A Review of Remote Intracerebral Hemorrhage after Chronic Subdural Hematoma Evacuation

2021 ◽  
Author(s):  
Giuseppe Emmanuele Umana ◽  
Maurizio Salvati ◽  
Marco Fricia ◽  
Maurizio Passanisi ◽  
Leonardo Corbino ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Subdural Hematoma ◽  
Literature Search ◽  
Case Reports ◽  
Rapid Change ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Time Interval ◽  
Cerebellar Infarction ◽  
Female Ratio

Abstract Background Remote intracerebral hemorrhage (RICH) is a severe complication following chronic subdural hematoma (cSDH) drainage, and only case reports and small case series have been reported to date. The authors present an emblematic patient affected by RICH following cSDH drainage. A systematic review of the literature on diagnosis and management of patients affected by RICH following cSDH evacuation has also been performed. Methods A literature search according to the PRISMA statement was conducted using PubMed and Scopus databases with the following Mesh terms: [(remote) AND (intracerebral hemorrhage or cerebral hematoma or cerebral infarction or cerebellar hemorrhage or cerebellar hematoma or cerebellar infarction) AND (chronic subdural hematoma)]. Results The literature search yielded 35 results, and 25 articles met our inclusion criteria: 22 articles were case reports and 3 were case series including three to six patients. Overall, 37 patients were included in the study. Age was reported in all 37 patients, 26 males (70.3%) and 11 females (29.7%), with a male-to-female ratio of 2.4:1. The mean age at diagnosis was 64.6 years (range: 0.25–86 years). Only in 5 cases (13.5%) did the ICH occur contralaterally to the previously drained cSDH. The rapidity of drainage can lead to several types of intracranial hemorrhages, caused by a too rapid change in the cerebral blood flow (CBF) and/or tears of bridging veins. The average time interval between cSDH drainage and neurologic deterioration was 71.05 hours (range: 0–192 hours). Conclusions RICH following cSDH represents a rare occurrence and a serious complication, associated with elevated morbidity. Careful monitoring of drain speed after cSDH evacuation surgery is recommended, and minimally invasive techniques such as twist drill craniostomy are suggested, especially for massive cSDHs.

scholarly journals A Review of Recent Korean Medicine Treatment for Chronic Subdural Hematoma Using the CNKI Database

2021 ◽  
Vol 42 (3) ◽  
pp. 308-322
Author(s):  
Yu-ran Je ◽  
Kyong-lim Kim ◽  
Won-deok Hwang
Keyword(s):  
Subdural Hematoma ◽  
Clinical Studies ◽  
Case Reports ◽  
Evaluation Criteria ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Duration Of Treatment ◽  
Korean Medicine ◽  
Randomized Controlled ◽  
Control Study

Objectives: This study investigates the latest clinical studies on Korean medicine treatment of chronic subdural hematoma (CSDH) in China.Methods: A CNKI search investigated the last 10 years of clinical studies of Korean medicine treatments in Chinese medical journals for CSDH. The search focused on authors, publication years, types of studies, purposes of studies, methods and duration of treatment, evaluation criteria, and results of treatment.Results: In 19 studies, there were 14 randomized controlled trials (RCTs), 4 case series, and 1 case-control study. In all 19 studies, Korean medical treatment and Western treatment were combined. Herbal medicine was used in 19 studies and acupuncture treatment in 2 studies. The most frequently used prescription was Hyeolbuchukeo-tang-gagambang, and the most frequently used acupoint was PC6. In all 19 studies, the effectiveness of Korean medicine treatment performed in parallel with Western treatment was confirmed.Conclusions: In this study, Korean medicine combined with Western treatment for CSDH was effective. More clinical studies and case reports are required to develop a guided treatment for CSDH.

scholarly journals Intracerebral Hemorrhage Immediately Following Surgical Treatment of Chronic Subdural Hematoma

1984 ◽  
Vol 24 (1) ◽  
pp. 27-29 ◽  
Author(s):  
Noboru NAKAHARA ◽  
Toshio MASUZAWA ◽  
Koichi KUNO ◽  
Fumiaki SATO
Keyword(s):  
Surgical Treatment ◽  
Intracerebral Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma

scholarly journals Twist drill aspiration of chronic subdural hematoma at the Ignace Deen hospital of Conakry

2021 ◽  
Vol 9 (5) ◽  
Author(s):  
Alpha Boubacar Bah ◽  
Seylan Diawara ◽  
Ibrahima Sory Souare ◽  
Abdoulaye Barry ◽  
Ansoumane Donzo ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Outcome Data ◽  
Twist Drill ◽  
Suitable Alternative ◽  
Female Ratio ◽  
Tertiary Centre ◽  
Male Female Ratio ◽  
Reasonable Approach

Bedside percutaneous twist drill aspiration (TDA) is described as a surgical method of management of Chronic subdural hematoma (CSDH) and appear to be a reasonable approach in low medical resources environment. We report the results of TDA of CSDH in a single tertiary centre in Conakry Republic of Guinea in West Africa, for the period March 2015 to October 2017. The charts and medical record of 38 cases of CSDH treated with TDA were collected retrospectively, with a mean follow-up of 84.2 days. The outcome data assessed were neurologic status evaluated by the follow-up Markwalder grading scale (MGS: 0=normal to 4=coma), recurrence, infection and mortality. The Male-Female ratio was 1.3:1. Mean age at diagnosis was 78.2+/-12 years. Traumatic brain injury (TBI) was identified as causal in 28.2% of cases studied. All patients were operated on under local anesthesia and had a postoperative drain left in place for 3 days. The mean postoperative MGS was 1.06, up from a mean preoperative MGS of 3.7. Two cases of recurrence occurred subsequent to TDA causing death and three other patients died from unknown causes during the follow-up period. No cases of post-operative infection were diagnosed during the follow-up. Our study shows that Bedside TDA appears to be a suitable alternative to burr hole craniotomies in urgent cases of CSDH in the low socio-economic setting, where a surgical theatre is not always available.

scholarly journals Middle meningeal artery embolization for chronic subdural hematoma: Endovascular technique and radiographic findings

2018 ◽  
Vol 24 (4) ◽  
pp. 455-462 ◽  
Author(s):  
Thomas W Link ◽  
Benjamin I Rapoport ◽  
Stephanie M Paine ◽  
Hooman Kamel ◽  
Jared Knopman
Keyword(s):  
Subdural Hematoma ◽  
Case Reports ◽  
Cranial Nerves ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Safe Alternative ◽  
Selective Embolization ◽  
Radiographic Findings ◽  
Pathologic Process ◽  
Meningeal Artery

Background and purpose Embolization of the middle meningeal artery (MMA) has recently been proposed as an alternative to surgery for treatment of chronic subdural hematoma (SDH), and several case reports have been published supporting its efficacy. It has been suggested that the primary pathologic process in chronic SDH is repeated microhemorrhaging into the subdural collection from fragile neovasculature within the SDH membrane that arises from distal branches of the MMA. Embolization could thus provide a means of eliminating this chronic rebleeding. Materials and methods Images were selected from MMA embolization procedures performed at our institution in order to illustrate the technique and theory behind its efficacy for treatment of chronic SDH. Results Images from MMA angiograms demonstrate the variability of MMA anatomy and help illustrate the importance of avoiding potential ophthalmic collaterals and branches supplying cranial nerves. The findings of irregular wispiness of the distal MMA vasculature, contrast outlining of the SDH membrane on angiography, and homogenous increased density within the SDH on postembolization head computed tomography are described. Conclusion MMA embolization may provide a safe alternative for treatment of chronic SDH, but careful angiographic assessment of MMA anatomy should be performed to avoid potential complications. The findings illustrated here lend support to the theory that the pathologic process of chronic SDH is repeated leakage of blood products from an inflamed, abnormal arterial neovasculature within the SDH membrane that arises from the MMA, and thus selective embolization could provide an effective treatment.

Transradial middle meningeal artery embolization for chronic subdural hematoma using Onyx: case series

2020 ◽  
pp. neurintsurg-2020-016185
Author(s):  
Gary B Rajah ◽  
Muhammad Waqas ◽  
Rimal H Dossani ◽  
Kunal Vakharia ◽  
Andrew D Gong ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Conscious Sedation ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Antiplatelet Agents ◽  
Middle Meningeal Artery ◽  
Complication Rates ◽  
Femoral Access ◽  
Guide Catheter ◽  
Meningeal Artery

BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.

Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Series of 60 Cases

Neurosurgery ◽  
2018 ◽  
Vol 85 (6) ◽  
pp. 801-807 ◽  
Author(s):  
Thomas W Link ◽  
Srikanth Boddu ◽  
Stephanie M Paine ◽  
Hooman Kamel ◽  
Jared Knopman
Keyword(s):  
Subdural Hematoma ◽  
Large Scale ◽  
Case Series ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Recurrence Rates ◽  
Surgical Evacuation ◽  
Procedural Complications ◽  
Previously Treated ◽  
Meningeal Artery

Abstract BACKGROUND Chronic subdural hematoma (SDH) is a particularly challenging pathology due to high recurrence rates (2%-37%) and complex medical comorbidities that tend to afflict the patient population. Recently, there have been several case series published describing the use of middle meningeal artery (MMA) embolization as an alternative to surgery for treatment of new or recurrent chronic SDH. OBJECTIVE To describe our first 60 cases of MMA embolization for chronic SDH. METHODS MMA embolization was performed using angiography, selective microcatheterization of the MMA, and infusion of polyvinyl alcohol particles. Outcomes were assessed clinically and with interval imaging studies at 1 d, 2 wk, and 6 wk postprocedure, and additional intervals as indicated. RESULTS MMA embolization was performed successfully on 60 total SDHs in 49 patients. This includes upfront treatment for new (not previously treated) SDH in 42, for recurrence in 8, and prophylaxis (soon after surgical evacuation) in 10. There were 3 mortalities (unrelated to the procedure), and no procedural complications. Of the 50 nonprophylactic cases, there were 4 (8.9%) cases of recurrence requiring surgical evacuation, and 31 (68.9%) that had resolution or reduction in size >50% of SDH at longest follow-up. Overall, 41 (91.1%) were stable or decreased in size and able to avoid surgery. CONCLUSION MMA embolization may represent a minimally-invasive alternative to surgery for new or recurrent chronic SDH, or as prophylaxis to reduce the risk of recurrence after surgery. Given our encouraging results with a 91% long-term success rate, a large scale clinical trial is warranted.

Adult Hemophagocytic Lymphohistiocytosis: Clinical Presentation and Follow-Up in a Consecutive Series of Ten Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3845-3845
Author(s):  
Keisuke Shirai ◽  
Alberto Montero ◽  
Jesse Powell ◽  
Lydia Christiansen ◽  
John Lazarchick
Keyword(s):  
Hemophagocytic Lymphohistiocytosis ◽  
Case Reports ◽  
Case Series ◽  
Hematologic Malignancies ◽  
Neurological Involvement ◽  
Consecutive Series ◽  
Female Ratio ◽  
Etoposide Treatment ◽  
Male Female Ratio ◽  
Underlying Causes

Abstract Hemophagocytic Lymphohistiocytosis (HLH) is very rare in adults but can be fatal without treatment. Reports in adults are limited to case reports and very small case series. Clinically it is characterized by fever, hepatosplenomegaly, lymphadenopathy, severe cytopenias, hepatic dysfunction, coagulopathy, as well as neurological involvement. This syndrome is associated with diverse processes including: infection, rheumatologic, and hematologic malignancies. Presently, the underlying cause of HLH is unknown. We present a cosecutive series of 10 adults with HLH diagnosed at our institution between 2004–2006. All diagnoses were confirmed by pathology. The median age was 59 years (range: 18–73 years), and a male: female ratio of 4:1. All patients uniformly presented with fever. Half of the patients presented with evidence of hepatomegaly or splenomegaly. The most predominant laboratory abnormalities included: leukopenia or thrombocytopenia (100%), and elevation of liver enzymes (50%). EBV IgG was positive in 8 of 10 patients. The underline illnesses associated with HLH were diverse. The underlying causes were as follows; acute leukemia (n=2), infection (n=2), rheumatologic (n=2), post transplant (n=2) sickle cell disease (n=2), unknown (n=2). Mortality rate was 60% with a median survival time since diagnosis of 58 days. One patient is still on maintenance cyclosporin after etoposide treatment. One patient is on steroid and cytoxan. One patient recovered just with supportive care. In conclusion, due to the high morality rate associated with HLH, early treatment with immunosuppressant is warranted and attempts to identify underlying cause.

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