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Parkin K, Taylor E, Rane N, Dawe G, Hall C. Pearls & Oy-sters: What Came First, the Bleed or the Fall?: An Aneurysmal Subdural Hemorrhage. Neurology 2024; 102:e209491. [PMID: 38771999 DOI: 10.1212/wnl.0000000000209491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2024] Open
Abstract
Acute subdural hemorrhages are a common emergency presentation often associated with trauma. However, in the absence of significant trauma, it is important to consider alternative causes. In this case, a 58-year-old woman with trivial trauma after a sudden collapse had bilateral subdural hemorrhages on CT. CT-angiogram revealed anterior communicating artery aneurysm, which had ruptured. This case explores intracerebral aneurysms as a rare cause of subdural hemorrhage that is important to consider in the absence of significant trauma.
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MESH Headings
- Humans
- Female
- Middle Aged
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/complications
- Aneurysm, Ruptured/diagnostic imaging
- Aneurysm, Ruptured/complications
- Hematoma, Subdural, Acute/diagnostic imaging
- Hematoma, Subdural, Acute/etiology
- Hematoma, Subdural/diagnostic imaging
- Hematoma, Subdural/etiology
- Hematoma, Subdural/complications
- Tomography, X-Ray Computed
- Computed Tomography Angiography
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Affiliation(s)
- Katherine Parkin
- From the Department of Radiology (K.P.), St Bartholomew's and the Royal London Hospital; Department of Imaging (E.T., G.D.) and Interventional Neuroradiology (N.R., C.H.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Eleanor Taylor
- From the Department of Radiology (K.P.), St Bartholomew's and the Royal London Hospital; Department of Imaging (E.T., G.D.) and Interventional Neuroradiology (N.R., C.H.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Neil Rane
- From the Department of Radiology (K.P.), St Bartholomew's and the Royal London Hospital; Department of Imaging (E.T., G.D.) and Interventional Neuroradiology (N.R., C.H.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Gemma Dawe
- From the Department of Radiology (K.P.), St Bartholomew's and the Royal London Hospital; Department of Imaging (E.T., G.D.) and Interventional Neuroradiology (N.R., C.H.), Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Charles Hall
- From the Department of Radiology (K.P.), St Bartholomew's and the Royal London Hospital; Department of Imaging (E.T., G.D.) and Interventional Neuroradiology (N.R., C.H.), Imperial College Healthcare NHS Trust, London, United Kingdom
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2
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Shi XY, Zhang JX, Tang ZX, Sun H, Shen Z. Severe spontaneous acute arterial subdural hematoma as an initial symptom of chronic myeloid leukemia. Br J Neurosurg 2023; 37:1721-1724. [PMID: 33605812 DOI: 10.1080/02688697.2021.1885625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
Acute subdural hematoma (SDH) is a rare occurrence in chronic myeloid leukemia (CML) patients with only two cases reported in literature. However, sudden severe acute SDH caused by CML has not been reported on. Our patient was admitted for 'sudden unconsciousness for more than 1 hour'. Computed tomography (CT) angiography revealed a large amount of acute SDH on the left side. Physical exam showed the patient's left pupil was dilated and signs of cerebral herniation were present. The preoperative coagulation profile was normal. Emergency craniotomy for hematoma clearance and decompression was performed. During the surgery, a ruptured cerebral artery was located in the perisylvian region and hemostasis was achieved through electrocautery. Pre-operative white blood count was 58,100 cell/µl, with post-operative bone marrow examination、cytogenetic analysis and RT-PCR detection revealing a diagnosis of CML, for which hydroxyurea chemotherapy was initiated. Leukocyte count of the patient gradually returned to normal. After 24 days, the patient regained consciousness and on day 30, repeat CT scan showed no SDH recurrence. The patient recovered with no neurological deficits and achieved a good prognosis.
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MESH Headings
- Humans
- Hematoma, Subdural, Acute/surgery
- Arteries
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/diagnosis
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/surgery
- Tomography, X-Ray Computed/adverse effects
- Computed Tomography Angiography
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/etiology
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Affiliation(s)
- Xiao-Yong Shi
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Jin-Xia Zhang
- Department of Clinical Psychology(Sleep Medical Center), Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University,Hangzhou 310000, Zhejiang Province, China
| | - Zhu-Xiao Tang
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Hu Sun
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Zheng Shen
- Brain Center, Affiliated Zhejiang Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
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3
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Fukuda H, Hayakawa A, Takahashi Y, Komatsu Y, Kawamura M, Kubo R, Tokue H, Kominato Y, Sano R. Acute subdural hematoma caused by rupture of a mycotic aneurysm due to meningitis associated with infectious endocarditis: comparison of autopsy findings with postmortem computed tomography. Forensic Sci Med Pathol 2023:10.1007/s12024-023-00640-3. [PMID: 37222902 DOI: 10.1007/s12024-023-00640-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/25/2023]
Abstract
Forensic pathologists often encounter cases of acute subdural hematoma (SDH) due to trauma, whereas those attributable to endogenous causes are rare. Here, we report a case of the latter type in a 42-year-old man who was found dead at home after several months of fever and malaise. Postmortem computed tomography (PMCT) and autopsy were undertaken to clarify the cause of death. PMCT images revealed a fatal SDH and a localized hyper-density area in the right parietal lobe; macroscopic and microscopic examinations revealed SDH due to rupture of a mycotic aneurysm (MA) associated with meningitis. The PMCT images also indicated thickening and calcification of the mitral valve, while autopsy demonstrated infective endocarditis (IE). In addition, PMCT demonstrated a low-density area in the spleen, which was shown to be a splenic abscess at autopsy. PMCT also demonstrated tooth cavities. Based on the findings of autopsy, the cause of death was considered to be SDH due to rupture of the MA resulting from meningitis with IE and splenic abscess. Although PMCT was unable to clarify the significance of any individual feature, a retrospective review of the PMCT images might have suggested IE, bacteremia, or ruptured MA leading to SDH. This case suggests that, instead of interpreting individual features demonstrated on PMCT images, integrated interpretation of overall PMCT findings might provide clues for identifying causes of death, despite the fact that PMCT lacks diagnostic accuracy for infectious diseases such as IE and meningitis.
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Affiliation(s)
- Haruki Fukuda
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Akira Hayakawa
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan.
| | - Yoichiro Takahashi
- Department of Legal Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan
| | - Yuka Komatsu
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Miki Kawamura
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rieko Kubo
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Hiroyuki Tokue
- Department of Diagnostic Radiology & Nuclear Medicine, Graduate School of Medicine, Gunma University, Maebashi, 371-8511, Japan
| | - Yoshihiko Kominato
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
| | - Rie Sano
- Department of Legal Medicine, Graduate School of Medicine, Gunma University, 3-39-22 Showa-Machi, Maebashi, 371-8511, Japan
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Leclerc A, Gohel H, Malczuk J, Anzalone L, Emery E, Gaberel T. Systematic Review of Meningiomas Revealed by Spontaneous Intracranial Hemorrhage: Clinicopathological Features, Outcomes, and Rebleeding Rate. World Neurosurg 2023; 172:e625-e639. [PMID: 36738963 DOI: 10.1016/j.wneu.2023.01.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Meningiomas are rarely revealed by an intracranial hemorrhage (ICH). Rebleeding occurrence rate and time of onset are unknown. Here, we performed a systematic review of the literature of meningiomas revealed by ICH. METHODS We retrospectively collected all meningiomas revealed by spontaneous ICH published between January 1980 and December 2021. We reported clinicopathological features of meningiomas revealed by ICH. We also estimated rebleeding rate and time to onset. RESULTS Ninety-two studies met all inclusion criteria, led to a total of 120 cases. The mean age was 56.3 years, with 66 (55%) female. Seventy-nine (66%) cases were conscious before surgery, 20 (17%) were in coma, and 17 (14%) were unconscious after deterioration. The most frequent bleeding type was subdural hemorrhage (N = 49, 41%) followed by intraparenchymal hemorrhage (IPH) (N = 44, 37%), subarachnoid hemorrhage (SAH) (N = 22, 18%), and intraventricular hemorrhage (IVH) (N = 5, 4%). IPH and hindbrain/ventricular locations are associated with poor outcomes (P = 0.031 and < 0.001, respectively). Among the 19 patients who did not undergo surgical resection of the meningioma, 14 (74%) experienced rebleeding with a median occurrence of 120 days (interquartile, [90; -]). Rebleeding occurs earlier if the type of bleeding is SAH or IVH and for hindbrain location (both P < 0.01). CONCLUSIONS ICH is a rare presentation of meningiomas. Hindbrain and ventricular tumor location and IPH are associated with poor outcomes. Rebleeding rate is high and premature. It occurs earlier if the first bleeding was SAH or IVH and for hindbrain location.
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Affiliation(s)
- Arthur Leclerc
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France.
| | | | - Joséphine Malczuk
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Louis Anzalone
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France
| | - Evelyne Emery
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, CHU de Caen-Normandie, Caen, France; Normandie Université, UNICAEN, Caen, France; Normandie Université, UNICAEN, INSERM, U1237, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Cyceron, Caen, France
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5
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Algahtani AY, Alghamdi AM, Ashqar A, Basurrah AA, Alzahrani M. Idiopathic spontaneous bilateral subdural hematoma in a 28-year-old male: A comprehensive literature review and case report. Surg Neurol Int 2023; 14:130. [PMID: 37151458 PMCID: PMC10159296 DOI: 10.25259/sni_226_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 03/26/2023] [Indexed: 05/09/2023] Open
Abstract
Background Subdural hematoma (SDH) is considered spontaneous in the absence of trauma history. It is a common presentation in the geriatric age group due to the many influential factors. Most cases have a known underlying etiology that explains the incidence, otherwise, they are considered idiopathic. We present a rare case report of idiopathic nontraumatic bilateral SDH with a literature review of similar cases. Case Description A 28-year-old fit individual presented to the Emergency Department with a chronic history of severe headache and neck pain, associated with behavioral changes in the last 2 days. He reported that his symptoms started after lifting a heavy object 2 months ago; however, they became worse after a neck chiropractor therapy session. He is not on any chronic medications, and there was a negative history of trauma, seizure, hematological diseases, family history of neurological conditions, smoking, alcohol, or drug abuse with an unremarkable systemic review. A brain computerized tomography (CT) showed bilateral SDHs, for which he underwent bilateral mini craniotomies and drainage. The symptoms improved after surgery and the follow-up brain CT showed no recurrence. Conclusion Idiopathic spontaneous bilateral SDH in the adult age group is an extremely rare pathology and the literature review only revealed three similar cases. With the absence of any pathology that would explain the presentation after extensive investigations, we hypothesized that a sudden rise in vascular pressure was the underlying etiology, especially with the fact that the symptoms became unbearable after the neck chiropractor therapy session.
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Affiliation(s)
- Abdulhadi Y. Algahtani
- Department of Neurosurgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdulaziz M. Alghamdi
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
- Corresponding author: Abdulaziz M. Alghamdi, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.
| | - Alaa Ashqar
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Moajeb Alzahrani
- Department of Neurosurgery, King Abdulaziz Medical City, National Guard Health Affairs, Jeddah, Saudi Arabia
- King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
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6
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Okholm SH, Nagy D, Körmendiné Farkas D, Fuglsang CH, Troelsen FS, Henderson VW, Sørensen HT. Non-Traumatic Subdural Hematoma and Cancer: A Cohort Study. Clin Epidemiol 2023; 15:629-633. [PMID: 37187767 PMCID: PMC10178369 DOI: 10.2147/clep.s408667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Cancer may increase the risk of bleeding. However, whether subdural hematoma is a marker of occult cancer remains unknown. We examined the association between non-traumatic subdural hematoma and cancer risk in a cohort study. Materials and Methods Using Danish nationwide health registries, we identified 2713 patients with non-traumatic subdural hematoma and no previous cancer diagnosis, who were hospitalized between April 1, 1996 and December 31, 2019. We computed age-, sex-, and calendar year-standardized incidence ratios (SIRs) as the ratio of the observed to expected number of patients with cancer by using national incidence rates as reference as a measure of relative risk. Results We identified 77 cancer cases within the first year of follow-up and 272 cancer cases thereafter. The one-year risk of cancer was 2.8% (95% confidence interval: 2.2-3.5), and the one-year SIR was 1.7 (95% confidence interval: 1.3-2.1). During the subsequent years, the SIR was 1.0 (95% confidence interval: 0.9-1.1). The relative risk was elevated for some hematological and liver cancers. Conclusion The risk of a new cancer diagnosis was clearly increased in patients with non-traumatic subdural hematoma compared with the general population during the first year of follow-up. However, the absolute risk was low, thus limiting the clinical relevance of pursuing early cancer detection in these patients.
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Affiliation(s)
- Søren Hauge Okholm
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dávid Nagy
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Dóra Körmendiné Farkas
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Cecilia Hvitfeldt Fuglsang
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Victor W Henderson
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Departments of Epidemiology & Population Health and of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Correspondence: Henrik Toft Sørensen, Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Olof Palmes Allé 43-45, Aarhus N, 8200, Denmark, Tel +45 87 16 82 15, Email
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Brandel MG, Gupta M, Pannell JS, Schwartz MS. Spontaneous chronic subdural haematoma due to hypoplastic rostral superior sagittal sinus. BMJ Case Rep 2022; 15:e252016. [PMID: 36585051 PMCID: PMC9809270 DOI: 10.1136/bcr-2022-252016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The superior sagittal sinus (SSS) is a midline structure of the superficial cerebral venous system that drains the anterior cerebral hemispheres. Hypoplasia of the rostral SSS is a known variant, although associated complications are rare. A woman in her 30s presented for evaluation of a symptomatic left-sided acoustic neuroma and was found to have an incidental chronic subdural haematoma (SDH) over the left frontoparietal convexity without trauma or precipitating event. The SDH expanded on serial imaging and the patient eventually underwent left-sided frontoparietal craniotomy for haematoma evacuation. Haematological evaluation was benign, but angiography revealed absence of the anterior half of the SSS. We report the first case of spontaneous SDH in the setting of hypoplastic rostral SSS.
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Affiliation(s)
| | - Mihir Gupta
- Neurosurgery, UCSD, La Jolla, California, USA
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Ciochon UM, Bindslev JBB, Hoei-Hansen CE, Truelsen TC, Larsen VA, Nielsen MB, Hansen AE. Causes and Risk Factors of Pediatric Spontaneous Intracranial Hemorrhage—A Systematic Review. Diagnostics (Basel) 2022; 12:diagnostics12061459. [PMID: 35741269 PMCID: PMC9221737 DOI: 10.3390/diagnostics12061459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 01/10/2023] Open
Abstract
Previous studies suggest that the most common cause of spontaneous intracerebral hemorrhage in children and adolescents is arteriovenous malformations (AVMs). However, an update containing recently published data on pediatric spontaneous intracranial hemorrhages is lacking. The aim of this study is to systematically analyze the published data on the etiologies and risk factors of pediatric spontaneous intracranial hemorrhage. This systematic review was performed in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search in PubMed, Embase, Scopus, Web of Science and Cochrane Library was conducted aiming for articles published in year 2000 and later, containing data on etiology and risk factors of spontaneous intracranial hemorrhages in unselected cohorts of patients aged between 1 month and 18 years. As a result, forty studies were eligible for data extraction and final analysis. These included 7931 children and adolescents with 4009 reported etiologies and risk factors. A marked variety of reported etiologies and risk factors among studies was observed. Vascular etiologies were the most frequently reported cause of pediatric spontaneous intracranial hemorrhages (n = 1727, 43.08% of all identified etiologies or risk factors), with AVMs being the most common vascular cause (n = 1226, 70.99% of all vascular causes). Hematological and systemic causes, brain tumors, intracranial infections and cardiac causes were less commonly encountered risk factors and etiologies.
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Affiliation(s)
- Urszula Maria Ciochon
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Correspondence:
| | - Julie Bolette Brix Bindslev
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Christina Engel Hoei-Hansen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Thomas Clement Truelsen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Neurology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Vibeke Andrée Larsen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
| | - Michael Bachmann Nielsen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Adam Espe Hansen
- Department of Diagnostic Radiology, Copenhagen University Hospital—Rigshospitalet, 2200 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
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Acute, nontraumatic subdural hemorrhage as a presentation of meningioma: A report of two cases and literature review. INTERDISCIPLINARY NEUROSURGERY 2022. [DOI: 10.1016/j.inat.2022.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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10
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Khaki D, Ljungqvist J, Kirknes A, Bartek J, Corell A. Differences in Presentation, Radiological Features, and Outcomes in Traumatic Versus Spontaneous Acute Subdural Hematomas-A Single-Institution Population-Based Study. World Neurosurg 2022; 164:e235-e244. [PMID: 35487492 DOI: 10.1016/j.wneu.2022.04.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous acute subdural hematoma (sASDH) is a rare neurosurgical condition, with the literature mainly consisting of case reports. In the present study, we compared sASDH with traumatic ASDH (tASDH) to determine the differences in presentation, radiological features, and outcomes in a population-based setting. METHODS All adult patients (age ≥18 years) who had undergone surgery for ASDH (n = 266), either spontaneous or traumatic, from 2010 to 2020 were included retrospectively. The cohort was divided into 2 groups for comparative analysis: sASDH group (n = 24) versus tASDH group (n = 242). RESULTS Of the 266 patients, 24 (9.0%) had presented with sASDH. The sASDH group had a mean age of 66.2 years, and sudden headache was the most common presenting symptom (83.3%). The sASDH group had a higher Glasgow coma scale score at presentation compared with the tASDH group (Glasgow coma scale scores, 10 and 8, respectively; P < 0.01). The outcomes, assessed using the Glasgow outcome scale (GOS), revealed a greater incidence of more favorable outcomes (GOS score 4-5) for the sASDH group (72.7%) than for the tASDH group (41.5%). CONCLUSIONS In the present population-based study of surgically evacuated ASDH cases, 9% were spontaneous without previous trauma. The outcomes (GOS scores) were significantly more favorable for those with sASDH than for those with tASDH. In one half of the patients with sASDH, arterial bleeding was noted perioperatively, although the preoperative radiological examinations revealed no abnormalities for most patients. However, the lack of sufficient examinations such as computed tomography angiography made it difficult to establish the most common etiology of bleeding in those with sASDH. Further research is warranted to determine the reference standard method for the investigation of sASDH.
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Affiliation(s)
- Djino Khaki
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Ljungqvist
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden
| | - Astrid Kirknes
- Department of Emergency Medical Service, Vestfold Hospital Trust, Tønsberg, Norway
| | - Jiri Bartek
- Department of Neurosurgery and Clinical Neuroscience, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Neurosurgery, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Alba Corell
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden.
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11
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Watanabe A, Tsutsumi S, Nonaka S, Ishii H. Microvascular proliferation in the clots: The key finding of acute subdural hematoma transforming into chronic subdural hematoma? Surg Neurol Int 2021; 12:601. [PMID: 34992918 PMCID: PMC8720441 DOI: 10.25259/sni_1103_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/19/2021] [Indexed: 11/04/2022] Open
Abstract
Background:
Despite extensive investigations, the exact etiology of chronic subdural hematoma (CSDH) remains elusive. Organized CSDHs are a distinct but less-understood type of CSDH.
Case Description:
A 50-year-old hypertensive woman experienced headache without any previous head injury. At presentation, the patient showed no focal neurological deficits. Cranial computed tomography (CT) revealed a slightly compressive subdural hematoma that spontaneously regressed and no intracranial vascular lesions. Cerebral magnetic resonance imaging identified a non-enhancing nodular lesion in the subdural hematoma. After the patient presented disorientation and aphasia on post hospitalization day 14, CT showed a considerable enlargement of the subdural hematoma. Partial removal of the bi-layered hematoma was performed through a parietal craniotomy. Histological examination revealed microvascular proliferation in both the outer membrane and the nodular lesion. On postoperative day 35, CT demonstrated a remarkable resolution of the residual hematoma.
Conclusion:
Development of microvascular proliferation in the clots of an acute subdural hematoma may lead to its rapid enlargement as an organized CSDH. Organized CSDH can be managed by partial removal of the outer membrane and hematoma through a craniotomy.
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12
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Incidence of Spinal CSF Leakage on CT Myelography in Patients with Nontraumatic Intracranial Subdural Hematoma. Diagnostics (Basel) 2021; 11:diagnostics11122278. [PMID: 34943515 PMCID: PMC8699929 DOI: 10.3390/diagnostics11122278] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/25/2021] [Accepted: 12/02/2021] [Indexed: 01/24/2023] Open
Abstract
The aim of the present study was to demonstrate the incidence of spinal cerebrospinal fluid (CSF) leaks in patients with nontraumatic intracranial subdural hematoma (SDH) and determine clinical parameters favoring such leaks. This retrospective study was approved by the institutional review board. Patients diagnosed with nontraumatic intracranial SDH who underwent computed tomography (CT) myelography between January 2012 and March 2018 were selected. 60 patients (male: female, 39:21; age range, 20–82 years) were enrolled and divided into CSF leak-positive and CSF leak-negative groups according to CT myelography data. Clinical findings were statistically compared between the two groups. Spinal CSF leak was observed in 80% (48/60) of patients, and it was significantly associated with an age of <69 years (p = 0.006). However, patients aged ≥69 years also had a tendency to exhibit spontaneous intracranial hypotension (SIH)-induced nontraumatic intracranial SDH (60.87%; 14/23). Therefore, CT myelography is recommended to be performed for the evaluation of possible SIH in patients with nontraumatic intracranial SDH, particularly those aged <69 years. Patients aged ≥69 years are also good candidates for CT myelography because SIH tends to occur even in this age group.
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Mohamed T, Swed S, Al-Mouakeh A, Sawaf B. Nontraumatic bilateral subdural hematoma: Case report. Ann Med Surg (Lond) 2021; 71:102907. [PMID: 34712475 PMCID: PMC8528674 DOI: 10.1016/j.amsu.2021.102907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022] Open
Abstract
A subdural hematoma (SDH) is a type of bleeding in which a collection of blood gathers between the inner layer of the dura mater and the arachnoid mater of the meninges surrounding the brain. Although most cases reported of subdural hematoma are due to traumatic brain injury, to the best of our knowledge this is a rare case of nontraumatic subdural hematoma. A 31 year-old-Male presented to the emergency department with a severe headache for 3 weeks, with the presence of oculomotor disorders. There is no history of major trauma, minor trauma or fights. Also, no history of hypertension, or Haematological diseases. Magnetic resonance imaging (MRI) showed bilateral subdural hematoma. The right-sided hematoma was treated conservatively and the Left-sided was treated by surgery. Follow-up for three months revealed no recurrence. Nontraumatic subdural hematoma is one of the challenging cases that neurosurgeons face. We presented a patient with idiopathic spontaneous subdural hematoma. Computed tomography (CT) is the first step for diagnosis and Magnetic resonance imaging (MRI) is considered an excellent imaging investigation to evaluate such patients. Symptomatic subdural hematomas require an emergent treatment by identifying and controlling sites of bleeding conservatively or by surgery. Subdural hematoma with no history of trauma should be treated emergently and evaluated strictly. Follow-up is essential in patients with neural symptoms. Massive symptomatic subdural hematoma (SDH) should be treated with surgery to control the bleeding. A subdural hematoma (SDH) is a collection of blood between the dura and the arachnoid membranes. There are many causes of SDH like trauma, hematological diseases and hypertension. Bilateral nontraumatic subdural hematoma is an extremely rare. MRV and MRI and Computed tomography confirm the diagnosis.
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Affiliation(s)
- Tasneem Mohamed
- Neurosurgery Department, Ribt University Hospital, Burri, Khrtoum, Sudan
| | - Sarya Swed
- Faculty of Human Medicine, Aleppo University, Aleppo, Syria
| | | | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Damascus, Syria
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Sandouno TM, Bachir H, Alaoui HB, Hamaz S, Eloumri AA, Berrimi M, Serraj K. Acute spontaneous subdural hematoma as an inaugural presentation of systemic lupus erythematosus with acquired factor XIII deficiency: a case report. Pan Afr Med J 2021; 39:207. [PMID: 34603588 PMCID: PMC8464216 DOI: 10.11604/pamj.2021.39.207.26336] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 07/05/2021] [Indexed: 11/11/2022] Open
Abstract
Acute spontaneous subdural hematoma is a rare clinical situation. Among its various etiologies, underlying coagulopathy is associated with a considerable risk of mortality. A 43-year-old female patient with no comorbidity and no personal or family history of bleeding disorders, consulted for acute and intense headache. The brain computed tomography (CT) scan showed a compressive left fronto-parietal acute subdural hematoma. The cerebral magnetic resonance angiography and routine hemostasis workup were normal. Factor XIII activity was low at 41% and the etiological investigation was consistent with the diagnosis of systemic lupus erythematosus. Surgical evacuation of the hematoma, factor XIII supplementation and systemic corticosteroid therapy with hydroxy chloroquine resulted in a favorable outcome. Acquired factor XIII deficiency should be systematically investigated for any acute spontaneous subdural hematoma with a normal hemostasis assessment in an adult with no personal or family history of hemorrhage.
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Affiliation(s)
- Tamba Marc Sandouno
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Houda Bachir
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Habiba Bennesser Alaoui
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Siham Hamaz
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Ahmed Amine Eloumri
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Mohammed Berrimi
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
| | - Khalid Serraj
- Internal Medicine, Immunohematology and Cellular Therapy Laboratory, Medical School of Medicine Oujda, University Mohammed I, Oujda, Morocco
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Fukushima Y, Matsuda K, Yoshino S, Hirakawa K, Inoue T. A Pure Acute Subdural Hematoma Presenting with a Diploic Arteriovenous Fistula: Case Report and Literature Review. JOURNAL OF NEUROENDOVASCULAR THERAPY 2021; 16:123-126. [PMID: 37502645 PMCID: PMC10370970 DOI: 10.5797/jnet.cr.2020-0206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/21/2021] [Indexed: 07/29/2023]
Abstract
Objective We report a case of pure acute subdural hematoma (SDH) caused by a diploic arteriovenous fistula (AVF) and it is a first case report as far as we researched it. Case Presentation A 19-year-old man was admitted as an emergency to our hospital with headache and nausea. CT scan on hospital admission showed a right acute SDH. Because there was no history of head trauma, MRI, MRA, and DSA were performed to identify a source of bleeding. DSA disclosed an AVF. The shunt was located between a frontotemporal branch of the middle meningeal artery (MMA) and a diploic vein, and its shunting point formed an aneurysmal sac, which was considered to have ruptured. Endovascular treatment was administered rather than surgical treatment to prevent re-bleeding because the patient was conscious and alert, CT showed a small SDH, and the left MMA near the shunting point was accessible for catheterization. A diluted mixture of 25% n-butyl-2-cyanoacrilate was injected into a left frontoparietal branch just before the shunting point and the shunt, including the aneurysmal sac, was obliterated. The patient's postoperative course was uneventful and he was discharged without neurological deficits. Conclusion We experienced a patient with a pure acute SDH caused by diploic AVF. In patients with non-traumatic acute SDH, DSA is recommended to determine its underlying cause. Our review of published reports yielded few instances of non-traumatic pure acute SDH in young people. Possible causative factors should be investigated promptly and appropriate treatment provided immediately.
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Affiliation(s)
- Yutaka Fukushima
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Koudai Matsuda
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
- Department of Neurosurgery, Faculty of Medicine, University of Fukuoka, Fukuoka, Fukuoka, Japan
| | - Shinichiro Yoshino
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Katsuyuki Hirakawa
- Department of Neurosurgery, Fukuoka City Hospital, Fukuoka, Fukuoka, Japan
| | - Tooru Inoue
- Department of Neurosurgery, Faculty of Medicine, University of Fukuoka, Fukuoka, Fukuoka, Japan
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The usefulness of postmortem computed tomography angiography for subdural hematoma caused by rupture of the cortical artery: A report of two autopsy cases and a literature review. Leg Med (Tokyo) 2021; 53:101941. [PMID: 34293697 DOI: 10.1016/j.legalmed.2021.101941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 07/08/2021] [Indexed: 11/23/2022]
Abstract
Acute subdural hematoma (SDH) occurs following severe head trauma with brain contusion or rupture of bridging veins. Conversely, SDH caused by rupture of a cortical artery without trauma or with minor trauma is also possible. Although over 150 cases of the latter SDH have been reported, they were predominantly diagnosed only during surgery, and therefore, no adequate histological evaluation has been performed. Therefore, essential etiology of this SDH type has remained unclear. In addition, the scarcity of autopsy cases may be attributed to arterial rupture being missed if the macroscopic findings are too minimal to detect during autopsy. Here, we describe two autopsy cases of SDH of cortical artery origin. Extravasation on postmortem computed tomography angiography and arterial leakage on macroscopic observation during autopsy facilitated detection of the ruptured artery and allowed detailed histological evaluation of the ruptured artery and adjacent dura mater. The etiology of arterial rupture is briefly described on the basis of histopathological findings in this study and the available literature.
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17
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Nam JW, Park ES, Park JB, Seo JH, Kim M, Jung NY. Benign meningioma manifesting with acute subdural hematoma and cerebral edema: a case report and review of the literature. J Med Case Rep 2021; 15:335. [PMID: 34187580 PMCID: PMC8244191 DOI: 10.1186/s13256-021-02935-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/31/2021] [Indexed: 01/09/2023] Open
Abstract
Background Spontaneous subdural hematoma rarely presents with a hypervascular or malignant tumor but even less frequently in a benign tumor like meningioma. We encountered a patient with acute subdural hematoma associated with benign meningioma. Here, we report this case along with a review of previous reports, especially focusing on their clinical features and possible bleeding mechanisms. Case presentation A 53-year-old Asian woman presented with severe headache and progressive neurologic deterioration due to cerebral edema. The patient was submitted to open surgery for evacuation of the subdural hematoma and concurrent tumor removal on the ipsilateral parietal convexity. A hypervascular, encapsulated mass was identified during surgery and completely removed including the adjacent dura mater (Simpson grade 0). The tumor was histologically confirmed as an angiomatous meningioma (World Health Organization grade I). Her clinical course was uneventful after surgery. Conclusions Although meningiomas are commonly benign according to their histological traits, they can lead to spontaneous bleeding and cause neurologically unstable condition. Therefore, meningiomas need to be considered as a cause of spontaneous subdural hematoma if radiologically suspicious, which should be reflected by proper management for a positive outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-02935-x.
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Affiliation(s)
- Ji Won Nam
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Eun Suk Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jun Bum Park
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Jae Hee Seo
- Department of Pathology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Minsoo Kim
- Department of Neurosurgery, Gangneung Asan Hospital, Gangneung, Republic of Korea
| | - Na Young Jung
- Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea.
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Witten AJ, Ordaz JD, Alentado VJ, Bohnstedt B. Intracranial Vasospasm After Evacuation of Acute Spontaneous Subdural Hematoma. Cureus 2021; 13:e15284. [PMID: 34194885 PMCID: PMC8236072 DOI: 10.7759/cureus.15284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Cerebral vasospasm is a well-known entity following aneurysmal subarachnoid hemorrhage. While it has been described in trauma, it has been much less studied. There have been no previous reports of cerebral vasospasm following spontaneous subdural hematoma or after subdural hematoma evacuation. In this case report, we present a 38-year-old otherwise healthy female who suffered an acute spontaneous subdural hematoma. After surgical evacuation of her hematoma, she developed neurologic decline. Computer tomography angiography demonstrated intracranial vasospasm. She was treated with blood pressure augmentation and nimodipine. She went on to make a full neurologic recovery.To our knowledge, this is the first reported case of cerebral vasospasm after acute spontaneous subdural hematoma or after subdural hematoma evacuation, and the patient recovered without sequelae. The promising outcome of this case may provide a framework for future similar cases. Neurosurgeons and intensivists should keep cerebral vasospasm in their differentials for patients who have neurologic decline after craniotomy for acute subdural hematoma and have an otherwise negative scan for new acute abnormality.
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Affiliation(s)
- Andrew J Witten
- Neurological Surgery, Indiana University School of Medicine, Indianapolis, USA
| | - Josue D Ordaz
- Neurological Surgery, Indiana University, Indianapolis, USA
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Bordia R, Le M, Behbahani S. Pitfalls in the diagnosis of subdural hemorrhage - Mimics and uncommon causes. J Clin Neurosci 2021; 89:71-84. [PMID: 34119298 DOI: 10.1016/j.jocn.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/17/2021] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Subdural hemorrhage (SDH), the accumulation of blood between the dura and arachnoid mater, is one of the most commonly encountered traumatic findings in emergency radiology setting. The purpose of this essay is to review the pitfalls in the diagnosis of SDH including a) mimics on CT imaging and b) etiology other than accidental trauma. We describe several entities that closely mimic SDH on non-contrast CT scans. A knowledge of these mimics is essential in the emergency setting since overdiagnosis of SDH can lead to unnecessary hospital admissions, potentially invasive procedures, or even delay in necessary treatment. The mimics of SDH on non-contrast head CT include: PATHOLOGIC ENTITIES IATROGENIC MIMICS ANATOMIC/PHYSIOLOGIC MIMICS ARTIFACTUAL MIMICSWe also briefly review non-accidental and non-traumatic causes of SDH. Although, the most common cause of SDH is accidental trauma, other routinely encountered causes of SDH include coagulopathy, non-accidental trauma, cranial surgery, vascular malformations etc. CONCLUSION: Clinicians dealing with SDH in the emergency setting should consider SDH mimics and less common etiologies of SDH in order to facilitate appropriate patient management.
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Affiliation(s)
- Ritu Bordia
- Department of Radiology, NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA.
| | - Megan Le
- Department of Radiology, NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA.
| | - Siavash Behbahani
- Department of Radiology, NYU Winthrop Hospital, 259 First Street, Mineola, NY 11501, USA
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20
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Doherty JA, Millward CP, Sarsam Z. Spontaneous and recurrent subdural haematoma in a patient with May-Hegglin anomaly. BMJ Case Rep 2021; 14:e243134. [PMID: 33962937 PMCID: PMC8108649 DOI: 10.1136/bcr-2021-243134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/03/2022] Open
Abstract
Both acute and chronic subdural haematomas typically occur following trauma. Non-traumatic causes are less common, but aetiologies include arteriovenous malformation, intracranial aneurysm rupture, tumour-associated haemorrhage and coagulopathies. May-Hegglin anomaly is an example of a coagulopathy, which is caused by a mutation in the gene encoding non-muscle myosin heavy chain 9 (MYH9) and therefore falls into a group of diseases referred to as MYH9-related diseases (MYH9-RD). The symptomology of MYH9-RD is often mild, and patients tend to experience epistaxis, gingival bleeding and bruising. Life-threatening haemorrhage rarely occurs. In this short report, we describe a patient with known May-Hegglin anomaly who presented with a potentially life-threatening, spontaneous subdural haematoma requiring surgery on two occasions. This is only the second such report in the literature, and the first of spontaneous and recurrent haemorrhage in association with May-Hegglin anomaly.
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Affiliation(s)
- John Anthony Doherty
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher Paul Millward
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
- Institute of Systems, Molecular, & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Zaid Sarsam
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
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21
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MIYAUCHI T, SAGA I, KOJIMA A. Acute Subdural Hematoma Complicating Heparin-induced Thrombocytopenia: A Case Report. NMC Case Rep J 2021; 8:799-803. [PMID: 35079551 PMCID: PMC8769446 DOI: 10.2176/nmccrj.cr.2021-0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/05/2021] [Indexed: 11/24/2022] Open
Abstract
Heparin-induced thrombocytopenia (HIT) is an antibody-mediated drug reaction to heparin use that causes platelet aggregation, followed by thrombocytopenia. Despite the thrombocytopenia, the main complications of HIT are thromboembolic in nature rather than hemorrhagic, and in particular, intracranial hemorrhage is rare. Herein, we describe a case of atraumatic acute subdural hematoma secondary to HIT, which was treated by platelet transfusion and surgery. A 77-year-old woman was admitted to our hospital for the treatment of severe aortic valve stenosis. Unfractionated heparin was administered during the preoperative period and during the aortic valve replacement surgery. Three days after the cardiac surgery, the patient presented with coma consistent with an acute subdural hematoma in the posterior fossa and obstructive hydrocephalus. Laboratory examination revealed a marked decrease of the platelet count to 40000/µL, and subsequent serological assay confirmed the diagnosis of HIT. The patient was treated by transfusion of platelets and fresh frozen plasma, and surgical removal of the hematoma. We started the administration of argatroban for substitution of heparin 4 days after the craniotomy. On day 13 after the neurosurgery, the patient developed cerebral infarction due to left middle cerebral artery occlusion and persistent right hemiparesis. We presented a rare case of the patient who developed acute subdural hematoma complicating HIT. Emergency craniotomy was successfully performed after administering platelet transfusions. Our experience with the present case suggests that platelet transfusions may be effective for performing emergency surgery for intracranial hemorrhage, even in patients with HIT.
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Affiliation(s)
- Tsubasa MIYAUCHI
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
| | - Isako SAGA
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
| | - Atsuhiro KOJIMA
- Department of Neurosurgery, Saitama City Hospital, Saitama, Saitama, Japan
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Savopoulos C, Pilalas D, Kaiafa GD, Panagiotou G, Grammenou MC, Kouskouras K, Tegos T, Psomas E, Papa A, Foroglou N, Hatzitolios AI. West Nile virus neuroinvasive disease. QJM 2020; 113:125-126. [PMID: 31593223 DOI: 10.1093/qjmed/hcz255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 09/25/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Savopoulos
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - D Pilalas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G D Kaiafa
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - G Panagiotou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - M-C Grammenou
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | | | - T Tegos
- First Department of Neurology, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - E Psomas
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
| | - A Papa
- Department of Microbiology, Medical School, Aristotle University, Thessaloniki, Greece
| | - N Foroglou
- First Department of Neurosurgery, AHEPA University Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - A I Hatzitolios
- From the First Propedeutic Department of Internal Medicine, Thessaloniki, Greece
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de Oliveira A, da Silva Paiva W, Teixeira MJ. Rare acute idiopathic subdural hematoma: A case report and literature review. Surg Neurol Int 2020; 11:9. [PMID: 31966928 PMCID: PMC6969380 DOI: 10.25259/sni_499_2019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 12/03/2022] Open
Abstract
Background: Acute spontaneous subdural hematoma is rare. For patients under 40 years of age, we found only five previous reports. Here, we have presented a sixth case study. Case Description: A 27-year-old male initially presented with a high-intensity headache without any neurological deficits. The brain computed tomography revealed a left frontoparietal lesion, consistent with an acute epidural hematoma. However, the bone window examination showed no fracture, and at surgery, this lesion proved to be an acute subdural hematoma. Additional studies, including cerebral angiography, brain magnetic resonance imaging, and a complete coagulation work-up, were all negative. Conclusion: This case report and literature review focused on the rarity of acute idiopathic/spontaneous subdural hematomas.
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Affiliation(s)
- Adilson de Oliveira
- Department of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da USP, Sao Paulo, Brazil.,Neurosurgery Service, Clinica Girassol, Luanda, Angola
| | - Wellingson da Silva Paiva
- Department of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
| | - Manoel Jacobsen Teixeira
- Department of Neurosurgery, Hospital das Clinicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
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Singh S, Kaushal A, Datta R, Unnithan RR, Mishra N. A Rare Case of Epileptic Seizure After-effect Resulting in Nontraumatic Spontaneous Subdural Hemorrhage. Indian J Crit Care Med 2020; 24:722-723. [PMID: 33024384 PMCID: PMC7519606 DOI: 10.5005/jp-journals-10071-23535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Generalized tonic-clonic seizures (GTCS) result in diverse physiological alterations that are mostly short-lived and rarely lead to immediate serious consequences. Some early serious complications reported are head trauma and aspiration. While most cases of seizures are diagnosed readily from clinical history, some cases remain indolent and present later. A brain hemorrhage can have varied manifestations that warrant every clinician to be vigilant in diagnosis and management to prevent life-threatening complications. Furthermore, many reports have described seizures in patients operated for subdural hematoma (SDH), but to the best of our knowledge, none reveals SDH after the seizure. We encountered an unexpected incident of severe SDH in a 32-year-old adult following witnessed GTCS. How to cite this article Singh S, Kaushal A, Datta R, Unnithan RR, Mishra N. A Rare Case of Epileptic Seizure After-effect Resulting in Nontraumatic Spontaneous Subdural Hemorrhage. Indian J Crit Care Med 2020;24(8):722-723.
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Affiliation(s)
- Shalendra Singh
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharastra, India
| | - Ashutosh Kaushal
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
| | - Rashmi Datta
- Department of Anaesthesiology and Critical Care, Command Hospital (WC), Chandigarh, India
| | - Rijesh R Unnithan
- Department of Anaesthesiology and Critical Care, Armed Forces Medical College, Pune, Maharastra, India
| | - Nitasha Mishra
- Department of Anaesthesiology and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Spontaneous Intracranial and Lumbar Subdural Hematoma Presenting as Vaginal Pain. J Emerg Med 2019; 56:e43-e46. [PMID: 30745198 DOI: 10.1016/j.jemermed.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 12/11/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.
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Matsuoka G, Eguchi S, Ryu B, Tominaga T, Ishikawa T, Yamaguchi K, Kawamata T. Treatment Strategy for Recurrent Hemorrhage from Meningioma: Case Report and Literature Review. World Neurosurg 2019; 124:75-80. [PMID: 30620893 DOI: 10.1016/j.wneu.2018.12.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 12/12/2018] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
We came across a rare case of recurrent hemorrhage from a meningioma. Here, we describe this case and discuss the treatment strategies for recurrent hemorrhage from a meningioma using a literature review. A 61-year-old woman with a history of two episodes of hemorrhage from a meningioma originating from the left falx cerebri, presented to our outpatient clinic. She was asymptomatic, and MRI revealed a small tumor along the falx cerebri; however, we decided to remove the hemorrhagic meningioma. No abnormal vascular structures were recognized on preoperative angiography and on intraoperative evaluation. The tumor was easily removed along the falx cerebri (Simpson grade I). The pathological diagnosis was transitional meningioma, World Health Organization grade I. The patient experienced no recurrence of tumor or hemorrhage for up to 15 months after surgery. The incidence of repeated bleeding from meningiomas is very rare and is seldom reported, because the mortality associated with hemorrhage in meningiomas is high (28-50%). Immediate diagnosis and surgical treatment with both hematoma evacuation and tumor removal are crucial to avoid inadequate and delayed treatment that may cause mortality.
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Affiliation(s)
- Go Matsuoka
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan.
| | - Seiichiro Eguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bikei Ryu
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tadasuke Tominaga
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Koji Yamaguchi
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo, Japan
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Umehara T, Goto Y, Kajikawa R, Wakayama A, Kishima H. Life-Threatening Hemorrhagic Moyamoya Disease: Report of Rare Case of Atraumatic Acute Subdural Hematoma Due to Ruptured Transdural Anastomosis. World Neurosurg 2018; 118:16-20. [PMID: 30257290 DOI: 10.1016/j.wneu.2018.06.197] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Atraumatic acute subdural hematoma (ASDH) associated with moyamoya disease (MMD) is rare, and only a few studies have reported the bleeding origin. We present a case of atraumatic ASDH attributable to a transdural anastomosis that developed owing to the compensatory mechanisms involved in the pathogenesis of advanced MMD. This is the first case of life-threatening atraumatic ASDH associated with MMD in which the rupture point was clearly visualized using a 3-dimensional rotational reconstructed image. CASE DESCRIPTION A 37-year-old woman presented with sudden-onset, serious, atraumatic ASDH requiring emergency decompressive craniectomy. The cerebral angiograms revealed that she had advanced MMD with transdural anastomosis that was classified as Suzuki stage V with a 5-mm saccular aneurysm in the middle meningeal artery on the affected side, which was suggested as the bleeding origin. Follow-up angiograms demonstrated that the aneurysm spontaneously disappeared and was inferred to be a pseudoaneurysm. We performed a left extraintracranial bypass to prevent recurrent hemorrhage. With intensive rehabilitation, the patient accordingly achieved stroke-free survival with a modified Rankin Scale score of 3 for 1 year. CONCLUSIONS Atraumatic ASDH associated with MMD is a rare type of hemorrhagic MMD, and a 3-dimensional-rotational reconstructed image was useful to confirm the origin of the bleeding. The transdural anastomosis development most likely correlates with the occurrence of any type of hemorrhagic MMD. We should consider that the transdural anastomosis collapse can cause a life-threatening atraumatic ASDH and should plan a surgical strategy carefully so as not to destroy collateral supply through the transdural anastomosis in such cases.
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Affiliation(s)
- Toru Umehara
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Yuko Goto
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Neuromodulation and Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Ryuichiro Kajikawa
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Akatsuki Wakayama
- Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
| | - Haruhiko Kishima
- Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Liao PY, Chen CY. Regarding Spontaneous Subdural Hematoma in a Middle-Aged Adult. J Emerg Med 2016; 51:e67-9. [PMID: 27381951 DOI: 10.1016/j.jemermed.2015.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Revised: 02/18/2015] [Accepted: 03/03/2015] [Indexed: 10/21/2022]
Affiliation(s)
- Pen-Yuan Liao
- Departments of Emergency Medicine and Medical Imaging, Imaging Research Center, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Cheng-Yu Chen
- Departments of Medical Imaging and Radiology, Imaging Research Center, Taipei Medical University, Taipei City, Taiwan
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Awaji K, Inokuchi R, Ikeda R, Haisa T. Nontraumatic Pure Acute Subdural Hematoma Caused by a Ruptured Cortical Middle Cerebral Artery Aneurysm: Case Report and Literature Review. NMC Case Rep J 2016; 3:63-66. [PMID: 28664000 PMCID: PMC5386168 DOI: 10.2176/nmccrj.cr.2015-0151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 11/28/2015] [Indexed: 11/20/2022] Open
Abstract
Nontraumatic or "spontaneous" acute subdural hematoma (SDH) is rare, and "pure" acute SDH without subarachnoid hemorrhage (SAH) due to aneurysmal rupture is extremely rare. We report a case of nontraumatic pure acute SDH caused by the rupture of a cortical middle cerebral artery (MCA) aneurysm. A 43-year-old man with no antecedents, except hypertension, presented to the emergency department with acute-onset moderate headache and nausea after swimming. He reported neither preceding head trauma nor dental check-up. Neurological examinations and laboratory tests were unremarkable. Computed tomography (CT) showed an acute SDH on the left convexity without SAH, but both magnetic resonance (MR) angiography and three-dimensional CT (3D-CT) angiography disclosed no vascular abnormality. As he became drowsy, the patient emergently underwent an evacuation of the SDH. Unexpectedly, a small saccular aneurysm of a cortical branch of the left MCA was recognized at surgery. Although indocyanine green (ICG) angiography revealed this aneurysm was thrombosed, a clip was applied on the aneurysmal base. He was discharged home without any complications 21 days after admission. To seek the cause of nontraumatic acute SDH, supplementary examinations including 3D-CT, MR, and/or catheter angiography are necessary. Even if angiography reveals no vascular lesions, the present case warrants that the cortical surface should be meticulously inspected at surgery, because a thrombosed cortical artery aneurysm might be an underlying cause.
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Affiliation(s)
- Kentaro Awaji
- Department of Emergency Medicine and Neurosurgery, Shibuya, Tokyo
| | - Ryota Inokuchi
- Department of Emergency Medicine and Neurosurgery, Shibuya, Tokyo
| | - Ritsuko Ikeda
- Department of JR Tokyo General Hospital, Shibuya, Tokyo
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Intracranial subdural haematoma following neuraxial anaesthesia in the obstetric population: a literature review with analysis of 56 reported cases. Int J Obstet Anesth 2016; 25:58-65. [DOI: 10.1016/j.ijoa.2015.09.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 09/14/2015] [Accepted: 09/15/2015] [Indexed: 12/13/2022]
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Inokuchi G, Makino Y, Yajima D, Motomura A, Chiba F, Torimitsu S, Hoshioka Y, Iwase H. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography. Int J Legal Med 2015; 130:441-6. [PMID: 26362305 DOI: 10.1007/s00414-015-1262-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 09/03/2015] [Indexed: 11/30/2022]
Abstract
Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.
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Affiliation(s)
- Go Inokuchi
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Yohsuke Makino
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Daisuke Yajima
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Ayumi Motomura
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Fumiko Chiba
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Suguru Torimitsu
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yumi Hoshioka
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan
| | - Hirotaro Iwase
- Department of Legal Medicine, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.,Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Adverse Outcomes After Initial Non-surgical Management of Subdural Hematoma: A Population-Based Study. Neurocrit Care 2015; 24:226-32. [DOI: 10.1007/s12028-015-0178-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chye CL, Lin KH, Ou CH, Sun CK, Chang IW, Liang CL. Acute spontaneous subdural hematoma caused by skull metastasis of hepatocellular carcinoma: case report. BMC Surg 2015; 15:60. [PMID: 25958386 PMCID: PMC4432998 DOI: 10.1186/s12893-015-0045-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 05/04/2015] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Skull and intracranial metastases from hepatocellular carcinoma (HCC) have seldom been reported. A skull metastasis of HCC with a tumor bleeding resulting in spontaneous subdural hematoma (SDH) is extremely unusual. We report the first case of acute spontaneous SDH in a 69-year-old woman who presented with acute onset of headache, because of tumor bleeding caused by skull metastasis of HCC. CASE PRESENTATION A 69-year-old woman was referred to our hospital because of progressive headache, nausea, and vomiting for 3 days. Brain computed tomography (CT) performed in the emergency department (ED) revealed a left temporal SDH with a slight mass effect and a small left temporal bone erosion. Tri-phasic abdominal CT demonstrated a large right lobe liver tumor compatible with HCC. She experienced progressive deterioration of consciousness in the intensive care unit. Follow-up CT showed an enlargement of the SDH. An emergency craniotomy for hematoma evacuation and removal of skull tumor was performed. She regained consciousness and had no neurological deficits during the postoperative course. Pathological examination of the skull specimen indicated metastasis of a HCC. CONCLUSION Patients with acute SDH without a history of head injury are rarely encountered in the ED. Metastatic carcinoma with bleeding should be included as a differential diagnosis for acute spontaneous SDH. Before an operation for SDH, the possibility of metastatic lesion of the skull should be considered in the surgical planning and the origin of malignancy should be sought.
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Affiliation(s)
- Cien-Leong Chye
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan
| | - Kuo-Hsuan Lin
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Chang-Hsien Ou
- Department of Diagnostic Radiology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, School of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - I-Wei Chang
- Department of Pathology, E-Da Hospital, Kaohsiung, Taiwan
| | - Cheng-Loong Liang
- Department of Neurosurgery, E-Da Hospital, School of Medicine, I-Shou University, 1 E-Da Rd., Yan-Chau Dist, 824, Kaohsiung City, Taiwan.
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