Neuroendoscopic Removal of Acute Subdural Hematoma with Contusion: Advantages for Elderly Patients

Background. Large craniotomy for acute subdural hematoma is sometimes too invasive. We report good outcomes for two cases of neuroendoscopic evacuation of hematoma and contusion by 1 burr hole surgery.Case Presentation.Both patients arrived by ambulance at our hospital with disturbed consciousness after falling. Case1was an 81-year-old man who took antiplatelet drugs for brain infarction. Case2was a 73-year-old alcoholic woman. CT scanning showed acute subdural hematoma and frontal contusion in both cases. In the acute stage, glycerol was administered to reduce edema; CTs after 48 and 72 hours showed an increase of subdural hematoma and massive contusion of the frontal lobe. Disturbed consciousness steadily deteriorated. The subdural hematoma and contusion were removed as soon as possible by neuroendoscopy under local anesthesia, because neither patient was a good candidate for large craniotomy considering age and past history. 40%~70% of the hematoma was removed, and the consciousness level improved.Conclusion. Neuroendoscopic removal of acute subdural hematoma and contusion has advantages and disadvantages. For patients with underlying medical issues or other risk factors, it is likely to be effective.

Pyogenic Ventriculitis ComplicatingAggregatibacter aphrophilusInfective Endocarditis: A Case Report and Literature Review

Pyogenic ventriculitis (PV) is an uncommon, but frequently fatal infection that results from inflammation of the ventricular ependymal lining associated with a purulent ventricular system. PV has been rarely reported as a secondary complication of infective endocarditis. Prompt diagnosis and treatment with appropriate culture-directed antibiotics with adequate central nervous system penetration is crucial when managing patients who are suspected of having PV. The present study reports on a fatal case of a previously well 42-year-old alcoholic woman with infective endocarditis caused byAggregatibacter aphrophilus,with secondary brain abscess and spontaneous rupture into the ventricles causing PV.

Disulfiram-Induced Hepatitis: Case Report and Review of the Literature

A case of hepatitis is reported in a 38-year-old alcoholic woman taking disulfiram to aid in maintaining sobriety. She presented with anorexia, vomiting, fatigue, right upper-quadrant pain, pruritus, darkened urine, and jaundice after about two weeks of disulfiram 500 mg/d. The patient also had been taking enalapril 10 mg/d for one year. Hepatocellular enzymes, total bilirubin, and eosinophils were significantly elevated. Hepatitis B core antibody, hepatitis A antibody, hepatitis B surface antibody, and antinuclear antibody were negative. After discontinuation of disulfiram, the clinical and biochemical manifestations of hepatitis began to resolve and the patient was discharged in a much improved condition. Seventeen previous cases of disulfiram-induced hepatitis are reviewed. It has been suggested that the mechanism of hepatotoxicity is an allergic or hypersensitivity reaction. The findings in this case are consistent with the earlier descriptions of hypersensitivity hepatitis, and lend further support to the possibility that disulfiram may cause hepatitis.