Factors influencing the presence of hemiparesis in chronic subdural hematoma

2019 ◽  
Vol 131 (6) ◽  
pp. 1926-1930 ◽  
Author(s):  
Rouzbeh Motiei-Langroudi ◽  
Ron L. Alterman ◽  
Martina Stippler ◽  
Kevin Phan ◽  
Abdulrahman Y. Alturki ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Univariate Analysis ◽  
Chronic Subdural Hematoma ◽  
Threshold Value ◽  
Antiplatelet Drug ◽  
Midline Shift ◽  
Trauma History ◽  
Factors Influencing ◽  
Clinical Presentations ◽  
Maximal Thickness

OBJECTIVEChronic subdural hematoma (CSDH) has a variety of clinical presentations, including hemiparesis. Hemiparesis is of the utmost importance because it is one of the major indications for surgical intervention and influences outcome. In the current study, the authors intended to identify factors influencing the presence of hemiparesis in CSDH patients and to determine the threshold value of hematoma thickness and midline shift for development of hemiparesis.METHODSThe authors retrospectively reviewed 325 patients (266 with unilateral and 59 with bilateral hematomas) with CSDH who underwent surgical evacuation, regardless of presence or absence of hemiparesis.RESULTSIn univariate analysis, hematoma loculation, age, hematoma maximal thickness, and midline shift were significantly associated with hemiparesis. Moreover, patients with unilateral hematomas had a higher rate of hemiparesis than patients with bilateral hematomas. Sex, trauma history, anticoagulant and antiplatelet drug use, presence of comorbidities, Glasgow Coma Scale score, hematoma density characteristics on CT scan, and hematoma signal intensity on T1- and T2-weighted MRI were not associated with hemiparesis. In multivariate analysis, the presence of loculation and hematoma laterality (unilateral vs bilateral) influenced hemiparesis. For unilateral hematomas, maximal hematoma thickness of 19.8 mm and midline shift of 6.4 mm were associated with a 50% probability of hemiparesis. For bilateral hematomas, 29.0 mm of maximal hematoma thickness and 6.8 mm of shift were associated with a 50% probability of hemiparesis.CONCLUSIONSPresence of loculations, unilateral hematomas, older patient age, hematoma maximal thickness, and midline shift were associated with a higher rate of hemiparesis in CSDH patients. Moreover, 19.8 mm of hematoma thickness and 6.4 mm of midline shift were associated with a 50% probability of hemiparesis in patients with unilateral hematomas.

scholarly journals Midline shift threshold value for hemiparesis in chronic subdural hematoma

2015 ◽  
Vol 143 (7-8) ◽  
pp. 386-390 ◽  
Author(s):  
Mirela Jukovic ◽  
Dejan Stojanovic
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Threshold Value ◽  
Threshold Level ◽  
Total Sample ◽  
Line Shift ◽  
Threshold Values ◽  
Clinical Presentations ◽  
Contrast Ct ◽  
Symptoms And Signs

Introduction. Chronic subdural hematoma (CSDH) has a variety of clinical presentations, with numerous neurological symptoms and signs. Hemiparesis is one of the leading signs that potentially indicates CSDH. Objective. Purpose of this study was to determine the threshold (cut-off) value of midsagittal line (MSL) shift after which hemiparesis is likely to appear. Methods. The study evaluated 83 patients with 53 unilateral and 30 bilateral CSDHs in period of three years. Evaluated computed tomography (CT) findings in patients with CSDH were diameter of the hematoma and midsagittal line shift, measured on non-contrast CT scan in relation with occurrence of hemiparesis. Threshold values of MSL shift for both types of CSDHs were obtained as maximal (equal) sensitivity and specificity (intersection of the curves). Results. MSL is a good predictor for hemiparesis occurrence (total sample, AUROC 0.75, p=0.0001). Unilateral and bilateral CSDHs had different threshold values of the MSL for hemiparesis development. Results suggested that in unilateral CSDH the threshold values of MSL could be at 10 mm (AUROC=0.65; p=0.07). For bilateral CSDH the threshold level of MSL shift was 4.5 mm (AUROC=0.77; p=0.01). Conclusion. Our study pointed on the phenomenon that midsagittal line shift can predict hemiparesis occurrence. Hemiparesis in patients with bilateral CSDH was more related to midsagittal line shift compared with unilateral CSDH. When value of midsagittal line shift exceed the threshold level, hemiparesis occurs with certain probability.

scholarly journals Kernohan-Woltman notch phenomenon and intention tremors in case of chronic subdural hematoma

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.

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

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.

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.

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

2022 ◽  
Vol 22 (1) ◽  
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 ◽  
Midline Shift ◽  
Subdural Hygroma ◽  
Case Summary ◽  
The Status ◽  
History Of ◽  
Type 1 Dm

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.

Abstract TP38: Efficacy of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Ashish Kulhari ◽  
Amrinder Singh ◽  
Siddhart Mehta ◽  
Farah Fourcand ◽  
Jawad.F. Kirmani ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Complete Resolution ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Burr Hole ◽  
Midline Shift ◽  
Artery Embolization ◽  
Burr Hole Evacuation ◽  
Meningeal Artery

Background: Symptomatic chronic subdural hematoma (SDH) is treated with surgical evacuation. SDH has a high incidence of recurrence despite evacuation, reported between 2% and 37%. Multiple case reports and case series demonstrate embolization of the Middle Meningeal artery (MMA) for the treatment of chronic SDH to be an adjunct treatment and a possible alternative to surgical evacuation. Method: Retrospective analysis of patients with chronic SDH who underwent MMA embolization at our community based, Comprehensive Stroke Center between April and August 2019 was done. MMA embolization was performed using 100-300 or 300-500 μm Embospheres. Results: 18 patients presented with chronic SDH, 55% female. Mean age and modified Rankin score was 70 (range: 48-95 years) and 1 (range: 0-3), respectively. 17 patients (94%) required a total of 20 MMA embolizations. 83% had unilateral MMA embolization and 17% had bilateral MMA embolizations. 100-300 μm Embospheres were used for the MMA embolization in 82% of the patients and 300-500 μm Embospheres in 18% of the patients. 33% had Burr hole prior to the procedure. 5% ( n= 1) patient had Burr hole evacuation after embolization due to Neurosurgeon preference, not neurological deterioration. 56 % patient received treatment to resume anticoagulation/antiplatelet and 44% received prophylactic embolization to prevent reaccumulation after Burr hole evacuation. Mean size of maximum diameter of SDH was 16.9 mm and 4.6 mm of midline shift on admission CT. Mean SDH size and midline shift at discharge was 13 mm and 2.27 respectively. 50% patients had 1 month follow up CT with mean SDH size was 8.2 mm (in comparison to 19.7 in these patients). 17 % (n=3) patients had complete resolution on 3 month follow up. The one patient treated with 300-500 μm Embospheres had an acute on chronic asymptomatic SDH on 1 month follow up CT, requiring accessory meningeal artery embolization with 100-300 μm Embospheres ultimately resulting complete resolution of the SDH at 1 month post embolization. Conclusion: Despite limited data available, Middle Meningeal artery embolization using 100-300 μm Embospheres leads to reproducible results to prevent recurrence of chronic subdural hematoma. A large randomized controlled study is needed to verify our results.

scholarly journals Subdural Hematoma: A Rare Presentation of a Convexity Meningioma

2014 ◽  
Vol 41 (4) ◽  
pp. 506-507 ◽  
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.

scholarly journals Time to surgery following chronic subdural hematoma: post hoc analysis of a prospective cohort study

2019 ◽  
Vol 1 (1) ◽  
pp. e000012
Author(s):  
Sara Venturini ◽  
Daniel M Fountain ◽  
Laurence J Glancz ◽  
Laurent J Livermore ◽  
Ian C Coulter ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Subdural Hematoma ◽  
Multivariable Analysis ◽  
Chronic Subdural Hematoma ◽  
Positive Association ◽  
Multivariable Logistic Regression Analysis ◽  
Significant Positive Association ◽  
Time To Surgery ◽  
Factors Influencing ◽  
The Impact

BackgroundChronic subdural hematoma (CSDH) is a common neurological condition; surgical evacuation is the mainstay of treatment for symptomatic patients. No clear evidence exists regarding the impact of timing of surgery on outcomes. We investigated factors influencing time to surgery and its impact on outcomes of interest.MethodsPatients with CSDH who underwent burr-hole craniostomy were included. This is a subset of data from a prospective observational study conducted in the UK. Logistic mixed modelling was performed to examine the factors influencing time to surgery. The impact of time to surgery on discharge modified Rankin Scale (mRS), complications, recurrence, length of stay and survival was investigated with multivariable logistic regression analysis.Results656 patients were included. Time to surgery ranged from 0 to 44 days (median 1, IQR 1–3). Older age, more favorable mRS on admission, high preoperative Glasgow Coma Scale score, use of antiplatelet medications, comorbidities and bilateral hematomas were associated with increased time to surgery. Time to surgery showed a significant positive association with length of stay; it was not associated with outcome, complication rate, reoperation rate, or survival on multivariable analysis. There was a trend for patients with time to surgery of ≥7 days to have lower odds of favorable outcome at discharge (p=0.061).ConclusionsThis study provides evidence that time to surgery does not substantially impact on outcomes following CSDH. However, increasing time to surgery is associated with increasing length of stay. These results should not encourage delaying operations for patients when they are clinically indicated.

scholarly journals Chronic subdural hematoma pressure measurement and its correlation with clinical characteristics and postoperative neurological outcome

2021 ◽  
Vol 9 (1) ◽  
pp. 44
Author(s):  
Tinu Ravi Abraham ◽  
Shaju Mathew ◽  
P. K. Balakrishnan ◽  
Ajax John ◽  
Haris Thottathil Pareed ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Prognostic Value ◽  
Clinical Characteristics ◽  
Chronic Subdural Hematoma ◽  
Pressure Group ◽  
Midline Shift ◽  
Hematoma Volume ◽  
Ranking Score ◽  
The Mean ◽  
Gcs Score

Background: The pressure of the chronic SDH (subdural haemotoma), the age of the patient, preoperative GCS score and midline shift were considered prognostic dependent factors. The study aimed at the significance of the pressure of chronic SDH in the outcome of patients.Methods: A correlation between subdural hematoma pressure and preoperative and postoperative clinical variables such as hematoma volume, midline shift, age, GCS score and postoperative modified ranking scale score as well as complications were assessed and analyzed.Results: According to the pressure of chronic SDH, 56 patients were grouped into 4 groups. In the pressure group <15 cm/h20 group the mean age was 85 and postoperative ranking score was 3 and the recurrence was 21 % while in high pressure group (>25 cm/h20) the mortality was 14% and no recurrence.Conclusions: The pressure of the chronic SDH has significant prognostic value in chronic SDH surgeries.

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