Nontraumatic Acute Subdural Hematoma Research Articles

Nontraumatic Acute Subdural Hematoma Eight Days After COVID-19 Vaccination: A Case Report

Nontraumatic acute subdural hematoma is rare, and no associations with the COVID-19 vaccine have been reported. This report presents the case of a 77-year-old woman who developed a nontraumatic acute subdural hematoma eight days after vaccination with the BNT162b2 COVID-19 vaccine. The patient regularly took 50 mg/day of clopidogrel and was diagnosed with severe acute subdural hematoma and brain herniation at admission. Although the BNT162b2 vaccine has not been determined as a risk factor, intracranial hemorrhage after its administration has been reported in Japan. Nontraumatic acute subdural hematoma may be included as an extremely rare adverse event of the BNT162b2 vaccine, but more data may be needed to confirm this.

Rare case of dural arteriovenous fistula presenting by spontaneous acute subdural hematoma: A case report and review of literature

Introduction. Dural arteriovenous fistulas represent pathological acquired bonds between the meningeal blood vessels (arteries) and drainage veins associated to them. These fistulas can vary in clinical presentations, from being asymptomatic to causing serious neurological deficits, depending mostly on the localization and size. Only one fourth of dural fistulas present themselves with intracranial bleeding. This hemorrhage is most frequently localized in subarachnoid space, occasionally intracerebrally, and seldom beneath the dura mater, ie subdurally. Case report. We presented a rare case of a patient with spontaneous acute subdural hematoma. After the initial treatment and consequent imaging methods, a diagnosis of a dural arteriovenous fistula was established. After the craniotomy for hematoma evacuation, the patient underwent an uneventful endovascular treatment. Despite the rarity of non-traumatic acute subdural hematoma caused by dural arteriovenous fistula, one should not overlook the possible pathogenesis and etiology in patients with spontaneous acute subdural hematoma. Even with the absence of the symptoms and signs of subdural bleeding, dural arteriovenous fistula, as a cause of it, should not be immediately ruled out. Conclusion. Despite the rarity of non-traumatic acute subdural hematoma being caused by dural arteriovenous fistulas, one should not immediately overlook the possible pathogenesis and etiology. Cautious approach is needed when treating such diseases even in the absence of typical symptoms.

Intracranial Acute Subdural Hematoma Following Spinal Anesthesia: Our Experience with Six Patients.

To describe our experience with the occurrence of intracranial acute subdural hematoma (ASDH) following spinal anesthesia. We reviewed our records from 2010 to 2017 to detect cases of nontraumatic ASDH following spinal anesthesia. All cases were analyzed for the etiological factors, time lag between the procedure and hematoma diagnosis, treatment, and outcome. Of 329 cases of nontraumatic ASDH, we identified 6 patients whose spontaneous ASDH developed following spinal anesthesia. All our patients were obstetrical and received spinal anesthesia for delivery. Patient ages ranged from 21 to 34 years. Two patients presented with deterioration of consciousness a few hours after delivery. Three patients presented with persistent headache and lethargy days after delivery. One patient presented 3 days after delivery with severe deterioration of consciousness. All patients had undergone surgical evacuation of a hematoma. Five patients recovered and one patient died 2 days after surgery. Records showed none of the six patients had coagulopathy or any other blood disorder. Although uncommon, intracranial ASDH should be considered in patients following spinal anesthesia, especially those with a prolonged headache after the procedure.

Acute Subdural Hematomas in Ruptured Brain Arteriovenous Malformations: Association with Distal Flow-Related Aneurysms.

Non-traumatic acute subdural hematomas (SDH) are rare and have seldom been reported in ruptured brain arteriovenous malformations (BAVM). The aim of this study was to report the frequency of acute SDH in BAVM-related hemorrhage and to determine the relationship of SDHs with BAVM angioarchitectural features. This was aretrospective monocentric study of patients admitted for BAVM rupture between 2003 and 2017. Patients with rupture complicating or closely following partial embolization procedures were excluded. Univariate followed by multivariate logistic regression analysis was used to determine factors significantly and independently associated with SDHs and distal flow-related aneurysms. A total of 181 patients with 188 BAVM ruptures admitted during the study period were included, eleven cases of acute SDH were identified (6%) and 2 cases of isolated SDH were found. The presence of adistal flow-related aneurysm was the only feature independently and significantly associated with SDH (odds ratio [OR]8.1, 95% confidence interval, CI 1.9-34.5, P = 0.003). Distal flow-related aneurysms were associated with proximal flow-related aneurysms (OR28, 95%CI 4.9-163.8, P < 0.001), were more frequent in infratentorial BAVMs (OR3.7, 95%CI 1.3-10.2, P = 0.01) and more often found in cases of acute SDH (OR16.9, 95%CI 3.6-79.6, P < 0.001) and subarachnoid hemorrhage (SAH) (OR4.5, 95%CI 1.7-12.2, P = 0.003). Ruptured BAVMs can rarely present with acute SDH and SDH in ruptured BAVMs are often associated with distal flow-related aneurysms. This finding may impact acute management of ruptured BAVMs with SDH by eliciting an emergent and thorough imaging work-up to identify distal flow-related aneurysm(s), in turn leading to treatment.

Arachnoid Cyst with a Non-traumatic Acute Subdural Hematoma in an Eleven-year-old Patient

AbstractA non-traumatic intra-cystic hemorrhage in an arachnoid cyst is a rare event, with few cases reported in the literature. We present a case of an eleven-year-old boy patient, which presented a spontaneous acute subdural hematoma and intra-cystic hemorrhage after a strong headache episode. The results were evidenced by a computed tomography (CT) scan and surgical findings. We perform a brief literature review on the arachnoid cyst and its suggested treatments. In our case, the patient underwent a surgical treatment with a complete resolution of the case.

Bilateral Non-Traumatic Acute Subdural Hematoma in Newborn

Yenidoğan akut subdural hematomu çok ender bir patoloji olmakla beraber, literatürde az sayıda olgu bildirilmiştir. En sık nedeni doğum travması olup, özellikle vakum veya forceps gibi eksternal fiksatörlerin kullanımı ile sıklığı artmaktadır. Yenidoğan olgumuz, doğum sonrası 5. günde kafasında şişlik nedeniyle polikliniğimize başvurdu. Öyküsünde son 3 gündür çok uyuduğu ve kusmalarının olduğu öğrenildi. Doğum travması öyküsü yoktu. Nörolojik muayenesi doğal olan olgumuzun Bilgisayarlı Beyin Tomografisinde (BBT) bilateral parietal bölgede sefal hematom ve temporalden oksipital bölgeye uzanan sıvama tarzında akut safhada bilateral subdural hematom tespit edildi. Cerrahi düşünülmedi. Hasta takiplerinde nörolojik olarak gerileme gözlenmedi. Yatışının altıncı gününde taburcu edildi. Klinik veya radyolojik olarak intrakranial basınç artışı olan olgularda cerrahi girişim gerekebilir. BBT, tanı ve izlem amacı ile tercih edilmesi gereken yöntemdir.

Curious association between Plasmodium vivax malaria and nontraumatic acute subdural hematoma.

Sir, A 65-year-old male was brought to the erectile dysfunction with acute onset of altered consciousness level. Relatives informed that the patient was having high-grade fever 4 days back that lasted for 2 days. On the day of admission, the patient suddenly lost his consciousness following an episode of vomiting. Relatives denied any history of abnormal limb movements or frothing from mouth or any facial deviation. Repeated questioning of all the available relatives was negative for history of head trauma (even trivial). On examination, he was afebrile with heart rate 76/min, regular, blood pressure 130/80 mmHg. He was stuporous, Glasgow coma scale-E1 M5 V1 with bilateral equal size (2 mm) pupils reacting to light. There was a paucity of movement in the right side with right-sided extensor plantar reflex. There was no hepatosplenomegaly. Respiratory, cardiovascular, and skin examinations were unremarkable. Computed tomography head showed acute subdural hematoma involving left cerebral convexity with 7 mm midline shift [Figures ​[Figures11 and ​and2].2]. Laboratory investigations revealed leukopenia (3400/mm3) with normal differential count, thrombocytopenia (25,000/mm3) with normal hemoglobin level. Blood urea nitrogen and serum creatinine level were mildly elevated (41 and 1.6 mg/dl, respectively). Liver function test, electrocardiography, and chest X-ray did not reveal any abnormality. Peripheral blood film (both thick and thin film) showed Plasmodium vivax trophozoites. Rapid test for malaria (lactate dehydrogenase based antigen detection test, First sign) was also positive for P. vivax. Dengue serology (NS1, IgG, and IgM dengue) was negative. Patient was intubated and placed on mechanical ventilation. He was started on intravenous artesunate and clindamycin as per WHO guideline and was planned for decompressive craniotomy following platelet transfusion. Only the following day, the patient could be taken up for surgery following eight random donor and one single donor platelet transfusion. Left frontotemporoparietal craniotomy, evacuation of the hematoma and cranioplasty was done [Figure 2]. In the following days in the intensive care unit patient's blood film became negative for malaria parasites and platelet count normalized. However, his sensorium never showed improvement-he remained comatose throughout the postoperative course. On day 16 the family decided to take him home against medical advice. Figure 1 Acute subdural hematoma over left cerebral convexity Figure 2 Postcraniotomy Increasing number of severe manifestations reported in the literature contributed to the increasing interest in P. vivax infection recently. In an observational study of 40 cases of severe vivax malaria, Kochar et al., described different complications, including ARDS, acute kidney injury, thrombocytopenia, hepatic dysfunction, and cerebral malaria.[1] Mixed infection with Plasmodium falciparum species was ruled out by PCR method in all these cases. Falciparum malaria complicated by subdural hematoma has been described in the literature.[2,3] All these cases had associated thrombocytopenia. To the best of my knowledge, this is the first case reported in the literature of a case of vivax malaria associated with acute nontraumatic subdural hematoma.

Subdural Hematomas in Pulmonary Arterial Hypertension Patients Treated with Protacyclin Analogs

Prostacyclin analogs therapy has been associated with development of thrombocytopenia. Little is known whether this treatment increases the risk of intracranial hemorrhage in pulmonary artery hypertension (PAH) patients. We queried the Cleveland Clinic billing database to identify cases of nontraumatic sudural hematoma (SDH) in patients with PAH. We identified those individuals who were receiving prostacyclin analogs therapy at the time of the neurological event and assessed whether these patients were also taking antiplatelet or anticoagulation therapies. We identified three cases of nontraumatic SDH in 856-patient-year of prostacylin analog treatment. All patients were women, had low normal platelet counts or thrombocytopenia, and were concomitantly receiving anticoagulation therapy in the appropriate therapeutic anticoagulation range. All three patients were managed conservatively and had no neurologic sequelae. Nontraumatic acute subdural hematoma is a rare event in patients with PAH treated with prostacyclin analogs. All affected patients were concomitantly receiving anticoagulation therapy.

Can Atropa belladonna L. poisoning result in acute subdural hematoma?

I read with interest the case series reported by Cikla et al that has recently been published in Human and Experimental Toxicology. They described nine suspected cases of accidental Atropa belladonna L. intoxication that almost all of them had one or more sign(s) and symptom(s) of anticholinergic toxidrome. One of their patients, who had multiple sclerosis, had developed acute subdural hematoma (ASDH) that the authors believed that to be due to the intoxication, as it is clear from their article title and ‘Discussion’. After the description of his brain surgery, the authors have explained about the clinical manifestations of A. belladonna L. poisoning and anticholinergic toxidrome and nothing about the cause(s) of development of ASDH in their concerned case. Interestingly, they have only stated that the reason of ASDH was unclear, while acute tachycardia and hypertension arising in such patients might have given the way. The main question is that whether acute tachycardia and hypertension in the setting of anticholinergic toxidrome can cause ASDH. If it is true, then the ASDH cannot be a rare event. As you know, ASDH usually follows head trauma, most frequently from the tearing of bridging veins between the cerebral cortex and the draining sinuses. Also, skull fracture may or may not be present. However, rarely, ASDH may occur spontaneously in the absence of head trauma. Only approximately 100 cases of nontraumatic ASDH have been described in the literature in sporadic case reports. These limited cases often have an arterial source. There are a number of possible causes or risk factors that may lead to nontraumatic ASDH, which include ruptured cortical artery, ruptured intracranial aneurysm, hypertensive cerebral hemorrhage, neoplasm, hematologic disorders, anticoagulant and thrombolytic therapy, cerebral amyloid angiopathy, dural arteriovenous fistulas, cocaine abuse, and acquired immune deficiency syndrome. Therefore, it seems that ASDH in the authors’ case is not due to the acute tachycardia and hypertension. The major concern in this regard is that if ASDH cannot be explained by the authors’ suggestions, why has it developed? Anticholinergics such as A. belladonna L., besides other signs and symptoms, as the authors have themselves mentioned, may produce agitation in association with coma and seizure. In these situations, it is very likely that the patient has suffered a head trauma. Thus, I think that the most possible explanation for the development of ASDH in this patient is head trauma that has been missed and not the acute tachycardia and hypertension, per se.

Nontraumatic acute subdural hematoma associated with the myelodysplastic/myeloproliferative neoplasms

Nontraumatic acute subdural hematoma associated with the myelodysplastic/myeloproliferative neoplasms

Spontaneous Resolution of Nontraumatic Acute Spinal Subdural Hematoma

Spinal subdural hematoma (SSDH) is an extremely uncommon condition. Causative factors include trauma, anticoagulant drug administration, hemostatic disorders, and vascular disorders such as arteriovenous malformations and lumbar punctures. Of SSDH cases, those that do not have any traumatic event can be considered cases of nontraumatic acute spinal subdural hematoma, which is known to have diverse clinical progress. Treatment typically consists of surgical decompression and cases in which the condition is relieved with conservative treatment are rarely reported. We report two nontraumatic acute spinal subdural hematoma patients who were successfully treated without surgery.

Inhospital Spontaneous Acute Subdural Hematoma (SADH) Patient with Antiplatelet Therapy due to Acute Cerebral Ischemia - A Case Report -

A case of “spontaneous” acute subdural hematoma caused by aspirin and plavix therapy has not been described previously. As an isolated cerebrovascular event related to aspirin and plavix therapy, this is the first report described in the literature. It also represents a new differential diagnosis for nontraumatic acute subdural hematomas.

Successful surgical treatment of a hemophiliac infant with nontraumatic acute subdural hematoma

Background The moderate hemophiliacs usually have no spontaneous bleeding, but bleed after minor or major trauma. The proper management of intracranial hemorrhage in hemophiliac children is a challenge. Case description An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure. The CT scans showed an acute subdural hematoma in the right temporoparietooccipital region with midline shift and a coincidental right cerebellar arachnoid cyst. After bolus factor VIII replacement, a right temporoparietal craniotomy was performed, and the subdural hematoma was evacuated. The postoperative CT scans demonstrated no hematoma. Conclusions The possibility of intracranial hemorrhage in a moderate hemophiliac infant should be considered even if the patient has no history of trauma. The surgical treatment results in a successful outcome in hemophiliac children with subdural hematomas provided that an aggressive factor replacement therapy is initiated before surgery.

Nontraumatic Acute Spinal Subdural Hematoma

The authors assessed the affect of gamma knife radiosurgery on patients with glaucoma.Fifteen eyes in 14 patients were treated with gamma knife radiosurgery during a 14-month period. Ocular pain was alleviated in all patients and intraocular pressure was decreased. There were no early side effects.Further studies are needed to elucidate the best treatment parameters, long-term results, and some of the pathophysiological effects.

Nontraumatic Acute Spinal Subdural Hematoma

Nontraumatic Acute Spinal Subdural Hematoma

Nontraumatic acute spinal subdural hematoma

Acute subdural spinal hematoma occurs rarely; however, when it does occur, it may have disastrous consequences. The authors assessed the outcome of surgery for this lesion in relation to causative factors and diagnostic imaging (computerized tomography [CT], CT myelography), as well as eventual preservation of the subarachnoid space. The authors reviewed 106 cases of nontraumatic acute subdural spinal hematoma (101 published cases and five of their own) in terms of cause, diagnosis, treatment, and long-term outcome. Fifty-one patients (49%) were men and 55 (51%) were women. In 70% of patients the spinal segment involved was in the lumbar or thoracolumbar spine. In 57 cases (54%) there was a defect in the hemostatic mechanism. Spinal puncture was performed in 50 patients (47%). Late surgical treatment was performed in 59 cases (56%): outcome was good in 25 cases (42%) (in 20 of these patients preoperative neurological evaluation had shown mild deficits or paraparesis, and three patients had presented with subarachnoid hemorrhage [SAH]). The outcome was poor in 34 cases (58%; 23 patients with paraplegia and 11 with SAH). The formation of nontraumatic acute spinal subdural hematomas may result from coagulation abnormalities and iatrogenic causes such as spinal puncture. Their effect on the spinal cord and/or nerve roots may be limited to a mere compressive mechanism when the subarachnoid space is preserved and the hematoma is confined between the dura and the arachnoid. It seems likely that the theory regarding the opening of the dural compartment, verified at the cerebral level, is applicable to the spinal level too. Early surgical treatment is always indicated when the patient's neurological status progressively deteriorates. The best results can be obtained in patients who do not experience SAH. In a few selected patients in whom neurological impairment is minimal, conservative treatment is possible.

Dural Cavernous Angioma Causing Acute Subdural Hemorrhage —Case Report—

A 78-year-old female presented with a nontraumatic acute subdural hematoma (ASDH) caused by hemorrhage from a cavernous angioma located on the convexity dura mater. The hematoma and angioma were removed successfully. Neuroimaging performed 2 years previously had not revealed cavernous angioma. The angioma most likely grew rapidly over the 2 year period, during which she had received oral antiplatelet medication. Nontraumatic ASDH may originate from a cavernous angioma which grows rapidly.

Nontraumatic Acute Subdural Hematoma

A case of an acute subdural hematoma in association with a hypertensive intracerebral hemorrhage is presented. Scene examination, medical history, and autopsy findings support the conclusion that the subdural hemorrhage was the result of natural disease. Although the majority of acute subdural hematomas occurring in cases of sudden unexpected death involve trauma of some type, they can occur as a result of natural processes, or as a spontaneous phenomenon associated with cortical artery rupture. The literature describing nontraumatic causes of subdural hemorrhage is reviewed.