Spontaneous Hematoma Research Articles

Spontaneous triceps hematoma and radial nerve impairment due to warfarin use

Spontaneous triceps hematoma and radial nerve impairment due to warfarin use

Additional treatment after primary conservative treatment in patients with chronic subdural hematoma-A retrospective study.

Chronic subdural hematoma (CSDH) is a common neurological condition and is typically treated with burr hole craniostomy. Nevertheless, conservative treatment may lead to spontaneous hematoma resolution in some patients. This study aims to describe the characteristics of patients who were treated conservatively without the eventual need for additional treatment. Data were retrospectively collected from patients who were primarily treated conservatively in three hospitals in the Netherlands from 2008 to 2018. The Primary outcome was the nonnecessity of additional treatment within 3 months after the initial CSDH diagnosis. We used univariable and multivariable logistic regression analyses to identify factors associated with not receiving additional treatment. In this study, 83 patients were included and 61 patients (73%) did not receive additional treatment within 3 months. Upon first presentation, the patients had a Markwalder Grading Scale score (MGS) of 0 (n=5, 6%), 1 (n=43, 52%), and 2 (n=35, 42%). Additional treatment was less often received by patients with smaller hematoma volumes (adjusted odds ratio [aOR] 0.78 per 10mL; 95% confidence interval [CI] 0.64-0.92). Patients using antithrombotic medication also received less additional treatment, but this association was not significant (aOR 2.02; 95% CI 0.61-6.69). Three quarters of the initially conservatively treated CSDH patients do not receive additional management. Typically, these patients have smaller hematoma volumes. Further, prospective research is needed to distinguish which patients require surgical intervention and in whom primary conservative treatment suffices.

Endoscopic Evacuation Versus Open Craniotomy and Evacuation of Non-traumatic Intracerebral Bleed: A Comparative Study.

Objective In patients with intracerebral hemorrhage (ICH), the usage of microsurgical instrumentation and techniques can reduce traction-related injuries and enhance postoperative outcomes compared with traditional hematoma evacuation.The purpose of this study was to compare the results of endoscopic evacuation of spontaneous non-traumatic ICH with conventional open craniotomies and evacuations of ICH in terms of safety, feasibility, and neurological outcomes. Methods This was a prospective study that included 21 patients with spontaneous intracerebral hematomas managed by surgical evacuation endoscopically and another 24 patients with spontaneous supratentorial ICH who underwent hematoma evacuation by open craniotomy. Primary outcomes included operation duration, operative blood loss, hematoma evacuation rate, re-bleeding rate, and postoperative Glasgow Coma Scale (GCS) score. Results The median operation durations were 110 (90-200) and 230 (120-460) minutes in the endoscopic and open procedure groups, respectively (p = 0.00001). The median operative blood loss was 160 (80-300) and 530 (100-2000) mL in the endoscopic and open procedure groups, respectively (p < 0.00001). The median hematoma removal rates were 90% (60%-99%) and 85% (60%-100%) in the endoscopic and open procedure groups, respectively (p = 0.0348). Re-bleeding rates were higher in the endoscopic group (p = 0.46). Postoperative Glasgow Outcome Scale scores at two-month and six-month intervals were similar between the groups (p = 0.87). Conclusion Endoscopic hematoma evacuation for spontaneous supratentorial hemorrhage is becoming a standard surgical procedure, and promising clinical results can be expected. In addition, an endoscope can enhance time efficiency, hematoma evacuation rates, and reduce bleeding. Although endoscopic surgeries have higher re-bleeding rates, the difference is not significant when compared to open craniotomies with similar postoperative GCS scores. It is therefore important to be familiar with the endoscope and its associated equipment in order to achieve better results and reduce complications.

Spontaneous Subdural Hematoma associated with Meningioma : Two case reports

Introduction: Spontaneous subdural hematoma rarely presents with a hyper vascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered two cases with spontaneous subdural hematoma associated with benign meningioma. Case Description: A 47-year-old Asian woman presented with severe headache and forgetfulness, initiated 3 months before, with no other complaints, denying any previous head trauma. Head computed tomography revealed a chronic left hemisphere subdural hematoma for this issue she underwent burr hole and evacuation of hematoma 1 month before. However her symptoms was not relieved and her magnetic resonance imaging of brain showed left frontal lesion , suggestive of meningioma. Surgical treatment was performed. The tumor was histologically confirmed as a transitional meningioma grade I. After surgery, no neurological deficits were registered, and headache subsided. Similarly, second case, a 56-year-old woman presented with complaints of severe headache for 6 hours. There is no history of seizure like activities, any previous history of head trauma. On examination, no neurological deficits noted. Computed Tomography (CT) of head showed a hyper dense extradural lesion with acute subdural lesion on left hemisphere. MRI brain revealed well defined extra axial round to oval lesion measuring 3.1 X 3.5 X 2.5 cm with areas of heterogeneous enhancement of the left parietal parasagittal area .She underwent left parietal craniotomy and en-bloc tumor resection done. Post operatively there was no neurological deficits and she was discharged on 5th post-operative day. Conclusions: As we could not identify any other cause for the subacute subdural hematoma, hemorrhage from the meningioma was the most probable cause. Although meningiomas are commonly benign according to their histological traits, they can lead to spontaneous bleeding and cause neurologically unstable condition. Therefore, meningiomas need to be considered as a cause of spontaneous subdural hematoma if radiologically suspicious, which should be reflected by proper management for a positive outcome.

Application of Robotic Stereotactic Assistance (ROSA) for spontaneous intracerebral hematoma aspiration and thrombolytic catheter placement

BackgroundSpontaneous intracerebral hemorrhage (ICH) accounts for up to 20% of all strokes and results in 40% mortality at 30 days. Although conservative medical management is still the standard treatment for ICH patients with small hematoma, patients with residual hematoma ≤15 mL after surgery are associated with better functional outcomes and survival rates. This study reported our clinical experience with using Robotic Stereotactic Assistance (ROSA) as a safe and effective approach for stereotactic ICH aspiration and intra-clot catheter placement. MethodsA retrospective analysis was conducted of patients with spontaneous ICH who underwent ROSA-guided ICH aspiration surgery. ROSA-guided ICH surgical techniques, an aspiration and intra-clot catheter placement protocol, and a specific operative workflow (pre-operative protocol, intraoperative procedure and postoperative management) were employed to aspirate ICH using the ROSA One Brain, and appropriate follow-up care was provided. ResultsFrom September 14, 2021 to May 4, 2022, a total of 7 patients were included in the study. Based on our workflow design, ROSA-guided stereotactic ICH aspiration effectively aspirated more than 50% of hematoma volume (or more than 30 mL for massive hematomas), thereby reducing the residual hematoma to less than 15 mL. The mean operative time of entire surgical procedure was 1.3 ± 0.3 h, with very little perioperative blood loss and no perioperative complications. No patients required catheter replacement and all patients’ functional status improved. ConclusionsWithin our clinical practice ROSA-guided ICH aspiration, using our established protocol and workflow, was safe and effective for reducing hematoma volume, with positive functional outcomes.

Can Angiography Be Planned Based on Specific CT Signs of Ongoing Soft Tissue Bleeding in COVID-19 Patients Receiving Anticoagulants?

Background. Anticoagulant therapy is recommended as basic medical treatment for COVID-19 patients with risk factors. At the same time, it is accompanied by a large number of hemorrhagic complications. Massive bleeding into abdominal and chest walls soft tissues as well as retroperitoneal space significantly worsens the course of underlying disease.Objective: to assess the prognostic value of specific CT signs and their correlation with angiography data for the diagnosis of ongoing bleeding into soft tissues in COVID-19 patients.Material and methods. A retrospective study was conducted, in which multi-slice computed tomography (MSCT) and angiography data were assessed and compared in 60 COVID-19 patients with spontaneous bleeding into chest and abdominal wall soft tissues as well as retroperitoneal space. A retrospective analysis of MSCT was carried out to identify symptoms specific to coagulopathic bleeding into soft tissues: contrast agent extravasation, hematocrit effect, and signal flare phenomenon.Results. Contrast agent extravasation identified by MSCT was confirmed in 57 (95%) patients. More often (39 (68.4%) patients), extravasation was detected in MSCT arterial phase. In MSCT venous phase it was noted in 17 (29.8%) cases, in delayed phase – in 1 (1.8%) patient. With native MSCT, hematoma contained clots and fluid level (hematocrit effect) in 43 (71.7%) patients, in 17 (28.3%) patients it had a homogeneous structure. With intravenous contrast, in 39 (90.7%) cases with fluid level the signal flare phenomenon was established, which was more often detected in the arterial phase (33 (84.6%) cases). Extravasation was detected on angiography in 27 (45%) patients; they underwent therapeutic embolization. In another 15 patients preventive embolization was performed. When extravasation into hematoma without fluid level on MSCT (13 cases), extravasation on angiography was detected in 4 (30.8%) patients. In the presence of extravasation into hematoma with fluid level, but without signal flare phenomenon (4 patients) it was noted on angiography in 1 case. In the presence of all three signs (extravasation, hematocrit effect, and signal flare phenomenon – 39 patients), the incidence of extravasation on angiography was the highest – 56.4% (p = 0.028), and patients more often required therapeutic embolization.Conclusion. Detection of extravasation, fluid level and signal flare phenomenon on MSCT in the structure of spontaneous hematoma in COVID-19 patients corresponded to ongoing bleeding and more often required embolization than in isolated extravasation.

The Effect of Tranexamic Acid on Neurosurgical Intervention in Spontaneous Intracerebral Hematoma: Data From 121 Surgically Treated Participants From the Tranexamic Acid in IntraCerebral Hemorrhage-2 Randomized Controlled Trial.

An important proportion of patients with spontaneous intracerebral hemorrhage (ICH) undergo neurosurgical intervention to reduce mass effect from large hematomas and control the complications of bleeding, including hematoma expansion and hydrocephalus. The Tranexamic acid (TXA) for hyperacute primary IntraCerebral Hemorrhage (TICH-2) trial demonstrated that tranexamic acid (TXA) reduces the risk of hematoma expansion. We hypothesized that TXA would reduce the frequency of surgery (primary outcome) and improve functional outcome at 90 days in surgically treated patients in the TICH-2 data set. Participants enrolled in TICH-2 were randomized to placebo or TXA. Participants randomized to either TXA or placebo were analyzed for whether they received neurosurgery within 7 days and their characteristics, outcomes, hematoma volumes (HVs) were compared. Characteristics and outcomes of participants who received surgery were also compared with those who did not. Neurosurgery was performed in 5.2% of participants (121/2325), including craniotomy (57%), hematoma drainage (33%), and external ventricular drainage (21%). The number of patients receiving surgery who received TXA vs placebo were similar at 4.9% (57/1153) and 5.5% (64/1163), respectively (odds ratio [OR] 0.893; 95% CI 0.619-1.289; P -value = .545). TXA did not improve outcome compared with placebo in either surgically treated participants (OR 0.79; 95% CI 0.30-2.09; P = .64) or those undergoing hematoma evacuation by drainage or craniotomy (OR 1.19 95% 0.51-2.78; P -value = .69). Postoperative HV was not reduced by TXA (mean difference -8.97 95% CI -23.77, 5.82; P -value = .45). TXA was not associated with less neurosurgical intervention, reduced HV, or improved outcomes after surgery.

Spontaneous retroperitoneal haemorrhage after pulmonary endarterectomy surgery

Spontaneous retroperitoneal hematoma (SRH) is a rare complication of anticoagulation therapy. Presentation may vary from limb paresis to hypovolemic shock due to blood loss. The optimal treatment is controversial. It can be managed conservatively or surgically. We report a case of a 73-year-old man presenting with progressively worsening abdominal pain and severe pain radiating to his left lower limb twenty-five days after his pulmonary endarterectomy (PEA) surgery. He was on anticoagulation per our institutional protocol for PEA patients. Investigations revealed a large, spontaneously occurring iliopsoas hematoma. Our patient was treated conservatively, and the SRH stabilised.

A Rare Case of a Spontaneous Thoracic Epidural Hematoma in a Young Male Weightlifter

A Rare Case of a Spontaneous Thoracic Epidural Hematoma in a Young Male Weightlifter

A Case of Spontaneous Intracranial Hematoma with Critically Low Platelet Count: A Neurointensivist's Nightmare

AbstractComplications of immune thrombocytopenia (ITP) are more frequent at a platelet count lower than 10,000/μL of blood. Intracranial hematoma (ICH) is one of the most severe complications of ITP. Subdural hematoma (SDH) and subarachnoid hemorrhage (SAH) usually occur as extensions of ICH and is generally spontaneous in nature. We report a case of ICH along with SDH and SAH who presented with critically low platelet count managed using apheresis platelet transfusion, desmopressin, intravenous immunoglobulin, and methylprednisolone. The patient was discharged successfully from hospital without any neurological deficit. The importance of early referral and immediate aggressive management and monitoring at an advanced center is suggested.

Natural history of renal angiomyolipoma in a high-volume center: our experience during more than 15years of follow up.

To describe the natural history of AML, the clinical results and the need for treatment during long-term follow-up of renal AML. Retrospective study of patients diagnosed with AML by computed tomography or nuclear magnetic resonance between 2001 and 2019, with at least two follow-up images. Clinical and imaging variables, need for intervention, complications and follow-up time were recorded. Statistical analysis was performed using SPSS 22.0. 111 patients and 145 AML were included. The median follow-up was 6.17years (range 0.7-18.1, IQR 11.8-12.2). The median tumor size at diagnosis was 13mm (IQR 7.5-30), with 24 (16.4%) being ≥ 4cm. Most presented as an incidental finding (85.5%); in 3 (2.1%) cases, the presentation was as a spontaneous retroperitoneal hematoma. The main indication for intervention was size ≥ 4cm in 50%. Eighteen (12%) patients received a first intervention, being urgent in 3. Embolization was performed in 15 cases and partial nephrectomy in 3. The need for reintervention was recorded in five: two underwent partial nephrectomy and two total nephrectomy; one patient required a new urgent embolization. Of the non-operated patients, 43% decreased in size or did not change, while 57% increased, with the median annual growth being 0.13mm (IQR -0.11 to 0.73). There were no differences in the median growth in tumors measuring ≥ 4cm (0.16mm) at diagnosis vs. < 4cm (0.13mm) (p = 0.9). The findings of this study suggest that AML typically demonstrate a slow-progressing clinical course during long-term follow-up. Moreover, our observations, which cast doubt on tumor size as a reliable predictor of adverse clinical outcomes, advocate for a less intensive monitoring strategy in both monitoring frequency and choice of imaging modality.

Spontaneous Spinal Subdural Hematoma: A Case Report

Spinal epidural hematomas (SEH) are a rare form of hematoma affecting the nervous axis. Spontaneous epidural hematomas are defined as the presence of blood in the epidural space without any known cause. They may be associated with coagulopathies or arteriovenous malformations. HSSE can lead to disabling neurological deficits. Imaging and rapid intervention should be initiated as soon as a patient presents with symptoms suggestive of HGSS. We report the case of a 36-year-old patient who presented with SEH in a setting of acute spinal cord compression.

Clinical and radiological risk factors for poor outcomes in patients with spontaneous muscle hematomas

PurposeSpontaneous muscle hematomas (SMH) are frequently seen in the Emergency Department (ED), particularly as a complication of anticoagulation treatments. To date, there are no standard guidelines for the management of this condition in the ED.This work aims to identify clinical-radiological parameters of SMH at risk of poor outcomes. MethodThis is a retrospective, observational cohort study conducted in an urban teaching hospital from 2016 to 2019. A multivariate logistic regression analysis was performed to identify parameters independently associated with an adverse outcome defined as the need for treatment (blood products, TAE, surgery) or hospitalization. The parameters analyzed were hematoma size, anticoagulation therapy, age, and the Charlson Comorbidity Index (CCI). ROC analysis was performed to identify the best cut-off hematoma size value to predict poor outcomes. ResultsOur study enrolled 231 patients aged between 18 and 96 years, with a mean age of 67 years. In our population, 125 patients (54.1 % %) were on anticoagulant therapy.Multivariate analysis showed that an SMH diameter > 5.5 cm was independently associated with poor outcome ((odds Ratio [95 % CI] 4,009 [1,786–9,001], p 0.001). Among clinical parameters, only advanced age was proved to be an independent predictor of adverse outcomes (odds Ratio [95 % CI] 1,035 [1,003–1,069], p = 0.033) ConclusionsOur data suggest that an SMH diameter greater than 5.5 cm on a CT scan and advanced age are predictors of poor outcomes. Surprisingly, anticoagulant therapy seems to play a minor role in the outcome of SMHs.

Spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma: a rare case

BackgroundGastric intramural hematoma is a rare disease. Here we report a case of spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma.Case presentationA 75-years-old man was admitted to our department with complaints of abdominal pain. He underwent a whole abdominal computed tomography (CT) scan in the emergency department, which showed extensive thickening of the gastric wall in the gastric body and sinus region with enlarged surrounding lymph nodes, localized thickening of the intestinal wall in the transverse colon, localized indistinct demarcation between the stomach and transverse colon, and a small amount of fluid accumulation in the abdominal cavity. Immediately afterwards, he was admitted to our department, and then we arranged a computed tomography with intravenously administered contrast agent showed a spontaneous isolated gastric intramural hematoma combined with spontaneous superior mesenteric artery intermural hematoma. Therefore, we treated him with anticoagulation and conservative observation. During his stay in the hospital, he was given low-molecular heparin by subcutaneous injection for anticoagulation therapy, and after discharge, he was given oral anticoagulation therapy with rivaroxaban. At the follow-up of more than 4 months, most of the intramural hematoma was absorbed and became significantly smaller, and the intermural hematoma of the superior mesenteric artery was basically absorbed, which also confirmed that the intramural mass was an intramural hematoma.ConclusionA gastric intramural hematoma should be considered, when an intra-abdominal mass was found to be attached to the gastric wall. Proper recognition of gastric intramural hematoma can reduce the misdiagnosis rate of confusion with gastric cancer.

Surgical management of spontaneous posterior fossa hematoma: predictors of the neurological outcome

ObjectiveTo detect demographic, clinical, and radiological predictors of patient outcomes and prognosis in spontaneous cerebellar hematoma patients that may guide accurate decision making.MethodsThis retrospective study was conducted on 45 patients with spontaneous cerebellar hematoma who underwent surgical treatment. The patient data including demographics (age, gender), preoperative consciousness at the time of admission, medical comorbidities (HTN, DM), radiological findings (location, volume, and diameter of the cerebellar hematoma, hydrocephalus, compression of the fourth ventricle, effacement of the quadrigeminal cistern, intraventricular hematoma, tight posterior fossa, and brain stem compression), and treatment methods were collected and correlated with prognosis. Outcome assessment was done using the Glasgow Outcome Scale (GOS), classified into good outcome (favorable result; GOS > 4) and poor outcome (unfavorable result; GOS < 4).ResultsThere was a statistically significant correlation (p = 0.030) between the time to surgery and GOS, with more favorable outcomes in patients who underwent early surgery compared to late surgery. Unfavorable outcomes were detected in patients with higher Taneda grade and Kirollos grade, and both were statistically significant (p = 0.001). The presence of hydrocephalus and/or brainstem compression had a statistically significant (p < 0.001) negative impact on outcomes. Patients with extensive IVH had an unfavorable outcome compared to other patients (p = 0.016). The mortality rate in our study was 28.9%.ConclusionsSurgical management of spontaneous cerebellar hematoma is challenging. Many factors influence the appropriate decision making and surgical outcome. Predictors of an unfavorable outcome include the level of consciousness at admission, delayed time to surgery, a higher grade of 4th ventricular effacement (Kirollos) and quadrigeminal cistern effacement (Taneda), extensive IVH, hydrocephalus, and brainstem compression (statistically significant). There was no statistical significance regarding gender, age, hematoma volume, or hematoma diameter in relation to an unfavorable outcome.

A Case report on subdural hematoma in a 60yr old male patient with ESRD

A subdural hematoma occurs when a clot forms between the brain and its outer covering. Chronic dialysis becomes necessary as a treatment to externally filter the blood, when kidneys are no capable of fulfilling this role. This validates that the patients undergoing hemodialysis face a higher risk of developing subdural hematoma. The KDIGO foundation guidelines defines the chronic kidney disease using the markers such as the proteinuria and the glomerular filtration rate(GFR). Hemodialysis patient and other type of bleeding tendency are more prone to the spontaneous traumatic subdural hematoma and the intracerebral hematoma. This increased risk is attributed to the elevated mortality rate observed in the dialysis patient affected by the subdural hematoma. Consequently, it becomes imperative to implement the preventive measures aimed at reducing the occurrence of subdural hematoma in the individuals with the end stage renal disease, especially those undergoing the hemodialysis treatment. The high occurrence rate of the subdural hematoma and its recent surge is related to the increased use of anticoagulant in the long-term hemodialysis patient. Hence proper care for the patient is necessary to prevent devastating the disorder. This case report is demonstrating that there is a striking enrichment for the underlying comorbid conditions in the patient who has developed subdural hematoma and has the high risk of the immediate mortality.

Nephrotic syndrome with rectus sheath hematoma: a case report

BackgroundRectus sheath hematoma is a rare presentation often associated with abdominal trauma and anticoagulant therapy. Here, we present a patient with severe rectus sheath hematoma accompanied by nephrotic syndrome who achieved significant clinical improvement without the need for invasive treatment.Case presentationA 72-year-old Japanese woman was referred to our hospital for the treatment of nephrotic syndrome. She was receiving steroid and anticoagulant therapy. Then she had abdominal pain and she was diagnosed with spontaneous rectus sheath hematoma by abdominal computed tomography. She received transfusion and was managed conservatively with bed rest, which led to improvement in abdominal pain.ConclusionDespite the absence of trauma history, rectus sheath hematoma should be considered in patients at risk of vascular failure, including those receiving anticoagulant or steroid therapy, those who are elderly, and those with nephrotic syndrome.

Spontaneous large subperiosteal orbital hematoma in a patient with neuroblastoma

Abstract: We present a case of spontaneous large subperiosteal orbital hematoma in a 2-year-old boy causing compressive optic neuropathy. On physical examination, he was found to have an abdominal mass. The patient underwent urgent drainage of the subperiosteal orbital hematoma along with a biopsy of the abdominal mass which confirmed the diagnosis of neuroblastoma. Following surgery, proptosis, optic disc swelling, and afferent pupillary defect (APD) improved, and after one month of receiving two doses of chemotherapy, his general condition improved.

Case of spontaneous hematoma of the renal compartment resulting in hemorrhagic shock: A unique presentation in urology

Hemorrhagic shock from spontaneous retroperitoneal hematoma of renal origin is a rare condition, and there are few publications on this subject. We present the case of a 60-year-old obese patient who experienced hemorrhagic shock from a right renal subcapsular hematoma that had ruptured into the retroperitoneum after initiation of anticoagulant treatment for acute pulmonary edema in the context of recurrent paroxysmal atrial fibrillation. The CT scan revealed a retroperitoneal hematoma and a possible hemorrhagic cyst in the right kidney. An emergency nephrectomy was necessary for hemostasis. The histology of the nephrectomy specimen confirmed the diagnosis of renal cell carcinoma.

Pediatric scurvy case report: a novel presentation with deep vein thrombosis secondary to large bilateral spontaneous iliac subperiosteal hematomas

BackgroundScurvy is an uncommon disease in developed countries caused by deficiency of vitamin C. We present a case of scurvy in a 14-year-old male with autism with both novel presentation and imaging findings. This case had the novel presentation of lower limb deep vein thrombosis (DVT) secondary to compression of the external iliac vein from large bilateral iliac wing subperiosteal hematomas. Subperiosteal hematoma is a well-recognised feature of scurvy but large and bilateral pelvic subperiosteal hematoma causing DVT has not previously been described.Case presentationA 14 year old Caucasian male with background of autism and severe dietary restriction presented with lower limb swelling and immobility. He was diagnosed with lower limb DVT. Further investigation revealed an iron deficiency anaemia, and he was found on MRI to have large bilateral subperiosteal iliac hematomata causing compression of the iliac vessels. He improved following treatment with vitamin C replacement and follow-up imaging demonstrated resolution of the DVT and hematoma.ConclusionDVT is rare in children and when diagnosed should prompt investigation as to the underlying cause. This case demonstrates an unusual cause of DVT and as an unusual presentation of paediatric scurvy.