Bilateral Supratentorial Subdural Hematomas after Craniotomy for Posterior Fossa Tumor Removal

AbstractA 69-year-old man was admitted to the emergency department with headache and dizziness. He was submitted to brain computed tomography (CT) which showed a tumor in the right cerebellar hemisphere, findings which were subsequently confirmed with magnetic resonance imaging (MRI). He underwent a paramedian suboccipital craniotomy for removal of the mass. Histology confirmed the presence of a hemangiopericytoma. The patient was discharged 5 days postoperatively with improvement in his symptoms. Fifteen days later, he presented with gait difficulties. Clinical examination revealed positive Mingazzini sign on his left side. He was submitted to brain MRI which revealed bilateral subdural hematomas on late subacute stage with mass effect and midline shift caused by the largest on the right. The patient underwent burr hole evacuation of the right subdural hematoma. The postoperative CT showed evacuation of the right chronic subdural hematoma. Two days postoperatively, the patient's symptoms improved.

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Calcified chronic subdural hematoma: illustrative case

Journal of Neurosurgery: Case Lessons ◽

10.3171/case21468 ◽

2021 ◽

Vol 2 (15) ◽

Author(s):

Rupesh Pakrasi ◽

Payoz Pandey ◽

Srijan Das ◽

Shreya Datta ◽

Dipti Saha

Keyword(s):

Subdural Hematoma ◽

Rare Variants ◽

Surgical Intervention ◽

Chronic Subdural Hematoma ◽

Illustrative Case ◽

Subdural Hematomas ◽

Magnetic Resonance Imaging Mri ◽

The Right ◽

Calcified Chronic Subdural Hematoma ◽

Acute Neurological Deterioration

BACKGROUND Calcified chronic subdural hematomas (CCSDHs) are rare variants of chronic subdural hematomas (CSDHs) accounting to only 0.3–2.7% of CSDHs. Although the majority of the patients with CSDHs recover from surgery, there still is some doubt about its being applied to CCSDHs. OBSERVATIONS In this case report, the authors present a case of a 75-year-old male presenting with deterioration of motor function in his left limbs over the course of 18 months and acute neurological deterioration in the form of altered sensorium for 7 days. The patient experienced an episode of aspiration in the preoperative period that led to deterioration of pulmonary function in the postoperative period. A chest radiograph showed diffuse patches suggesting pulmonary compromise. Computed tomography and magnetic resonance imaging (MRI) documented a large subdural collection at the right frontal and parietal hemisphere with calcification, which was successfully and completely removed by surgery. LESSONS The chances of a subdural hematoma progressing to calcification is extremely rare. The presentation of this case was such that surgical intervention was the only option left for the patient. The presence of lacunar infarcts in the thalamus on MRI can also be attributed to the calcified hematoma.

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Warning with chronic subdural hematomas in the elderly

Journal of Neurology & Stroke ◽

10.15406/jnsk.2021.11.00467 ◽

2021 ◽

Vol 11 (4) ◽

pp. 114-117

Author(s):

Dinh Thi Phuong Hoai ◽

Nguyen Thi My Dung ◽

Hoang Manh Cuong ◽

Huynh Thi Kieu Oanh ◽

Ngo Thuy Tram ◽

...

Keyword(s):

Left Hemisphere ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Mass Effect ◽

The Elderly ◽

Brain Parenchyma ◽

History Of ◽

Apparent Reason ◽

The Right ◽

Contrast Ct

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

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Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-015493 ◽

2020 ◽

Vol 12 (4) ◽

pp. 436-436 ◽

Cited By ~ 2

Author(s):

Gary B Rajah ◽

Michael K Tso ◽

Rimal Dossani ◽

Kunal Vakharia ◽

Adnan H Siddiqui

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Mass Effect ◽

Middle Meningeal Artery ◽

Vascular Lesion ◽

External Carotid ◽

Invasive Treatment ◽

History Of ◽

The Right ◽

Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

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Punctate pattern and Milky Way appearance caused by PML in a patient with AIDS

10.5327/1516-3180.690 ◽

2021 ◽

Author(s):

João Henrique Fregadolli Ferreira ◽

André Franzoi ◽

Bernardo Corrêa de Almeida Teixeira ◽

Tamires Maier Silva Ferreira ◽

Mariana de Moura Souza ◽

...

Keyword(s):

Milky Way ◽

Jc Virus ◽

Brain Mri ◽

Mass Effect ◽

Final Diagnosis ◽

Cd4 Cell Count ◽

Magnetic Resonance Imaging Mri ◽

Punctate Pattern ◽

The Right ◽

Cd4 Cell

Introduction: Progressive multifocal leukoencephalopathy (PML) is an opportunistic infection caused by reactivation of JC virus in the central nervous system and is an important differential diagnosis in patients with subacute focal neurologic deficits. Magnetic resonance imaging (MRI) is the most sensitive tool for detection of early manifestations of the disease1 . Case Report: A 42-year-old woman with a previous diagnosis of HIV infection, without treatment for the last two years, presented with progressive headache, left hemiparesis, hypoesthesia and homonymous hemianopia in the last two months. CD4 cell count was 16 cel/mm3 and viral load of 99.364 copies/mL. Brain MRI revealed multifocal, subcortical and confluent hyperintense T2/FLAIR lesions in the right parietooccipital lobe, crossing the midline by the corpus callosum, with hyperintense peripheral rim on DWI-image and a central hypointense core, without mass effect. On T2-weighted image, typical multiple punctiform hyperintensities formed the Punctate Pattern, which is known as the Milky Way appearance when nearby a larger PML lesion. The final diagnosis was confirmed by the detection of JC virus on cerebrospinal fluid by PCR. Discussion: The punctate pattern is characterized by at least three punctiform (<5mm) hyperintense lesions on T2/FLAIR images, with or without contrast enhancement. It has already been described in PML, neurosarcoidosis, hematologic diseases, CLIPPERS and CNS vasculitis. Recently it was described as a highly specific feature of PML related to natalizumab, even in pre-symptomatic stages. Further studies are required stablish its incidence in patients with PML from other causes2.

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Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

Romanian Neurosurgery ◽

10.2478/romneu-2014-0013 ◽

2014 ◽

Vol 21 (1) ◽

pp. 109-112

Author(s):

P. Sasikala ◽

Bindu Menon ◽

Amit Agarwal

Keyword(s):

Ct Scan ◽

Movement Disorders ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Mass Effect ◽

Midline Shift ◽

Rare Presentation ◽

Surgical Evacuation ◽

Significant Mass Effect ◽

Significant Mass

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.

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Recurrent Chronic Subdural Hematoma: Clinical and Imaging Risk Factors

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1669492 ◽

2018 ◽

Vol 15 (01) ◽

pp. 008-015 ◽

Cited By ~ 1

Author(s):

Benaissa Abdennebi ◽

Maher Al Shamiri

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Heart Diseases ◽

Chronic Subdural Hematoma ◽

Antiplatelet Agents ◽

The Elderly ◽

Imaging Data ◽

Anticoagulation Agents ◽

The Right ◽

Recurrence Group

Abstract Background Chronic subdural hematoma (CSDH) is a major cause of neurosurgical emergencies in the elderly. Despite the use of routine surgical practices, recurrence of this condition is expected. This study was conducted to identify the risk factors (RF) for recurrent CSDH. Methods Between January 2016 and July 2017, 103 consecutive patients suffering from CSDH were admitted to our department. The no-recurrence group (NRG) consisted of 91 patients, and the recurrence group (RG) consisted of 12 patients. To identify the RF involved in recurrent CSDH, we analyzed multiple factors, including patient comorbidities and imaging data. Results Between the two groups, there were no statistical differences (p > 0.05) for head trauma, diabetes mellitus (DM), high blood pressure, heart diseases, anticoagulation agents, or seizures; however, DM was associated with one of the above-mentioned factors. In contrast, there were significant differences for antiplatelet agents (APA) (p < 10–6) and the right side of the hematoma location (p = 0.03). Conclusion Although the literature highlights the controversy regarding RF for CSDH, we detected APA and the right side as RF, whereas DM alone or associated with another comorbidity does not affect the CSDH outcome.

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Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015005003 ◽

2015 ◽

Vol 42 (5) ◽

pp. 283-287 ◽

Cited By ~ 7

Author(s):

JAMIL FARHAT NETO ◽

João Luiz Vitorino Araujo ◽

Vinícius Ricieri Ferraz ◽

Luciano Haddad ◽

José Carlos Esteves Veiga

Keyword(s):

Subdural Hematoma ◽

Drainage System ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Prognostic Indicators ◽

Altered Consciousness ◽

Prognostic Analysis ◽

Motor Abnormalities ◽

The Right ◽

Change Of Consciousness

Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

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Chronic subdural hematoma of the posterior fossa treated by suboccipital craniotomy

Surgical Neurology International ◽

10.4103/sni.sni_239_17 ◽

2018 ◽

Vol 9 (1) ◽

pp. 20

Author(s):

Tomonori Kobayashi ◽

Yuichi Mochizuki ◽

Akitsugu Kawashima ◽

Takayuki Funatsu ◽

Takakazu Kawamata

Keyword(s):

Posterior Fossa ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Suboccipital Craniotomy

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Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

Romanian Neurosurgery ◽

10.1515/romneu-2017-0002 ◽

2017 ◽

Vol 31 (1) ◽

pp. 8-16

Author(s):

D. Adam ◽

D. Iftimie ◽

Gina Burduşa ◽

Cristiana Moisescu

Keyword(s):

Conservative Treatment ◽

Subdural Hematoma ◽

Clinical Presentation ◽

Surgical Intervention ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Neurological Status ◽

Spontaneous Resolution ◽

Subdural Hematomas ◽

Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

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Overlapping anti-N-methyl-D-aspartate receptor (NMDAR) Encephalitis With Neuromyelitis Optica Spectrum Disorders: A Case Report

10.21203/rs.3.rs-907816/v1 ◽

2021 ◽

Author(s):

Jialin Pan ◽

Begench Ovlyakulov ◽

Lili zhou

Keyword(s):

Neuromyelitis Optica ◽

Brain Magnetic Resonance Imaging ◽

Chinese Patient ◽

Cerebellar Hemisphere ◽

Double Positive ◽

Blurred Vision ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Magnetic Resonance Imaging Mri ◽

The Right

Abstract BackgroundAnti-N-methyl-D-aspartate receptor (NMDAR) encephalitis can coexist with neuromyelitis optica spectrum disorder (NMOSD). Patients with overlapping anti-NMDAR encephalitis with positive NMDAR antibodies and aquaporin 4 immunoglobulin G (AQP4-IgG)-seropositive NMOSD are rare but should not be ignored.Case presentationThis report describes a unique case of anti-NMDAR encephalitis coexisting with NMOSD is presented. A 27-year-old male presented with blurred vision, cognitive impairment, psychosis, dysphagia, gait instability and urinary incontinence. Brain magnetic resonance imaging (MRI) showed abnormal signals in the right cerebellar hemisphere, temporal lobe, and corpus callosum. NMDAR antibodies were positive in the CSF. AQP4-IgG antibodies were positive in the serum. The patient's condition was stable following intravenous gamma globulin, corticosteroids, immunosuppressants and symptomatic treatments. ConclusionsThis case provides further evidence for the occurrence of anti-NMDAR encephalitis overlapping NMOSD with AQP4-IgG-seropositive in a Chinese patient. However, the mechanisms underlying the occurrence of double positive antibodies remain elusive.

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