Head Trauma in Hemophilia: Value of Computer Tomography of The Brain in Localizing Multiple Hematomas

A 20 year old man with classical hemophilia (Factor VIII, 3%) was found unconscious in an alley after being struck on the head with a baseball bat. He transiently regained consciousness in the Emergency Room, but then became comatose and developed a right 3rd nerve palsy. He was immediately given AHF concentrate, 50 units per Kg, and had a computed tomographic (CT.) brain scan which revealed bilateral fronto-parietal subdural hematomas. These were removed through burr-holes and a right fronto-parieta1 craniotomy. He was maintained on 12-hourly doses of AHF concentrate, 50 u/per Kg, and did well for the first 3 post-operative days. Signs of increasing intracranial pressure then developed, and a repeat CT scan disclosed a right intracerebral hematoma. This was surgically evacuated and the remainder of his post-operative course was uneventful. He was discharged after 6 weeks of hospitalization with no residual neurological defect. A second patient, seen 6 years earlier for subdural hematomas following cranial trauma, also had evidence of deterioration in the early post-operative period. At that time, C.T. scans were not available, and the site of the new hematoma was not established. Although the patient recovered, there was a severe residual neurologic defect. Our experiences indicate that C.T. scans of the brain are valuable adjuncts in the management of head trauma in hemophilia, and, when combined with vigorous neurosurgical intervention, offer an improved prognosis.

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Acute Brain Swelling during Evacuation of Subdural Hematoma Caused by Delayed Contralateral Extradural Hematoma: Report of Two Cases

Neurosurgery ◽

10.1227/00006123-198702000-00023 ◽

1987 ◽

Vol 20 (2) ◽

pp. 326-328 ◽

Cited By ~ 26

Author(s):

Kotoo Meguro ◽

Eiki Kobayashi ◽

Yutaka Maki

Keyword(s):

Intracranial Pressure ◽

Ct Scan ◽

Subdural Hematoma ◽

The Other ◽

Ct Scans ◽

Brain Swelling ◽

Extradural Hematoma ◽

Computed Tomographic ◽

Subdural Hematomas ◽

Burr Holes

Abstract Two patients experienced severe brain swelling during the evacuation of acute subdural hematomas. Postoperative computed tomographic (CT) scans revealed delayed extradural hematomas on the sides opposite the subdural hematomas. Extradural bleeding occurred in the area of the fractured skull. One patient improved neurologically after evacuation of the extradural hematoma, and the other was not operated because he was moribund. Drilling exploratory burr holes in the fractured area may have been a better strategy than awaiting a postoperative CT scan. The reduction of intracranial pressure after the removal of subdural hematoma was postulated to be the most important factor contributing to the formation of the extradural hematoma.

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Postoperative Extradural Hematomas: Computed Tomographic Survey of 1105 Intracranial Operations

Neurosurgery ◽

10.1227/00006123-198610000-00013 ◽

1986 ◽

Vol 19 (4) ◽

pp. 589-593 ◽

Cited By ~ 50

Author(s):

Akira Fukamachi ◽

Hidehito Koizumi ◽

Yoshishige Nagaseki ◽

Hideaki Nukui

Keyword(s):

Brain Tumor ◽

Postoperative Period ◽

Ventricular Dilatation ◽

Systemic Hypertension ◽

Intracerebral Hematoma ◽

Causal Factors ◽

Computed Tomographic ◽

The Brain ◽

Shunting Procedure ◽

Ventricular Shunting

Abstract We reviewed the computed tomographic findings after 1055 intracranial operations to determine the incidence of postoperative extradural hematomas. There were 11 medium and 5 large hematomas after 1055 operations (1.0%). Ten of the 16 hematomas were operated upon (10/1055, 0.9%). Four of the 10 hematomas were seen after 278 brain tumor removals (1.4%), another four after 190 aneurysmal operations (2.1%), one after 14 intracerebral hematoma removals (7.1%), and the last one after 251 ventricular shunting or drainage procedures (0.4%). In 4 of the 10 operated hematomas, sites were regional, in five sites were adjacent, and in one the site was distant. All of the five adjacent hematomas extended downward from a lower rim of the operative locus. Causes were analyzed in the three types of the hematomas. In case of the regional hematomas, the causes were incomplete hemostasis of the dura mater or the bone in all four patients, nonperformance of central stay sutures in three, systemic hypertension in one, and hypofibrinogenemia in one. In the adjacent hematomas, we could find dural separation at an edge of craniotomy in all five patients, abrupt collapse of the brain in all, ventricular dilatation in two, and systemic hypertension during immediate postoperative period in two. In one distant hematoma, ventricular dilatation and ventricular shunting procedure were themselves thought to be the causal factors.

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Results of Stereotactic Aspiration in 175 Cases of Putaminal Hemorrhage

Neurosurgery ◽

10.1227/00006123-198906000-00005 ◽

1989 ◽

Vol 24 (6) ◽

pp. 814-819 ◽

Cited By ~ 63

Author(s):

Hiroshi Niizuma ◽

Yukihiko Shimizu ◽

Tsutomu Yonemitsu ◽

Nobukazu Nakasato ◽

Jiro Suzuki

Keyword(s):

Intracerebral Hematoma ◽

Entire Series ◽

Stereotactic Aspiration ◽

Computed Tomographic ◽

Consciousness Level ◽

Therapeutic Results ◽

Putaminal Hemorrhage ◽

Minimal Invasion ◽

The Brain ◽

Definite Role

Abstract Believing that improved therapeutic results in cases of intracerebral hematoma might be obtained by minimal invasion of the brain, we used computed tomographic-guided stereotactic aspiration in 175 of 241 patients with putaminal hemorrhage. These patients, who were treated 6 or more hours after onset, had hematomas larger than 8 ml and were unable to raise an arm and/or leg on the affected side. Craniotomy was performed in 15 other patients, most of whom were brought to the hospital with large hematomas within 6 hours of onset. The remaining patients either had mild deficits of consciousness (33 patients) or severe deficits and/or were elderly (18 patients) and were treated conservatively. Thirteen patients (7.4%) showed rebleeding after stereotactic aspiration (6 instances of major and 7 instances of minor rebleeding). Craniotomy and removal of the hematoma were required in three of these patients. Aspiration should be avoided in patients who have a tendency for bleeding, even if mild, because rebleeding occurred in 6 of 23 such patients (26%) in these study. The consciousness level improved in 66 patients (38%), was unchanged in 103 patients (59%), and was worse in 6 patients (3%) 1 week postoperatively. Motor function of the arm improved in 55 patients (31%) and was worse in 23 patients (14%). Six months after surgery, the results for the 175 patients who underwent stereotactic aspiration were: 19% excellent, 32% good, 35% fair, 7% poor, 6% dead, and 1% unknown. For the entire series of 241 patients, the results were: 24% excellent, 26% good, 31% fair, 7% poor, 11% dead, and 1% unknown. These results seem to indicate that stereotactic aspiration can play a definite role in the treatment of spontaneous intracerebral hematoma.

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The spectrum of computed tomographic findings in head trauma

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1983.19.3.492 ◽

1983 ◽

Vol 19 (3) ◽

pp. 492

Author(s):

Y C Lee ◽

K S Lee ◽

K S Kim

Keyword(s):

Head Trauma ◽

Computed Tomographic

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Chronic subdural hematomas: single versus double burr holes

Journal of Neurosurgical Sciences ◽

10.23736/s0390-5616.18.04577-0 ◽

2020 ◽

Vol 64 (2) ◽

Author(s):

Salvatore D'oria ◽

Mariagrazia Dibenedetto ◽

Eleonora Squillante ◽

Carlo Delvecchio ◽

Francesco Zizza ◽

...

Keyword(s):

Subdural Hematomas ◽

Burr Holes ◽

Single Versus

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Pure Motor Stroke Secondary to Cerebral Infarction of Recurrent Artery of Heubner after Mild Head Trauma: A Case Report

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2016.013 ◽

2016 ◽

Vol 4 (1) ◽

pp. 139-141

Author(s):

Ali Yilmaz ◽

Zahir Kizilay ◽

Ayca Ozkul ◽

Bayram Çirak

Keyword(s):

Ischemic Stroke ◽

Head Trauma ◽

Distal Part ◽

Brain Mri ◽

Artery Occlusion ◽

Acute Ischemia ◽

Post Traumatic ◽

The Brain ◽

Perforating Arteries ◽

Pure Motor

BACKGROUND: The recurrent Heubner's artery is the distal part of the medial striate artery. Occlusion of the recurrent artery of Heubner, classically contralateral hemiparesis with fasciobrachiocrural predominance, is attributed to the occlusion of the recurrent artery of Heubner and is widely known as a stroke syndrome in adults. However, isolated occlusion of the deep perforating arteries following mild head trauma also occurs extremely rarely in childhood.CASE REPORT: Here we report the case of an 11-year-old boy with pure motor stroke. The brain MRI showed an acute ischemia in the recurrent artery of Heubner supply area following mild head trauma. His fasciobrachial hemiparesis and dysarthria were thought to be secondary to the stretching of deep perforating arteries leading to occlusion of the recurrent artery of Heubner.CONCLUSION: Post-traumatic pure motor ischemic stroke can be secondary to stretching of the deep perforating arteries especially in childhood.

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Primary Cranial Vault Lymphoma Extending between Subcutaneous Tissue and Brain Parenchyma without Skull Destruction after Mild Head Trauma: A Case Report and Literature Review

Case Reports in Oncology ◽

10.1159/000516272 ◽

2021 ◽

pp. 1118-1123

Author(s):

Kengo Setta ◽

Takaaki Beppu ◽

Yuichi Sato ◽

Hiroaki Saura ◽

Junichi Nomura ◽

...

Keyword(s):

Tumor Cells ◽

Head Trauma ◽

Dura Mater ◽

Subcutaneous Tissue ◽

Bone Destruction ◽

B Cell Lymphoma ◽

Brain Parenchyma ◽

Skin Tumor ◽

Cranial Vault ◽

The Brain

Malignant lymphoma of the head rarely arises outside of the brain parenchyma as primary cranial vault lymphoma (PCVL). A case of PCVL that invaded from subcutaneous tissue into the brain, passing through the skull, and occurred after mild head trauma is reported along with a review of the literature. The patient was a 75-year-old man with decreased activity. One month before his visit to our hospital, he bruised the left frontal area of his head. Magnetic resonance imaging showed homogeneously enhanced tumors with contrast media in the subcutaneous tissue corresponding to the head impact area and the cerebral parenchyma, but no obvious abnormal findings in the skull. A biopsy with craniotomy was performed under general anesthesia. The pathological diagnosis was diffuse large B-cell lymphoma. On histological examination, tumor cells grew aggressively under the skin. Tumor cells invaded along the emissary vein into the external table without remarkable bone destruction and extended across the skull through the Haversian canals in the diploe. Tumor cells were found only at the perivascular areas in the dura mater and extended into the brain parenchyma. Considering the history of head trauma and the neuroimaging and histological findings, the PCVL in the present case arose primarily under the skin, passed though the skull and dura mater, and invaded along vessels and reached the brain.

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Differential diagnosis of spontaneous intracranial hemorrhage in young

Medical Science And Education Of Ural ◽

10.36361/1814-8999-2021-22-1-83-86 ◽

2021 ◽

Vol 22 (1) ◽

pp. 83-86

Author(s):

O. A. Kicherova ◽

◽

L. I. Reikhert ◽

O. N. Bovt ◽

◽

...

Keyword(s):

Hemorrhagic Stroke ◽

Young Patients ◽

Vascular Diseases ◽

Cerebrovascular Diseases ◽

Intracerebral Hematoma ◽

Toxic Substances ◽

Brain Substance ◽

Secondary All ◽

Visualization Techniques ◽

The Brain

In recent years, cerebral vascular diseases have been increasingly detected in young patients. It is due not only to better physicians’ knowledge about this pathology, but also to the improvement of its diagnosis methods. Modern neuroimaging techniques allow us to clarify the nature of hemorrhage, to determine the volume and location of intracerebral hematoma, and to establish the degree of concomitant edema and dislocation of the brain. However, despite the high accuracy of the research, it is not always possible to establish the cause that led to a brain accident, which greatly affects the tactics of management and outcomes in this category of patients. A special feature of the structure of cerebrovascular diseases of young people is the high proportion of hemorrhagic stroke, the causes of which are most often arterio-venous malformations. Meanwhile, there are a number of other causes that can lead to hemorrhage into the brain substance. These include disorders of blood clotting, and various vasculitis, and exposure to toxic substances and drugs, and tumor formations (primary and secondary). All these pathological factors outline the range of diagnostic search in young patients who underwent hemorrhagic stroke. Diagnosis of these pathological conditions with the help of modern visualization techniques is considered to be easy, but this is not always the case. In this article, the authors give their own clinical observation of a hemorrhagic stroke in a young patient, which demonstrates the complexity of the diagnostic search in patients with this pathology.

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