Clinical Characterization of Traumatic Acute Interhemispheric Subdural Hematoma

ABSTRACT:Object:Interhemispheric subdural hematomas (IHSDHs) are thought to be rare. Surgical management of these lesions presents a challenge as they are in close proximity to the sagittal sinus and bridging veins. IHSDHs are poorly characterized clinically and their exact incidence is unknown. There are also no clear guidelines for the management of IHSDH.Methods:This is a retrospective review of all admitted patients with a diagnosis of traumatic brain injury over a 4-year period at a Level I trauma centre. Clinical characteristics of all patients with subdural hematoma (SDH) and IHSDH were collected.Results:Of 2165 admissions, 1182 patients had acute traumatic SDHs, 420 patients had IHSDHs (1.9% of admissions and 35.5% of SDH), 35 (8.3% of IHSDH) were ≥8 mm in width. IHSDH was isolated in 16 (3.8%) of the cases. Average age was 61.7 ± 21.5 years for all IHSDHs and 77.1 ± 10.4 for large IHSDH (p < 0.001). For large IHSDH, a transient loss of consciousness (LOC) occurred in 51.5% of individuals, post-traumatic amnesia (PTA) in 47.8% of cases, and motor weakness in 37.9% of patients. Five of the large IHSDH patients presented with motor deficits directly related to the IHSDH, and weakness resolved in four of these five individuals. None were treated surgically. Progression of IHSDH width occurred in one patient.Conclusion:IHSDHs are often referred to as rare entities. Our results show they are common. Conservative management is appropriate to manage most IHSDHs, as most resolve spontaneously, and their symptoms resolve as well.

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In trauma, expect the unexpected: a rare case of post-traumatic pancreatitis associated with salmonellosis and enterocolitis

BMJ Case Reports ◽

10.1136/bcr-2018-226286 ◽

2018 ◽

pp. bcr-2018-226286

Author(s):

Nadja Apelt ◽

Emily Thompson ◽

Erica Brown ◽

David Schindel

Keyword(s):

Rare Case ◽

Gunshot Wound ◽

Burst Fracture ◽

Exploratory Laparotomy ◽

Trauma Centre ◽

Diaphragmatic Injury ◽

Imaging Studies ◽

Post Traumatic ◽

Level I ◽

Traumatic Pancreatitis

A 16-year-old Hispanic man was transferred to our level I paediatric trauma centre with pancreatitis. Ten days prior, he had sustained a gunshot wound to the abdomen requiring an exploratory laparotomy for repair of a traumatic left diaphragmatic injury. Additional injuries included gastric, renal, liver and pancreatic lacerations as well as a T12 burst fracture that resulted in paraplegia. Conservative management of pancreatitis was unsuccessful over the next 10 days, resulting in progressive symptoms of severe unresolved pain, nausea, emesis and rising lipase. Workup for post-traumatic, biliary and drug-associated causes of pancreatitis was negative, and no anatomical abnormalities were found on imaging. A fever workup on hospital day 10 revealed a urinary tract infection with non-typhoidSalmonellasp, and subsequent stool and imaging studies revealed salmonellosis associated with right-sided colitis andClostridium difficileinfection. Pancreatitis resolved within 48 hours following treatment of salmonellosis andClostridium.

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Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic Subdural Hematoma: Case Report and Literature Review

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0040-1713092 ◽

2021 ◽

Author(s):

Tiago Silva Holanda Ferreira ◽

Gilnard Caminha de Menezes Aguiar ◽

Daniel Gurgel Fernandes Távora ◽

Lucas Alverne Freitas de Albuquerque ◽

Stélio da Conceição Araújo Filho

Keyword(s):

Case Report ◽

Subdural Hematoma ◽

Specific Antigen ◽

Chronic Subdural Hematoma ◽

Radical Resection ◽

Prostate Adenocarcinoma ◽

Meningeal Carcinomatosis ◽

Motor Deficits ◽

Friable Material ◽

The Central Nervous System

Abstract Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies.Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy.Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection.At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other key markers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma. Discussion Meningeal carcinomatosis presents clinically with headache, motor deficits, vomiting, changes in consciousness and seizures.The two most discussed mechanisms of neoplastic infiltration are the hematogenous route and retrograde drainage by the vertebral venous plexus. Conclusion Variable clinical presentations may occur in dural metastases; however, the radiological presentation as subdural hematoma is rare. There are few descriptions of cases like this one in the literature.To support the diagnosis, the previous medical history is as important as the complementary exams and the radiological findings, because the symptoms are common at the neurological emergency. To our knowledge, this is the first report of a prostate neoplasm mimicking chronic subdural hematoma in Brazil.

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Relationship between post-traumatic amnesia and white matter integrity in traumatic brain injury using tract-based spatial statistics

Scientific Reports ◽

10.1038/s41598-021-86439-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Jye Cho ◽

Sung Ho Jang

Keyword(s):

Traumatic Brain Injury ◽

White Matter ◽

Patient Group ◽

Injury Severity ◽

White Matter Integrity ◽

Superior Cerebellar Peduncle ◽

Uncinate Fasciculus ◽

Traumatic Amnesia ◽

Post Traumatic ◽

Cerebellar Peduncle

AbstractThis study used tract-based spatial statistics to examine the relationship between post-traumatic amnesia (PTA) and white matter integrity in patients with a traumatic brain injury (TBI). Forty-seven patients with TBI in the chronic stage and 47 age- and sex-matched normal control subjects were recruited to the study. Correlation coefficients were calculated to observe the relationships among the PTA duration, white matter fractional anisotropy (FA) values, and mini-mental state examination (MMSE) results in the patient group. Both before and after Benjamini–Hochberg (BH) corrections, FA values of 46 of the 48 regions of interests of the patient group were lower than those of the control group. The FA values of column and body of fornix, left crus of fornix, left uncinate fasciculus, right hippocampus part of cingulum, left medial lemniscus, right superior cerebellar peduncle, left superior cerebellar peduncle, and left posterior thalamic radiation (after BH correction: the uncinate fasciculus and right hippocampus part of cingulum) in the patient group were negatively correlated with PTA duration. PTA duration was related to the injury severity of eight neural structures, each of which is involved in the cognitive functioning of patients with TBI. Therefore, PTA duration can indicate injury severity of the above neural structures in TBI patients.

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Scoring systems for early prediction of tibial fracture non-union: an update

International Orthopaedics ◽

10.1007/s00264-021-05088-0 ◽

2021 ◽

Author(s):

George D. Chloros ◽

Nikolaos K. Kanakaris ◽

James S. H. Vun ◽

Anthony Howard ◽

Peter V. Giannoudis

Keyword(s):

Tibial Fracture ◽

Scoring Systems ◽

Trauma Centre ◽

Predictive Values ◽

Non Union ◽

Post Operative Period ◽

Male Patients ◽

Level I ◽

Healing Score ◽

Tibial Shaft Fractures

Abstract Purpose To evaluate the available tibial fracture non-union prediction scores and to analyse their strengths, weaknesses, and limitations. Methods The first part consisted of a systematic method of locating the currently available clinico-radiological non-union prediction scores. The second part of the investigation consisted of comparing the validity of the non-union prediction scores in 15 patients with tibial shaft fractures randomly selected from a Level I trauma centre prospectively collected database who were treated with intramedullary nailing. Results Four scoring systems identified: The Leeds-Genoa Non-Union Index (LEG-NUI), the Non-Union Determination Score (NURD), the FRACTING score, and the Tibial Fracture Healing Score (TFHS). Patients demographics: Non-union group: five male patients, mean age 36.4 years (18–50); Union group: ten patients (8 males) with mean age 39.8 years (20–66). The following score thresholds were used to calculate positive and negative predictive values for non-union: FRACTING score ≥ 7 at the immediate post-operative period, LEG-NUI score ≥ 5 within 12 weeks, NURD score ≥ 9 at the immediate post-operative period, and TFHS < 3 at 12 weeks. For the FRACTING, LEG-NUI and NURD scores, the positive predictive values for the development of non-union were 80, 100, 40% respectively, whereas the negative predictive values were 60, 90 and 90%. The TFHS could not be retrospectively calculated for robust accuracy. Conclusion The LEG-NUI had the best combination of positive and negative predictive values for early identification of non-union. Based on this study, all currently available scores have inherent strengths and limitations. Several recommendations to improve future score designs are outlined herein to better tackle this devastating, and yet, unsolved problem.

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Post-traumatic amnesia

Journal of Clinical Neuroscience ◽

10.1016/j.jocn.2012.11.022 ◽

2013 ◽

Vol 20 (11) ◽

pp. 1475-1481 ◽

Cited By ~ 35

Author(s):

Laurence A.G. Marshman ◽

David Jakabek ◽

Maria Hennessy ◽

Frances Quirk ◽

Eric P. Guazzo

Keyword(s):

Traumatic Amnesia ◽

Post Traumatic

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Pterional Approach for Surgical Treatment of Olfactory Groove Meningiomas

Neurosurgery ◽

10.1227/00006123-198912000-00014 ◽

1989 ◽

Vol 25 (6) ◽

pp. 942-947 ◽

Cited By ~ 50

Author(s):

W. Hassler ◽

J. Zentner

Keyword(s):

Surgical Treatment ◽

Superior Sagittal Sinus ◽

Cerebrospinal Fluid Fistula ◽

Pterional Approach ◽

Olfactory Groove ◽

Sagittal Sinus ◽

Frontal Brain ◽

Bridging Veins ◽

Frontal Sinuses ◽

Fluid Fistula

Abstract We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the tumor, and late dissection of tumor borders. Moreover, it also compensates for the shortcomings of other techniques, e.g., compression of frontal bridging veins, late dissection of dorsal tumor aspects involving vessels and optic nerves as well as facultative infection and cerebrospinal fluid fistula-related complications caused by opening of frontal sinuses. To date, 11 patients were treated in this way. As we encountered no surgical complications in our series we are encouraged to present our procedure.

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