Interhemispheric Subdural Hematoma Research Articles

Interhemispheric chronic subdural haematoma: Case report and brief review of the literature

Background: Chronic subdural haematoma usually arises from a traumatic acute haemorrhage in the subdural space, frequently causing mass effect and consequent neurological decline. This lesion is mainly found over the cortical convexity and its evolution and surgical approach has been extensively studied. Nevertheless, inter-hemispheric chronic subdural haematoma is considered a rare lesion.Aim and case report: This study reported a case of traumatic acute interhemispheric subdural haematoma, initially asymptomatic, and its evolution to a chronic symptomatic lesion, as well as the surgical approach employed. A brief review of the literature is presented with a discussion of the therapeutic options.

Interhemispheric Subdural Hematoma Presenting with Falx Syndrome after Trauma

Isolated interhemispheric subdural hematoma (ISH) represents one of the rarest forms of posttraumatic intracranial hemorrhage. ISH was first described at autopsy by Aring and Evans in 1940 and was first recognized in a living person by Jacobson in 1955. Although a subdural hematoma usually occurs over the convexity of a hemisphere, it occurs occasionally in the interhemispheric fissure. ISH usually occurs after head trauma, and its spontaneous or nontraumatic occurrence is extremely rare. The clinical picture of ISH often comprises a falx syndrome characterized by monoparesis of the lower extremity, or hemiparesis in which the leg is weaker than the arm. Other symptoms may include headache, vomiting, seizures, dementia, language disturbance, oculomotor nerve palsy, or loss of consciousness. One case of ISH and tentorial hemorrhage presenting with visual disturbances has been reported. Although most patients with ISH exhibit neurological deficits at the initial presentation, the appearance of such deficits may be delayed by a few hours to 10 days. And there is no consensus on the ideal treatment of ISH. We recently treated a patient with ISH who presented with delayed falx syndrome and sensory and visual disturbances. We present this case of ISH and review the clinical presentation and management.

Acute Interhemispheric Subdural Haematoma

Acute interhemispheric subdural haematoma (AISH) was considered extremely rare until identification with imaging studies. Interhemispheric subdural hematoma in adults is a rare complication of head injury with no more than 100 cases reported since 1940. The classical presentation of this disorder is a contralateral monoparesis of the leg or a hemiparesis more pronounced in the leg1. Treatment may consist of conservative observation or craniotomy and is dictated by the clinical course. Conservative management is the treatment of choice for patients without disturbances of consciousness and for patients with stable clinical conditions. Surgical treatment is necessary in patients with progressive neurological deterioration. We describe the case of traumatic AISH in a 31-year-old patient who presented a contralateral monoparesis of the leg.

Ataxia associated with an interhemispheric subdural hematoma: a case report

Interhemispheric subdural hematomas are uncommon lesions. This case report describes a 77-year-old woman using anticoagulants who suddenly developed headache and ataxia of both legs. Computed tomography of the brain revealed an interhemispheric subdural hematoma, which was treated conservatively. Interhemispheric subdural hematomas should be considered in patients, especially in those using anticoagulants, even in the absence of trauma.

Post-Traumatic Inter-Hemispheric Subdural Haematoma

Interhemispheric subdural haematoma (ISDH) had been considered extremely rare and less than 100 cases have been reported. ISDHs can present in all age groups and the most common aetiologic factor is trauma (traffic accident and fall). Rarely acute ISDH of non-traumatic origin may be due to cerebral aneurysm rupture, child abuse, and haemodialysis. Treatment strategies are based on the individual neurological response of each case and the risk-benefit ratio to decide on an operative or conservative approach. The outcome of an individual patient is not related to the therapeutic approach, but to the level of consciousness and the neurological condition on admission. We report a case of post-traumatic acute ISDH in an elderly gentleman and review the literature. Keywords: Interhemispheric subdural haematoma, subdural haematoma, trauma Nigerian Journal of Orthopaedics and Trauma Vol. 6 (2) 2007: pp. 86-87

Traumatic Interhemispheric Subdural Hematoma Presenting the Falx Syndrome after Decompressive Craniectomy: A Case Report

Interhemispheric subdural hematoma (ISH) had been considered very rare until identification with image studies, such as brain computed tomography (BCT) and magnetic resonance imaging (MRI). There are still some controversies in the management ISH, will be treated surgically or medically. We present one case of traumatic ISH which showed the falx syndrome after decompressive craniectomy for convexity subdural hematoma and was treated surgically with good outcome. Surgical treatment should be considered for symptomatic ISH patient, because ISH did not migrate over the convexity, as showed in our case. (J Kor Neurotraumatol Soc 2008;4:93-96)

Traumatic Anterior Cerebral Artery Aneurysm following Blunt Craniofacial Trauma

Background: Traumatic aneurysms of the anterior cerebral artery (ACA) were retrospectively reviewed in an effort to identify patients at high risk of ACA aneurysm. Methods: Blunt craniofacial trauma patients featuring vascular injuries over the region of the ACA were studied. Results: Six patients featuring eight ACA aneurysms were diagnosed between June 1992 and December 2005, inclusively. Seven aneurysms were located at nonbranched sites and one was located over the right ACA-anterior communicating artery junction. One patient died immediately of massive intracranial lobar hemorrhage (ICH). The other 5 patients experienced rebleeding during a period of from 1 to 29 days. Brain computed tomography revealed subarachnoid hemorrhage (SAH) in 1 of these 6 patients, ICH over the medial frontal area or cingulated gyrus in 4 patients, intraventricular hemorrhage (IVH) in 3 patients, and an interhemispheric subdural hematoma (SDH) in 2 patients. Conclusion: Delayed-onset deterioration of neurological deficit is the most common clinical presentation of traumatic ACA aneurysms. Midline hemorrhage such as medial frontal hemorrhage or cingulate gyrus hemorrhage, and the presence of an interhemispheric SDH associated with SAH and IVH subsequent to blunt craniofacial trauma should be further evaluated, as they pre-sent a high risk of traumatic ACA aneurysms to patients.

Acute Interhemispheric Subdural Hematoma Presenting as Falx Syndrome

Acute Interhemispheric Subdural Hematoma Presenting as Falx Syndrome

Comparison of Accidental and Nonaccidental Traumatic Head Injury in Children on Noncontrast Computed Tomography

Mixed-density convexity subdural hematoma and interhemispheric subdural hematoma suggest nonaccidental head injury. The purpose of this retrospective observational study is to investigate subdural hematoma on noncontrast computed tomography in infants with nonaccidental head injury and to compare these findings in infants with accidental head trauma for whom the date of injury was known. Two blinded, independent observers retrospectively reviewed computed tomography scans with subdural hematoma performed on the day of presentation on 9 infant victims of nonaccidental head injury (mean age: 6.8 months; range: 1-25 months) and on 38 infants (mean age: 4.8 months; range: newborn to 34 months) with accidental head trauma (birth-related: 19; short fall: 17; motor vehicle accident: 2). Homogeneous hyperdense subdural hematoma was significantly more common in children with accidental head trauma (28 of 38 [74%]; nonaccidental head trauma: 3 of 9 [33%]), whereas mixed-density subdural hematoma was significantly more common in cases of nonaccidental head injury (6 of 9 [67%]; accidental head trauma: 7 of 38 [18%]). Twenty-two (79%) subdural hematomas were homogeneously hyperdense on noncontrast computed tomography performed within two days of accidental head trauma, one (4%) was homogeneous and isodense compared to brain tissue, one (4%) was homogeneous and hypodense, and four (14%) were mixed-density. There was no statistically significant difference in the proportion of interhemispheric subdural hematoma, epidural hematoma, calvarial fracture, brain contusion, or subarachnoid hemorrhage. Homogeneous hyperdense subdural hematoma is more frequent in cases of accidental head trauma; mixed-density subdural hematoma is more frequent in cases of nonaccidental head injury but may be observed within 48 hours of accidental head trauma. Interhemispheric subdural hematoma is not specific for inflicted head injury.

“Benign” shaken baby syndrome. Case report

The authors report an infant with clinical and neuroimaging findings of shaken baby syndrome. The pitfalls encountered in the assessment on the cause of the bilateral frontal and interhemispheric subdural hematomas in this child are also briefly discussed. We have called this condition "benign" shaken baby syndrome and emphasize that not always acute subdural hematomas are of non-accidental nature.

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.

Interhemispheric subdural haematoma from ruptured aneurysm

Interhemispheric subdural haematoma from ruptured aneurysm

A non–traumatic interhemispheric subdural haematoma: presented with headache as the sole complaint

Due to their localisations and symptoms, interhemispheric subdural haematomas (ISH) compose a distinct category. Altered level of consciousness and hemiparesis are the most frequent symptoms. We report a case of ISH who presented with headache as the sole complaint. Left cerebellar haematoma and ISH were found in cranial MRI and cranial computed tomography Cranial MR angiogram was normal. Haemogram and coagulation parameters were within normal limits. ISH should be considered among the diagnostic possibilities in elderly patients who present with headache as the sole symptom without other clinical features such as meningeal irritation signs, focal neurological symptoms and alteration of consciousness. Cranial imaging studies should be done in such cases.

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

Adult interhemispheric subdural haematoma: A simple option for an uncommon problem

Two cases of interhemispheric subdural haematoma are presented. None of the patients had any neurological deficit on admission. They developed progressive neurological deficits within a day or two. Surgical treatment was by a large convexity craniectomy and a wide opening of the dura. The dura was left open in one case and primary duroplasty was done in the other. No deliberate attempt was made to remove the interhemispheric clot. Both patients made a quick and complete recovery by this simple procedure. Cranioplasty was carried out subsequently. Chinese Abstract imageimage

閉じこめ症候群を発症した橋延髄境界部断裂の１救命例

We report a case of a pontomedullary tear presenting as locked-in syndrome. A 38-year-old man injured in a traffic accident while driving a motorcycle was unconscious upon arrival and computed tomography (CT) showed only a small interhemispheric subdural hematoma. He became alert 6 hours later and was found to have locked-in syndrome. His neurologic deficits pointed to a lesion involving the lower pons and magnetic resonance imaging (MR) clarified that the pontomedullary junction was partially torn, leading to a determination of locked-in syndrome resulting from a pontomedullary tear. Pontomedullary lesions may be found in cases of hyperextension injury of the head.

Hematoma subdural agudo interhemisférico

Interhemispheric subdural hematoma in adults is a rare complication of head injury with no more than 100 cases reported since 1940. The classical presentation of this disorder is a contralateral monoparesis of the leg or a hemiparesis more pronounced in the leg. We report three cases of interhemispheric subdural hematoma following closed head injuries and the review of the literature with an analysis and of the therapeutic possibilities. Conservative management under close supervision may be a proper attitude in those patients without alterations of consciousness. Surgical treatment is necessary in patients with progressive deterioration.

Interhemispheric subdural hematoma caused by a ruptured internal carotid artery aneurysm: Case report

BACKGROUND Interhemispheric subdural hematoma (ISH) usually occurs after head trauma; nontraumatic ISH is extremely rare. CASE DESCRIPTION The authors describe a 62-year-old male presenting with severe headache and ptosis on the left side. Computed tomography (CT) and magnetic resonance imaging disclosed a hematoma in the interhemispheric subdural space without subarachnoid hemorrhage. Cerebral angiography revealed an aneurysm arising from the left internal carotid-posterior communicating artery (IC-PC) junction. The patient underwent emergency clipping of the aneurysm and was discharged without neurological deficit. CONCLUSION Ruptured aneurysms resulting in ISH without subarachnoid hemorrhage have been reported in only a few cases; this is the second case to describe the association of a ruptured IC-PC aneurysm with an ISH. The etiology of ISH formation due to ruptured aneurysms and the diagnosis are discussed.

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.

円蓋部慢性硬膜下血腫を合併したsubacute interhemispheric subdural hematomaの成人例

症例は54歳の男性で, 後頭部を打撲後10日目に右下肢単麻痺にて発症した亜急性大脳半球間裂硬膜下血腫(ISDH)例である.保存的療法で軽快したが, 左円蓋部慢性硬膜下血腫の合併により右下肢単麻痺が再発し, さらに運動性失語症, 右上肢の麻痺が出現した.ISDH経過中の円蓋部慢性硬膜下血腫の合併はこれまで4例の報告がある.その発生機序は液状化したISDHの円蓋部への移行とされているが, 本例ではISDHによる大脳半球の圧迫が強く, 血腫が慢性期にpassiveに大脳半球間裂から円蓋部に移行したとは考えにくく, 受傷後すでに円蓋部にみられた薄い亜急性硬膜下血腫が慢性硬膜下血腫に移行したと考えられた.