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.

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.

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.

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.

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.

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.

Massive subdural hematoma misdiagnosed as delayed encephalopathy of carbon monoxide poisoning: a case report and literature review

Subdural hematoma is often secondary to brain trauma and other diseases.The onset is hidden and the condition is critical.Timely detection and early treatment are particularly important.The patient denied a history of trauma,but had a history of consciousness loss after charcoal burning.The clinical symptoms were progressive cognitive impairment.The initial diagnosis was delayed encephalopathy caused by carbon monoxide poisoning.However,computed tomography(CT)scan of the brain showed a large area of subdural hematoma on the left side and the formation of a cerebral hernia,which was life-threatening.The patienfs symptoms gradually improved after an emergency operation.

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.

Epidural blood patch for spontaneous intracranial hypotension with subdural hematoma: A case report and review of literature

BACKGROUND Cerebrospinal fluid(CSF)leakage at C1/2 in spontaneous intracranial hypotension(SIH)is rare.Subdural hematoma(SDH),a serious complication of SIH,may lead to neurological deficits.This report presents a case of SDH after spontaneous C1/2 CSF leakage,which was treated with a targeted epidural blood patch(EBP).CASE SUMMARY A 60-year-old man with no history of trauma was admitted to our hospital with orthostatic headache,nausea,and vomiting.Brain computed tomography imaging revealed bilateral,subacute to chronic SDH.Brain magnetic resonance imaging(MRI)findings were SDH with dural enhancement in the bilateral cerebral convexity and posterior fossa and mild sagging,suggesting SIH.Although the patient underwent burr hole trephination,the patient’s orthostatic headache was aggravated.MR myelography led to a suspicion of CSF leakage at C1/2.Therefore,we performed a targeted cervical EBP using an epidural catheter under fluoroscopic guidance.At 5 d after EBP,a follow-up MR myelography revealed a decrease in the interval size of the CSF collected.Although his symptoms improved,the patient still complained of headaches;therefore,we repeated the targeted cervical EBP 6 d after the initial EBP.Subsequently,his headache had almost disappeared on the 8th day after the repeated EBP.CONCLUSION Targeted EBP is an effective treatment for SDH in patients with SIH due to CSF leakage at C1/2.

Mycotic Aneurysm from Abiotrophia Defectiva Causing Subdural Hematoma with Herniation

This case describes a ruptured mycotic aneurysm from Abiotrophia defectiva that led to a subdural hematoma and subsequent herniation. In the current literature, there have been cases highlighting mycotic aneurysms leading to subdural hematoma. Several others describe similar topics;however, none were caused by Abiotrophia defectiva, leading to a herniation event. Abiotrophia defectiva, while not common, is an insidious bacterium that is difficult to detect and leads to a poor prognosis. In their paper, Ding et al. described a hematoma formation from a ruptured aneurysm of the distal middle cerebral artery [1]. Similar cases include two instances published by Boukobza et al. [2]. These prior articles and our report summarizes that this diagnosis typically warrants careful evaluation of etiologies and close management of the patient.

Brain Stroke as a Post-Operative Lethal Complication of a Bilateral Chronic Subdural Hematoma: A Case Report

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.

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.

Management and Outcome of Acute Subdural Hematoma in Gabriel TouréHospital

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.

Estimation of Chronic Subdural Hematoma Size Using CT Imaging;a Comparison of In-Plane Thickness to 3D Volumetry

Backgrounds: Pre- and postoperative chronic subdural hematoma (CSDH) sizes have been used in clinical trials to predict the risk of postoperative recurrence. Commonly, dimensions of the pre- and postoperative lesions have been assessed by computerized tomography (CT) scans using maximum thickness as a linear measurement. Our goal was to characterize this common method for quantification of pre- and postoperative lesion sizes and to assess its estimation validity compared to estimation by hematoma volumetry. Methods: We prospectively investigated pre- and 1st postoperative day CT scans of 107 adult surgical patients with uni- or bilateral CSDH. Pre- and postoperative thickness of CSDH was determined and then compared to pre- and postoperative lesion volume measured with 3D hematoma volumetry. Results: Pearson correlation coefficients between mean pre- and postoperative lesion thickness and mean pre- and postoperative lesion volume in the unilateral subgroup were 0.491 and 0.498, respectively;in the bilateral subgroup 0.505 and 0.579, respectively;and in the whole series 0.653 and 0.472, respectively. Conclusions: Pre- and postoperative thickness of CSDH does not offer reasonable approximations of the pre- and postoperative lesion size when compared with results from 3D volumetry in the unilateral subgroup, bilateral subgroup or overall.

Usage of neuronavigation system to treat a case of traumatic acute subdural hematoma after two-side ventriculoperitoneal shunt

Traumatic acute subdural hematoma is one of the most lethal causes of head injuries,which leads to high mortality.While combined diseases always make it more intractable for the treatment.We present a case of a 68-year-old female patient with traumatic acute subdural hematoma combined with hydrocephalus after ventriculoperitoneal shunt assisted by the neuronavigation system in January 12,2017.She was undergone ventriculoperitoneal shunt 6 years and 5 months ago on two sides respectively because of hydrocephalus,with the ventriculoperitoneal shunt device on the right side out of work.The initial neurological examination showed a Glasgow Coma Scale of E2V1M5 with no papillary defect.A CT scan of the head revealed a left homogeneously hyperdense and subdural hematoma,with compression of the lateral ventricle(2.6 cm thick)and a 0.5 cm midline shift.To protect the ventriculoperitoneal shunt device,we used neuronavigation system to precisely mark the relative location of the device and“invisible”subdural hematoma,thus to design a perfect incision preoperatively.Subsequently,evacuation of the subdural hematoma was performed via craniotomy without damaging the ventriculoperitoneal shunt device.Postoperative CT of the head showed totally removing of the subdural hematoma.The patient recovered three months later.With the assistant of neuronavigation system,it is much easier for the preoperative planning and to reduce the surgical risk.Our case gives a clue that more approaches can be considered when encountering acute head trauma with the complicated combined diseases.

Recurrent Intracranial Hypotension Complicated with Subdural Hematoma—A Case Report and a Case Series Review

Intracranial hypotension has variable clinical manifestations;subdural hematoma is one of the complications of intracranial hypotension with the reported incidence ranging from 16% to 57%. The author would like to share a case of subdural hematoma caused by recurrent intracranial hypotension with different cerebrospinal fluid (CSF) leakage site and to review a case series of intracranial hypotension treated in the author’s hospital (Kaohsiung Veterans General Hospital). A 44-year-old male having the past history of intracranial hypotension was treated in our Neurology division one month previous to this admission, who was sent to our emergency room (ER) due to severe orthostatic headache with nausea and vomiting. Computed tomography (CT) scan of brain at ER showed bilateral subdural hematoma, more on the left side with mass effect. Both surgical removal of the subdural hematoma and epidural blood patch were performed and he had a good outcome. Orthostatic headache is a specific symptom sign of intracranial hypotension. Epidural blood patch is effective to manage intracranial hypotension either the leakage site of CSF is detected or not. In case of non-traumatic subdural hematoma, intracranial hypotension should be kept in mind.

Subarachnoid hemorrhage misdiagnosed as acute coronary syndrome leading to catastrophic neurologic injury: A case report

BACKGROUND Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome(ACS).Troponin levels in ACS patients can often be more than 50 times the upper reference limit.Some patients with subarachnoid hemorrhage(SAH)also show electrocardiogram abnormalities,myocardial damage,and elevated cardiac biomarkers.Unlike ACS patients,patients with SAH only have a slight increase in troponin,and the use of anticoagulants or antiplatelet drugs is prohibited.Because of the opposite treatment modalities,it is essential for clinicians to distinguish between SAH and ACS.CASE SUMMARY A 56-year-old female patient was admitted to the emergency department at night with a sudden onset of severe back pain.The final diagnosis was intraspinal hematoma in the thoracic spine.We performed an emergency thoracic spinal canal hematoma evacuation procedure with the assistance of a microscope.Intraoperatively,diffuse hematoma formation was found in the T7-T10 spinal canal,and no obvious spinal vascular malformation changes were observed.Postoperative head and spinal magnetic resonance imaging(MRI)showed a small amount of SAH in the skull,no obvious abnormalities in the cervical and thoracic spinal canals,and no abnormal signals in the lumbar spinal canal.Thoracoab-dominal aorta computed tomography angiography showed no vascular malfor-mation.Postoperative motor system examination showed Medical Research Council Scale grade 1/5 strength in both lower extremities,and the patient experienced decreased sensation below the T12 rib margin and reported a Visual Analog Scale score of 3.CONCLUSION Extremely elevated troponin levels(more than 50 times the normal range)are not unique to coronary artery disease.SAH can also result in extremely high troponin levels,and antiplatelet drugs are contraindicated in such cases.Emergency MRI can help in the early differential diagnosis,as a misdiagnosis of ACS can lead to catastrophic neurological damage in patients with spontaneous spinal SAH.

Comparison of standard large trauma craniotomy with routine craniotormy in treatment of acute subdural hematoma

Objective: To compare the therapeutic effect and indication between standard large trauma craniotomy and routine craniotomy. Methods: There were 97 patients in the standard large trauma craniotomy group and 110 patients in the routine craniotomy group. The mortality, postoperative ICP (intracranial pressure), ratio of pupil rebound, complication and results of six month follow up after operation were compared between the two groups. Results: Fifteen patients ( 15.6 %) died in the standard large trauma craniotomy group and 30 ( 27.7 %) in the routine craniotomy group. The postoperative mean ICP was 3.75 kPa±1.89 kPa in the standard large trauma craniotomy group and 5.11 kPa±1.57 kPa in the routine craniotomy group. The pupil rebound was found in 47 patients ( 61.0 %) in the standard large trauma craniotomy group and in 41 patients ( 46.1 %) in the routine craniotomy group (P< 0.01 ). The rate of complication was lower in the standard large trauma craniotomy group, but no obvious difference in long term therapeutic effect was found between the two groups. Conclusions: Standard large trauma craniotomy can attenuate brain hernia and the mortality of the patients with acute subdural hematoma . The incidence of complication can also be decreased. But the long term life quality of the patients can not be improved.