Contralateral Acute Subdural Hematoma Research Articles

Rapid Spontaneous Resolution of Contralateral Lentiform Acute Subdural Hematoma After Burr Hole Trephination for Chronic Subdural Hematoma

Although rare, acute subdural hematoma (ASDH) may occur after burr hole trephination (BHT) for chronic subdural hematoma (CSDH). It usually occurs in the hemisphere ipsilateral to the burr hole site and rarely in the hemisphere contralateral to the burr hole site. On computed tomography (CT), SDH is usually crescent-shaped and occasionally lentiform or biconvex, which can be misdiagnosed as epidural hematoma (EDH). In rare cases, ASDH may resolve spontaneously and rapidly. Here, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy. A 55-year-old man developed left CSDH 2 months after traumatic brain injury. Left BHT was performed, and a lentiform hematoma, presumed to be EDH, was found in the right frontal region on the CT scan acquired immediately after BHT. On the CT scan acquired 12 hours later, the lentiform hematoma disappeared and spread along the hemisphere. It was presumed to be ASDH. To prevent contralateral ASDH after BHT, slow decompression and minimal gentle or no irrigation should be performed during BHT, particularly in patients with brain atrophy.

Contralateral Acute Subdural Hematoma Developing Intraoperatively following Evacuation of an Ipsilateral Spontaneous Acute Subdural Hematoma in an Elderly Patient

Contralateral Acute Subdural Hematoma Developing Intraoperatively following Evacuation of an Ipsilateral Spontaneous Acute Subdural Hematoma in an Elderly Patient

Contralateral development of acute subdural hematoma (SDH) immediately following a burr-hole craniostomy for chronic SDH

Abstract Background Burr-hole trephination is a widely used surgical technique for chronic subdural hematoma (CSDH). Although various postoperative complications following burr-hole craniostomy have been discussed, no contralateral acute SDH (ASDH) immediately after the initial surgery without concurrent hemorrhages has been reported so far; we experienced this very rare complication in a previously healthy 84 year old male. Details of this very rare case are presented in this report. Materials and methods 87 patients with chronic SDH underwent a burr hole trephination, that is, craniostomy between July 2012 and June 2014; there were 47 male and 40 female patients. 24 of 87 patients harbored bilateral SDHs. 67 of 111 lesions were drained with two catheters and the remaining 44 employed a single catheter. Results Unsatisfactory results following the craniastomy included recurrence, insufficient drain, aggravated acute SDH and contralateral development of incracranial hemorrhage. Contralateral intracranial hemorrhage occurred to three patients. One died and the other two were discharged without any sequelae. One of the three contralateral hemorrhages was a mere ASDH which was complicated to a previously healthy 84 year old male within less than an hour after the initial surgery. The patient was discharged without sequelae. Conclusion This report represents a contralateral ASDH that occurred less than an hour after a burr-hole trephination for CSDH. Several hypotheses concerning the etiology of this rare complication, albeit inconclusive, are worth contemplation. Excessive drain of CSDH must be refrained from in order not to encounter any unexpected complications.

Contralateral Delayed Acute Subdural Hematoma Following Evacuation of a Chronic Subdural Hematoma with Burr-Hole Craniotomy and Continuous Closed System Drainage: Case Report and Literature Review

Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice [1]. The potential for recovery from the evacuation of a CSDH is relatively high. However, some postoperative complications may affect the postoperative course [2]. In this study, we report a rare complication of contralateral acute hematoma following the evacuation of a CSDH with burr-hole craniotomy and continuous closed system drainage. Chronic subdural hematoma (CSDH) is a relatively frequent problem in neurologic or neurosurgical practice. Treatments for CSDH are well established and provide positive postoperative outcome; however, some atypical postoperative complications can occur. This study reports a rare complication of delayed contralateral acute hematoma following the evacuation of a chronic subdural hematoma with burr-hole craniotomy and continuous closed system drainage. According to our research, our study is the first to report a delayed contralateral acute subdural hematoma following CSDH surgery.

Intracranial pressure monitoring alone: Not an absolutely reliable tool after decompressive craniectomy for traumatic acute subdural hematoma

Introduction: The monitoring of intracranial pressure (ICP) in traumatic brain injury (TBI) is important for postoperative care. In our clinical practice, we have found that neurological deterioration because of contralateral epidural hematoma (EDH) occurs despite normal ICP in patients who have undergone decompressive craniectomy (DC). This study was performed to elucidate the dilemmas associated with ICP monitoring after DC and the possible complementary role of intraoperative and immediate postoperative imaging studies. Methods: Patients who had received DC due to TBI during a 7-year period were retrospectively identified from our database and evaluated. Logistic regression analyses were used to evaluate the associations between patients. Results: Twenty patients had contralateral skull fractures. Five patients (5 of 10, 50%) who developed EDH on the ipsilateral side of the skull fracture underwent operations for EDH evacuation due to the deterioration of their clinical condition. The ICP was significantly lower (P = 0.016) in these patients compared with patients who did not undergo secondary surgery due to EDH. Conclusions: ICP monitoring alone cannot absolutely ensure early detection of contralateral space-occupying lesion after DC due to improvement in cerebral compliance. Imaging studies using brain computed tomography is beneficial for early detection of delayed EDH after DC in a high-risk skull fracture with contralateral acute subdural hematoma patients.

Contralateral Acute Subdural Hematoma Following Traumatic Acute Subdural Hematoma Evacuation

Contralateral acute subdural hematoma (ASDH) occurring after removal of traumatic ASDH is a rare, but nearly devastating postoperative complication. We treated a 26-year-old male who developed a contralateral ASDH shortly after craniectomy for evacuation of a traumatic ASDH. Burr-hole craniotomy was performed before decompressive craniectomy, and the bleeding source was a cortex artery within the frontal lobe contusion. Despite supportive therapy with barbiturate and mild hypothermia he expired 3 days later of brain death. Literature review suggests that the old are more susceptible to contralateral ASDH following evacuation of traumatic ASDH. Contralateral ASDH following evacuation of traumatic ASDH is a rare but potentially lethal complication, so neurosurgeons should try to detect such contralateral hematoma formation and prevent clinical deterioration.

Immediate development of a contralateral acute subdural hematoma following acute subdural hematoma evacuation

Contralateral hematoma formation following acute subdural hematoma (ASDH) evacuation is a well-described complication. The most common type of contralateral hematoma is an epidural hematoma. Rarely, ASDH develops on the contralateral side. We report an elderly woman who presented with a post-traumatic ASDH and underwent ipsilateral hematoma evacuation by craniotomy and subsequently developed a contralateral ASDH. Because of the potential consequences of a delayed ASDH, there should be a low threshold for early post-operative imaging following ASDH evacuation, especially in elderly patients and those with additional associated intracranial injuries.

Contralateral acute subdural hematoma after surgical evacuation of the initial hematoma: two case reports and review of the literature

Remote intracranial hemorrhages after craniotomy or craniectomy may rarely develop. As the sparse literature on this phenomenon has focused on contralateral intraparenchymal and epidural clots, only seven cases of postoperative contralateral acute subdural hematomas have been reported in the literature. We presented two patients who developed contralateral acute subdural hematomas after surgical evacuation of their initial hematomas. Case 1: A 19-year-old male fell from a height. CT scan revealed a left parietal acute epidural hematoma. A left craniotomy and epidural hematoma evacuation were performed; however, the brain expanded towards the craniotomy site. Dural incision revealed a thick subdural hematoma. Evacuation of the subdural hematoma was performed. The bone flap was not replaced. An emergency CT scan revealed a right acute subdural hematoma, and a right decompressive craniectomy and hematoma evacuation were performed. Case 2: A 7-year-old boy was hit by a motor vehicle. CT scan revealed a right frontotemporal acute subdural hematoma. A right decompressive craniectomy and subdural hematoma evacuation were performed; however, the brain expanded towards the craniectomy site. An emergency CT scan revealed a left acute subdural hematoma. We also reviewed the literature and discussed about these characteristics.

Contralateral Acute Subdural Hematoma After Surgical Evacuation of Acute Subdural Hematoma

We present a case of an 81-year-old woman who developed an acute left-sided subdural hematoma with midline shift shortly after craniotomy for evacuation of a traumatic right-sided acute subdural hematoma. She was immediately taken back to the operating room for evacuation of the left-sided clot and her neurologic outcome was excellent. Believed to be caused by rapid brain decompression, bleeding far from the operative site, such as a within the contralateral subdural space, can occur after a craniotomy and must be promptly recognized.

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.

Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma

Background Although rare, patients with acute subdural hematoma (ASDH) because of severe head injury can develop contralateral acute epi- or subdural hematoma, requiring consecutive surgical procedures. The choice of treatment strategies for such patients is clinically important. Methods Among 88 patients with ASDH who were surgically treated over 13 years, we encountered and studied 5 patients who developed contralateral acute epi- or subdural hematoma (5.7%). Results All 5 patients were male, ranging in age from 17 to 40. According to the Glasgow Coma Scale on admission, 1 patient was rated 3, 1 was 4, 1 was 5, and 2 were 6. All patients underwent consecutive surgical procedures for ASDH and contralateral ASDH and/or acute epidural hematoma, and were given postoperative supportive therapy with barbiturates and mild hypothermia. Patients’ outcomes according to the Glasgow Outcome Scale were as follows: 1 patient, good recovery (20.0%); 1, mild disability (20.0%); 2, severe disability (40.0%), and 1, persistent vegetative state (20.0%). No patients died. Although decompressive craniectomy and evacuation of hematoma may lead to contralateral acute epi- or subdural hematoma in patients with ASDH, this therapy is justified because hematoma irrigation with trephination therapy has a poor outcome for comatose patients. Conclusion Awareness of intraoperative brain swelling is important, as it suggests the development of contralateral hematoma. Immediate computed tomography and a rapid return to the operating room are therefore critical.

Acute Subdural Hematoma after Irrigation of the Contralateral Chronic Subdural Hematoma in a Hemodialyzed Patient

A case of acute subdural hematoma immediately after surgical intervention for the contralateral chronic subdural hematoma in a regularly hemodialyzed patient is reported. A 59-year-old male was admitted because of progressive right hemiparesis after six years of regular hemodialysis. A computed tomography (CT) scan revealed typical left chronic subdural hematoma. Irrigation and drainage of the hematoma through a single burr hole was performed. The right hemiparesis was improved after surgery and a CT scan two hours after surgery revealed a marked reduction of the hematoma cavity. However, the patient suddenly became comatose eight hours after surgery, and another CT scan showed a contralateral acute subdural hematoma. The patient expired the following morning. Postmortem pathologic examination showed an old left subdural hematoma membrane and a massive subdural hematoma without any membrane in the right fronto-temporal area. Subdural hematoma has a higher mortality rate among hemodialysis patients than in the normal population, and many authors have reported disappointing results of surgical intervention in such cases. This case suggests that the high frequency of subdural hematoma can be attributed to the accompanying coagulopathy and the acute decrease of intracranial pressure. The authors emphasize careful management including peritoneal dialysis before and after the surgical intervention.