Abstract WP429: Therapeutic Strategy For Chronic Subdural Hematoma Associated With Cerebrospinal Fluid Hypovolemia

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Takafumi Shimogawa
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Therapeutic Strategy ◽  
Clinical Symptoms ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Treatment Result ◽  
Hematoma Evacuation ◽  
The Third ◽  
Blood Patch

Chronic subdural hematoma (CSH) with the cerebrospinal fluid (CSF) hypovolemia is often reported, but the therapeutic strategy is not established. We examined the therapeutic strategy and the treatment result for CSH with the CSF hypovolemia that we experienced in our hospital. [Object and method] In 544 patients with CSF hypovolemia during January 2000 to July 2012, 7 cases (1.3%) had CSH bilaterally. About CSF hypovolemia, 5 cases was diagnosed as spontaneous, 1 case as post-traumatic injury, and 1 case as post-traffic injury. We devided them into 3 groups; the first group which performed epidural blood patch (EBP) therapy first, the second group which performed hematoma evacuation for CSH first, and the third group group which performed the hematoma evacuation for CSH and EBP simultaneously. [Result] In the first group included 5 cases, only 1 case of CSH resolved spontaneously, and another 4 cases needed additional hematoma evacuation by aggravation of clinical symptoms. In the second group included 1 case, CSH recurred, and additional EBP therapy and hematoma evacuation were needed. In the third group included 1 case, the improvement of prompt clinical symptoms was obtained and CSH did not recurr. [Conclusion] The treatment for CSH with CSF hypovolemia needs EBP therapy first, however most cases needs an additional hematoma evacuation. If it takes into consideration, it may be better to do the hematoma evacuation and the EBP simultaneouly. In addition, it is necessary to consider a CSF hypovolemia as a cause of a bilateral CSH which relapse after treatment.

scholarly journals Cerebrospinal fluid leak as a driving factor in chronic subdural hematoma formation: A histological study

2021 ◽  
Vol 12 ◽  
pp. 578
Author(s):  
Antonio Colamaria ◽  
Matteo Sacco ◽  
Savino Iodice ◽  
Nicola Pio Fochi ◽  
Francesco Carbone
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Reaction ◽  
Subdural Hematoma ◽  
Histological Study ◽  
Fluid Collection ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leak ◽  
Demographic Shift ◽  
Csf Leakage

Background: Chronic subdural hematoma (CSDH) represents the most common neurosurgical disease. Given the demographic shift toward an aging population, the overall incidence of this condition is increasing. Nevertheless, clarity in the pathophysiological process is yet to be made. Several etiological mechanisms have been proposed to initiate and consequently promote fluid collection in the subdural space. Traumatic injury of the bridging veins has long been considered the primum movens of the pathology but increasing evidence shows that trauma is not the only factor involved. Along with recent advances we sought to understand the role of the cerebrospinal fluid (CSF) in the buildup of the intense inflammatory reaction that characterizes CSDH. Methods: In the present study, we examined histological features of reactive membranes secondary to extracranial CSF leakage with CSDH-related membranes. Similarity and differences between the specimens were examined by means of light microscopy. Results: Histological similarities were consistently found between CSDH membranes and reactive membranes secondary to CSF leakage in the extracranial space. Activated histiocytes were highlighted in all specimens along with an intense inflammatory reaction. Conclusion: CSDH is most likely the result of a complex interaction among different pathophysiological events resulting from both traumatic and inflammatory etiologies. In the present work, we highlight how CSF leakage could be an early factor that leads to a cascade of events that culminates in CSDH formation.

scholarly journals A Case of Spontaneous Cerebrospinal Fluid Hypovolemia with Coma and Chronic Subdural Hematoma after Epidural Self-blood Patch Therapy

2009 ◽  
Vol 18 (7) ◽  
pp. 525-530 ◽  
Author(s):  
Naomi Hashimoto ◽  
Kanji Yamane ◽  
Norihumi Okii ◽  
Saori Ishinokami ◽  
Hidehiro Onda ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Blood Patch

Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma

2008 ◽  
Vol 108 (2) ◽  
pp. 275-280 ◽  
Author(s):  
Rudolf A. Kristof ◽  
Jochen M. Grimm ◽  
Birgit Stoffel-Wagner
Keyword(s):  
Cerebrospinal Fluid ◽  
Recurrence Rate ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Cerebrospinal Fluid Leakage ◽  
Subdural Space ◽  
Subdural Hygroma ◽  
Fluid Leakage ◽  
Csf Leakage

Object The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. Methods In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of β -trace protein (β TP) in the subdural fluid (βTPSF) and serum (βTPSER), and the CSDH/SH recurrence rate. The βTPSF was considered to indicate an admixture of CSF to the subdural fluid if βTPSF/βTPSER > 2. Results The median β TPSF level for the whole patient group was 4.29 mg/L (range 0.33–51 mg/L). Cerebrospinal fluid leakage, as indicated by βTPSF/βTPSER > 2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p = 0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the βTPSF concentrations (median 6.69 mg/L, range 0.59–51 mg/L) were significantly higher (p = 0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33–26.8 mg/L). Conclusions As indicated by the presence of βTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of βTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

Letter to the Editor Regarding “Twist Drill Procedure for Chronic Subdural Hematoma Evacuation—An Analysis of Predictors for Treatment Success”

2020 ◽  
Vol 139 ◽  
pp. 698 ◽  
Author(s):  
Giuseppe Emmanuele Umana ◽  
Stefano Chiriatti ◽  
Marco Fricia ◽  
Nicola Alberio ◽  
Salvatore Cicero ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Treatment Success ◽  
Chronic Subdural Hematoma ◽  
Twist Drill ◽  
Hematoma Evacuation ◽  
Letter To The Editor

scholarly journals Review of spinal pseudomeningoceles and cerebrospinal fluid fistulas

2000 ◽  
Vol 9 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Mark W. Hawk ◽  
Kee D. Kim
Keyword(s):  
Cerebrospinal Fluid ◽  
Treatment Options ◽  
Traumatic Injury ◽  
Bed Rest ◽  
Diagnostic Tools ◽  
Lumbar Region ◽  
Low Back ◽  
True Incidence ◽  
Blood Patch ◽  
Close Observation

Spinal pseudomeningoceles and cerebrospinal fluid (CSF) fistulas are uncommon extradural collections of CSF that may result from inadvertent tears in the dural–arachnoid layer, traumatic injury, or may be congenital in origin. Most pseudomeningoceles are iatrogenic and occur in the posterior lumbar region following surgery. The true incidence of iatrogenic pseudomeningoceles following laminectomy or discectomy is unknown; however, the authors of several published reports suggest that the incidence of lumbar pseudomeningoceles following laminectomy or discectomy is between 0.07% and 2%. Pseudomeningoceles are often asymptomatic, but patients may present with recurrence of low-back pain, radiculopathy, subcutaneous swelling, or with symptoms of intracranial hypotension. Very rarely, they present with delayed myelopathy. Although magnetic resonance imaging is the neurodiagnostic study of choice, computerized tomography myelography and radionuclide myelographic study may be helpful diagnostic tools in some cases. Analysis of suspect fluid for β2 transferrin may be a useful adjunctive study. Treatment options include close observation for spontaneous resolution, conservative measures such as bed rest and applicaton of an epidural blood patch, lumbar subarachnoid drainage, and definitive surgical repair.

Production of clinical form of chronic subdural hematoma in experimental animals

1972 ◽  
Vol 37 (5) ◽  
pp. 552-561 ◽  
Author(s):  
Satoru Watanabe ◽  
Hironobu Shimada ◽  
Shozo Ishii
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Clinical Form ◽  
Content Type ◽  
Experimental Animals ◽  
Fine Print

✓ A method for producing a clinical form of experimental chronic subdural hematoma is reported. When blood is mixed with cerebrospinal fluid and incubated, a peculiar clot is formed which, when inoculated into the subdural space of dogs or monkeys, grows gradually. Histologically the capsule of the hematoma is comparable to that seen in human chronic subdural hematoma. In some animals progressive hemiparesis develops.

scholarly journals Spontaneous Intracranial Hypotension Manifesting as a Unilateral Subdural Hematoma with a Marked Midline Shift

2015 ◽  
Vol 7 (1) ◽  
pp. 71-77 ◽  
Author(s):  
Joji Inamasu ◽  
Shigeta Moriya ◽  
Junpei Shibata ◽  
Tadashi Kumai ◽  
Yuichi Hirose
Keyword(s):  
Mental Status ◽  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Altered Mental Status ◽  
Midline Shift ◽  
Hematoma Evacuation ◽  
Neurologic Deterioration ◽  
Blood Patch ◽  
Csf Leakage

Spontaneous intracranial hypotension (SIH) is a syndrome in which hypovolemia of the cerebrospinal fluid (CSF) results in various symptoms. Although its prognosis is usually benign, cases with a rapid neurologic deterioration resulting in an altered mental status have been reported. One of the characteristic radiographic findings in such cases is the presence of bilateral accumulation of subdural fluid (hematoma/hygroma). When SIH-related subdural hematoma is present only unilaterally with a concomitant midline shift, making an accurate diagnosis may be challenging, and inadvertent hematoma evacuation may result in further neurologic deterioration. We report a 58-year-old woman with an altered mental status who had visited a local hospital and in whom a brain CT showed a unilateral subdural hematoma with a marked midline shift. She was referred to our department because of her neurologic deterioration after hematoma evacuation. A CT myelography revealed a massive CSF leakage in the entire thoracic epidural space. She made a full neurologic recovery following blood patch therapy. Our case is unique and educational because the suspicion for SIH as an underlying cause of subdural hematoma is warranted in nongeriatric patients not only with bilateral but also unilateral lesions. An immediate search for CSF leakage may be important in cases with failed hematoma evacuation surgery.

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