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1.
BMJ Case Rep ; 15(11)2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36375855

RESUMO

The literature on the anaesthetic management of a toddler presenting to the emergency department with an acute epidural haematoma with an uncorrected tetralogy of Fallot is sparse and management can be challenging. The main anaesthetic goals are to increase or maintain systemic vascular resistance and decrease pulmonary vascular resistance for cardiovascular stability, while maintaining cerebral perfusion pressure and decreasing intracranial pressure for cerebral protection. Thus, a balanced approach is desirable while managing such cases from emergency to the intensive care unit.


Assuntos
Anestésicos , Hematoma Epidural Craniano , Hematoma Epidural Espinal , Tetralogia de Fallot , Pré-Escolar , Humanos , Tetralogia de Fallot/complicações , Tetralogia de Fallot/cirurgia , Hematoma Epidural Craniano/complicações , Hematoma Epidural Craniano/cirurgia
2.
No Shinkei Geka ; 50(6): 1286-1300, 2022 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-36426529

RESUMO

Traumatic injuries in infants tend to be concentrated in the head due to the large volume ratio of the head to the trunk, and the injury mechanisms change from passive(e.g., crashes and falls from a certain height due to caregiver negligence, or child abuse)to automatic(e.g., playground equipment and bicycle accidents, crashes and falls from heights)as the child grows and develops. Subsequently, as mobility increases, injuries from traffic accidents, sports-related trauma, and self-inflicted injuries increase. In addition, there are many cases that require urgent surgical treatment for forms of injury unique to the pediatric age, such as epidural hematoma, depressed fractures and penetrating traumatic brain injury. Since pediatric head injury is a broad category encompassing all of these changes, it is necessary to appropriately address the anatomical and physiological changes in the central nervous system, and detailed treatment that takes into account the individual background can lead to a better functional prognosis. This article describes craniotomies for head injury seen in pediatric age other than acute subdural hematoma(acute epidural hematoma, open depressed fracture, and penetrating traumatic brain injury)and also describes the technique of intracranial pressure sensor insertion, which is key to intensive care for intracranial hypertension.


Assuntos
Lesões Encefálicas Traumáticas , Traumatismos Craniocerebrais , Hematoma Epidural Craniano , Lactente , Criança , Humanos , Traumatismos Craniocerebrais/terapia , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Craniotomia , Acidentes de Trânsito , Lesões Encefálicas Traumáticas/cirurgia
3.
J Emerg Med ; 63(4): 557-560, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36229321

RESUMO

BACKGROUND: Post-traumatic epidural hematoma (EDH) accounts for 1-3% of pediatric closed head injury admissions. There is a 2.5:1 male predominance. Etiology varies by age; motor vehicle collisions are the primary cause of EDH in adolescents. Post-traumatic EDH accompanies up to 4% of adult head injuries, and is associated with 10% mortality in adults and 5% mortality in children. In North America, standard of care for post-traumatic EDH includes decompressive craniotomy or trepanation via burr hole. Such lifesaving care is typically provided in the operating room by consulting neurosurgery teams or other personnel trained in the use of burr hole equipment. CASE REPORT: The case of a 17-year-old female patient who presented to a community emergency department (ED) after being involved in a motor vehicle collision is discussed. At the scene of the accident, she refused emergency medical services transport and was brought to the ED via private vehicle. She quickly decompensated in the ED and required intubation. Neurosurgical services were not available and transport to the nearest pediatric trauma center was delayed due to weather. Decompression and drainage of her EDH was accomplished with an EZ-IO® driver and intraosseous needle under virtual guidance of a pediatric neurosurgeon until definitive care could be obtained. The patient made a full neurologic recovery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS: EDHs have high morbidity and mortality. In settings without access to neurosurgical services, and where ED access to or familiarity with burr hole equipment is limited, the EZ-IO® device may be a temporizing and lifesaving intervention until definitive neurosurgical care can be obtained.


Assuntos
Traumatismos Cranianos Fechados , Hematoma Epidural Craniano , Hematoma Epidural Espinal , Adulto , Adolescente , Feminino , Criança , Masculino , Humanos , Trepanação/efeitos adversos , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Craniano/etiologia , Infusões Intraósseas/efeitos adversos , Traumatismos Cranianos Fechados/complicações , Hematoma Epidural Espinal/complicações
4.
Ulus Travma Acil Cerrahi Derg ; 28(8): 1088-1094, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35920418

RESUMO

BACKGROUND: Traumatic brain injury (TBI) is an important cause of death, especially in underdeveloped and developing countries. Diffuse edema in the damaged cerebral tissue as a result of trauma and the subsequent increase in intracranial pressure cause signifi-cant neurological deterioration. Consequently, decompressive craniectomy (DC) is performed as the surgical treatment of TBI. The aim of this study is to evaluate the post-operative mortality and morbidity rates of patients who underwent DC for TBI in our clinic. METHODS: The data of 57 cases of TBI were retrospectively analyzed. Clinical, radiological and surgical features of these cases were reviewed. The rates of mortality and morbidity, as well as main indicators of mortality were investigated. RESULTS: Twenty-five (43.8%) patients were female and 32 (56.1%) were male. The mean age was 54.5 years. Fourteen (24.5%) patients were presented with subdural hematoma, 5 (8.7%) with epidural hematoma, 18 (31.5%) with intracerebral hematoma, 13 (22.8%) with subarachnoid hemorrhage, and 7 (12.2%) with other radiological findings. DC was performed in all cases as soon as pos-sible after admission. Twelve (21.1%) patients died in the first 3 days postoperatively and 7 (12.2%) patients in the postoperative 3-15 days due to progressive cerebral damage and secondary infections. Six (10.5%) patients recovered completely and were discharged. Thirty-two (56.1%) patients were transferred to palliative care clinics and physical therapy clinics after the surgical treatment. CONCLUSION: DC, which is performed in the early period of treatment in TBI, is as important as the degree of intracerebral damage at the time of admission and the high Glasgow coma scale score. Post-operative results are more satisfactory in patients who underwent DC at an earlier stage of treatment.


Assuntos
Lesões Encefálicas Traumáticas , Craniectomia Descompressiva , Hematoma Epidural Craniano , Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Feminino , Hematoma Epidural Craniano/cirurgia , Humanos , Pressão Intracraniana , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
5.
BMJ Case Rep ; 15(8)2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35914800

RESUMO

Head trauma is still a leading cause of mortality in neurosurgical practice. Among various post-traumatic pathologies, extradural haematoma (EDH) is an acute condition that has good neurological outcomes if intervened promptly. New contralateral delayed EDH (DEDH) in an operated case of ipsilateral EDH is a very rare entity, which if not diagnosed timely may lead to devastating outcomes, sometimes even death. We present a case of newly found contralateral DEDH with significant mass effect and midline shift in the immediate postoperative scan, in an operated case of right frontoparietal EDH, which was not found in the initial preoperative scan. A high index of suspicion is needed in cases of unilateral EDH with contralateral skull fracture along with tense dura after the evacuation of EDH, to diagnose rare but life-threatening contralateral DEDH. Routine immediate postoperative CT scan will prevent devastating complications in these kinds of patients.


Assuntos
Traumatismos Craniocerebrais , Hematoma Epidural Craniano , Fraturas Cranianas , Traumatismos Craniocerebrais/complicações , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X/efeitos adversos
6.
Medicine (Baltimore) ; 101(31): e30012, 2022 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-35945716

RESUMO

RATIONALE: Subdural anaplastic large-cell lymphoma (SALCL) is an extremely rare subtype of primary central nervous system (CNS) lymphoma. Here, we report a very rare subdural lymphoma case, which was misdiagnosed as a subacute epidural hematoma based on the radiological examination. PATIENT CONCERNS: We present the case of an 82-year-old patient who presented with a 2-day history of headache and consciousness disorder following head injury. Computed tomography of the head revealed a fusiform isodense/slightly dense shadow under the right temporoparietal occipital cranial plate, suggesting a subacute epidural hematoma. It was initially misdiagnosed as a right traumatic subacute epidural hematoma with hemiplegia of the left limb. According to the patient's condition, an emergency craniotomy was performed to remove the hematoma. However, it was found that the lesion was located under the dura mater and was yellowish-brown with yellowish-brown liquid inside. The appearance of the lesion looked like bean curd residue. Histopathological examination diagnosed ALCL. DIAGNOSIS: SALCL presenting as a subacute epidural hematoma on imaging. INTERVENTIONS: Operation. OUTCOMES: The patient died 1 month after being discharged automatically. CONCLUSIONS: This report shows a rare radiography presentation of SALCL. SALCL can mimic the appearance of an epidural hematoma and should be regarded as a differential diagnosis even in patients with a history of craniocerebral injury and the "typical" imaging appearance of an epidural hematoma. The report is hoped to provide a scientific reference for the clinical diagnosis of subdural lymphoma.


Assuntos
Traumatismos Craniocerebrais , Hematoma Epidural Craniano , Hematoma Epidural Espinal , Linfoma Anaplásico de Células Grandes , Idoso de 80 Anos ou mais , Traumatismos Craniocerebrais/complicações , Craniotomia/efeitos adversos , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Espinal/cirurgia , Humanos , Linfoma Anaplásico de Células Grandes/diagnóstico , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Espaço Subdural , Tomografia Computadorizada por Raios X/efeitos adversos
7.
Neurol India ; 70(3): 1230-1231, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35864674

RESUMO

Subdural hematoma (SDH) is a common intracranial lesion seen in severe traumatic brain injury (TBI). The development of contralateral delayed extradural hematoma (EDH) after surgery is well described. But limited literature available about immediate contralateral EDH after subdural hematoma (SDH) evacuation. We report a case of a young adult who developed contralateral EDH following decompressive surgery for acute SDH.


Assuntos
Craniectomia Descompressiva , Hematoma Epidural Craniano , Hematoma Subdural Agudo , Craniectomia Descompressiva/efeitos adversos , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Agudo/etiologia , Hematoma Subdural Agudo/cirurgia , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-35682054

RESUMO

To evaluate the teaching effect of a trauma training program in emergency cranial neurosurgery in Cambodia on surgical outcomes for patients with traumatic brain injury (TBI). We analyzed the data of TBI patients who received emergency burr-hole trephination or craniotomy from a prospective, descriptive cohort study at the Military Region 5 Hospital between January 2015 and December 2016. TBI patients who underwent emergency cranial neurosurgery were primarily young men, with acute epidural hematoma (EDH) and acute subdural hematoma (SDH) as the most common diagnoses and with long transfer delay. The incidence of favorable outcomes three months after chronic intracranial hematoma, acute SDH, acute EDH, and acute intracerebral hematoma were 96.28%, 89.2%, 93%, and 97.1%, respectively. Severe traumatic brain injury was associated with long-term unfavorable outcomes (Glasgow Outcome Scale of 1-3) (OR = 23.9, 95% CI: 3.1-184.4). Surgical outcomes at 3 months appeared acceptable. This program in emergency cranial neurosurgery was successful in the study hospital, as evidenced by the fact that the relevant surgical capacity of the regional hospital increased from zero to an acceptable level.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Epidural Craniano , Hematoma Subdural Agudo , Lesões Encefálicas Traumáticas/complicações , Camboja , Fortalecimento Institucional , Hemorragia Cerebral , Estudos de Coortes , Craniotomia/efeitos adversos , Escala de Coma de Glasgow , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hospitais , Humanos , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Trepanação/efeitos adversos
9.
Pan Afr Med J ; 41: 219, 2022.
Artigo em Francês | MEDLINE | ID: mdl-35721655

RESUMO

Subperiosteal haematoma of the orbit associated with frontal extradural hematoma is very rare. We here report a case treated in our Department with a literature review. The study involved a 15-year-old boy, victim of head injury from white weapon, a week before his admission to the emergency room. He had inflammatory and painful exophthalmos on the left side, associated with left ophthalmoplegia and blindness. Brain scanner showed left frontal extradural hematoma associated with subperiosteal hematoma of the ipsilateral orbit. Frontal craniotomy associated with fracture orbitotomy allowed evacuation of the extradural hematoma, and then, of the subperiosteal hematoma. Patient´s outcome was favorable. Simultaneous occurrence of frontal extradural hematoma and subperiosteal hematoma of the orbit is extremely rare. Generally, attention is drawn by exophthalmos and visual disturbances. Emergency brain scan without contrast agent injection can be used to make a diagnosis. Prognosis depends on visual function, then adequate management helps to safeguard the eye and vision.


Assuntos
Doenças Ósseas , Traumatismos Craniocerebrais , Exoftalmia , Hematoma Epidural Craniano , Doenças Orbitárias , Adolescente , Traumatismos Craniocerebrais/complicações , Exoftalmia/etiologia , Hematoma/complicações , Hematoma/cirurgia , Hematoma Epidural Craniano/complicações , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino , Órbita , Doenças Orbitárias/complicações , Doenças Orbitárias/etiologia
10.
Ulus Travma Acil Cerrahi Derg ; 28(6): 805-811, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35652865

RESUMO

BACKGROUND: Supratentorial midline epidural hematoma is rare but challenging in diagnosis and management. Indication for surgery can arise even following hospital admission. Being familiar to the presentation and watching out for direct and indirect signs on axial computed tomography (CT) such as suture diastasis or fracture traversing midline are essential to plan multi-planar CT enabling exact diagnosis including form and mass effect of hematoma. METHODS: Nine patients with midline epidural hematoma including two pediatric patients underwent surgery between 2013 and 2018. Pre-operative and post-operative patient status, radiological features, and surgical technique were analyzed. RESULTS: Four patients had deteriorating consciousness levels and two patients had paraparesis. All had fractures traversing midline and epidural hematomas with significant mass effect. They were operated through separated craniotomies around the midline and midline bone strip was used for dural tenting and as support for natural closure of bone flaps. No post-operative complications were developed. All patients were discharged with Glasgow Outcome Score of 5. CONCLUSION: Because of the rarity of the lesion and small number of patients, definitive conclusions may be misleading but we think that, in experienced hands, midline epidural hematomas can safely be operated on and, preservation of midline bone strip pro-vides easier bleeding control.


Assuntos
Fraturas Ósseas , Hematoma Epidural Craniano , Hematoma Epidural Espinal , Criança , Fraturas Ósseas/cirurgia , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Espinal/cirurgia , Humanos , Procedimentos Neurocirúrgicos/efeitos adversos , Tomografia Computadorizada por Raios X
11.
Pan Afr Med J ; 41: 169, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35655673

RESUMO

Epidural hematoma (EDH) is defined as a traumatic accretion of blood separating the dural membrane and the internal table of the skull that caused from contact bending or skull fracture. The cases of contrecoup EDH are as not common, and there are just 10 recorded cases on this. As a result of its uncommonness, we disclose one subject of a 33-year-old man having countrecoup EDH who suffered from a head trauma caused by falling from 4 meters high. The main symptoms were decreasing consciousness and vomiting. Clinical findings showed a Glasgow Coma Scale score of 9, laceration in the left parietal region with stable hemodynamic. Head Computed tomography showed a large EDH in the right frontal and temporal region with coronal suture diastasis. The patient immediately underwent surgery, and craniotomy with evacuation of extradural hematoma were performed. This case presents that a force, which creates an angle, can propagates and causes opposite coronal suture diastasis and makes contrecoup EDH.


Assuntos
Traumatismos Craniocerebrais , Hematoma Epidural Craniano , Fraturas Cranianas , Adulto , Traumatismos Craniocerebrais/complicações , Traumatismos Craniocerebrais/cirurgia , Craniotomia , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino , Fraturas Cranianas/complicações , Fraturas Cranianas/diagnóstico , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X/efeitos adversos
12.
Clin Neurol Neurosurg ; 219: 107313, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35688003

RESUMO

OBJECTIVE: Approximately 69 million people suffer from traumatic brain injury (TBI) annually. Patients with isolated epidural hematomas (EDH) with access to timely surgical intervention often sustain favorable outcomes. Efforts to ensure safe, timely, and affordable access to EDH treatment may offer tremendous benefits. METHODS: A comprehensive literature search was conducted. A random-effects model was used to pool the outcomes. Studies were further categorized into groups by World Bank Income classification: high-income countries (HICs) and low- and middle-income countries (LMICs). RESULTS: Forty-nine studies were included, including 36 from HICs, 12 from LMICs, and 1 from HIC / LMIC. Incidence of EDH amongst TBI patients 8.2 % (95 % CI: 5.9,11.2), including 9.2 % (95 %CI 6.4,13.2) in HICs and 5.8 % (95 % CI: 3.1,10.7) in LMICs (p = 0.20). The overall percent male was 73.7 % and 47.4 % were caused by road traffic accidents. Operative rate was 76.0 % (95 %CI: 67.9,82.6), with a numerically lower rate of 74.2 % (95 %CI: 64.0,81.8) in HICs than in LMICs 82.9 % (95 %CI: 65.4,92.5) (p = 0.33). This decreased to 55.5 % after adjustment for small study effect. The non-operative mortality (5.3 %, 95 %CI: 2.2,12.3) was lower than the operative mortality (8.3 %, 95 %CI: 4.6,14.6), with slightly higher rates in HICs than LMICs. This relationship remained after adjustment for small study effect, with 9.3 % operative mortality compared to 6.9 % non-operative mortality. CONCLUSION: With an overall EDH incidence of 8.2 % and an operative rate of 55.5 %, 3.1 million people worldwide require surgery for traumatic EDH every year, most of whom are in prime working age. Given the favorable prognosis with treatment, traumatic EDH is a strong investment for neurosurgical capacity building.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Epidural Craniano , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/cirurgia , Hematoma Epidural Craniano/epidemiologia , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Incidência , Masculino , Pobreza , Prognóstico
14.
Neurochirurgie ; 68(5): e34-e39, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35477013

RESUMO

BACKGROUND: Cutaneous Central Follicular Lymphoma (CCFL) is a type B cutaneous lymphoma with a usually indolent course. Scalp localization of CCFL is extremely rare, we report a new case mimicking an epidural hematoma, and showing a rapid progression with aggressive infiltration of skin, calvaria, dura and brain parenchyma. CASE REPORT: A 58-year-old patient with an unlabeled polymalformative syndrome was admitted to the Emergency department following a head injury secondary to a self-resolving tonic-clonic epileptic seizure. The initial CT-scan was interpreted as a minor subcutaneous and epidural hematoma initially deemed for conservative management. Within 4 days, the patient showed a progressive neurological deterioration culminating into a stuporous status which prompted a constrast-enhanced brain MRI. The scan revealed a multilayered solid lesion, extending from the subgaleal compartment to the subdural space, threatening the integrity of overlying skin and causing infiltration of the brain parenchyma. Following emergency neurosurgical excision a definitive histology diagnosis of central follicular lymphoma was made. A focused chemotherapy with high-dose Methotrexate with R-CHOP protocol led to disease control until the latest follow up at 2 years. CONCLUSION: To our knowledge, this case represents the first CCFL invading the brain parenchyma and the second extending to the dura. Although such tumor is usually indolent the aggressive behavior herein reported extend the differential diagnosis to high-grade meningiomas, sarcomas, and metastases. Prognostication and appropriate adjuvant treatment require prompt surgical excision and histological confirmation.


Assuntos
Hematoma Epidural Craniano , Linfoma Folicular , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Linfoma Folicular/complicações , Metotrexato , Pessoa de Meia-Idade , Couro Cabeludo , Tomografia Computadorizada por Raios X/efeitos adversos
15.
BMJ Open ; 12(3): e051247, 2022 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-35264341

RESUMO

INTRODUCTION: Controversy and variation exist in surgical management for acute epidural haematoma (AEDH). Although craniotomy for AEDH is conventionally employed, no specific evaluation on the necessity of decompressive craniectomy (DC) followed by AEDH evacuation has been performed. METHODS AND ANALYSIS: This is a multicentre prospective, phase III observational study that evaluates different surgical managements for the AEDH. Patients of both genders, aged 18-65 years, presenting to the emergency room with a clinical and radiological diagnosis of AEDH, complying with other inclusion and exclusion criteria, are enrolled. Clinical information, including diagnosis of AEDH, radiological information, treatment procedures and follow-up data of 1, 3 and 6 months post-injury, is collected on 2000 eligible patients among 263 hospitals in China. Recruitment for the study started in April 2021, and inclusion will be continued until the sample size is obtained, expected is an inclusion period of 24 months. The interventions of concern are surgical treatments for AEDH, including craniotomy and DC. The primary outcome is the Glasgow Outcome Score-Extended 6 months post-injury. Secondary outcomes include the incidence of postoperative cerebral infarction, the incidence of additional craniocerebral surgery and other evaluation indicators within 6 months post-injury. ETHICS AND DISSEMINATION: The study protocol has been approved by the ethics committee and institutional review board of Renji Hospital, School of Medicine, Shanghai Jiao Tong University. All study investigators strictly follow the Declaration of Helsinki and Human Biomedical Research Ethical Issues. Signed written informed consent will be obtained from all enrolled patients. The trial results will be disseminated through academic conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT04229966.


Assuntos
Craniotomia , Hematoma Epidural Craniano , Adolescente , Adulto , Idoso , China , Ensaios Clínicos Fase III como Assunto , Craniotomia/métodos , Feminino , Hematoma Epidural Craniano/cirurgia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Estudos Observacionais como Assunto , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
16.
Neurochirurgie ; 68(5): e40-e43, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35260278

RESUMO

Post-traumatic cerebral venous sinus thrombosis (ptCVST) is often associated with brain hemorrhage; consequently, the anticoagulation may be challenging. We report the case of a 42-year-old man who presented with post-traumatic epidural hematoma and rapidly developed transverse sinus thrombosis extending to the internal jugular vein. As the patient was asymptomatic, we decided not to use anticoagulants: close clinical and radiological monitoring was implemented. The hematoma resolved within 2 months, and the CVST diminished by the third month. Such a good outcome is not always the case in ptCVST. The present article also discusses pathophysiological mechanisms and treatment options when hematoma is associated with ptCVST.


Assuntos
Hematoma Epidural Craniano , Hematoma Epidural Espinal , Trombose dos Seios Intracranianos , Adulto , Anticoagulantes/uso terapêutico , Cavidades Cranianas , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Hemorragias Intracranianas , Masculino , Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/tratamento farmacológico , Trombose dos Seios Intracranianos/etiologia
17.
Mil Med ; 187(9-10): 1127-1135, 2022 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-35038725

RESUMO

INTRODUCTION: To date, there is no evidence concerning the emergency surgical management of severe trauma patients (STP) with severe traumatic brain injury (STBI) presenting a life-threatening intracranial hematoma and a concomitant extra-cranial noncompressible active bleeding. Current guidelines recommend stopping the extra-cranial bleeding first. Nevertheless, the long-term outcome of STP with STBI mainly depends from intracranial lesions. Thus, we propose a combined damage-control surgical strategy aiming to reduce the time spent with intracranial hypertension and to hasten the admission in the intensive care unit. The main objective of the study is to evaluate the benefits of combined cranial and extra-cranial surgery of STP on the long-term outcome. MATERIALS AND METHODS: We retrospectively searched through the database of STBI of a level 1 trauma center facility (Sainte-Anne Military Teaching Hospital, Toulon, France) from 2007 until 2021 looking for patients who benefited from combined cranial and extra-cranial surgery in an acute setting. RESULTS: The research yielded 8 patients. The mean age was 35 years old (±14) and the male to female sex ratio was 1.7/1. The trauma mechanism was a fall in 50% of the cases and a traffic accident in 50% of the cases. The median Glasgow coma scale score was 8 (IQR 4) before intubation. The median Injury Severity Score was 41 (IQR 16). Seven patients (88%) presented hypovolemic shock upon admission. Six patients (75%) benefited from damage-control laparotomy among, whom 4 (67%) underwent hemostatic splenectomy. One patient benefited from drainage of tension pneumothorax, and one patient benefited from external fixator of multiple limb fractures. Seven patients (88%) benefited from decompressive craniectomy for acute subdural hematoma (5 patients) or major brain contusion (2 patients). One patient (12%) benefited from craniotomy for epidural hematoma. Three patients presented intraoperative profound hypovolemic shock. Six patients (75%) presented a favorable neurologic outcome with minor complications from extra-cranial surgeries and 2 patients died (25%). CONCLUSION: Performing combined life-saving cranial and extra-cranial surgery is feasible and safe as long as the trauma teams are trained according to the principles of damage control. It may be beneficial for the neurologic prognostic of STP with STBI requiring cranial and extra-cranial surgery.


Assuntos
Lesões Encefálicas Traumáticas , Hematoma Epidural Craniano , Hipertensão Intracraniana , Adulto , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Craniotomia/efeitos adversos , Feminino , Escala de Coma de Glasgow , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Humanos , Hipertensão Intracraniana/etiologia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Childs Nerv Syst ; 38(4): 827-830, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34228175

RESUMO

BACKGROUND: Spontaneous spinal epidural hematoma (SSEH) is a rare neurologic entity, especially in infants, that develops in the absence of underlying coagulopathy, bleeding diathesis, infection, vascular malformation, trauma, iatrogenic, or other identifiable cause. In contrast to adults, diagnosis is frequently delayed or missed in infants due to non-specific symptoms and limited clinical examination. CASE ILLUSTRATION: An 11-month-old female demonstrated symptoms of irritability, intermittent diarrhea, lethargy, decreased oral intake, and difficulties crawling before presenting to the emergency room. At time of presentation, she was noted to have minimal spontaneous movement of the lower extremities and anisocoria with ptosis of the right eye. Given her clinical presentation, a magnetic resonance image (MRI) of the spine was obtained which revealed an epidural hematoma with compression extending from C7-T3. She underwent C7-T3 laminoplasty and hematoma evacuation. Following surgical intervention, she demonstrated significant improvements in her lower extremity strength and resolution of Horner syndrome. CONCLUSION: SSEH in infants is a rare neurologic condition, with diagnosis often delayed due to nonspecific symptomatology. Prompt diagnosis and intervention are essential in the treatment of SSEH to prevent permanent neurologic dysfunction. Physicians should have a high index of suspicion for SSEH in these instances, and investigation with spinal MRI imaging is recommended.


Assuntos
Hematoma Epidural Craniano , Hematoma Epidural Espinal , Síndrome de Horner , Adulto , Feminino , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Espinal/complicações , Hematoma Epidural Espinal/diagnóstico por imagem , Hematoma Epidural Espinal/cirurgia , Síndrome de Horner/complicações , Humanos , Lactente , Imageamento por Ressonância Magnética/efeitos adversos , Coluna Vertebral/patologia
19.
Childs Nerv Syst ; 38(3): 683-686, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34129080

RESUMO

Fetal intracranial hemorrhage affects 1 in every 10,000 pregnancies. In most cases, the etiology of the bleeding is multifactorial, and they can be either related to the mother or the fetus. Blunt prenatal trauma was occasionally associated with these hemorrhages, nevertheless, reports of hematomas secondary to mild traumas are rare. Within the prenatal intracranial bleedings, the most frequent are the subarachnoid hematoma and intraparenchymal, scarcely ever the epidural hematoma. Treating these bleedings is challenging due to the ongoing pregnancy. Thus, the prognosis is often reserved, with a mortality rate of 43% and 25% of neurological sequelae. Here, we report a singular case of a fetal epidural hematoma secondary to a mild blunt trauma at the third trimester with a good outcome.


Assuntos
Doenças Fetais , Hematoma Epidural Craniano , Hematoma Epidural Espinal , Ferimentos não Penetrantes , Feminino , Feto , Hematoma/complicações , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hematoma Epidural Espinal/complicações , Humanos , Gravidez , Ferimentos não Penetrantes/complicações , Ferimentos não Penetrantes/diagnóstico por imagem
20.
Neurosurg Rev ; 45(1): 819-830, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34313885

RESUMO

Vertex epidural hematoma (VEDH) is a rare extradural hematoma and often misdiagnosed because of its variety of clinical symptoms and characteristic location. Determining optimal timing and technique for VEDH surgery is difficult because of its midline location and atypical clinical course. This study aims to understand the clinical manifestations and current treatment strategies for VEDH. We searched the published literature regarding VEDH through PubMed and Google Scholar, and individual patient data (IPD) were obtained from the eligible articles. A systematic review and IPD meta-analysis were conducted. In total, 70 patients' individual participant data were gathered. Most patients were male (87%), and traffic-related accidents were the most common injury mechanism (49%). Approximately half the patients (47%) were neurologically intact with nonspecific symptoms such as headache, dizziness, and vomiting at admission. Motor weakness alone (17%) and symptoms related to cranial nerve dysfunction such as anosmia, blurred vision, or diplopia (10%) were also noted. A surgical approach was initially chosen for 20 patients (28%), but eventually chosen for 20 more (total 40, 57%) during the observation period (average delay to surgery, 5 days). Patients who received surgery showed significantly poorer neurological status and larger hematoma size. Totally, two patients (3%) died, but most patients (94%) had a favorable outcome scoring 5 on the Glasgow Outcome Scale. Although VEDH generally showed favorable outcomes, clinicians must be aware of a high rate of delayed neurological deterioration during the observation period, which can be fatal due to central downward herniation.


Assuntos
Hematoma Epidural Craniano , Acidentes de Trânsito , Escala de Resultado de Glasgow , Hematoma Epidural Craniano/diagnóstico , Hematoma Epidural Craniano/cirurgia , Humanos , Masculino
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