A fluid level in an acute extradural haematoma

Controlateral epidural hematoma after VP shunt: A case report

Cerebrospinal fluid over-drainage is a common complication of ventriculoperitoneal devices (Ventriculoperitoneal shunt). In terms of hemorrhage, subdural hematomas are usually more frequent lesions than epidural hematomas, which, more rarely, may also be seen after ventricular shunt procedures and may lead to rapid neurological decline and even death unless a surgical procedure can be promptly performed. In our study we report the case of a 5 years old boy with history of congenital obstructive hydrocephalus treated with a ventriculoperitoneal shunt insertion when he was 8 months old. The patient was admitted with sudden deterioration of level of consciousness secondary to tri-ventricular hydrocephalus. He underwent a shunt revision. Two weeks later, he developed a loss of consciousness with a large left extradural hematoma contralateral to the side of ventriculoperitoneal shunt. He underwent an evacuation of the hematoma with a good postoperative outcome. Epidural hematoma, especially controlateral to Ventriculoperitoneal shunt, is extremely rare. The pathophysiology and the possible use of a programmable valve to prevent these lesions are briefly discussed.

Sensitivity and specificity of blood-fluid levels for oral anticoagulant-associated intracerebral haemorrhage

Intracerebral haemorrhage (ICH) is a life-threatening emergency, the incidence of which has increased in part due to an increase in the use of oral anticoagulants. A blood-fluid level within the haematoma, as revealed by computed tomography (CT), has been suggested as a marker for oral anticoagulant-associated ICH (OAC-ICH), but the diagnostic specificity and prognostic value of this finding remains unclear. In 855 patients with CT-confirmed acute ICH scanned within 48 h of symptom onset, we investigated the sensitivity and specificity of the presence of a CT-defined blood-fluid level (rated blinded to anticoagulant status) for identifying concomitant anticoagulant use. We also investigated the association of the presence of a blood-fluid level with six-month case fatality. Eighteen patients (2.1%) had a blood-fluid level identified on CT; of those with a blood-fluid level, 15 (83.3%) were taking anticoagulants. The specificity of blood-fluid level for OAC-ICH was 99.4%; the sensitivity was 4.2%. We could not detect an association between the presence of a blood-fluid level and an increased risk of death at six months (OR = 1.21, 95% CI 0.28-3.88, p = 0.769). The presence of a blood-fluid level should alert clinicians to the possibility of OAC-ICH, but absence of a blood-fluid level is not useful in excluding OAC-ICH.

Contralateral extradural haematoma after insertion of a programmable-valve ventriculoperitoneal shunt

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Epidural hematoma after ventriculoperitoneal shunt surgery. Report of two cases

Ventriculoperitoneal shunt operations represent the most used choice for treating hydrocephalus, although some related complications have been reported. Due to its rarity, potential dangers, and mortality rate, we present two cases of epidural hematoma following ventriculoperitoneal shunt, discussing its pathophysiology and prophylaxis.