RESUMEN
BACKGROUND: Major craniotomy is currently the de facto operative treatment for traumatic acute extradural hematoma (AEDH). This craniotomy, involving extensive scalp dissection (the trauma flap) and major cranial bone opening, can be impracticable in the remote regions of some Western countries, and even more so in the low-resource health systems of most developing countries. METHODS: We describe the surgical technique of minicraniotomy under local anesthesia plus monitored sedation as a much less invasive operative treatment for AEDH. The results of its use in a preliminary patient group are also presented. RESULTS: The procedure has been carried out in 10 consecutive patients (7 men), including an infant 4 months of age. The age range was 4 months to 56 years. The patients suffered varying severity of head injury, with a median Glasgow Coma Scale (GCS) score of 11 out of 15 (range, 4-15). The median trauma to surgery time was 25 hours (range, 13-192 hours). The surgery was successfully completed, with hematoma evacuated and hemostasis achieved. The median duration of surgery was 90 minutes. The in-hospital outcome was Glasgow Outcome Scale score of normal status in 6 patients, moderate deficit in 2 patients, and vegetative state in the patient whose preoperative GCS score was 4. One other patient, admitted with a GCS score of 11, died 5 days postoperatively from extracranial causes. The surviving patients have been followed-up for a median time of 15 months with no new deficits. CONCLUSIONS: Compared with full craniotomy under general anesthesia, minicraniotomy under local anesthesia plus sedation may be a more pragmatic, less invasive, and low-cost surgical treatment option for uncomplicated traumatic acute extradural hematoma.
Asunto(s)
Craneotomía/métodos , Hematoma Epidural Craneal/cirugía , Adolescente , Adulto , Anestesia Local/métodos , Niño , Sedación Consciente/métodos , Traumatismos Craneocerebrales/complicaciones , Femenino , Escala de Consecuencias de Glasgow , Hematoma Epidural Craneal/etiología , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
INTRODUCTION: Trauma is a major contributor to global morbidity and mortality, and injury to the central nervous system is the most common cause of death in these patients. While the provision of surgical services is being recognized as essential to global public health efforts, specialty areas such as neurosurgery remain overlooked. METHOD: This is a retrospective case review of patients with operable lesions, such as extra-axial hematomas and unstable depressed skull fractures that underwent neurosurgical interventions under local anesthesia. RESULTS: A total of 13 patients underwent neurosurgical intervention under local anesthesia. Two and three patients with burr hole decompression of epidural and subdural hematomas, respectively; seven patients had elevation of depressed skull fractures and lastly one patient had an aspiration of a brain abscess. All patients survived with and without residual neurological deficits. CONCLUSION: Access to resources and staff required to deliver general anesthesia is challenging in resource-poor settings. We have therefore begun performing emergent interventions under local anesthesia, with or without conscious sedation. While some patients had some minor residual weakness after the procedure, the degree of neurological deficit was improved from that observed before the procedure in all patients.
Asunto(s)
Anestesia Local , Países en Desarrollo , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Absceso Encefálico/cirugía , Niño , Descompresión Quirúrgica , Femenino , Hematoma Epidural Craneal/cirugía , Hematoma Intracraneal Subdural/cirugía , Humanos , Lactante , Malaui , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Fractura Craneal Deprimida/cirugía , Adulto JovenRESUMEN
According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.
Asunto(s)
Inhibidores del Factor Xa/efectos adversos , Hematoma Epidural Craneal/inducido químicamente , Rivaroxabán/efectos adversos , Adulto , Hematoma Epidural Craneal/diagnóstico por imagen , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Riesgo , Tomografía Computarizada por Rayos XRESUMEN
Summary According to our research, this is the first case described in the literature of spontaneous intracranial epidural hematoma secondary to the use of Xareltor. Spontaneous intracranial epidural hematomas are rarely described in the literature. They are associated with infectious diseases of the skull, coagulation disorders, vascular malformations of the dura mater and metastasis to the skull. Long-term post-marketing monitoring and independent reports will probably detect the full spectrum of hemorrhagic complications of the use of rivaroxaban.
Resumo Segundo nossa pesquisa, descrevemos o primeiro caso na literatura de hematoma epidural intracraniano espontâneo secundário ao uso de Xareltor. Hematomas epidurais intracranianos espontâneos raramente são descritos na literatura, sendo comumente associados a doenças infecciosas cranianas, distúrbios de coagulação, malformações vasculares da dura-máter e metástases cranianas. A elaboração de relatórios de monitoramento em longo prazo de pós-comercialização e relatórios independentes provavelmente irá detectar o espectro completo de complicações hemorrágicas do uso desse medicamento.
Asunto(s)
Humanos , Masculino , Adulto , Inhibidores del Factor Xa/efectos adversos , Rivaroxabán/efectos adversos , Hematoma Epidural Craneal/inducido químicamente , Tomografía Computarizada por Rayos X , Riesgo , Hematoma Epidural Craneal/cirugía , Hematoma Epidural Craneal/diagnóstico por imagenRESUMEN
BACKGROUND: Acute extradural hematoma (EDH) is the collection of blood in the potential space between the dura mater and endocranium within 3 days of an incident. It is usually, but not always, a neurosurgical emergency, and early treatment reduces morbidity and mortality, although the outcome is still affected by some other determinants. In Nigeria, the National Health Insurance Scheme does not cover neurosurgical cases, and patients have to pay for all of their treatment regardless of the emergency status. We evaluate epidemiologic patterns, management protocols, and outcome, especially in relation to timely operative intervention, in patients with acute extradural hematoma who presented to our recently established neurosurgical service. METHODS: This prospective study comprised cases managed in our center from May 2006 to July 2013. Data of all patients with acute EDH were collected on Microsoft Excel software and complemented with hospital charts and operative records. Demographic data, etiologic factors, time interval from injury to presentation in our service, time interval from presentation to definitive treatment, and outcome were collected and analyzed. RESULTS: Within the 86-month study period, 1648 patients presented to our service with head injuries. Acute EDH constituted 3.03%, with a mean of 7.14 cases per year. Among the cases of acute EDH, 92% involved male patients (male-to-female ratio, 11.5:1). Peak age incidence (42%) was 21-30 years (mean, 23 years), and motorcycle road traffic accident was the most common etiologic factor (72%). Operative treatment was performed in 84% of the cases (in 57.1%, operative treatment occurred within 1 week of presentation). Conservative management was employed in 10% of cases. Mortality was 14.9%; most (10%) had severe head injury, although 2.1% had mild injury known to be associated with 0% mortality. CONCLUSIONS: Acute EDH is a potentially fatal condition that is easily treatable if presentation, diagnosis, and treatment occur promptly. Our outcomes could be improved if the present logistics associated with the cash-and-carry health care delivery system in Nigeria could be reduced or obviated.
Asunto(s)
Hematoma Epidural Craneal/cirugía , Procedimientos Neuroquirúrgicos/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/epidemiología , Manejo de Caso , Niño , Preescolar , Femenino , Escala de Coma de Glasgow , Escala de Consecuencias de Glasgow , Hematoma Epidural Craneal/epidemiología , Hematoma Epidural Craneal/etiología , Humanos , Incidencia , Lactante , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud , Procedimientos Neuroquirúrgicos/economía , Nigeria/epidemiología , Estudios Prospectivos , Adulto JovenRESUMEN
A 14-year-old girl presented with a rare case of spontaneous bilateral supratentorial epidural hematomas which developed rapidly following cervical surgery. The hematomas presumably resulted from dural dynamics changes secondary to cerebrospinal fluid loss and intracranial hypotension. Intracranial epidural hemorrhage after spinal surgery is extremely uncommon with only one previous case report. Spontaneous intracranial epidural hematoma is an extremely rare complication, but should be considered as a possible complication of spine surgery, especially in adolescents complicated by delayed consciousness and breathing restoration from anesthesia. This case report expands the presently known clinical spectrum of this uncommon complication.
Asunto(s)
Aracnoides/cirugía , Descompresión Quirúrgica , Hematoma Epidural Craneal/etiología , Neoplasias Meníngeas/cirugía , Neurilemoma/cirugía , Complicaciones Posoperatorias/etiología , Compresión de la Médula Espinal/cirugía , Adolescente , Amnesia/etiología , Quistes Aracnoideos/complicaciones , Quistes Aracnoideos/cirugía , Infarto Encefálico/etiología , Vértebras Cervicales , Craneotomía , Retraso en el Despertar Posanestésico/etiología , Duramadre/lesiones , Femenino , Trastornos Neurológicos de la Marcha/etiología , Hematoma Epidural Craneal/fisiopatología , Hematoma Epidural Craneal/cirugía , Hemostasis Quirúrgica , Humanos , Oxigenoterapia Hiperbárica , Hipoxia Encefálica/etiología , Hipoxia Encefálica/terapia , Hipotensión Intracraneal/etiología , Imagen por Resonancia Magnética , Neoplasias Meníngeas/complicaciones , Neurilemoma/complicaciones , Paresia/etiología , Complicaciones Posoperatorias/fisiopatología , Complicaciones Posoperatorias/cirugía , Respiración Artificial , Compresión de la Médula Espinal/etiologíaAsunto(s)
Accidentes por Caídas/prevención & control , Estimulación Acústica , Adulto , Craneotomía , Diagnóstico Diferencial , Electroencefalografía , Electromiografía , Hematoma Epidural Craneal/patología , Hematoma Epidural Craneal/cirugía , Humanos , Imagen por Resonancia Magnética , Masculino , Fracturas Craneales/patología , Grabación en VideoRESUMEN
No disponible
No disponible
Asunto(s)
Masculino , Humanos , Anticoagulantes/efectos adversos , Terapia por Estimulación Eléctrica , Electrodos Implantados/efectos adversos , Enoxaparina/efectos adversos , Neuralgia/terapia , Paraplejía/etiología , Complicaciones Posoperatorias/etiología , Compresión de la Médula Espinal/etiología , Hematoma Epidural Craneal/etiología , Corticoesteroides/uso terapéutico , Antiinflamatorios/uso terapéutico , Anticoagulantes/administración & dosificación , Terapia Combinada , Drenaje , Enoxaparina/administración & dosificación , Complicaciones Posoperatorias/inducido químicamente , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/cirugía , Hematoma Epidural Craneal/inducido químicamente , Hematoma Epidural Craneal/complicaciones , Hematoma Epidural Craneal/tratamiento farmacológico , Hematoma Epidural Craneal/cirugíaRESUMEN
Posttraumatic spinal epidural hematoma is an unusual pathology. The authors report the case of a 64-year-old woman who experienced thoracic epidural hematoma during a session of spinal manipulation therapy (SMT). In the literature, such an event has been reported previously only twice. This case represents the first spinal epidural hematoma occurring after a chiropractic manipulation in the lumbar region. Surgical evacuation of the spinal hematoma resulted in complete recovery in the patient. Complications of SMT are reviewed, and the etiology and features of spinal epidural hematoma are discussed.
Asunto(s)
Hematoma Epidural Craneal/etiología , Manipulación Espinal/efectos adversos , Vértebras Torácicas , Femenino , Hematoma Epidural Craneal/cirugía , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Compresión de la Médula Espinal/etiologíaRESUMEN
OBJECTIVE AND IMPORTANCE: Posttraumatic spinal epidural hematoma is an uncommon entity. We present the first report of spinal epidural hematoma occurring after chiropractic manipulation in a healthy young adult without preexisting cervical disease or any obvious predisposing factors. CLINICAL PRESENTATION: The patient presented with radicular and myelopathic symptoms that developed 15 minutes after chiropractic manipulation. Computed tomography and magnetic resonance imaging were performed. They revealed a cervical epidural hematoma. INTERVENTION: The hematoma was evacuated, and all of the patient's neurological symptoms improved over the course of the next 3 days. CONCLUSION: Although cervical spinal epidural hematoma is a rare clinical entity, it must be considered in patients with pain or neurological deficit after cervical trauma.
Asunto(s)
Quiropráctica/efectos adversos , Hematoma Epidural Craneal/etiología , Adulto , Femenino , Hematoma Epidural Craneal/diagnóstico , Hematoma Epidural Craneal/cirugía , Humanos , Imagen por Resonancia Magnética , Cuello , Tomografía Computarizada por Rayos XRESUMEN
The authors report a case of spontaneous spinal epidural hematoma causing paraplegia secondary to a qualitative platelet disorder from excessive garlic ingestion. The case also demonstrates satisfactory recovery from thoracic spinal epidural hematoma in a nonagenarian. Recovery from severe spinal cord compression can occur even in the very elderly.
Asunto(s)
Trastornos de las Plaquetas Sanguíneas/complicaciones , Ajo/efectos adversos , Hematoma Epidural Craneal/etiología , Plantas Medicinales , Anciano , Anciano de 80 o más Años , Dieta , Hematoma Epidural Craneal/cirugía , Humanos , MasculinoRESUMEN
Post-traumatic cervical epidural hematoma is an uncommon entity. A case is presented in which such a lesion developed after chiropractic manipulation of the neck. The patient presented with a Brown-Séquard syndrome, which has only rarely been reported in association with cervical epidural hematoma. The correct diagnosis was obtained by computed tomographic scanning. Surgical evacuation of the hematoma was followed by full recovery.
Asunto(s)
Hematoma Epidural Craneal/complicaciones , Parálisis/etiología , Enfermedades de la Médula Espinal/complicaciones , Heridas y Lesiones/complicaciones , Accidentes de Tránsito , Anciano , Anciano de 80 o más Años , Quiropráctica , Hematoma Epidural Craneal/etiología , Hematoma Epidural Craneal/cirugía , Humanos , Masculino , Cuello , Síndrome , Tomografía Computarizada por Rayos XRESUMEN
The pathophysiology and outcome following severe head injury in 85 children are presented. The commonest initial CT diagnosis was of acute brain swelling. This swelling was associated with an increased white matter density on the CT scan which decreased to normal concomitant with recovery and increased ventricular size. CBF measurements in 6 of these patients revealed an increased blood flow despite a decreased CMRO2 and clinical coma. This CT pattern of diffuse swelling is believed to be due to acute cerebrovascular congestion and hyperemia and not to edema. Because of this, all children were treated with endotracheal intubation and controlled hyperventilation as part of the initial management. Mass lesions were uncommon, 20%. ICP was monitored in 40 children. The ICP rose above 20 Torr despite therapy in 80% of children with decerebrate or flaccid coma and in only 20% of children with spontaneous motor function. The ICP was at its highest between the second and fifth day. Aggressive therapy to control the ICP, with barbiturates if necessary, was successful in 80% of the patients. The overall results were useful recovery in 87.5% of the children, 3.5% were left vegetative or severely disabled and 9% died.