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Bouhaddoune Y, Benbouchta K, El Ouafi N, Bazid Z. Spontaneous subdural hematoma in a patient receiving dual antiplatelet therapy following percutaneous coronary intervention: A case report. Ann Med Surg (Lond) 2021; 71:102941. [PMID: 34703590 PMCID: PMC8524112 DOI: 10.1016/j.amsu.2021.102941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/08/2021] [Accepted: 10/09/2021] [Indexed: 10/29/2022] Open
Abstract
Introduction and importance: Dual antiplatelet therapy with clopidogrel and aspirin is routinely prescribed after coronary artery stenting, plays a critical role in secondary prevention among patients with acute coronary syndrome and has decreased the rates of re-infarction and stent thrombosis after percutaneous coronary intervention, but they are prone to internal bleeding. Intracranial hemorrhage is the most serious bleeding complication in a patient put on antiplatelet therapy following PCI. Acute spontaneous subdural hematoma (ASSDH) without trauma is a rare event, which needs to be promptly recognized and managed. Case presentation In this mini-review, we report a case of a 71-year-old man who represented spontaneous acute subdural hematoma receiving dual antiplatelet (aspirin and clopidogrel) following percutaneous coronary intervention for acute coronary syndrome. Rapid discontinuation of all of the antiplatelet drugs and hematoma evacuation were performed with good postoperative evolution. Clinical discussion Management of hemorrhagic patients under antithrombotic therapy is very difficult. Resuming the treatment could lead to recurrence bleeding, on the other hand, suspension or stopping of treatment could expand the thrombotic risk. ASSDH after PCI is true diagnostic then therapeutic emergency, especially in patients with rapid neurological degradation. Treatment may be managed by nonoperative conservative approach in selected cases. Conclusion Spontaneous subdural hematoma is a rare, serious entity, although it can engage the functional and vital prognosis of the patient, hence the interest of diagnosis and prompt treatment to improve the prognosis.
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Affiliation(s)
- Youssra Bouhaddoune
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Karima Benbouchta
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noha El Ouafi
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Zakaria Bazid
- Department of Cardiology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.,Epidemiological Laboratory of Clinical Research and Public Health, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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de Aguiar GB, Veiga JCE, de Almeida Silva JM, Conti MLM. Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula. J Clin Neurosci 2016; 25:159-60. [DOI: 10.1016/j.jocn.2015.05.057] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/14/2015] [Accepted: 05/22/2015] [Indexed: 11/19/2022]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Coombs JB, Coombs BL, Chin EJ. Acute Spontaneous Subdural Hematoma in a Middle-Aged Adult: Case Report and Review of the Literature. J Emerg Med 2014; 47:e63-8. [DOI: 10.1016/j.jemermed.2014.04.026] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Revised: 02/08/2014] [Accepted: 04/28/2014] [Indexed: 11/25/2022]
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Abstract
Most acute subdural hematomas (ASDHs) develop after rupture of a bridging vein or veins. The anatomy of the bridging vein predisposes to its tearing within the border cell layer of the dura mater. Thus, the subdural hematoma actually forms within the dura. The hematoma grows by continued bleeding into the border cell layer. However, the venous pressure would not be expected to cause a large hematoma. Therefore, some type of mechanism must account for the hematoma's expansion.
Cerebral venous pressure (CVP) has been demonstrated in animal models to be slightly higher than intracranial pressure (ICP), and CVP tracks the ICP as pressure variations occur. The elevation of CVP as the ICP increases is thought to result from an increase in outflow resistance of the terminal portion of the bridging veins. This probably results from a Starling resistor model or, less likely, from a muscular sphincter.
A hypothesis is derived to explain the mechanism of ASDH enlargement. Tearing of one or more bridging veins causes these vessels to bleed into the dural border cell layer. Subsequent ICP elevation from the ASDH, cerebral swelling, or other cause results in elevation of the CVP by increased outflow resistance in the intact bridging veins. The increased ICP causes further bleeding into the hematoma cavity via the torn bridging veins. Thus, the ASDH enlarges via a positive feedback mechanism.
Enlargement of an ASDH would cease as blood within the hematoma cavity coagulates. This would stop the dissection of the dural border cell layer, and pressure within the hematoma cavity would equalize with that in the torn bridging vein or veins.
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Affiliation(s)
- Jimmy D. Miller
- 1Division of Neurosurgery, Greenwood Leflore Hospital, Greenwood, Mississippi
| | - Remi Nader
- 2Division of Neurosurgery, University of Texas Medical Branch, Galveston; and
- 3Texas Center for Neurosciences, Beaumont, Texas
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Czyż M, Jarmundowicz W, Szarek D, Tabakow P, Markowska-Wojciechowska A. Bilateral chronic subdural haematomas in a patient with meningioma of the superior sagittal sinus - case report and pathophysiological study. Neurol Neurochir Pol 2012; 45:500-4. [PMID: 22127946 DOI: 10.1016/s0028-3843(14)60319-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Bilateral chronic subdural haemorrhage accompanying meningioma is a very rare clinical condition. We present a case of a 69-year-old female patient with large meningioma completely obliterating the posterior third part of the superior sagittal sinus with accompanying bilateral chronic subdural haematomas. Three anatomical zones of venous collateral circulation were revealed by the preoperative digital subtraction angiography. The tumour and haematomas were removed completely with no major complications. The most likely pathomechanism of the development of bilateral chronic subdural haematomas was venous hypertension caused by an occlusion of major cerebral venous trunks. As a result of a minor thrombotic incident or insignificant head injury, the distended veins of collateral circulation that were volumetrically burdened could have been damaged. Patients with large tumours occluding the superior sagittal sinus, who did not qualify for or refused surgery, should be carefully monitored clinically and neuroradiologically because of possibly increased risk of an intracranial haemorrhage.
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Affiliation(s)
- Marcin Czyż
- Katedra i Klinika Neurochirurgii, Akademicki Szpital Kliniczny AM we Wrocławiu, ul. Borowska 213, 50-556 Wrocław.
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Fryburg K, Nguyen HS, Cohen-Gadol AA. Spontaneous acute subdural hematoma due to fondaparinux: Report of two cases. Surg Neurol Int 2011; 2:44. [PMID: 21660271 PMCID: PMC3108447 DOI: 10.4103/2152-7806.79759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 03/22/2011] [Indexed: 12/03/2022] Open
Abstract
Background: Spontaneous acute subdural hematomas (SDHs) are rare. Risk factors for development of these hematomas include conditions such as hypertension, vascular abnormalities such as aneurysm or arteriovenous malformation, or consumption of anticoagulants. Case Description: Here, the authors report two patients who suffered from spontaneous acute SDH while taking fondaparinux for venous thromboembolism prophylaxis. One patient suffered from a remote episode of traumatic brain injury and underwent a decompressive craniectomy 3 weeks prior to presentation, whereas the other patient had been self-medicating with aspirin. Conclusion: To our knowledge, these two patients illustrate the first cases of spontaneous acute SDH formation most likely attributed to consumption of fondaparinux.
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Affiliation(s)
- Karsten Fryburg
- St. Francis Hospital, Division of Neurological Surgery, Department of Neurological Surgery, Indiana University, Indianapolis, IN, USA
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Cho CB, Park HK, Chough CK, Lee KJ. Spontaneous bilateral supratentorial subdural and retroclival extradural hematomas in association with cervical epidural venous engorgement. J Korean Neurosurg Soc 2009; 46:172-5. [PMID: 19763223 DOI: 10.3340/jkns.2009.46.2.172] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 02/22/2009] [Accepted: 08/04/2009] [Indexed: 11/27/2022] Open
Abstract
We describe a case of 36-year-old man who presented with a subacute headache preceded by a 1-month history of posterior neck pain without trauma history. Head and neck magnetic resonance imaging (MRI) studies disclosed bilateral supratentorial subdural and retroclival extradural hematomas associated with marked cervical epidural venous engorgement. Cerebral and spinal angiography disclosed no abnormalities except dilated cervical epidural veins. We performed serial follow-up MRI studied to monitor his condition. Patient's symptoms improved gradually. Serial radiologic studies revealed gradual resolution of pathologic findings. A 3-month follow-up MRI study of the brain and cervical spine revealed complete resolution of the retroclival extradural hematoma, disappearance of the cervical epidural venous engorgement, and partial resolution of the bilateral supratentorial subdural hematoma. Complete resolution of the bilateral supratentorial subdural hematoma was confirmed on a 5-month follow-up brain MRI. The diagnosis and possible mechanisms of this rare association are discussed.
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Affiliation(s)
- Chul Bum Cho
- Catholic Neuroscience Center, Department of Neurosurgery, St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Korea
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Akioka N, Fukuda O, Takaba M, Kameda H, Saito T, Endo S. Clinical Investigation of Acute Spontaneous Subdural Hematoma Cases. J Stroke Cerebrovasc Dis 2007; 16:109-13. [DOI: 10.1016/j.jstrokecerebrovasdis.2006.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2006] [Revised: 11/16/2006] [Accepted: 11/29/2006] [Indexed: 11/24/2022] Open
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Hymel KP, Jenny C, Block RW. Intracranial hemorrhage and rebleeding in suspected victims of abusive head trauma: addressing the forensic controversies. Child Maltreat 2002; 7:329-348. [PMID: 12408245 DOI: 10.1177/107755902237263] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Does an expanded subarachnoid space predispose to subdural bleeding? What does heterogeneity in the appearance of a subdural collection on CT or MRI imaging indicate? Spontaneous rebleeding? Minor re-injury? Major re-injury? In some specific cases, answers to these questions have important forensic implications. To conclude objectively that an infant's intracranial hemorrhage or rebleeding resulted from inflicted injury or re-injury requires an in-depth understanding of the pathogenesis of posttraumatic subdural and subarachnoid collections. The authors present two cases of indoor, accidental, pediatric, closed-head trauma that resulted in intracranial rebleeding. Both accidental cranial impacts occurred in medical settings and were independently witnessed by medical personnel. In addition, the authors summarize the relevant medical literature regarding pediatric intracranial bleeding and rebleeding.
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Affiliation(s)
- Kent P Hymel
- Inova Fairfax Hospital for Children, Falls Church, Virginia, USA
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Fukui K, Miyachi S, Kato M, Miyazaki M. A case of spontaneous acute subdural haematoma in traumatic carotid- cavernous fistula. Interv Neuroradiol 2000; 6:147-52. [PMID: 20667193 PMCID: PMC3679590 DOI: 10.1177/159101990000600211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2000] [Accepted: 03/30/2000] [Indexed: 03/19/2024] Open
Abstract
SUMMARY We report a case of acute subdural haematoma in traumatic carotid-cavernous fistula. The patient had a history of head trauma four years ago. Postoperative study revealed CCF of dominant posterior drainage with giant pseudoaneurysm. Thereafter endovascular treatment using detachable balloons and detachable platinum micro-coils made successful occlusion of the fistula preserving the ICA.
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Affiliation(s)
- K Fukui
- Department of Neurosurgery, Nagoya Ekisaikai Hospital; Nagoya, Japan
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