scholarly journals Neurological Deterioration Following Bilateral Burr-Hole Drainage for Chronic Subdural Hematoma: A Case Report

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Tomita Y
Keyword(s):  
Subdural Hematoma ◽  
Fluid Collection ◽  
Spontaneous Intracranial Hypotension ◽  
Chronic Subdural Hematoma ◽  
Arterial Embolization ◽  
Severe Case ◽  
Neurological Deterioration ◽  
Free Air ◽  
Unknown Reason ◽  
Neurologically Intact

Background: Spontaneous intracranial hypotension (SIH) is a relatively rare but known pathology that results in brain herniation or sagging due to CSF hypovolemia. SIH can commonly be misdiagnosed when occurring with other pathologies including chronic subdural hematoma (CSDH). Neurological decline caused by SIH is rare, but is often rapid and much more severe. Case description: A 69-year-old man was delivered to the emergency department for loss of consciousness and mild left hemiparesis. Brain computed tomography (CT) revealed increased density over basal cisterns suggestive of subarachnoid hemorrhage (SAH), and CSDH. Cerebral angiography showed dural arteriovenous fistula, but there was no apparent cerebral aneurysm. We first performed trans-arterial embolization using n-butyl cyanoacrylate, followed by bilateral hematoma evacuation. A postoperative CT showed that CSDH was evacuated, but the subdural space was filled with free air. A subsequent CT examination revealed mild re-accumulation of CSDH without significant brain compression. On postoperative day 14 the patient became progressively lethargic, for which he was transferred to the intensive care unit. As gadolinium-enhanced magnetic resonance imaging and radionuclide cisternography suggested the leakage of cerebrospinal fluid, an epidural catheter was inserted in the head- down positioned patient and an epidural infusion of saline was given for 3 days. The patient stabilized and regained consciousness over 2 weeks. The patient became neurologically intact with imaging showing almost complete parenchymal expansion and resolution of subdural fluid collection. Conclusion: This is an instructive case because the patient deteriorated after the surgery for CSDH, but it is also a unique case because the deterioration occurred over 14 days. This report emphasizes the possibility that SIH should be taken into consideration when there is an unknown reason for early CSDH recurrence and neurological deterioration.

Chronic subdural hematoma recurrence due to contralateral neovascularization following middle meningeal artery embolization

2021 ◽  
pp. 159101992110651
Author(s):  
Zachary S Hubbard ◽  
Sami Al Kasab ◽  
Guilherme B Porto ◽  
Alejandro Spiotta
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Middle Meningeal Artery ◽  
Artery Embolization ◽  
Diagnostic Investigation ◽  
Neurologically Intact ◽  
Radiographic Result ◽  
Radiographic Improvement ◽  
Meningeal Artery

Introduction Chronic subdural hematoma (CSDH) is one of the most commonly encountered neurosurgical diseases. Middle meningeal artery embolization (MMAE) is a technique for the management of CSDH that has elicited promising results. Despite the encouraging results of MMAE, recurrence does occur. One uncommon mechanism for recurrence of CSDH is by means of neovascularization of the contralateral middle meningeal artery (MMA). We describe two cases of CSDH recurrence by means of contralateral middle meningeal artery neovascularization treated with contralateral MMAE. Methods We identified two cases of recurrent subdural hematoma secondary to neovascularization following treatment with contralateral MMAE. Results Two patients initially treated with MMAE were identified with CSDH recurrence secondary to contralateral MMA neovascularization. There was no traumatic or coagulopathic contribution to CSDH recurrence. In both cases, patients underwent contralateral MMAE. Both patients were neurologically intact with radiographic improvement of CSDH at follow up. Conclusions Re-accumulation of SDH following MMAE by means of contralateral MMA neovascularization is a rare subtype of subdural hematoma (SDH) recurrence following MMAE. Within the context of re-accumulation of SDH following MMAE, catheter angiography is an important diagnostic investigation to elucidate the etiology of the recurrence. Furthermore, when angiography reveals neovascularization of the contralateral MMA, embolization of the contralateral MMA achieves good clinical and radiographic result.

Subdural sarcoma associated with chronic subdural hematoma

1997 ◽  
Vol 86 (3) ◽  
pp. 553-557 ◽  
Author(s):  
Giuseppe Cinalli ◽  
Michel Zerah ◽  
Michel Carteret ◽  
François Doz ◽  
Laurent Vinikoff ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Fluid Collection ◽  
Chronic Subdural Hematoma ◽  
Subsequent Development ◽  
Good Resolution ◽  
Content Type ◽  
First Case ◽  
Contrast Enhanced ◽  
Fluid Collections

✓ The authors report the cases of two children who presented in the first months of life with progressive macrocrania related to chronic pericerebral fluid collection. This condition resolved spontaneously without treatment after a few months in the first case, whereas it required several aspirations of blood-stained fluid via the fontanel in the second case. Both patients developed normally without evidence of disease in the earliest years of life and presented at the ages of 3 1/2 and 4 1/2 years, respectively, with symptoms and signs of rapidly progressing intracranial hypertension. In both cases contrast-enhanced computerized tomography and magnetic resonance imaging revealed masses in the subdural space of the skull base and the cranial vault associated with significant subdural fluid collections. In the first case the lesion was misdiagnosed in the initial phase and treated, by means of multiple craniotomies, as an organized subdural hematoma. After a diagnosis of liposarcoma had been made, the patient was treated with chemotherapy, which resulted in a good resolution of the lesions at 3-month follow-up review. In the second case a biopsy allowed the diagnosis of fibrohistiocytic sarcoma and the patient was treated with chemotherapy. The authors review the literature of the few reported cases and discuss the possible pathophysiological association between pericerebral fluid collection and the subsequent development of a subdural sarcoma.

scholarly journals Spreading depolarization may represent a novel mechanism for delayed fluctuating neurological deficit after chronic subdural hematoma evacuation

2020 ◽  
pp. 1-9 ◽  
Author(s):  
Laila M. Mohammad ◽  
Mohammad Abbas ◽  
C. William Shuttleworth ◽  
Rosstin Ahmadian ◽  
Annapoorna Bhat ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Neurological Deficit ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Brain Dysfunction ◽  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Focal Neurological Deficit ◽  
Entire Cohort ◽  
Subdural Electrode

OBJECTIVEMost patients with chronic subdural hematoma (cSDH) recover after surgical evacuation with a straightforward course. There is a subset of patients who develop transient and fluctuating deficits not explained by seizures, stroke, or mass effect after evacuation. The objective of this study was to investigate whether these postoperative neurological deficits may be related to temporary brain dysfunction caused by cortical spreading depolarizations (SDs).METHODSThe authors conducted a prospective observational study of 40 patients who underwent cSDH evacuation. At the time of surgery, a 1 × 6 subdural electrode strip was placed on the cortex parallel to the subdural drain. Clinical outcomes were assessed utilizing the Markwalder Grading Scale, need for clinical EEG for new deficit, and presence of new deficits.RESULTSDefinitive SD was detected in 6 (15%) of 40 patients. Baseline and cSDH characteristics did not differ between patients with and without SD. More patients experienced postoperative neurological deterioration if they had SD (50%) compared to those without SD (8.8%; p = 0.03). Only 2 patients in the entire cohort demonstrated early neurological deterioration, both of whom had SD. One of these cases demonstrated a time-locked new focal neurological deficit (aphasia) at the start of a series of multiple clusters of SD.CONCLUSIONSThis is the first observation of SD occurring after cSDH evacuation. SD occurred at a rate of 15% and was associated with neurological deterioration. This may represent a novel mechanism for otherwise unexplained fluctuating neurological deficit after cSDH evacuation. This could provide a new therapeutic target, and SD-targeted therapies should be evaluated in prospective clinical trials.

scholarly journals Targeted Epidural Blood Patch Treatment for Refractory Spontaneous Intracranial Hypotension: A Case Report

2021 ◽  
Vol 82 (04) ◽  
pp. e49-e52
Author(s):  
Nan Liu ◽  
Yue Fei ◽  
Fei-fang He
Keyword(s):  
Case Report ◽  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Epidural Blood Patch ◽  
Spontaneous Intracranial Hypotension ◽  
Chronic Subdural Hematoma ◽  
Neurologic Deficit ◽  
Blood Patch

Abstract Purpose of Review Spontaneous intracranial hypotension (SIH) is recognized far more commonly than before, and it is well known that SIH is sometimes complicated by chronic subdural hematoma (SDH). We reported a patient who was treated with epidural blood patch (EBP) five times for refractory SIH and SDH surgery. Recent Findings We experienced that targeted EBP was useful in refractory SIH, and also can be performed safely prior to drainage of the hematoma. Summary We report the case of SIH patient with a bilateral SDH who came to our hospital and was discharged 2 weeks later with no neurologic deficit after trephination and five times EBP treatment. It shows that targeted EBP was useful in refractory SIH, and also can be performed safely prior to drainage of the hematoma.

scholarly journals Cerebrospinal fluid leak as a driving factor in chronic subdural hematoma formation: A histological study

2021 ◽  
Vol 12 ◽  
pp. 578
Author(s):  
Antonio Colamaria ◽  
Matteo Sacco ◽  
Savino Iodice ◽  
Nicola Pio Fochi ◽  
Francesco Carbone
Keyword(s):  
Cerebrospinal Fluid ◽  
Inflammatory Reaction ◽  
Subdural Hematoma ◽  
Histological Study ◽  
Fluid Collection ◽  
Traumatic Injury ◽  
Chronic Subdural Hematoma ◽  
Cerebrospinal Fluid Leak ◽  
Demographic Shift ◽  
Csf Leakage

Background: Chronic subdural hematoma (CSDH) represents the most common neurosurgical disease. Given the demographic shift toward an aging population, the overall incidence of this condition is increasing. Nevertheless, clarity in the pathophysiological process is yet to be made. Several etiological mechanisms have been proposed to initiate and consequently promote fluid collection in the subdural space. Traumatic injury of the bridging veins has long been considered the primum movens of the pathology but increasing evidence shows that trauma is not the only factor involved. Along with recent advances we sought to understand the role of the cerebrospinal fluid (CSF) in the buildup of the intense inflammatory reaction that characterizes CSDH. Methods: In the present study, we examined histological features of reactive membranes secondary to extracranial CSF leakage with CSDH-related membranes. Similarity and differences between the specimens were examined by means of light microscopy. Results: Histological similarities were consistently found between CSDH membranes and reactive membranes secondary to CSF leakage in the extracranial space. Activated histiocytes were highlighted in all specimens along with an intense inflammatory reaction. Conclusion: CSDH is most likely the result of a complex interaction among different pathophysiological events resulting from both traumatic and inflammatory etiologies. In the present work, we highlight how CSF leakage could be an early factor that leads to a cascade of events that culminates in CSDH formation.

Spontaneous Intracranial Hypotension, a Possible Cause of Chronic Subdural Hematoma

2011 ◽  
Vol 7 (1) ◽  
pp. 35
Author(s):  
Seung-Hwan Lee ◽  
Taek-Hyun Kwon ◽  
Sung-Kon Ha ◽  
Jong-Hyun Kim ◽  
Joo-Han Kim ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Intracranial Hypotension ◽  
Spontaneous Intracranial Hypotension ◽  
Chronic Subdural Hematoma ◽  
Possible Cause
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