Spontaneous Subdural Hematoma Research Articles

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.

Spontaneous acute subdural hematoma: a case report and literature review

Background: Subdural hematoma is very often associated with head trauma. There are few documented cases of spontaneous acute subdural hematoma without a history of Case presentation: A 50-year-old man was admitted for a mild-intensity headache in helmet-like, which occurred in the night without any cause waking him up from his sleeping. He denied any drug taken, mainly anticoagulant, non-steroidal anti-inflammatory drugs. The neurological exam was absolutely normal. The head CT Scan performed showed a thick left fronto-temporal spontaneous acute subdural hematoma The blood investigations were normal. Brain angio-CT didn’t show any The patient benefited fromconservative treatment under observation and experienced a progressive regression of the headache throughout the hospitalization stay. He was discharged an eleventh day later. Conclusion: Spontaneous acute subdural hematoma is a rare entity. It requires painstaking clinical, biological, and imaging and a strict follow-up for its management.

Cerebral venous sinus thrombosis manifesting as chronic spontaneous subdural hematoma: case report and review of the literature

BackgroundCerebral venous sinus thrombosis (CVST) is a rare form of stroke that is mainly seen in young women. It is frequently associated with hemorrhagic venous infarction and subarachnoid hemorrhage. There are few reports of CVST associated with chronic non-traumatic subdural hematoma (SDH). The diagnosis of CVST with spontaneous SDH is difficult because of the variability of its clinical features. The management of SDH associated with CVST is controversial and not well-established.Case presentationWe report a 26-year-old woman with positive COVID-19 serology who presented with superior longitudinal sinus thrombosis associated with chronic spontaneous SDH. She was managed conservatively and treated with anticoagulation and corticosteroids. A follow-up angioscan 1 month after treatment showed regression of the SDH volume with partial repermeabilisation of the thrombosed sinus. Three months later, the follow-up angioscan showed complete resolution of the chronic SDH and superior longitudinal sinus thrombosis with restoration of venous flow.ConclusionsCVST can also present with spontaneous chronic SDH. The management of SDH concomitant with CVST remains controversial due to the rarity of its presentation and the risks associated with the use of anticoagulation.

Spontaneous Chronic Subdural Hematoma in Young Man Patient with Conservative Treatment : A Case Report

Background: Chronic subdural hematoma (cSDH) is a common neurosurgery disorder among the elderly, but it is rare in the younger patients. Incidence of cSDH is approximately 5/100.000 a year in the general population but it has higher rate in elderly. Most cases of cSDH has prior trauma event which then leads to hematoma formation in subdural space and inflammation is believed to have an important role in its pathophysiology.
 Case Report: This study reports a spontaneous cSDH case in a young adult patient whose symptoms appeared to be chronic headache, nausea, vomiting and dizziness. Any neurological deficit was absent. This patient was treated conservatively using an osmotic agent, mannitol, despite the fact that the current patient had an indication of surgical treatment. The patient was discharged from the hospital with a good outcome. After 2 months of follow-up, there was no sign of recurrence.
 Conclusion: Our study found several considerations in deciding treatment options for cSDH, including the condition of the patient and the doctor in charge’s viewpoint.

Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases.

Arachnoid cysts (ACs) are congenital abnormalities that can be located anywhere within the subarachnoid space along the cerebrospinal axis, although they are most often found on the left side in the temporal fossa and sylvian fissure. ACs comprise approximately 1% of all intracranial space-occupying lesions and are considered potential risk factors for subdural hematoma (SDH) in individuals of all age groups who have experienced traumatic brain injury. Although it is uncommon for an intracystic hemorrhage of an AC to occur without evidence of head trauma, it may be more common among children and young adults. Here, the authors present three cases of spontaneous AC intracystic hemorrhage with chronic SDH. Additionally, they provide a thorough review of the existing literature. All three patients with AC were adolescent males. In all cases, AC was identified using the Galassi classification (type II or III) and associated with spontaneous intracystic hemorrhage and chronic SDH as seen on imaging. Spontaneous intracystic hemorrhage is a rare complication and occurs most commonly on the left side. Surgery is the definitive treatment, requiring either craniotomy or burr hole for hematoma evacuation and microsurgical fenestration to drain the cyst into the subarachnoid cisterns.

Spontaneous spinal subdural hematoma secondary to chronic warfarin intake: A case report

Spontaneous spinal subdural hematoma secondary to chronic warfarin intake: A case report

Management of Immune Thrombotic Thrombocytopenic Purpura without Therapeutic Plasma Exchange: Analysis of Efficacy and Safety Data

Background: Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening autoimmune disorder caused by ADAMTS13 deficiency. Caplacizumab, an anti-VWF nanobody, is approved for iTTP treatment, reducing the need for therapeutic plasma exchange (TPE) and improving platelet recovery and survival. Methods: We conducted a retrospective study on 42 acute iTTP cases in Austria and Germany, treated with a modified regimen aimed at avoiding TPE if platelet count increased post-first caplacizumab dose. An extensive efficacy and safety analysis of this approach was performed, in comparison with a control group of 59 patients with iTTP, receiving frontline caplacizumab treatment with TPE and immunosuppression (standard of care, SOC). The main outcome was time to platelet count normalization. Secondary outcomes included clinical response, exacerbation, refractory iTTP, and iTTP-related deaths. Retrospective safety assessments with evaluation of treatment emergent adverse events (TEAE) were performed in both cohorts. Results: The median time to platelet count normalization was similar between the two cohorts (3 and 4 days; P = 0.31, see Figure 1). There were no significant differences in clinical response, exacerbations, refractoriness, or iTTP-related deaths (see Table 1). Four patients did not respond to the first dose of caplacizumab, and TPE was initiated. Cytomegalovirus infection, HIV/hepatitis B co-infection, and ovarian teratoma may have hindered immediate treatment response. Platelet count doubling and median platelet count change after first caplacizumab dose were unaffected by TPE. The median time to LDH normalization was 11 days in the TPE-free cohort. During overall follow-up at least one adverse event (TEAE) was observed in 11 patients (26.2%) in the TPE-free group and 15 patients (25.4%) in the SOC group (excluding adverse events of iTTP that were evaluated as outcome parameters) (see Table 1). There was one TTP-related death reported in the SOC group (1.7%). The cause of death in this patient was cerebral ischemia due to multiple strokes. Serious adverse events associated with therapeutic plasma exchange were observed in 3 patients (5.1%) exclusively in the SOC cohort. These included (1) in-hospital cardiac arrest (IHCA), (2) generalized seizure and supraventricular tachycardia and (3) a transfusion reaction with hypotension, rigors, pruritus and exanthema. Bleeding complications were reported without a significant difference and mainly comprised gingival bleeding and epistaxis. Two patients in the TPE-free cohort (4.8%) experienced major bleeding events, namely subdural hematoma requiring surgical intervention and gastrointestinal bleeding with mass transfusion. Spontaneous subdural hematoma occurred in one patient after 20 days of caplacizumab treatment. Gastrointestinal bleeding from a colon diverticulum occurred in another patient after a clinical response and resulted in a significant drop in hemoglobin and thrombocytes. Gastrointestinal bleeding worsened with concomitant factor XIII deficiency, which was reconstituted intravenously in addition to mass transfusion. Conclusion: Caplacizumab and immunosuppression, without TPE, rapidly controlled microvascular thrombosis and achieved a sustained clinical response in iTTP. The efficacy was similar to the control group, which received SOC. Standard iTTP treatment with TPE may lead to a prolonged hospital stay, including admission to the ICU, multiple sessions of daily TPE with associated risks, and the associated costs of plasma, equipment, nursing care, and medical supervision. The number of patients experiencing critical adverse events was comparable between groups. Bearing all restrictions of a retrospective cohort in mind, we did not identify a critical safety signal for TPE-free iTTP-treatment. However, TPE itself resulted in three life-threatening adverse events in the SOC cohort, including an in-hospital cardiac arrest. In conclusion, omitting TPE appears to be a viable choice for acute iTTP management that may reduce treatment burden without compromising patient outcomes or safety.

Spinal subdural hematoma in a patient with immune thrombocytopenic purpura following microvascular decompression: a rare case report.

This article reports a case of spontaneous spinal subdural hematoma (SSDH) after brain surgery in a patient with immune thrombocytopenic purpura (ITP), reviews the relevant literature, and discusses the etiology, pathogenesis, and clinical features of SSDH in patients with ITP. A male patient in his early 50 s with an 8-year history of ITP and suffering from coexistent hemifacial spasm and trigeminal neuralgia underwent microvascular decompression in our department. His preoperative corrected platelet count was within the normal range. On postoperative day 2, the patient complained of acute low back pain and sciatica. Lumbar magnetic resonance imaging demonstrated an SSDH extending from L3 to L4 with a significantly decreased platelet count (30.0 × 109/L). The pain was gradually relieved after 2 weeks of conservative treatment, and no neurological deficit occurred during the 1-year follow-up. Brain surgery may increase the risk of postoperative SSDH in patients with ITP. Clinicians planning brain surgery must conduct a rigorous assessment through detailed physical examination, laboratory tests, and medical history records and maintain perioperative platelet counts within the normal range to prevent various risks associated with spinal cord compression.

Spontaneous epidural and subdural hematomas of the spine: Review of anatomy and imaging findings.

Spontaneous epidural (SEH) and subdural hematomas (SSH) of the spine are a rare cause of spinal injury and morbidity. They often present in the emergency setting, though magnetic resonance imaging is the gold-standard for diagnosis. Knowledge of anatomy, and in particular of the dural layers of the spine, is crucial to understand the location of SEH and SSH and their relationship with spinal structure. In this pictorial review, we aim to explain imaging features of the SEH and SSH, and to rule out their main differential diagnosis.

A spontaneous chronic subdural hematoma in a boy after lifting a heavy object: a case report

Background: Subdural hematoma (SDH) is the accumulation of blood below the inner layer of the dura but external to the brain and arachnoid membrane. Chronic SDHs (cSDHs) are well documented in infants where it is frequently observed as a single entity but rare beyond infancy. Variable clinical manifestations may result, including headache, nausea or vomiting, mental status change, seizure, weakness, sensory disturbance, gait abnormality, and coma. Case Presentation: The current report presents a case of a 10-year-old boy, medically free, who presented to the emergency department complaining of bilateral generalized lower limb pain, headache, nausea, and vomiting. The patient reported that symptoms started following lifting a heavy object 2 days ago at school. All labs were normal. Physical examination was normal. Urgent head computed tomography showed a left-sided subdural collection. Urgent surgical evacuation was done, and the patient had a full recovery. The patient was discharged after 2 days and followed up within 1 month. Conclusion: Subdural bleeding can be triggered by a sudden rise in intravenous pressure. Early diagnosis and treatment with craniotomy and drainage revealed an excellent prognosis.

Challenges in Perioperative management of spontaneous acute subdural hematoma in haemophilia patients

Intracranial hemorrhage in patients with hemophilia is associated with high mortality and morbidity. We report a case of 15 years old boy with haemophilia A, who presented with a spontaneous acute subdural hematoma and underwent craniotomy for clot evacuation. The patient also received Factor VIII infusions peri-operatively along with other measures, to decrease blood loss. The patient presented with signs of raised intracranial pressure and received mannitol intra-operatively and postoperatively to prevent brain edema. Hypertonic saline (3 ml/kg of 3% solution) was also given over 30 minutes for brain relaxation. Recommendations for peri-operative preparation and management of haemophilia, especially in the setting of emergency major surgery were also reviewed.

INTRACRANIAL HEMORRHAGE IN APLASTIC ANEMIA – A REVIEW AND DISCUSSION OF TWO DISTINCT CLINICAL CASES

Aplastic anemia (AA) is a syndrome of bone marrow failure characterized by peripheral pancytopenia and marrow hypoplasia. Anemia, bleeding, and infection are usually presenting symptoms. Intracranial hemorrhage (IH) is a life-threatening complication of AA. We aim to examine laboratory and radiological findings in two patients with intracranial hemorrhage associated with AA and their therapeutic approach. Methods: A 12-year-old boy with a diagnosis of severe acquired AA was admitted to our hospital. After multiple bleeding episodes and febrile neutropenia he developed a spontaneous subdural hematoma without indication for surgical care. Medical treatment was initiated with eltrombopag, immunoglobulin plus methylprednisolone, platelet transfusion and FVII, FXIII and fibrinogen administration as needed. A 70-year-old woman with AA and priors of hypertension, atrial fibrillation and multiple bleeding events was admitted to our hospital after reporting a strong progressive headache, nausea and generalized lack of strength. CT brain imaging showed several cerebral micro-bleeding sites and a hemorrhage on the right cerebellar hemisphere. The chosen course of treatment was medical: immunoglobulin plus dexamethasone, eltrombopag, fibrinogen correction and platelet transfusion. Three months later the boy's hematoma reabsorbed and he was refered for allogenic transplantation with hematopoietic progenitor cells. On the other hand, despite optimized medical treatment, the woman's intracranial bleed worsened with mass effect and deteriorated clinical status. IH is a serious complication of pancytopenia in AA and should be treated as soon as the diagnosis is made. A detailed patient history and physical examination, as well as laboratory and radiological monitoring, are crucial to the management of intracranial bleeding in this context. In some cases, conservative treatment can be effective by correcting the thrombocytopenia and clotting factor levels.

Non-traumatic Spontaneous Spinal Subdural Hematoma in a Patient with Acute Paraplegia

Acute non-traumatic spinal subdural hematoma (SSDH) is a rare clinical condition in the emergency medicine practice and difficult to diagnose during the primary physical examination. It mostly occurs at thoracal vertebra levels due to trauma, use of anticoagulants, medical procedures such as acupuncture, arteriovenous malformations, hematological disorders or space-occupying lesions. Here, we discussed an elderly female patient who was not on anticoagulant and described sudden loss of muscle strength and sensation in both lower extremities. Initial laboratory and imaging including brain computerized tomography (CT) and magnetic resonance imaging (MRI) were in normal range. Her secondary examination revealed anesthesia under the T4 dermatome level. Cervical spine-MRI imaging revealed a subdural hematoma significantly compressing the spinal cord on the C7-T1 dermatome segments. Any emergency neurosurgical intervention was not considered and the patient was interned in the neurosurgical clinic for conservative treatment and further examination. Patient , with no progress seen in consecutive MRI scans, was discharged after offering an outpatient check-up. We recommend secondary physical examination in emergency department (ED). In the case of appearance of sensory deficits of certain dermatomes, spine-MR imaging may lead to put the diagnose early in ED.

Factors Associated with Nontraumatic Spontaneous Subdural Hematomas in Pediatric Patients.

In our study, we aimed to summarize the etiology of subdural hematoma that was not traumatic and required operation in pediatric patients. The subdural hematoma characteristics, possible etiologies, and treatment, as well as the patient outcomes, were analyzed. A retrospective examination was made of pediatric patients with subdural hematoma who were operated on at Ümraniye Training and Research Hospital. Patients with a history of trauma were excluded. Data on patient sex, age, bleeding location, type of hematoma based on computed tomography imaging, surgical treatment, presenting symptoms, presence of comorbidities, Glasgow Coma Scale, thrombocyte counts, and international normalized ratio values were recorded. Of the 19 patients included in the study, 4 were female and 15 were male. Their ages ranged between 0 and 15 (mean = 5.84) years. In 57.8% of the patients, comorbidities, including acute myeloid leukemia, a history of shunt operation, epilepsy, mucopolysaccharidosis, known subdural effusion, autism, coagulopathy, ventricular septal defect/tetralogy of Fallot, cerebrospinal fluid leakage after baclofen pump administration, Marfan's syndrome, and late neonatal sepsis were present, while 21% had arachnoid cysts and 21% had no reported comorbidities. This study suggests that, in pediatric patients with subdural hematoma with an amount of bleeding requiring surgical management, any underlying comorbidities should be investigated regardless of the presence of a history of trauma. While investigating systemic diseases, special attention should be paid to the presence of arachnoid cysts or disruption in cerebrospinal fluid dynamics along with a history of hematologic diseases.

Idiopathic Spinal Subarachnoid and Subdural Hemorrhage in a Patient With Eosinophilic Granulomatosis and Polyangiitis

BACKGROUND AND IMPORTANCE: Development of concomitant spontaneous subdural hematoma (SSDH) and spontaneous subarachnoid hemorrhage (SSAH) in the spine without inciting trauma, iatrogenic event, or underlying cerebrovascular malformation is rare. It is rarer still for these to present in a patient with eosinophilic granulomatosus with polyangiitis. CLINICAL PRESENTATION: Herein, we present the case of a 73-year-old woman with a complex medical history, including possible eosinophilic granulomatosus with polyangiitis, who was admitted to the medical intensive care unit at Dartmouth-Hitchcock Medical Center and was found to have concominant SSAH and SSDH. CONCLUSION: This case serves as a review of the common and uncommon symptoms of IS-SAH with SSDH to improve recognition of this acute neurosurgical emergency in the medical intensive care setting.

PB2326: SAFE AND EFFECTIVE PROPHYLAXIS WITH PLASMA-DERIVED FACTOR X CONCENTRATE IN AN ELDERLY PATIENT WITH HEREDITARY FACTOR X DEFICIENCY

Background: Coagulation factor X, human is a plasma-derived factor X concentrate indicated to treat and prevent bleeding in individuals with hereditary factor X deficiency (HFXD). The ages of patients in whom data was collected in the initial registration trials and post-marketing studies ranged from 0-58 years. To date, there have been no reports on treatment of elderly (>65 years) patients with plasma-derived factor X (pdFX) concentrate. Aims: To report the experience with pdFX concentrate in the prophylactic treatment of HFXD in a patient >65 years. Methods: Data was collected on a 71-year-old female with HFXD receiving prophylactic treatment with pdFX. Results: Although suspected to have some type of bleeding disorder since age 2, this individual was not diagnosed with HFXD until age 20. Initial treatment included fresh frozen plasma on-demand for acute bleeding episodes. Subsequent treatment included three-factor prothrombin complex concentrate (PCC), starting in the 1990s. Prophylactic treatment was started at age 57 after she developed a spontaneous subdural hematoma. She was transitioned from PCC to pdFX prophylaxis in November 2019 to more directly address her factor X deficiency and to avoid increasing other clotting factor levels above the normal range. She is currently receiving pdFX 21 units/kg weekly, which has been well tolerated and she has experienced no bleeding issues since starting this therapy. Summary/Conclusion: This is the first reported experience of prophylactic treatment of an elderly patient with pdFX. Additional details of this case including laboratory data and updates from her recent clinic visit(s) will be presented. The data supports the successful prophylactic treatment of elderly patients and the need to continue to collect data in this population of patients with this rare bleeding disorder.

Combined CSF-venous Fistula and middle meningeal artery embolization for treatment of spontaneous intracranial hypotension.

Transvenous Onyx embolization was recently described as an effective treatment of spontaneous intracranial hypotension caused by CSF-venous fistulas. Patients with CSF-venous fistulas can present with a wide spectrum of clinical and imaging findings, sometimes including spontaneous subdural hematomas, subdural hygromas, or a combination of both. Here, we describe four patients with spontaneous intracranial hypotension complicated by subdural fluid collections caused by CSF-venous fistulas. The patients were treated with transvenous Onyx embolization of their CSF-venous fistulas and transarterial particle embolization of the bilateral middle meningeal arteries, with both procedures performed in a single treatment session. All four patients had clinical improvement and decreased size or resolution of their subdural fluid collections. Based on our findings, we believe that middle meningeal embolization could be a useful adjunct to CSF-venous fistula embolization. A case-control study comparing patients who did or did not undergo middle meningeal embolization will be necessary to validate this supposition.

Management of a Patient with Bombay Blood Group and Chronic Liver Disease with Subdural Hematoma

AbstractThe Bombay blood group is an extremely rare entity within the conventional ABO blood grouping system. End-stage liver disease also presents with myriad disorders of coagulation due to impaired synthesis and dysfunction of clotting factors, which predisposes patients to spontaneous and life-threatening episodes of bleeding. We report a patient with Bombay blood group and end-stage liver disease who presented to our hospital with a spontaneous subdural hematoma. Although conventional parameters of coagulation in this patient were abnormal, we were able to safely defer product transfusion because his thromboelastography (TEG) report was within acceptable ranges. In this article, we discuss our strategy for optimization of extremely limited blood resources in this scenario and perioperative strategies for the management of coagulation anomalies in patients with liver dysfunction.

Subdural hematoma prevalence and long-term developmental outcomes in patients with benign expansion of the subarachnoid spaces.

Benign expansion of the subarachnoid spaces (BESS) is a condition seen in macrocephalic infants. BESS is associated with mild developmental delays which tend to resolve within a few years. It is accepted that patients with BESS are at increased risk of spontaneous subdural hematomas (SDHs), although the exact pathophysiology is not well understood. The prevalence of spontaneous SDH in BESS patients is poorly defined, with only a few large single-center series published. In this study the authors aimed to better define BESS prevalence and developmental outcomes through the longitudinal review of a large cohort of BESS patients. A large retrospective review was performed at a single institution from 1995 to 2020 for patients 2 years of age or younger with a diagnosis of BESS by neurology or neurosurgery and head circumference > 85th percentile. Demographic data, head circumference, presence of developmental delay, occurrence of SDH, and need for surgery were extracted from patient charts. The subarachnoid space (SAS) size was measured from the available MR images, and the sizes of those who did and did not develop SDH were compared. Free text search revealed BESS mentioned within the medical records of 1410 of 2.6 million patients. After exclusion criteria, 480 patients remained eligible for the study. Thirty-two percent (n = 154) of patients were diagnosed with developmental delay, most commonly gross motor delay (53%). Gross motor delay resolved in 86% of patients at a mean age of 22.2 months. The prevalence of spontaneous SDH in this BESS population over a period of 25 years was 8.1%. There was no significant association between SAS size and SDH formation. This study represents results for one of the largest cohorts of patients with BESS at a single institution. Gross motor delay was the most common developmental delay diagnosed, and a majority of patients had resolution of their delay. These data support that children with BESS have a higher prevalence of SDH than the general pediatric population, although SAS size was not significantly associated with SDH development.

Acute spontaneous spinal subdural hematoma presenting with Takotsubo cardiomyopathy: a rare case report and literature review.

Spontaneous spinal subdural hematoma (SSDH) is a rare and dangerous intraspinal hematoma that usually occurs in the thoracic vertebra. The influence of early cardiovascular changes secondary to spinal cord injury is an important emergent issue.Herein, we report a case of a middle-aged woman with clinical manifestations of back pain and motion and sensory disturbances below the level of spinal cord compression. During the disease course, she also developed changes indicative of myocardial injury, such as tachycardia, markedly increased concentrations of brain natriuretic peptide and cardiac troponin I, and a decreased left ventricular ejection fraction, which were consistent with the diagnosis of Takotsubo cardiomyopathy (TTC). After the administration of supportive therapies, the symptoms of myocardial injury rapidly resolved. With the absorption of SSDH, the symptoms and clinical signs were alleviated. We also reviewed the literature on cases of concomitant SSDH and TTC.This rare case broadens the symptom spectrum of SSDH and highlights the need for clinicians to be aware of concomitant SSDH and TTC. Initial conservative treatment is a viable option for SSDH with concomitant TTC. However, urgent surgery may be a better option if the SSDH progressively enlarges and causes spinal cord compression.