Spontaneous Subdural Hematoma Research Articles

Benign meningioma manifesting with acute subdural hematoma and cerebral edema: a case report and review of the\xa0literature

BackgroundSpontaneous subdural hematoma rarely presents with a hypervascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered a patient with acute subdural hematoma associated with benign meningioma. Here, we report this case along with a review of previous reports, especially focusing on their clinical features and possible bleeding mechanisms.Case presentationA 53-year-old Asian woman presented with severe headache and progressive neurologic deterioration due to cerebral edema. The patient was submitted to open surgery for evacuation of the subdural hematoma and concurrent tumor removal on the ipsilateral parietal convexity. A hypervascular, encapsulated mass was identified during surgery and completely removed including the adjacent dura mater (Simpson grade 0). The tumor was histologically confirmed as an angiomatous meningioma (World Health Organization grade I). Her clinical course was uneventful after surgery.ConclusionsAlthough 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.

A RARE CASE REPORT OF SUBDURAL HAEMATOMA WITH ANEMIA APLASTIC

Objective and Importance. To illustrate the development of a rare case of spontaneous subdural hematoma (SDH) secondary to aplastic anemia and conservative treatment of SDH. Clinical Presentation. A 43-year-old male complained of severe progressive headaches that starting from one month ago. His laboratory values showed pancytopenia and his peripheral blood smear showed no abnormalities except lack of the number of erythrocytes, leukocyte, and thrombocyte and we could not find any malignancy in the smear. He experienced headache, disorder of balance and decrease of consciousness CT imaging of the head showed a 7.0 cm (2 cm thickness) left frontal-parietal subdural hematoma. Conclusion. Aplastic anemia is a rare case with manifested of subdural hematoma.

A Rare Complications of Sickle Cell Disease: Empyema and Chronic Subdural Hematoma

Sickle cell disease is a hemoglobinopathy responsible for many complications that are sometimes frightening. Brain damage is part of one of the complications that can affect the vital and/or functional prognosis of patients. We report two cases of neurological complications, patients with known homozygous sickle cell disease, admitted to the Resuscitation Service of the JRA University Hospital for neurological deficit of recent appearance. One presented a spontaneous bilateral chronic bilateral subdural hematoma, and the other an extradural empyema diagnosed on brain scan. The patients benefited from a neurosurgical intervention with favorable postoperative outcomes, marked by an improvement in neurological symptoms. This form of complication is relatively rare in patients with sickle cell disease. It is favoured by repeated vaso-occlusive crises responsible for vascular fragility following repeated ischemia and inflammatory phenomena. The surgical indication depends on the clinical condition and the radiological aspect

Complicated Post-Partum HELLP Syndrome Causing Acute Renal Failure and a Spontaneous Acute Subdural Hematoma

HELLP syndrome is characterized by hemolysis, elevated liver enzymes, and thrombocytopenia. It is a devastating illness that typically occurs in the third trimester of gestation. We present a unique case of complicated post-partum HELLP syndrome.The patient was a 34-year-old Caucasian G1PO woman at 40 weeks’ gestational age who presented for induction of labor. She underwent successful vaginal delivery. However, postoperatively the patient developed HELLP syndrome complicated by acute renal failure. She was transferred to the intensive care unit, where her renal function continued to decline, ultimately necessitating hemodialysis. She subsequently spontaneously developed an acute subdural hematoma.Most cases of HELLP syndrome occur in the third trimester, whereas fewer manifest post-partum. The pathophysiology of HELLP syndrome is poorly understood. While the defining organ of injury in HELLP syndrome is the liver, both kidney injury and spontaneous subdural hematomas can occur, as seen in this patient. The gold standard therapy for HELLP syndrome is prompt delivery of the fetus.HELLP syndrome continues to be a serious constellation of symptoms that can affect women late in their gestational period. As illustrated in this case report, prompt diagnosis of HELLP syndrome and appropriate management is critical.

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.

A CASE REPORT OF ACUTE NONTRAUMATIC SPONTANEOUS SUBDURAL HAEMATOMA DUE TO PSEUDOANEURYSM OF MIDDLE MENINGEAL ARTERY

Acute subdural bleeding is blood collection in subdural space, usually caused by laceration of the bridging vein that runs from cortex to meningeal layer. On the other hand, the acute epidural hematoma is a collection of blood above the dura mater, usually caused by tearing of the middle meningeal artery. Subdural hematoma acute more likely happen in elderly than young adult. This case report discusses acute spontaneous subdural hematoma that was caused by a pseudoaneurysm of the middle meningeal artery. Seventeen years old boy came with symptoms of high intracranial pressure because of massive subdural bleeding. He was undergone craniotomy. After the clot removal operation, Digital Subtraction Angiography revealed vascular blush and pseudoaneurysm of the middle meningeal artery. Onyx embolization was delivered to proximal to a distal branch of the middle meningeal artery. The patient recovered in good condition, and no rebleeding in two years. Conclusion. Acute spontaneous subdural bleeding even though it is quite rare, but the chance of fatal rebleeding is high. As a result, one still has to look for the source of bleeding and manage comprehensively with embolization.

Spontaneous spinal hematoma

Background. Spontaneous spinal hematoma (SSH) is a rare condition that can result in severe functional disability and even death. But early detection and prompt intervention can substantially reduce the morbidity. We present a series of seven operated cases of SSH. Methods. All operated cases of SSH between 2017 and 2019 were studied. The demographic and clinical features, risk factors and imaging features were analyzed. The functional outcome at discharge and 6 months were assessed. Results. Seven operated cases of SSH with mean age 35(SD-20.9) were studied. Six cases were spontaneous spinal extradural hematomas (SSEDH) and one case was spontaneous spinal subdural hematoma (SSSDH). The most common site was cervicothoracic. Risk factors associated with SSH were thrombocytopenia, pregnancy, and necrotising pancreatitis. Two patients had preoperative Frankel’s grade A-B, three had grade C and two had D. The mean interval between the onset of symptoms and surgery was 4.7days. The functional outcome was dependent on the pre-operative functional status of the patient. Patients with SSEDH and thrombocytopenia had a poor outcome. Conclusion. SSH even though spontaneous may be associated with risk factors. The presence of thrombocytopenia and preoperative functional status predicted outcome. This is the only single institution case series to report thrombocytopenia as a factor predicting poor outcome.

A retrospective analysis of emergency referrals and admissions to a regional neurosurgical centre 2016–2018

Background and objectives Emergencies account for 60% of UK neurosurgical workload. We analysed the emergency referrals made to the on-call neurosurgical registrar in a regional centre over three years, aiming to identify temporal trends in volume of referrals, admission practices and major diagnostic categories contributing to referrals and admissions. Methods Individual referrals recorded in on-call databases were processed to extract basic demographics, call timing, diagnosis category and whether the patient was admitted under neurosurgery. Linear regression analysis was used to identify temporal trends across the three years. Results A total of 18128 calls were made to the on-call registrar between 2016 and 2018, with a significant increase in monthly calls. On average, one call was received every 88 minutes. An increasing proportion of these calls were taken out of office hours. Diagnostic categories accounting for the largest percentage of calls were traumatic brain injury (17.7%) and cauda equina syndrome (13%). Significant increases in referral volume were seen in cauda equina syndrome, traumatic brain injury, spinal trauma and spinal tumours, while no category had a significant decrease. The admission rate was 17.1% – no change was seen in this across the study period, resulting in increasing numbers of admissions, reflecting increasing referrals. Categories most likely to result in admission were hydrocephalus (41.1%), spontaneous subarachnoid haemorrhage (39.4%), intracranial infection (32.6%) and chronic subdural haematoma (CSDH, 32.2%). A change in admission rate was seen only for CSDH, with a significant increase in the percentage of referrals across the study period. Conclusion Emergency neurosurgical referrals continue to rise in the UK at a rate exceeding population growth. This implies a decreasing referral threshold. However, the constant admission rate suggests either an increasing amount of neurosurgical pathology, the threshold for admission/intervention has decreased, or a combination. Neurosurgical services need to adapt in order to meet increasing demands.

Risk Factor Analysis and Surgical Outcomes of Acute Spontaneous Spinal Subdural Hematoma. An Institutional Experience of Four Cases and Literature Review

Spontaneous spinal subdural hematoma (SSSDH) is exceedingly rare, with significant morbidity in most patients. Acute neurologic deficit in the context of a SSSDH is considered a neurosurgical emergency. We performed a literature review and compared the results with our institutional experience to evaluate the risk factors and neurologic outcomes of SSSDH. We retrospectively collected the medical, radiologic, and surgical information of 4 patients with SSSDH who were operated on in our neurosurgical unit. A literature review of surgically managed patients with SSSDH and their neurologic outcomes was performed. Ordered logistic regression statistics were used to study the risk factors influencing the postoperative Domenicucci grade. A total of 112 patients were evaluated, with a female/male ratio of 1.3:1. Mean patient age was 60.25 years. Our analysis of the data showed that the cohort of patients presenting with bladder dysfunction in addition to paraparesis were found to have worse neurologic outcomes postoperatively. Adjusted analysis identified 3 clinical characteristics that influenced surgical outcome: cervical SSSDH (P= 0.029), neurologic deficit (P < 0.001), and anticoagulation medication (P < 0.001). This review shows that patients aged ≥60 years and on anticoagulation are at an increased risk of sustaining a spontaneous subdural spinal hematoma without history of trauma. To our knowledge, this is also the first study to show a presenting symptom of bladder dysfunction as a significant risk factor for poor surgical outcome in SSSDH. Our study supports surgical evacuation of acute SSSDH in the presence of these risk factors.

Spontaneous subdural haematoma in a neonate requiring urgent surgical evacuation

We describe the unusual case of a clinically significant subdural haematoma without any underlying cause in a term baby delivered by an elective caesarean section, which required surgical evacuation. We review the literature and describe the presentation, investigation and management options in infants with this infrequent condition.

A case series of hemorrhagic neurological complications of sickle cell disease: Multiple faces of an underestimated problem!

Sickle cell disease (SCD) is a group of hemoglobinopathies that vary in severity, the most severe form, homozygous sickle cell anemia, is often associated with neurologic complications. The incidence of various neurologic complications in SCD ranges from 6% to 30% in different series. Although the incidence of acute ischemic stroke and chronic cerebral ischemia is higher in SCD, about 20–30% of the neurological complications may be hemorrhagic in nature. Complications such as spontaneous subarachnoid hemorrhage, hemorrhagic stroke, extradural, and subdural hematomas have been described in the literature. The aim of this article was to report uncommon spontaneous hemorrhagic neurological manifestations of SCD. We have described three uncommon hemorrhagic neurological complications of SCD. One case had a parenchymal (intracerebral) bleed and presented with acute onset of parkinsonism, while two cases had an extradural hematoma (EDH), of which one patient had recurrent EDH at the same site which is hitherto not reported in the literature. Two patients survived, while one with recurrent EDH succumbed. Hemorrhagic neurological complications should be included in the list of differential diagnoses of neurological presentations in patients of SCD. EDH is an uncommon complication of SCD, while recurrent EDH is extremely rare. The condition should be suspected early in patients with SCD, as timely treatment often reduces the mortality.

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.

A 44 year old male Filipino with spontaneous acute subdural hematoma and subarachnoid hemorrhage caused by a dural arteriovenous fistula of the occipital lobe

Spontaneous acute subdural hematoma (ASDH) comprises only 2.6% of all ASDH. In one study, only 178 cases of spontaneous ASDH were documented, however, only 1 case among them was attributed to the presence of dural arteriovenous fistula (dAVF).Only less than 10% of all subarachnoid hemorrhage (SAH) are caused by vascular malformations. Spontaneous ASDH and SAH occurring together is extremely rare. There is a scarcity of literature on cases with dAVF of the occipital lobe as a cause of simultaneous spontaneous ASDH and SAH. A 44 year old Filipino male with no history of trauma, presented with severe headache, vomiting, and decreasing sensorium. CT scan revealed acute parenchymal bleed in the left occipital lobe with subarachnoid extension and subdural hematoma in the left frontoparietotemporal convexity and posterior interhemispheric falx. Due to the location of the lesion seen on CT scan and the gender distribution, Arteriovenous malformation (AVM) was initially considered, thus proceeded to CTA to establish the diagnosis of vascular anomaly, however, revealed dAVF instead. Four-vessel angiogram was done to assess the tributaries of the dAVF and confirmed the diagnosis. Complete obliteration of dAVF of the occipital lobe was done with Onyx Embolization in one session. This is the first case of Borden type II, Cognard type IIa+IIb dAVF, as reported in this institution. Although extremely rare as a cause of SAH and ASDH, dAVF should be considered as a differential in patients with the absence of identifiable common cause of new onset of severe headache and poor neurologic status.

45 External Validation of a Subdural Hematoma Risk Decision Instrument in Emergency Department Patients

Anticoagulation, hematoma size, and midline shift are significant prognostic factors for poor outcomes in the acute phase of subdural hematomas (SDH). They were used by Pruitt et al in 2017 to develop a decision instrument identifying low risk patients with traumatic SDH. We wished to externally validate this decision instrument in our emergency department (ED), an academic, Level 1 trauma center. We conducted a retrospective chart review study of patients ≥18 years old in the ED with CT-documented SDH from 2014-2016. Patients were considered high risk per the decision instrument if they had hematoma thickness >5mm, warfarin or clopidogrel use, initial Glasgow Coma Scale <14, midline shift, or ≥1 hematoma. Primary composite outcome included in-hospital death or transition to hospice, need for neurosurgery, neurologic decline, and/or worsening hematoma on CT. Five hundred twenty-three charts were reviewed, and 222 met inclusion criteria. Forty-one (18.5%) patients were low risk per the decision instrument. Of these, 13 (31.7%) experienced the composite outcome. The sensitivity for this instrument was 89.4% (95% CI 82.6% - 94.3%), and the specificity was 28.3% (95% CI 19.7% - 38.2%). Patients on novel oral anticoagulant (NOAC) agents had a 55.6% (5/9) composite outcome. Including all patients on NOACs as high risk did not affect sensitivity (89.4%, 95% CI 82.6% - 94.3%) and marginally worsened specificity (24.2%, 95% CI 16.2% - 33.9%). The current decision instrument resulted in a 31.7% adverse outcome rate for low risk patients. This could be due to differences in our patient population including higher rate of NOAC use, inclusion of patients with spontaneous SDH, and higher overall mortality in our population. We recommend further study before implementing reduced level of care for patients with SDH.

A case of acute spontaneous subdural hematoma associated with fibromuscular dysplasia

A case of acute spontaneous subdural hematoma associated with fibromuscular dysplasia

Spontaneous Recurrent Chronic Subdural Hematoma in a Young Woman

Spontaneous Recurrent Chronic Subdural Hematoma in a Young Woman

Spontaneous Acute Subdural Hematoma as an Initial Presentation of Chronic Myeloid Leukemia.

Spontaneous Acute Subdural Hematoma as an Initial Presentation of Chronic Myeloid Leukemia.

Spontaneous acute subdural hematoma. An unusual presentation of ruptured cerebral aneurysm

Spontaneous acute subdural hematoma. An unusual presentation of ruptured cerebral aneurysm

Acute idiopathic spinal subdural hematoma: What to do in an emergency?

Acute spinal cord compression usually results from trauma, infection, or cancer. Spinal subdural hematoma is an uncommon cause of spinal cord compression that occurs after spine trauma or spinal invasive procedure, especially in context of coagulopathy. In the following reported case, an 82-year-old woman with a history of rapidly progressive paraparesis after a sudden middle back pain, with no previous trauma or coagulopathy, due to an acute spontaneous spinal subdural hematoma. In fact, the main difficulty was to determine, in an emergency situation, the right strategy to identify both the lesion and its cause to adapt therapeutics. This case not only provides an illustrative unusual condition in an emergency department but also a challenging discussion to choose the right treatment for a sudden neurological impairment. According to a literature review of the idiopathic cases of spinal subdural hematomas without coagulopathy, the clinical outcome depends on severity of neurological impairment. MRI is the main examination to perform in an emergency. Thus surgical evacuation should be performed in emergency in patients presenting with severe neurological impairment.

Spontaneous acute subdural hematoma and intracerebral hemorrhage following HELLP syndrome: a case report

Spontaneous acute subdural hematoma and intracerebral hemorrhage following HELLP syndrome: a case report