequate drainage and antibiotic treatment.CONCLUSION Patients with unexplained subdural effusion,especially asymmetric subdural effusion with intracranial infection,should be assessed for chronic SDE.Early surgical treatment may be beneficial.

Positioning and design by computed tomography imaging in neuroendoscopic surgery of patients with chronic subdural hematoma

BACKGROUND Neuroendoscopy is a very useful technique to Chronic Subdural Hematoma(CSH).But how to achieve the goal of treatment more minimally invasive?AIM To develop a simple,fast and accurate preoperative planning method in our way for endoscopic surgery of patients with CSH.METHODS From June 2018 to May 2020,forty-two patients with CSH,admitted to our hospital,were performed endoscopic minimally invasive surgery;computed tomography(CT)imaging was employed to locate the intracerebral hematoma and select the appropriate endoscopic approach before the endoscopic surgery.The clinical data and treatment efficacy were analyzed.RESULTS According to the learning of CT scanning images,the surgeon can accurately design the best minimally invasive neuroendoscopic surgical approach and realize the precise positioning and design of the drilling site of the skull and the size of the bone window,so as to provide the most effective operation space with the smallest bone window.In this group,the average operation time was only about 1 h,and the clearance rate of hematoma was about 95%.CONCLUSION Patients with CSH can achieve good therapeutic effect by using our way to positioning and design to assist the operation of CSH according to CT scan and image,and our way is very useful and necessary.

Rare combination of traumatic subarachnoid-pleural fistula and intracranial subdural hygromas:A case report

BACKGROUND Subarachnoid-pleural fistula(SPF)is a complex and rare condition characterized by a pathological shunt between the subarachnoid and pleural spaces.It can lead to the accumulation of cerebrospinal fluid(CSF)in the pleural space,pneumocephalus,and the development of central nervous system infection.Trauma or thoracic spinal surgery are common causes of SPF,with symptoms including postural headache,consciousness status changes,and dyspnea.The combination of SPF and subdural hygroma is a severe and rare condition,with little existing literature on its clinical correlation.CASE SUMMARY We report a case of an 83-year-old male patient with traumatic SPF and bilateral frontal subdural hygroma following a fall from height.The patient initially presented with severe lower back and buttock pain.During admission,the patient developed worsening lower limb weakness and pleural effusion.Further investigation revealed the presence of subdural hygromas with mass effect,requiring emergency bilateral subdural drainage.A multidisciplinary approach was undertaken to manage this complex condition,including intervention for hypovolemic CSF status and subdural hygroma management.The pleural effusion eventually resolved and the patient attained a higher level of con-sciousness after bilateral hygroma drainage surgery.We also reviewed the present literature relating to this rare combination of medical conditions.CONCLUSION Traumatic SPF with subsequent subdural hygroma is a rare but serious combination.Although the optimal treatment strategy for this complex condition remains uncertain,our literature review suggested that a multidisciplinary approach,including intervention for hypovolemic CSF and management of the subdural hygroma,is the most beneficial.

Acute spinal subdural haematoma complicating a posterior spinal instrumented fusion for congenital scoliosis:A case report

BACKGROUND Acute spinal subdural haematoma(ASSH)is a rare and potentially devastating condition with a variable prognosis.Previously described subdural haematomas were thought to have occurred spontaneously or be related to major or minor iatrogenic or traumatic injuries caused by surgery,spinal puncture or epidural anaesthesia.Other contributing pathologies have been described,such as intradural tumours or spinal arteriovenous malformations.ASSH has also been associated with anticoagulation therapy,haemostatic abnormalities and risk factors such as pregnancy.To the best of our knowledge,this case study described the first reported occurrence of an ASSH during spinal surgery in a paediatric patient.The patient was not known to have any coagulopathies,and no obvious vascular lesions were documented.The surgical procedure did not directly involve the dura mater,and no evident intraoperative dural tears were found.CASE SUMMARY We reported and discussed a case of ASSH complicating a posterior spinal instrumented fusion during surgery for paediatric congenital scoliosis.This condition has not been previously described.We made recommendations for facing such an occurrence,explored its aetiology in the context of malformation and discussed the benefits of neuromonitoring during scoliosis correction and the management protocol.We conducted a PubMed literature review for cases of paediatric ASSH and other closely related disorders.We reviewed recommendations regarding neuromonitoring and treatment management in such cases.CONCLUSION ASSH is a rare complication of posterior spinal instrumented fusion.Published cases are more often associated with anticoagulation therapy or coagulopathy.Neuromonitoring is strongly recommended to detect and assess neurological status,thus enabling rapid diagnosis and treatment and facilitating early spinal decompression and a return to a normal neurological status.

Risk Factors of Reoperation and Outcome of Patients Operated for Chronic Subdural Hematoma in a Teaching Hospital in Rabat

Background: chronic subdural hematoma is a common pathology, especially in the elderly. Although it has a good prognosis, it poses the problem of recurrence after surgical evacuation. Objective: To analyze the risk factors of reoperation in patients surgically treated for chronic subdural hematoma (cSDH) and evaluate the outcome of patients who benefited from a reoperation. Materials and Methods: A retrospective review was conducted in a single University Hospital Center in Rabat (Morocco) on 49 patients operated on from January 2020 to June 2021 for cSDH. Possible risk factors described in the literature were analyzed and the outcome of post-operative course was evaluated. Statistical significance was defined by p-value Results: 49 patients underwent surgical evacuation of cSDH. The sex ratio of male/female was 3.08. The mean age was 70.6 years. Concerning the medical history, 8.2% were diabetics, 10.2% had heart disease, 18.4% had hypertension, 16.3% associated of comorbidities, 2% had pulmonary embolism, and 2% had neoplasm. 18.4% were on anticoagulation therapy, no patients were on new oral anticoagulants. The clinical findings upon admission were motor deficit at 57.1%, signs of intracranial hypertension at 20.4%, altered consciousness at 16.9% and impaired behavior at 6.1%. 28.6% of patients had a past history of head trauma. The pre-operative CT scan showed unilateral cSDH at 81.6%, midline shifts at 77.6%, and false membranes at 34.7%. Blood appeared chronic at 40.8%, subacute at 24.5%, and mixed densities at 34.7%. The post-operative course was uneventful in 73.5%. According to Ibanez grading 8 patients had mild complications (grade I) and 5 moderate complications (grade II) after the first surgery. We recorded 10.2% of patients who needed a second surgery because of the deterioration of neurologic status or motor deficit associated with an abnormal CT scan. According to the GOS, 85.7% of patients had a good recovery while 10.2% died. None of the factors assessed was found to be a risk factor for reoperation. Conclusion: No risk factors of reoperation after an initial burr hole evacuation for cSDH were found. However medical history and male sex was common condition among reoperated patients with their CT scan showing a chronic aspect of blood, midline shift and false membranes. Most patients who underwent revision surgery died on the postoperative course.

Enigmatic rapid organization of subdural hematoma in a patient with epilepsy:A case report

BACKGROUND Determining a subdural hematoma(SDH)to be chronic by definition takes 3 wk,whereas organized chronic SDH(OCSDH)is an unusual condition that is believed to form over a much longer period of time,which generally demands large craniotomy.Therefore,it is a lengthy process from the initial head trauma,if any,to the formation of an OCSDH.Acute SDH(ASDH)with organization-like,membranaceous appearances has never been reported.CASE SUMMARY A 56-year-old woman presented to our hospital with a seizure,and computed tomography(CT)on admission was negative for signs of intracranial hemorrhage.She had clear consciousness and unimpaired motor functions on arrival and remained stable for the following week,during which she underwent necessary examinations.On the morning of day 10 of hospitalization,she accidentally hit her head hard against the wall in the bathroom and promptly lapsed into complete coma within 2 h.Therefore,we performed emergency CT and identified a left supratentorial SDH that was an absolute indication for surgery.However,the intraoperative findings were surprising,with no liquefaction observed.Instead,a solid hematoma covered with a thick membrane was noted that strongly resembled an organized hematoma.Evacuation was successful,but the family stopped treatment the next day due to financial problems,and the patient soon died.CONCLUSION Neurosurgeons should address SDHs,especially ASDHs,with discretion and individualization due to their highly diversified features.

应用Subdural专用引流管治疗慢性硬膜下血肿

目的比较钻孔闭式引流和Subdural专用引流管穿刺引流在慢性硬膜下血肿(CSDH)中的疗效。方法回顾分析我院收治的88例CSDH患者,46例行钻孔闭式引流(A组),42例行Subdural专用引流管穿刺引流术(B组),比较两组治疗效果。结果A组40例一次钻孔引流成功,6例因继发颅内血肿而改行开颅手术,再手术率13.04%,癫发作3例;B组41例一次性引流成功,1例因继发血肿再次手术,再手术率2.38%,无癫发作。结论Subdural引流术较钻孔冲洗闭式引流术更微创、更安全有效,并发症少,宜作为治疗CSDH的首选方法。

Ossified Subdural Chronic Hematoma: Two Cases Report and Literature Review

Ossified subdural chronic hematoma (OSCH) is a rare disease that accounts 0.3% to 2% of subdural chronic hematoma which is common. The surgical management depends on his clinical expression. The aim of this study is to highlight the surgical procedure because the management of this type of lesion has no consensus. The authors reported two cases of OSCH which were successfully excised with good outcomes. Taking care during the procedure of dissection from parenchyma is the key for this surgery.

Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report

Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma(SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a wellknown treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky.

Efficacy evaluation of neuroendoscopy vs burr hole drainage in the treatment of chronic subdural hematoma:An observational study

BACKGROUND Chronic subdural hematoma(CSDH)is a common disease in neurosurgery.The traditional treatment methods include burr hole drainage,bone flap craniectomy and other surgical methods,and there are certain complications such as recurrence,pneumocephalus,infection and so on.With the promotion of neuroendoscopic technology,its treatment effect and advantages need to be further evaluated.AIM To study the clinical effect of endoscopic small-bone approach in CSDH.METHODS A total of 122 patients with CSDH admitted to our hospital from August 2018 to August 2021 were randomly divided into two groups using the digital table method:the neuroendoscopy group(n=61 cases)and the burr hole drainage group(n=61 cases).The clinical treatment effect of the two groups of patients with CSDH was compared.RESULTS At the early postoperative stage(1 d and 3 d),the proportion of 1/2 re-expansion of brain tissue in the hematoma cavity and the proportion of complete reexpansion was higher in the neuroendoscopy group than in the burr hole drainage group,and the difference between the two groups was statistically significant(P<0.05).The recurrence rate of hematoma in the neuroendoscopy group was lower than that in the burr hole drainage group,and the difference between the two groups was statistically significant(P<0.05).No intracranial hematoma,low cranial pressure,tension pneumocephalus or other complications occurred in the neuroendoscopy group.CONCLUSION The neuroendoscopic approach for the treatment of CSDH can clear the hematoma under direct vision and separate the mucosal lace-up.The surgical effect is apparent with few complications and definite curative effect,which is worthy of clinical promotion and application.

Efficacy of Single Burr Hole in Management of Chronic Subdural Hematoma

Background: Surgery of chronic subdural hematoma (CSDH) is a common practice of neurosurgeons. CSDH is considered a pathology of the elderly and usually many co-morbidities are present. CSDH carries high risk of mortality if not treated or not treated well. So, the minimal, safe and adequate surgical intervention is the bases to choose specific surgical maneuver. Aim of the Study: The efficacy of a single burr in evacuation and treatment of chronic subdural hematoma. Methods: This study was held in Assiut university hospitals, neurosurgical department. It is a prospective randomized controlled study. 113 patients were enrolled in this study in the period between March 2018 and June 2019. We included all cases of chronic subdural hematoma (CSDH) and subacute subdural hematoma that were evacuated with single burr hole. Hematomas either, unilateral or bilateral were included. Septated hematomas were excluded. Patients’ clinical characteristics as age, sex, clinical presentation, co-morbidities and patients outcome were recorded. Postoperative status as regards improvement of the neurological status, complications and recurrence of hematoma were recorded. Results: We had 113 patients operated via properly situated single burr hole in our study. 113 patients were included in this study, 79 males (69.9%) and 34 females (30.1%). Age of the patients ranges between 27 years old and 90 years old. Postoperative follow up was evaluated according to Glasgow outcome score (GOS). We had 98 patients with good recovery, 4 patients with moderate disability, 6 patients with severe disability and 5 patients died. Complications were in form of 3 patients with residual hematoma, 2 patients with tension pneumocephalus, 7 patients developed postoperative seizure, 5 cases developed cortical/parenchymal hematoma and 9 cases developed hematoma recurrence. Conclusion: Single, properly situated burr hole with previously described characters is an effective treatment option in cases of CSDH. It helps adequate, effective and safe removal of the pathology with limited maneuver.

Recovery of corticospinal tract injury following subdural hematoma removal A diffusion tensor imaging study

Subdural hematoma can cause compression or damage to the neural tracts in the brain;however,very little is known about this injury.We report on a patient with subdural hematoma who was evaluated by diffusion tensor imaging prior to and after trephination and drainage of subdural hematoma.A 58-year-old male patient and ten age-matched normal control subjects were evaluated.The patient showed mild hemiparesis for 3 weeks prior to surgery.His hemiparesis recovered to a nearly normal state at 5 weeks post-surgery when the follow up diffusion tensor image was acquired.Two diffusion tensor image parameters,fractional anisotropy and apparent diffusion coefficient,were measured along the corticospinal tract.Pre-operative diffusion tensor image showed that the corticospinal tract of the affected hemisphere seemed to be injured or compressed.However,the follow up diffusion tensor image showed recovery of this corticospinal tract to a normal state.It would appear that diffusion tensor images are a useful tool for evaluation of the effects of subdural hematomas on neural tracts.

Intervention of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma

Objective:To study the intervention effect of Peiyuan Huayu Decoction on the neuron damage in model rats with acute subdural hematoma (ASDH).Methods: 160 SD rats were randomly divided into four groups, and the ASDH model rats were made by stereotactic autoblood injection, and sham operation group received craniotomy without blood injection. Sham operation group and model group were normally bred after model establishment, and 6 h after model establishment, the treatment group received intragastric administration of Peiyuan Huayu Decoction, and control group received intragastric administration of Piracetam Tablets, 1 time a day. On the 1d, 3d, 5d and 7d after model establishment, the general conditions of rats (activity, food intake and mental state) were observed, blood was collected via auricula dextra, ELISA method was used to determine peripheral plasma NSE and S100β protein contents, routine HE staining was conducted after perfusion fixation, the neurons in blood injection side of brain tissue were counted, and the neuron damage was observed.Results: 26 rats were dead in the experiment. The general conditions of sham operation group were significantly better than those of other groups, treatment group was significantly better than model group and control group on the 5d group (P<0.05), and there was no significant difference on the 1d, 3d and 7d (P>0.05);neuron count of sham operation group was basically stable, treatment group was not different from model group and control group on the 1d (P>0.05), treatment group was better than model group (P<0.05), and not different from control group (P>0.05) on the 3d, and treatment group was better than model group and control group on the 5d and 7d (P<0.05);peripheral plasma S100β protein and NSE contents of sham operation group were at lower levels, treatment group was not significantly different from model group and control group on the 1d (P>0.05), S100β protein and NSE contents decreased significantly on the 3d, and treatment group was significantly different from model group and control group (P<0.05), S100β protein and NSE contents increased on the 5d and 7d, the increase in treatment group was slower than that in model group and control group, and there was significant difference (P<0.05).Conclusion:Peiyuan Huayu Decoction has obvious protective effect on the neurons in ASDH model rats, and this effect may be based on the inhibition of secondary neuron damage.

Neonatal infratentorial subdural hematoma contributing to obstructive hydrocephalus in the setting of therapeutic cooling: A case report

BACKGROUND Symptomatic neonatal subdural hematomas usually result from head trauma incurred during vaginal delivery,most commonly during instrument assistance.Symptomatic subdural hematomas are rare in C-section deliveries that were not preceded by assisted delivery techniques.Although the literature is inconclusive,another possible cause of subdural hematomas is therapeutic hypothermia.CASE SUMMARY We present a case of a term neonate who underwent therapeutic whole-body cooling for hypoxic ischemic encephalopathy following an emergent C-section delivery for prolonged decelerations.Head ultrasound on day of life 3 demonstrated a rounded mass in the posterior fossa.A follow-up brain magnetic resonance imaging confirmed hypoxic ischemic encephalopathy and clarified the subdural hematomas in the posterior fossa causing mass effect and obstructive hydrocephalus.CONCLUSION The aim of this report is to highlight the rarity and importance of mass-like subdural hematomas causing obstructive hydrocephalus,particularly in the setting of hypoxic ischemic encephalopathy and therapeutic whole-body cooling.

Subdural empyema complicated with intracranial hemorrhage in a postradiotherapy nasopharyngeal carcinoma patient: A case report and review of literature

The prevalence of nasopharyngeal carcinoma(NPC) is higher in southern China, Hong Kong, and Taiwan than in other areas in the world. Radiotherapy is an important part of treatment for NPC patients, especially those with stage Ⅲ/Ⅳ disease. Subdural empyema is a rare but life-threatening complication in postradiotherapy NPC patients which should be paid more attention. Here, we present the case of a 64-year-old female postradiotherapy NPC patient with subdural empyema complicated with intracranial hemorrhage. She was treated by burr-hole surgery but unfortunately died because of recurrent intracranial hemorrhage. The mechanisms potentially underlying the formation of subdural empyema in postradiotherapy NPC patients and the surgical strategies that can be used in these patients are discussed in this report.

Traumatic Subdural Effusion Evolving into Chronic Subdural Hematoma

Background: Chronic subdural hematoma (CSDH) is a common complication in head injuries. The objective of this study is to establish the evolution of traumatic subdural effusion (TSDE) into CSDH using clinical signs and symptoms as well as radiology. Our aim is to effectively manage such cases without postoperative recurrence (PR). Methodology: The study was a retrospective cohort carried out in the No. 1 People’s Hospital of Jingzhou from August 2007 to November 2013. The hospital is affiliated to the Yangtze University. All the patients included in this study were involved in road traffic accidents and sustained various degree of head injury. Serial CT scans were done to establish the development TSDE and the evolution of the TSDE into CSDH and treatment options. Results: In all 159 patients developed TSDE and out of these 34 which constitute 21.38% had their TSDE evolving into CSDH. Most of the patients were elderly. Twelve patients were treated conservatively while the remaining patients were treated surgically by drilling and drainage of hematoma. All the patients survived with marked improvement in their sign and symptoms with no recurrence. Conclusion: TSDE is one of the etiological factors for the development of CSDH in the elderly although in most cases the etiology of CSDH is usual multifactory. It must be stated clearly that, the evolution of TSDE into CSDH is initially a hidden process and presents with nonspecific signs and symptoms which can easily be missed. CT scan is usually the initial radiology of choice in making diagnosis of TSDE but MRI could be used to make early diagnosis of the transgression of TSDE into CSDH, and hence early surgical intervention before the formation of a neomembrane could reduce PR rate.