Case Of Acute Subdural Hematoma Research Articles

Thrombolytic Therapy as a Superior Option: Insights from Three Cases of Acute Subdural Hematoma Following Surgery for Chronic Subdural Hematoma

Chronic subdural hematoma (cSDH) ranks among the most prevalent neurosurgical conditions, with burr-hole drainage typically yielding favorable prognoses. Nevertheless, perioperative complications may arise, with remote intraparenchymal hemorrhage and subarachnoid hemorrhage occurring infrequently, while acute subdural hematoma (aSDH) remains a relatively common complication post-cSDH removal. The standard treatment for aSDH, typically large craniotomy, substantially elevates surgical risk. This study presents three cases of postoperative aSDH in elderly patients with cSDH, examining potential causative factors and proposing pertinent strategies. Three elderly patients, admitted urgently due to exacerbating symptoms, underwent preoperative assessment followed by emergency parietal burr-hole drainage. Regrettably, all three patients developed aSDH postoperatively. Various treatment approaches were employed: two cases received thrombolysis with 50,000 units of urokinase, while one case required a large craniotomy. Despite the patients achieving satisfactory outcomes without significant neurological deficits, this study advocates thrombolytic therapy as a potentially superior option for aSDH following cSDH surgery. Urokinase-mediated subdural thrombolysis enhances hematoma clearance rates, suggesting a shift towards minimally invasive treatments to mitigate greater trauma. However, the paucity of evidence necessitates extensive research to validate its safety and efficacy.

Optimizing shunt integrity during acute subdural hematoma evacuation.

Even mild head trauma can cause severe intracranial hemorrhage in patients with cerebrospinal fluid (CSF) shunts for hydrocephalus. CSF shunts are considered a risk factor for subdural hematoma (SDH). The management of acute SDH (ASDH) in shunted patients with normal pressure hydrocephalus can be challenging. Addressing the hematoma and the draining function of the shunt is important. To preserve the shunt, we set the shunt valve pressure to the highest and perform hematoma evacuation for ASDH. In this study, we report the surgical cases of ASDH in patients with shunts. Between 2013 and 2019, five patients with ASDH and CSF shunts underwent hematoma evacuation at our hospital. We retrospectively analyzed data regarding their clinical and radiological presentation, hospitalization course, the use of antithrombotic medications, and response to different treatment regimens. The patients presented with scores of 5-14 in the Glasgow coma scale and severe neurological signs, consciousness disturbance, and hemiparesis. Most patients were elderly, taking antithrombotic medications (four of five cases), and had experienced falls (4 of 5 cases). All patients underwent hematoma evacuation following resetting their programmable shunt valves to their maximal pressure setting and shunt preservation. ASDH enlargement was observed in only one patient who underwent burr-hole drainage. Glasgow outcome scale scores at discharge were 1 and 3, respectively. In hematoma evacuation, increasing the valve pressure may reduce the bleeding recurrence. To preserve the shunt, setting the shunt valve pressure to the highest level and performing endoscopic hematoma evacuation with a small craniotomy could be useful.

Three Cases of Acute Subdural Hematoma after Cardiac Surgery

心臓外科手術の術中・術後に急性硬膜下血腫を発症した3症例を経験した．発症要因として，既報で論じられているヘパリン化や凝固能異常，マンニトールによる脳容積減少に加えて，術中の手技も発症の一要因としてなり得たのではないかと考察した．今回経験した1症例では，術中のBIS値の急激な低下が早期診断の一助となったが，心臓外科手術後の脳神経障害は，術中や術後の鎮静薬，鎮痛薬の影響で早期発見が困難である場合が多い．人工心肺を用いた心臓外科手術では特に高齢者において急性硬膜下血腫が発症し得ることを念頭に置き，術中に頭部に加わる外力を最小限にすることや，術後に定期的な中枢神経評価を行うことが重要である．

Management and Outcome of Acute Subdural Hematoma in Gabriel Touré Hospital

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.

A life-saving case of acute subdural hematoma in a child with bilateral mydriasis: A Case Report

A life-saving case of acute subdural hematoma in a child with bilateral mydriasis: A Case Report

A case of acute subdural hematoma associated with von Willebrand disease treated with factor VIII

A case of acute subdural hematoma associated with von Willebrand disease treated with factor VIII

Acute Subdural Hematoma in High School Rugby Players in Japan: The Importance of Playing Experience for Injury Prevention

Acute subdural hematoma (ASDH) is known to be devasting sport-related head injury but it is relatively rare in rugby compared with other contact sports. Certain cases of ASDH have happened in high school rugby players in Japan. To prevent them from the injury we report a background of the players. Data of high school rugby players who suffered ASDH were extracted from injury reports in the Japan Rugby Football Union between April 2004 and March 2020. The number of injured players, diagnosis on the report, school year, phase of play where the injury occurred, and playing career were analyzed. There were 30 cases of ASDH including 16 cases in the first year, 9 in the second year, and 5 in the third year of playing. Phase of play was mainly being tackled in 11 (37%), and tackling in 13 (43%). Novice players, defined as a player having less playing experience of rugby during junior high school, accounted for 77% of phase of tackling, 82% of being tackled. First year novice players accounted for 100% of phase of being tackled. Outcome within 6 months after injury was recovery in 14, morbidity in 6, mortality in 2, and unknown in8. Playing experience in high school rugby players should be considered as an important factor for prevention of ASDH-in particular, phase of being tackled is riskier than that of tackling for first year novice players.

Acute subdural hematoma post ventricular puncture in infants: A case report and review of the literature.

Introduction and importanceAcute subdural hematoma in infants is often due to non-accidental causes such as shaken baby syndrome or abuse. Occasionally a rupture of the cerebral bridge veins after ventricular puncture can lead to a subdural hematoma in infant. In this article we report the very first case of acute subdural hematoma after ventricular puncture of cerebrospinal fluid.Case presentationIt is a 40-day-old male infant received at the pediatric emergency room for an infectious syndrome. An etiological assessment was carried out including a ventricular puncture of the cerebrospinal fluid. Two days after the puncture, the child develops a sudden alteration of consciousness during hospitalization, with a Blantyre coma score of 3/5. The CT scan performed showed a right subdural parieto-temporal hematoma associated with a right fronto-temporal parietal parenchymal hypodensity. A right temporo-parietal decompressive craniectomy was performed with evacuation of the acute subdural hematoma. Clinical improvement was obtained and the child was discharged after 3 weeks of hospitalization.Clinical discussionAcute subdural hematoma post ventricular puncture is rarely reported in the literature. The mechanism would probably be a rupture of the bridging veins by sudden collapse of the parenchyma following rapid and excessive aspiration of cerebrospinal fluid. Its management is medico-surgical. This manuscript further demonstrates the importance of mastering the ventricular puncture technique which must be performed by an experienced neurosurgeon.ConclusionThe ventricular puncture remains a delicate gesture which must be carried out by a qualified neurosurgeon because of the risks of complications such as an acute subdural hematoma.

A Case of Acute Subdural Hematoma associated with Severe COVID-19 under Extracorporeal Membrane Oxygenation (ECMO)

体外式膜型人工肺 (ECMO) 管理下で凝固能亢進をきたしたCOVID-19症例では強力な抗凝固療法を要し, 頭蓋内出血合併時はきわめて予後不良である. 今回手術で良好な転帰を得た症例を報告する. 60歳男性. COVID-19による呼吸不全と凝固能亢進に対しECMOを導入し強力な抗凝固療法を行っていた. 非外傷性急性硬膜下血腫のため瞳孔不同を呈した. 担当医と連携し, 手術適応や術式を検討, 極小開頭・血腫洗浄除去療法 (HITT) を施行した. 術後はヘパリン不使用下にECMO管理を行い, 90日後にはmRS 3の転帰を得た. また, 緊急事態であったが, 十分な感染対策を行い院内感染も防ぐことができた.

A case of acute subdural hematoma after burr hole surgery for chronic subdural hematoma, which was rapidly removed from the burr hole

A case of acute subdural hematoma after burr hole surgery for chronic subdural hematoma, which was rapidly removed from the burr hole

Fifteen Cases of Endoscopic Treatment of Acute Subdural Hematoma with Small Craniotomy under Local Anesthesia: Endoscopic Hematoma Removal Reduces the Intraoperative Bleeding Amount and the Operative Time Compared with Craniotomy in Patients Aged 70 or Older.

We report cases of acute subdural hematoma (ASDH) treated by endoscopic hematoma removal with a small craniotomy under local anesthesia. From 2015 to 2019, we retrospectively analyzed 15 ASDH patients who were 70 years or older and met our criteria for endoscopic treatment: (1) comorbidities indicated risks associated with a large craniotomy under general anesthesia; (2) decompressive craniectomy was unlikely; and (3) an enlarging hematoma was absent. We also performed a case–control study using the inverse probability weighting method to compare the 15 patients to 20 ASDH patients who were 70 years or older, met criteria (2) and (3), and were treated by craniotomy between 2012 and 2019. Among the 15 ASDH patients, the median age was 86 (range, 70–101) years, and fall was the common cause. The median Glasgow Coma Scale score on admission, operative time, stay time in the operation room, and bleeding amount were 8 (6–15), 91 (48–156) min, 120 (80–205) min, and 20 (5–400) mL, respectively. The extraction rates of all the hematomas exceeded 90%. No patients required conversion to craniotomy under general anesthesia. Three patients had favorable outcomes, and five died. The comparison with craniotomy revealed that the endoscopic procedure reduced the intraoperative bleeding amount, operative time, and stay time in the operation room (p <0.001, p = 0.02, and p <0.001, respectively). In summary, endoscopic hematoma removal for selected ASDH patients aged 70 years or older did not improve functional outcomes but reduced the bleeding amount and the operative time compared with craniotomy.

Subdural hematoma as a manifestation of cerebral venous thrombosis. Case report

Cerebral venous thrombosis (CVT) is a common complication in pregnant, postpartum and eclampsia patients in a developing country, more common with another pathology prothrombotic profile. Commonly, acute non-traumatic subdural hematomas are rare in young patients without haematological disorders. We reported a case of acute subdural hematoma (ASH) in a patient with cerebral venous thrombosis. A 34-year-old postpartum woman who present seizure in a postpartum period, was studied in the ICU of our hospital. She is under sedation and CT cranial study to show hyperdensity in the superior longitudinal sinus and the left transverse sinus with diffuse subcortical cortical hypodensity in both parietal and occipital lobes and delta sign. All date according a CVT. In addition, a subdural hematoma is appreciate in the left temporal region. The management was non-surgical and a subsequent CT cranial scan showed resolution of the hematoma. Subsequently prothrombotics studies ruled out a hematological problem. The patient was discharged asymptomatic and with anticoagulant treatment. Patients with CVT are frequently in our environment but it does not exist a large number of studies from the neurological point of view. Neurological manifestations are varied and infrequent in a general neurological approach. Our case illustrates that subdural hematomas can be a symptom of cerebral venous thrombosis.

Prognostic Factors in Operated Cases of Acute Subdural Hematoma

Prognostic Factors in Operated Cases of Acute Subdural Hematoma

Step-Ladder Expansive Cranioplasty: A Study on a Cadaveric Model

AbstractNotwithstanding the ongoing debates on the necessity, indication, extent, and technique of achieving decompressive hemicraniectomy (DC), any procedure that can deliver the envisaged advantages of a DC, without having to take up the patient for a second surgery in the form of cranioplasty, can be of a great advantage in situations in which DC is being used.Step-ladder expansive cranioplasty has been proposed as an effective single-step alternative to DC and cranioplasty at a later date, resulting in a fixed but assured volume augmentation. Recently, a case report has emerged documenting a successfully managed case of acute subdural hematoma (SDH) using this technique. In the present in vitro study, an attempt has been made to evaluate different variants of step-ladder expansive cranioplasty constructs using cadaver and clay models.The findings suggest that the cranial volume expansion in step-ladder expansive cranioplasty is not dependent solely on the patient's skull bone thickness. If the clinical trials prove the procedure to be safe, it can be used at one end, as an alternative to preserving the bone flap at another site prior to cranioplasty, and as a complete one-stage alternative to DC and cranioplasty at a later date, on the other.

Factors Contributing to Surgical Intervention for Subacute Subdural Hematoma Enlargement in Patients with Mild Head Injuries

Delayed neurological deterioration following mild head injury(MHI)usually occurs within 24 hours. However, some cases require delayed surgical evacuation of an acute subdural hematoma(ASDH), owing to subacute progressive hematoma enlargement. This study aimed to determine radiological or clinical parameters associated with surgical intervention in ASDH cases in which surgery was not initially considered necessary. From 2010 to 2015, 64 patients were non-surgically treated for ASDH following MHI. We evaluated the various outcomes of eventual surgical ASDH evacuation after the first 48 hours following injury, due to hematoma enlargement and clinical deterioration. Univariate and multivariate analyses were applied to both the demographic and initial radiographic features to identify risk factors for ASDH progression and surgery. Overall, at the time of their last follow-up computed tomography, 57 patients(89%)demonstrated minimal ASDH or spontaneous hematoma resolution with conservative non-surgical management. The remaining 7 patients(11%)received delayed surgical ASDH evacuation a median of 5.1 days after the head trauma. There were no significant differences between the two groups for baseline characteristics, including age, prior history of anticoagulants, the presence of cerebral contusions, or subarachnoid hemorrhages. On multivariate analysis, use of antiplatelet drugs(p=0.013, OR=28, 95%CI=1.82-24)was independently associated with delayed hematoma evacuation. These data indicate that as much as 11% of patients with minimal ASDHs after MHI can deteriorate over the course of a week and then require surgical intervention, and that patients on concurrent antiplatelet medication require especially careful monitoring of hematoma progression.

Supratentorial acute subdural haematoma during microvascular decompression surgery: report of three cases

Supratentoiral haemorrhage during posterior fossa surgery is very rare. Authors report three cases of acute subdural haematoma occurred during microvascular decompression (MVD). Bleeding was observed in the suboccipital surgical area during operation but the origin of the bleeding was not confirmed intraoperatively in all cases. Decompression procedure was completed and immediate postoperative computed tomography revealed supratentorial subdural haematoma. This complication was observed during MVD in healthy young patients with hemifacial spasm in our cases. Flexion of the head with reduction of cerebrospinal fluid may have induced rotational movement of the cerebrum resulting in rupture of bridging veins, but no definitive mechanism that fulfils the clinical characteristics was clearly determined.

Chronic anticoagulation with warfarin is associated with decreased functional outcome and increased length of stay following craniotomy for acute subdural hematoma

Abstract Introduction With the continued rise of the aging population, the incidence of acute subdural hematoma (ASDH) in the setting of chronic oral anticoagulation with warfarin is expected to increase. No study has directly addressed the risks of poorer outcomes in chronically anticoagulated patients after ASDH evacuation. Methods We reviewed retrospectively 94 consecutive cases of ASDH at a single institution with fresh frozen plasma and craniotomy. The outcomes of patients with ASDH in the setting of chronic oral anticoagulation were compared to those of patients with ASDH not taking oral anticoagulation. Results There were 22 patients receiving chronic anticoagulation (11 male, 11 female, mean age 63.7 ± 4 years) with ASDH requiring craniotomy for evacuation. These patients had significantly lower mean discharge Glasgow Outcome Scores (GOS) when compared to control subjects (2.3 ± 0.3 versus 3.0 ± 0.2). Despite presentation with higher Glasgow Coma Scores (GCS), ASDH size tended to be larger in anticoagulated patients, although not significant. Overall mortality was nearly double, that is 55% in anticoagulated patients compared to 29% in those without anticoagulation. Of previously anticoagulated patients alive at discharge, hospital length of stay was longer compared to controls (31.9 ± 8.5 days versus 21.1 ± 2.4 days). Conclusions These data suggest that ASDH evacuation in chronically anticoagulated patients is associated with higher mortality rates, decreased likelihood of independent function, and increased length of hospital stay. Further research is needed to determine if the effect of chronic anticoagulation on outcome is independent of cofounders, such as age and medical comorbidities. These data may help practitioners and families create treatment plans and furthermore serve as the gold standard for the future evaluation of novel anticoagulation reversal agents such as factor VIIa.

A case of acute subdural hematoma associated with arachnoid cyst by sport-related head injury

A case of acute subdural hematoma associated with arachnoid cyst by sport-related head injury

Acute Subdural Hematoma after Carotid Artery Stenting

Cerebral hyperperfusion syndrome is a major cause of morbidity and mortality following carotid artery stenting (CAS). We present a case of acute subdural hematoma (SDH) 2 hours after CAS. In this case, arterial origin of bleeding was verified during operation. To our knowledge, there is no prior case report of SDH without intraparenchymal nor subarachnoid hemorrhage subsequent to CAS. We postulate that SDH was caused by sudden rise in intracranial pressure due to the hyperperfusion which disrupted a corticodural bridging artery. Key Words: Carotid artery stenting, Cerebral hyperperfusion syndrome, Subdural hematoma

Histopathological study of the outer membrane of the dura mater in chronic sub dural hematoma: Its clinical and radiological correlation.

Background:A chronic subdural hematoma is an old clot of blood on the surface of the brain between dura and arachnoid membranes. These liquefied clots most often occur in patients aged 60 and older with brain atrophy. When the brain shrinks inside the skull over time, minor head trauma can cause tearing of blood vessels over the brain surface, resulting in a slow accumulation of blood over several days to weeks.Aim of the Study:To evaluate the role of membrane in hematoma evaluation and to correlate its histopathology with clinic-radiological aspects of the condition and overall prognosis of patients.Material and Methods:The study incorporated all cases of chronic SDH admitted to the Neurosurgery department of JLN Hospital and Research Centre, Bhilai, between November 2011 and November 2013. All such cases were analyzed clinically, radiologically like site, size, thickness in computed tomography, the attenuation value, midline shift and histopathological features were recorded.Criteria for Inclusion:All cases of chronic subdural haematoma irrespective of age and sex were incorporated into the study.Criteria for Exclusion:All cases of acute subdural haematoma and cases of chronic sub dural hematoma which were managed conservatively irrespective of age and sex were excluded from the studyResults:In our series of cases, the most common histopathological type of membrane was the inflammatory membrane (Type II) seen in 42.30% of cases followed by hemorrhagic inflammatory membrane (Type III) seen in 34.62% of cases while scar inflammatory type of membrane (Type IV) was seen in 23.08% of cases. No case with noninflammatory type (Type I) was encountered.