Intracranial Subdural Hematoma Research Articles

Intracranial Subdural Hematoma: A Rare Complication Following Spinal Anesthesia for C/S Surgery

Intracranial Subdural Hematoma: A Rare Complication Following Spinal Anesthesia for C/S Surgery

Clinical Diagnosis and Management of Traumatic Acute Intracranial Subdural Hematoma: Review Article

Traumatic brain injury (TBI) is the leading cause of death and disabling conditions in persons. The frequency and severity of head injuries have both decreased as a result of numerous industrial safety improvements, the installation of airbags in automobiles, and the enforcement of speed restrictions. TBI survivorship has increased due to advancements in emergency response times and acute care, but this has also increased the need for accurate ways to detect individuals at risk of subsequent diseases. Pupil reactivity, the Glasgow Coma Scale, and head computed tomography are currently the main clinical signs indicating the existence of brain damage. The current review will cover the clinical presentation, diagnosis, and treatment of TBI,

Acute Intracranial Subdural Hematoma Masquerading as a Postpartum Headache: A Case Report.

An acute subdural hematoma is a collection of blood in the space between the dural and arachnoid membranes overlying the brain. Head trauma is the most common cause. Less frequently, low cerebrospinal fluid pressure, due to a spontaneous or iatrogenic cerebrospinal fluid leak can result in a subdural hematoma. We discuss the case of a 26-year-old woman who presented with a frontal headache following epidural anesthesia for vaginal delivery. The differential diagnosis included spinal headache, postpartum hypercoagulability, dural sinus thrombosis, and intracranial hemorrhage or mass. Her vital signs and physical examination were normal. A computed tomography of the brain revealed an acute subdural hematoma along the left frontal cerebral hemisphere, without midline shift or mass effect. A blood patch was placed with complete resolution of her symptoms. This case illustrates an unusual case of an acute subdural hematoma in the postpartum period following epidural anesthesia for labor pain management. It was thought to be caused by intracranial hypotension following epidural anesthesia and a cerebrospinal fluid leak.

Intracranial subdural hematoma during labor analgesia without apparent dural puncture.

Intracranial subdural hematoma during labor analgesia without apparent dural puncture.

Pituitary Apoplexy and Subdural Hematoma after Caesarean Section

Pituitary apoplexy can occur postpartum, and subdural hematoma following epidural anesthesia is a rare complication. Cooccurrence of these two complications is extremely rare and has not been previously reported in the literature. In this article, we present a case of pituitary apoplexy along with intracranial subdural hematoma happening two days after spinal anesthesia for cesarean section. The patient presented with peripheral facial nerve paralysis accompanied by headache, eye pain, and blurred vision and was diagnosed by imaging modalities. The patient made a good recovery with conservative treatment without serious health events.

Emergency Craniotomy and Burr-Hole Trephination in a Low-Resource Setting: Capacity Building at a Regional Hospital in Cambodia.

To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1–3) (OR = 23.9, 95% CI: 3.1–184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.

Abstract WP111: Deployment Of Portable, Bedside, Low-field Magnetic Resonance Imaging In The Emergency Department To Evaluate Patients With Acute Stroke

Background and Aims: MRI is critical for diagnosing acute stroke and guiding candidate selection for potential reperfusion therapy. However, rapid stroke evaluation using MRI is often dissuaded by the time required for patients to travel to access-controlled, high-field (1.5-3T) systems. Advances in low-field MRI enable the acquisition of clinically valuable images at the bedside. We report neuroimaging in patients presenting to the Emergency Department (ED) with stroke symptoms using a low-field portable MRI (pMRI) device. Methods: A 64mT pMRI device was deployed in the Yale-New Haven Hospital ED from August 2020 to July 2021. Patients presenting as a “Stroke Code” or “Intracranial Hemorrhage Alert” with no MRI contraindications were scanned. Exams were performed at the bedside, in the vicinity of ED room equipment. Research staff acquired imaging via tablet, with images available immediately after acquisition. Sequences obtained and axial scan times (in minutes) included T1-weighted imaging (4:54), T2-weighted imaging (7:03), fluid-attenuated inversion recovery imaging (9:31), and diffusion-weighed imaging with apparent diffusion coefficient mapping (9:04). Patients’ demographic information, hours from the time of patients' last known normal (LKN) to time of scan, and discharge diagnoses (determined from final imaging interpretation) were assessed. Results: pMRI exams were obtained on 54 patients (28 females, 51.9%; median age 71 years, 20-98 years). Discharge diagnoses included ischemic stroke (42.6%) no intracranial abnormality (31.5%), intraparenchymal hemorrhage (7.4%), atherosclerosis (7.4%), tumor (5.6%), subdural hematoma (3.7%), and intraventricular hemorrhage (1.9%). Patient LKN times ranged from 2 to 144 hours (median of 12 hours; 3 patients with no LKN excluded). The pMRI did not interfere with ED equipment and no significant adverse events occurred. Conclusion: We report the use of a pMRI for bedside neuroimaging in the ED. This approach suggests that pMRI may be viable for supporting rapid diagnosis and treatment candidate selection in patients presenting with stroke symptoms to the ED.

Simultaneous intracranial and spinal subdural hematoma

Spinal subdural hematoma is a rare condition. Herein, we present a case of simultaneous intracranial and spinal subdural hematoma. An 81-year-old woman went to a local hospital for a 2-m fall 1 month before her visit to our institution, and computed tomography (CT) showed no unusual findings. However, due to subjective lower extremity weakness and severe radiating pain in the legs, brain CT and lumbar-spine CT re-imaging was performed during follow-up. Follow-up showed subacute spinal subdural hematoma in the brain and spine. The patient was transferred to our hospital and underwent bilateral burr-hole trephination and posterior lumbar decompression with spinal subdural hematoma removal. Upon follow-up, the spinal subdural hematoma was significantly reduced, and the patient’s symptoms recovered. In this report, we discuss a case of simultaneous spinal and intracranial subdural hematoma. Keywords: Spinal subdural hematoma; Intracranial subdural hematoma

Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia

Intracranial subdural hematoma (SDH) formation is an uncommon but serious complication of planned or unintentional dural puncture (DP) during straight epidural anesthesia, combined spinal-epidural, dural puncture epidural, or spinal anesthesia. Diagnosis of intracranial SDH following neuraxial anesthesia may be delayed or misdiagnosed due to rare occurrence, lack of knowledge, as well as an overlap in clinical presentation with postdural puncture headache (PDPH). Increased awareness of intracranial SDH as a complication of DP may result in earlier recognition and prevention of potentially devastating outcomes. This article reviews the relevant literature on association of neuraxial anesthesia with intracranial SDH formation.
 Key words: Intracranial subdural hematoma; Anesthesia, Neuraxial; Anesthesia, Epidural; Combined spinal-epidural; Dural puncture; Anesthesia, spinal; Pregnancy; Postdural puncture headache
 Citation: Dhoon TQ, Joshi J, Portnoy D, Rajan GC. Intracranial subdural hematoma: a rare but serious complication following neuraxial anesthesia in obstetric anesthesia. Anaesth. pain intensive care 2021;25(6):828-831:
 DOI: 10.35975/apic.v25i6.1719
 Received: August 4, 2021, Reviewed: September 2, 2021, Accepted: October 3, 2021

Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma.

The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.

Chronic intracranial subdural hematoma after spinal anesthesia for a cesarean section: a case report

BackgroundSubdural hematoma is a rare, potentially devastating, yet curable complication of spinal anesthesia. Differentiation between post-dural puncture headache and subdural hematoma can be difficult, resulting in a delay in diagnosis.Case presentationWe present a 28-year-old Ethiopian female patient who underwent elective cesarean section under spinal anesthesia and returned to the emergency department after 1 month with a worsening headache. Brain computed tomography revealed a chronic subdural hematoma with a significant midline shift. The patient recovered completely after surgical evacuation.ConclusionsA high index of suspicion and close attention to the pattern and characteristics of the headache, coupled with a meticulous neurologic examination and neuroimaging, can help to achieve timely diagnosis of this serious entity. Investigation with head computed tomography or magnetic resonance imaging is vital.

P-OT023. Intracranial subdural empyema mimicking acute on chronic subdural hematoma: a case report

Introduction. Intracranial subdural empyema is a rare localized intracranial infection that forms between dura and arachnoid membrane of the meninges. Its unspecific clinical presentations as well as neuroimaging findings that might resemble subdural hematoma make the definitive diagnosis of subdural empyema difficult. This report aims to highlight the importance of making a differential diagnosis of subdural empyema in a suspected case of subdural hematoma. Results. A 71 years old male presented with acute mild to moderate intermittent headache that was followed by sudden difficulty in word findings and right limbs weakness. No history of fever, trauma, seizure, or prior history of ear, nose, throat, tooth infections, and intracranial surgical procedure. Increased white blood cells count was not found despite the increased neutrophil to lymphocyte ratio as well as C-reactive protein. Non-contrast head CT-scan showed crescentic hyperdense lesion within a wider hypodense lesion in the left frontotemporoparietal region, characterizing acute on chronic subdural hematoma. During burr hole drainage, pus was found, consistent with subdural empyema. An intralesion antibiotic treatment was given after complete removal of the pus. Conclusion. Intracranial subdural hematoma and subdural empyema with the involvement of neurological deficits are emergency conditions. However, it is difficult to differentiate these two conditions even after the examinations of clinical, laboratory, and neuroimaging with non- contrast head CT-scan, particularly without the triad of subdural empyema: fever, headache, vomiting. Our case showed that even without noticeable port d’entry, intracranial subdural empyema could be formed.

P.136 All that fits isn’t eclampsia

Introduction: Intracranial subdural haematoma (ISH) due to inadvertent puncture of the spinal dura mater following central neuraxial blockade is exceedingly rare, with fewer than 100 cases reported. [1] Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. Google Scholar In obstetrics, ISH secondary to epidural anaesthesia is around 1:500,000. [1] Szeto V, Kosirog J, Eilbert W. Intracranial subdural hematoma after epidural anesthesia: a case report and review of the literature. Int J Emerg Med 2018; 11:36. Google Scholar We present an obstetric case exemplifying these consequences, ultimately presenting with seizure, also revealing an undiagnosed cerebral structural abnormality.

Unsubstantiated belief in the diagnostic accuracy of the triad of abusive head trauma may lead to incorrect diagnoses of alleged abuse cases.

Unsubstantiated belief in the diagnostic accuracy of the triad of abusive head trauma may lead to incorrect diagnoses of alleged abuse cases.

Intracranial subdural haematoma following dural puncture accidental: Clinical case

Abstract Intracranial subdural haematoma is a rare, but potentially lethal complication of neuraxial procedures. Considering the high frequency of neuraxial techniques in the obstetric population, parturients are more susceptible to this fearful complication. The diagnosis is often masked and delayed because it shares similar clinical characteristics with posdural puncture headache, with headache being the most common symptom. This case report describes a timely diagnosis and successful management of an intracranial subdural haematoma, after unintentional dural puncture during labour epidural analgesia. Postpartum headache following epidural analgesia, remains a clinical challenge for the caring team, requiring a close follow-up and awareness for non-benign causes that require prompt management, avoiding devastating consequences.

Intracranial Subdural Hematoma after Cesarean Section with Neuraxial Anesthesia

Intracranial Subdural Hematoma after Cesarean Section with Neuraxial Anesthesia

Intracranial subdural hematoma following spinal anesthesia: A case report and literature review

Intracranial subdural hematoma (ICSH) is a rare complication of spinal anesthesia (SA). Because of similar characteristics with postdural puncture headache (PDPH), the definitive diagnosis of ICSH is usually delayed or masked, which potentially results in morbidity or mortality. Herein, we report the case of a young male who developed ICSH following SA and emphasize the differences between ICSH and PDPH in terms of atypical presentations. Furthermore, this report aims to identify the criteria for performing an epidural blood patch in patients with ICSH after dural puncture.

Chronic Intracranial Subdural Hematoma Case Report and Review of the Literature

Chronic Intracranial Subdural Hematoma Case Report and Review of the Literature

Study Finds Increased Risk for Intracranial Subdural Hematomas in Postpartum Women with Post-Dural Puncture Headaches

Study Finds Increased Risk for Intracranial Subdural Hematomas in Postpartum Women with Post-Dural Puncture Headaches

Association Between Post–Dural Puncture Headache After Neuraxial Anesthesia in Childbirth and Intracranial Subdural Hematoma

Women giving birth have high rates of dural puncture secondary to neuraxial anesthesia and are at high risk for a resulting headache. It appears to be unknown whether there is a significant association between post-dural puncture headache and subsequent intracranial subdural hematoma. To determine the association of post-dural puncture headache with postpartum intracranial subdural hematoma. This cohort study of patients used hospital discharges recorded in the US Agency for Healthcare Research and Quality National Readmission Database for women who experienced childbirth from January 2010 to December 2016. Patients were included if they had been admitted for childbirth, had 2 months of follow-up data, and did not receive a diagnostic lumbar puncture. Only the first delivery for a calendar year was studied. Data were analyzed from January 2018 to June 2019. Women with post-dural puncture headache associated with neuraxial anesthesia in the 2-month postpartum period were identified using International Classification of Disease (Ninth Edition and Tenth Edition) codes and were compared with those without post-dural puncture headaches. The primary outcome was intracranial subdural hematoma in the 2-month postpartum period. Secondary outcomes included in-hospital mortality and occurrence of neurosurgery. A total of 26 469 771 patients with 26 498 194 deliveries were included. Exclusion of repeated deliveries (n = 28 423), deliveries without 2 months of follow-up data (n = 4 329 621), and deliveries with diagnostic lumbar puncture (n = 9334) resulted in a final cohort of 22 130 815 patients and deliveries. For the cohort, the mean (SD) age was 28.1 (6.0) years, and there were 68 374 post-dural puncture headaches, for an overall rate of 309 (95% CI, 302-316) per 100 000. There were 342 cases of subdural hematoma identified, indicating a rate of 1.5 (95% CI, 1.3-1.8) per 100 000 women. Of these, 100 cases were in women with post-dural puncture headache, indicating a rate of 147 (95% CI, 111-194) hematoma cases per 100 000 deliveries in this subgroup. Post-dural puncture headache had an unadjusted absolute risk increase of 145 (95% CI, 117-174) subdural hematoma cases per 100 000 deliveries. After adjusting for confounders, post-dural puncture headache had an odds ratio for subdural hematoma of 199 (95% CI, 126-317; P < .001) and an adjusted absolute risk increase of 130 (95% CI, 90-169; P < .001) per 100 000 deliveries. The presence of presumed post-dural puncture headache after neuraxial anesthesia in childbirth, compared with no headache, was associated with a small but statistically significant absolute increase in the risk of being diagnosed with intracranial subdural hematoma. Further research is needed to establish if this association is causal for this rare outcome.