scholarly journals Kernohan-Woltman Notch Phenomenon in Chronic Subdural Hematoma: An under-Diagnosed Phenomenon?

2021 ◽  
pp. 115-123
Author(s):  
M. Asante-Bremang ◽  
B. A. B. Alhassan ◽  
E. O. Ofori ◽  
S. Yussif ◽  
K. Agyen-Mensah ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Cerebral Peduncle ◽  
Elderly Male ◽  
Elderly Female ◽  
Short Period ◽  
History Of ◽  
Low Volume ◽  
Supratentorial Mass ◽  
Wrong Site

Introduction: Kernohan-Woltman notch phenomenon is a neurological picture of mydriasis and hemiparesis/ hemiplegia ipsilateral to a supratentorial mass lesion causing compression of the contralateral cerebral peduncle against the tentorial edge.  The aim of this paper is to report  series of cases from a low volume centre of neurosurgical care and highlight the fact that Kernohan’s notch phenomenon, although, reported to be quite rare but it’s not uncommon and to also look out for this phenomenon to avoid wrong site surgeries.  Presentation of Cases: We report four cases of chronic subdural hematoma presenting with Kernohan- Woltmann notch phenomenon. The patients include: a young alcoholic who was found in a gutter after binge drinking, a middle aged man who was accidentally hit on the head with a car tire jack, an elderly female with no history of trauma, a fall nor use of anticoagulant and an elderly male, a diabetic. All four patients had emergency burr hole and drainage of subdural hematoma.   Discussion: This incidence of this phenomenon among patients with chronic subdural hematoma is rarely reported in the literature, however, a low volume centre for neurosurgical services like ours has seen five cases in a short period of time.   Conclusion: This paradoxical neurological sign is probably under-diagnosed judging from the number of cases diagnosed in a low volume center like ours.

scholarly journals Post traumatic isolated ipsilateral oculomotor nerve palsy

2019 ◽  
pp. 188-190
Author(s):  
Praveen Kumar ◽  
Sharad Pandey ◽  
Kulwant Singh ◽  
Mukesh Sharma ◽  
Prarthana Saxena
Keyword(s):  
Subdural Hematoma ◽  
Nerve Palsy ◽  
Chronic Subdural Hematoma ◽  
Oculomotor Nerve Palsy ◽  
Rare Presentation ◽  
Third Nerve Palsy ◽  
Common Causes ◽  
History Of ◽  
Post Traumatic ◽  
Third Nerve

The common causes of isolated third nerve palsy are microvascular infarction, intracranial aneurysm, diabetes, hypertension and atherosclerosis. Here we are presenting a case of 26-year female presenting with a history of head injury two months back. She presented with ptosis on the left side. On computed tomography, a large left-sided chronic subdural hematoma with significant midline shift was found. Isolated ipsilateral third nerve palsy is a rare presentation with unilateral chronic subdural hematoma. Improvement in ptosis after surgery indicate a good neurological outcome.

A NOVEL ASSOCIATION BETWEEN A CHRONIC SUBDURAL HEMATOMA AND A FIBRINOLYTIC PATHWAY DEFECT

Neurosurgery ◽  
2009 ◽  
Vol 64 (6) ◽  
pp. E1192-E1192 ◽  
Author(s):  
Anand I. Rughani ◽  
Chris E. Holmes ◽  
Paul L. Penar
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Plasminogen Activator Inhibitor ◽  
Aminocaproic Acid ◽  
Type I ◽  
Novel Association ◽  
History Of ◽  
Inhibitor Type ◽  
Activator Inhibitor Type ◽  
Pai 1

Abstract OBJECTIVE Chronic subdural hematoma (CSDH) is a common form of intracranial hemorrhage that is known to recur in up to one-fifth of treated patients. We present a patient with recurrent CSDH who was found to have a defect in the fibrinolytic pathway, which may be a novel explanation for recurrent CSDH. This defect, deficiency of plasminogen activator inhibitor type I (PAI-1), should be recognized as a possible cause of CSDH. CLINICAL PRESENTATION A 49-year-old man presented with a CSDH, which recurred each time after 2 initially-effective craniotomies. INTERVENTION A deficiency of PAI-1 was diagnosed after the second recurrence. We hypothesize that this defect in the fibrinolytic system contributed to the recurrent hematoma. Treatment with aminocaproic acid led to resolution of the CSDH. CONCLUSION PAI-1 deficiency should be considered in patients with recurrent CSDH that lack another compelling explanation, particularly in patients with a family history of bleeding diatheses. PAI-1 deficiency can be identified by measuring plasma levels and can be treated with an oral course of aminocaproic acid.

scholarly journals Chronic subdural hematoma

2021 ◽  
pp. 1-7
Author(s):  
Blanca Piedra Herrera ◽  
Yanet Yanet Acosta Piedra
Keyword(s):  
Subdural Hematoma ◽  
Head Injuries ◽  
Young Patients ◽  
Chronic Subdural Hematoma ◽  
Complete Recovery ◽  
Computed Tomography Scan ◽  
History Of ◽  
Third Cranial Nerve Palsy ◽  
The Right ◽  
Tomography Scan

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma. The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics. Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson’s pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.

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.

scholarly journals Warning with chronic subdural hematomas in the elderly

2021 ◽  
Vol 11 (4) ◽  
pp. 114-117
Author(s):  
Dinh Thi Phuong Hoai ◽  
Nguyen Thi My Dung ◽  
Hoang Manh Cuong ◽  
Huynh Thi Kieu Oanh ◽  
Ngo Thuy Tram ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
The Elderly ◽  
Brain Parenchyma ◽  
History Of ◽  
Apparent Reason ◽  
The Right ◽  
Contrast Ct

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

Transradial embolization of the left middle meningeal artery and accessory middle meningeal artery for treatment of subacute–chronic subdural hematoma

2020 ◽  
Vol 12 (4) ◽  
pp. 436-436 ◽  
Author(s):  
Gary B Rajah ◽  
Michael K Tso ◽  
Rimal Dossani ◽  
Kunal Vakharia ◽  
Adnan H Siddiqui
Keyword(s):  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
Middle Meningeal Artery ◽  
Vascular Lesion ◽  
External Carotid ◽  
Invasive Treatment ◽  
History Of ◽  
The Right ◽  
Meningeal Artery

This 52-year-old man with no remarkable medical history, no anticoagulation use, and no history of trauma was noted to have a subacute–chronic left subdural hematoma during outpatient headache evaluation. No occult vascular lesion or cross-calvarial supply of the right middle meningeal artery (MMA) to the left side was identified on bilateral selective external carotid injections. Because the patient preferred non-surgical management, we performed a left MMA embolization with Onyx 18 (Medtronic), utilizing a Headway Duo microcatheter (MicroVention) via the transradial route. A 6 French Benchmark (Penumbra) was utilized for transradial support into the left external carotid. The patient was discharged home the same day. Repeat scans from 2 to 6 weeks revealed complete resolution of the subdural hematoma. The patient’s headaches resolved. Transradial MMA embolization for subacute–chronic subdural hematoma represents a minimally invasive treatment option for mass effect and hemorrhage-related symptoms. Tailored embolizations are necessary when >1 meningeal vessel supplies the subdural hematoma.

Reversible Parkinsonism due to Chronic Subdural Hematoma: A Case Report

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Brahim EM ◽  
◽  
Mostarchid ME ◽  
Abderrahmane H ◽  
Inas K ◽  
...  
Keyword(s):  
Case Report ◽  
Elderly Patients ◽  
Parkinson Disease ◽  
Ct Scan ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Clinical Symptomatology ◽  
Cause And Effect ◽  
History Of ◽  
Effect Relation

Although Chronic Subdural Hematoma (CSDH) is frequent in elderly patients, the CSDH can exceptionally cause a parkinsonism or aggravation of pre-existing parkinsonism. Only 27 cases reversible parkinsonism due to chronic subdural hematoma was reported in the literature. Disappearance of the extra pyramidal symptoms followed craniotomy and removal of the CSDH suggest a cause-and-effect relation between the haematoma and the clinical symptomatology. A case of a 62-year-old man with a two weeks history of parkinsonism caused by a CSDH reversible after surgery evacuation of the haematoma is reported. CSDH is a rare cause of reversible parkinsonism after surgery. CT scan must be recognized in any acute Parkinsonism or any deterioration of preexisting Parkinson disease to diagnose the Parkinsonism secondary to CSDH.

Bilateral Chronic Subdural Hematoma and Blindness: Bilateral Infarction to the Posterior Cerebral Artery following Evacuation of Bilateral Chronic Subdural Hematoma — A Rare Case Report and Review of Literature

2017 ◽  
Vol 14 (01) ◽  
pp. 046-052
Author(s):  
Sendilkumar Adimoolam ◽  
Syamala Shunmugam ◽  
Sneha Balasubramanian
Keyword(s):  
Subdural Hematoma ◽  
Past History ◽  
Rare Complication ◽  
Chronic Subdural Hematoma ◽  
Vascular Abnormality ◽  
Rare Case Report ◽  
History Of ◽  
Burr Holes ◽  
Bilateral Chronic Subdural Hematoma ◽  
Ct And Mri

Objective The authors report a rare scenario in which evacuation of bilateral chronic subdural hematoma (CSDH) was followed by bilateral PCA infarction and blindness. A literature review was also conducted, which revealed only four cases of blindness after CSDH evacuation. Methods A 45-year-old man was admitted with the chief complaint of holocranial headache for 2 months with past history of head trauma. Clinical examination was normal. CT and MRI scanning showed bilateral frontotemperoparietal CSDH without midline shift and parenchymal and vascular abnormality. Bilateral frontal and parietal burr holes and evacuation of CSDH was done. Results The patient developed progressive blindness in both the eyes in the postoperative period. MRI revealed bilateral PCA infarction. Discussion Bilateral PCA infarction following bilateral CSDH evacuation is an extremely rare entity. Only four case of blindness following CSDH evacuation have been reported so far, and all the patients suffered permanent visual loss. The exact etiopathogenesis and mechanism of this rare complication remain unknown. Conclusion Bilateral CSDH is a separate entity with altered pathophysiology and deranged cerebral autoregulation. The authors conclude that Bilateral CSDH may be sentinel tags for bilateral PCA infarction secondary to altered hemodynamics in the posterior circulation, and hence, needs to be evaluated and treated with greater diligence.

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