scholarly journals No Value of Routine Brain Computed Tomography 6 Weeks after Evacuation of Chronic Subdural Hematoma

2017 ◽  
Vol 03 (04) ◽  
pp. e174-e176 ◽  
Author(s):  
Christian Pedersen ◽  
Filippa Sundbye ◽  
Frantz Poulsen

Background The aim of this study was to evaluate the value of planned control postoperative brain computed tomography (CT) scan performed 4 to 6 weeks after the evacuation of chronic subdural hematoma. Materials and Methods This retrospective study examined 202 patients who during a 2-year period from 2011 and 2012 underwent surgical treatment for chronic subdural hematoma (CSDH). Information on patient age, sex, alcohol consumption, anticoagulant/antiplatelet treatment, history of head trauma, Glasgow coma scale (GCS), neurological symptoms, laterality of CSDH, and surgical technique was retrieved from patient charts. Results Overall, 27 out of 202 patients had a recurrence of CSDH and re-evacuation of the hematoma was performed. In all patients recurrence of neurological symptoms preceded the planned postoperative control brain CT 4 to 6 weeks after primary surgery. Conclusion Routinely postoperative control brain CT scan 4 to 6 weeks after the evacuation of a CSDH has no clinical value.

Background: Head trauma and subsequent traumatic brain injury are among the main causes of morbidity and mortality in Iran. The present study aimed to assess the abnormal findings of brain computed tomography (CT) scan in motorcyclist patients with traumatic brain injury. Materials and Methods: This retrospective cross-sectional study (July-September 2016) was conducted on all motorcyclist patients over 12 years who were referred for brain CT scan to the Emergency Department of Shahid Rajaei Hospital in Shiraz. Patients' archived medical files were reviewed, and a data collection form including age, gender, and findings related to acute trauma and incidental findings were completed. The obtained data were then statistically analyzed. Results: A total of 642 patients were enrolled. The mean age score of participants was reported as 33.61±17.12 years. All patients were male. A number of 51 (7.9%) patients had abnormal findings in their brain CT scans. The most-reported findings were skull-based (23%) and cranial linear (17%) fractures. No incidental findings (findings unrelated to acute trauma) were found. Moreover, 8 (15.7%) patients died with abnormal findings in their brain CT scans. Conclusion: Since in the present study, only 7.9% of the patients had abnormal findings in their brain CT scan and considering the comparison of the results of this research with those obtained in other similar studies, brain CT scan is highly used in this center.


2014 ◽  
Vol 21 (1) ◽  
pp. 109-112
Author(s):  
P. Sasikala ◽  
Bindu Menon ◽  
Amit Agarwal

Abstract Movement disorders are atypical and rare presentation of chronic subdural hematomas. We report a case of 60 year man who presented with intention tremors and altered sensorium. The patient had Kernohan-Woltman notch phenomenon on clinical examination. CT scan brain showed a large left fronto-temporo-parietal chronic subdural hematoma with significant mass effect and midline shift. His symptoms relieved completely after surgical evacuation of the hematoma.


2002 ◽  
Vol 42 (2) ◽  
pp. 53-56 ◽  
Author(s):  
Yutaka HIRASHIMA ◽  
Naoya KUWAYAMA ◽  
Hideo HAMADA ◽  
Nakamasa HAYASHI ◽  
Shunro ENDO

2020 ◽  
Vol 73 (9-10) ◽  
pp. 295-300
Author(s):  
Mirela Jukovic ◽  
Viktor Till

Introduction. Chronic subdural hematoma has become an important entity in radiological, neurological and neurosurgery practice. Classification. The classification of chronic subdural hematoma is most often done in relation to the time of the disease onset (acute, subacute and chronic), whereas the second classification is based on hematoma density using computed tomography. Clinical presentation. The clinical presentation may mimic a spectrum of various diseases and chronic subdural hematoma can be easily overlooked without radiological verification. Diagnosis. The diagnosis of chronic subdural hematoma is partly clinical and partly radiological. In most cases, computed tomography is the initial diagnostic method for detection of this disease. Many studies point to different management strategies in the diagnosis and treatment of the disease. Therapy. The therapy of chronic subdural hematoma depends on the patient?s neurological deficit, but generally it is divided into conservative and surgical treatment. Conclusion. The aim of this paper is to review chronic subdural hematomas with reference to their clinical and radiological characteristics for better understanding of these phenomena.


2020 ◽  
Vol 17 (02) ◽  
pp. 110-120
Author(s):  
Ramesh Chandra Vemula ◽  
B. C.M. Prasad ◽  
Venkat Koyalmantham ◽  
Kunal Kumar

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.


2020 ◽  
Vol 9 (03) ◽  
pp. 147-150
Author(s):  
Ibrahim Assoumane ◽  
M. Al-Zekri ◽  
A. Khelifa ◽  
N. Touati ◽  
N. Lagha ◽  
...  

Abstract Introduction Subdural hematoma can occur as a complication of a ventriculoperitoneal shunt (VPS), and it should be considered in any patient who present a shunt dysfunction or who does not show the expected recovery after revision of a shunt. Computed tomography (CT) scan is a quick and easy way of detecting subdural hematoma. Materials and Methods We conduct a retrospective study of 17 patients. All of them are admitted for a subdural hematoma on a VPS. The diagnosis in 13 cases is made by CT scan; three cases by brain MRI. Results We operated 16 patients and the evacuation of the hematoma with revision of the shunt was performed; we used an adjustable shunt for three patients and endoscopic third ventriculostomy in one case. The operative outcomes were favorable in 12 patients; there were 4 recurrences, 2 of which required evacuation of the hematoma through a bone flap. Conclusion The subdural hematoma is a complication observed during the surgical treatment of the hydrocephalus and can be a serious issue. We suggest that a brain CT scan should be routinely performed in symptomatic patients with VPS.


2019 ◽  
Vol 11 (1) ◽  
pp. 87-93
Author(s):  
Takuro Inoue ◽  
Hisao Hirai ◽  
Ayako Shima ◽  
Fumio Suzuki ◽  
Masayuki Matsuda

Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare. The surgical strategy is still controversial. We report a case of bilateral CSH in the posterior fossa successfully treated with a single-burr hole surgery. A 74-year-old man under anticoagulation and antiplatelet therapy developed headache and nausea during observation for an asymptomatic supratentorial CSH. Radiological examinations revealed appearance of bilateral CSH in the posterior fossa associated with hydrocephalus. Upon rapid deterioration of the patient’s consciousness, an urgent treatment was required. A burr hole was made near the transverse-sigmoid junction on the left side to access the hematoma. No ventricular drainage was placed as his consciousness improved during the decompression of the hematoma. Postoperative computed tomography showed that bilateral CSH and hydrocephalus had been successfully treated. In bilateral CSH in the posterior fossa, there may be a connection between each side. CSH in the posterior fossa, when urgent, can be treated under local anesthesia with a unilateral burr hole irrigation.


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