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LeBeau GJ, Alkiswani AR, Mauro DJ, Camarata PJ. A Plausible Historical and Forensic Account of the Death of Thomas Aquinas. World Neurosurg 2024; 182:45-51. [PMID: 37979685 DOI: 10.1016/j.wneu.2023.11.041] [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: 08/28/2023] [Accepted: 11/09/2023] [Indexed: 11/20/2023]
Abstract
Thomas Aquinas (1225-1274) was an influential medieval Christian theologian and arguably one of the greatest scholastic philosophers. He produced more than 60 works in his 48 years, including his magnum opus, the Summa Theologica. The Catholic Church regards him as a canonized saint and one of 37 Doctors of the Church. On his way to an ecumenical council in 1274, he was "struck with sudden illness" requiring rest at a monastery where he was cared for until death several weeks later. An obscure Latin text describes an incident where he hit his head violently on an overhanging branch. Becoming progressively ill, he arrived at a Cistercian abbey where he died on March 7. Through an analysis of his final illness as documented in key Latin and Italian historical texts, and careful observation of the reputed skull relic in Priverno, Italy, the authors postulate that Aquinas may have suffered a traumatic brain injury and that his death at age 48 was occasioned by a chronic subdural hematoma. Examination of the skull was inconclusive; however, the historical textual analysis supports this theory. A more in-depth forensic analysis of the skull may help confirm the diagnosis.
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Affiliation(s)
- Gabriel J LeBeau
- The University of Kansas School of Medicine, Kansas City, Kansas, USA; Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | | | - Daniel J Mauro
- Kenrick-Glennon Roman Catholic Theological Seminary, St. Louis, Missouri, USA
| | - Paul J Camarata
- Department of Neurological Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
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2
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Mowla A, Abdollahifard S, Farrokhi A, Yousefi O, Valibeygi A, Azami P. Middle Meningeal Artery Embolization with Liquid Embolic Agents for Chronic Subdural Hematoma: A Systematic Review and Meta-analysis. J Vasc Interv Radiol 2023; 34:1493-1500.e7. [PMID: 37182671 DOI: 10.1016/j.jvir.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To assess the efficacy and safety of middle meningeal artery (MMA) embolization with liquid embolic agents and the outcomes of patients following this procedure. MATERIALS AND METHODS A review of the literature was conducted to identify studies investigating the efficacy and safety of MMA embolization with liquid embolic agents in patients with chronic subdural hematoma (cSDH) in PubMed, Scopus, Embase, and Web of Science. The keywords "liquid embolic agent," "middle meningeal artery," "cSDH," and "embolization" as well as their synonyms were used to build up the search strategy. The R statistical software and random-effects model were used for analysis. Heterogeneity was reported as I2, and publication bias was calculated using the Egger test. RESULTS Of 628 articles retrieved, 14 studies were eligible to be included in this study. Data of 276 patients were analyzed. n-Butyl cyanoacrylate and ethylene vinyl alcohol copolymer were the most commonly used embolic agents. This study revealed a pooled mortality rate of 0% (95% confidence interval [CI], 0.00%-100%), recurrence and failure rate of 3% (95% CI, 1%-10%), reoperation/reintervention rate of 4% (95% CI, 2%-12%), rate of size decrease of 94% (95% CI, 79%-98%), technical success rate of 100% (95% CI, 76%-100%), and adverse event rate of 1% (95% CI, 0.00%-4%). CONCLUSIONS With low mortality, recurrence, reoperation, and adverse event rates and a remarkable decrease in the size of hematomas, MMA embolization with liquid embolic agents may be considered a safe and effective treatment option in patients in whom surgical intervention has previously failed and as an alternative to conventional treatments.
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Affiliation(s)
- Ashkan Mowla
- Division of Stroke and Endovascular Neurosurgery, Department of Neurological Surgery, Keck School of Medicine, University of Southern California (USC), Los Angeles, California.
| | - Saeed Abdollahifard
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Amirmohammad Farrokhi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz; Research Center for Neuromodulation and Pain, Shiraz
| | - Omid Yousefi
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
| | - Adib Valibeygi
- Fasa Neuroscience Circle, Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran
| | - Pouria Azami
- Trauma Research Center, Shahid Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz
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3
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Orscelik A, Senol YC, Bilgin C, Kobeissi H, Arul S, Cloft H, Lanzino G, Kallmes DF, Brinjikji W. Middle meningeal artery embolization combined with surgical evacuation for chronic subdural hematoma: A single-center experience of 75 cases. Interv Neuroradiol 2023:15910199231196453. [PMID: 37635326 DOI: 10.1177/15910199231196453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Chronic subdural hematoma (cSDH) is a challenging and common neurosurgical condition. Our goal is to demonstrate that middle meningeal artery (MMA) embolization combined with surgical evacuation can be a promising adjuvant option for treatment of cSDHs and prevent recurrence in symptomatic patients who require surgical treatment. METHOD We retrospectively collected data from patients who underwent MMA embolization using polyvinyl alcohol particles and surgical evacuation with burr hole or craniotomy in a single center for the treatment of new and recurrent cSDHs. The primary outcome was recurrence of cSDH requiring surgical rescue during follow up, and secondary outcomes were defined as >50% decrease in the maximum width of cSDHs on the longest follow-up computed tomography (CT) scan, complications following procedure, and improvement in modified Rankin scale (mRS) score. RESULTS A total of 51 patients successfully underwent 72 MMA embolization procedures (96% of the total 75 cases in the cohort) combined with surgical evacuation. Seventy cases (93.3%) achieved at least 50% reduction in the size of the cSDHs on the last CT imaging. A surgical evacuation was required in five cases (6.7%) due to cSDH recurrence during the follow-up period. There were three complications (6.0%) related to embolization procedure. Forty patients (78.4%) showed improvement in mRS score. There was one mortality (2%) regardless of the embolization and evacuation. CONCLUSIONS Our study demonstrates the safety and efficacy of adjunct MMA embolization in significantly reducing size and recurrence of cSDHs.
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Affiliation(s)
| | - Yigit Can Senol
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Cem Bilgin
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | | | - Santhosh Arul
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Harry Cloft
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Giuseppe Lanzino
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Waleed Brinjikji
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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4
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Kan P, Maragkos GA, Srivatsan A, Srinivasan V, Johnson J, Burkhardt JK, Robinson TM, Salem MM, Chen S, Riina HA, Tanweer O, Levy EI, Spiotta AM, Kasab SA, Lena J, Gross BA, Cherian J, Cawley CM, Howard BM, Khalessi AA, Pandey AS, Ringer AJ, Hanel R, Ortiz RA, Langer D, Kelly CM, Jankowitz BT, Ogilvy CS, Moore JM, Levitt MR, Binning M, Grandhi R, Siddiq F, Thomas AJ. Middle Meningeal Artery Embolization for Chronic Subdural Hematoma: A Multi-Center Experience of 154 Consecutive Embolizations. Neurosurgery 2021; 88:268-277. [PMID: 33026434 DOI: 10.1093/neuros/nyaa379] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 06/27/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Middle meningeal artery (MMA) embolization has emerged as a promising treatment for chronic subdural hematoma (cSDH). OBJECTIVE To determine the safety and efficacy of MMA embolization. METHODS Consecutive patients who underwent MMA embolization for cSDH (primary treatment or recurrence after conventional surgery) at 15 centers were included. Clinical details and follow-up were collected prospectively. Primary clinical and radiographic outcomes were the proportion of patients requiring additional surgical treatment within 90 d after index treatment and proportion with > 50% cSDH thickness reduction on follow-up computed tomography imaging within 90 d. National Institute of Health Stroke Scale and modified Rankin Scale were also clinical outcomes. RESULTS A total of 138 patients were included (mean age: 69.8, 29% female). A total of 15 patients underwent bilateral interventions for 154 total embolizations (66.7% primary treatment). At presentation, 30.4% and 23.9% of patients were on antiplatelet and anticoagulation therapy, respectively. Median admission cSDH thickness was 14 mm. A total of 46.1% of embolizations were performed under general anesthesia, and 97.4% of procedures were successfully completed. A total of 70.2% of embolizations used particles, and 25.3% used liquid embolics with no significant outcome difference between embolization materials (P > .05). On last follow-up (mean 94.9 d), median cSDH thickness was 4 mm (71% median thickness reduction). A total of 70.8% of patients had >50% improvement on imaging (31.9% improved clinically), and 9 patients (6.5%) required further cSDH treatment. There were 16 complications with 9 (6.5%) because of continued hematoma expansion. Mortality rate was 4.4%, mostly unrelated to the index procedure but because of underlying comorbidities. CONCLUSION MMA embolization may provide a safe and efficacious minimally invasive alternative to conventional surgical techniques.
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Affiliation(s)
- Peter Kan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Georgios A Maragkos
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Aditya Srivatsan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Visish Srinivasan
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | - Jeremiah Johnson
- Department of Neurosurgery, Baylor College of Medicine, Houston, Texas
| | | | - Timothy M Robinson
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Stephen Chen
- Department of Radiology, Baylor College of Medicine, Houston, Texas
| | - Howard A Riina
- Department of Neurosurgery, NYU Langone Medical Center, New York City, New York
| | - Omar Tanweer
- Department of Neurosurgery, NYU Langone Medical Center, New York City, New York
| | - Elad I Levy
- Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York
| | - Alejandro M Spiotta
- Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina
| | - Sami Al Kasab
- Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina
| | - Jonathan Lena
- Department of Neurosurgery, Medical College of South Carolina, Charleston, South Carolina
| | - Bradley A Gross
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jacob Cherian
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - C Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Brian M Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia
| | - Alexander A Khalessi
- Department of Neurosurgery, University of California, San Diego, La Jolla, California
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Andrew J Ringer
- Mayfield Clinic, TriHealth Neuroscience Institute, Good Samaritan Hospital, Cincinnati, Ohio
| | - Ricardo Hanel
- Lyerly Neurosurgery, Baptist Neurological Institute, Jacksonville, Florida
| | - Rafael A Ortiz
- Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
| | - David Langer
- Department of Neurosurgery, Lenox Hill Hospital, New York City, New York
| | - Cory M Kelly
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | | | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Justin M Moore
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington
| | - Mandy Binning
- Department of Neurosurgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Farhan Siddiq
- Department of Neurosurgery, University of Missouri, Columbia, Montana
| | - Ajith J Thomas
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
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Karn M, Yonghang S. Acute on Chronic Bilateral Subdural Hematoma in a Woman with a Remote History of Previous Subdural Hematoma Managed by Trephination: A Case Report. ACTA ACUST UNITED AC 2020; 58:607-610. [PMID: 32968298 PMCID: PMC7580380 DOI: 10.31729/jnma.5122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Bilateral chronic subdural hematoma are not that common. It may be recurrent and rarely superimposed by acute bleed leading to rapid progression and poor clinical outcomes. We report the case of a seventy six years old lady with a history of traumatic subdural hematoma evacuated by trephination twenty years back, presenting at our hospital with a history of persistent headache and acute onset of several episodes of vomiting. A non-contrast head CT revealed bilateral chronic subdural hematoma with acute on chronic bleed on one side. Trephination was done initially unilaterally, but the symptoms persisted and bilateral trephination was performed. The patient developed bilateral pneumocephalus and chest infection post-surgery. Bilateral, recurrent subdural hematoma with acute superimposition of bleed is a rare entity that presents with signs of increased intracranial pressure as opposed to unilateral SDH. A single burr hole trephination can be an effective intervention in these cases.
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Affiliation(s)
- Mitesh Karn
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
| | - Sapana Yonghang
- Gandaki Medical College Teaching Hospital and Research Center, Pokhara, Nepal
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6
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Acute on chronic bilateral subdural hematoma presenting with acute complete flaccid paraplegia and urinary retention mimicking an acute spinal cord injury: a case report. BMC Res Notes 2017; 10:627. [PMID: 29183359 PMCID: PMC5704450 DOI: 10.1186/s13104-017-2969-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 11/21/2017] [Indexed: 12/03/2022] Open
Abstract
Background A subdural hematoma refers to a collection of blood between the dura and the arachnoid membranes and is classified into acute, sub acute and chronic. Subdural hematoma has been referred to as the “great neurologic imitator” as it can mimic many neurological conditions. Case presentation Forty-three year old Sri Lankan female presented 2 weeks following traumatic head injury with bilateral flaccid complete paraplegia and urinary retention. Her non-contrast computer tomography of the brain revealed bilateral acute, chronic subdural hematomas. Both subdural hematomas were aspirated and she recovered completely. Conclusions Chronic subdural hematoma can present in many different unusual ways including bilateral complete paraplegia and acute urinary retention mimicking acute spinal cord pathology. The exact mechanism of this clinical presentation is not clear and may be due to direct compression of the motor cortex to the falx or due to compression of the anterior cerebral artery due to subfalcine herniation. This case illustrates the importance of considering subdural hematoma as a rare cause for acute paraplegia and the importance of performing a computer tomography scan in traumatic brain injury when indicated. Failure to consider non-spinal causes of paraplegia results in potential mismanagement. According to our knowledge this is the first case report of acute on chronic subdural hematoma presenting as acute flaccid complete paraplegia with urinary retention.
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7
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Kutty RK, Peethambaran AK, Sunilkumar, Anilkumar M. Conservative Treatment of Chronic Subdural Hematoma in HIV-Associated Thrombocytopenia with Tranexamic Acid. J Int Assoc Provid AIDS Care 2016; 16:211-214. [PMID: 27909114 DOI: 10.1177/2325957416680294] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Chronic subdural hematomas (CSDHs) and its management comprise a majority work in a neurosurgical specialty. The effectiveness of surgery is beyond doubt and sometimes even lifesaving in severe cases. However, the straightforward surgery is sometimes complicated by the associated comorbidities of the patient. Comorbidities in the form of coagulopathies secondary to chronic liver diseases, drugs (warfarin, ecosprin, clopidogrel), thrombocytopenia secondary to systemic illness are always a challenge to deal with in patients with CSDH. The authors encountered a patient with thrombocytopenia secondary to systemic HIV infection who presented with CSDH. Her coagulation profile was severe enough to preclude surgery. She was managed conservatively with tranexamic acid and responded well. The authors present the challenges they faced in the course of successful management of this patient.
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Affiliation(s)
- Raja K Kutty
- 1 Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | | | - Sunilkumar
- 1 Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
| | - M Anilkumar
- 1 Department of Neurosurgery, Government Medical College, Trivandrum, Kerala, India
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8
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Chhabra S, Gupta A. Chronic subdural hematoma associated with idiopathic thrombocytopenic purpura in an elderly female: A rare case report. ROMANIAN NEUROSURGERY 2016. [DOI: 10.1515/romneu-2016-0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Intracranial hemorrhage is the most fatal complication of idiopathic thrombocytopenic purpura(ITP) and is very rare(<1%) mostly in young females and intraparenchymal or subarachnoid in most of the cases. We report a case of 63 years of female presented with acute SDH with petechiae in both lower limbs and headache. After ruling out all causes patient was diagnosed as having idiopathic thrombocytopenic purpura(ITP).Considering her haematological and neurological profile patient was kept conservatively. Platelets and steroids were given to the patient following which platelet counts improved but patient deteriorated clinically. Hence patient was operated and surgical evacuation of SDH was done through burr hole. Although some studies have shown disappearance of chronic SDH with medical management, but it failed in our case and so surgical evacuation was done.
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9
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Lee KS. Chronic Subdural Hematoma in the Aged, Trauma or Degeneration? J Korean Neurosurg Soc 2016; 59:1-5. [PMID: 26885279 PMCID: PMC4754581 DOI: 10.3340/jkns.2016.59.1.1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 10/22/2015] [Accepted: 12/03/2015] [Indexed: 12/30/2022] Open
Abstract
Chronic subdural hematomas (CSHs) are generally regarded to be a traumatic lesion. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. From 20th century, it became a traumatic lesion. CSH frequently occur after a trauma, however, it cannot occur when there is no enough subdural space even after a severe head injury. CSH may occur without trauma, when there is sufficient subdural space. The author tried to investigate trends in the causation of CSH. By a review of literature, the author suggested a different view on the causation of CSH. CSH usually originated from either a subdural hygroma or an acute subdural hematoma. Development of CSH starts from the separation of the dural border cell (DBC) layer, which induces proliferation of DBCs with production of neomembrane. Capillaries will follow along the neomembrane. Hemorrhage would occur into the subdural fluid either by tearing of bridge veins or repeated microhemorrhage from the neomembrane. That is the mechanism of hematoma enlargement. Trauma or bleeding tendency may precipitate development of CSH, however, it cannot lead CSH, if there is no sufficient subdural space. The key determinant for development of CSH is a sufficient subdural space, in other words, brain atrophy. The most common and universal cause of brain atrophy is the aging. Modifying Virchow's description, CSH is sometimes traumatic, but most often caused by degeneration of the brain. Now, it is reasonable that degeneration of brain might play pivotal role in development of CSH in the aged persons.
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Affiliation(s)
- Kyeong-Seok Lee
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
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10
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Abstract
Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis.
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Affiliation(s)
- Yad R Yadav
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Vijay Parihar
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Hemant Namdev
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
| | - Jitin Bajaj
- Department of Neurosurgery, NSCB Medical College, Jabalpur, Madhya Pradesh, India
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11
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Takase H, Tatezuki J, Ikegaya N, Yamamoto D, Hashimoto M, Takagi M, Mochimatsu Y, Kawahara N. Therapeutic Suggestions for Chronic Subdural Hematoma Associated with Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review. NMC Case Rep J 2015; 2:118-122. [PMID: 28663980 PMCID: PMC5364897 DOI: 10.2176/nmccrj.2014-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 12/24/2014] [Indexed: 11/24/2022] Open
Abstract
A 66-year-old woman who was previously diagnosed with idiopathic thrombocytopenic purpura (ITP) presented with mild right-sided hemiparesis and drowsiness. Head computed tomography (CT) imaging demonstrated a massive left chronic subdural hematoma (CSDH) with a midline shift. Because initial laboratory data showed a significantly decreased blood platelet count (0.3 × 104/mm3), medical treatments such as platelet transfusion, intravenous immunoglobulin (IVIG), and high-dose corticosteroid therapy, were initiated. She clinically and radiologically responded well to these treatments without any surgical intervention. In addition to presenting our case, we searched the PubMed and Ichushi Web databases to comprehensively illustrate clinical characteristics and treatment outcomes of similar cases. Including the present case, we found 19 reports and 23 cases of CSDH associated with ITP in the literature, and assessed 17 reports and 21 cases that were written in English and Japanese. None or mild neurological symptom were seen in 13 cases, and severe, such as coma and hemiparesis, were described in the younger 8 cases with significant difference. All except one were first treated with medical therapies. Most cases of the former group responded well to conservative therapy. On the other hand, most in the latter eventually needed surgical treatment in addition except recent two cases including the present case. CSDH associated with ITP is rarely described, and its management remains controversial. However, this report highlights multiple continuous medical treatments under strict observation and general care might be a useful alternative to avoid surgery in cases presenting with severe neurological deficits and extremely low platelet counts.
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Affiliation(s)
- Hajime Takase
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa.,Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Junya Tatezuki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Naoki Ikegaya
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa.,Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Daisuke Yamamoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Mizuki Hashimoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Makoto Takagi
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Yasuhiko Mochimatsu
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa
| | - Nobutaka Kawahara
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa
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12
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Seon G, Park JM, Eom KS. Bilateral Spontaneous Resolution of Chronic Subdural Hematoma: A Case Report. JOURNAL OF TRAUMA AND INJURY 2015. [DOI: 10.20408/jti.2015.28.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
| | - Ji-Min Park
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea
| | - Ki Seong Eom
- Department of Neurosurgery, Wonkwang University School of Medicine, Iksan, Korea
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13
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Takase H, Tatezuki J, Ikegaya N, Yamamoto D, Hashimoto M, Takagi M, Mochimatsu Y, Kawahara N. Therapeutic Suggestions for Chronic Subdural Hematoma Associated with Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review. NMC Case Rep J 2014. [DOI: 10.2176/nmccrj.cr.2014-0209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hajime Takase
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Junya Tatezuki
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
| | - Naoki Ikegaya
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
| | - Daisuke Yamamoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
| | - Mizuki Hashimoto
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
| | - Makoto Takagi
- Department of Neurosurgery, Yokohama City Minato Red Cross Hospital
| | | | - Nobutaka Kawahara
- Department of Neurosurgery, Graduate School of Medicine, Yokohama City University
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14
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Abstract
OPINION STATEMENT Clinical presentation, neurologic condition, and imaging findings are the key components in establishing a treatment plan for acute SDH. Location and size of the SDH and presence of midline shift can rapidly be determined by computed tomography of the head. Immediate laboratory work up must include PT, PTT, INR, and platelet count. Presence of a coagulopathy or bleeding diathesis requires immediate reversal and treatment with the appropriate agent(s), in order to lessen the risk of hematoma expansion. Reversal protocols used are similar to those for intracerebral hemorrhage, with institutional variations. Immediate neurosurgical evaluation is sought in order to determine whether the SDH warrants surgical evacuation. Urgent or emergent surgical evacuation of a SDH is largely influenced by neurologic examination, imaging characteristics, and presence of mass effect or elevated intracranial pressure. Generally, evacuation of an acute SDH is recommended if the clot thickness exceeds 10 mm or the midline shift is greater than 5 mm, regardless of the neurologic condition. In patients with patients with an acute SDH with clot thickness <10 mm and midline shift <5 mm, specific considerations of neurologic findings and clinical circumstances will be of importance. In addition, consideration will be given as to whether an individual patient is likely to benefit from surgery. For an acute SDH, evacuation by craniotomy or craniectomy is preferred over burr holes based on available data. Postoperative care includes monitoring of resolution of pneumocephalus, mobilization and drain removal, and monitoring for signs of SDH reaccumulation. Medical considerations include seizure prophylaxis and management as well as management and resumption of antithrombotic and anticoagulant medication.
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Affiliation(s)
- Carter Gerard
- Department of Neurosurgery, Rush University Medical Center, 1725 West Harrison Street, POB, Chicago, IL, 60612, USA,
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15
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Rapid resolution of a spontaneous large chronic subdural haematoma in the posterior fossa under conservative treatment with platelet administration to aplastic anaemia. Clin Neurol Neurosurg 2013; 115:2236-9. [DOI: 10.1016/j.clineuro.2013.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 06/12/2013] [Accepted: 07/06/2013] [Indexed: 11/20/2022]
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16
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Patnaik A, Mishra SS, Senapati SB, Pattajoshi AS. Management of chronic subdural haematoma in a case of idiopathic thrombocytopenic purpura. J Surg Tech Case Rep 2013; 4:132-4. [PMID: 23741595 PMCID: PMC3673359 DOI: 10.4103/2006-8808.110265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracranial hemorrhage is a rare devastating complication of idiopathic thrombocytopenic purpura (ITP), mostly presenting as intraparenchymal or subarachnoid haemorrhage. Isolated chronic subdural haematoma (SDH) is still very rare and the optimal management is unsettled. Spontaneous resolution of chronic SDH in patients with idiopathic thrombocytopenic purpura is possible. We report a case of spontaneous chronic SDH in a patient with ITP with hemiparesis where the haematoma significantly decreased in size with complete resolution of hemiparesis as a result of platelet transfusions and continuing therapy with steroids. Surgical treatment of subdural haematoma with consequent bleeding complications can be avoided in this scenario.
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Affiliation(s)
- Ashis Patnaik
- Department of Neurosurgery, SCB Medical College and Hospital, Cuttack, Odisha, India
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17
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Gelabert-González M, Frieiro-Dantas C, Serramito-García R, Díaz-Cabanas L, Aran-Echabe E, Rico-Cotelo M, García-Allut A. [Chronic subdural hematoma in young patients]. Neurocirugia (Astur) 2012; 24:63-9. [PMID: 23158924 DOI: 10.1016/j.neucir.2012.08.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/03/2012] [Accepted: 08/03/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. PATIENTS AND METHODS This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011). RESULTS Of the 42 cases analysed, 32 were males and 10 were females, and the mean age at diagnosis was 29.3±8.9 years (range: 4 to 39 years). The mean interval from trauma to appearance of clinical symptoms was 33.4±9.7 days (range: 19 to 95 days). The main symptoms were headache (59.5%) and seizures (21.4%), and the most frequent predisposing factors were ventriculoperitoneal shunting in 5 (11.9%) patients and haematological disorders in another 5 (11.9%) cases. CSDH was right-sided in 21 cases (50%), left-sided in 19 cases (45.3%) and bilateral in the remaining 2 patients (4.7%). Postoperative complications occurred in 2 patients (1 recurrence and 1 acute subdural haematoma). CONCLUSIONS CSDH is a rare pathology during the first decades of life. It mainly affects males and headache is usually the first symptom. Prognosis is good in young patients, since postoperative complications and recurrences are less frequent at this age than in older populations.
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MESH Headings
- Adolescent
- Adult
- Child
- Child, Preschool
- Craniotomy
- Dominance, Cerebral
- Female
- Headache/etiology
- Hematoma, Subdural, Chronic/complications
- Hematoma, Subdural, Chronic/diagnostic imaging
- Hematoma, Subdural, Chronic/epidemiology
- Hematoma, Subdural, Chronic/surgery
- Humans
- Male
- Postoperative Complications/etiology
- Retrospective Studies
- Seizures/etiology
- Tomography, X-Ray Computed
- Trephining
- Ventriculoperitoneal Shunt/adverse effects
- Young Adult
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Affiliation(s)
- Miguel Gelabert-González
- Servicio de Neurocirugía, Departamento de Cirugía, Hospital Clínico Universitario de Santiago, Universidad de Santiago de Compostela, Santiago, La Coruña, España.
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18
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Akyüz M, Çalışkan S, Kaya C. Bilateral ureteral stones and spontaneous perirenal hematoma in a patient with chronic idiopathic thrombocytopenic purpura. Korean J Urol 2012; 53:502-4. [PMID: 22866224 PMCID: PMC3406199 DOI: 10.4111/kju.2012.53.7.502] [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: 04/13/2011] [Accepted: 09/01/2011] [Indexed: 11/18/2022] Open
Abstract
Idiopathic thrombocytopenic purpura (ITP) is an immune thrombocytopenia with a usually benign clinical course. Bleedings are mostly of the mucocutaneous type with mild symptoms. Massive bleedings requiring transfusion are rarely seen, unless the number of platelets decreases to extremely low levels. In this case, bilateral perirenal hematoma and bilateral distal ureteral stones were detected on a non-contrast computed tomography scan of a 57-year-old male patient who developed macroscopic hematuria during his treatment in the clinics of internal medicine because of left flank pain and diffuse petechial rashes all over his body. The patient, who had been receiving chronic ITP treatment for 1 year, had a very low platelet count (4,000/mm(3)). The patient was prescribed bed rest, and his platelet count increased to a safe level for surgical intervention of above 50,000/mm(3) with administration of prednisolone, intravenous immune globulin, and platelet suspension. A stone-free state was achieved after bilateral ureterorenoscopy and pneumatic lithotripsy. A conservative approach was followed for the perirenal hematoma. Upon regression of the perirenal hematoma, the patient was discharged at 9 weeks postoperatively.
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Affiliation(s)
- Mehmet Akyüz
- Clinic of Urology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Selahattin Çalışkan
- Clinic of Urology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Cevdet Kaya
- Clinic of Urology, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
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Pandey M, Saraswat N, Vajifdar H, Chaudhary L. Subdural haematoma in pregnancy-induced idiopathic thrombocytopenia: Conservative management. Indian J Anaesth 2011; 54:470-1. [PMID: 21189889 PMCID: PMC2991661 DOI: 10.4103/0019-5049.71036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Conservative management of subdural haematoma with antioedema measures in second gravida with idiopathic thrombocytopenic purpura (ITP) resulted in resolution of haematoma. We present a case of second gravida with ITP who developed subdural haematoma following normal vaginal delivery. She was put on mechanical ventilation and managed conservatively with platelet transfusion, Mannitol 1g/kg, Dexamethasone 1mg/kg and Glycerol 10ml TDS. She regained consciousness and was extubated after 48 hrs. Repeat CT after 10 days showed no mass effect with resolving haematoma which resolved completely after 15 days. Trial of conservative management is safe in pregnant patient with ITP who develops subdural haematoma.
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Affiliation(s)
- Maitree Pandey
- Department of Anaesthesia, Lady Hardinge Medical College, New Delhi, India
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20
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[Spontaneous subdural hematoma associated to purpura fulminans in a splenectomized patient]. Med Intensiva 2008; 32:453. [PMID: 19080869 DOI: 10.1016/s0210-5691(08)75723-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Panicker JN, Pavithran K, Thomas M. Management of subdural hematoma in immune thrombocytopenic purpura: report of seven patients and a literature review. Clin Neurol Neurosurg 2008; 111:189-92. [PMID: 19084327 DOI: 10.1016/j.clineuro.2008.08.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2008] [Revised: 07/17/2008] [Accepted: 08/16/2008] [Indexed: 11/28/2022]
Abstract
Intracranial hemorrhage is a devastating complication of immune thrombocytopenic purpura (ITP). Subdural hematoma (SDH) is rare and the optimal management unsettled. We report a series of seven patients of ITP who developed isolated SDH and subsequently review the literature. Three patients had acute ITP (mean duration 2.3 months) while four had chronic ITP (mean duration 8.3 years). Mean platelet count at admission was 25 x 10(9)/L (range 16 x 10(9)/L to 30 x 10(9)/L). Mean age at which SDH occurred was 38 years. Headache and bilateral papilloedema were the commonest clinical features at presentation. Diagnosis was made by CT/MR imaging and SDH was acute in two patients and chronic in five. Precipitating factors could not be identified in any patient. Neurological parameters were closely monitored including level of consciousness, pupillary size and development of new neurological deficits. Two patients with acute SDH developed worsening neurological parameters, underwent craniotomy and hematoma evacuation, and survived. Of the two patients who expired, one was brought in an advanced stage that precluded surgery and the other developed metabolic complications due to underlying lupus nephritis. Reports of isolated SDH in ITP are infrequent. Compared to those developing intracerebral hemorrhage, SDH occurs more in patients who are older, having chronic ITP and having a higher platelet count. Medical management with close monitoring of neurological parameters is a viable treatment option in patients of ITP developing SDH.
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Affiliation(s)
- J N Panicker
- Department of Medicine, Medical College Hospital, Thiruvananthapuram, Kerala 695011, India.
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