Paradoxical herniation associated with hyperbaric oxygen therapy after decompressive craniectomy: A case report.

BACKGROUND: Whether hyperbaric oxygen therapy (HBOT) can cause paradoxical herniation is still unclear. CASE SUMMARY: A 65-year-old patient who was comatose due to brain trauma underwent decompressive craniotomy and gradually regained consciousness after surgery. HBOT was administered 22 d after surgery due to speech impairment. Paradoxical herniation appeared on the second day after treatment, and the patient's condition worsened after receiving mannitol treatment at the rehabilitation hospital. After timely skull repair, the paradoxical herniation was resolved, and the patient regained consciousness and had a good recovery as observed at the follow-up visit. CONCLUSION: Paradoxical herniation is rare and may be caused by HBOT. However, the underlying mechanism is unknown, and the understanding of this phenomenon is insufficient. The use of mannitol may worsen this condition. Timely skull repair can treat paradoxical herniation and prevent serious complications.

Rapid absorption of frontal lobe contusion and laceration with hematoma: A case report and review of literature.

RATIONALE: It is rare for a traumatic intracranial hematoma to self-absorb rapidly after conservative treatment. To the best of our knowledge, there has been no report in the relevant literature of rapid absorption of hematoma formation following cerebral contusion and laceration. PATIENT CONCERNS: A 54-year-old male was admitted to our hospital with head trauma at 3 hours prior to admission. He was alert and oriented, glasgow coma scale score of 15. Head computed tomography (CT) showed left frontal brain contusion with hematoma, however, a reexamination of CT about 29 hours following the trauma revealed that the hematoma had been absorbed. DIAGNOSES: A diagnosis of contusion and laceration of left frontal lobe with hematoma formation was made based on the CT images. INTERVENTIONS: The patient underwent conservative treatment. OUTCOMES: After treatment, dizziness and headache subsided for the patient, and no special discomfort was reported. LESSONS: It is likely that the reason for rapid absorption in this case is that the hematoma is prone to liquefaction because of abnormal platelet values and coagulation dysfunction. As the liquefaction hematoma breaks into the lateral ventricle, it is redistributed and absorbed in the lateral ventricle and subarachnoid space. Further evidence is required to support this hypothesis.

Accuracy of Susceptibility-Weighted Imaging and Dynamic Susceptibility Contrast Magnetic Resonance Imaging for Differentiating High-Grade Glioma from Primary Central Nervous System Lymphomas: Meta-Analysis.

BACKGROUND AND PURPOSE: It is always a great challenge to distinguish high-grade glioma (HGG) from primary central nervous system lymphoma (PCNSL). We conducted a meta-analysis to assess the performance of dynamic susceptibility contrast (DSC) and susceptibility-weighted imaging (SWI) in differentiating HGGs from PCNSLs. METHODS: Heterogeneity and threshold effect were evaluated, and sensitivity, specificity (SPE), and areas under the summary receiver operating characteristic curve (SROC) were calculated. RESULTS: Thirteen studies with a total of 704 participants were included in this meta-analysis. For the dynamic susceptibility contrast (DSC) technique, the pooled sensitivity and SPE were 0.94 and 0.84, respectively. The area under the curve (AUC) under the SROC was 0.9595, and the diagnostic odds ratio was 81.880. For the susceptibility weighted imaging (SWI) technique, the pooled sensitivity and SPE were 0.92 and 0.87, respectively. The AUC under the SROC was 0.9608, and the diagnostic odds ratio was 89.774. A Z test showed that no significant difference in AUC values between DSC and SWI (P = 0.97) was observed. In addition, no obvious public bias was observed in both the DSC (P = 0.69) and SWI (P = 0.32) groups. CONCLUSIONS: This meta-analysis indicated that both DSC-MRI and SWI have a high and similar level of diagnostic accuracy for differentiating HGGs from PCNSLs.