Meningeal Carcinomatosis for Prostate Adenocarcinoma Mimicking Chronic SubduralHematoma: Case Report and Literature Review

Introduction Cerebral metastases are the most common cancer of the central nervous system (CNS). Meningeal infiltration by neoplasms that did not originate in the CNS is a rare fact that is present in 0.02% of the autopsies. Epidemiologically, the radiological presentation mimicking a subdural hematoma is even more uncommon. We report a case of meningeal carcinomatosis by an adenocarcinoma of the prostate mimicking a chronic subdural hematoma. Case Report A 60-year-old male patient was diagnosed with prostate cancer in 2011. He underwent radical resection of the prostate, as well as adjuvant hormonal therapy and chemotherapy. Five years later, the patient presented peripheral facial paralysis that evolved with vomiting and mental confusion. Tomography and magnetic resonance imaging scans confirmed the subdural collection. At surgery, the dura was infiltrated by friable material of difficult hemostasis. The anatomicopathological examination showed atypical epithelial cells. The immunohistochemistry was positive for prostate-specific antigen (PSA) and other keymarkers, and it was conclusive for meningeal carcinomatosis by a prostate adenocarcinoma.

Chronic subdural hematoma treatment with adjustment of programmable valve in idiopathic normal pressure hydrocephalus patient: a case report / Tratamento de hematoma subdural em paciente com hidrocefalia de pressão normal idiopática com ajuste da válvula programável: relato de caso

Chronic subdural hematoma (CSDH) is a common entity in daily neurosurgical practice. It is considered a benign condition. Idiopathic normal pressure hydrocephalus (INPH) is characterized by gait disturbance, dementia and/or urinary incontinence added to dilation of ventricular system due to disturbance of cerebrospinal fluid (CSF) circulation with normal CSF pressure. We describe an experience of a conservative treatment of subdural hematoma based in the physiopathology and ability to control the pressure in programmable valves. The adjustment of programmable valves in the treatment of INPH allow us the therapeutic control of hydrocephalus and an important tool to manage complications, especially overshunting and undershunting.

O hematoma subdural crônico é uma entidade neurocirúrgica comum, podendo ocorrer como complicação da derivação ventricular em pacientes com hidrocefalia de pressão normal idiopática. Descrevemos nossa experiência de tratamento conservador de hematoma subdural em paciente com derivação ventriculoperitoneal. O ajuste da pressão da válvula permite tanto a otimização terapêutica de pacientes com hidrocefalia de pressão normal idiopática quanto o manejo não invasivo de complicações de menor gravidade, principalmente hipodrenagem e hiperdrenagem.

Apresentaçao clínica e prognóstico dos pacientes com hematoma subdural crônico / Relation between clinical presentation and prognosis in chronic subdural hematoma patients

Introdução: O hematoma subdural crônico é considerado uma das lesões neurocirúrgicas que apresenta bom prognóstico. Os autores apresentam sua experiência sobre apresentação clínica e prognóstico. Pacientes e métodos: Foram analisados, retrospectivamente, 60 casos de hematoma subdural crônico entre janeiro de 2002 e junho de 2008. Os dados analisados foram características demográficas, quadro clínico, tratamento, complicações e prognóstico. Resultados: A idade variou entre 38 e 82 anos, com média de 58 anos. Houve predomínio do sexo masculino com relação masculino:feminino de 2,53:1. A localização foi unilateral em 49 casos e bilateral em 11 casos. Fatores predisponentes: traumatismo craniano (30), alcoolismo crônico (14), uso de anticoagulante oral (6), outras causas (6) e desconhecido (4). Apresentações clínicas foram: acidente vascular cerebral (16), hipertensão intracraniana (12), distúrbios psiquiátricos (11), síndrome piramidal (8), crises convulsivas (8), sintoma extrapiramidal (4) e hemorragia subaracnóidea (2). Tratamento cirúrgico foi realizado em 58 casos. Os casos de alcoolismo crônico associados à apresentação psiquiátrica tiveram péssimo prognóstico, seguidos dos casos de uso de anticoagulantes orais associados a hipertensão intracraniana. Os resultados foram ótimos em casos de hematoma subdural crônico associados a hipertensão intracraniana e nos casos com clínica piramidal e extrapiramidal. Cinco pacientes foram a óbito (dois por intercorrências cirúrgicas, dois por doenças sistêmicas e um por infecção hospitalar). Conclusão: O hematoma subdural crônico manifesta-se por formas clínicas variadas, seu prognóstico encontra-se diretamente relacionado à causa básica, apresentação clínica e tratamento.

Traumatismo craneoencefálico en el adulto mayor / Cranioencephalic traumatism in older adult

Fundamento: Los mayores de 60 años representan el 15 por ciento de la población cubana y se espera que para el 2025 alcancen el 20 por cientoconvirtiéndose Cuba en el territorio más envejecido de América Latina, proporcionalmente mayor número de ancianos solicitarán atención neuroquirúrgica. El traumatismo craneoencefálico es la principal causa de morbimortalidad neuroquirúrgica en el adulto mayor en nuestro. Objetivo: Caracterizar el traumatismo craneoencefálico en el adulto mayor. Método: Se realizó un estudio descriptivo de todos los pacientes de 60 años y más atendidos por el servicio de neurocirugía del Hospital Provincial Universitario Manuel Ascunce Domenech de Camagüey desde enero de 2002 a enero de 2006 con diagnóstico de traumatismo craneoncéfalico. Resultados: El 73 por ciento padecían alguna enfermedad crónica. El trauma craneoncefálico no complicado fue la variante de mayor incidencia. El hematoma subdural crónico y el trauma craneoncefálico grave fueron las principales causas de operaciones. El 51 por ciento de los operados presentó alguna complicación. La mortalidad en esta serie fue del 21 por ciento. Conclusiones: El hematoma subdural crónico fue las variedad del trauma craneoncefálico más frecuente en el anciano. El trauma craneoncefálico grave tiene una elevada mortalidad determinada fundamentalmente por la severidad del trauma y por el desarrollo de complicaciones.

Background: Elders of 60 years represent the 15 per cent of Cuban population and it is hoped that for the 2025 will reach the 20 percent become Cuba the most aged territory of Latin America, proportionally a great number of old men will request neurosurgical attention. Cranioencephalic traumatism is the main cause of neurosurgical morbimortality in the adult in our environment. Objective: To characterize the cranioencephalic traumatism in the adult. Method: A descriptive study of all the patients of 60 years and over attended by the neurosurgery service at Manuel Ascunce Domenech University Provincial Hospital of Camagüey was conducted from January 2002 to January 2006 with cranioencephalic traumatism as diagnosis. Results: The 73 percent suffered any chronic disease. The non complicated cranioencephalic trauma was the variant of higher incidence. The chronic subdural hematoma and the severe cranioencephalic trauma were the principal causes of operations. The 51 percent of the operated presented any complication. Mortality in this series was about the 21 percent. Conclusions: The chronic subdural hematoma was the most frequent variety of cranioencephalic trauma in the old man. The severe cranioencephalic trauma has a high mortality determined fundamentally by the severity of trauma and for the development of complications.

Hematoma subdural crónico calcificado: reporte de un caso / Calcified chronic subdural hematoma: a case report

El hematoma subdural crónico constituye una enfermedad frecuente en la práctica neuroquirúrgica cotidiana. Su diagnóstico se realiza actualmente de forma temprana en la mayoría de los pacientes, a partir de la introducción de las modernas técnicas de imagenología. Se presenta el caso de un enfermo de 84 años de edad con historia de cefalea, mutismo acinético y cuadriparesia, cuyo examen tomográfico mostró una colección extraxial supratentorial hemisférica derecha con calcificación masiva; se practicó la exéresis mediante una craneotomía y el estudio histopatológico confirmó el diagnóstico de hematoma subdural crónico. Se concluye que, al constituir la calcificación masiva del hematoma subdural crónico una rara forma de presentación imagenológica en la actualidad, deben contemplarse otras entidades en el diagnóstico diferencial como neoplasias y malformaciones vasculares intracraneales; por otro lado, aumenta la complejidad quirúrgica ya que es imprescindible la práctica de una craneotomía para la evacuación de la lesión.

The chronic subdural hematoma constitutes a frequent disease in daily neurosurgical practice. Currently its diagnosis of premature form is performed in the majority of patients, since the introduction of imaging's modern techniques. An 84 years old patient with history of cephalea, akinetic mutism and cuadriparesis, whose tomographic exam showed a right hemispheric supratentorial extraxial collection with massive calcification; the exeresis was performed by means of a craniotomy and the histopathological study confirmed the diagnosis of chronic subdural hematoma. It was concluded that, when constitute the massive calcification of the chronic subdural hematoma a rare form of imaging presentation at present, should contemplate another entities in the differential diagnostic like neoplasias and intracranial vascular malformations; In addition, increases the surgical complexity since it is essential the practice of a craniotomy for the evacuation of the lesion.

Idiopathic chronic subdural hematoma, MCA infarct and cortical atrophy with status epilepticus in infants.

Spontaneous chronic subdural hematomas in infants are extremely rare. A very limited number of cases are known and reported in literature. The clinical presentation can be myriad varying from asymptomatic cases to gross neurological deficits. We report the cases of 2 infants who presented to us with repeated episodes of generalized tonic clonic seizures since birth. No etiology could be established for either of them. Subsequent imaging revealed chronic subdural hematoma, MCA infarct and cortical atrophy in both the cases. Both the cases improved following evacuation of the chronic subdural hematoma. One of the infants had secondary craniosynostosis for which additional coronal suturectomy had to be done. The management of such cases and a brief review of literature are discussed.

Chronic subdural hematoma with sudden clinical uncal herniation and coma: case report

Context: Chronic subdural hematomas are frequent diseases in neurosurgery units. Decreased level of consciousness is observed in 28 to 100 percent of cases, nevertheless in rare cases are seen comatous patients. We describe a case of a patient with clinical uncal herniation elapsed by a chronic subdural hematoma. Case report: Patient with previous diagnosis of breast cancer, presented sudden occurrence of a headache followed by decreasing level of consiousness the day before reaching our service. The patient was taken than to another Hospital at 1:00 AM in Glasgow Coma Scale (GCS) 13, with isochonic pupils. At 7:00 AM the GCS went to 7 and the pupils became anisochonic L > R and than transferred to our Unit and immediatly submitted to a computed tomohraphy scanning of the head that showed a chronic subdural hematoma with midline shift. The patient promptly was taken to surgical room and treated with a single burr hole with drainage of hypertensive chronic subdural hematoma. The level of consiousness increased few hours after surgery, being in GCS 15 just 6 hours after, without motor deficits. Conclusion: In spite of commonly progressive evolution chronic subdural hematomas can present with herniation, becoming itself a neurosurgical emergency.

Hematoma subdural crônico no idoso / Chronic subdural hematoma in elderly

Os distúrbios auditivos da terceira idade vêm recebendo crescente importância na medida em que a esperança de vida aumenta e, conseqüentemente, a idade da população. A presbiacusia, alteração mais freqüente, ao lado de outras doenças auditivas são discutidas, abordando-se suas principais características, diagnóstico e o tratamento.(au)