scholarly journals Value of Adding Cisternostomy to Decompressive Hemicraniectomy in the Management of Traumatic Acute Subdural Hematoma Patients

2020 ◽  
Vol 8 (B) ◽  
pp. 1014-1022
Author(s):  
Omar Youssef ◽  
Taher M. Ali ◽  
Khaled Anbar ◽  
Osama El-Shahawy ◽  
Abdelrhman Enayet
Keyword(s):  
Subdural Hematoma ◽  
Mass Effect ◽  
University Hospital ◽  
Neurological Deficits ◽  
Acute Subdural Hematoma ◽  
Inclusion Criteria ◽  
Decompressive Hemicraniectomy ◽  
Decompressive Craniotomy ◽  
Significant Mass Effect ◽  
Significant Mass

BACKGROUND: Surgical evacuation of acute subdural hematoma has remained the mainstay of the treatment for acute subdural hematoma (ASDH) in patients with progressive neurological deficits, increasing intracranial pressure (ICP), or significant mass effect. Cisternostomy entails opening the basal cisterns aiming to their opening to atmospheric pressure and therefore reducing the intraparenchymal pressure. AIM: We aimed to evaluate value of adding cisternostomy to decompressive craniotomy on outcome of traumatic ASDH patients. METHODS: Prospective study included 40 patients who presented to Cairo University hospital emergency department with traumatic acute subdural hematoma in the period between January 2018 and June 2019 and matching our inclusion criteria: Age from 12 to 65 years, traumatic acute subdural hematoma with thickness ≥ 10 mm or midline shift ≥ 5 mm, and Glasgow Coma Scale (GCS) on admission < 10, with no associated intraparenchymal hematoma ≥ 1 cm or severe comorbidities. Patients were randomized into one of two groups according to their order of coming. The first group patients were operated on by decompressive craniotomy (DHC) plus cisternostomy and the second group was operated on by decompressive craniotomy only. Glasgow Outcome Score (GOS) was used for outcome assessment. RESULTS: Outcome was better 2nd but not statistically significant – in the first group (DHC+ cisternostomy) in terms of mortality: 7/20 patients (35%) (p = 0.337) and median GOS: 3 (p = 0.337), compared to the second group (DHC only) in which mortality occurred in 10/20 (50%) and median GOS was 1. Adding cisternostomy to decompressive craniotomy increased surgery time with 35.5 minutes in average. In our study, older age and lower GCS on admission had significantly worse outcome. CONCLUSION: Adding cisternostomy to decompressive craniotomy in traumatic patients had better 2nd but not statistically significant outcome. Whether it should replace the routine decompressive craniotomy in these cases or not needs further larger clinical trials.

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.

Superior Hypophyseal Artery Ruptured Aneurysm in a 5-Month-Old Child Presenting as an Acute Subdural Hematoma: A Case Report

2020 ◽  
pp. 1-6
Author(s):  
Piotr Komuński ◽  
Emilia Nowosławska ◽  
Krzysztof Zakrzewski ◽  
Bartosz Polis ◽  
Wojciech Świątnicki
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Mass Effect ◽  
Ruptured Aneurysm ◽  
Treatment Modalities ◽  
Acute Subdural Hematoma ◽  
Clot Removal ◽  
Right Cerebral Hemisphere ◽  
The Right ◽  
Significant Mass Effect

<b><i>Introduction:</i></b> We present a very rare case of ruptured superior hypophyseal artery (SHA) aneurysm that presented as an acute subdural hematoma (SDH) discussing its initial presentation, diagnosis, and treatment modalities. To our knowledge it is one of very few if any cases of a ruptured aneurysm in infants regarding that specific vascular location. <b><i>Case Report:</i></b> A 5-month-old boy was referred to our department due to acute SDH over the right cerebral hemisphere without significant mass effect nor hydrocephalus. Further evaluation revealed a right internal carotid artery (ICA) aneurysm arising from the SHA segment. Microsurgical clip ligation using a fenestrated, angled clip was performed with simultaneous subdural clot removal and proximal control of the ICA dissected in the neck. Our patient made an excellent recovery without any complicating features. <b><i>Conclusion:</i></b> Surgical management seems to be a better option in this subgroup of patients given the long life expectancy and durability of microsurgical clip ligation. We believe that our brief case report would add some insight into the management of this rare subgroup of patients, leading to better decision-making and outcome.

scholarly journals Ruptured Arteriovenous Malformation Presenting with Kernohan’s Notch

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Christopher F. Dibble ◽  
Michael P. Wemhoff ◽  
Tarik Ibrahim ◽  
Deanna Sasaki-Adams ◽  
Sten Solander ◽  
...  
Keyword(s):  
Cerebral Hemisphere ◽  
Rare Case ◽  
Motor Impairment ◽  
Mass Effect ◽  
Neurological Deficits ◽  
Neurological Improvement ◽  
Bone Replacement ◽  
False Localizing Sign ◽  
Significant Mass Effect ◽  
Significant Mass

AVMs are congenital lesions that predispose patients to intracranial hemorrhage and resultant neurological deficits. These deficits are often focal and due to the presence of local neurologic disruption from hemorrhage in the contralateral cerebral hemisphere. We present a rare case of a patient with ipsilateral neurological deficits due to Kernohan’s Notch phenomenon resulting from hemorrhage from an AVM. A 31-year-old woman with seizures underwent MR and angiographic imaging which confirmed an unruptured left parietal AVM. The patient declined treatment and presented with obtundation 4 years later. Imaging revealed an acute left parietal ICH and SDH with significant mass effect. The patient underwent emergent hemicraniectomy and hematoma evacuation. Postoperatively, she made significant improvement and was following commands contralaterally with ipsilateral hemiplegia. MR imaging revealed right Kernohan’s Notch. The patient had significant rehabilitation with neurological improvement. She eventually underwent elective embolization followed by subsequent surgical resection and bone replacement. Three years from the initial hemorrhage, the patient had only mild left-sided weakness and ambulates without assistance. A false localizing sign, Kernohan’s Notch phenomenon, should be considered in the setting of AVM hemorrhage with paradoxical motor impairment and can be identified through MRI.

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.

scholarly journals Delayed neurological deterioration due to progressive pneumocephalus

2015 ◽  
Vol 22 (1) ◽  
pp. 128-131
Author(s):  
Amit Agrawal ◽  
S. Satish Kumar ◽  
Umamaheswara Reddy V.
Keyword(s):  
Ct Scan ◽  
Clinical Presentation ◽  
Mass Effect ◽  
Neurological Status ◽  
Tension Pneumocephalus ◽  
Delayed Neurological Deterioration ◽  
Mass Lesions ◽  
Multiple Episodes ◽  
Significant Mass Effect ◽  
Significant Mass

Abstract Pneumocephalus can develop immediately following head trauma or clinical presentation may be delayed for days. We report a case of 35 year male whose initial CT scan brain plain small specks of pneumocephalus in left para-sellar region. However the next day he was complaining of severe headache and had multiple episodes of vomiting. Repeat CT scan showed increase in the size of pneumocephalus including appearance of intraventricular air with mild cerebral edema. The patient recovered well with conservative management. The present case is a gentle reminder that in a subgroup of head injury patients, intracranial air can produce significant mass effect leading to tension pneumocephalus which can can behave like other intracranial mass lesions and causes worsening of the neurological status of these patients.

STEREODYNAMICS, MASS EFFECT AND DOCKING FROM O(3P) + HD → OH + D AT Ecol = 0.4–1.0eV AND O(3P) + HD → OD + H AT Ecol = 0.5–1.0eV

2013 ◽  
Vol 12 (01) ◽  
pp. 1250104 ◽  
Author(s):  
VICTOR WEI-KEH (WU) CHAO
Keyword(s):  
Angular Momentum ◽  
Relative Velocity ◽  
Mass Effect ◽  
Dihedral Angles ◽  
Angular Momentum Vector ◽  
Momentum Vector ◽  
Docking Mechanism ◽  
Drug Modification ◽  
Significant Mass Effect ◽  
Significant Mass

Quasiclassical Trajectory (QCT) calculation for O(3P) + HD → OH + D and O(3P) + HD → OD + H at E col = 0.4–1.0 eV and 0.5–1.0 eV, respectively, on the lowest PES 1 3A″ of Kuppermann et al. has been done. Distribution p(ϑr) of azimuthal angles between the relative velocity k of the reactants and rotational angular momentum vector j′ of either OH or OD , p(φr) of polar as well as dihedral angles correlating k - k′ -j′, p(ϑr, φr), and PDDCS dependent upon the scattering angle ϑt of either OH , or OD between k and k′ of the reactants and products, respectively, are presented and discussed. The stereodynamics and isotopic mass effects at the smallest possible collision energies 0.4 eV and 0.5 eV for OH and OD , respectively, are significantly different. The significant mass effect with quotient 1/2 of H/D, at the corresponding collision threshold may be applied for the investigation of docking mechanism, drug modification and delivery.

scholarly journals Massive thoracic ganglioneuroma with significant mass effect on left hemithorax

2018 ◽  
pp. bcr-2017-222250 ◽  
Author(s):  
Jacob T Lambdin ◽  
Kyongjune B Lee ◽  
Gregory Trachiotis ◽  
Carlose Picone
Keyword(s):  
Mass Effect ◽  
Left Hemithorax ◽  
Significant Mass Effect ◽  
Significant Mass

Spontaneous Thrombosis of an Intracranial Giant Aneurysm

1999 ◽  
Vol 5 (4) ◽  
pp. 327-332 ◽  
Author(s):  
G. Warschewske ◽  
G. Benndorf ◽  
Th. Lehmann ◽  
W. Lanksch
Keyword(s):  
Giant Aneurysm ◽  
Mass Effect ◽  
Anterior Communicating Artery ◽  
Complete Disappearance ◽  
Spontaneous Thrombosis ◽  
Short Period ◽  
Clinical Consequences ◽  
Slow Blood Flow ◽  
Significant Mass Effect ◽  
Significant Mass

Spontaneous thrombosis in giant aneurysms is known, whereas complete occlusion of such aneurysms in a short period of time is rarely reported. We present the case of a 50-year-old man with a giant anuersym arising from the anterior communicating artery (ACA) producing significant mass effect with clinical consequences. The digital subtraction arteriogram (DSA) showed a patent lumen of about 20 mm and a very small neck leading to extremely slow blood flow inside the sac and stagnation of contrast. During catheterization for endovascular occlusion four weeks later, the arteriogram revealed complete disappearance of the aneurysm, while the patient remained clinically stable. The patient was operated upon and the thrombosed sac was removed with no complications. He was discharged one week later and recovered completely from his symptoms within three months.

scholarly journals Extensive Upper Airway Hematoma Secondary to Supratherapeutic Warfarin Anticoagulation

2020 ◽  
Vol 4 (4) ◽  
pp. 634-635
Author(s):  
Taofiq Oyedokun ◽  
Kevin Durr
Keyword(s):  
Upper Airway ◽  
Mass Effect ◽  
Endoscopic Examination ◽  
Past Medical History ◽  
Fatal Complication ◽  
Case Presentation ◽  
History Of ◽  
Retropharyngeal Hematoma ◽  
Significant Mass Effect ◽  
Significant Mass

Case Presentation: A 63-year-old female presented to the emergency department complaining of cough, neck swelling, dysphagia, and dysphonia for two days, with a past medical history of atrial fibrillation managed with warfarin. Investigations revealed a supratherapeutic international normalised ratio (greater than 10). Imaging and endoscopic examination showed an extensive retropharyngeal hematoma with significant mass effect on the airway. Discussion: A rare but potentially fatal complication of warfarin anticoagulation is upper airway hematoma, with violent coughing described as an inciting cause. Signs of airway compromise necessitate specialist consultation and definitive airway management, while mild cases without airway concerns can be managed conservatively with medical anticoagulation reversal.

Embolization of the middle meningeal artery for the treatment of epidural hematoma

2009 ◽  
Vol 110 (6) ◽  
pp. 1247-1249 ◽  
Author(s):  
Ian B. Ross
Keyword(s):  
Epidural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Embolization Therapy ◽  
Clot Removal ◽  
Meningeal Arteries ◽  
Endovascular Technology ◽  
Significant Mass Effect ◽  
Meningeal Artery ◽  
Significant Mass

Epidural hematomas (EDHs) are sometimes treated nonoperatively. Decision making, however, is not always perfect, and some hematomas chosen for observation later deteriorate and require surgical clot removal. With the current endovascular technology it is possible to embolize meningeal arteries to stop epidural bleeding. In this study, the author presents his experience in the treatment of a patient with a troublesome postoperative EDH successfully controlled with embolization therapy. This treatment is also useful in posttraumatic EDH and may obviate the need for surgery in some patients with EDHs who present early after injury and without significant mass effect.

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