Thin Subdural Hematoma Research Articles

Holohemispheric Hemorhhage in Infantile Acute Subdural Hematoma: Serial Neuroimaging Analysis

Background: An acute subdural hematoma (ASDH) in infants without any external sign of trauma is differently recognized as shaken baby syndrome (SBS) / abusive head trauma (AHT) in the United States or as infantile acute subdural hematoma (IASDH) due to minor head trauma in Japan. The present case report aimed to demonstrate that IASDH can occur after a mild head impact if the dural border cell layer is disrupted in an infant with cranio-cerebral disproportion (CCD). Case description: A 5-month-old, male patient fell from a baby bed and struck his occiput against a mat. He began to cry and soon thereafter demonstrated signs of altered consciousness. He was taken to a pediatric hospital where computed tomography (CT) revealed a thin subdural hematoma (SDH) surrounding the entire right cerebral hemisphere. Fundoscopy found a right-sided retinal hemorrhage. Magnetic resonance imaging (MRI) on hospital day 4 revealed a thin, high-intensity ASDH surrounding the entire, cerebral convexity on the right side. In addition, benign enlargement of the subarachnoid space (BESS) and large sylvian fissure (LSF) were noted. On hospital day 12 and 18, follow-up MRI revealed a residual SDH with minimal reduction. The patient had an uneventful clinical course and met all the normal, developmental milestones as of his current age of 3 years. Conclusion: The present case is invaluable because it demonstrates that ASDH can occur as a result of a mild, occipital impact. Particularly relevant here is the thin, holohemispheric appearance of the hematoma on neuroimaging studies, which has been suitably termed, holohemispheric subdural hematoma (HHSDH). Also noteworthy is the long-term presence of the HHSDH with minimal reduction of the SDH. The HHSDH may be caused by entrapment of the hematoma in the dural border cell layer in the absence of any communication with the surrounding structures.

The role of coagulopathy and subdural hematoma thickness at admission in predicting the prognoses of patients with severe traumatic brain injury: a multicenter retrospective cohort study from China.

Traumatic brain injury (TBI) is one of the diseases with high disability and mortality worldwide. Recent studies have shown that TBI-related factors may change the complex balance between bleeding and thrombosis, leading to coagulation disorders. The aim of this retrospective study was to investigate the prediction of coagulopathy and subdural hematoma thickness at admission using the Glasgow Outcome Scale (GOS) in patients with severe TBI at 6 months after discharge. In this retrospective cohort study, a total of 1006 patients with severe TBI in large medical centers in three different provinces of China from June 2015 to June 2021 were enrolled after the exclusion criteria, and 800 patients who met the enrollment criteria were included. A receiver operating characteristic (ROC) curve was used to determine the best cut-off values of platelet (PLT), international normalized ratio (INR), activated partial thromboplastin time (APTT), and subdural hematoma (SDH) thickness. The ROC curve, nomogram, calibration curve, and the decision curve were used to evaluate the predictive effect of the coagulopathy and Coagulopathy-SDH(X1) models on the prognoses of patients with severe TBI, and the importance of predictive indicators was ranked by machine learning. Among the patients with severe TBI on admission, 576/800 (72%) had coagulopathy, 494/800 (61%) had SDH thickness ≥14.05mm, and 385/800 (48%) had coagulopathy combined with SDH thickness ≥14.05mm. Multivariate logistic regression analyses showed that age, pupil, brain herniation, WBC, CRP, SDH, coagulopathy, and X1 were independent prognostic factors for GOS after severe TBI. Compared with other single indicators, X1 as a predictor of the prognosis of severe TBI was more accurate. The GOS of patients with coagulopathy and thick SDH (X1, 1 point) at 6 months after discharge was significantly worse than that of patients with coagulopathy and thin SDH (X1, 2 points), patients without coagulopathy and thick SDH (X1, 3 point), and patients without coagulopathy and thin SDH (X1, 4 points). In the training group, the C-index based on the coagulopathy nomogram was 0.900. The C-index of the X1-based nomogram was 0.912. In the validation group, the C-index based on the coagulopathy nomogram was 0.858. The C-index of the X1-based nomogram was 0.877. Decision curve analysis also confirmed that the X1-based model had a higher clinical net benefit of GOS at 6 months after discharge than the coagulopathy-based model in most cases, both in the training and validation groups. In addition, compared with the calibration curve based on the coagulopathy model, the prediction of the X1 model-based calibration curve for the probability of GOS at 6 months after discharge showed better agreement with actual observations. Machine learning compared the importance of each independent influencing factor in the evaluation of GOS prediction after TBI, with results showing that the importance of X1 was better than that of coagulopathy alone. Coagulopathy combined with SDH thickness could be used as a new, accurate, and objective clinical predictor, and X1, based on combining coagulopathy with SDH thickness could be used to improve the accuracy of GOS prediction in patients with TBI, 6 months after discharge.

Technical Nuances in the Perioperative Management of Chronic Subdural Hematoma by Twin Burr Hole Craniostomy: Tips, Tricks, and Tactics

AbstractChronic subdural hematoma (CSDH) remains to be the most common neurosurgical entity usually encountered in the elderly population. With an increasing life expectancy and associated comorbidities, the incidence of CSDH is ever increasing. There is a lack of uniformity among neurosurgeons regarding management of CSDH, but surgical evacuation using twin burr hole craniostomy remains to be the most preferred modality. Other options available are twist drill craniostomy and craniotomy. A conservative approach may be preferred in a thin subdural hematoma with no or minimal neurological deficit or in high operative risk patients. Complications such as pneumocephalus, recollection, or rebleeding may be seen following surgical evacuation of CSDH. Herein we aimed to address the technical nuances associated with twin burr hole evacuation of CSDH to reduce the complications and the overall associated morbidity and mortality.

A case of pyridoxine-dependent epilepsy with novel ALDH7A1 mutations.

Pyridoxine-dependent epilepsy (PDE) is a rare autosomal-recessive disorder typically presenting with neonatal seizures and is sometimes difficult to diagnose, because the clinical features mimic those of birth asphyxia. A Japanese newborn boy presented with pulmonary haemorrhage and convulsions on the day of birth. Brain computed tomography showed diffuse, but mild, low-density cerebral white matter and a thin subdural hematoma in the posterior fossa. He did not have thrombocytopenia or coagulopathy. His respiratory status improved with conservative treatment, but his convulsions were persistent even after prescription of several antiepileptic drugs. His serum and cerebrospinal fluid showed decreased vitamin B6 vitamers and increased upstream metabolites of α-aminoadipic semialdehyde dehydrogenase, strongly suggesting a diagnosis of PDE; the epileptic spasms ceased after administration of intravenous pyridoxal phosphate hydrate. Gene analysis revealed novel compound heterozygous mutations in ALDH7A1 that included NM_001182.4:[c.1196G > T] and [c.1200 + 1G > A]. Atypical birth asphyxia with persistent neonatal seizure should prompt vitamin B6/metabolite screening.

Managing Nonoperable Intracranial Bleeding Associated With Apixaban: A Series of 2 Cases

Objective: To report 2 cases of nonoperable intracranial bleeding associated with apixaban managed by 3-factor prothrombin complex concentrate (PCC3). Case Summaries: Case 1 presented with a 1.3-cm left parieto-occipital hemorrhage and a thin subdural hematoma (SDH) on the left tentorium of the brain about 6 hours after his last dose of apixaban. Case 2 presented with a 4-mm left parafalcine SDH with time of most recent apixaban dose unknown. The patients received 24.9 to 25.5 U/kg of PCC3 with none to 1 U fresh frozen plasma (FFP) and demonstrated minimal or no progression in lesions measured by repeat computed tomography (CT) after treatment. One patient was discharged to a skilled nursing facility after 8 days; the other patient was discharged to home after 18 days. Discussion: Apixaban has no specific antidote. Current bleeding management strategies are based on expert opinion. The risks and benefits for differing strategies are unclear, and little clinical experience for managing apixaban-associated intracranial bleeding has been reported to date. These cases describe the clinical use of PCC3 to manage parieto-occipital and subdural hemorrhage associated with apixaban in events not requiring surgical intervention. Conclusion: In these 2 cases, 25 U/kg PCC3, with none to one unit FFP, ceased apixaban-associated intracranial bleeding without apparent thrombogenic complications.

Subdural and Cerebellar Hematomas Which Developed after Spinal Surgery: A Case Report and Review of the Literature

Cerebellar hemorrhage following a spinal surgery is extremely rare; however, considering the localization, it can cause major clinical manifestations. While it is considered that these types of bleedings occur secondary to a venous infarct, the pathogenesis is still unclear. A 57-year-old male patient who underwent a laminectomy by exposing T12-L5 and had pedicle screws placed for ankylosing spondylitis developed a CSF leak due to a 2 mm dural tear. A hemorrhage with parallel streaks on the left cerebellar hemisphere was seen in CT scan, and a thin subdural hematoma at right frontotemporal region was seen on cranial MRI, performed after the patient developed intense headache, nausea, vomiting, and stiff neck in the early postoperative period. In this paper, a case of cerebellar and subdural hematomas following a spinal surgery is discussed with its clinical and radiologic findings.

Exceptional Neurologic Recovery in a Teenage Football Player After Second Impact Syndrome With a Thin Subdural Hematoma

PM&RVolume 4, Issue 7 p. 530-532 Case Presentation Exceptional Neurologic Recovery in a Teenage Football Player After Second Impact Syndrome With a Thin Subdural Hematoma Michelle A. Potts MD, Corresponding Author Michelle A. Potts MD Michelle.Potts@nationwidechildrens.org Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, 700 Children's Dr, Columbus, Oh 43205Disclosure: nothing to discloseAddress correspondence to: M.A.P.Search for more papers by this authorEric W. Stewart MD, Eric W. Stewart MD Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHSearch for more papers by this authorMichael J. Griesser MD, Michael J. Griesser MD Department of Orthopaedic Surgery, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorJoshua D. Harris MD, Joshua D. Harris MD Department of Orthopaedic Surgery, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorCarl D. Gelfius MD, Carl D. Gelfius MD Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, OH; Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorKarl Klamar MD, Karl Klamar MD Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, OH; Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this author Michelle A. Potts MD, Corresponding Author Michelle A. Potts MD Michelle.Potts@nationwidechildrens.org Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, 700 Children's Dr, Columbus, Oh 43205Disclosure: nothing to discloseAddress correspondence to: M.A.P.Search for more papers by this authorEric W. Stewart MD, Eric W. Stewart MD Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHSearch for more papers by this authorMichael J. Griesser MD, Michael J. Griesser MD Department of Orthopaedic Surgery, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorJoshua D. Harris MD, Joshua D. Harris MD Department of Orthopaedic Surgery, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorCarl D. Gelfius MD, Carl D. Gelfius MD Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, OH; Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this authorKarl Klamar MD, Karl Klamar MD Division of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, OH; Department of Physical Medicine and Rehabilitation, Ohio State University Medical Center, Columbus, OHDisclosure: nothing to discloseSearch for more papers by this author First published: 18 April 2012 https://doi.org/10.1016/j.pmrj.2012.01.015Citations: 12 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume4, Issue7July 2012Pages 530-532 This article also appears in:PediatricsTBI/Concussion RelatedInformation

Poster 8 Exceptional Neurologic Recovery in a Teenage Football Player After Second Impact Syndrome With a Thin Subdural Hematoma: A Case Report

Poster 8 Exceptional Neurologic Recovery in a Teenage Football Player After Second Impact Syndrome With a Thin Subdural Hematoma: A Case Report

Spiral head CT in the evaluation of acute intracranial pathology: a pictorial essay

The purpose of this pictorial essay is to review the benefits of spiral head computed tomography (CT) with routine multiplanar reformations in the evaluation of acute intracranial pathology. This technique is particularly useful in trauma patients for detection of skull base or calvarial fractures, thin tentorial subdural hematomas, or for more specific characterization of intracranial hemorrhage. The benefits of multiplanar reformations have been described for a variety of other diagnoses in the chest, abdomen, extremities, and spine, and their routine use continues to grow with the widespread availability of multi-slice CT scanners. In this article, we describe spiral head CT technique with multiplanar reformations as an alternative to the routinely used sequential technique. Subtle findings and lesions aligned predominantly in the axial plane can often be visualized to better advantage with multiplanar reformations. We also address technical factors for optimizing spiral technique.

スポーツ外傷における繰り返し脳損傷の病態と予防対策

The most common head injury in sports is concussion and experiencing multiple concussions in a short period of time sometimes can cause severe brain damage. In this paper, we investigate severe brain damage due to repeated head injury in sports and discuss the pathophysiology of repeated sports injury. The majority of these severe cases are usually male adolescents or young adults that suffer a second head injury before they have recovered from the first head injury. All cases that could be confirmed by brain CT scan after the second injury revealed brain swelling associated with a thin subdural hematoma. We suggested that the existence of subdural hematoma is one of the major causes of brain swelling after repeated head injury in sports. Since repeated concussions occurring within a short period may have a risk for severe brain damage, the diagnosis for initial cerebral concussion should be done appropriately. To prevent catastrophic brain damage, the player who suffered from concussion should not engage in any sports before recovery. The american Academy of Neurology and Colorado Medical Society set a guideline to return to play after cerebral concussion. An international conference on concussion in sports was held at Prague in 2004. The summary and agreement of this meeting was published and the Sports Concussion Assessment Tool (SCAT) was introduced to treat sports-related concussion. In addition, a number of computerized cognitive assessment tests and test batteries have been developed to allow athletes to return to play. It is important that coaches, as well as players and trainers, understand the medical issues involved in concussion.

Subdural Hematoma following Minor Head Trauma in Patients with Ventriculoperitoneal Shunts : Two Case Reports

*3 Abstract : Subdural hematoma or effusion is a common complication in ventriculoperitoneal shunts. However, the incidence of subdural hematoma in shunted patients requiring a surgical proce- dure has been decreasing recently, since it can be treated with a newly developed pressure-program- mable valve system. We treated two shunted patients with subdural hematomas caused by simple falls during gait training. The management was complicated, involving multiple surgical procedures. Case 1 : A 65-year-old woman, who had undergone ventriculoperitoneal shunting for normal pressure hydrocephalus after removal of a meningioma, suffered mild head trauma due to a fall during gait training and developed consciousness disturbance after 2 hours. Computed tomography revealed an acute subdural hematoma with marked midline shift. Emergency craniotomy and hematoma evacua- tion were performed. Case 2 : A 61-year-old man, who had previously undergone ventriculoperitoneal shunting for normal pressure hydrocephalus after subarachnoid hemorrhage, fell to the floor during gait training. Computed tomography demonstrated a thin subdural hematoma, thus the pressure-pro- grammable valve was adjusted to a higher pressure. However, the hematoma continued to enlarge and his level of consciousness deteriorated. Consequently, shunt ligation and irrigation of the chron- ic subdural hematoma were performed 6 days after the head trauma. Brain atrophy and a lowering of the intracranial pressure, which are both shunt-related complications, may have contributed to these patient' s subdural hematomas forming after such relatively minor head traumas. In conclusion, reha- bilitation physicians treating shunted patients must be aware of the possibility of a catastrophic intracranial hemorrhage following minor head trauma and of the various treatment-related difficulties arising in such a scenario including exacerbation of hydrocephalus, meningitis, and rebleeding. (Jpn J Rehabil Med 2008;45:193 ― 200)

Role of invasive ICP monitoring in patients with traumatic brain injury: An experience of 98 cases

The outcome of patients with head injury depends upon several factors, and most important among them is the raised intracranial pressure. ICP monitoring using subdural Richmond bolt system was used in 98 cases of TBI. The age range was 9–75 years; there were 78 adults and 20 children. This included 52 cases of severe HI and 46 cases with moderate HI.The GCS range was 4–10(mean: 5.6). Mortality was 64% in severe HI (34/52) and 9.5% in moderate HI patients (4/42). ICP ranged from 6–28mm Hg in moderate HI (mean 11.6 mm) and 8–42mm Hg in severe HI (mean 19.6 mmHg). Of 98 cases of HI, 41(41.8%) patients were operated (26 had moderate HI and 15 cases had severe HI. Seventy-three (74.5%) cases had single/multiple contusions in frontal/temporal regions while 25/73(25.5%) patients had diffuse axonal injury (10 cases) and thin subdural hematoma (15 cases). Fifty-seven patients were managed conservatively with decongestants, elective ventilation and continuous ICP monitoring for 3 days. Of these, 16(43%) had moderate HI and 41(71%) cases had severe HI. In the absence of intracranial hypertension (ICP <10 mm Hg), good recovery (Glasgow outcome scale: 4–5) was noted in 8/57(14%) cases in conservative group and in 4/41(9.7%)cases in operative group. In patients with ICP in 11–20 mm range, good recovery was noted in 6/41(14.6%) patients in operative group and in 9/ 57(15.8%) patients managed conservatively. When the ICP was >20 mm Hg, 10/41(24.3%) operated patients expired while only 6/57(10.5%) patients in conservative group expired. ICP malfunction after day 1 was noted in 27 cases ((27.5%) while ICP site infection/CSF leak was noted in 8 cases (8.2%). Outcome was related to severity of head injury and intracranial hypertension. Outcome was better in patients of moderate HI after surgery than in severe HI patients. Mortality was higher in patients operated in the presence of intracranial hypertension than in those managed conservatively. ICP monitoring was associated with a high blockage (27.5%) and infection rate (8.2%). ICP monitoring improved overall outcome in moderate head injury patients.

Subdural Hematoma Caused by Intracranial Hypotension After Syringosubarachnoid Shunting-Case Report-

A 32-year-old man developed an extremely rare subdural hematoma after syringosubarachnoid shunting for syringomyelia. He presented with a 4-year history of neck pain and spastic paraparesis resulting from T-7 and T-8 vertebral body fracture suffered in a traffic accident at age 22 years. Magnetic resonance imaging revealed syringomyelia between the craniocervical junction and the T-10 level. The symptoms were slowly progressive, and a syringosubarachnoid shunting was performed. His spasticity improved after surgery, but he developed orthostatic headache 7 days after surgery. Magnetic resonance imaging of the brain demonstrated a thin subdural hematoma over the right cerebral convexity. The subdural hematoma resolved spontaneously within a week with conservative treatment. Vigorous cerebrospinal fluid outflow observed during surgery presumably lowered the pressure in the syrinx cavity, leading to significant but transient intracranial hypotension and consequently the formation of subdural hematoma.

Clinicopathologic Case Report: Progressive Aphasia in a 77-Year-Old Man

Clinicopathologic Case Report: Progressive Aphasia in a 77-Year-Old Man

Spontaneous disappearance of a middle fossa arachnoid cyst associated with subdural hematoma

The case of a 7-year-old boy with a middle fossa arachnoid cyst that spontaneously disappeared is presented. Computed tomography (CT) scan revealed an arachnoid cyst in the right middle fossa with a thin subdural hematoma on the same side. As the subdural hematoma spontaneously resolved, the cyst became smaller and finally disappeared without surgical intervention after 18 months on the follow-up CT scans. Possible mechanisms of the spontaneous disappearance of an arachnoid cyst are discussed.

Strangulation in child abuse: CT diagnosis.

The central nervous system is commonly affected in child abuse. Between April 1985 and July 1986 three infants were identified in whom the primary mode of injury had been strangulation. In each case computed tomography (CT) demonstrated a large cerebral infarction confined to vascular territories associated with small subdural hematomas. There was no history or visible evidence of significant head trauma. Autopsy of one infant confirmed the presence of a hemispheric infarct, thin subdural hematoma, and an area of subintimal hemorrhage in the carotid artery ipsilateral to the infarct. The remaining two patients survived with residual hemiparesis. CT findings of a large cerebral infarction with an associated subdural hematoma in an infant without a history of a significant trauma should suggest the possibility of child abuse and may be the primary manifestation of abuse in some patients.

Operative indication of large decompressive craniectomy for cerebral contusion with subdural hematoma (author's transl)

The usefulness of large decompressive craniectomy in cases of severe contusion with thin subdural hematoma has been reported by Ransohoff et al. The beneficial effects of this procedure, however, still remained obscure from the standpoints that its mechanism and limits within which effectiveness can reasonably be expected were not clear. The present study was designed to obtain an index of the limits for effective decompressive craniectomy mainly in terms of intracranial pressure, cerebral blood flow, electroencephalogram, and far field acoustic response from both animal experiments and clinical investigations. Experimental results indicated that decompressive craniectomy was useless if the intracranial pressure was more than 60 mmHg and the vasomotor index (the ratio of intracranial pressure and systemic arterial pressure) was more than 0.5 with reduced perfusion pressure, impaired venous return, and if there was an 80-90% decrease in cerebral blood flow. It was also shown that such conditions coincided with the absence of far field acoustic response as an expression of the brainstem function. In clinical studies of 60 cases of severe brain contusion with thin subdural hematoma following large decompressive craniectomy, intracranial pressure, cerebral blood flow, angiogram, CT scan and far field acoustic responses were retrospectively checked in both the survival and dead groups. It was found that effective results by this procedure was difficult to obtain whenever the II-VII was in far field acoustic response was absent, the vasomotor index was more than 0.5 and when non-filling angiograms were observed. Thus, indication for large decompressive craniectomy for the treatment of severe brain contusion with thin subdural hematoma is established based on the analysis of these results.