A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants

Chronic Subdural Heamatoma (CSDH) is defined as collection of blood in the brains surface, subdural space between dura and arachnoid. It is one of the most common clinical entities in daily neurosurgical practice among the elders, several weeks after the head injury. CSDH doesnt always produce symptoms but when it does, it generally requires surgical treatment. The diagnosis and treatment are well established, but the cause of recurrence, complications and related factors are not completely understood. This study evaluated the clinical features, radiological findings and surgical results in a large series of patients treated at the Neurosurgery department of Dhaka Medical College Hospital. 300 consecutive patients (250 men and 50 women) age ranging from 30-85 years, GCS 5-15, volume of blood >25cc, symptomatic with CSDH were treated by one or two burr hole craniostomies. Haematoma cavity was irrigated with normal saline and closed system subdural drainage was continued for 1-2 days from January 2012 to December 2015. The clinical outcome was measure on 1st, 3rd, 5th and 7th POD using GCS scoring and GOS after 4 and 8 weeks of operations. Most patients 94%(282) had good recovery (GOS 5,4,3), 4%(12) showed no changes (GOS 2) and 2%(6) worsened (GOS 1). Recurrence of haematoma was recognized in 5%(15) patients 1-8 weeks after the first operation. 4%(12) patients suffered post operative complications of which 1.33%(4)patients were acute subdural haematoma caused by incomplete haemostasis of the scalp wound, 1.33%(4)patients were tension pneumocephalus and remaining due to hypertension, use of anticoagulants, poor general health and medical problems. Careful haemostasis and complete replacement of subdural haematoma with normal saline to prevent influx of air into the subdural space will further improve the surgical outcome for patients with CSDH.J Dhaka Medical College, Vol. 24, No.2, October, 2015, Page 126-131

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Intracranial Extension and Spontaneous Hemorrhage of a Sphenoid Plasmacytoma

Neurosurgery ◽

10.1227/00006123-198212000-00015 ◽

1982 ◽

Vol 11 (6) ◽

pp. 797-799 ◽

Cited By ~ 10

Author(s):

Lonnie Harper ◽

Hector J. LeBlanc ◽

James R. McDowell

Keyword(s):

Radiation Therapy ◽

Trigeminal Nerve ◽

Abrupt Onset ◽

Sphenoid Bone ◽

Intracranial Extension ◽

Subdural Space ◽

Middle Fossa ◽

Early Symptoms ◽

Spontaneous Hemorrhage ◽

Nerve Involvement

Abstract A case of intracranial extension of a plasmacytoma of the sphenoid bone is reported. Early symptoms of trigeminal nerve involvement preceded the abrupt onset of coma. Uncal herniation occurred secondary to a large middle fossa mass that bled into the subdural space. Earlier recognition of the intracranial extension would have prompted radiation therapy, which could have obviated the subsequent catastrophic hemorrhage.

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SUBDURAL FLUID AS A CONSEQUENCE OF PNEUMOENCEPHALOGRAPHY

PEDIATRICS ◽

10.1542/peds.5.3.375 ◽

1950 ◽

Vol 5 (3) ◽

pp. 375-389

Author(s):

HONOR V. SMITH ◽

BRONSON CROTHERS

Keyword(s):

Cerebral Palsy ◽

Subdural Hematoma ◽

Cerebral Atrophy ◽

Mental Deficiency ◽

Signs And Symptoms ◽

Brain Lesions ◽

Subdural Space ◽

Suitable Treatment ◽

Superior Longitudinal Sinus ◽

The Brain

When lumbar or cisternal pneumoencephalography is carried out on children with nonprogressive brain lesions causing mental deficiency, cerebral palsy or epilepsy, air is seen in the subdural space in at least a third of cases. This proportion is much larger in children 2 years of age or under. The roentgenographic appearances of subdural air are described and the importance of not attributing these appearances to cerebral atrophy or hypoplasia is emphasized. In approximately one third of cases in which air enters the subdural space, that is, in from 10% to 15% of all cases, recovery from pneumoencephalography is delayed by the development of signs and symptoms suggesting a rise in intracranial pressure. In such cases fluid can usually be found by needling the subdural space. Typically this fluid is characteristic of that found in subdural hematoma. There is no evidence that such a collection of fluid was present before pneumoencephalography. It is therefore suggested that as air enters the subdural space and the brain falls away from the dura, vessels may be torn as they cross this space to reach the superior longitudinal sinus, with the formation of what may be termed subdural hematoma artefacta. Although the incidence of this complication is moderately high, its effects are seldom serious, provided the situation is appreciated and suitable treatment given. The length of time the child spends in the hospital is, however, often greatly prolonged and occasionally operation proves necessary for removal of a subdural membrane. Since the subdural hematoma is an artefact occurring in the course of treatment, its removal does not influence the ultimate prognosis.

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On Hæmorrhages and False Membranes within the Cerebral Subdural Space, occurring in the Insane (including the so-called Pachymeningitis)

Journal of Mental Science ◽

10.1192/bjp.33.144.509 ◽

1888 ◽

Vol 33 (144) ◽

pp. 509-523

Author(s):

Joseph Wiglesworth

Keyword(s):

Pathological Process ◽

Subdural Space ◽

Simple Result

The title of this paper implies the assumption that the current doctrine with reference to the condition known as pachymeningitis is not the true one; obviously the use of this term signifies that the pathological process underlying the morbid changes met with is one of inflammation, and that without the operation of this agency they would not occur. Now, without denying the possible occurrence of a condition to which the name of cerebral pachymeningitis might with appropriateness be applied, my endeavour will be to bring forward arguments and proofs to show that the condition which usually passes under that term is not the result of inflammation at all, but that all the phenomena met with may be explained as the simple result of effusion of blood into the subdural space (arachnoid cavity).

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Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

Journal of Neurosurgery ◽

10.3171/jns/2008/108/2/0275 ◽

2008 ◽

Vol 108 (2) ◽

pp. 275-280 ◽

Cited By ~ 29

Author(s):

Rudolf A. Kristof ◽

Jochen M. Grimm ◽

Birgit Stoffel-Wagner

Keyword(s):

Cerebrospinal Fluid ◽

Recurrence Rate ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Postoperative Recurrence ◽

Cerebrospinal Fluid Leakage ◽

Subdural Space ◽

Subdural Hygroma ◽

Fluid Leakage ◽

Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

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