Dural metastasis of prostate carcinoma misdiagnosed as a bilateral subdural hematoma: A case report / Metástasis dural de carcinoma de próstata mal diagnosticado como hematoma subdural bilateral: informe de un caso

Dural metastases originating from prostate cancer are exceedingly uncommon and may clinically imitate a subdural hematoma. Additionally, head computed tomography scan findings can be mistaken for meningioma or subdural hematoma. We present a 75-year-old male patient with dural metastasis as a first presenting sign of prostate cancer, misdiagnosed as a bilateral subdural hematoma on initial non-contrast brain CT scan. Also, a review of literature is presented. We found 12 cases of dural metastasis of prostate cancer mimicking subdural hematoma described in the literature, and unlike in our case, prostate cancer was already diagnosed (AU)

Las metástasis durales originadas por el cáncer de próstata son muy poco frecuentes y pueden parecerse clínicamente a un hematoma subdural. Además, los hallazgos en las tomografías computarizadas de la cabeza pueden confundirse con un meningioma o un hematoma subdural. Presentamos el caso de un paciente varón de 75 años con metástasis dural como primer signo de presentación de cáncer de próstata, mal diagnosticado como un hematoma subdural bilateral en la TAC cerebral inicial sin contraste. A su vez, se presenta una revisión de la bibliografía. En la bibliografía encontramos 12 casos de metástasis dural de cáncer de próstata que se asemejaban a un hematoma subdural y, a diferencia de nuestro caso, el cáncer de próstata ya estaba diagnosticado (AU)

Abusive head trauma: evidence, obfuscation, and informed management.

Abusive head trauma remains the major cause of serious head injury in infants and young children. A great deal of research has been undertaken to inform the recognition, evaluation, differential diagnosis, management, and legal interventions when children present with findings suggestive of inflicted injury. This paper reviews the evolution of current practices and controversies, both with respect to medical management and to etiological determination of the variable constellations of signs, symptoms, and radiological findings that characterize young injured children presenting for neurosurgical care.

Spontaneous Intracranial and Lumbar Subdural Hematoma Presenting as Vaginal Pain.

BACKGROUND: Spontaneous spinal and intracranial subdural hematomas are rarely reported, especially occurring simultaneously. Anticoagulation use has been associated with spontaneous hemorrhages. Prompt diagnosis is required to prevent permanent neurological sequelae. In this case report, we describe a spontaneous spinal and intracranial subdural hematoma in a woman taking warfarin and initially presenting with severe vaginal pain. CASE REPORT: A 42-year-old woman who had a history of mechanical valve replacement and was therefore taking warfarin, came to an emergency department for relief of severe vaginal pain. Mild concurrent lumbar pain increased concern about spinal pathology, so magnetic resonance imaging of her spine was performed. It revealed a subdural hematoma extending from L1-S1 with arachnoiditis, which suggested intracranial pathology, though the patient had no complaint of a headache. Computed tomography of her brain demonstrated a large right subdural hemorrhage with midline shift. Subsequent imaging revealed no aneurysm or source of the intracranial bleeding. We concluded that the patient experienced spontaneous anticoagulation-related intracranial hemorrhage resulting in lumbar subdural hematoma and arachnoiditis with referred vaginal pain. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Pelvic, vaginal, or perineal pain may be the presenting symptom in patients with lower spinal pathology. It is important to consider causes other than gynecological ones in the differential diagnosis of these patients, as well as to be cognizant of the relationship between spinal and intracranial subdural hemorrhages. In patients with back pain or radiating lumbar pain, especially coupled with neurological effects, clinicians should consider spinal subdural hemorrhage and arachnoiditis to expedite imaging studies and treatment of these rare entities.

Aspirin treatment does not increase microhemorrhage size in young or aged mice.

Microhemorrhages are common in the aging brain and are thought to contribute to cognitive decline and the development of neurodegenerative diseases, such as Alzheimer's disease. Chronic aspirin therapy is widespread in older individuals and decreases the risk of coronary artery occlusions and stroke. There remains a concern that such aspirin usage may prolong bleeding after a vessel rupture in the brain, leading to larger bleeds that cause more damage to the surrounding tissue. Here, we aimed to understand the influence of aspirin usage on the size of cortical microhemorrhages and explored the impact of age. We used femtosecond laser ablation to rupture arterioles in the cortex of both young (2-5 months old) and aged (18-29 months old) mice dosed on aspirin in their drinking water and measured the extent of penetration of both red blood cells and blood plasma into the surrounding tissue. We found no difference in microhemorrhage size for both young and aged mice dosed on aspirin, as compared to controls (hematoma diameter = 104 +/- 39 (97 +/- 38) µm in controls and 109 +/- 25 (101 +/- 28) µm in aspirin-treated young (aged) mice; mean +/- SD). In contrast, young mice treated with intravenous heparin had an increased hematoma diameter of 136 +/- 44 µm. These data suggest that aspirin does not increase the size of microhemorrhages, supporting the safety of aspirin usage.

Prognostic significance of hematoma thickness to midline shift ratio in patients with acute intracranial subdural hematoma: a retrospective study.

Acute intracranial subdural hematoma (ASDH) is commonly associated with a grave prognosis citing a high incidence of morbidity and mortality. The parameters to decide on surgical evacuation of the hematoma are sometimes controversial. In this study, we theorized that the ratio between maximal hematoma thickness and midline shift would be varied by associated intrinsic brain pathology emanating from the trauma and would thus objectively evaluates the prognosis in ASDH. The records of patients diagnosed with ASDH who were submitted to surgical evacuation through a craniotomy were revised. Data collected included basic demographic data, preoperative general and neurological examinations, and radiological findings. The maximal thickness of the hematoma (H) on the preoperative CT brain was divided by the midline shift at the same level (MS) formulating the H/MS ratio. Postoperative data obtained included Glasgow Coma Scale (GCS), Glasgow Outcome Scale (GOS), and follow-up period. Sixty-seven eligible patients were included in the study, of which 53 (79.1%) patients were males. Mean age was 34 years. The H/MS ratio ranged from 0.69 to 1.8 with a mean of 0.93. Age above 50 years (P = 0.0218), admission GCS of less than 6 (0.0482), and H/MS ratio of 0.79 or less (P = 0.00435) were negative prognostic factors and correlated with a low postoperative GCS and GOS. H/MS ratio is a useful prognostic tool in patients diagnosed with ASDH and can be added to the armamentarium of data to improve the management decision in this cohort of patients.

Role of surgery in the management of patients with supratentorial spontaneous intracerebral hematoma: Critical appraisal of evidence.

BACKGROUND: Whether surgery improves the outcome more than medical management alone continues to be a subject of intense debate and controversy. However, there is optimism that the management of spontaneous supratentorial intracerebral haemorrhage will change in future based new insight and better understanding of the acute pathophysiology of hematomas and its dynamics. Craniotomy as a surgical approach has been the most studied intervention for spontaneous supratentorial intracerebral haemorrhage but with no significant benefit when compared to best medical management. METHOD: A literature search was conducted using electronic data bases including the Cochrane Central Register of Controlled Trials (CENTRAL) on the Cochrane library, MEDLINE and EMBASE. In addition, critical appraisal of most current evidences was carried out. RESULT: About 1387 articles identified through database search over 10-year period of which one systematic review and two randomised controlled trials most relevant to this review were critically appraised. CONCLUSION: The role of surgery in the management of spontaneous intracerebral haemorrhage still remains a matter of debate. There is insufficient evidence to justify a general policy of early surgery for patients with spontaneous intracerebral haemorrhage compared to initial medical management but STICH did demonstrate that patients with superficial hematoma might benefit from craniotomy.

Twist Drill Procedure for Chronic Subdural Hematoma Evacuation: An Analysis of Predictors for Treatment Success.

BACKGROUND: Twist drill craniostomy (TDC) is a minimally invasive and cost-effective technique to treat chronic subdural hematomas (CSDHs). Predictors for treatment success such as imaging characteristics, hematoma volume, and drainage volume are not established; thus, they are purpose of this analysis. MATERIAL AND METHODS: We retrospectively evaluated all data of patients with CSDH undergoing TDC in our institution between January 2010 and December 2013. We analyzed imaging characteristics (extension and composition), volumetrically calculated pre- and postoperative hematoma volumes, measured drainage volume, and clinical course. Primary treatment success was defined as sufficient if definitive treatment was achieved via a single TDC (TDC-1) and insufficient if more than one TDC was needed. The need for open surgical evacuation was defined as treatment failure. RESULTS: Data of 233 patients undergoing 387 TDCs were available for our study. A total of 67% of TDCs treated CSDHs effectively, whereas the remainder required further open surgical evacuation. Via use of the median-split-method, we found that sufficient treatment was achieved more frequently in smaller hematomas (P < 0.05). Treatment effectiveness was neither correlated with hematoma image characteristics (presence of membranes: P = 0.11, extent of chronification: P = 0.55) nor with the respective drainage volume (P = 0.95). Residual hematoma volume was consistently greater than expected by drainage calculation (P < 0.05). CONCLUSIONS: TDC is an effective treatment option for CSDH. Sufficient treatment with single TDC was more common in smaller hematomas with an associated smaller residual hematoma. Failure of brain re-expansion after TDC may increase the treatment failure rates. In these cases, an open surgical evacuation might accelerate treatment and clinical recovery.

Fatal endocarditis with methicilin-sensible Staphylococcus aureus and major complications: rhabdomyolysis, pericarditis, and intracerebral hematoma: A case report and review of the literature.

BACKGROUND: Over the last decades Staphylococcus aureus (SA) has become the dominant etiology of native valve infective endocarditis, with the community-acquired methicillin-sensible Staphylococcus aureus (CA-MSSA) strains being the prevailing type. CASE: We report here a case of extremely severe CA-MSSA aortic valve acute endocarditis associated with persistent Staphylococcus aureus bacteremia (SAB) in a previously healthy man and include a literature review.The patient developed severe and rare complications (purpura, purulent pericarditis, intracerebral hematoma, and rhabdomyolysis) through systemic embolism; they required drainage of pericardial empyema and cerebral hematoma, the latter eventually caused a fatal outcome. The strains recovered from sequential blood culture sets and pericardial fluid were MSSA negative for genes encoding for staphylococcal toxic shock syndrome toxin (TSST)-1 and Panton-Valentine leukocidin. C, G, and I enterotoxin genes were detected. CONCLUSIONS: This case with unusually severe evolution underlines the limited ability of vancomycin to control some MSSA infections, possibly due to potential involvement of SA virulence factors, hence the importance of clinical vigilance for community SAB cases.

Hematoma espontáneo crónico del diploe / Chronic spontaneous diploic haematoma

No disponible

Delayed Onset Intracranial Subdural Hematoma Following Spinal Surgery.

In this case-based review, the authors analyzed relevant literature with an illustrative patient of theirs about subdural hematoma secondary to dural tear at spinal surgery. Intracranial hypotension is a condition of decreased cerebrospinal fluid volume and pressure. Even though intracranial hypotension is temporary and can be managed conservatively, it may progress and result in subdural fluid collections, hematoma formations, "brain sagging or slumping" states, syringohydromyelia, encephalopathy, coma, and even death. The authors present an 81-year-old man admitted with subdural hematoma 50 days following previous spinal surgery for lumbar spinal stenosis. In his previous spinal surgery he had had dural tear, which had been closed primarily. To the literature, only 21 patients have been reported to develop subdural hematoma following spinal surgery. In patients with subdural hematoma following spinal surgery, the female:male ratio was 3:4 and the median age was 55 years. Surgical diagnoses for previous spinal surgeries were intervertebral disc herniation (5), spinal canal stenosis and spondylolisthesis (6), failed back syndrome (2), tethered cord syndrome and myelodysplastic spine (2), spinal cord tumor, spinal epidural hematoma, vertebral dislocation, vertebral fracture, vertebral tumor, and inflammatory spine. Patients presented with signs and symptoms of subdural hematoma within 6 hours to 50 days following the spinal surgery. Source of cerebrospinal fluid leak was most commonly from lumbar region (13 patients, 62%). Ten of 21 (48%) patients were treated conservatively. Late-onset neurological findings should not prevent the evaluation of cranial vault with computed tomography and magnetic resonance imaging. Spinal dural tear should be more aggressively treated instead of suture alone approach, when recognized in older patients during the spinal surgery.

Dislocated Pacemaker Electrode Simulating Focal Epileptic State in a Patient with Subdural Hematoma-Case Report and Review of the Literature.

BACKGROUND: Due to demographic changes, the number of patients with traumatic brain injury carrying a cardiac resynchronization therapy device is increasing. One of the common complications of subdural hematoma (SDH) is epilepsy, whereas one of the most frequent early complications after cardiac resynchronization therapy device implantation is lead dislocation. The latter might then cause unintended skeletal muscle stimulation that might be misinterpreted in seizure-prone patients. CASE DESCRIPTION: An 86-year-old female patient with an initially conservatively treated SDH on the right side presented with a tonic muscle contraction in her left arm 2 weeks after the trauma not responding to antiepileptic therapy. A computed tomography scan revealed residual hematoma on the right side with regular, time-dependent resorption. The muscle contraction was misdiagnosed as a focal epileptic state leading to evacuation of the chronic SDH. Additionally, routine postoperative chest radiographs were performed. Postoperatively, the tonic muscle contraction in her arm persisted. Chest radiographs revealed a dislocation of the left ventricular electrode, which appeared retracted into the left subclavian vein, next to the plexus brachialis. After deactivating the electrode, the alleged focal state ceased. CONCLUSIONS: In case of refractory treatment of epilepsy, dislocation of pacemaker electrodes is a, most certainly, rare but possible differential diagnosis. Confirmation of electrode position and function is easily and quickly feasible and will help prevent futile seizure-directed therapy.

Spontaneous retroclival hematoma: a case series.

OBJECTIVE: Retroclival hematomas are rare, appearing mostly as posttraumatic phenomena in children. Spontaneous retroclival hematoma (SRH) in the absence of trauma also has few descriptions in the literature. None of the reported clinical cases features the combination of an SRH and intraventricular hemorrhage (IVH). Nevertheless, despite extensive cases of idiopathic or angiographically negative subarachnoid hemorrhage (SAH) of the posterior fossa, only a single case report of a patient with a unique spontaneous retroclival hematoma has been identified. In this study, the authors reviewed the presentation, management, and clinical outcome of this rare entity. METHODS: The authors performed a retrospective analysis of all patients with diagnosed SRH at their institution over a 3-year period. Collected data included clinical history, laboratory results, treatment, and review of all imaging studies performed. RESULTS: Four patients had SRH. All were appropriately evaluated for coagulopathic and/or traumatic etiologies of hemorrhage, though no etiology could be found. Moreover, all of the patients demonstrated SRH that both clearly crossed the basioccipital synchondrosis and was contained within a nondependent configuration along the retroclival dura mater. CONCLUSIONS: Spontaneous retroclival hematoma, often associated with IVH, is a rare subtype of intracranial hemorrhage frequently recognized only when MRI demonstrates compartmentalization of the posterior fossa hemorrhage. When angiography fails to reveal an underlying lesion, SRH patients, like patients with traditional angiographically negative SAH, enjoy a remarkably good prognosis.

A calvarial acute subdural hematoma migrating into the spinal canal in a young male.

It is not common for an acute subdural hematoma (SDH) in the supratentorial region to show rapid resolution or migration during the clinical course. In this report, we present a rare case where the SDH in the supratentorial region was observed to rapidly migrate into the lumbar spinal canal, leading to severe radiculopathy. A 20-year-old male patient was admitted to the emergency department with severe headache after head trauma. The patient's overall condition was good, whereas his Glasgow Coma Scale score was 15 and blood pressure was normal. He had vomited 3 times after the onset of pain. No stiff neck was found, and the computed tomography showed an ASDH over the outer layer of the right hemisphere, causing a 7- to 8-mm shift. During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. Acute SDH associated with a minor head trauma may migrate from the supratentorial compartment into the spinal canal by the help of elastic cerebral tissues in young adults and children.

Coexistence of spontaneous spinal and undiagnosed cranial subdual hematomas.

Spinal subdual hematoma (SDH) is an uncommon pathology, and its simultaneous occurrence with cranial SDH is even rarer. We report a unique case of spinal SDH combined with bilateral intracranial SDH, in which the cranial lesion was detected after the evacuation of spinal SDH. The undiagnosed chronic SDH developed acute-on-chronic SDH after the evacuation of spinal SDH. The patient had an uneventful clinical course, and a satisfactory outcome was achieved. The reason for reporting this case is to draw attention to the possibility of concurrent cranial SDH in patients with unexplained spinal SDH. The removal of the spinal SDH may exacerbate intracranial hemorrhage and consequently lead to the potential occurrence of tentorial herniation in patients with accompanied cranial SDH.

Organized hematoma developed after suboccipital craniectomy.

An organized hematoma shows a heterogeneous signal intensity on T1-and T2-weighted images on MR imaging, reflecting variable stages of hemorrhage. Although rather nonspecific, precontrast CT images of an organized hematoma demonstrate inhomogeneous hyperdense mass with or without calcification. We report a case of an organized hematoma in a 44-year-old man, which developed 5 years after decompressive suboccipital craniectomy following acute cerebellar infarction. To our best knowledge, there has been no report describing organized hematoma in the suboccipital craniectomy site. Computed tomography and magnetic resonance imaging findings of the organized hematoma are shown and discussed. We believe that recognition of the characteristic imaging findings of the organized hematoma as well as consideration of the history of surgery or anticoagulation treatment assists in its correct diagnosis enabling an inappropriate surgery to be avoided.