Calcified chronic subdural hematoma: illustrative case

BACKGROUND Calcified chronic subdural hematomas (CCSDHs) are rare variants of chronic subdural hematomas (CSDHs) accounting to only 0.3–2.7% of CSDHs. Although the majority of the patients with CSDHs recover from surgery, there still is some doubt about its being applied to CCSDHs. OBSERVATIONS In this case report, the authors present a case of a 75-year-old male presenting with deterioration of motor function in his left limbs over the course of 18 months and acute neurological deterioration in the form of altered sensorium for 7 days. The patient experienced an episode of aspiration in the preoperative period that led to deterioration of pulmonary function in the postoperative period. A chest radiograph showed diffuse patches suggesting pulmonary compromise. Computed tomography and magnetic resonance imaging (MRI) documented a large subdural collection at the right frontal and parietal hemisphere with calcification, which was successfully and completely removed by surgery. LESSONS The chances of a subdural hematoma progressing to calcification is extremely rare. The presentation of this case was such that surgical intervention was the only option left for the patient. The presence of lacunar infarcts in the thalamus on MRI can also be attributed to the calcified hematoma.

Download Full-text

Bilateral Supratentorial Subdural Hematomas after Craniotomy for Posterior Fossa Tumor Removal

Journal of Neurological Surgery Reports ◽

10.1055/s-0038-1642026 ◽

2018 ◽

Vol 79 (02) ◽

pp. e23-e25

Author(s):

Aikaterini Solomou ◽

Pantelis Kraniotis ◽

George Bonanos ◽

Constantine Constantoyannis

Keyword(s):

Subdural Hematoma ◽

Brain Mri ◽

Chronic Subdural Hematoma ◽

Mass Effect ◽

Cerebellar Hemisphere ◽

Suboccipital Craniotomy ◽

Subdural Hematomas ◽

Magnetic Resonance Imaging Mri ◽

Burr Hole Evacuation ◽

The Right

AbstractA 69-year-old man was admitted to the emergency department with headache and dizziness. He was submitted to brain computed tomography (CT) which showed a tumor in the right cerebellar hemisphere, findings which were subsequently confirmed with magnetic resonance imaging (MRI). He underwent a paramedian suboccipital craniotomy for removal of the mass. Histology confirmed the presence of a hemangiopericytoma. The patient was discharged 5 days postoperatively with improvement in his symptoms. Fifteen days later, he presented with gait difficulties. Clinical examination revealed positive Mingazzini sign on his left side. He was submitted to brain MRI which revealed bilateral subdural hematomas on late subacute stage with mass effect and midline shift caused by the largest on the right. The patient underwent burr hole evacuation of the right subdural hematoma. The postoperative CT showed evacuation of the right chronic subdural hematoma. Two days postoperatively, the patient's symptoms improved.

Download Full-text

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

Romanian Neurosurgery ◽

10.1515/romneu-2017-0002 ◽

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.

Download Full-text

Spontaneous Acute Subdural Hematoma following Contralateral Calcified Chronic Subdural Hematoma Surgery: An Unusual Case

Pediatric Neurosurgery ◽

10.1159/000090468 ◽

2006 ◽

Vol 42 (2) ◽

pp. 122-124 ◽

Cited By ~ 5

Author(s):

M. Tatli ◽

A. Guzel ◽

N. Altinors

Keyword(s):

Subdural Hematoma ◽

Unusual Case ◽

Chronic Subdural Hematoma ◽

Acute Subdural Hematoma ◽

Calcified Chronic Subdural Hematoma

Download Full-text

Recurrent Chronic Subdural Hematoma: Clinical and Imaging Risk Factors

Indian Journal of Neurotrauma ◽

10.1055/s-0038-1669492 ◽

2018 ◽

Vol 15 (01) ◽

pp. 008-015 ◽

Cited By ~ 1

Author(s):

Benaissa Abdennebi ◽

Maher Al Shamiri

Keyword(s):

Risk Factors ◽

Subdural Hematoma ◽

Heart Diseases ◽

Chronic Subdural Hematoma ◽

Antiplatelet Agents ◽

The Elderly ◽

Imaging Data ◽

Anticoagulation Agents ◽

The Right ◽

Recurrence Group

Abstract Background Chronic subdural hematoma (CSDH) is a major cause of neurosurgical emergencies in the elderly. Despite the use of routine surgical practices, recurrence of this condition is expected. This study was conducted to identify the risk factors (RF) for recurrent CSDH. Methods Between January 2016 and July 2017, 103 consecutive patients suffering from CSDH were admitted to our department. The no-recurrence group (NRG) consisted of 91 patients, and the recurrence group (RG) consisted of 12 patients. To identify the RF involved in recurrent CSDH, we analyzed multiple factors, including patient comorbidities and imaging data. Results Between the two groups, there were no statistical differences (p > 0.05) for head trauma, diabetes mellitus (DM), high blood pressure, heart diseases, anticoagulation agents, or seizures; however, DM was associated with one of the above-mentioned factors. In contrast, there were significant differences for antiplatelet agents (APA) (p < 10–6) and the right side of the hematoma location (p = 0.03). Conclusion Although the literature highlights the controversy regarding RF for CSDH, we detected APA and the right side as RF, whereas DM alone or associated with another comorbidity does not affect the CSDH outcome.

Download Full-text

Chronic subdural hematoma: epidemiological and prognostic analysis of 176 cases

Revista do Colégio Brasileiro de Cirurgiões ◽

10.1590/0100-69912015005003 ◽

2015 ◽

Vol 42 (5) ◽

pp. 283-287 ◽

Cited By ~ 7

Author(s):

JAMIL FARHAT NETO ◽

João Luiz Vitorino Araujo ◽

Vinícius Ricieri Ferraz ◽

Luciano Haddad ◽

José Carlos Esteves Veiga

Keyword(s):

Subdural Hematoma ◽

Drainage System ◽

Chronic Subdural Hematoma ◽

The Elderly ◽

Prognostic Indicators ◽

Altered Consciousness ◽

Prognostic Analysis ◽

Motor Abnormalities ◽

The Right ◽

Change Of Consciousness

Objective : To characterize patients with chronic subdural hematoma undergoing surgery and to identify prognostic indicators. Methods : We conducted a retrospective analysis of patients diagnosed with chronic subdural hematoma (CSDH) undergoing surgical treatment. We analyzed: age, period from trauma to diagnostic imaging, pre and postoperative Glasgow coma scale, type of surgery, associated comorbidities, use of postoperative drainage and outpatient treatment. Results : The sample consisted of 176 patients, 126 male and 50 female patients (ratio 2.5 : 1), ages ranged from six months to 97 years, with an average of 59.3 years. CSDH was caused by trauma in 52% of patients, with the time from trauma to imaging averaging 25.05 days; 37.7% were hypertensive patients and 20% had a neurological disease. Eighty-five (48.3%) patients were elderly and altered consciousness was present in 63% of cases. Of the 91 (51.7%) non-elderly patients, 44% presented with headache, altered consciousness occurred in 40% and motor abnormalities in 27.5%. The CSDH was located on the right in 41%, left in 43% and bilaterally in 16% of patients. Conclusion : the change of consciousness was the most common clinical alteration in the elderly and headache in non-elderly. The most associated comorbidity was the arterial hypertension and the most frequent cause, head trauma. The trepanation with two oriffices associated with a closed drainage system was the most used operating, with high efficacy and low complication rate.

Download Full-text

Calcified Chronic Subdural Hematoma: Case Report

Medical Bulletin of Haseki ◽

10.4274/haseki.2292 ◽

2015 ◽

Vol 53 (2) ◽

pp. 168-170 ◽

Cited By ~ 1

Author(s):

Mehmet Ufuk Akmil ◽

Ezgi Akar ◽

Metin Orakdöğen ◽

Tamer Altay

Keyword(s):

Case Report ◽

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Calcified Chronic Subdural Hematoma

Download Full-text

Skull angiosarcoma associated with a calcified chronic subdural hematoma

British Journal of Neurosurgery ◽

10.1080/02688697.2019.1594693 ◽

2019 ◽

pp. 1-4

Author(s):

Guowen Qin ◽

Peng Xu ◽

Shengyong Lan ◽

Yipu Mao ◽

Yongta Huang ◽

...

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Calcified Chronic Subdural Hematoma

Download Full-text

Trephine Craniotomy versus Burr Hole Drainage for Chronic Subdural Hematoma—An Institutional Analysis of 156 Patients

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713461 ◽

2020 ◽

Vol 17 (02) ◽

pp. 110-120

Author(s):

Ramesh Chandra Vemula ◽

B. C.M. Prasad ◽

Venkat Koyalmantham ◽

Kunal Kumar

Keyword(s):

Ct Scan ◽

Recurrence Rate ◽

Subdural Hematoma ◽

Surgical Intervention ◽

Chronic Subdural Hematoma ◽

Burr Hole ◽

P Value ◽

First Choice ◽

Significant Difference ◽

Preoperative Ct

Abstract Introduction Some neurosurgeons believe that doing a trephine craniotomy (TC) decreases the chance of recurrence in chronic subdural hematoma (cSDH). But this is not supported by any evidence. Methods A retrospective analysis of patients who were operated for cSDH from 2014 to 2019 at our institute was done. Factors causing recurrence were studied. Results A total of 156 patients were operated in the given period, among which 88 underwent TC and 68 patients underwent burr hole drainage (BHD) for evacuation of cSDH. All patients underwent two trephines or two burr holes placed according to the maximum thickness of the hematoma. Rate of recurrence in trephine group was 12.5% and in burr-hole group was 11.76% and was not statistically significant. Significant factors for recurrence included nontraumatic cSDH, anticoagulant use, presence of membranes, preoperative computed tomography (CT) showing iso- or mixed-density subdural collection and SDH volume > 60 mL. There was selection bias for the procedure. Patients with subdural membranes were preferentially taken for TC as the percentage of subdural membrane found intraoperatively was significantly greater in trephine group (51.1%) than burr-hole group (17.6%) (p value < 0.001).When all the patients who showed membranes in CT scan were excluded, there was no statistical difference in the base line characteristics of both the groups. After excluding the patients with membranes in preoperative CT scan, there was no significant difference in recurrence rate between the two groups.In TC group with membranes, 8 out of 45 had recurrence, whereas in burr-hole group with membranes, 8 out of 12 had recurrence. This difference was statistically significant. (p value < 0.001). Conclusion Surgical intervention in both modalities improves patient outcome with an overall recurrence rate of 12.17%. In the absence of any identifiable membranes in preoperative CT scan, BHD is the preferred surgical intervention. We prefer TC as first choice for patients with membranes in CT scan.

Download Full-text

Simultaneous Spinal and Intracranial Chronic Subdural Hematoma Cured by Craniotomy and Laminectomy: A Video Case Report

Case Reports in Neurology ◽

10.1159/000445709 ◽

2016 ◽

Vol 8 (1) ◽

pp. 72-77 ◽

Cited By ~ 4

Author(s):

Hideki Kanamaru ◽

Kenji Kanamaru ◽

Tomohiro Araki ◽

Kazuhide Hamada

Keyword(s):

Subdural Hematoma ◽

Chronic Subdural Hematoma ◽

Rare Condition ◽

Rare Entity ◽

Resonance Imaging ◽

Lumbar Mri ◽

Magnetic Resonance Imaging Mri ◽

Enhanced Computed Tomography ◽

Video Case Report ◽

Space Occupying Lesion

Simultaneous spinal and intracranial chronic subdural hematoma (CSDH) is a rare entity. A 67-year-old man visited our hospital due to headache after diving into a river 2 weeks before. Non-enhanced computed tomography (CT) and magnetic resonance imaging (MRI) revealed bilateral intracranial CSDH. The bilateral CSDH was evacuated and his symptoms improved. Three days after craniotomy, he complained of sensory disturbance on his buttocks. Lumbar MRI showed a space-occupying lesion behind the thecal sac at L5. CT with myelography showed a subdural mass lesion; there was no communication with the subarachnoid space. Fourteen days after craniotomy, L5 laminectomy was performed and the dura mater was incised carefully. The video shows that a liquid hematoma similar to the intracranial CSDH flowed out, followed by cerebrospinal fluid. His symptoms improved after the operation and the hematoma did not recur. This is a rare condition of spinal CSDH demonstrated by neuroimaging and intraoperative video.

Download Full-text