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1.
World Neurosurg ; 133: 256-259, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31629135

RESUMO

BACKGROUND: Endovascular embolization of the middle meningeal artery (MMA) is effective for recurrent chronic subdural hematoma (CSDH). CSDH associated with dural metastasis is generally refractory to burr hole surgery and has poor prognosis even if any interventions are applied. To the best of our knowledge, this study is the first to report a case of refractory CSDH associated with dural metastasis that was successfully treated with embolization of the MMA. CASE DESCRIPTION: A 66-year-old man with a 1-year history of lung adenocarcinoma had also undergone whole-brain irradiation for multiple brain metastases 5 months before presentation, surgical removal of relapse of brain metastases 3 months prior, and stereotactic radiotherapy for the relapses 1 month prior. He was admitted to our institution with speech disturbance, severe headache, and right-sided motor weakness. Head computed tomography on admission revealed left-sided CSDH, and emergency burr hole irrigation surgery was performed. However, CSDH recurred twice in a short period after hospitalization. Histological examination revealed adenocarcinoma cells in the dura mater and in hematoma samples during the first surgery; therefore, the patient was diagnosed with refractory CSDH associated with dural metastasis of lung adenocarcinoma. We performed endovascular embolization of the MMA, followed by systemic chemotherapy at 1 month after embolization, and no recurrence of the CSDH was observed. CONCLUSIONS: Embolization of the MMA has few surgical risks and could be a treatment option for refractory CSDH associated with dural metastasis because it might prolong the therapeutic time window until radical therapies are administered.


Assuntos
Adenocarcinoma de Pulmão/secundário , Dura-Máter/patologia , Embolização Terapêutica/métodos , Hematoma Subdural Crônico/terapia , Neoplasias Pulmonares/patologia , Artérias Meníngeas , Neoplasias Meníngeas/secundário , Adenocarcinoma de Pulmão/complicações , Idoso , Hematoma Subdural Crônico/complicações , Humanos , Neoplasias Pulmonares/complicações , Masculino , Neoplasias Meníngeas/complicações , Resultado do Tratamento
2.
World Neurosurg ; 134: 472-476, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31756510

RESUMO

BACKGROUND: Spinal subdural hematoma (SSDH), which can cause lower back pain, leg pain, and leg weakness, is rare and will usually be associated with a bleeding tendency, trauma, spinal vascular malformation, intraspinal tumor, or iatrogenic invasion. Only a few cases of SSDH after intracranial chronic subdural hematoma (CSDH) have been reported. We report a case of lumbar SSDH in the absence of predisposing factors after reoperation for recurrent intracranial CSDH, which improved with conservative treatment. CASE DESCRIPTION: Approximately 1 month after falling, a 63-year-old woman was experiencing left hemiparesis and impaired orientation that was diagnosed as right intracranial CSDH using computed tomography. Surgical treatment of the CSDH led to immediate improvement of her symptoms. On postoperative day 29, the right CSDH had recurred with left hemiparesis, and successful reoperation relieved the symptoms within a few hours postoperatively. However, 1 day after the second operation, very small acute subdural hematomas in regions along the left tentorium cerebelli and left falx cerebri were found on computed tomography. On day 31, she complained of sitting-induced bilateral radiating lower limb pain. Magnetic resonance imaging on day 34 showed an acute SSDH at the L4-L5 level and a sacral perineural cyst filled with hematoma, although her radiating pain was showing improvement. She was treated conservatively and was discharged without symptoms on day 44. CONCLUSIONS: Although SSDH is rare, it is important for neurosurgeons and physicians to consider the possibility of a SSDH when lower limb pain or paresis occurs after procedures that will result in rapid intracranial pressure alterations such as drainage of an intracranial CSDH.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Intracraniano/complicações , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/patologia , Feminino , Hematoma Subdural Crônico/patologia , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Intracraniano/patologia , Hematoma Subdural Intracraniano/cirurgia , Humanos , Região Lombossacral , Pessoa de Meia-Idade , Recidiva , Reoperação
3.
World Neurosurg ; 132: e716-e721, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31421304

RESUMO

BACKGROUND: Postoperative seizures are potential complications of chronic subdural hematoma (cSDH). Knowledge of risk factors may help to identify patients that may benefit from antiepileptic prophylaxis. METHODS: A total of 101 patients (mean age, 70.1 ± 32.1 years) with surgical evacuation of cSDH were enrolled. We retrospectively collected patient characteristics, hematoma specifics, and procedural aspects and evaluated their impact on postoperative seizures within a 14-day follow-up period by means of bivariate logistic regression analysis. RESULTS: Postoperative seizures occurred in 14 patients (13.9%). At discharge, the mean Markwalder grading scale score was 1.1 ± 1.1 and 0.5 ± 0.8 in patients with and without seizures, respectively (P = 0.04). In the univariate analysis, preoperative midline shift (8.3 vs. 4.5 mm, P = 0.045), open craniotomy (85.7% vs. 55.2%, P = 0.031), and membranectomy (57.1% vs. 20.7%, P = 0.004) were significantly associated with postoperative seizures, respectively. In the multivariate analysis, preoperative midline shift (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.01-1.26; P = 0.029) and membranectomy (OR, 3.9; 95% CI, 1.0-15.0; P = 0.048) remained as independent risk factors for seizures. CONCLUSIONS: Perioperative antiepileptic prophylaxis may be recommended in patients with preoperative midline shift. Membranectomy may not be routinely applied during surgery.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Complicações Pós-Operatórias/epidemiologia , Convulsões/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniotomia , Feminino , Seguimentos , Humanos , Masculino , Membranas/cirurgia , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Análise de Regressão , Estudos Retrospectivos , Fatores de Risco , Convulsões/etiologia , Resultado do Tratamento
4.
World Neurosurg ; 131: 95-103, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31394354

RESUMO

BACKGROUND: Chronic subdural hematoma (CSDH) is uncommon in the spine. Most spinal CSDHs occur as solitary lesions in the lumbosacral region. We report a rare case of multiple spinal CSDHs associated with hematomyelia. The diagnostic and therapeutic management of these complex spinal CSDHs is reviewed as well as the pertinent literature. CASE DESCRIPTION: A 79-year-old woman on warfarin therapy presented with lower back pain and progressive lower extremity weakness that had developed in the previous 2 weeks. She subsequently developed paraplegia and urinary incontinence. Thoracolumbar magnetic resonance imaging showed a CSDH from T12-L3 compressing the cauda equina. Single-shot whole-spine magnetic resonance imaging showed another CSDH and hematomyelia at T2-3. She underwent L2-3 hemilaminectomy, which revealed a liquefied subdural hematoma. Delayed T2 laminectomy exposed an organized subdural hematoma and xanthochromic hematomyelia. After each surgery, the patient showed significant motor recovery. Finally, the patient could walk, and the urinary catheter was removed. CONCLUSIONS: Spinal CSDH may occur in multiple regions and may be associated with hematomyelia. Whole-spine magnetic resonance imaging is useful to examine the entire spine for CSDH accurately and thoroughly. Comprehensive surgical exploration of all symptomatic hematomas may restore neurologic functions even with delayed surgery.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Espinal/diagnóstico por imagem , Doenças Vasculares da Medula Espinal/diagnóstico por imagem , Idoso , Feminino , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Espinal/complicações , Hematoma Subdural Espinal/cirurgia , Humanos , Laminectomia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Imagem por Ressonância Magnética , Paraplegia/etiologia , Doenças Vasculares da Medula Espinal/etiologia , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Retenção Urinária/etiologia
5.
World Neurosurg ; 130: 165-169, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299306

RESUMO

BACKGROUND: Ossified chronic subdural hematoma (CSH) associated with neoplasm has rarely been reported in the literature. We describe a patient with ossified CSH and underlying large B-cell lymphoma and discuss the relationship between lymphoma and CSH, emphasizing clinical characteristics, tumorigenic mechanism, and histopathologic analysis. CASE DESCRIPTION: A 46-year-old man with a history of alcohol abuse and a right frontotemporoparietal and left frontal ossified CSH that was diagnosed 2 years previously presented with headache and memory loss over 6 days. The patient was being followed with serial imaging, which showed the static state of the mass and no other lesions 7 months before admission. He underwent right frontotemporoparietal craniectomy to remove the ossified CSH and tumor. When the bone was lifted and the thin dura was opened, a hard, thick, ossified capsule was observed. No apparent tumor invasion was noted in the skull or epidural space. Despite refusing further chemotherapy and radiation therapy, the patient has been disease-free and working for 5 years. CONCLUSIONS: Based on reported cases and relevant literature, large B-cell lymphoma may be associated with ossified CSH.


Assuntos
Dura-Máter/cirurgia , Hematoma Subdural Crônico/cirurgia , Linfoma de Células B/virologia , Linfoma/cirurgia , Calcinose/complicações , Calcinose/cirurgia , Dura-Máter/patologia , Dura-Máter/virologia , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico , Herpesvirus Humano 4/patogenicidade , Humanos , Linfoma/complicações , Linfoma/virologia , Linfoma de Células B/diagnóstico , Linfoma de Células B/cirurgia , Masculino , Pessoa de Meia-Idade
6.
World Neurosurg ; 130: e133-e139, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203079

RESUMO

BACKGROUND: Most patients with bilateral chronic subdural hematomas (bCSDH) undergo initial bilateral evacuation. Risk factors associated with the recurrence of bCSDH after initial bilateral evacuation have not been published to date. In this study, we aimed to identify risk factors related to recurrence of bCSDH after initial bilateral evacuation, and to develop a prognostic grading system for clinical reference. METHODS: This study included 102 patients with bCSDH who underwent initial bilateral evacuation. Predictors of recurrence were identified via univariate analysis and multivariate logistic regression analysis. A prognostic grading system was created based on the independent predictors combined with a cutoff value. All cases were scored according to the prognostic grading system, and the recurrence rates of the different scores were reanalyzed. RESULTS: Anticoagulant use (odds ratio [OR], 84.266; 95% confidence interval [CI], 13.113-541.522; P < 0.001), severe brain atrophy (OR, 11.551; 95% CI, 2.558-52.163; P = 0.001), and postoperative pneumocephalus volume (PostPV) (OR, 0.978; 95% CI, 0.957-1.000; P = 0.049) were independent risk factors for the recurrence of bCSDH after initial bilateral evacuation. The cutoff value of PostPV was >20.9484 cm3. A prognostic grading system was then developed, and the recurrence rates based on score were determined. Rates were 2.8% for a score of 0-1, 28.1% for a score of 2-3, and 100% for a score of 4-5, showing a significant increase in risk with increasing score (P < 0.001). CONCLUSIONS: Anticoagulant use, severe brain atrophy, and PostPV were identified as independent risk factors for recurrence of bCSDH after initial bilateral evacuation. The prognostic grading system for recurrence of bCSDH after initial bilateral evacuation is reliable and applicable for clinical reference.


Assuntos
Encéfalo/cirurgia , Hematoma Subdural Crônico/diagnóstico , Hematoma Subdural Crônico/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/efeitos adversos , Atrofia/complicações , Atrofia/diagnóstico , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Feminino , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/complicações , Pneumocefalia/diagnóstico , Complicações Pós-Operatórias/etiologia , Recidiva , Fatores de Risco , Sensibilidade e Especificidade
7.
No Shinkei Geka ; 47(5): 531-536, 2019 May.
Artigo em Japonês | MEDLINE | ID: mdl-31105076

RESUMO

Arachnoid cysts(AC)are benign cystic lesions often diagnosed in childhood. Although usually asymptomatic, AC can become symptomatic when the lesion size increases or coexists with a subdural hygroma or hematoma. AC patients with signs of increasing intracranial pressure(IICP)or neurological deficits may need surgical intervention; this usually results in a good prognosis. However, whether asymptomatic AC patients should undergo surgical treatment is controversial. Although trivial head trauma, such as that from contact sports, can cause subdural hematoma in AC patients, there are currently no definite criteria regarding sports participation for children with AC. CASE: A 12-year-old boy who belonged to a soccer club visited an ophthalmologist with the chief complaint of having had diplopia for two weeks. He was identified as having bilateral papilledema. Since he had been diagnosed with a right middle cranial fossa AC five years earlier, he was referred to our outpatient clinic. Cranial CT scans showed right chronic subdural hematoma alongside the AC. The patient subsequently underwent burr hole surgery and was discharged after one week. In this case, the patient did not present with the typical signs of IICP, such as headache or vomiting. This experience indicates that care must be taken when encountering patients with atypical symptoms, particularly children. In addition, it is important to carefully consider sports participation for children with AC.


Assuntos
Cistos Aracnóideos , Hematoma Subdural Crônico , Papiledema , Cistos Aracnóideos/classificação , Criança , Fossa Craniana Média , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Papiledema/complicações , Trepanação
8.
World Neurosurg ; 128: e1010-e1023, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31102774

RESUMO

BACKGROUND: Chronic subdural hematoma (CSDH) is a common neurosurgical condition, especially among elderly patients. Here we have analyzed our institutional experience with surgical management of CSDH. We aimed at identifying predictors of hematoma recurrence and cure, and the respective time course. METHODS: Pertinent data were collected from all 208 patients (136 males; median age, 78 years) treated for unilateral CSDH in our department from 2014 to 2016 after exclusion of cases with CSDH following previous head surgery or missing postoperative imaging. Pre- and postoperative neuroimaging studies were subjected to computer-assisted volumetric analyses. CSDH composition and anatomy were assessed using a modified Nakaguchi classification. RESULTS: A total of 67.8% of the patients presented with neurologic deficits, and 51.4% were at least on 1 anticoagulant agent. Burr hole trephinations were performed in 94.7%. The median residual hematoma volume was 35.0 mL (44.1 mL including air). Surgical recurrences were seen in 17.8%. The median time to repeat surgery was 17 days, and 91.9% of recurrences occurred within 60 days. Recurrence rates varied between 36.4% (separated or trabecular subtypes and postoperative CSDH volume ≥35.0 mL) and 3.7% (all other subtypes and postoperative CSDH volume <35.0 mL). A neuroimaging proven cure could be documented in an estimated 90% of cases at 145 days after first surgery. CONCLUSIONS: Postoperative CSDH volume and the Nakaguchi classification subtypes proved the most powerful predictors of recurrence, cure, and the time to recurrence and cure. Although our results demonstrate the important impact of CSDH volume, composition, and anatomy, they also show that other so far unknown factors play a significant role as well.


Assuntos
Hematoma Subdural Crônico/cirurgia , Procedimentos Neurocirúrgicos/métodos , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/uso terapêutico , Feminino , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Neuroimagem , Valor Preditivo dos Testes , Recidiva , Análise de Sobrevida , Resultado do Tratamento , Trepanação
9.
World Neurosurg ; 127: 409-413, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30999086

RESUMO

BACKGROUND: Severe factor V deficiency is an extremely rare coagulation disorder. Patients with factor V activity <5% usually become symptomatic in early childhood. CASE DESCRIPTION: We report the case of an 82-year-old woman with incidentally diagnosed severe factor V deficiency, who developed a symptomatic chronic subdural hematoma, requiring burr hole craniostomy. Successful management was achieved by a multidisciplinary approach. Preoperatively, factor V activity was increased from 2% to 50% by administration of 25 mL/kg body weight of fresh frozen plasma over 30 minutes under close cardiopulmonary monitoring in the intensive care unit. Straight afterward, the patient was transferred to the operating room where surgery was performed under general anesthesia. Burr hole craniostomy could be performed without perioperative complications. In the postoperative days, there was no relevant recurrence of the subdural hematoma in the follow-up computed tomography scans under frequent control of coagulation parameters. However, despite further transfusion of fresh frozen plasma, factor V activity did not increase >16%. The patient was discharged without any neurologic deficits. In a hemostaseologic follow-up 2 months after surgery, factor V activity <1% was confirmed with evidence of a factor V inhibitor in the modified Bethesda assay. Most likely, the patient suffered from an acquired form of factor V deficiency with preformed antibodies that had been boosted by the initial treatment with fresh frozen plasma. CONCLUSIONS: We conclude that in this rare bleeding disorder, intracranial surgery was successfully managed because of a thoroughly planned perioperative therapeutic strategy. However, if there is time prior to surgery, a full checkup of the bleeding disorder is advisable.


Assuntos
Deficiência do Fator V/diagnóstico por imagem , Deficiência do Fator V/cirurgia , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Assistência Perioperatória/métodos , Índice de Gravidade de Doença , Idoso de 80 Anos ou mais , Gerenciamento Clínico , Deficiência do Fator V/complicações , Feminino , Hematoma Subdural Crônico/complicações , Humanos , Resultado do Tratamento
10.
J Neurosurg ; 131(6): 1926-1930, 2019 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-30641839

RESUMO

OBJECTIVE: Chronic subdural hematoma (CSDH) has a variety of clinical presentations, including hemiparesis. Hemiparesis is of the utmost importance because it is one of the major indications for surgical intervention and influences outcome. In the current study, the authors intended to identify factors influencing the presence of hemiparesis in CSDH patients and to determine the threshold value of hematoma thickness and midline shift for development of hemiparesis. METHODS: The authors retrospectively reviewed 325 patients (266 with unilateral and 59 with bilateral hematomas) with CSDH who underwent surgical evacuation, regardless of presence or absence of hemiparesis. RESULTS: In univariate analysis, hematoma loculation, age, hematoma maximal thickness, and midline shift were significantly associated with hemiparesis. Moreover, patients with unilateral hematomas had a higher rate of hemiparesis than patients with bilateral hematomas. Sex, trauma history, anticoagulant and antiplatelet drug use, presence of comorbidities, Glasgow Coma Scale score, hematoma density characteristics on CT scan, and hematoma signal intensity on T1- and T2-weighted MRI were not associated with hemiparesis. In multivariate analysis, the presence of loculation and hematoma laterality (unilateral vs bilateral) influenced hemiparesis. For unilateral hematomas, maximal hematoma thickness of 19.8 mm and midline shift of 6.4 mm were associated with a 50% probability of hemiparesis. For bilateral hematomas, 29.0 mm of maximal hematoma thickness and 6.8 mm of shift were associated with a 50% probability of hemiparesis. CONCLUSIONS: Presence of loculations, unilateral hematomas, older patient age, hematoma maximal thickness, and midline shift were associated with a higher rate of hemiparesis in CSDH patients. Moreover, 19.8 mm of hematoma thickness and 6.4 mm of midline shift were associated with a 50% probability of hemiparesis in patients with unilateral hematomas.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Paresia/diagnóstico por imagem , Paresia/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Paresia/terapia , Estudos Retrospectivos
11.
World Neurosurg ; 121: 166-168, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30326314

RESUMO

BACKGROUND: Patients with chronic subdural hematoma (CSDH) typically present with symptoms of increased intracranial pressure, including headache, nausea/vomiting, and somnolence, or with contralateral weakness. Compression of the convexity cerebral cortex usually causes motor deficit that is more readily appreciated in the upper extremity rather than in the leg, and very subtle deficit may be detected only by looking for pronator drift. The precise pattern of signs and symptoms in CSDH may vary from case to case depending on the specific anatomy of compression, but isolated lower extremity weakness is rare. CASE DESCRIPTION: A 79-year-old woman presented with isolated footdrop. CSDH overlying the cerebral convexity was detected on computed tomography. The foot weakness resolved on surgical drainage. CONCLUSIONS: CSDH overlying the cerebral convexity may manifest with isolated foot weakness. Awareness of the potential for this unusual presentation of CSDH may be useful to the clinician assessing a patient with otherwise unexplained foot weakness.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Neuropatias Fibulares/etiologia , Neuropatias Fibulares/cirurgia , Idoso , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Drenagem , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Neuropatias Fibulares/diagnóstico por imagem , Tomografia Computadorizada por Raios X
12.
Neurosurg Rev ; 42(2): 427-431, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29679178

RESUMO

Increasing age and lower pre-operative Glasgow coma score (GCS) are associated with worse outcome after surgery for chronic subdural haematoma (CSDH). Only few studies have quantified outcomes specific to the very elderly or comatose patients. We aim to examine surgical outcomes in these patient groups. We analysed data from a prospective multicentre cohort study, assessing the risk of recurrence, death, and unfavourable functional outcome of very elderly (≥ 90 years) patients and comatose (pre-operative GCS ≤ 8) patients following surgical treatment of CSDH. Seven hundred eighty-five patients were included in the study. Thirty-two (4.1%) patients had pre-operative GCS ≤ 8 and 70 (8.9%) patients were aged ≥ 90 years. A higher proportion of comatose patients had an unfavourable functional outcome (38.7 vs 21.7%; p = 0.03), although similar proportion of comatose (64.5%) and non-comatose patients (61.8%) functionally improved after surgery (p = 0.96). Compared to patients aged < 90 years, a higher proportion of patients aged ≥ 90 years had unfavourable functional outcome (41.2 vs 20.5%; p < 0.01), although approximately half had functional improvement following surgery. Mortality risk was higher in both comatose (6.3 vs 1.9%; p = 0.05) and very elderly (8.8 vs 1.1%; p < 0.01) groups. There was a trend towards a higher recurrence risk in the comatose group (19.4 vs 9.5%; p = 0.07). Surgery can still provide considerable benefit to very elderly and comatose patients despite their higher risk of morbidity and mortality. Further research would be needed to better identify those most likely to benefit from surgery in these groups.


Assuntos
Coma/cirurgia , Hematoma Subdural Crônico/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Coma/etiologia , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Resultado do Tratamento
13.
Medicine (Baltimore) ; 97(38): e12479, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30235747

RESUMO

RATIONALE: A spinal subdural hematoma (SDH) is rarely complicated with an intracranial SDH. We found only 7 cases of spontaneous concurrent lumbar spinal and cranial SDHs, in which lumbar symptoms occurred before head symptoms. PATIENT CONCERNS: We describe a 77-year-old man with spontaneous concurrent spinal and cranial SDHs, in whom the spinal SDH was identified 30 days before the intracranial chronic SDH. DIAGNOSIS: Magnetic resonance imaging showed a spinal SDH at L4/L5. There was no paralysis, and the patient was managed conservatively. About 30 days after the onset of back pain, he experienced tinnitus and visual hallucination. Brain computed tomography showed a chronic SDH and midline shift. INTERVENTIONS: Burr-hole evacuation was performed, and the patient's condition improved. OUTCOMES: At 5 months of follow-up, there was no recurrence of the spinal or intracranial SDH. LESSONS: It is important to consider the possibility of intracranial hemorrhage when a spinal SDH is identified.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Intracraniano/etiologia , Hematoma Subdural Espinal/complicações , Idoso , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Espinal/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino
14.
World Neurosurg ; 119: e518-e526, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30075268

RESUMO

BACKGROUND: Hemiparesis is a major symptom of chronic subdural hematoma (CSDH). Its severity does not always correlate with hematoma size. The authors analyzed hematoma thickness, pressure, and tension to clarify the mechanism of hemiparesis in CSDH patients. METHODS: A burr-hole surgery was performed on 124 CSDHs in 102 patients. Hematoma thickness and midline shift were measured by computed tomography, and hematoma pressure was measured in surgery. According to Laplace law, tension was calculated as follows: (half the hematoma thickness × hematoma pressure)/2. Student t test and Pearson correlation coefficient (r) were applied in statistical analysis of findings. RESULTS: Motor weakness was identified in 76.5% of our cases. Tension was strongly related to hemiparesis (r = -0.747, P < 0.01), whereas hematoma thickness (r = -0.458, P < 0.01) and pressure (r = -0.596, P < 0.01) were moderately correlated. Mean age of 14 patients (13.7%) with headache was much younger than those without headache (P < 0.01). Stronger midline shift (P < 0.01) and greater ratio of midline shift to hematoma thickness (P < 0.01) were statistically correlated with headache. Recurrence was recognized in 8 patients (7.8%), and stronger midline shift (P < 0.05) and greater ratio of midline shift to hematoma thickness (P < 0.05) were statistically associated with recurrence. CONCLUSIONS: Tension is the most influencing factor to hemiparesis in CSDH patients. This study also elucidates the mechanism for quick recovery from hemiparesis after surgery in that tension on the motor cortex is decreased immediately by drainage.


Assuntos
Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/fisiopatologia , Paresia/etiologia , Paresia/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Craniotomia , Feminino , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , Cefaleia/fisiopatologia , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Córtex Motor/diagnóstico por imagem , Córtex Motor/fisiopatologia , Paresia/diagnóstico por imagem , Paresia/cirurgia , Pressão , Recidiva , Espaço Subdural/diagnóstico por imagem , Espaço Subdural/fisiopatologia , Espaço Subdural/cirurgia , Tomografia Computadorizada por Raios X
16.
Rinsho Shinkeigaku ; 58(6): 399-402, 2018 Jun 27.
Artigo em Japonês | MEDLINE | ID: mdl-29863098

RESUMO

An 86-year-old woman presented with generalized chorea in the face and extremities, which gradually progressed for two weeks. Cranial CT revealed a chronic subdural hematoma (CSDH) that covered the left parietal lobe. Discontinuation of amantadine did not improve the chorea. The hematoma was evacuated and the chorea completely subsided in a week. The pathogenesis leading to chorea in CSDH remains unclear. A unilateral hematoma presenting with generalized chorea similar to the present patient and two others with unilateral CSDH causing ipsilateral hemichorea have been reported. The rarity of these movement disorders due to CSDH indicates that these patients had a preclinical dysfunction within neuronal networks interconnecting basal ganglia the cerebral cortex. Our findings confirmed that CSDH could cause chorea, and further neuroimaging to evaluate cerebrovascular disease, taking a detailed family history and obtaining information about current medications might reveal factors likely to precipitate the development of chorea.


Assuntos
Coreia/etiologia , Hematoma Subdural Crônico/complicações , Idoso de 80 Anos ou mais , Amantadina/efeitos adversos , Coreia/terapia , Feminino , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Imagem por Ressonância Magnética , Paracentese/métodos , Lobo Parietal/diagnóstico por imagem , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
Neurocirugía (Soc. Luso-Esp. Neurocir.) ; 29(2): 86-92, mar.-abr. 2018. graf, tab
Artigo em Inglês | IBECS | ID: ibc-171433

RESUMO

Introduction: Chronic subdural hematoma (cSDH) is a common pathology encountered in neurosurgical practice, especially in elderly patients, who frequently require antithrombotic agents. The aim of this study was to investigate the influence of antithrombotic agents on recurrence rates and clinical outcomes in patients operated for cSDH. Methods: A cohort of patients operated for cSDH at one center during a 5 years period was analyzed retrospectively. Presenting symptoms, coagulation testing, history of antithrombotic agents and comorbidities were obtained from the patient charts. The standard neurosurgical procedure was a single burr hole under local anesthesia with insertion of a subdural drainage. Questionnaires and telephone interviews were used to assess the clinical outcome using the modified Rankin Scale (mRS). Good outcome was defined as mRS 0 to 3 and poor outcome as mRS 4 to 6. Results: 201 patients with cSDH underwent initial surgical treatment and were enrolled in the study. The median follow-up was 81 weeks. 41 patients (20.4%) were on antiplatelet drug and 43 (21.4%) were on phenprocoumon. A recurrent hematoma required surgery in 37 patients (18.4%). A poor outcome was seen in 36 patients (17.9%). Each of older age and administration of phenprocoumon at admission was an independent risk factor predictive of poor outcome, (p = 0.001 and p = 0.031, respectively)) Administration of antithrombotic agents had no impact on hematoma recurrence. Conclusion: Administration of phenprocoumon and older age might increase the risk of poor outcome in patients with cSDH. Neither the administration of phenprocoumon nor antiplatelet drug influenced the recurrence rate of subdural hematoma in our patient cohort


Introducción: El hematoma subdural crónico (HSC) es una enfermedad común en la práctica neuro-quirúgica, especialmente en pacientes mayores, quienes requieren con frecuencia agentes anti-trombóticos. El objetivo de este estudio fue investigar la influencia de los agentes anti-trombóticos en las tasas de recidiva y los resultados clínicos en los pacientes operados de HSC. Métodos: Se analizó retrospectivamente una cohorte de pacientes operados de HSC en un único centro, durante un periodo de 5 años. Se obtuvieron de las historias de los pacientes los síntomas de presentación, las pruebas de coagulación, el historial de agentes anti-trombóticos y las comorbilidades. El procedimiento quirúrgico estándar consistió en una trepanación bajo anestesia local, con inserción de un drenaje subdural. Se utilizaron cuestionarios y entrevistas telefónicas para valorar el resultado clínico mediante la Escala de Rankin modificada (mRS). El resultado favorable se definió como el valor de 0 a 3 de mRS, y el resultado desfavorable el valor de 4 a 6. Resultados: Doscientos uno pacientes con HSC fueron sometidos a tratamiento quirúrgico inicial, y fueron incluidos en el estudio. El seguimiento medio fue de 81 semanas. A 41 pacientes (20,4%) se les administró tratamiento anti-plaquetario y a 43 (21,4%) fenprocumón. El hematoma recurrente requirió cirugía en 37 pacientes (18,4%). Se observaron resultados desfavorables en 36 pacientes (17,9%). La avanzada edad y la administración de fenprocumón al ingreso resultaron factores predictivos independientes del resultado desfavorable (p = 0,001 y p = 0,031, respectivamente). La administración de agentes antitrombóticos no tuvo impacto sobre la recidiva del hematoma. Conclusión: La administración de fenprocumón y la edad avanzada pueden incrementar el riesgo de resultado desfavorable en los pacientes con HSC. Ni la administración de fenprocumón ni la de fármacos anti-plaquetarios influyeron en la tasa de hematomas subdurales en nuestra cohorte de pacientes


Assuntos
Humanos , Masculino , Feminino , Idoso , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Fibrinolíticos/uso terapêutico , Recidiva , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/diagnóstico por imagem , Fibrinolíticos/efeitos adversos , Femprocumona/efeitos adversos , Estudos Retrospectivos , Estudos de Coortes , Comorbidade , Inquéritos e Questionários , Análise Estatística , Razão de Chances
19.
J Neurosurg ; 130(1): 302-311, 2018 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-29393757

RESUMO

OBJECTIVE: Burr hole craniostomy is an effective and simple procedure for treating chronic subdural hematoma (CSDH). However, the surgical outcomes and recurrence of CSDH in patients with liver cirrhosis (LC) remain unknown. METHODS: A nationwide population-based cohort study was retrospectively conducted using data from the Taiwan National Health Insurance Research Database. The study included 29,163 patients who underwent first-time craniostomy for CSDH removal between January 1, 2001, and December 31, 2013. In total, 1223 patients with LC and 2446 matched non-LC control patients were eligible for analysis. All-cause mortality, surgical complications, repeat craniostomy, extended craniotomy, and long-term medical costs were analyzed. RESULTS: The in-hospital mortality rate (8.7% vs 3.1% for patients with LC and non-LC patients, respectively), frequency of hospital admission, length of ICU stay, number of blood transfusions, and medical expenditures of patients with LC who underwent craniostomy for CSDH were considerably higher than those of non-LC control patients. Patients with LC tended to require an extended craniotomy to remove subdural hematomas in the hospital or during long-term follow-up. The surgical outcome worsened with an increase in the severity of LC. CONCLUSIONS: Even for simple procedures following minor head trauma, LC remains a serious comorbidity with a poor prognosis.


Assuntos
Craniotomia , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/cirurgia , Cirrose Hepática/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Hematoma Subdural Crônico/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Cirrose Hepática/mortalidade , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida , Taiwan , Resultado do Tratamento , Adulto Jovem
20.
World Neurosurg ; 113: 86-90, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29452323

RESUMO

BACKGROUND: Neurosurgical intervention for a patient with an extensive scalp burn is rare, but it may be associated with a high risk of surgical site infection. CASE DESCRIPTION: An 80-year-old man had a severe and extensive scalp burn. A chronic subdural hematoma (CSDH) was observed on a computed tomographic view of the head, performed for the assessment of bacteremia during treatment in the intensive care unit. To evaluate whether the CSDH might underlie the patient's prolonged fever and sepsis, we urgently evacuated the hematoma using 1 burr hole. The surgery was uneventful. We made a skin incision through the deep burn wounds covering the right temporal muscle. We removed necrotic tissue from scalp burns continuously to avoid wound complications and intracranial infection. CONCLUSIONS: Temporal muscle with a constant blood supply served as an effective tissue for surgical wound closure. By use of this multidisciplinary approach, the CSDH resolved completely, and surgical wound complications were avoided.


Assuntos
Queimaduras/complicações , Hematoma Subdural Crônico/cirurgia , Couro Cabeludo/lesões , Trepanação/métodos , Idoso de 80 Anos ou mais , Bacteriemia/complicações , Bacteriemia/diagnóstico por imagem , Hematoma Subdural Crônico/complicações , Humanos , Masculino , Sepse/complicações , Infecção da Ferida Cirúrgica/complicações , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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