Spontaneous Subdural Hemorrhage Research Articles

Spontaneous subdural haemorrhage in an in vitro fertilisation conceived triplet pregnancy - A case study.

Spontaneous subdural haemorrhage in an in vitro fertilisation conceived triplet pregnancy - A case study.

Spontaneous subdural haemorrhage: an unusual cause

Spontaneous subdural haemorrhage: an unusual cause

Spontaneous Intracystic and Subdural Hemorrhage of an Arachnoid Cyst: A Case Report with Baseline Imaging of an Intact Cyst

Spontaneous Intracystic and Subdural Hemorrhage of an Arachnoid Cyst: A Case Report with Baseline Imaging of an Intact Cyst

Reversible Cerebral Vasoconstriction Syndrome with Spontaneous Spinal Subdural Hemorrhage—a Perplexing Conundrum!!!

A middle aged lady presented with thunderclap headache and vomiting without any deficits on examination. Her cerebral imaging including MR and CT angiogram were normal but lumbar puncture (LP) revealed uniformly blood stained CSF suggestive of SAH. Subsequent spine imaging revealed spontaneous spinal subdural hemorrhages (SSDH) in the dorsal and lumbosacral cord. Coagulopathy and other essential work up was normal. Digital subtraction angiography (DSA) done 3 weeks into ictus revealed extensive cerebral vasospasm with sausage like beaded appearance akin to reversible cerebral vasoconstriction syndrome (RCVS) with normal spinal vasculature. She was treated with Nimodipine for 6 weeks. Her headache improved without any recurrence. Repeat DSA and spine imaging was normal with resolution of both vasospasm and SSDH. Establishing the inciting event in this patient with 2 obvious pathologies, SSDH and possible RCVS, is a perplexing task and forms the central idea of discussion. We made an attempt to resolve this chicken egg paradox, ie, SSDH leading to intracranial vasospasm vs RCVS leading SSDH, by providing rational arguments for both the clinical scenarios. We would also like to highlight the necessity of spinal imaging in patients with thunderclap headache.

Systemic lupus erythematosus presenting as acquired factor XIII deficiency and spontaneous subdural haemorrhage

The Asian Journal of Internal Medicine is the official journal of the Sri Lanka College of Internal Medicine. It is an open access peer-reviewed journal which is currently published bi-annually. AJIM’s mission is to achieve the supreme standards of holistic patient care by dissemination of high quality scientific knowledge related to Internal Medicine in the whole of Asia and Sri Lanka.

(127) Amphetamine Salts in Hepatic Impairment: A Case of Spontaneous Subdural Hemorrhage

(127) Amphetamine Salts in Hepatic Impairment: A Case of Spontaneous Subdural Hemorrhage

A Rare Case of Spontaneous Subdural Hemorrhage in Dengue Fever That Mimics a Tumor on MRI: A Case Report

A Rare Case of Spontaneous Subdural Hemorrhage in Dengue Fever That Mimics a Tumor on MRI: A Case Report

Recurrent Spontaneous Bilateral Subdural Hemorrhage as a Consequence of High-Cervical Spontaneous CSF Leak—Lessons for Neurosurgeons

AbstractSpontaneous intracranial hypotension (SIH) is rare. It presents as intractable posture headache and is identified by radiological findings. It is confirmed by cerebrospinal fluid (CSF) manometry and myelography, and treatment is carried out with the help of epidural blood patch (EBP) therapy. SIH presenting with spontaneous bilateral recurrent subdural bleeds is uncommon. The cause being a high-spinal CSF leak is even more uncommon! Our patient had recurrent bilateral spontaneous chronic subdural hematomas. Myelographic examination of the spine showed a C1–C2 level leak of CSF. He was taken up for open microsurgery, and the leak was identified and closed with fibrin glue. The patient however deteriorated the next day. An EBP was applied in the lumbar region to cover the myelogram lumbar puncture site. We present a review of literature and an algorithm to detect the elusive CSF leak and effect definitive treatment, either open or EBP, to treat the source of the problem.

Spontaneous Subdural Hemorrhage in a Patient With Systemic Sclerosis: A Rare Association.

Spontaneous Subdural Hemorrhage in a Patient With Systemic Sclerosis: A Rare Association.

A Rare Case of Epileptic Seizure After-effect Resulting in Nontraumatic Spontaneous Subdural Hemorrhage

Generalized tonic–clonic seizures (GTCS) result in diverse physiological alterations that are mostly short-lived and rarely lead to immediate serious consequences. Some early serious complications reported are head trauma and aspiration. While most cases of seizures are diagnosed readily from clinical history, some cases remain indolent and present later. A brain hemorrhage can have varied manifestations that warrant every clinician to be vigilant in diagnosis and management to prevent life-threatening complications. Furthermore, many reports have described seizures in patients operated for subdural hematoma (SDH), but to the best of our knowledge, none reveals SDH after the seizure. We encountered an unexpected incident of severe SDH in a 32-year-old adult following witnessed GTCS.How to cite this articleSingh S, Kaushal A, Datta R, Unnithan RR, Mishra N. A Rare Case of Epileptic Seizure After-effect Resulting in Nontraumatic Spontaneous Subdural Hemorrhage. Indian J Crit Care Med 2020;24(8):722–723.

Post-Transplant Cyclophosphamide in Allogeneic Bone Marrow Transplantation for the Treatment of Benign Hematologic Diseases

Post-transplant cyclophosphamide (PTCy) based GVHD prevention regimens are an emerging platform in allogeneic transplantation for hematological malignancies and are being prospectively compared to traditional standards. We present a single-center retrospective series of adult allogeneic bone marrow transplantation with the use of post-transplant cyclophosphamide in the setting of benign hematological conditions. Ten patients were treated between 2013 to 2019. Non-myeloablative conditioning consisted of rATG 0.5mg/kg on day (D) -9, 2mg/kg on D-7,-8 (ATG was in one patient with DBA), fludarabine 30mg/m2 daily from D-6 to D-2, cyclophosphamide 14.5mg/kg D-6 and D-5, and 200cGy of total body irradiation D-1. The bone marrow graft was administered on D0. GVHD prophylaxis consisted of post-transplant cyclophosphamide at 50mg/kg/day IV D+3, and +4 mycophenolate mofetil (MMF) at 15 mg/kg 3 times daily (maximum daily dose 3000 mg) starting on D+5 with taper beginning at D+35 to be off around D+100, and tacrolimus on D+5 with a target trough of 5-10 ng/mL with tapering beginning at D+180 with a goal to be off at D+360 in the absence of any GVHD. The median age at the time of transplantation was 42 (range 24-73) and 4 of 10 were female. Diagnoses include severe aplastic anemia (n=6), Diamond-Blackfan Anemia (n=2), paroxysmal nocturnal hemoglobinuria (n=1), and pure red cell aplasia (n=1). Median Hematopoietic Cell Transplantation-specific Comorbidity Index (HCT-CI) was 0 (range 0-5). Bone marrow donors were haploidentical donors (n=6), fully matched unrelated donors(n=3), and fully matched sibling (n=1). The median donor age was 31 (range 22-53). Donor marrow grafts had a median CD34+ cell count of 4.41 x 106/kg recipient ideal body weight (range 1.12 x 106 to 20.5 x 106). At a median follow-up of 17 months (range 3, 63) after transplantation, all patients are alive, with donor-derived hematopoiesis and free of significant acute or chronic GVHD. Neutrophil and platelet engraftment occurred at a median of 21 (range 16-34) days and 33 (21-65) days, respectively, after transplantation. The patient with pure red cell aplasia developed secondary graft failure and required a second transplant using a peripherally collected graft with the same fully matched unrelated donor. For all recipients, median day +30 unsorted chimerism was 100% (range 71-100%). Patients have not experienced significant acute or chronic GVHD. There were no cases of grade II-IV acute GVHD observed. Chronic GVHD was observed in 3 patients with ocular disease (two mild, one moderate). All patients who are over 12 months after transplantation are off systemic immunosuppression. Three patients experienced CMV reactivation, two required preemptive treatment with oral valganciclovir, while the third had a single positive low level positive CMV PCR that resolved spontaneously. Three patients had low level positive EBV viremia, none of which required pre-emptive treatment. Other significant infectious complications before day +100 included BK cystitis in three patients, influenza, adenovirus cystitis, clostridium difficile colitis, streptococcal and enterococcal polymicrobial endocarditis, and enterococcal bacteremia. Significant non-infectious complications were rare. One patient experienced engraftment syndrome which resolved quickly with systemic steroid administration. Another patient suffered a small spontaneous subdural hemorrhage day +10 after transplantation, but subsequently made a full neurologic recovery. Post-transplant cyclophosphamide based non-myeloablative allogeneic bone marrow transplantation appears safe and effective for patients with non-malignant hematologic conditions and should be prospectively compared to historical regimens. Table 1. Cohort Characteristics. SAA - Severe aplastic anemia, DBA - Diamond Blackfan anemia, ATG- anti-thymocyte globulin, CSA- cyclosporine, Cy-cyclophosphamide, haplo- haploidentical Disclosures Defilipp: Incyte: Research Funding. Frigault:Nkarta: Consultancy; Novartis: Consultancy; Foundation Medicine: Consultancy; Xenetic: Consultancy; Juno/Celgene: Consultancy; Kite/Gilead: Honoraria; Incyte: Consultancy. Chen:Incyte: Consultancy; Magenta: Consultancy; Takeda: Consultancy; Kiadis: Consultancy; Abbvie: Consultancy.

Relevance of Abusive Head Trauma to Intracranial Hemorrhages and Bleeding Disorders.

Bleeding disorders and abusive head trauma (AHT) are associated with intracranial hemorrhage (ICH), including subdural hemorrhage (SDH). Because both conditions often present in young children, the need to screen for bleeding disorders would be better informed by data that include trauma history and are specific to young children. The Universal Data Collection database contains information on ICH in subjects with bleeding disorders, including age and trauma history. Study objectives were to (1) characterize the prevalence and calculate the probabilities of any ICH, traumatic ICH, and nontraumatic ICH in children with congenital bleeding disorders; (2) characterize the prevalence of spontaneous SDH on the basis of bleeding disorder; and (3) identify cases of von Willebrand disease (vWD) that mimic AHT. We reviewed subjects <4 years of age in the Universal Data Collection database. ICH was categorized on the basis of association with trauma. Prevalence and probability of types of ICH were calculated for each bleeding disorder. Of 3717 subjects, 255 (6.9%) had any ICH and 206 (5.5%) had nontraumatic ICH. The highest prevalence of ICH was in severe hemophilia A (9.1%) and B (10.7%). Of the 1233 subjects <2 years of age in which the specific location of any ICH was known, 13 (1.1%) had spontaneous SDH (12 with severe hemophilia; 1 with type 1 vWD). The findings in the subject with vWD were not congruent with AHT. In congenital bleeding disorders, nontraumatic ICH occurs most commonly in severe hemophilia. In this study, vWD is not supported as a "mimic" of AHT.

Spontaneous Intracranial Hemorrhage in Pregnancy: A Systematic Review of the Literature.

Stroke in pregnant women has a mortality rate of 1.4 deaths per 100,000 deliveries. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, nearly a quarter of strokes have an undeterminable cause. Spontaneous intracranial hemorrhage (ICH) is less frequent but results in significant morbidity. The main objective of this study is to review the literature on pregnant patients who had a spontaneous ICH. A systematic review of the literature was conducted on PubMed and the Cochrane library from January 1992 to September 2016 following the PRISMA guidelines. Studies reporting pregnant patients with spontaneous intraparenchymal hemorrhage (IPH), subarachnoid hemorrhage (SAH), and subdural hemorrhage (SDH) were selected and included if patients had non-structural ICH during pregnancy or up to 6weeks postpartum confirmed by imaging. Twenty studies were included, and 43 patients identified. Twenty-two patients (51.3%) presented with IPH, 15 patients (34.8%) with SAH, and five patients (11.6%) with SDH. The most common neurosurgical management was clinical in 76.7% of patients, and cesarean section was the most common obstetrical management in 28% of patients. The most common maternal outcome was death (48.8%), and fetal outcomes were evenly distributed among term delivery, preterm delivery, and fetal or neonatal death. Spontaneous ICH carries a high maternal mortality with IPH being the most common type, most frequently presenting in the third trimester. Diagnosis and management do not differ for the parturient compared to the non-pregnant woman.

Spontaneous subdural hemorrhage due to intracranial aneurysm rupture

Rupture of Intracranial aneurysm is a well known cause of intracranial hemorrhage and sudden death. Usually, intracranial aneurysms rupture leads to hemorrhage into subarachnoid space. Here, we report two cases of intracranial aneurysms causing subdural hemorrhage. So, subdural hemorrhage in the absence of head trauma requires meticulous examination of brain and Circle of Willis during autopsy to pick any ruptured intracranial aneurysms which may be hidden.

Spontaneous subdural haemorrhage due to meningioma in the post-partum setting

An acute presentation of a meningioma with spontaneous haemorrhage is rare, with mechanisms of haemorrhage remaining unclear. Here, we present a case of a meningioma causing spontaneous intra-tumoural and subdural haemorrhage in the post-partum setting, to our knowledge not previously described, with review of pertinent literature.

A Case of Sudden Death Due To Non Traumatic Acute Subdural Haemorrhage

Disease of the cardio vascular system (CVS) is the most common cause (45–50%) of sudden death in an apparently healthy adult followed by respiratory system and central nervous system (CNS). The suspicion of CVS involvement is more intense, if the deceased is obese and the death is immediate. We, in this case report, present a case which had similar pattern of death and thus cardiovascular disease was suspected by both the clinician and the forensic expert. However, on meticulous autopsy, it was concluded to be a case of spontaneous subdural haemorrhage. CNS conditions are the third leading cause of sudden death. The conditions are mostly attributed to cerebral/cerebellar haemorrhage, pontine haemorrhage, subarachnoid haemorrhage and thrombotic or embolic or other causes. Spontaneous subdural haemorrhage is a rare condition of sudden death. Subdural haemorrhage (SDH) is mostly traumatic in origin and is a very frequent observation at autopsy centres. This frequent observation may bias the autopsy surgeon, leading to over diagnosis of traumatic SDH, when in actual, it is a spontaneous SDH. This wrong diagnosis can grossly change the further course of events. So, in such suspicious cases, very meticulous observation and careful derivation of opinion is required to avoid confusion and error of diagnosis.

Subdural hemorrhages in acute lymphoblastic leukemia: case report and literature review

Acute lymphoblastic leukemia is a rare hematological malignancy. Pure subdural hemorrhages in a patient with acute lymphoblastic leukemia patient are extremely rare. This case presented acute spontaneous subdural hemorrhage without head trauma at first, and acute lymphoblastic leukemia was diagnosed later. The second time, the patient was admitted with multiple pure subdural hemorrhages in different locations and periods with a history of slight head trauma. Pure subdural hemorrhages can occur in a patient with acute lymphoblastic leukemia. More care would be needed for pure subdural hemorrhages without obvious head trauma, and patients with hematological malignancies should be protected from even mild head trauma.

Disseminated intravascular coagulation and subdural haemorrhage: complications from conservative management of placenta increta

SummaryConservative management of placenta accreta, though largely successful, can potentially result in significant morbidity, including sepsis or post‐partum haemorrhage. It can produce potentially debilitating consequences, including significant non‐obstetric haemorrhage. We report the rare event of disseminated intravascular coagulation with spontaneous concomitant cranial and spinal subdural haemorrhage arising from the conservative management of placenta increta. We discuss subsequent investigation and management to control the consumptive coagulopathy and prevent further neurological deterioration.

Spontaneous Acute Subdural Hemorrhage with Rupture of Intracranial Aneurysm: A Series of Two Cases and Review of Literature

We present a rare series of two cases of spontaneous intracranial aneurysmal hemorrhage associated with acute subdural hematoma. One patient was having ruptured anterior communicating artery aneurysm and acute subdural hematoma with no evidence of subarachnoid hemorrhage and the other patient presented with subarachnoid hemorrhage with bleeding in subdural, intraparenchymal, and intraventricular location with rupture of posterior communicating artery aneurysm. In this report, we are describing the pathophysiology and radiological features of subdural hematoma with aneurysm bleed.

Efficacy and Safety of Four Factor Prothrombin Complex Concentrates As a Reversal Agent for Oral Xa Inhibitors

INTRODUCTION: FDA had approved three oral Xa inhibitors (OXI) Rivaroxaban (R), Apixaban (A) and Edoxaban for the treatment of venous thromboembolism (VTE) and cardiac thromboembolism prophylaxis in patients with non-valvular atrial fibrillation (NV A fib). The incidence of major bleeding and intracranial hemorrhage (ICH) is lesser with OXI's compared to warfarin but due to lack of appropriate reversal agents, management of such situations are very difficult. In the healthy human volunteer studies Andexanet alfa, Activated or non-activated prothrombin complex concentrates (PCC) and recombinant factor VIIa have been studied but there is lack of good real time data due to which practices are diverse. KCentra (K) was FDA approved in 2013 for urgent reversal of warfarin in cases of acute major bleeding or emergent surgery and consists of inactive factors II, VII, IX, X, Protein C and Protein S. Our institution uses Kcentra to reverse OXIs starting in November 2014.METHODS: After IRB approval, all requests for KCentra from November 2014 to June 2015 were reviewed. For patients who were on an OXI and had acute life threatening bleeding or needed urgent surgery, the following variables were analyzed: demographics, clotting assays, dose and type of OXI, length of hospital stay, mortality, thrombotic events and medications.RESULTS: 12 requests for Kcentra were placed and at physicians discretion ten patients ultimately received it of which none died during that hospitalization. One of the two patients who didn't receive rapidly died (hepatic bleeding). Results include: Median age of 74 years (65-86 y), 6 were male (50%). Indications for OXI therapy- NV A fib (n=6), unprovoked VTE (n=2), provoked VTE (n=1), cancer associated VTE (n=1). The OXIs used were R (n=5) and A (n=5). Median time of administration of K from the last intake of the drug was 10 hours (8-15 h) and median length of hospital stay was 8 days (4-26). In 9 patients with available data, the pre-K median INR and PT was 1.4 (1.1-2.5)/20.6 s (11.8- 21.8s) and the median post-K INR and PT was 1.1 (1-1.8), 16.9 s (13.4-30.2 s), median activated partial thromboplastin time (aPTT) before K is 30.6 s (27.5-40.2 s). Anti Xa activity was tested in only 3 patients before K administration with a median of 0.66 IU/mL (0.54-1.48) and In 2 patients after K with a mean of 0.51 (0.32-0.71). Indications included emergent surgery in two (20%), ICH (20%)-1 spontaneous subdural hemorrhage (SDH) and 1 SDH after fall, 1 patient each on A and R, gastrointestinal bleeding (30%)- 1 gastric ulcer, 1 diverticular bleeding and 1 spontaneous with 2 of these 3 patients on R, Trauma (30%) causing spinal fractures (n=2) and hepatic bleeding (n=1). Median estimated glomerular filtration rate (eGFR), AST and ALT at the time of bleeding were 62 ml/min, 24 U/L and 17 U/L respectively. Median number of packed red blood cells (PRBC) transfused was 3 U with median hemoglobin at admission of 8.9 gm/dL (7-13.3) and median platelet count of 195 x10E3/cmm (163-356). The median K dose was 25 U/kg once (25-50) and one patient (10%) had acute VTE 14 days after administration (Lower extremity femoral DVT. 6 patients were on Aspirin (60%), 7 on p-glycoprotein (p-gp) inhibitors (70%), 3 (30%) on p-gp substrates & 2 (20%) on Selective Serotonin Reuptake Inhibitors.CONCLUSION: Kcentra use was observed to be safe as a reversal agent with acceptable risk of thrombosis. Advanced age, concurrent use of P-glycoprotein inhibitors, antiplatelet agents appear to be risk factors for bleeding and use of OXI's with such risk factors should be cautioned.TableAgeSexIndication of A/CDrugHospital daysIndication for Kcentra# of PRBCASAP-gp-XP-gp used64MNV AfibRivaroxaban 20 mg QD7Spontaneous SDH0YesYesAtorvastatin65MUnprovokedVTE/PERivaroxaban 20 mg QD9Trauma-Liver cyst rupture1NoNoNo76FProvokedVTERivaroxaban 20 mg QD4Spontaneous GI bleeding Diverticular7NoNoNo70MCancer AssociatedVTERivaroxaban 20 mg QD9Bleeding penile cancer-surgery4YesYesEsomeprazolePravastatin74MUnprovokedVTERivaroxaban 20 mg QD5GI bleeding-gastric ulcer3NoNoNo84FNV AfibApixaban5 mg BID4Fall-SDH0YesYesPropafenone73FNV AfibApixaban5 mg BID26Fall-Spinal trauma2NoYesOmeprazole68MNV AfibApixaban5 mg BID13Surgery-Type A Aortic aneurysm6YesYesAmiodoroneSimvastatin84FNV AfibApixaban5 mg BID23Trauma-Facial/spine fracture3YesYesPravastatin86MNV AfibApixaban5 mg BID5Spontaneous GI bleeding6YesYesAmiodorone DisclosuresOff Label Use: Kcentra is not FDA approved as a reversal agent for oral direct Xa inhibitors.