Calcified Chronic Subdural Hematoma Research Articles

Armored brain: A case report and review of the literature

Background:Calcified chronic subdural hematomas occur infrequently. When the calcifications are extensive and bilateral, the condition is termed “armored brain”. We describe a case of “armored brain” incidentally discovered in an adult presenting with abdominal pain and mild headaches, long after initial placement of a ventriculo-peritoneal (VP) shunt.Case Description:A 38-year-old woman, treated at infancy with a VP shunt, presented with a 2-month history of abdominal pain associated with nausea and chills. She was neurologically intact on exam. An abdominal computed tomography (CT) scan demonstrated a rim-enhancing loculated fluid collection surrounding the patient's distal VP shunt catheter tip. As a part of her initial work-up, she received a head CT to evaluate the proximal VP shunt, which demonstrated large bilateral chronic subdural hematomas with heavily calcified walls. She was eventually taken to the operating room (OR) for replacement of the distal catheter. It was felt that her acute clinical presentation was unrelated to the bilateral, calcified subdural hematomas and thus the decision was made to manage them conservatively.Conclusions:This rare complication of chronic shunting for hydrocephalus is sometimes referred to as armored brain. Surgery for armored brain is infrequently indicated and beneficial in only small subgroup of patients, with management guided by clinical presentation. Our patient fully recovered after shunt revision alone.

Calcifi ed epidural hematoma in pediatric age group: A report of two cases

The authors present a rare case of calcified (ossified) chronic epidural hematoma developed in a six-and-a-half-year-old female patient who was operated for cerebellar astrocytoma 6 months earlier. There was no history of trauma. Ossified epidural hematoma was seen as an incidental finding in the follow-up in computed tomography scan after 6 months of primary glioma surgery. Ossified chronic epidural hematoma with thick collagenous wall and newly formed bone on dura was excised. The development of calcified chronic subdural hematoma after decompressive intracranial surgery is a well-known occurrence, but the fact that a calcified epidural hematoma, which is rare and which can also develop after decompressive surgery, and the occurrence of calcified (ossified) epidural hematoma after postfossa a glioma surgery is not yet reported. The second case is a 9-year-old male anemic child with a history of fall while playing 5 months earlier who presented with headache of 3 months duration. He had bifrontal calcified epidural hematoma operated by craniotomy and excision of calcified dural edge.

A Giant Bilateral Calcified Chronic Subdural Hematoma

A calcified chronic subdural hematoma is a rare disease and its neuroradiological presentation is variable. The degree of calcification extends from thin calcified inner membranes to dense calcification and even ossification of the hematoma. Previous reports described a maximum of two hematoma cavities with calcified inner hematoma membranes. Neuroimaging report with illustrative computerized tomography images. A patient with a bilateral symptomatic calcified chronic subdural hematoma, or so-called "armoured brain", was admitted to our intensive care unit with clinical signs of increased intracranial pressure. Computerized cranial tomography demonstrated multiple bilaterally located hematoma cavities with thin calcified inner membranes. After neurosurgical intervention by bilateral burr hole trepanation, clinical symptoms improved. Our case of a calcified chronic subdural hematoma presents with an uncommon imaging pattern with more than four hematoma cavities bounded by predominantly convex- and concave-configured thin calcified inner membranes.

Shunt revision after 33 years in a patient with bilateral calcified chronic subdural hematomas

cation of shunting procedures for infantile hydrocephalus.1,2,4 Bilateral calcified chronic SDHs may be so extensive that they give the appearance of a so-called “armored brain.”3,5 This 33-year-old man was admitted to our department with symptoms of increased intracranial pressure. According to his medical history, the patient had undergone a ventriculoatrial shunt insertion for hydrocephalus 2 months after his birth at a children’s hospital. His mild spastic quadriparesis and learning difficulties were obvious since childhood. One year before the present admission, a brain computed tomographic (CT) scan performed after a minor head injury had shown the presence of large, calcified, bilateral SDHs, together with small ventricles and a ventricular catheter in place (Fig. 1A). At admission, a new brain CT scan revealed ventricular dilation (Fig. 1B). A ventriculoperitoneal shunt was inserted in the patient. The new ventricular catheter was inserted via a right frontal bur hole near the midline, avoiding the calcified hematoma. The old shunt was left in place because the catheter was considered to be entrapped inside the calcification. The postoperative clinical course of the patient was uneventful. The patient improved and returned to his neurological status before the dysfunction of the shunt, and a postoperative CT scan confirmed a reduction of ventricular size (Fig. 1C). Chronic SDHs that remain undiagnosed during childhood may contribute to neurological impairments, therefore intensive followup is necessary after shunting procedures in infants and children. Cases of bilateral extensively calcified SDHs have been rarely reported.5 Revision of the malfunctioning shunt in cases like these may be troublesome. (DOI: 10.3171/JNS/2008/108/2/0401)

Contralateral acute subdural hematoma occurring after removal of calcified chronic subdural hematoma

Supratentorial craniotomy for a nontraumatic lesion complicated by an acute subdural hematoma on the opposite side is rare. A 47-year-old woman presented with progressive headache and dizziness with no significant past history. Neuroimaging studies revealed a very large calcified chronic subdural hematoma over the entire right hemisphere with prominent mass effect. Despite a near total excision of the hematoma including the inner membranes by a large craniotomy with meticulous dissection, the brain parenchyma remained depressed. The dead space was therefore filled with saline and the operation was completed as usual. Repeat computed tomography scan for signs of left tentorial herniation demonstrated an acute contralateral subdural hematoma with severe shift of midline structures. We propose a prevention strategy for this event, which has not been previously described. We also discuss possible mechanisms involved in this unexpected complication.

Calcified Chronic Subdural Empyema

Calcified chronic subdural empyemas are rare. Surveying all available literature, we identified only 4 cases. We add a case of calcified chronic subdural empyema and review pertinent literature. We report a case of a 44-year-old man in whom there was diagnosed a calcified chronic subdural empyema. The patient, who had long history of otitis media, complained severe headache. Computed tomography showed a large hypodense space-occupying lesion in left frontotemporoparietal region. A large frontotemporoparietal craniotomy was carried out. Operative exploration revealed that the lesion was a subdural empyema filled with an acute inflammatory infiltrate composed of neutrophils, blood coagula, and small amount of pus. The wall was composed of dense collagenous fibrous connective tissue which was partially calcified. We concluded that the lesion could be totally removed because the margin of the wall was not adherent to the cortex. This is a rare case of calcified chronic subdural empyema successfully treated with total removal. Clinically, pathologically, and radiologically calcified chronic subdural empyemas are similar to calcified chronic subdural hematomas. Management of our case is not similar to a typical chronic subdural empyema filled with pus alone. How these 2 diagnoses are differentiated remains to be established. We conclude that any such subdural calcified space-occupying lesion, causing cerebral symptoms, should be considered for a surgical total removal.

Calcified chronic subdural hematoma mimicking calvarial mass: A case report

Head trauma is a frequent cause of mortality and morbidity in the pediatric population. Chronic subdural hematoma is the most common traumatic lesion in head injury. Chronic subdural hematomas are rare in children older than 2 years old; they are more frequent during adolescence. Calcified or ossified chronic subdural hematoma is a rare entity that usually presents as a space-occupying lesion over the cerebral convexity. Chronic calcified subdural hematomas are reported less than chronic subdural hematomas. In this article, we report a successfully treated patient with surgical removal case of calcified chronic subdural hematoma mimicking calvarial mass.

Calcified Chronic Subdural Hematoma — Case Report

Calcified or ossified chronic subdural hematoma is a rare entity that usually presents as a space-occupying lesion over the cerebral convexity. We report a case of calcified and ossified chronic subdural hematoma in an unusual location that has not been previously reported. A 24-year-old man with a history of tonic-clonic convulsions since 7 months of age was admitted because of increasing frequency and duration of seizures. Computed tomography and magnetic resonance imaging demonstrated a fusiform extra-axial lesion just above the tentorium and adjacent to the cerebral falx. A calcified and ossified chronic subdural hematoma was noted and was almost completely removed by craniotomy. Better seizure control was achieved by removal of the calcified chronic subdural hematoma. Calcified subdural hematoma, calcified epidural hematoma, calcified empyema, meningioma, calcified arachnoid cyst, and calcified convexity of the dura mater with acute epidural hematoma should be considered for the differential diagnosis of an extra-axial calcified lesion.

Calcified convexity dura mater and acute epidural haematoma mimicking calcified chronic subdural haematoma

Calcified convexity dura mater and acute epidural haematoma mimicking calcified chronic subdural haematoma

Contralateral trigeminal neuralgia as a false localizing sign in calcified chronic subdural hematoma: A case report

A case of trigeminal neuralgia caused by a contralateral calcified chronic subdural hematoma is reported. Preoperative magnetic resonance imaging revealed rotational displacement of the pons caused by huge chronic subdural hematoma. The neuralgia was completely alleviated after removal of the hematoma. The clinical and radiological features are described, and the possible mechanism of the neuralgia is briefly discussed.

Calcified chronic subdural hematoma with intracerebral rupture forming a subcortical hematoma: A case report

We report a calcified chronic subdural hematoma which ruptured intracerebrally forming an acute subcortical hematoma in the frontal lobe in a 59-year-old woman with long-standing liver cirrhosis. Both hematoma cavities communicated each other through a small defect within the inner membrane of the subdural hematoma. The content of both hematomas was identical and was of a clay-like clot. The inner membrane around this communication consisted of thick, very vascular granulation tissue with many hemosiderin deposits and was tightly adherent to the cortex. We speculated that a fresh bleeding into the granulation tissue resulted in formation of a subcortical hematoma through a rupture of the inner membrane. Disseminated intravascular coagulation likely played an important role in this unusual condition.

Removal of a large asymptomatic calcified chronic subdural hematoma

An asymptomatic case of a large calcified chronic subdural hematoma was examined. The calcified mass was nearly totally removed at operation using a high-speed air drill. Immediately after the operation signs of brain compression seen in computed tomography scanning were somewhat relieved. However, at follow-up after 3 months, the shift was resumed and the calcification reap-peared 10 months after the operation.

Calcified Chronic Subdural Hematoma in a Young Child

The patient, a male, had been born prematurely in October of 1980, at gestational week 32. His birthweight was 1, 820g. At 5 months of age he had a 5-minute episode of unconsciousness and was admitted to Sendai City Hospital. A computed tomography (CT) scan showed a very large, bilateral chronic subdural hematoma. The bilateral hematoma was evacuated and a right subdural peritoneal shunt was emplaced. In September of 1983 a left subdural peritoneal shunting procedure was carried out. However, 1 month later the latter shunt tube had to be removed because of infection. The hematoma then became calcified and gradually enlarged. In June of 1984 the organized, chronic subdural hematoma, which, together with the capsule, weighed 160g, was totally removed. The microscopic examination disclosed a relatively new hematoma within an old, organized hematoma. The postoperative course was uneventful and CT scans showed expansion of the brain.There has been debate about whether or not a calcified chronic subdural hematoma should be removed. McLaurin reported that removal of such hematoma resulted in postoperative seizures and no improvement of mental retardation. The present case, however, showed improvement of CT findings and no postoperative seizures. The result suggests that, in infants and young children, calcified chronic subdural hematomas should be removed to prevent further brain atrophy and mental retardation.

Numerous Weibel-Palade bodies in a calcified chronic subdural haematoma

A 75-year-old man who had a calcified chronic subdural haematoma is reported with reference to the role of Weibel-Palade (W-P) bodies. He developed progressive dementia and a disturbance of gait. Computerized tomography demonstrated a large subdural haematoma bordered by a calcified rim. A frontoparietal craniotomy was performed to reveal approximately 100 g of paste-like, muddy blood clot. The thick capsule consisted microscopically of fibrous tissue with deposits of calcium, haemosiderin and cholesterin. The calcified outer membrane contained a small number of proliferating capillaries which conceivably contributed to the leakage of blood. The fine structure of these capillaries showed endothelial sprouts with numerous W-P bodies. This finding suggested some correlation between W-P bodies and vascular proliferation. It is noteworthy that an active vascular proliferation was observed even in the healed tissue with calcification.