Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

Abstract Background While both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma. Case summary This study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment. Conclusion DKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

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Diabetic Ketoacidosis (DKA) Induced Cerebral Edema Complicating Small Chronic Subdural Hematoma/Hygroma/ at Zewuditu Memorial Hospital: A Case Report

10.21203/rs.3.rs-1050848/v1 ◽

2021 ◽

Author(s):

Mestet Yibeltal Shiferaw ◽

Tsegazeab Laeke T/Mariam ◽

Abenezer Tirsit Aklilu ◽

Yemisirach Bizuneh Akililu ◽

Bethelhem Yishak Worku

Keyword(s):

Cerebral Edema ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Newly Diagnosed ◽

Midline Shift ◽

Subdural Hygroma ◽

The Status ◽

History Of ◽

Type 1 Dm

Abstract BackgroundWhile both DKA & CSDH/subdural hygroma/ are known to cause significant morbidity and mortality, there is no a study that shows the role & effect of DKA on CSDH/subdural hygroma/ & vice versa to authors’ best knowledge; hence this work will show how important relation does exist between DKA & CSDH/ hygroma.Case summaryThis study highlights the diagnostic & management challenges seen for a case of a 44 years old female black Ethiopian woman admitted with a diagnosis of newly diagnosed type 1 DM with DKA + small CSDH/subdural hygroma/ after she presented with sever global headache and a 3 month history of lost to her work. She needed burrhole & evacuation for complete clinical improvement besides DKA’s medical treatment.ConclusionDKA induced cerebral edema on the CSDH/subdural hematoma/ can have a role in altering any of the parameters (except the thickness of CSDH) for surgical indication of patients with a diagnosis of both CSDH +DM with DKA. Hence, the treating physicians should be vigilant of different parameters that suggests tight brain &/ cerebral edema (including midline shift, the status of cisterns, fissures & sulci) and should not be deceived of the thickness of the CSDH/subdural hygroma/alone; especially when there is a disproportionately tight brain for the degree of collection. Whether DKA induced cerebral edema causes a subdural hygroma is unknown and needs further study.

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Subdural Hematoma: A Rare Presentation of a Convexity Meningioma

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100018576 ◽

2014 ◽

Vol 41 (4) ◽

pp. 506-507 ◽

Cited By ~ 2

Author(s):

David Pelz ◽

Adrian B. Levine ◽

Keith W. MacDougall

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Past Medical History ◽

Midline Shift ◽

Resonance Imaging ◽

Rare Presentation ◽

History Of ◽

Ct Head ◽

Magnetic Resonance Imaging Mri ◽

Gcs Score

A 69-year-old male presented to a peripheral emergency department with a several day history of increasing confusion and headache. On admission, his Glasgow Coma Scale (GCS) score was 10 (E3 M6 V1). He was mute but would obey commands intermittently. Cranial nerve exam was normal and there was no evidence of weakness. A computed tomogram (CT) head (Figure 1) showed a chronic subdural hematoma with midline shift, as well as a mass within the left frontal region that appeared consistent with a convexity meningioma seen on magnetic resonance imaging (MRI) two years prior (Figure 2). The patient was not on any blood thinners and had no history of falls. Past medical history also included hypertension and prostate cancer.

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

Journal of Neurosurgery ◽

10.3171/jns/2008/108/2/0275 ◽

2008 ◽

Vol 108 (2) ◽

pp. 275-280 ◽

Cited By ~ 29

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.

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Chronic Subdural Hematoma Secondary to Traumatic Subdural Hygroma

Journal of the Korean Radiological Society ◽

10.3348/jkrs.1994.30.2.219 ◽

1994 ◽

Vol 30 (2) ◽

pp. 219 ◽

Cited By ~ 1

Author(s):

Byung Ho Lee ◽

Pyo Nyun Kim ◽

Deok Hwa Hong ◽

Han Hyuk Lim ◽

Won Kyung Bae ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Subdural Hygroma

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Post traumatic isolated ipsilateral oculomotor nerve palsy

Romanian Neurosurgery ◽

10.33962/roneuro-2019-035 ◽

2019 ◽

pp. 188-190

Author(s):

Praveen Kumar ◽

Sharad Pandey ◽

Kulwant Singh ◽

Mukesh Sharma ◽

Prarthana Saxena

Keyword(s):

Subdural Hematoma ◽

Nerve Palsy ◽

Chronic Subdural Hematoma ◽

Oculomotor Nerve Palsy ◽

Rare Presentation ◽

Third Nerve Palsy ◽

Common Causes ◽

History Of ◽

Post Traumatic ◽

Third Nerve

The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.

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Comparative Study of Surgical Outcome of Chronic Subdural Hematoma Treated with and without External Drainage

Eastern Green Neurosurgery ◽

10.3126/egn.v2i1.27459 ◽

2020 ◽

Vol 2 (1) ◽

pp. 30-34

Author(s):

Suresh Sapkota ◽

Kiran Niraula ◽

Subash Lohani ◽

Shikher Shrestha ◽

Bibhusan Shrestha ◽

...

Keyword(s):

Local Anesthesia ◽

Subdural Hematoma ◽

Surgical Outcome ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

Midline Shift ◽

External Drainage ◽

Presenting Symptoms ◽

Number Of Patients ◽

Significant Difference

Background and purpose: Chronic subdural hematoma (cSDH) poses a significant morbidity and mortality risk particularly in elderly population. It can be treated with simple surgical techniques like burr hole drainage under local anesthesia, however it often recurs after surgical evacuation in significant number of patients. Material and methods: A randomized controlled trial was designed at Mayo Hospital/KEMU in 2013 to 2016. Total number of 98 patients who met the inclusion and exclusion criteria were randomized into ‘with drain’ and ‘without drain’ arm. All of them were treated with burr hole drainage under local anesthesia. Half of them had subdural drain while the remaining half did not. Recurrence of hematoma and surgical outcome was compared. Result: Among 98 patients included in the study(54 males and 44 females) met the inclusion criteria. Mean age of presentation was 63 years ± 12.4 (range 40-100). There was left sided preponderance in hematoma location (53.1%). Mean midline shift was 2.7 mm ± 1.5. Owing to drainage of cSDH, post-operative MRC score of patients along with midline shift in the CT brain showed statistically significant improvement. However, irrespective of insertion of drainage system, there was no significant difference noted in recurrence of cSDH, midline shift and improvement in presenting symptoms (hemiparesis or monoparesis) considering all post-operative days. Conclusion: There is no significant difference in recurrence rate depending on weather a postoperative external drainage is placed or not.

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