Chronic Subdural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 27-34
Author(s):  
Nathaniel Toop ◽  
Benjamin McGahan ◽  
Varun Shah ◽  
John McGregor
Keyword(s):  
Old Age ◽  
Conservative Management ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Neurological Dysfunction ◽  
Cortical Surface ◽  
Subdural Space ◽  
Presenting Symptoms ◽  
Subdural Drain ◽  
The Brain

Chronic subdural hematomas are collections of blood in the subdural space. They can present variably in size and age. They can present as a single hemorrhage event or with evidence of repeated hemorrhages. They tend to be more common in an aging population. The associated trauma can be surprisingly minimal. The brain atrophy associated with old age allows for more room for subdural blood to pool prior to causing significant neurological dysfunction. They may occur spontaneously, and the symptoms relate to mass effect and irritation of the cortical surface. Treatment varies depending on presenting symptoms, size, chronicity, and degree of septations. Care should be taken in surgical cases to avoid disruption of the cortical surface, assure hemostasis prior to closure, and consider placement of a subdural drain. Growing evidence suggests there is a roll for conservative management in select presentations.

Acute Subdural Hematoma

Neurotrauma ◽  
2019 ◽  
pp. 17-26
Author(s):  
Benjamin McGahan ◽  
Nathaniel Toop ◽  
Varun Shah ◽  
John McGregor
Keyword(s):  
Brain Injury ◽  
Arteriovenous Malformation ◽  
Conservative Management ◽  
Epidural Hematoma ◽  
Mass Effect ◽  
Acute Subdural Hematoma ◽  
Subdural Space ◽  
Cortical Injury ◽  
Subdural Hematomas ◽  
Hemorrhagic Lesion

Acute subdural hematomas are collections of acute blood in the subdural space. They usually present as a result of significant head trauma. They can occur spontaneously in relationship to an underlying hemorrhagic lesion such as tumor, arteriovenous malformation, or aneurysm. They are more likely to be associated with cortical injury than the epidural hematoma. Neurological symptoms on presentation are related to the underlying brain injury and/or mass effect. Acute subdural blood on CT scan is hyperdense, in a crescent shape, along the inner dural surface. Emergent surgical intervention via craniotomy is indicated in patients with at least 10 mm in thickness or at least 5 mm shift, or elevated ICP, or pupillary dilatations suggesting herniation, or progression of deficit based on the Glasgow Coma Score. Conservative management of small acute subdural hematomas may be done in select situations that include proper ICU monitoring for ICP elevations and neurological deteriorations.

Computerized tomography findings in arteriovenous malformations of the brain

1979 ◽  
Vol 51 (6) ◽  
pp. 765-772 ◽  
Author(s):  
Richard Leblanc ◽  
Roméo Ethier ◽  
John R. Little
Keyword(s):  
Ct Scan ◽  
Computerized Tomography ◽  
Brain Infarction ◽  
Mass Effect ◽  
Seizure Disorder ◽  
Neurological Dysfunction ◽  
Common Finding ◽  
Content Type ◽  
Additional Information ◽  
The Brain

✓ Computerized tomography (CT) scans of 54 patients with an arteriovenous malformation (AVM) of the brain were reviewed. The 31 males and 23 females (mean age: 33 years) were classified according to clinical presentation: 1) intracranial hemorrhage (30 patients); 2) seizure disorder (19 patients); and 3) other neurological disturbance (five patients). A brain hematoma was identified in all of the patients in the hemorrhage group having a CT scan within 1 week of the bleed. Extension of hemorrhage into the ventricular system as seen in eight cases was invariably accompanied by severe neurological dysfunction. A high-density lesion without associated mass effect was found in 48% of patients presenting with a seizure disorder. Dilatation of the ipsilateral lateral ventricle, a common finding in this group of patients, was thought to indicate an atrophic process. Evidence of discrete brain infarction was unusual. Intravenous infusion with Hypaque provided additional information in 31 of the 35 patients so studied. Demonstration of prominent or enlarged feeding arteries and/or draining veins occurred in 20% of patients with large malformations. Six cases of angiographically occult AVM's were found. A correlation of the CT scan with clinical, angiographic, and histological findings is presented.

CLINICAL CONFERENCE

PEDIATRICS ◽  
1957 ◽  
Vol 20 (3) ◽  
pp. 561-564
Author(s):  
Joseph Ransohoff
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Anterior Fontanelle ◽  
History Of ◽  
Group A ◽  
Therapeutic Problem ◽  
The Brain ◽  
Tentative Diagnosis ◽  
Internal Hydrocephalus

Dr. Ransohoff: I want to draw your attention to a group of infants with chronic subdural hematoma. The distinctive feature of these patients is marked enlargement of the skull. This megalocephaly was of such a degree in eight patients we treated that they were all admitted to the hospital with a tentative diagnosis of internal hydrocephalus. The presence of subdural hematoma was only discovered in these children at the time of tipping the subdural space through the enlarged anterior fontanelle prior to carrying out ventriculography. When air is injected into the subdural space in these patients, roentgenograms reveal fairly normal-sized cerebral hemispheres surrounded by hugely distended subdural spaces. We believe that it is this disproportion between the size of the boney vault and the size of the underlying brain which makes this group a special therapeutic problem (Fig. 1). When a surgeon drains blood and fluid from the subdural space, he expects the underlying compressed brain to re-expand and obliterate the remaining cavity. If the lesion is of long standing, he may find it necessary to remove the inner membrane of the subdural hematoma, which is covering the surface of the brain, before the expected re-expansion can occur. However, when the cranium has been so enlarged by bilateral subdural collections that it is considerably larger than the normal-sized brain, the brain cannot be expected to re-expand sufficiently to fill the entire cavity. We became aware of this therapeutic dilemma after applying the usual techniques of treatment to a 3-month-old infant admitted in 1952 with a definite history of trauma. After the removal of about 350 ml of subdural fluid by daily subdural taps, we made bone flaps, bilateral and frontoparietal, and removed the inner membranes of the subdural hematomas, 1 week apart.

scholarly journals A Simple Method to Avoid Brain Shift during Neuronavigation: Technical Note

2020 ◽  
Author(s):  
Jair Leopoldo Raso
Keyword(s):  
Dura Mater ◽  
Brain Area ◽  
Conventional Technique ◽  
Technical Note ◽  
Cortical Surface ◽  
Brain Shift ◽  
Simple Method ◽  
Cortex Area ◽  
Neuronavigation System ◽  
The Brain

Abstract Introduction The precise identification of anatomical structures and lesions in the brain is the main objective of neuronavigation systems. Brain shift, displacement of the brain after opening the cisterns and draining cerebrospinal fluid, is one of the limitations of such systems. Objective To describe a simple method to avoid brain shift in craniotomies for subcortical lesions. Method We used the surgical technique hereby described in five patients with subcortical neoplasms. We performed the neuronavigation-guided craniotomies with the conventional technique. After opening the dura and exposing the cortical surface, we placed two or three arachnoid anchoring sutures to the dura mater, close to the edges of the exposed cortical surface. We placed these anchoring sutures under microscopy, using a 6–0 mononylon wire. With this technique, the cortex surface was kept close to the dura mater, minimizing its displacement during the approach to the subcortical lesion. In these five cases we operated, the cortical surface remained close to the dura, anchored by the arachnoid sutures. All the lesions were located with a good correlation between the handpiece tip inserted in the desired brain area and the display on the navigation system. Conclusion Arachnoid anchoring sutures to the dura mater on the edges of the cortex area exposed by craniotomy constitute a simple method to minimize brain displacement (brain-shift) in craniotomies for subcortical injuries, optimizing the use of the neuronavigation system.

scholarly journals Cognitive impairments induced by necrotizing enterocolitis can be prevented by inhibiting microglial activation in mouse brain

2018 ◽  
Vol 10 (471) ◽  
pp. eaan0237 ◽  
Author(s):  
Diego F. Niño ◽  
Qinjie Zhou ◽  
Yukihiro Yamaguchi ◽  
Laura Y. Martin ◽  
Sanxia Wang ◽  
...  
Keyword(s):  
Necrotizing Enterocolitis ◽  
Microglial Activation ◽  
Gastrointestinal Disease ◽  
Cognitive Impairments ◽  
High Mobility ◽  
Neurological Dysfunction ◽  
Mucosal Inflammation ◽  
Signaling Axis ◽  
The Brain

Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease of the premature infant. One of the most important long-term complications observed in children who survive NEC early in life is the development of profound neurological impairments. However, the pathways leading to NEC-associated neurological impairments remain unknown, thus limiting the development of prevention strategies. We have recently shown that NEC development is dependent on the expression of the lipopolysaccharide receptor Toll-like receptor 4 (TLR4) on the intestinal epithelium, whose activation by bacteria in the newborn gut leads to mucosal inflammation. Here, we hypothesized that damage-induced production of TLR4 endogenous ligands in the intestine might lead to activation of microglial cells in the brain and promote cognitive impairments. We identified a gut-brain signaling axis in an NEC mouse model in which activation of intestinal TLR4 signaling led to release of high-mobility group box 1 in the intestine that, in turn, promoted microglial activation in the brain and neurological dysfunction. We further demonstrated that an orally administered dendrimer-based nanotherapeutic approach to targeting activated microglia could prevent NEC-associated neurological dysfunction in neonatal mice. These findings shed light on the molecular pathways leading to the development of NEC-associated brain injury, provide a rationale for early removal of diseased intestine in NEC, and indicate the potential of targeted therapies that protect the developing brain in the treatment of NEC in early childhood.

scholarly journals Neuroendoscopic fenestration of glioependymal cysts to the ventricle: report of 3 cases

2019 ◽  
Vol 131 (5) ◽  
pp. 1615-1619
Author(s):  
Anthony M. Alvarado ◽  
Kyle A. Smith ◽  
Roukoz B. Chamoun
Keyword(s):  
Minimally Invasive ◽  
Lateral Ventricle ◽  
Mass Effect ◽  
Ventricular System ◽  
Open Resection ◽  
Presenting Symptoms ◽  
Glioependymal Cyst ◽  
The Central Nervous System ◽  
Surgical Treatments ◽  
Endoscopic Fenestration

Glioependymal cysts are rare congenital lesions of the central nervous system. Reported surgical treatments of these lesions have varied and yielded mixed results, and the optimal surgical strategy is still controversial. The authors here report the clinical and surgical outcomes for three adult patients successfully treated with neuroendoscopic fenestration into the ventricular system. The patients had presented with symptomatic glioependymal cysts in the period from 2013 to 2016 at the authors’ institution. All underwent minimally invasive neuroendoscopic fenestration of the glioependymal cyst into the lateral ventricle via a stereotactically guided burr hole. Presenting clinical and radiological findings, operative courses, and postintervention outcomes were evaluated.All three patients initially presented with symptoms related to regional mass effect of the underlying glioependymal cyst, including headaches, visual disturbances, and hemiparesis. All patients were successfully treated with endoscopic fenestration of the cyst wall into the lateral ventricle, where the wall was thinnest. Postoperatively, all patients reported improvement in their presenting symptoms, and neuroimaging demonstrated decompression of the cyst. Clinical follow-up ranged from 4 months to 5 years without evidence of reexpansion of the cyst or shunt requirement.Compared to open resection and shunting of the cyst contents, minimally invasive endoscopic fenestration of a glioependymal cyst into the ventricular system is a safe and effective surgical option. This approach is practical, is less invasive than open resection, and appears to provide a long-term solution.

scholarly journals VI. On the comparative structure of the brain in rodents

1882 ◽  
Vol 33 (216-219) ◽  
pp. 15-21
Keyword(s):  
Olfactory Organ ◽  
Cortical Surface ◽  
Complex Relationship ◽  
Comparative Structure ◽  
The Subject ◽  
The Brain

I have endeavoured in this abstract to summarise the results of my recent researches into the minute structure of the brain in the smaller Rodents. The pig and sheep, which were the subjects of my former memoir, possess a highly developed olfactory apparatus conjoined to a well convoluted cortical surface; but in the smaller animals now under consideration the surface of the hemispheres is almost perfectly smooth, while the olfactory organ, from its comparative size and complex relationship, has an important part to play in the architecture of the brain. Animals possessing the latter type of cerebrum have been classed together as the Osmatic Lissencéphales, in contradistinction to those which were the subject of my former enquiries, the Osmatic Gyren-céphales. My researches into the structure of the brain of prominent members of the former group, viz., the rabbit and rat, may be considered under two heads:— ( a .) The histology of the complete cortical envelope.

scholarly journals Imaging features and surgery-related outcomes in intraventricular neurocysticercosis

2002 ◽  
Vol 12 (6) ◽  
pp. 1-8 ◽  
Author(s):  
Jonathan Stuart Citow ◽  
J. Patrick Johnson ◽  
Duncan Q. McBride ◽  
Mario Ammirati
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Computerized Tomography ◽  
Failure Rate ◽  
Treatment Algorithm ◽  
Parasitic Infection ◽  
Mass Effect ◽  
The United States ◽  
Imaging Features ◽  
Presenting Symptoms

Object Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system, and its prevalence is continuing to increase in the United States. The diagnosis of intraventricular NCC (IVNCC) may be difficult, and surgery frequently fails to resolve symptoms. A retrospective review of magnetic resonance (MR) imaging characteristics and surgery-related outcomes may improve management strategies of this disease. Methods The authors report the presentations, neuroimaging characteristics, surgical management, and outcomes of 30 patients with IVNCC treated over a 10-year period (mean follow-up period 4 years). Cysts were located in the lateral ventricles (five cases), the third ventricle (five cases), and the fourth ventricle (21 cases). One patient had lesions in both the lateral and fourth ventricles. Presenting symptoms were related to hydrocephalus or mass effect from the lesions. All patients underwent computerized tomography (CT) and MR imaging of the brain. Treatment consisted of shunt implantation or primary excision of an IVNCC lesion. Outcomes after operations and reoperations were evaluated in light of enhancement characteristics on MR imaging. Computerized tomography scanning demonstrated IVNCC lesions in 10% of cases, and MR revealed lesions in 100% of cases. In patients in whom gadolinium (Gd) enhancement of IVNCC lesions was demonstrated on MR imaging, the surgery-related failure rate was higher and patients required reoperation, and in those in whom gadolinium enhancement was absent the surgery-related failure rate was lower (64 and 19%, respectively; p < 0.0002). Conclusions Magnetic resonance imaging is superior to CT scanning for detecting IVNCC lesions. The absence of pericystic Gd enhancement on MR imaging is an indication for excision of the lesions. If pericystic enhancement is present, shunt surgery should be performed, and craniotomy reserved for treatment of those patients with symptomatic lesions secondary to mass effect. A treatment algorithm based on patient symptoms, cyst location, and MR imaging Gd enhancement characteristics is proposed.

SUBDURAL FLUID AS A CONSEQUENCE OF PNEUMOENCEPHALOGRAPHY

PEDIATRICS ◽  
1950 ◽  
Vol 5 (3) ◽  
pp. 375-389
Author(s):  
HONOR V. SMITH ◽  
BRONSON CROTHERS
Keyword(s):  
Cerebral Palsy ◽  
Subdural Hematoma ◽  
Cerebral Atrophy ◽  
Mental Deficiency ◽  
Signs And Symptoms ◽  
Brain Lesions ◽  
Subdural Space ◽  
Suitable Treatment ◽  
Superior Longitudinal Sinus ◽  
The Brain

When lumbar or cisternal pneumoencephalography is carried out on children with nonprogressive brain lesions causing mental deficiency, cerebral palsy or epilepsy, air is seen in the subdural space in at least a third of cases. This proportion is much larger in children 2 years of age or under. The roentgenographic appearances of subdural air are described and the importance of not attributing these appearances to cerebral atrophy or hypoplasia is emphasized. In approximately one third of cases in which air enters the subdural space, that is, in from 10% to 15% of all cases, recovery from pneumoencephalography is delayed by the development of signs and symptoms suggesting a rise in intracranial pressure. In such cases fluid can usually be found by needling the subdural space. Typically this fluid is characteristic of that found in subdural hematoma. There is no evidence that such a collection of fluid was present before pneumoencephalography. It is therefore suggested that as air enters the subdural space and the brain falls away from the dura, vessels may be torn as they cross this space to reach the superior longitudinal sinus, with the formation of what may be termed subdural hematoma artefacta. Although the incidence of this complication is moderately high, its effects are seldom serious, provided the situation is appreciated and suitable treatment given. The length of time the child spends in the hospital is, however, often greatly prolonged and occasionally operation proves necessary for removal of a subdural membrane. Since the subdural hematoma is an artefact occurring in the course of treatment, its removal does not influence the ultimate prognosis.

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