Bilateral Chronic Subdural Hematoma Research Articles

Topical dexamethason effectiveness combined with surgical intervention in patients suffering from chronic subdural hematoma

BackgroundA chronic subdural hematoma (CSDH) is one of the most common neurosurgery operations. This study aimed to evaluate the effect of topical corticosteroids combined with surgery in patients with CSDH. Materials and MethodsThe present study is a clinical trial study on patients referred to hospitals associated with Ahvaz University of Medical Sciences with chronic subdural hematoma in 2019. Patients requiring surgical drainage of chronic subdural hematoma who met the inclusion criteria underwent open craniotomy surgery on the side of the hematoma. A drain was placed in the open craniotomy site. On the third day after the operation, before removing the drain, 40 mg of methylprednisolone sodium succinate was injected through the drain into the subdural space, after which the drain was pulled entirely. Patients were evaluated with the Markwalder Grading Scale (MGS) on the third day, third month, and sixth month after surgery for improved or worsened neurological symptoms. Also, in the third and sixth months after surgery, the patients underwent Computerized Tomography Scan imaging and were checked for recurrence. Results32 patients with CSDH entered the study, including 28 men and four women, with a mean age of 71.62 ± 9.85 years. Moreover, 87.5 % had a unilateral chronic subdural hematoma (uCSDH), and 12.5 % had a bilateral chronic subdural hematoma (bCSDH). Left and right uCSDHs had the same frequency (43. 8 %). After surgery, 26 patients had no postoperative complications, and six patients experienced pneumocephalus. ConclusionTopical dexamethasone injection through the potential CSDH cavity can result in desirable outcomes.

Untoward outcomes of successful chronic subdural hematoma evacuation, cortical blindness and brain stem stroke: A Case series

Chronic subdural hematoma (CSDH) is one of the most commonly encountered emergencies in neurosurgery practice. Burr hole with drainage of hematoma has been a time-tested standard treatment with good results and in itself a simple procedure to relieve patient clinical status. However, apparently simple surgery may at times have an unexpected surgical outcome of bilateral vision loss. All bilateral CSDHs should be treated diligently with early recognition of any visual deterioration in post-operative phase if any and due to possible interventions to be offered to the patients for prevention of permanent vision loss.

Transient neurological deficits in a patient with chronic subdural hematoma

A 62-year-old, right-handed man was diagnosed with asymptomatic bilateral chronic subdural hematomas and underwent hematoma removal on the left side only. At 1 month after surgery, he was admitted to our hospital because he began to have one or two attacks/day of apraxia of speech and dysesthesia of the right hand with a duration of approximately 5 ‍min. The left hematoma had not re-expanded, but fluid-attenuated inversion resonance imaging showed hyperintense lesions in the sulci adjacent to the hematoma. Moreover, single-photon emission computed tomography revealed low-uptake lesions in the left cerebrum adjacent to the hematoma. Electroencephalogram showed no abnormalities, and CT angiography showed a slight deviation of the left middle cerebral arteries due to the hematoma. The attacks disappeared within 10 days, although the volume of the hematoma was unchanged. It was suggested that his transient neurological deficits were caused by cerebral ischemia related to chronic subdural hematoma.

Bilateral abducens nerve palsy from post-spinal-anesthesia-induced bilateral chronic subdural hematoma: case report

BackgroundA chronic cranial subdural hematoma arising after post-spinal anesthesia is a rare but serious and life-threatening complication of spinal anesthesia. It usually mimics the typical post-spinal-anesthesia headache or post-dural-puncture headache, potentially masking its detection. Abducens nerve palsy tends to occur in chronic subdural hematoma of post-dural-puncture etiology rather than in cases attributed to other causes of subdural hematoma. Preferential damage to the abducens nerve is frequent and can be attributed to its anatomic course because the abducens nerve runs in the direction of the typical caudad displacement of the brain related to intracranial hypotension.ObservationHere, we present a report on the clinical presentation, pathogenesis, and management of two cases that developed bilateral abducens nerve palsy following post-spinal anesthesia administered for cesarean sections due to obstetric indications.LessonPost-spinal-anesthesia-induced chronic subdural hematoma, although a rare, life-threatening complication, must be differentiated from post-spinal-anesthesia headache and treated surgically. Cranial nerve palsy (more commonly called abducens nerve palsy) is more common in post-spinal-anesthesia-induced subdural hematoma than subdural hematomas of other etiologies as the cerebrospinal fluid brain cushioning is partly lost. Cranial nerve palsies resolve in most cases if surgery is performed in a timely manner.

A Case of Chronic Subdural Hematoma Detected in an Asymptomatic Patient during Health Checkup

<p>本案例為68歲女性，日前至本院預防醫學中心進行年度例行性健康檢查。病史詢問時告知四週前有騎機車自摔，並有撞擊到右側顳骨處。於車禍後並無不適或神經功能缺損。理學檢查及神經學檢查皆無異常。後續於健康檢查中的腦部電腦斷層發現雙側慢性硬腦膜下血腫。此案例提醒基層醫師，若病人有頭部外傷史，應小心鑑別診斷慢性硬腦膜下血腫，且有可能以無症狀做為表現。</p> <p> </p><p>This case report highlights the development of bilateral chronic subdural hematoma (SDH) following minor trauma, which was asymptomatic upon presentation. A 68-year-old female patient presented to the preventive medicine center for her annual health examination. History taking revealed a minor head trauma at the right temporal four weeks prior. No discomfort or neurological deficit were noted following the trauma. Physical and neurological examinations showed normal results. A head CT was performed, revealing the presence of bilateral chronic SDH. This case underscores the importance of considering the possibility of chronic subdural hematoma even in the absence of symptoms or neurological deficits. Early detection and appropriate management are essential for ensuring optimal patient outcomes.</p> <p> </p>

Lidocaine for headache prevention during chronic subdural hematoma embolization.

Middle meningeal artery embolization (MMAE) for the management of chronic subdural hematomas (CSDH) with ethylene vinyl alcohol (EVOH) causes an evident patient discomfort due to meningeal nociceptors stimulation. The aim of this study was to assess safety and efficacy of intra-arterial lidocaine (IAL) before MMAE of CSDH with EVOH. We analyzed all consecutive patients with bilateral CSDH undergoing MMAE with EVOH. We used a monolateral IAL injection, with casual allocation. We assessed the headache felt by patients during embolization with the visual analog scale (VAS) and compared scores obtained after embolization of both sides. We followed the STROBE guidelines for case-control studies. Paired t-test and χ2 test were used to compare the distribution of variables in IAL vs control group. Between September 2021 and March 2023, 32 patients underwent bilateral MMAE with EVOH for a CSDH. Lidocaine treatment resulted in a substantially lower VAS score compared to the control group (median 3 vs 7, p < 0.001), with no substantial side effect. Compliance also benefited from lidocaine administration. In patients with CSDH undergoing MMAE, IAL seems to reduce pain sensation associated with EVOH injection and to increase patients' compliance during treatment.

Relationship between Bilateral Chronic Subdural Hematomas and Postoperative Recurrence

Objective: The association between bilateral chronic subdural hematomas and postoperative recurrence remains controversial as conflicting evidence regarding this association exists in the literature. We carried out the present study to assess whether bilateral chronic subdural hematomas are associated with increased postoperative recurrence compared to unilateral chronic subdural hematomas after burrhole drainage. Materials &amp; Methods: We retrospectively studied the data of all the patients operated on in our department for chronic subdural hematoma evacuation through burrhole drainage and then included the data of sixty-three patients in our study. For the sake of uniformity, only patients without postoperative drainage were included in the study. The patients operated on for unilateral and bilateral chronic subdural hematomas were then compared with each other for their association with postoperative recurrence. Results: Forty-five patients in our study had been operated on for a unilateral chronic subdural hematoma. Eighteen patients had been operated for bilateral chronic subdural hematomas. Of the forty-five patients who operated for unilateral chronic subdural hematomas, eight (17.8%) had a recurrence. Twelve (66.7%) of the eighteen patients operated for bilateral chronic subdural hematoma had a recurrence. This difference in recurrence between the unilateral and bilateral chronic subdural hematomas was found to be very significant (p = 0.0002). Conclusion: We conclude that a bilateral chronic subdural hematoma is associated with significantly increased postoperative recurrence compared to a unilateral chronic subdural hematoma following burrhole drainage. Keywords: Bilateral chronic subdural hematoma, unilateral chronic subdural hematoma, burrhole drainage, recurrence.

Burr hole locations are associated with recurrence in single burr hole drainage surgery for chronic subdural hematoma

BackgroundVarious factors have been reported as risk factors for chronic subdural hematomas (CSDH) recurrence. However, few studies have quantitatively evaluated the impact of CSDH locations and burr hole positions on recurrence. This study aimed to reveal the relation between CSDH recurrence and the locations of CSDH and burr holes. MethodsInitial single burr hole surgeries for CSDH with a drainage tube between April 2005 and October 2021 at Otemae Hospital were enrolled. Patients’ medical records, CSDH volume, and CSDH computed tomography values (CTV) were evaluated. The locations of CSDH and burr holes were assessed using Montreal Neurological Institute coordinates. ResultsA total of 223 patients were enrolled, including 34 patients with bilateral CSDH, resulting in 257 surgeries investigated. The rate of CSDH recurrence requiring reoperation (RrR) was 13.5%. The RrR rate was significantly higher in patients aged ≥76 years, those with bilateral CSDH, and those with postoperative hemiplegia. In RrR, the preoperative CSDH volume was significantly larger, and CTV was significantly smaller. The locations of CSDH had no influence on recurrence. However, in RrR, the locations of burr holes were found to be more lateral and more ventral. Multivariate Cox proportional hazards regression analysis showed that bilateral CSDH, more ventral burr hole positions, and postoperative hemiplegia were risk factors for recurrence. ConclusionsThe locations of burr holes are associated with CSDH recurrence. In RrR, CSDH profiles tend to show a larger volume and reduced CTV. Hemiplegia after burr hole surgery serves as a warning sign for RrR.

Effect of postoperative tranexamic acid on recurrence rate and complications in chronic subdural hematomas patients: preliminary results of a randomized controlled clinical trial.

Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. A prospective, randomized, and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6months and potential clinical and/or surgical complications impact of TXA. Twenty-six patients were randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 to 16months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness, and drain use. Clinical and radiological recurrence occurred in three patients (6%), being two cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in two patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had two complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.

Outcome of Chronic Subdural Haematoma Patients Following Burr Hole Craniostomy and Irrigation without Post-Operative Drain

Objective: To evaluate the efficacy of burr whole craniostomy and irrigation without any post-operative drainage in the treatment of patients of Chronic subdural hematoma (CSDH). Methods: This was a prospective study. A total of 50 patients of CSDH were included in the study. The clinical history of patients was noted. At the time of admission, level of consciousness as well as Galsgow Coma Score (GCS), conditions of the pupil as well as long tract signs in any of the limbs were recorded. All patients undergone for computed tomography (CT) at pre and 48 hours after operation. The findings of CT were recorded. Results: The mean age of patients was 61.00±12.33 ranging from 20-90 years. Majority were males (78%). Headache (92%) and hemi paresis (76%) were the most common clinical presentation. Previous history of trauma was present among half of patients (50%). Incontinence was present in 26% of patients. Right side subdural haematoma was involved in 48% of patients. Bilateral was in 32% patients. After 48 hours post-operative, CT showed that 52% patients of unilateral CSDH did not had Residual collection not causing midline shift. Of the bilateral CSDH, 60% patients had no collection. Clinically, there was improvement among 92% patients. Conclusion: Burr whole craniostomy with intraoperative irrigation and without post-operative drainage is an effective treatment option for CSDH. The results of surgical intervention with one burr hole are as good as using 2 burr holes for drainage of hemispheric chronic subdural haematoma.

Retracted: Surgical Treatment of Bilateral Chronic Subdural Hematoma.

[This retracts the article DOI: 10.1155/2022/2823314.].

BILATERAL CHRONIC SUBDURAL HEMATOMA – CLINICAL PRESENTATION, RISK FACTORS, MANAGEMENT AND OUTCOME: A SINGLE CENTRE EXPERIENCE FROM NORTH-EASTERN INDIA

Study design: Background: Retrospective hospital-based study. Annual incidence of bilateral Chronic Subdural Hematoma (CSDH) is increasing due to an increase in the aging population, associated medical comorbidities such as hemodialysis, anticoagulant and/or antiplatelet therapy. 1. To study the clinical spectrum of Bilateral Chronic Subdural Hematoma Objectives: patients. 2. To study the treatment modalities used and outcome of the patients. A retrospective hospital-based study was carried Method: out on 50 conrmed patients of bilateral CSDH. Information of patients such as socio-demographic prole, clinical presentation, and laboratory investigations, along with treatment and outcome were recorded and analyzed. Among 50 patients, male and female were 80% and 20% res Results: pectively. The mean age of patients was 62.08 years. A history of head injury was reported by 40% of patients. The mean Glasgow coma scale (GCS) was 12.24. Common presenting symptoms were headache (76%), hemiparesis (40%), aphasia (28%), complete loss of consciousness (20%). Clinical improvement was observed in 80% while 10% had no change, 04% showed clinical deterioration and 06% of patients died during treatment. Bilateral CSDH is common Conclusion: in the elderly and prognosis is poor with increasing age. Bilateral hematoma has a higher risk of acute deterioration of clinical symptoms because of downward herniation, resulting in a poor clinical outcome. Timely interventions can improve the outcome in bilateral CSDH patients.

The effect of antithrombotic therapy on the recurrence and outcome of chronic subdural hematoma after burr-hole craniostomy in a population-based cohort

PurposeTo study the effect of antithrombotic therapy (ATT) on the outcome of operatively treated chronic subdural hematomas (CSDH).MethodsA retrospective population-based cohort study from Eastern Finland including all adult patients who underwent a burr-hole craniostomy (BHC) for CSDH during 2016 and 2017. The follow-up time for recurrence was 6 months and for mortality 3 years.ResultsA total of 301 CSDH patients were included in the study. ATT (antithrombotic therapy; antiplatelet or anticoagulant medication) was used by 164 patients (54.5%) at the time of diagnosis. The hematoma was bilateral in 102 patients (33.9%). Forty-seven patients (15.8%) encountered hematoma recurrence. Bilateral CSDHs required reoperations more often than unilateral hematomas (12.6% vs. 22.0%; p = 0.036) regardless of the primary operation (uni- or bilateral). A bivariate logistic regression analysis showed that bilateral hematoma (OR 1.918; 95% CI 1.013–3.630; p = 0.045) and male gender (OR 2.363; 95% CI 1.089–5.128; p = 0.030) independently predicted hematoma recurrence. The overall three-year mortality was 27.9%. The use of ATT was not associated with CSDH recurrence, and the length of the temporary postoperative ATT discontinuation did not correlate with the rate of thromboembolic events.ConclusionsATT did not affect CSDH recurrence in our study population, and the duration of the temporary postoperative ATT discontinuation was not associated with the rate of thromboembolic complications. Male gender and bilateral hematomas were more frequently associated with recurrences.

Bilateral chronic subdural hematoma in postpartum period: Case report and review of literature

Introduction: Postpartum chronic subdural hematoma (PCSDH) of non-traumatic origin is a rare but potentially life-threatening complication in the obstetric population which usually presents with severe headache. Case Report: We describe timely diagnosis and surgical management of a 27-year-old female patient with bilateral chronic subdural hematoma of non-traumatic origin in the post-postpartum period for which surgical management was employed following irresponsive conservative management. Conclusion: The suspicion of chronic subdural hematoma should be considered in any patient complaining of severe persistent headache following spinal anesthesia in the postpartum period and requires prompt neuroimaging for timely identification. Surgical management following irresponsive conservative management in selected patients can be achieved with satisfactory outcomes.

Surgical Treatment of Bilateral Chronic Subdural Hematoma.

Background Chronic subdural hematoma (CSDH) is one of the common clinical intracranial hemorrhagic disorders, accounting for 16%–20% of bilateral CSDH. At present, the surgical treatment of bilateral CSDH mainly includes drilling drainage and neuroendoscopic assistance. The main objective of this paper was to compare the effects of two surgical methods on CSDH. Methods 153 patients who were diagnosed with CSDH were included in this study. 79 patients were treated with bilateral drilling drainage, and the other 74 patients were treated with neuroendoscope-assisted drainage. The clinical data of the two groups were compared, and the surgical indexes, neurological function, cure rate, and recurrence rate of the two groups were compared. The operation indexes of patients include operation time, postoperative hematoma volume, hospital stay, extubation time, misplacement of drainage tube, recurrence, and hematoma clearance rate. Results All patients underwent CT examination one day after operation. The CT imaging detection of the two groups was generally good. The cranial CT was reexamined before discharge. The bilateral hematoma disappeared in 114 patients, the unilateral hematoma disappeared in 29 patients, a small amount of compensatory crescent very low-density shadow subdural effusion was observed on the other side, and a small amount of compensatory crescent very low-density shadow subdural effusion was observed on both sides in 10 patients. There was no space occupying effect and intracranial gas disappeared. Compared with neuroendoscopic assisted drainage, the operation time of drilling drainage patients was significantly shorter. The extubation time, drainage tube dislocation, recurrence rate, postoperative hematoma volume, and hematoma clearance rate of patients receiving neuroendoscopic assisted drainage were significantly better than those receiving drilling drainage. The Markwalder score and hospital stay between the two groups were not significant. Conclusions Drilling drainage and neuroendoscopic assisted surgery have good therapeutic effects on bilateral CSDH. The operation time of drilling drainage is shorter. Neuroendoscopic assisted surgery has more advantages in extubation time, misplacement of drainage tube, recurrence, postoperative hematoma volume, and hematoma clearance rate.

Practical concepts in the identification of bilateral chronic subdural hematoma

Bilateral chronic subdural hematoma is a neurosurgical pathology whose incidence in older adults has been increasing, as a consequence of the ageing of the population, added to the factors that are linked to it. Neurosurgical diseases with chronic evolution generate a high burden of disease due to morbidity, disability, mortality and health costs associated with reinterventions and rehabilitation. For this reason, the interest in this disease has been increasing, also justified by the little information there is about it, unlike unilateral chronic subdural hematomas, although it has been described that both may have pathophysiological similarities that help to understand them.

Iatrogenic pseudoaneurysm of the middle meningeal artery during embolization of bilateral chronic subdural hematomas.

Summary/AbstractMiddle meningeal artery embolization has become an important treatment option for chronic subdural hematomas. While the treatment is safe, we present a unique case of development of an iatrogenic middle meningeal artery pseudoaneurysm during endovascular embolization with use of a dual-lumen balloon catheter used for injection of a liquid embolic agent. A 62-year-old man on Coumadin for portal vein thrombosis presented to the hospital with headache and supratherapeutic INR. Imaging revealed bilateral acute on chronic subdural hematomas. Given his medical comorbidities he underwent endovascular middle meningeal artery embolization. During the embolization, angiography revealed a pseudoaneurysm of the middle meningeal artery related to use of a dual-lumen balloon catheter. This pseudoaneurysm was successfully treated with ethylene vinyl alcohol embolization. Intracranial pseudoaneurysm related to balloon catheter use is a rare cause of iatrogenic pseudoaneurysm and could lead to life-threatening intracranial bleeding. Therefore, recognition and timely treatment are important.

Bilateral chronic subdural hematoma: clinical presentation, outcome and review literature.

Study design: Prospective hospital-based study. Background: Annual incidence of bilateral chronic subdural hematoma (CSDH) is increasing due to an increase in the ageing population, associated medical comorbidities such as haemodialysis, anticoagulant and/or antiplatelet therapy. Objectives: 1. To determine the socio-demographic and clinical profile of bilateral CSDH patients. 2. To determine treatment outcome and its association with the socio-demographic profile. Method: A prospective hospital-based study was carried out on 100 confirmed patients of bilateral CSDH. Information of patients such as socio-demographic profile, clinical presentation and laboratory investigation, along with treatment and outcome were recorded and analysed. Results: Among 100 patients, male and female were 74% and 26%. The mean age of patients was 63.03±13.57 years. A history of head injury was reported by 49% of patients. The mean Glasgow coma scale (GCS) was 12.14±2.38. Common presenting symptoms were hemiparesis (69%), headache (58%), aphasia (18%) and complete loss of consciousness (16%). Clinical improvement was observed in 81% while 09% had no change, 06% shows clinical deterioration and 04% of patients die during treatment. Conclusion: Bilateral CSDH is common in the elderly and prognosis is poor with increasing age however gender has no association with poor outcomes. More than 80% of patients recover with timely interventions. Key message: Surgery leads to achieving good outcomes in cases of bilateral chronic SDH, but not all such patients will recover completely. Similarly, good functional outcomes can also be achieved in those presented early after symptom onset when managed promptly.

Early–stage epidural blood patch for spontaneous intracranial hypotension with bilateral chronic subdural hematoma: Two cases

Early–stage epidural blood patch for spontaneous intracranial hypotension with bilateral chronic subdural hematoma: Two cases

Retrospective analysis of 195 surgically treated cases of chronic subdural hematoma.

The incidence of chronic subdural hematoma (CSDH) is increasing. This study evaluates the etiologic causes and findings of CSDH and compared unilateral CSDH with bilateral CSDH. This study aims to draw attention to this increasingly prevalent condition. We retrospectively analysed 195 surgically treated cases of CSDH in our clinic between 2008 and 2018. The average age of the patients was 65.7 ± 19.6 years. The most common symptom was headache (53.3%). The case background was the use of anticoagulant (37.9%), head trauma (34.3%). The hematomas were 28.7% right side, 44.6% left side, and 26.7% bilateral. The mean Glasgow Coma Score (GCS) was 13.4 ± 2.9, early postop 13.8 ± 2.5, and late postop was 14.6 ± 1.1. Postoperative complications included acute subdural hematoma (5.1%), cerebral infarction (1.5%), wound infection (0.5%) and others (13.3%). Re-expansion of the brain were statistically significantly less frequent and impaired consciousness, anticoagulant use, early and late postop thickness were statistically significantly more frequent in patients with bilateral CSDH. CSDH is seen more patients of advanced age, those who use anticoagulants, patients with hypertension and diabetes and in patients with a history of head trauma. Prognosis is worse in bilateral CSDH. We estimate that the incidence of CSDH will go up in the future.