Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is frequently encountered in neurosurgery practice. Its etiologies are dominated by traumatic head injury, and clinical presentations are vario...Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is frequently encountered in neurosurgery practice. Its etiologies are dominated by traumatic head injury, and clinical presentations are various. The prognosis is generally good, but complications can be seen. Some of these complications can lead to the death of the patient. We report the rare case of a 70-year-old man admitted to the emergency room for the management of bilateral CSDH revealed by severe headache, vomiting, and loss of consciousness. He underwent a successful evacuation of both hematomas but had a stroke in both posterior cerebral artery territories, which was lethal 72 hours after surgery. We present and try to find an explanation for this exceptional post-operative complication of CSDH.展开更多
This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural ...This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).展开更多
BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlar...BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.展开更多
Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative...Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.展开更多
Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic h...Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.展开更多
Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical ou...Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.展开更多
目的探讨机器人引导下穿刺引流10~30 mL脑内小血肿的临床效果。方法采用回顾性病例对照研究。选取2019年1月至2022年12月在梅州市人民医院接受治疗的83例高血压脑出血患者,依据治疗方法不同分为机器人手术组(观察组)39例和保守治疗组(...目的探讨机器人引导下穿刺引流10~30 mL脑内小血肿的临床效果。方法采用回顾性病例对照研究。选取2019年1月至2022年12月在梅州市人民医院接受治疗的83例高血压脑出血患者,依据治疗方法不同分为机器人手术组(观察组)39例和保守治疗组(对照组)44例。比较两组患者临床效果、住院期间并发症发生情况、住院时间及住院费用、出院时及出院3个月时基础性日常生活能力量表(basic activity of daily living scale,BADL)评分及美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分。结果①入院时两组NIHSS评分和BADL评分无统计学差异(P>0.05);但出院时、出院3个月随访时观察组NIHSS评分更低(P<0.05),BADL评分更高(P<0.05)。②观察组和对照组的平均住院时间分别为(12.8±3.3)d和(13.8±4.0)d,两组比较无统计学差异(P=0.252)。观察组和对照组的住院费用分别为(38496.23±6369.06)元和(19258.36±4068.68)元,观察组高于对照组(P<0.05)。③观察组和对照组的并发症发生率分别为2.6%(1/39)和6.8%(3/44)。观察组发生穿刺行程区出血1例,对照组并发肺部感染3例,两组比较无统计学差异(P>0.05)。结论机器人引导下穿刺引流10~30 mL脑内小血肿的疗效较好,术后并发症少,操作便捷简单,可促进患者术后功能的恢复,有效提高患者的生活质量。展开更多
目的探讨早期强化降压对高血压脑出血患者颅内血肿扩大及血肿周围水肿的影响。方法回顾性分析本院2013年9月至2015年6月收治的幕上高血压脑出血患者的临床资料,根据我院神经内、外科对高血压脑出血早期血压管理方式的不同,将病例资料分...目的探讨早期强化降压对高血压脑出血患者颅内血肿扩大及血肿周围水肿的影响。方法回顾性分析本院2013年9月至2015年6月收治的幕上高血压脑出血患者的临床资料,根据我院神经内、外科对高血压脑出血早期血压管理方式的不同,将病例资料分为强化降压组（3 h内收缩压降至≤140 mm Hg,并维持120～140 mm Hg 1周）和对照组（目标收缩压160～180 mm Hg,平均动脉压100～130 mm Hg）。分别从年龄、格拉斯哥昏迷评分（Glasgow coma scale,GCS）、收缩压、起病后干预时间、血肿体积5个方面分层次比较2组3 d内血肿扩大发生率,并计算相对危险度降低率（relative risk reduction,RRR）,对比2组第3、7、14天水肿变化。结果共筛选出90例行强化降压幕上高血压脑出血患者的临床资料,再筛选出与之相匹配的对照组90例,2组的一般资料比较差异无统计学意义（P〉0.05）。强化降压组血肿扩大9例（10.0%）,对照组血肿扩大24例（26.7%）,差异有统计学意义（P〈0.01）,RRR值为62.5%（95%CI为23.9%～81.5%）。2组水肿量在第3、7、14天差异无统计学意义（P〉0.05）。结论脑出血早期强化降压能减少患者颅内血肿扩大概率,不增加血肿周围水肿体积。展开更多
文摘Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is frequently encountered in neurosurgery practice. Its etiologies are dominated by traumatic head injury, and clinical presentations are various. The prognosis is generally good, but complications can be seen. Some of these complications can lead to the death of the patient. We report the rare case of a 70-year-old man admitted to the emergency room for the management of bilateral CSDH revealed by severe headache, vomiting, and loss of consciousness. He underwent a successful evacuation of both hematomas but had a stroke in both posterior cerebral artery territories, which was lethal 72 hours after surgery. We present and try to find an explanation for this exceptional post-operative complication of CSDH.
文摘This study was a retrospective analysis of outcome of surgically treated acute traumatic epidural hematomas based on the Glasgow coma scale. The series enrolled forty-six consecutive cases of acute traumatic epidural hematomas. The mean age of patients was 29.56 years and 63.04% of the patients were between 21 and 30 years of age. Forty-tree out of 46 (93.47%) of the patients were males. Road traffic crash was the main mode of injury. The severity of the traumatic brain injury was classified according to the Glasgow coma scale score at admission. The injury was mild or moderate in 35 (76.08%) cases and severe in 11. Eight patients (17.39%) presented with pupillary abnormalities. The computed tomography scanning of the head has objectivized the epidural hematoma in all patients and has shown a mass effect with midline shift in all but one case (45/46). The most frequent surgical procedure done was craniotomy. Six (13.04%) patients died (GOS 1), but 38 (82.60%) recovered fully (GOS 5) and two (04.34%) were disabled but independent (GOS 4). The Glasgow coma score at admission was very predictive for good or poor outcome, since all patients but one who died and all survivors who were disabled were comatose at admission (GCS ≤ 8).
基金the National Natural Science Foundation of China, No. 30570628, 30770751
文摘BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups （P 〈 0.01）. CONCLUSION： Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.
文摘Introduction: Extradural hematoma (EDH) is considered one of the most serious and recognized secondary insults of traumatic brain injury (TBI). We will analyse the data of cases required conversion from a conservative to a surgical management and identify the possible patient and disease related risk factors in such cases. Patients and Methods: This prospective study included 90 patients with traumatic EDH, admitted to the Neurotrauma department in Cairo University hospitals from March 2014 to August 2016. Their CT scans reveal EDH alone or with associated cerebral lesions initially fitting the criteria of conservative management. Results: The commonest site is frontal in 21 patients (23.3%), followed by parietotemporal in 18 patients (20%). While Posterior fossa hematomas occurred in 3 cases, which was the least common site (3.3%). The mean size of the EDH was 17.02 ml, with a standard deviation of 6.29 ml. The minimum size was 2 ml and a maximum of 28 ml. The cut off value of the size of the hematoma requiring conversion to a surgical management was 19 ml. Conclusion: Clear indications of EDH evacuation have been well known, however studying which risk factors are more liable to convert conservative management plan to evacuation is important. Increased caution and closer monitoring are required when the size of the hematoma is >19 ml or the hematoma is overlying a venous sinus. Unlike coagulopathy which was found to be a potential risk factor, but larger number study is needed.
文摘Background: Traumatic Brain Injury (TBI) is a major health problem worldwide. It is the main cause of trauma mortality. Acute subdural hematoma (ASDH) has a reputation for being the most serious of all posttraumatic head injuries. Its frequency is estimated to be 1% to 5% of all head injuries and 22% of severe head injuries. The aim of this study was to assess the epidemiological, clinical and prognosis aspects of ASDH in our department. Material and Methods: This prospective study, from January to December 2019, included 57 patients admitted to the Gabriel Touré Teaching Hospital for ASDH. Patients underwent detailed clinical and radiological evaluation and ASDH was diagnosed by non-contrast computed tomography (CT) scan. Functional outcome was evaluated 6 months after injury by Glasgow Outcome Scale. Results: During the study period, 662 patients were admitted for TBI including 57 (8.61%) cases of ASDH. The mean age was 34 years with extremes of 2 and 77 years. There was a male predominance with 52 (91.2%). The main cause of trauma was motor vehicle accidents in 38 (66.6%) patients. According to the Glasgow coma scale (GCS), 33 (57.9%) patients were classified mild (Table 2). The thickness of the hematoma was more than 1 cm in 13 (22.8%) patients and less than 1 cm in 44 (77%) patients. Surgical treatment was performed in 13 (22.8%) patients. The outcome was favorable in 30 (52.6%) patients and the mortality rate was 33.3%. Conclusion: ASDH remains a difficult challenge because of the high mortality. The mortality rate remains high particularly in patient with poor GCS score at admission.
文摘Introduction: Acute post traumatic subdural hematoma is a clinical condition with increased morbidity and mortality despite the developments in neurosurgery and urgent intervention is required to have best clinical outcome. We will evaluate hinged craniotomy technique in terms of offering adequate brain decompression plus avoiding removal of bone flap which requires second replacement surgery in comparison to cisternostomy effect. Material and Methods: A prospective study was conducted over 30 patients with traumatic acute subdural hematoma presented to neurotrauma unit in Cairo University hospitals from January 2017 to February 2018, operated by hinged craniotomy plus evacuation of hematoma and duroplasty. We avoid rapping the head with elastic bandage post-operative. Generous subcutaneous dissection (5 - 7 cm) all around skin flap was done routinely. Effect of brain decompression was evaluated by measuring the level of brain in relation to skull in post-operative computerized topography. Results: Twenty-one patients operated with initial GCS less than eight. Ten cases (33%) show that cortical surface in relation to skull bone was at inner table, nine cases (30%) at diploid layer and two cases (6.7%) at outer table in post-operative CT brain. Twenty patients died (66.7%);eight patients (26.6%) became fully conscious and two patients (6.7%) had vegetative outcome. No re-operation was done in any of our patients. Conclusion: Hinged craniotomy may be a safe and effective alternative technique with comparable results to cisternotomy in cases of traumatic brain injury that require decompression to avoid second surgery, especially in centres lacking cisternostomy experience. Although gaining cisternostomy experience may help in other indications, future prospective studies with larger number are required.
文摘目的探讨机器人引导下穿刺引流10~30 mL脑内小血肿的临床效果。方法采用回顾性病例对照研究。选取2019年1月至2022年12月在梅州市人民医院接受治疗的83例高血压脑出血患者,依据治疗方法不同分为机器人手术组(观察组)39例和保守治疗组(对照组)44例。比较两组患者临床效果、住院期间并发症发生情况、住院时间及住院费用、出院时及出院3个月时基础性日常生活能力量表(basic activity of daily living scale,BADL)评分及美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分。结果①入院时两组NIHSS评分和BADL评分无统计学差异(P>0.05);但出院时、出院3个月随访时观察组NIHSS评分更低(P<0.05),BADL评分更高(P<0.05)。②观察组和对照组的平均住院时间分别为(12.8±3.3)d和(13.8±4.0)d,两组比较无统计学差异(P=0.252)。观察组和对照组的住院费用分别为(38496.23±6369.06)元和(19258.36±4068.68)元,观察组高于对照组(P<0.05)。③观察组和对照组的并发症发生率分别为2.6%(1/39)和6.8%(3/44)。观察组发生穿刺行程区出血1例,对照组并发肺部感染3例,两组比较无统计学差异(P>0.05)。结论机器人引导下穿刺引流10~30 mL脑内小血肿的疗效较好,术后并发症少,操作便捷简单,可促进患者术后功能的恢复,有效提高患者的生活质量。
文摘目的探讨早期强化降压对高血压脑出血患者颅内血肿扩大及血肿周围水肿的影响。方法回顾性分析本院2013年9月至2015年6月收治的幕上高血压脑出血患者的临床资料,根据我院神经内、外科对高血压脑出血早期血压管理方式的不同,将病例资料分为强化降压组（3 h内收缩压降至≤140 mm Hg,并维持120～140 mm Hg 1周）和对照组（目标收缩压160～180 mm Hg,平均动脉压100～130 mm Hg）。分别从年龄、格拉斯哥昏迷评分（Glasgow coma scale,GCS）、收缩压、起病后干预时间、血肿体积5个方面分层次比较2组3 d内血肿扩大发生率,并计算相对危险度降低率（relative risk reduction,RRR）,对比2组第3、7、14天水肿变化。结果共筛选出90例行强化降压幕上高血压脑出血患者的临床资料,再筛选出与之相匹配的对照组90例,2组的一般资料比较差异无统计学意义（P〉0.05）。强化降压组血肿扩大9例（10.0%）,对照组血肿扩大24例（26.7%）,差异有统计学意义（P〈0.01）,RRR值为62.5%（95%CI为23.9%～81.5%）。2组水肿量在第3、7、14天差异无统计学意义（P〉0.05）。结论脑出血早期强化降压能减少患者颅内血肿扩大概率,不增加血肿周围水肿体积。
