A Case of Growing Chronic Subdural Hematoma with Niveau Formation Showing an Enhanced Subdural Hyperintense Band on Magnetic Resonance Diffusion-weighted Imaging Over Time.

This case report describes an 84-year-old female patient with a growing chronic subdural hematoma (CSDH) that showed an enhanced subdural hyperintense band (SHB) on magnetic resonance (MR) diffusion-weighted imaging over time, indicating that it reflects fresh bleeding from the outer membrane covering the hematoma. The presence of SHB on MR diffusion-weighted imaging of CSDH, possibly reflecting hemorrhagic diathesis of the outer membrane, might be a predictor of enlargement of CSDH.

Acute subdural hematoma requiring surgery in the subacute or chronic stage.

The aim of this study was to clarify the clinical characteristics and pathophysiology of conservatively treated cases of acute subdural hematoma (ASDH) that ultimately require surgery in the subacute or chronic stage, and devise an appropriate form of management for them. A total of 50 patients with ASDH were admitted to our institution during a 5-year period. Hematoma removal in the subacute or chronic stage was performed in 8 patients. The ASDH had been caused by a fall in 5 patients. Five patients had been treated with antiplatelet agents. Fluid-attenuated inversion recovery magnetic resonance (MR) imaging demonstrated an irregularly shaped hematoma with gyrus patterns in 4 of 5 patients. Diffusion-weighted MR imaging demonstrated a two-layered hematoma structure in 3 of 4 patients. The hematoma was removed via a craniotomy, a small craniotomy, and a burr hole in 1, 1, and 6 patients, respectively. At surgery in the craniotomy case, a solid clot was located beneath the dura, and a liquid hematoma was located close to the brain. After hematoma removal, no inner membrane was observed on the brain surface. One patient had typical chronic subdural hematoma in the subacute stage, and 2 patients had so-called subacute subdural hematoma (SASDH) in the chronic stage. Although the majority of such cases can be treated by burr-hole surgery, a small craniotomy or craniotomy ought to be considered as a further surgical option if SASDH is diagnosed on the basis of clinical and radiological data, especially diffusion-weighted MR imaging.

Epidemiology of subarachnoid hemorrhage in the Yaeyama Islands, an isolated subtropical region of Japan most frequently affected by typhoons: a population-based study.

OBJECTIVE: The present study analyzed epidemiological data for patients with subarachnoid hemorrhage (SAH) in a subtropical region of Japan that is the most frequently affected by typhoons. PATIENTS AND METHODS: The medical records of hospitalized patients who had been diagnosed as having SAH at Okinawa Prefectural Yaeyama Hospital during a 13-year period were reviewed. Demographic and epidemiological data including date and time of onset and activity at onset and clinical data were collected. Meteorological data for typhoon's approaches to the Yaeyama Islands were obtained from the web-site of the Japan Meteorological Agency. In addition, patients who had developed SAH during a period of 3days before and after the closest approach of a typhoon (CAT) were examined. RESULTS: A total of 94 patients were identified. A monthly peak in August, a weekly peak on Monday, and two daily peaks in the evening and morning were observed. The incidence of SAH during a period of 3days before and after the CAT was approximately twice as high as that on other days, and a statistically significant difference was found. CONCLUSION: Periodic patterns of SAH onset revealed unusual monthly and circaseptan variations and the usual circadian variation. SAH onset was associated with typhoon's approaches.

[Aneurysmal subarachnoid hemorrhage in the Yaeyama Islands, Japan, from 1989 to 2002].

The aim of this study was to analyze epidemiological and clinical data of patients with aneurysmal subarachnoid hemorrhage (SAH) in the Yaeyama islands, an isolated subtropical region of Japan. A total of 94 patients (31 men and 63 women, mean age 57.3 years) were diagnosed as having non-traumatic SAH during a 13-year period from 1989 to 2002. The age-and sex-adjusted annual incidence rate of SAH was 17.4 per 100,000 population. The incidence of SAH was the highest in August. Seventy-nine patients were hospitalized within 24 hours after onset of SAH. Seventeen patients were transferred by helicopter. The Hunt and Kosnik grade was I in 29 patients (30.9%). The CT Fisher group was 3 in 42 patients (44.7%). Ruptured aneurysm was detected in 78 patients (saccular type in 70 patients, small size in 49 patients, and internal carotid artery in 28 patients). Rebleeding occurred in 20 patients (21.3%). Symptomatic vasospasm occurred in 26 patients (27.7%). Acute and chronic hydrocephalus occurred in 25 (26.6%) and 22 (23.4%) patients respectively. A total of 120 neurosurgical operations were performed in 70 patients (operation for ruptured aneurysm in 62, early operation in 39). A total of 42 operative complications occurred in 29 patients. Fifty-one patients (54.3%) had a good outcome. The number of full-time neurosurgeons did not influence the performance of neurosurgical operation and outcome. In conclusion, epidemiologically, the high incidence of SAH in August is unusual. Patients with aneurysmal SAH in the Yaeyama islands have common clinical characteristics and undergo standard neurosurgical treatment.

Recurrence and extension of lobar hemorrhage related to cerebral amyloid angiopathy: multivariate analysis of clinical risk factors.

BACKGROUND: Many recent studies have analyzed clinical risk factors for the recurrence and extension of intracerebral hemorrhage. However, they have not been investigated in patients with lobar hemorrhage related to cerebral amyloid angiopathy (CAA). METHODS: We studied 40 surgically treated patients with lobar hemorrhage diagnosed histologically as being related to CAA. To determine clinical factors influencing the recurrence and hematoma size their clinical data (demographics, medical history, and radiographic and laboratory data) were examined retrospectively and subjected to multivariate analysis. RESULTS: Twelve patients (30%) had recurrent lobar hemorrhage. Twenty-one patients had a small hematoma and 19 had a large hematoma. Hypertension was the only significant clinical factor influencing the recurrence of CAA-related lobar hemorrhage. There was no significant clinical factor influencing the hematoma size of CAA-related lobar hemorrhage. CONCLUSIONS: The history of hypertension is associated with an increase in the recurrence of CAA-related lobar hemorrhage.