scholarly journals Subdural hematomas in young children: clinical and electrophysiological features

2020 ◽  
Vol 10 (6) ◽  
pp. 93-99
Author(s):  
Tat’yana V. Melashenko ◽  
Maria Yu. Fomina ◽  
Ivan N. Usenko ◽  
Yuriy V. Rodionov
Keyword(s):  
Young Children ◽  
Brain Damage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cerebral Atrophy ◽  
Psychomotor Development ◽  
Behavioral Disturbances ◽  
Subdural Hematomas ◽  
Structural Epilepsy ◽  
The Brain

Subdural hematoma is a sufficiently rare, but serious pathology of the brain in infants, which can lead to severe neurological deficit or result in death. Subdural hematomas are detected in 2025 per 100,000 children under 1 year. A retrospective analysis of autopsy material revealed that subdural hematomas were diagnosed in 72% of children who died before the age of 5 months from intracranial hemorrhage. According to localization, subdural hematomas are divided into supra- and subtentorial, mainly associated localization, which are located along the tent of cerebellum and sickle of the brain, mainly. The main mechanism of development of subdural hematomas is associated with the rupture of the bridge veins of the subdural space as a result of their tension, both traumatic etiology and nontraumatic brain damage, accompanied by progressive cerebral atrophy. It is believed that perinatal hypoxic-ischemic brain damage is one of the leading etiological factors of developed subdural hematomas in young children. In addition, the formation of subdural hematomas in young children can be observed with intraamniotic infections, congenital fermentopathies, and above all, in children with aciduria. In some infants, subdural hematomas occur without clinical manifestation, but in most cases are accompanied by the development of neurological disorders, both in acute and in distant periods. In the main, subdural hematomas in the acute period manifest with focal convulsions with secondary generalization of seizures, behavioral disturbances, respiration, and symptoms of intracranial hypertension. During the formation of chronic subdural hematoma, development of structural epilepsy (up to 20%), microcephaly, impaired psychomotor development is observed. In 55% of young children with acute subdural hematomas, the formation of chronic subdural hematomas is observed.

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.

scholarly journals Spontaneous resolution of large non-traumatic bilateral acute-on-chronic subdural hematoma

2017 ◽  
Vol 31 (1) ◽  
pp. 8-16
Author(s):  
D. Adam ◽  
D. Iftimie ◽  
Gina Burduşa ◽  
Cristiana Moisescu
Keyword(s):  
Conservative Treatment ◽  
Subdural Hematoma ◽  
Clinical Presentation ◽  
Surgical Intervention ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Neurological Status ◽  
Spontaneous Resolution ◽  
Subdural Hematomas ◽  
Gcs Score

Abstract Background and importance: Chronic subdural hematomas are a frequently encountered neurosurgical pathology, especially in the elderly. They often require surgical evacuation, but recent studies have shown good results with conservative treatment in selected cases. Clinical presentation: We report the case of a 72-year old patient that developed large, non-traumatic, bilateral, acute-on-chronic subdural hematoma after repeated abdominal surgery for appendicular carcinoma. He presented an abdominal wound infection and good neurological status (GCS score of 14 points), factors that indicated the delay of surgical intervention. Subsequent clinical and radiological improvement forestalled the operation altogether and he presented complete spontaneous resolution of subdural hematomas at only 5 months after diagnosis. Conclusion: Although surgical treatment is performed in the majority of chronic subdural hematomas, in clinically and radiologically selected cases, the operation can be avoided. The hematoma can present resolution, either spontaneously or with the help of conservative treatment.

Brain scans and echoencephalography in the diagnosis of chronic subdural hematoma

1974 ◽  
Vol 40 (3) ◽  
pp. 347-350 ◽  
Author(s):  
Sheldon R. Hurwitz ◽  
Samuel E. Halpern ◽  
George Leopold
Keyword(s):  
Cerebral Angiography ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Brain Scans ◽  
Subdural Hematomas ◽  
Fine Print

✓ Eighteen patients with chronic subdural hematomas were studied by both brain scans and echoencephalography. All cases were verified by cerebral angiography. Brain scanning was accurate in predicting hematomas in 93% of the cases, and echoencephalography in 44%. When hematomas were bilateral or when frontal clots caused no shift in the diencephalic midline, the routine echoencephalogram often was negative. The two procedures are complementary, and serial studies may be helpful in the study of changing clinical situations.

scholarly journals The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma

2014 ◽  
Vol 67 (9-10) ◽  
pp. 277-281 ◽  
Author(s):  
Mirela Jukovic ◽  
Kosta Petrovic ◽  
Viktor Till
Keyword(s):  
Subdural Hematoma ◽  
Clinical Symptoms ◽  
Great Influence ◽  
Chronic Subdural Hematoma ◽  
Functional Condition ◽  
Neurological Symptoms ◽  
Special Focus ◽  
Subdural Hematomas ◽  
Time Required ◽  
Bilateral Chronic Subdural Hematoma

Introduction. Chronic subdural hematoma is an intracranial hemorrhagic lesion that illustrates various expressions in clinical and radiological practice. The aim of this study was to emphasize the correlation between the brain site of chronic subdural hematoma and clinical symptoms/signs of disease. Furthermore, the study denotes the significance of hemiparesis occurrence in the patients with unilateral chronic subdural hematomas more than in those with bilateral ones, associated with time required to diagnose hematoma. Material and Methods: A three-year study included 72 patients with chronic subdural hematoma. According to their clinical and neurological symptoms on hospital admission, all patients underwent non-contrast brain computed tomography scan, which confirmed the diagnosis. The radiological parameters, inlcuding the site of chronic subdural hematoma, a hematoma width and midline shift were recorded to give precise data about the correlation with neurological symptoms. A special focus was put on the lag time between the onset of symptoms and signs to diagnosis of chronic subdural hematoma. Results. The study proved that the patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the rightsided ones to present its symptoms although the average hematoma diameter value was almost the same. Conclusion. The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients.

scholarly journals Concomitant chronic subdural hematomas and arachnoid cysts in young adults

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 421
Author(s):  
Huseyin Berk Benek ◽  
Emrah Akcay
Keyword(s):  
Young Adults ◽  
Arachnoid Cyst ◽  
Subdural Hematoma ◽  
Neurological Complication ◽  
Chronic Subdural Hematoma ◽  
Arachnoid Cysts ◽  
Predisposing Factor ◽  
Trauma History ◽  
Subdural Hematomas ◽  
And Gender

Objective: This study aimed to evaluate the correlation between arachnoid cysts and chronic subdural hematomas in young adults. Methods: This retrospective study evaluated ten patients having concomitant chronic subdural hematomas and arachnoid cysts. Patients were evaluated with the data of age and gender, location of hematoma and arachnoid cyst, trauma history, symptoms at admission, maximum hematoma diameter, contiguity between arachnoid cyst and hematoma, and treatment  methods. Results: We treated 285 patients who were diagnosed with cSDH between January 2013 and December 2019. 22 patients were under the age of 40 years. Ten of them had both cSDH and arachnoid cysts. The mean age of patients was 24.8±3.9 years. Patients with only chronic subdural hematoma had higher mean age than the patients with arachnoid cyst-related chronic subdural hematoma. In four patients, the onset of chronic subdural hematoma was reported after arachnoid cyst diagnosis. Four of the patients did not have causative trauma history, and two patients suffered minor sports-related traumas. All patients had headache, and only two patients had hemiparesis. The location of arachnoid cysts were in the middle fossa in eight patients. All patients had chronic subdural hematomas on the ipsilateral side of arachnoid cyst. Four patients who had smaller than 10 mm maximal cSDH diameter underwent conservative management. They were followed by serial neuroimaging studies and it was noted that the hematoma disappered and the size of the arachnoid cysts decreased over time without any neurological complication. In six cases, craniotomy was required, and all recovered completely. cSDH did not recur during 5–60 months of follow-up period (median 12 months). Conclusions: It seems that presence of an arachnoid cyst in young adults is a predisposing factor for the formation of chronic subdural hematoma. Coincidentally diagnosed arachnoid cyst patients may be followed up with periodical clinical examinations and neuroimaging studies.

RESULTS OF MAGNETIC RESONANCE IMAGING AND COMPUTERIZED TOMOGRAPHY DURING SURGERY OF CHRONIC SUBDURAL HEMATOMA IN HOP LUC GENERAL HOSPITAL - THANH HOA

2017 ◽  
pp. 20-25
Author(s):  
Thanh Van Nguyen
Keyword(s):  
Subdural Hematoma ◽  
Clinical Symptoms ◽  
Chronic Subdural Hematoma ◽  
The Elderly ◽  
Ct Scanner ◽  
Intracranial Hematomas ◽  
The Brain ◽  
Large Hematoma ◽  
Neurosurgical Techniques ◽  
Timely Treatment

Consequence of traumatic brain injury as intracranial hematomas are severe complications with disability and high mortality. The diagnosis and treatment are difficult expecially for provincial hospitals. Chronique subdural hematoma (SDH) could occur at any age but mostly in the elderly. Clinical symptoms of chronic SDH often fuzzy, nonspecific. The large hematoma trường hợpuses prolonged tamponade leading to irrversible damage in the brain. The consequences may lead to death or severe sequelae. With actual advances in diagnostic imaging and neurosurgical techniques, chronic SDH may be considered benign lesions. With early detection, timely treatment, the results will be very positive. From 2007 – 2014 we operated 97 caes of chronic SDH with good results. Key words: chronic hematoma, result MRI and CT Scanner, chronic capillary surgery

Neurosurgical Aspects of the Parietal Boss in Patients with Chronic Subdural Hematomas

Neurosurgery ◽  
1981 ◽  
Vol 9 (5) ◽  
pp. 531-534 ◽  
Author(s):  
Takashi Iwabuchi ◽  
Tetsuji Sekiya ◽  
Tetsuji Sekiya
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Ct Scanning ◽  
Burr Hole ◽  
Computed Tomographic ◽  
Subdural Hematomas ◽  
Ct Analysis

Abstract There are many modes of trephination for the treatment of chronic subdural hematoma. Angiographic and computed tomographic (CT) analysis of 60 consecutive patients with chronic subdural hematoma indicated that the parietal boss, which is likely to be overlooked by routine CT scanning, is one of the most suitable places for opening a burr hole. Our patients responded satisfactorily to irrigation therapy via a single burr hole in the parietal boss.

scholarly journals Subependymal hemorrhage following drainage of chronic subdural hematoma: Probable causative mechanisms and prevention strategies

2015 ◽  
Vol 6 (02) ◽  
pp. 252-254 ◽  
Author(s):  
Amey R. Savardekar ◽  
Pravin Salunke
Keyword(s):  
Subdural Hematoma ◽  
Intraventricular Hemorrhage ◽  
Chronic Subdural Hematoma ◽  
Clinical Entity ◽  
Rare Occurrence ◽  
Prevention Strategies ◽  
Cure Rates ◽  
The Brain

ABSTRACTChronic subdural hematoma (cSDH) is a common clinical entity treated by neurosurgeons with good cure rates. Recurrence of the hematoma and failure of the brain to re-expand are commonly observed complications following surgery for cSDH. An intracerebral or intraventricular hemorrhage following evacuation of cSDH is very rarely observed, albeit with devastating consequences. We report the finding of a subependymal hemorrhage after evacuation of a cSDH and discuss the probable causative mechanisms underlying this rare occurrence and the prevention strategies to avoid it.

Infantile chronic subdural hematoma of the posterior fossa diagnosed by computerized tomography

1977 ◽  
Vol 47 (6) ◽  
pp. 949-952 ◽  
Author(s):  
Barry N. French ◽  
Arthur B. Dublin
Keyword(s):  
White Matter ◽  
Brain Stem ◽  
Computerized Tomography ◽  
Posterior Fossa ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cerebral White Matter ◽  
Hounsfield Units ◽  
Content Type ◽  
The Brain

✓ A 9-week-old infant manifested continuous vomiting for 1 week accompanied by a tense fontanel, “sun setting” of the eyes, frequent opisthotonos, and hypertonicity. The head circumference was at the 50th percentile. Computerized tomography (CT) revealed acute hydrocephalus and a posterior fossa subdural hematoma. The brain stem and cerebellum were of greater density (54 Hounsfield units) than normal cerebral white matter (42 Hounsfield units) whereas the subdural hematoma was the same density as normal cerebral white matter (“isodense”). The cerebellum and brain stem became enhanced by contrast (68 Hounsfield units), but no enhancement occurred in the cerebral white matter or subdural hematoma. A shunt followed by occipital craniectomy resolved both the hydrocephalus and subdural hematoma. Repeat CT scan 15 days postoperatively disclosed continuing higher density of the cerebellum and brain stem (60 Hounsfield units) relative to cerebral white matter. Increased density of the infantile cerebellum has been noted previously but not to the same extent as in this patient.

scholarly journals Development of the Chronic Subdural Hematoma Grading System to Predict Postoperative Recurrence

2021 ◽  
Author(s):  
Shuai Han ◽  
Yan Feng ◽  
Na Chuan Xu ◽  
Zhen Xue Li ◽  
Yun Chun Zhang ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Characteristic Curve ◽  
Area Under The Curve ◽  
Chronic Subdural Hematoma ◽  
Cerebral Atrophy ◽  
Predictive Performance ◽  
Postoperative Recurrence ◽  
Expansion Rate ◽  
Grading System ◽  
Grading Systems

Abstract Objective Assessing the risk of postoperative recurrence of chronic subdural hematoma (CSDH) is a clinical focus. To screen the main factors associated with the perioperative hematoma recurrence. We also propose a new prognostic grading system and compare it with previous grading systems to deliver a quick and effective system.Methods We included 242 unilateral patients with CSDH as the training group for modeling. Factors predicting postoperative recurrence requiring reoperation (RrR) were determined using univariate and multivariate regression analyses. The cut-off value for the brain re-expansion rate was determined through receiver operating characteristic curve analysis. Based on these, we developed a new prognostic scoring system and conducted preliminary verification. A verification group including 119 patients with unilateral CSDH was used to verify the predictive performance of the new and other grading systems.Results The key factors for predicting unilateral CSDH recurrence were cerebral re-expansion rate (≤ 40%) at postoperative days 7 – 9 and the preoperative computed tomography density classification (isodense or hyperdense, or separated or laminar types). Cerebral atrophy played a key role in brain re-expansion. The CSDH prognostic grading system ranged from 0 to 3. An increased score was associated with a more accurate progressive increase in the RrR rate. Our grading system demonstrated the best predictive performance compared with other systems (area under the curve = 0.856).Conclusions Our prognostic grading system could quickly and effectively screen high-risk RrR patients with unilateral CSDH. However, increased attention should be paid to brain re-expansion rate after surgery in patients with CSDH.

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