Acute Interhemispheric Subdural Hematoma Research Articles

Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma

Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH. This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected. Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient. IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.

Frequency and characteristics of traumatic brain injury in restrained drivers involved in road traffic accidents.

While seatbelt is an important device protecting drivers from traumatic brain injury (TBI), it has rarely been reported how often and in what circumstances restrained drivers sustain TBI after road traffic accident (RTA). Whole-body computed tomography (WBCT) for blunt trauma patients may provide a unique opportunity to investigate the frequency and characteristics of TBI sustained by restrained drivers. A single-center, retrospective observational study was conducted using prospectively acquired data. Between January 2013 and December 2017, 409 restrained drivers (284 men/125 women, mean age of 45.0 ± 19.1years) whose vehicle had been severely damaged in RTAs underwent WBCT for evaluation of injuries. Multivariate regression analysis was performed to identify variables predictive of TBI. Influence of collision patterns (frontal, lateral or rollover) on the frequency and severity of TBI was evaluated. Relationship between collision patterns and CT findings was also reviewed. Thirty-one restrained drivers (7.6%) sustained TBI after RTA. The distribution of Glasgow Coma Scale (GCS) scores among the 31 drivers was 15 in 9, 13-14 in 9, 9-12 in 4, and ≤ 8 in 9, indicating that the majority of TBIs were classifiable as mild. The frequency of TBI in alert and oriented drivers, i.e., those with a GCS score of 15, was 2.9%. Multivariate regression analysis showed that both altered mental status (OR, 4.933; 95% CI, 1.135-21.431) and loss of consciousness (OR, 6.492; 95% CI, 1.669-25.249) were associated with TBI. The frequency of TBI tended to be higher in drivers with rollover collision than those with frontal collision (6 vs. 13%, p = 0.07). Interhemispheric acute subdural hematoma and subcortical petechial hemorrhage seemed to be characteristic CT findings in drivers with frontal and lateral collision, respectively. The key finding of this study, i.e., that (1) TBI was observed in 7.6% of restrained drivers with severe vehicular damage, may provide useful information to neurosurgeons who take care of RTA victims. The majority of the TBIs were mild without need for neurosurgical intervention. While association may exist between type of collision and type of brain injury, further studies with prospective design are warranted.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Abstracts from The 12th Symposium of the International Neurotrauma Society February 1-4, 2016 Cape Town, South Africa.

Interhemispheric Acute Subdural Hematoma: A Distinct Entity of Subdural Hematoma.

We wish to notify the readers on a rare case of interhemispheric acute subdural hematoma (ASH) who presented to our emergency department (ED) with a falx syndrome of contralateral hemiparesis in lower extremity and severe headache. A 25-year-old previously healthy man was involved in a traffic accident and presented to our ED with complaints of repeated vomiting and severe headache. On arrival to the ED, he had an initial Glasgow coma scale (GCS) of 14 (opening her eyes with verbal stimuli, obeys commands, orientated) and normal vital signs (blood pressure: 130/85 mm Hg; heart rate: 86 bpm). No other injuries were noted. Neurological examination revealed mild weakness of the right lower extremity (strength score: 4/5). His routine blood tests, including complete blood counts, prothrombin time, and thromboplastin time were unremarkable. The plain films of the skull were normal. Non-enhanced cranial (CT) scan performed 4 h after the accident revealed a small left-sided acute interhemispheric subdural hematoma, which was posteriorly located (Fig. 1a). Magnetic resonance imaging (MRI) of the brain during the first 24 h after admission confirmed minimal ASH in the posterior interhemispheric fissure with subacute subdural hematoma in the left parietooccipital cortex and occipital regions (Fig. 1b). Considering the clinical condition of the patient, surgery was not planned by the neurosurgical department but the patient was kept under observation in the ED. He was discharged home 48 h after the trauma with a normal neurological examination and mild intermittent headaches. Interhemispheric ASH is a relatively uncommon type of ASH because of their unusual location [1]. They usually occur in patients with bleeding disorders and are associated with trauma in the majority of cases [2]. Computed tomography (CT) and MRI are important neuroradiological techniques for the accurate diagnosis of interhemispheric ASH [1, 2]. Although interhemispheric ASH is a rare form of subdural hematoma, early diagnosis and treatment is of great importance because of its emergent condition [2, 3]. CT and MRI are important diagnostic tools, as it was in this case. MRI may have the advantage rather than CT due to the absence of beam-hardening and multiplanar imaging. The best management modality for interhemispheric ASH depends upon the neurologic status on admission and clinical course [2]. If the patient is neurologically stable, conservative treatment is generally preferred. Surgical treatment is reserved in patients with disturbances of consciousness and for patients with progressive neurological deterioration [3].

An Unusual Head Computed Tomography in an Elderly Patient With Head Trauma

An 80-year-old man with asthma, diabetes, hypertension and Parkinson’s disease was admitted due to refusal to eat, increased somnolence and pain over right side of head, neck and body following a fall from his bed. There was no history of unconsciousness, vomiting, convulsions or any bleeding. The patient had a Glasgow Coma Score of 12/15 (spontaneous eye opening, uttering inappropriate words and localizing painful stimuli), both pupils were equal and reactive to light, tone was increased in all limbs and bilateral Babinski signs were present. A noncontrast computed tomography of brain (Figure 1) showed an acute interhemispheric subdural hematoma (ISH, white arrows), with a left occipital acute epidural hematoma (black arrow), dilated cortical sulci containing cerebrospinal fluid (gray arrow head) and longstanding subdual hygromas (black arrow heads, based on previous computed tomographies).

Spinal Subdural Hematoma Associated With Traumatic Intracranial Interhemispheric Subdural Hematoma

A 78-year-old female fell and hit the back of her head on the floor. Head computed tomography (CT) showed right acute interhemispheric subdural hematoma (ISDH). Her left hemiparesis worsened, so partial removal of ISDH was performed. The hemiparesis was improved, but leg monoparesis persisted. Lumbar magnetic resonance imaging showed spinal subdural hematoma (SSDH) at the S1-2 level. Nerve conduction velocity measurements at the knee joint to lower limb showed disappearance of the left peroneal nerve conduction wave, indicating that one of the causes of drop foot was common peroneal nerve palsy. With conservative therapy, her drop foot was gradually improved, then she recovered to walk with a stick and moved to a rehabilitation hospital. Lumbar MR imaging should be performed to rule out SSDH in a patient with posterior fossa subdural hematoma on initial head CT who develops leg palsy.

Acute inter-hemispheric subdural hematoma in a kabaddi player: A comment

Acute inter-hemispheric subdural hematoma in a kabaddi player: A comment

Acute inter-hemispheric subdural hematoma in a Kabaddi player

Acute inter-hemispheric subdural hematoma in a Kabaddi player

Acute Interhemispheric Subdural Hematoma Presenting as Falx Syndrome

Acute Interhemispheric Subdural Hematoma Presenting as Falx Syndrome

Acute interhemispheric subdural hematoma due to hemodialysis: case report

Background Acute interhemispheric subdural hematoma (AISH) is an extremely limited complication in patients on maintenance hemodialysis. Diagnostic difficulties result from a fact that symptoms of acute hematoma such as headache, nausea, vomiting, apathy, sleepiness, paresthesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as hypertensive encephalopathy. Case Description A case of acute interhemispheric subdural hematoma during long-term dialysis is presented. Conclusion AISH caused by hemodialysis is a very important complication. It is sometimes difficult to differentiate from dysequilibrium or dialysis dementia. Clinicians must pay closer attention on neurological examination of hemodialyzed patient. Surgical treatment must be as prompt as possible because of the possible sudden worsening of the patient's clinical condition.

皮質動脈損傷による大脳半球間裂急性硬膜下血腫の1手術例

皮質動脈損傷による大脳半球間裂急性硬膜下血腫の1手術例

３００日以上脳死状態が持続した幼児の１例

Case: An 11-month-old boy bruised his head and experienced convulsions, followed by a coma with decerebrate rigidity. Initial CT scans showed an acute interhemispheric subdural hematoma and diffuse brain swelling. On day 2, he developed dilated pupils, absent light reflex, and sudden hypotension. Dopamine (DOA) and antidiuretic hormone (ADH) were administered to maintain his circulation. CT scans on day 3 revealed brain tamponade. The patient was diagnosed as brain dead on day 15. The patient was thereafter maintained under mechanical ventilation. DOA and ADH requirements decreased gradually, resulting in shift from DOA to docarpamine on day 146 and in the cessation of ADH administration on day 245. On day 139, autolysed brain parenchyma was discharged through the anterior fontanel and necrotic skin, resulting in the appearance of pneumocephalus on CT scans on day 299. Repeated EEGs, ABRs, dynamic CTs and intracranial Power Dopplers supported the diagnosis of brain death. Nevertheless, the patient's height increased consistently from 74cm on day 1 to 82cm on day 253. The secretion of thyroid stimulating hormone was detected until day 252. The boy developed septic renal failure and died on Day 326. Discussion and Conclusion: Although brain death in adults is usually followed by early cardiac arrest, the infant in this case was sustained in a state of brain death for over 300 days using ordinary intensive care. An analysis of endocrinological function and growth records may help to clarify the mechanism of the patient's sustained heart beat.

Occipital interhemispheric acute subdural hematoma treated by lambdoid suture tap

Occipital interhemispheric acute subdural hematoma treated by lambdoid suture tap

Computed Tomography of Craniocerebral Injury in the Abused Child

Computed tomography (CT) was performed in 26 infants and children with craniocerebral trauma related to abuse during a 41-month period. The pattern of brain injury differed from that seen in the nonabused traumatized infant or child. Parieto-occipital acute interhemispheric subdural hematoma (AIHSH) with associated parenchymal injury was the most frequent finding (58%). Follow-up by CT in patients with AIHSH demonstrated infarction in half and cerebral atrophy in all.

Interhemispheric acute subdural hematoma: a computed tomographic manifestation of child abuse by shaking.

Parieto-occipital interhemispheric acute subdural hematomas (IASH) were found in 17 (61%) of 28 abused children examined by computed tomography, presenting with neurologic symptoms. CT demonstration of IASH correlated with injury due to severe shaking, the presence of retinal hemorrhages, and the absence of the stigmata of battering. Subsequent computed tomographic examination in these patients demonstrated infarction in 50%, and cerebral atrophy in 100%.

Interhemispheric subdural hematoma secondary to hemorrhage from a calloso-marginal artery aneurysm

This report documents two unusual consequencies of bleeding from an aneurysm located on the callosomarginal artery; the development of an acute interhemispheric subdural hematoma which was removed at operation six days after hemorrhage and the angiographic delineation of spontaneous thrombosis of the aneurysm two weeks after the initial ictus.