Independent predictors of recurrence of chronic subdural hematoma: results of multivariate analysis performed using a logistic regression model

2003 ◽  
Vol 98 (6) ◽  
pp. 1217-1221 ◽  
Author(s):  
Hiromichi Yamamoto ◽  
Yutaka Hirashima ◽  
Hideo Hamada ◽  
Nakamasa Hayashi ◽  
Hideki Origasa ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Multivariate Analysis ◽  
Subdural Hematoma ◽  
Logistic Regression Model ◽  
Multivariate Analyses ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
History Of ◽  
Fine Print

Object. The authors attempted to determine independent predictors that contribute to the recurrence of chronic subdural hematoma (CSDH). Methods. A total of 105 consecutive patients who underwent surgery for CSDH were included in this study. Eleven patients underwent a repeated operation because the CSDH recurred. Univariate and multivariate analyses were performed to assess the relationships among various variables and CSDH recurrence. Finally, four variables were found to be independently associated with the recurrence of CSDH: 1) absence of a multiplicity of hematoma cavities on CT scans; 2) presence of a history of seizure; 3) width of the hematoma; and 4) absence of a history of diabetes mellitus (DM). Conclusions. As previously reported, the width of the hematoma is related to the incidence of CSDH recurrence. In this study, the lack of a multiplicity of hematoma cavities was the favorite predictor of CSDH recurrence. In addition, histories of seizure and no past DM are closely related to the incidence of CSDH recurrence.

Sedimentation level in chronic subdural hematoma visible on computerized tomography

1983 ◽  
Vol 58 (2) ◽  
pp. 246-251 ◽  
Author(s):  
Ming-Chien Kao
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Clinical Manifestations ◽  
Chronic Subdural Hematoma ◽  
Ct Scans ◽  
Content Type ◽  
Ct Examination ◽  
History Of ◽  
Chronic Hematoma ◽  
Fine Print

✓ A clear interface dividing subdural hematoma into an upper hypodense and a lower hyperdense part was seen on computerized tomography (CT) scan in seven of 140 patients with chronic subdural hematoma. All except one of the seven patients had a definite history of head trauma more than 1 month before they developed acute disturbances of consciousness and pronounced hemiparesis. Consequently, they remained bed-ridden until they underwent drainage of the subdural hematoma. This group was compared to seven chronic subdural hematoma patients with mild clinical manifestations who were selected and intentionally confined to bed for a period before CT examination and craniotomy. The CT scans in this latter group did not show the clear interface in the subdural hematoma seen in the first group. Based on this study, it is hypothesized that this sedimentation level occurred as a result of rebleeding into a chronic hematoma that was sufficiently old to result in its contents being homogenous prior to the rebleed. In cases of rebleeding, a sufficient period of bed confinement in the brow-up position before CT examination allows development of a gravitational sedimentation in the hematoma. This clear level of sedimentation is seen in only a small portion of patients, but this finding may be specific for a significant amount of rebleeding and may herald acute deterioration.

Relationship between drainage catheter location and postoperative recurrence of chronic subdural hematoma after burr-hole irrigation and closed-system drainage

2000 ◽  
Vol 93 (5) ◽  
pp. 791-795 ◽  
Author(s):  
Hiroshi Nakaguchi ◽  
Takeo Tanishima ◽  
Norio Yoshimasu
Keyword(s):  
Recurrence Rate ◽  
Closed System ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Postoperative Recurrence ◽  
Ct Scans ◽  
Subdural Space ◽  
Content Type ◽  
Drainage Catheter ◽  
Fine Print

Object. This study was conducted to determine the best position for the subdural drainage catheter to achieve a low recurrence rate after burr-hole irrigation and closed-system drainage of chronic subdural hematoma (CSDH).Methods. The authors studied 63 patients with CSDH in whom the drainage catheter tip was randomly placed and precisely determined on postoperative computerized tomography (CT) scans and 104 patients with CSDH in whom CT scans were obtained 7 days postsurgery. The location of the subdural drainage catheter, the maximum postoperative width of the subdural space, and the percentage of the ipsilateral subdural space occupied by air postoperatively were determined and compared with the postoperative recurrence and reoperation rates.Patients with parietal or occipital drainage had a higher rate of CSDH recurrence and much more subdural air than those with frontal drainage. In addition, patients with residual subdural air demonstrated on CT scans obtained 7 days postsurgery also had a higher recurrence rate than those without subdural air collections. Furthermore, patients with a subdural space wider than 10 mm on CT scans obtained 7 days postsurgery had a higher recurrence rate than those with a space measuring 10 mm or less.Conclusions. The incidence of postoperative fluid reaccumulation seems to be reduced by placing the tip of the drainage catheter in the frontal convexity and by removing subdural air during or after surgery.

Middle meningeal artery embolization for refractory chronic subdural hematoma

2000 ◽  
Vol 93 (4) ◽  
pp. 686-688 ◽  
Author(s):  
Shinya Mandai ◽  
Masaru Sakurai ◽  
Yuzo Matsumoto
Keyword(s):  
Liver Cirrhosis ◽  
Subdural Hematoma ◽  
Therapeutic Approach ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Content Type ◽  
Meningeal Artery ◽  
Fine Print

✓ The authors present a case of refractory chronic subdural hematoma (CSH) in a 59-year-old man with coagulopathy due to liver cirrhosis. The patient was successfully treated by embolization of the middle meningeal artery after several drainage procedures. This new therapeutic approach to recurrent CSH is discussed.

Chronic subdural hematoma simulating transient cerebral ischemic attacks

1975 ◽  
Vol 42 (1) ◽  
pp. 101-103 ◽  
Author(s):  
Eldad Melamed ◽  
Slvan Law ◽  
Avinoam Reches ◽  
Abraham Sahar
Keyword(s):  
Subdural Hematoma ◽  
Clinical Picture ◽  
Chronic Subdural Hematoma ◽  
Sensory Deficit ◽  
Transient Ischemic Attacks ◽  
Neurological Manifestations ◽  
Content Type ◽  
Pathophysiological Mechanisms ◽  
Cerebral Ischemic ◽  
Fine Print

✓ A patient is presented in whom chronic subdural hematoma simulated transient ischemic attacks. The neurological manifestations were those of recurrent, transient episodes of expressive dysphasia preceded by focal sensory deficit. Various pathophysiological mechanisms which could have caused the unusual clinical picture are briefly considered.

Chronic subdural hematoma in infancy

1990 ◽  
Vol 73 (2) ◽  
pp. 201-205 ◽  
Author(s):  
Nobuhiko Aoki
Keyword(s):  
Computerized Tomography ◽  
Subdural Hematoma ◽  
Treatment Protocol ◽  
Chronic Subdural Hematoma ◽  
Neurological Deficits ◽  
Acute Subdural Hematoma ◽  
Hemorrhagic Diathesis ◽  
Content Type ◽  
Fine Print ◽  
Subdural Tapping

✓ The cases of 30 infants with chronic subdural hematoma treated surgically between 1978 and 1987 (after the introduction of computerized tomography) were reviewed. This series was limited to infants presenting with increased intracranial pressure, neurological deficits, or developmental retardation. Nineteen patients were male and 11 were female, ranging in age from 1 to 14 months (average 6.1 months). The surgical treatment was initiated with percutaneous subdural tapping which was repeated periodically, if indicated, for 2 weeks. If the patients failed to respond to subdural tapping, subdural-peritoneal shunting was installed. The follow-up periods were from 3 months to 9 years 8 months (average 4 years 10 months). Computerized tomography at that time disclosed disappearance or minimal collection of subdural fluid in 28 cases (93%) and a significant collection (> 5 mm) in two (7%). Neurological examination revealed that the patients were “normal” in 17 cases (57%), “mildly or moderately disabled” in nine (30%), and “severely disabled” in four (13%). The majority of disabled patients had lesions secondary to infantile acute subdural hematoma, child abuse, or hemorrhagic diathesis. These results indicate that the treatment protocol in the present series is acceptable for the elimination of subdural hematoma. Together, early diagnosis and treatment of the etiological conditions causing the lesion are indispensable for obtaining a satisfactory neurological outcome.

Acute brain edema in fatal head injury: analysis by dynamic CT scanning

1985 ◽  
Vol 63 (6) ◽  
pp. 830-839 ◽  
Author(s):  
Eiji Yoshino ◽  
Tarumi Yamaki ◽  
Toshihiro Higuchi ◽  
Yoshiharu Horikawa ◽  
Kimiyoshi Hirakawa
Keyword(s):  
Head Injury ◽  
Brain Edema ◽  
Subdural Hematoma ◽  
Ct Scans ◽  
Acute Subdural Hematoma ◽  
Dynamic Ct ◽  
Content Type ◽  
Injured Patients ◽  
Fine Print ◽  
Diffuse Brain

✓ Dynamic computerized tomography (CT) was performed on 42 patients with acute head injury to evaluate the hemodynamics and to elucidate the nature of fatal diffuse brain bulk enlargement. Patients were divided into two groups according to the outcome: Group A included 17 nonfatally injured patients, eight with acute epidural hematomas and nine with acute subdural hematomas; Group B included 25 fatally injured patients, 16 with acute subdural hematomas and nine with bilateral brain bulk enlargement. Remarkable brain bulk enlargement could be seen in all fatally injured patients with acute subdural hematoma. In 29 (69%) of 42 patients, dynamic CT was performed within 2 hours after the impact. In the nonfatally injured patients with brain bulk enlargement, dynamic CT scans suggested a hyperemic state. On the other hand, in 17 (68%) of the 25 fatally injured patients, dynamic CT scans revealed a severely ischemic state. In the fatally injured patients with acute subdural hematoma, CT Hounsfield numbers in the enlarged hemisphere (hematoma side) were significantly lower than those of the opposite side (p < 0.001). Severe diffuse brain damage confirmed by follow-up CT scans and uncontrollable high intracranial pressure were noted in the fatally injured patients. Brain bulk enlargement following head injury originates from acute brain edema and an increase of cerebral blood volume. In cases of fatal head injury, acute brain edema is the more common cause of brain bulk enlargement and occurs more rapidly than is usually thought.

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.

Chronic subdural hematoma presenting as spontaneous subarachnoid hemorrhage

1985 ◽  
Vol 63 (5) ◽  
pp. 691-692 ◽  
Author(s):  
Zbigniew Kotwica ◽  
Jerzy Brzeziński
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Findings ◽  
Content Type ◽  
Acute Subarachnoid Hemorrhage ◽  
Spontaneous Subarachnoid Hemorrhage ◽  
Fine Print

✓ Six cases of chronic subdural hematoma presenting with the clinical findings of acute subarachnoid hemorrhage are reported. No systemic or focal cause for the bleeding was found, and possible mechanisms are discussed.

Experimental chronic subdural hematoma in mice

1987 ◽  
Vol 67 (5) ◽  
pp. 710-716 ◽  
Author(s):  
Hisashi Aikawa ◽  
Kinuko Suzuki
Keyword(s):  
Body Weight ◽  
Blood Vessels ◽  
Subdural Hematoma ◽  
Intraperitoneal Injection ◽  
Intraventricular Hemorrhage ◽  
Chronic Subdural Hematoma ◽  
Content Type ◽  
Single Intraperitoneal Injection ◽  
Thin Walled ◽  
Fine Print

✓ A new experimental model of chronic subdural hematoma in mice is described. A single intraperitoneal injection of 6-aminonicotinamide (25 mg/kg body weight) on the 5th postnatal day induced hydrocephalus in mice with almost 100% success. Approximately 60% of the mice spontaneously developed intracranial hemorrhage 20 days after the injection. About 1 week after the hemorrhage, a lens-shaped or spherical subdural hematoma was observed, accompanied by marked dilatation of the lateral ventricles and intraventricular hemorrhage. Histological examination revealed that the hematoma contained well-organized outer and inner membranes. Fresh hemorrhage surrounded by many hemosiderin-laden macrophages was seen at the margin of the hematoma adjacent to the organizing outer membrane, in which many fibroblasts and blood vessels were noted. The inner membrane of the hematoma was made up of several tiers of flattened cells with thin-walled blood vessels. The gross morphology and histology of these hematomas closely resembled those of human chronic subdural hematoma.

Production of clinical form of chronic subdural hematoma in experimental animals

1972 ◽  
Vol 37 (5) ◽  
pp. 552-561 ◽  
Author(s):  
Satoru Watanabe ◽  
Hironobu Shimada ◽  
Shozo Ishii
Keyword(s):  
Cerebrospinal Fluid ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Subdural Space ◽  
Clinical Form ◽  
Content Type ◽  
Experimental Animals ◽  
Fine Print

✓ A method for producing a clinical form of experimental chronic subdural hematoma is reported. When blood is mixed with cerebrospinal fluid and incubated, a peculiar clot is formed which, when inoculated into the subdural space of dogs or monkeys, grows gradually. Histologically the capsule of the hematoma is comparable to that seen in human chronic subdural hematoma. In some animals progressive hemiparesis develops.

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