Subdural hematoma in alcoholic patients / Hematoma subdural en pacientes alcohólicos

A subdural hematoma is a collection of blood between the duramater, which is the membrane that covers the brain, and the arachnoid, one of the layers of the meninges; it is due to the traumatic rupture of venous vessels that cross the subdural space, therefore a separation takes place between the layers of the arachnoid and the duramater. The objective was to determine the type of subdural hematoma in alcoholic patients. An observational cross-sectional descriptive study was carried out in the General University Provincial Hospital Carlos Manuel de Céspedes, in the period from December 2017 to September 2018. The population studied 13 alcoholic patients who met the criteria of inclusion. The group of 40 to 50 years with seven patients predominated; 53,84 percent of those studied had acute subdural hematoma, and the most affected side of the brain was the left which represents the 46,15 percent. It is concluded that the acute subdural hematoma, with involvement of the left side of the brain, is more frequent in alcoholic patients(EU)

Un hematoma subdural es una acumulación de sangre entre la duramadre, que es la membrana que cubre el cerebro, y la aracnoides, una de las capas de las meninges; se debe a la rotura traumática de vasos venosos que atraviesan el espacio subdural, por lo tanto se produce una separación entre las capas de la aracnoides y la duramadre. El objetivo fue determinar el tipo de hematoma subdural en pacientes alcohólicos. Se realizó un estudio observacional descriptivo transversal, en el Hospital Provincial General Universitario Carlos Manuel de Céspedes, en el período de diciembre de 2017 a septiembre de 2018. La población de estudio fue de 13 pacientes alcohólicos que cumplieron con los criterios de inclusión. Predominó el grupo de 40 a 50 años con siete pacientes; el 53,84 por ciento de los estudiados presentaron hematoma subdural agudo, y el lado del cerebro más afectado fue el izquierdo con el 46,15 por ciento. Se concluye que el hematoma subdural agudo, con afectación del lado izquierdo del cerebro, es más frecuente en los pacientes alcohólicos(AU)

Traumatic Brain Injury Profile of an Elderly Population in Puerto Rico.

OBJECTIVE: Describe the types of traumatic brain injury secondary to falls sustained by the members of an elderly population who received services at the Puerto Rico Medical Center and the demographic profile of that population. METHODS: A group of 332 adults (60 years and over) assessed for traumatic brain injury secondary to falls suffered in 2013 were included in the analysis. The cases were retrieved from the computerized database of the Neurosurgery Section. We analyzed information such as age, gender, type of traumatic brain injury, mechanism of injury, and the performance of surgery (if applicable). Descriptive analysis was performed to derive a general profile of elderly adults who presented with traumatic brain injury secondary to falls. RESULTS: The sample consisted of 332 elderly adults: 73% were men and 27% were women. The mean age was 76.74 (SD=9.95) years: 75.67 (SD=9.78) for men and 79.13 (SD=10.02) for women. The most common traumatic brain injury was subdural hematoma (51%) and the mechanism of injury most prevalent was the groundlevel fall (83%). Other traumatic brain injuries included traumatic subarachnoid hemorrhages (14%), cerebral contusions (18%) and epidural hematomas (3%). Of all the cases, 52% had were managed surgically. CONCLUSION: The elderly population is growing and the risk of falls increases with advancing age. Recurrent falls are an important cause of morbidity, and mortality rates oscillate from 6 to 18%. Elderly patients have longer rehabilitation times, incur more expenses, and have greater levels of disability. This study provides a platform for future epidemiological studies to help develop strategies for the prevention of traumatic brain injury in older adults.

Chronic and subacute subdural hematoma in the adult population: the Puerto Rico experience

OBJECTIVE: The purpose of this investigation was to study the epidemiology of chronic and subacute subdural hematoma in an adult population and associated factors such as treatment, recurrence, seizures, complications, and outcome. METHODS: We retrospectively reviewed 267 consecutive cases operated for a suspected diagnosis of chronic or subacute subdural hematoma during a six-year period. RESULTS: An incorrect diagnosis was done in 12 of the cases (4.5 per cent) giving a total of 255 cases of chronic or subacute subdural hematoma. The mean age of the patients was 68-year old. Two-thirds of the cases were chronic and one-third were subacute. A history of head trauma was identified in 79 per cent of the patients occurring more frequently in the subacute group. The hematoma was bilateral in 16 per cent of the patients. Recurrence occurred in 7.8 per cent of the cases, but there was no significant difference between chronic and subacute cases nor the type of operation done. Postoperative seizures occurred in 6.2 per cent of the cases. Preoperative seizures are not associated to the development of postoperative seizures. A postoperative intracerebral hematoma occurred in 2.7 per cent of the patients and was associated in most of the cases with a poor outcome. The morbidity rate was 9 per cent and the mortality rate was 0.9 per cent. Outcome is good in 95 per cent of the patients. CONCLUSIONS: Chronic subdural hematoma occurs more frequently than subacute subdural hematoma. Surgical treatment modality and the use of a drain do not change the recurrence rate. Preoperative seizures are not associated to the development of postoperative seizures. The use of postoperative prophylactic antiepileptic drugs does not decrease the postoperative seizure rate even in the alcoholic patient, therefore, their prophylactic use is not indicated.

Chronic and subacute subdural hematoma in the adult population. The Puerto Rico experience.

OBJECTIVE: The purpose of this investigation was to study the epidemiology of chronic and subacute subdural hematoma in an adult population and associated factors such as treatment, recurrence, seizures, complications, and outcome. METHODS: We retrospectively reviewed 267 consecutive cases operated for a suspected diagnosis of chronic or subacute subdural hematoma during a six-year period. RESULTS: An incorrect diagnosis was done in 12 of the cases (4.5%) giving a total of 255 cases of chronic or subacute subdural hematoma. The mean age of the patients was 68-year old. Two-thirds of the cases were chronic and one-third were subacute. A history of head trauma was identified in 79% of the patients occurring more frequently in the subacute group. The hematoma was bilateral in 16% of the patients. Recurrence occurred in 7.8% of the cases, but there was no significant difference between chronic and subacute cases nor the type of operation done. Postoperative seizures occurred in 6.2% of the cases. Preoperative seizures are not associated to the development of postoperative seizures. A postoperative intracerebral hematoma occurred in 2.7% of the patients and was associated in most of the cases with a poor outcome. The morbidity rate was 9% and the mortality rate was 0.9%. Outcome is good in 95% of the patients. CONCLUSIONS: Chronic subdural hematoma occurs more frequently than subacute subdural hematoma. Surgical treatment modality and the use of a drain do not change the recurrence rate. Preoperative seizures are not associated to the development of postoperative seizures. The use of postoperative prophylactic antiepileptic drugs does not decrease the postoperative seizure rate even in the alcoholic patient, therefore, their prophylactic use is not indicated.

Hematomas subdurales crónicos / Chronic subdural hematomas

Se revisan los conceptos clásicos sobre la fisiopatogenia de los hematomas subdurales crónicos y se confrontan con los nuevos que cuestionan la existencia del espacio subdural como tal, y con la nueva evidencia, la cual demuestra que el crecimiento de los hematomas subdurales crónicos se debe a hemorragias repetidas dentro de la cápsula, secundarias a alteración de la coagulación, como había sido propuesto por Putman y Cushing en 1925, y producidas por aumento de actividad fibrinolítica, según se ha demostrado recientemente. Se revisaron las historia clínicas de los pacientes con hematomes subdurales crónicos operados en la Fundación Santafé de Bogotá. De los 69 hematomas crónicos, 21 (30.43 por ciento) fueron bilaterales y 48 (69.56 por ciento) unilaterales; 51 (74 por ciento) ocurrieron en pacientes de sexo masculino y 18 (26 por ciento) en el femenino. El promedio de edad fue de 58 años; 56 para los hombres y 63 para las mujeres. Soló el 75 por ciento tenían antecedentes de traumatismo y el promedio de tiempo entre éste y el diagnóstico fue de 38 días; el 9 por ciento de los pacientes no presentaron síntomas orgánicas y se hace énfasis en que algunos pacientes con hematomas la sintomatología puede simular afecciones psiquiátricas, lo cual dificulta el diagnóstico; 38 de nuestros pacientes presentaron síntomas mentales. El examen de elección para el diagnóstico es la escanografía cerebral, pero en algunos casos, cuando el hematoma es isodenso y bilateral, puede ser interpretado erróneamente. Uno de los problemas en el tratamiento de los hematomas subdurrales crónicos es la posibilidad de reproducción, que fluctúa entre el 5 y el 37 por ciento; en nuestra serie fue del 10 por ciento.

Update of 156 episodes of central nervous system bleeding in hemophiliacs.

Between 1960 and 1991, 156 episodes of central nervous system (CNS) bleeding were documented in 106 patients from a total population of 1,410 hemophiliacs (7.5%). Ninety-one hemophilia A patients presented 131 bleeding episodes; 15 hemophilia B patients had 25 episodes. 32% of these episodes took place in patients less than 5 years of age. 46% were age 10 or less, and 72% were age 20 or less. The mean age was 14.8 years in hemophilia A and 9 years in hemophilia B patients. A significant increase in the mean age of hemophilia A patients has been observed over the last 10 years; this may be related to HIV infection. A history of recent trauma was documented in 39.7% of the episodes. Spontaneous CNS bleeding was predominant in severe hemophilia (85.2%). One hundred and fifty-four CNS bleeding episodes were intracranial and 2 intraspinal. Of the intracranial episodes, 37.7% were subarachnoid, 29.8 subdural, and 22.7% intracerebral. Factor VIII or IX inhibitors were present in 11.3% of the patients; this figure is slightly lower than that observed in our total hemophilic population. Over 50% of the patients had psychoneurological sequelae; the most frequent were seizure disorders and motor impairment. The overall mortality rate was 29.2%. The mortality was more closely related to the CNS bleeding site than to the severity of hemophilia. Treatment should be based on prompt and prolonged replacement therapy to ensure hemostatic levels of antihemophilia factors.

Hematomas subdurales cronicos / Chronic subdural hematomas

Los autores presentan las manifestaciones clinicas, los hallazgos escanograficos y los resultados del tratamiento quirurgico en 90 pacientes con hematomas subdurales cronicos supratentoriales atendidos entre 1973 y 1980. La mayor proporcion ocurrio despues de los 50 anos en hombres quienes habian sufrido traumatismos leves o moderados entre uno y dos meses antes del comienzo de cefalea, trastornos motores, cambios mentales, principalmente. Dos pacientes tuvieron el cuadro de un accidente cerebrovascular y dos presentaron solamente cefalea con examen neurologico normal. La escanografia en 45 casos mostro 51% isodensos entre ellos 4 bilaterales, 42% hipodensos y 6.6 hiperdensos. Se presentaron diez recurrencias de ellas dos pacientes murieron en el post-operatorio.

Chronic subdural haematoma: a clinical survey

Seventy-four cases of proven chronic subdural haematoma seen at the University Hospital of the West Indies between 1962 and 1971, were reviewed. The main problem associated with this condition remains one of diagnosis. The increasing incidence with age, and the increasing age and incidence of trauma in the population add to the relevance of a study of this condition. The clinical features are diversed and, for the most part non-specific; thus, the basis for initiating the diagnosis is still an adequate history and a high index of suspicion. Any patient with a history of trauma, presenting with headache, weakness, fluctuating changes in conscious level, or any combination of these features, should be investigated to rule out chronic subdural haematoma. Of various special investigations, carotid angiography proved to be the most useful. Simple burr hole evacuation was adequate treatment in 88 percent of the patients, only a minority requiring a more major neurosurgical procedure. The ultimate prognosis of patients with this condition is good, provided diagnosis is made early and treatment is prompt and adequate (AU)