Delayed Presentation of Traumatic Cerebral and Dural Arteriovenous Fistulae After a BB Gun Accident in a Pediatric Patient: Case Report

Neurosurgery ◽  
2011 ◽  
Vol 68 (6) ◽  
pp. E1750-E1755 ◽  
Author(s):  
Adib A. Abla ◽  
Felipe C. Albuquerque ◽  
Nicholas Theodore ◽  
Robert F. Spetzler
Keyword(s):  
Computed Tomography ◽  
Frontal Lobe ◽  
Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Emergency Evacuation ◽  
Delayed Presentation ◽  
Skull Fractures ◽  
Low Velocity ◽  
Left Frontal Lobe ◽  
Neurologically Intact

Abstract BACKGROUND AND IMPORTANCE: To present a case of traumatic cortical and dural arteriovenous fistula (AVF) after a BB gun accident. CLINICAL PRESENTATION: The patient presented with a small left frontal subdural hematoma and small contusions in the left frontal lobe after he was shot with a BB. He had no skull fractures or significant midline shift. The patient, who was neurologically intact, was discharged after 3 days of observation and having undergone serial computed tomography imaging. Five days later, the patient developed lethargy and emesis. Computed tomography showed a 5 × 3 × 5 cm intraparenchymal hematoma in the left frontal lobe. Emergency evacuation of the hematoma revealed a cortical AVF, which was resected. Postoperative angiography showed a dural AVF of the left middle meningeal artery, draining into the superior ophthalmic vein and a dural vein. The dural AVF was embolized with n-butyl cyanoacrylate. The patient was discharged after 3 days with no deficits. CONCLUSION: The subdural hematoma and contusions were caused by a BB, which often are used in low-velocity and small caliber weapons. Not all BB guns are low velocity, and the consequences can be dramatic. The BB gun used here was pneumatic. The patient had no skull fractures. Several days of stable imaging and normal examinations suggested nothing sinister. His initial bleeds appeared disproportionate to the mechanism. The delayed presentation of the debilitating hematoma in this case stresses the need for vigilance on the part of practitioners and families when patients have a suspicious bleed.

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

2021 ◽  
pp. 159101992110651
Author(s):  
Zachary S Hubbard ◽  
Sami Al Kasab ◽  
Guilherme B Porto ◽  
Alejandro Spiotta
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Diagnostic Investigation ◽  
Neurologically Intact ◽  
Radiographic Result ◽  
Radiographic Improvement ◽  
Meningeal Artery

Introduction Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur. One uncommon mechanism for recurrence of CSDH is by means of neovascularization of the contralateral middle meningeal artery (MMA). We describe two cases of CSDH recurrence by means of contralateral middle meningeal artery neovascularization treated with contralateral MMAE. Methods We identified two cases of recurrent subdural hematoma secondary to neovascularization following treatment with contralateral MMAE. Results Two patients initially treated with MMAE were identified with CSDH recurrence secondary to contralateral MMA neovascularization. There was no traumatic or coagulopathic contribution to CSDH recurrence. In both cases, patients underwent contralateral MMAE. Both patients were neurologically intact with radiographic improvement of CSDH at follow up. Conclusions Re-accumulation of SDH following MMAE by means of contralateral MMA neovascularization is a rare subtype of subdural hematoma (SDH) recurrence following MMAE. Within the context of re-accumulation of SDH following MMAE, catheter angiography is an important diagnostic investigation to elucidate the etiology of the recurrence. Furthermore, when angiography reveals neovascularization of the contralateral MMA, embolization of the contralateral MMA achieves good clinical and radiographic result.

Exploration of the Effects of Family Therapy on the Rehabilitation of Unipolar Depression Patients Under Computed Tomography Scan Information Technology

2020 ◽  
Vol 10 (9) ◽  
pp. 2223-2227
Author(s):  
Rui Mei ◽  
Fang Fan ◽  
Lu Lv ◽  
Fang Wang ◽  
Xiaobo Liu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Family Therapy ◽  
Frontal Lobe ◽  
Temporal Lobe ◽  
Unipolar Depression ◽  
Disease Course ◽  
Left Temporal Lobe ◽  
Left Frontal Lobe ◽  
Sf 36 ◽  
Before And After

The purpose of this study is to investigate the effects of family therapy on brain computed tomography (CT) information in unipolar depression patients. In this study, 35 cases of unipolar depression patients who visited xxx hospital from March 2017 to August 2019 but received no systematic treatment were taken as the study subjects. CT scan was used to detect and compare the CT values of left frontal lobe, right frontal lobe, left temporal lobe and right temporal lobe of patients with depression before and three months after family treatment. Patients’ levels of depression and anxiety before and after treatment were determined by Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). The cognitive function of patients before and after treatment was evaluated by Mini Mental State Examination (MMSE). The physical and social function, and mental health of them were assessed by health status questionnaire (SF-36). The correlation between CT values of each lobe and clinical characteristics of patients was analyzed by multivariate linear regression model. The results showed that the CT values and SF-36 scores of the left and right frontal lobe after treatment were significantly higher than that before treatment (P < 0.05), while the HAMD MMSE scores were significantly lower than those before treatment (P < 0.05). The linear-regression analysis results showed that CT values of the left frontal lobe were negatively correlated with the patient’s age and disease course (P < 0.05), and CT values of the right frontal lobe were negatively correlated with the patient’s age (P < 0.05), and CT values of the left temporal lobe were negatively correlated with the patient’s disease course (P < 0.05). It indicates that the pathogenesis of depression is related to the function of brain structure. However, the social ability of unipolar depression patients and their emotional depression and psychological state can be effectively improved by family therapy, which also has a significant effect on the recovery of the disease.

Incidence of Cerebral Hemorrhage in Traumatic Patients using Computed Tomography in Tabuk City, Saudi Arabia

2020 ◽  
Vol 5 (10) ◽  
pp. 460-463
Author(s):  
Amna Mohamed Ahmed ◽  
Towmader Awad ◽  
Hajer Yousif ◽  
Reem Nahari ◽  
Omnia Abdelrhman ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Saudi Arabia ◽  
Head Trauma ◽  
Subdural Hematoma ◽  
Cerebral Hemorrhage ◽  
Imaging Modality ◽  
Common Type ◽  
Radiology Department ◽  
Age Group ◽  
Ct Finding

Computed Tomography (CT) is the most commonly used imaging modality in the evaluation of cerebral hemorrhage in the head trauma patients. Objective: To study the incidence of a cerebral hemorrhage in traumatic patients using computed tomography. Method: This retrospective study was conducted at King Khalid hospital in Tabuk city, Saudi Arabia, in the radiology department, in the period from September 2018 to April 2020. The study was done by collecting 471 CT reports of patients all of them were exposed to head trauma with deferent reasons. The data were analyzed by Statistical Package for the Social Sciences (SPSS) program (ver. 20) and presented in tables and graphs according to the checklist which includes: patient age, gender, type of trauma, CT finding, and type of hemorrhage. Results: The most age group suffered from head trauma was less than 20 years percentage (55%), The male patients more exposed to head trauma than female patients with percentage (84.5%), the road traffic accident (RTA) is the most common type of trauma by percentage (63.5%), according to the CT finding; the cerebral hemorrhage represented (15.5%) with the highest percentage in a subdural hematoma (31.2%), the fracture represented (2.8%) while the normal appearance represented (81.7%) as the highest percentage. Conclusion: Most of the traumatic brain injury in patients caused cerebral hemorrhage and the CT scan reports show that: the common type of cerebral hemorrhage is subdural hematoma and it is common in males which exposed to (RTA) in the age group (21 - 40) years old.

scholarly journals Recurrence and Coniglobus Volumetric Resolution of Subacute and Chronic Subdural Hematoma Post-Middle Meningeal Artery Embolization

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 257
Author(s):  
Ambooj Tiwari ◽  
Adam A. Dmytriw ◽  
Ryan Bo ◽  
Nathan Farkas ◽  
Phillip Ye ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Volumetric Analysis ◽  
Primary Therapy ◽  
Curative Therapy ◽  
Complete Obliteration ◽  
Embolization Treatment ◽  
Long Term Follow Up ◽  
Meningeal Artery

Objective: To study the efficacy of middle meningeal artery (MMA) embolization for the treatment of chronic subdural hematoma (SDH) and characterize its post-embolization volumetric resolution. Methods: Ten patients diagnosed with 13 cSDH underwent MMA embolization. SDH volumes were measured from time of initial discovery on imaging to pre-operative, post-operative, short-term and long-term follow-up. Time between procedure to obliteration was also measured. Volumetric analysis was done using the coniglobus formula, and recurrence rate as well as resolution timeline was defined using best-fit models. Results: Out of 10 patients, five were recurrent lesions, three were bilateral and seven unilateral cSDH. Average and median pre-operative volumes were 105.3 cc and 97.4 cc, respectively. Embolization on average was performed 21 days after discovery. Sixty percent of patients had concurrent antiplatelets or anticoagulation use. Forty percent underwent embolization treatment as the primary therapy. Recurrence was not seen in any patients treated with embolization. There were no peri- or post-operative complications. Five patients experienced complete or near-complete obliteration, while those with partial resolution showed a composite average of 75% volumetric reduction in 45 days. Post-embolization, the volumetric resolution followed an exponential decay curve over time and was independent of initial volume. Conclusion: MMA embolization contributed to a marked reduction in SDH volume post-operatively and can be used as a curative therapy for primary or recurrent chronic SDH.

scholarly journals Risk of recurrence of subdural hematoma after EMMA vs surgical drainage – Systematic review and meta-analysis

2021 ◽  
pp. 159101992199096
Author(s):  
Joshua Dian ◽  
Janice Linton ◽  
Jai JS Shankar
Keyword(s):  
Confidence Interval ◽  
Subdural Hematoma ◽  
Meta Analysis ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Control Group ◽  
Complication Rates ◽  
Recurrence Rates ◽  
Invasive Approach ◽  
Risk Of Recurrence

Objective Chronic subdural hematoma (CSDH) is a common and debilitating neurological condition whose treatments, including burr hole drainage and craniotomy, suffer from high rates of recurrence and complication. Embolization of the middle meningeal artery (EMMA) is a promising minimally invasive approach to manage CSDH in a broad set of patients. Methods To evaluate the efficacy and safety of EMMA, a database search was conducted including the terms “subdural hematoma; embolization; embolized; middle meningeal” was performed and yielded a total of 260 results. Following exclusion based on predefined criteria, a total of four studies were identified and outcomes including recurrence rates and complication rates were extracted for analysis. Results Four studies including intervention and control groups were included with a total of n = 888 patients. The relative risk of CSDH recurrence in the EMMA (3.5%) compared to control group (23.5%) was significantly reduced when EMMA was performed (risk ratio = 0.17; 95% confidence interval (CI) 0.05–0.67). In addition, rates of complication were not significantly different between patients with conventional therapy and those who received EMMA (OR = 0.77; 95 confidence interval (CI) 0.3–1.99). Conclusion Based on limited data, EMMA reduces the risk of recurrence by 20% compared to surgical treatment for CSDH.

scholarly journals Neuroanatomy of cranial dural vessels: implications for subdural hematoma embolization

2021 ◽  
pp. neurintsurg-2020-016798
Author(s):  
Maksim Shapiro ◽  
Melanie Walker ◽  
Kate T Carroll ◽  
Michael R Levitt ◽  
Eytan Raz ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Ex Vivo ◽  
Vascular Anatomy ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Strategic Approach ◽  
Fundamental Understanding ◽  
Endovascular Approach ◽  
Meningeal Artery

Adoption of middle meningeal artery embolization in the management of chronic subdural hematomas has led to a renewed interest in dural vascular anatomy. The readily identifiable major dural arteries and potential hazards associated with their embolization are well described. Less emphasized are several levels of intrinsic dural angioarchitecture, despite their more direct relationship to dural based diseases, such as subdural hematoma and dural fistula. Fortunately, microvascular aspects of dural anatomy, previously limited to ex vivo investigations, are becoming increasingly accessible to in vivo visualization, setting the stage for synthesis of the old and the new, and providing a rationale for the endovascular approach to subdural collections in particular. In contrast with traditional anatomical didactics, where descriptions advance from larger trunks to smaller pedicles, we present a strategic approach that proceeds from a fundamental understanding of the dural microvasculature and its relationship to larger vessels.

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