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1.
Expert Opin Pharmacother ; 21(4): 435-444, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31957506

RESUMO

Introduction: Chronic subdural hematoma (CSDH) is a common neurosurgical disease, whose incidence has been steadily increasing with our aging population. While not common, CSDH can also occur in children. CSDH is often associated with traumatic head injury, but its underlying mechanism remains poorly understood. The first line treatment for CSDH is surgery. However, surgery is contraindicated in some patients and has a high rate of recurrence. Effective non-surgical treatment is therefore highly desirable.Areas covered: This review discusses the pathogenesis of CSDH and drugs that have been used to treat CSDH either as monotherapy or an adjuvant to surgery, including controlled clinical trials.Expert opinion: The pathophysiology of CSDH remains poorly understood. Developing effective drug treatments is therefore challenging. Most drugs discussed in this review are evaluated in small clinical studies without sufficient sample size and controls for confounding variables. More controlled clinical trials are therefore needed to carefully evaluate drugs for the non-surgical treatment of CSDH, especially for drugs targeting specific pathogenic pathways of CSDH.


Assuntos
Hematoma Subdural Crônico/tratamento farmacológico , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Atorvastatina/administração & dosagem , Atorvastatina/uso terapêutico , Diuréticos/administração & dosagem , Diuréticos/uso terapêutico , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/etiologia , Humanos , Incidência , Recidiva , Resultado do Tratamento
2.
World Neurosurg ; 132: e391-e398, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476468

RESUMO

OBJECTIVE: To compare clinical and radiologic characteristics and prognosis of patients with chronic subdural hematoma (CSDH) with and without a history of head trauma. METHODS: Clinical and radiologic characteristics and prognosis of patients with CSDH with a history of head trauma (HT group) and without a history of head trauma (WHT group) were comparatively analyzed. RESULTS: Mean age in the WHT group was 70.23 ± 11.53 years, which was significantly older than mean age 67.56 ± 11.18 years in the HT group (P = 0.008). Stroke, uremia, anticoagulant therapy, and antiplatelet therapy were encountered more often in the WHT group than the HT group. Motor weakness was more prevalent in the WHT group (P = 0.011). Modified Rankin Scale score of 2-3 was more common in the WHT group (P = 0.03), whereas a score of 4-5 was more common in the HT group (P = 0.014). Hematoma density on CT was mainly homogeneous in the 2 groups, with significantly more homogeneous density in the HT group compared with the WHT group (P = 0.014). There was significantly more mixed density in the WHT group (P = 0.001). Patients with CSDH in the WHT group had higher mortality (P = 0.026) and lower Glasgow Outcome Scale score (P = 0.033). CONCLUSIONS: Patients with CSDH with or without a history of head trauma presented with different clinical and radiologic characteristics. Patients with CSDH without a history of head trauma had a higher mortality and lower GOS score, which indicates these patients warrant more attention.


Assuntos
Traumatismos Craniocerebrais/complicações , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
3.
Rev Assoc Med Bras (1992) ; 65(6): 834-838, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340313

RESUMO

OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.


Assuntos
Hematoma Subdural Crônico/etiologia , Fatores Etários , Idoso , Craniotomia , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
4.
J Neurol Surg A Cent Eur Neurosurg ; 80(5): 359-364, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31181579

RESUMO

BACKGROUND: In an aging society, traumatic head injuries, such as acute subdural hematomas (aSDHs), are increasingly common because the elderly are prone to falls and are often undergoing anticoagulation treatment. Especially in advanced age, cranial surgery such as craniotomies may put patients in further jeopardy. But if treatment is conservative, a chronic subdural hematoma (cSDH) may develop, requiring surgical evacuation. Existing studies have reported a correlation between several risk factors contributing to the frequency of chronification. To improve the prediction of the course of disease and to aid counseling patients and relatives, this study aimed to determine the frequency and the main risk factors influencing the process of chronification of an aSDH following conservative treatment. METHODS: We identified patients presenting between January 2012 and September 2017 at our neurosurgical department with an aSDH. All patients treated conservatively were selected retrospectively, and the following parameters were documented: age, sex, chronification status, Glasgow Coma Scale score on admission and discharge, hematoma thickness and density, the degree of midline shift (MLS), prior anticoagulants and administration of procoagulants, thrombosis management, other coagulopathies, initial length of hospital stay, interval between discharge and readmission, and interval between initial injury and date of surgery and last follow-up. The cohort was divided into patients with complete resolution of their aSDH, and patients who needed surgery due to chronification. RESULTS: A total of 75 conservatively treated patients with aSDH were included. A chronification was observed in 24 cases (32%). The process of chronification takes an average of 18 days (range: 10-98 days). The following factors were significantly associated with the process of chronification: age (p = 0.001), anticoagulant medication (acetylsalicylic acid [ASA], Coumadin, and novel anticoagulants [NOACs]) before injury (p = 0.026), administration of procoagulants (p = 0.001), presence of other coagulopathies such as thrombocytopenia (p = 0.002), low hematoma density at discharge (p = 0.001), hematoma thickness on admission and discharge (p = 0.001), and the degree of MLS (p = 0.044). CONCLUSION: Chronification occurred in a third of all patients with conservatively treated aSDH, on average within 3 weeks. The probability of developing a cSDH is 0.96 times higher with every yearly increase in age, resulting in 56% chronification in patients ≥ 70 years. Hematoma thickness and impairment of the coagulation system such as anticoagulant medication (ASA, Coumadin, and NOACs) or thrombocytopenia are further risk factors for chronification.


Assuntos
Tratamento Conservador , Hematoma Subdural Agudo/terapia , Hematoma Subdural Crônico/etiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Escala de Coma de Glasgow , Hematoma Subdural Agudo/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
5.
World Neurosurg ; 128: 434-437, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31121372

RESUMO

BACKGROUND: Venous malformations are classified as slow-flow vascular malformations. Coagulation abnormalities are known to be frequent among patients with venous malformations. We report a case of repeated intracranial hemorrhage after delivery, induced by coagulopathy associated with multiple venous malformations. CASE DESCRIPTION: A 28-year-old woman presented with left chronic subdural hematoma 1 month after successfully giving birth. She had a history of multiple venous malformations around the pubic region and hips. The hematoma was evacuated by burr hole surgery. Three hours later, her level of consciousness rapidly deteriorated and computed tomography showed acute epidural hematoma. The hematoma was removed immediately by craniotomy under general anesthesia. No bleeding points were apparent in the operative field. Continuous bleeding around the dura mater and subdural space were encountered, and hemostasis was not achieved by electrocoagulation. After using fresh frozen plasma, hemostasis was achieved. Level of consciousness and neurologic symptoms improved postoperatively. Magnetic resonance imaging revealed multiple venous malformations in bilateral lower extremities and the pelvis. Disseminated intravascular coagulopathy was diagnosed, and thrombomodulin and blood coagulation factor XIII were administered. She was discharged home without any neurologic deficits. CONCLUSIONS: The delivery activated localized intravascular coagulopathy in the venous malformations and induced chronic subdural hematoma. Surgical interventions then resulted in progression of the coagulopathy to disseminated intravascular coagulopathy, inducing acute epidural hematoma.


Assuntos
Coagulação Intravascular Disseminada/terapia , Fator XIII/uso terapêutico , Hemorragias Intracranianas/cirurgia , Hemorragia Pós-Operatória/terapia , Trombomodulina/uso terapêutico , Malformações Vasculares/diagnóstico por imagem , Adulto , Transtornos da Coagulação Sanguínea/complicações , Transtornos da Coagulação Sanguínea/terapia , Craniotomia , Coagulação Intravascular Disseminada/etiologia , Feminino , Hematoma Epidural Craniano/etiologia , Hematoma Epidural Craniano/cirurgia , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Hemostasia Cirúrgica , Humanos , Hemorragias Intracranianas/etiologia , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Pelve/irrigação sanguínea , Plasma , Hemorragia Pós-Operatória/etiologia , Transtornos Puerperais/terapia , Malformações Vasculares/complicações
6.
World Neurosurg ; 127: e919-e924, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30959258

RESUMO

OBJECTIVE: Although mannitol is used widely to facilitate brain retraction in cases of ruptured aneurysms, there is no consensus about the intraoperative administration of mannitol in the case of unruptured aneurysms. Accordingly, this study was conducted to identify an intraoperative mannitol administration strategy. METHODS: Mannitol was administered routinely to patients (n = 90) from January 2015 to April 2016 and not administered to patients (n = 97) from May 2016 to June 2017. The patient groups with and without mannitol administration were then compared based on the patient medical records, radiologic data, and digital recordings from an intraoperative microscope. RESULTS: The patient groups with and without mannitol administration were comparable regarding patient age, number of elderly patients, sex, and aneurysm locations. No between-group difference was identified in terms of the intradural procedural time, retraction-induced cortical injury, postoperative electrolyte imbalance, symptomatic infarction, and postoperative epidural hematomas. However, the patient group without mannitol administration showed a significantly lower incidence of chronic subdural hematomas (CSDHs) >50 mL (13.3% vs. 3.1%, P = 0.010). Moreover, a multivariate analysis revealed that an advanced age (P = 0.019), male sex (P <0.001), and mannitol administration (P = 0.040) were all statistically significant risk factors for a postoperative CSDH >50 mL following unruptured aneurysm surgery. CONCLUSIONS: Withholding the administration of mannitol during a pterional or modified procedure for unruptured aneurysms was found to reduce the postoperative occurrence of a CSDH without increasing the operative difficulties or other postoperative complications.


Assuntos
Aneurisma Roto/cirurgia , Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/complicações , Manitol/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Aneurisma Roto/tratamento farmacológico , Craniotomia/efeitos adversos , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Incidência , Aneurisma Intracraniano/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Fatores de Risco , Instrumentos Cirúrgicos/efeitos adversos
7.
World Neurosurg ; 126: 120-123, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30862578

RESUMO

BACKGROUND: Angiosarcoma often arises as a cutaneous disease in the scalp and the face; however, subdural hematoma (SDH) associated with angiosarcoma is extremely rare. CASE DESCRIPTION: A 72-year-old woman visited our hospital with gait disorder and progressive consciousness disturbance approximately 3 months after a minor head injury. Initially, on reviewing the results of imaging studies, she was diagnosed with traumatic chronic SDH. Despite repeated operations thereafter, including the embolization of the middle meningeal artery, her general condition progressively worsened, and computed tomography of head repeatedly showed the recurrence of SDH. Based on histopathologic and intraoperative findings, she was finally diagnosed with angiosarcoma originating from the skull. She died shortly thereafter because of aggressive recurrent intracranial SDH caused by leptomeningeal dissemination. CONCLUSIONS: In addition to cancers metastatic to the skull or dura mater, angiosarcoma should be included in the differential diagnosis for patients with repeated SDH and bone defect. An effective treatment for angiosarcoma with SDH that shows an unfavorable prognosis has not been established; however, an early diagnosis might be useful for a novel treatment.


Assuntos
Hemangiossarcoma/patologia , Hematoma Subdural Crônico/patologia , Neoplasias Cranianas/patologia , Idoso , Evolução Fatal , Feminino , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/etiologia , Humanos , Recidiva , Neoplasias Cranianas/complicações , Neoplasias Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Br J Neurosurg ; 33(3): 302-304, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28658987

RESUMO

Parkinsonism has been reported as a complication of a ventriculoperitoneal shunt (VPS) or clinical symptoms of chronic subdural haematoma (CSDH). We report an interesting case of parkinsonism in a patient with CSDH secondary to placement of a VPS for obstructive hydrocephalus, and we discuss the possible pathophysiological mechanisms and treatment.


Assuntos
Hematoma Subdural Crônico/etiologia , Hidrocefalia/cirurgia , Transtornos Parkinsonianos/etiologia , Derivação Ventriculoperitoneal/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Próteses e Implantes/efeitos adversos , Tomografia Computadorizada por Raios X
9.
Br J Neurosurg ; 33(4): 428-431, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28660808

RESUMO

Background: Non traumatic subdural hematomas are rare, especially those associated with intracranial meningiomas. Among the most common meningiomas associated with spontaneous bleeding are angioblastic and malignant meningioma variants. The pathophysiological mechanisms of this association are not yet fully understood. The association of chronic subdural hematoma with microcystic meningioma histological subtype has not yet been described in the literature. Case report: The authors present a case report of a patient with a spontaneous non traumatic chronic subdural hematoma associated with a microcystic subtype grade I meningioma of the parietal convexity. Epidemiological, etiology, natural history, pathophysiology, risk factors of bleeding and treatment options are reviewed. Conclusion: Spontaneous subdural hematomas associated with meningiomas are rare, specially related to the microcystic variant of meningioma. Careful pre-operative consideration of specific anatomy and pathophysiological features are paramount to their full treatment.


Assuntos
Hematoma Subdural Crônico/etiologia , Neoplasias Meníngeas/complicações , Meningioma/complicações , Idoso de 80 Anos ou mais , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Craniotomia/métodos , Feminino , Hematoma Subdural Crônico/cirurgia , Humanos , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Recidiva , Tomografia Computadorizada por Raios X
10.
Neurosurg Focus ; 45(4): E7, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30269586

RESUMO

OBJECTIVE: Causes, clinical presentation, management, and outcomes of chronic subdural hematoma (CSDH) in low- and middle-income countries are not well characterized in the literature. Knowledge regarding these factors would be beneficial in the development and implementation of effective preventive and management measures for affected patients. The authors conducted a study to gain a better understanding of these factors in a low-income setting. METHODS: This prospective study was performed at Mbarara Regional Referral Hospital (MRRH) in Uganda between January 2014 and June 2017. Patients of any age who presented and were diagnosed with CSDH during the aforementioned time period were included in the study. Variables were collected from patients' files at discharge and follow-up clinic visits. The primary outcome of interest was death. Secondary outcomes of interest included discharge Glasgow Coma Scale (GCS) score, ICU admission, wound infection, and CSDH recurrence. RESULTS: Two hundred five patients, the majority of whom were male (147 [72.8%]), were enrolled in the study. The mean patient age was 60.2 years (SD 17.7). Most CSDHs occurred as a result of motor vehicle collisions (MVCs) and falls, 35.6% (73/205) and 24.9% (51/205), respectively. The sex ratio and mean age varied depending on the mechanism of injury. Headache was the most common presenting symptom (89.6%, 173/193), whereas seizures were uncommon (11.5%, 23/200). Presenting symptoms differed by age. A total of 202 patients underwent surgical intervention with burr holes and drainage, and 22.8% (46) were admitted to the ICU. Two patients suffered a recurrence, 5 developed a postoperative wound infection, and 18 died. Admission GCS score was a significant predictor of the discharge GCS score (p = 0.004), ICU admission (p < 0.001), and death (p < 0.001). CONCLUSIONS: Trauma from an MVC is the commonest cause of CSDH among the young. For the elderly, falling is common, but the majority have CSDH with no known cause. Although the clinical presentation is broad, there are several pronounced differences based on age. Burr hole surgery plus drainage is a safe and reliable intervention. A low preoperative GCS score is a risk factor for ICU admission and death.


Assuntos
Hematoma Subdural Crônico , Acidentes por Quedas , Acidentes de Trânsito , Fatores Etários , Idoso , Craniotomia , Países Desenvolvidos , Drenagem , Feminino , Escala de Coma de Glasgow , Cefaleia/etiologia , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/mortalidade , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Estudos Prospectivos , Distribuição por Sexo , Resultado do Tratamento , Uganda/epidemiologia
11.
World Neurosurg ; 120: e855-e862, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30189302

RESUMO

OBJECTIVE: Studies on resuming anticoagulation after burr-hole drainage for chronic subdural hematoma (CSDH) are limited. To evaluate the safety for early warfarin resumption after burr-hole drainage, we conducted a retrospective matched cohort study. METHODS: Between January 2008 and April 2015, 36 patients with warfarin-related unilateral CSDH and 151 patients with ordinary unilateral CSDH were enrolled in this study. Patients taking warfarin were managed homogeneously according to the study protocol, and the usual dosage of warfarin was resumed within 2 or 3 days of burr-hole drainage to reach a target international normalized ratio (INR) of 2.1. The primary outcome, defined as recurrent CSDH requiring repeated burr-hole drainage within 3 months of the initial surgery, was compared between the two groups. RESULTS: The primary outcome was observed in 4 (11%) of the 36 patients taking warfarin and in 18 (12%) of the 151 ordinary patients. After propensity score matching, the primary outcome was observed in 3 of 33 patients (9%) in the matched warfarin cohort and 11 of 74 patients (15%) in the matched ordinary cohort. When the results were analyzed using the generalized estimating equation, no significant difference was observed in the rate of recurrent CSDH between the 2 groups (P = 0.411). In addition, we found that recurrent CSDH was not related to postoperative international normalized ratio levels (P = 0.332). CONCLUSIONS: There was no definitive association between postoperative early warfarin resumption and the recurrence rate of CSDH. Patients with warfarin-related CSDH and a strong indication for anticoagulation can be managed by resuming warfarin within 3 days of burr-hole drainage.


Assuntos
Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/cirurgia , Varfarina/administração & dosagem , Varfarina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Drenagem , Feminino , Hematoma Subdural Crônico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Risco , Adulto Jovem
12.
J Chin Med Assoc ; 81(9): 781-786, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29929831

RESUMO

BACKGROUND: The risk factors implicated in the genesis of chronic subdural hematomas include old age, alcoholism, diabetes mellitus, arachnoid cysts, coagulopathy, anticoagulant (ACTh) and antiplatelet drugs. However, no study has reported an association between arterial hypertension (HTA) and chronic subdural hematomas. Therefore, the aim of this study was to investigate whether HTA is a risk factor for spontaneous chronic subdural hematomas (SCSDHs). METHODS: This multicenter study included patients aged over 60 years and was conducted from January 2009 to the end of 2015. One hundred and twenty-two patients with SCSDHs and 111 controls treated for other reasons with no evidence of intracranial hemorrhages on brain computed tomography were enrolled. The patients were separated into three age subgroups to provide a better insight into the role of risk factors with age. RESULTS: The average age in the SCSDH group was 74.45 ± 8.16 years, compared to 71.28 ± 6.69 years in the control group. The SCSDH group was significantly older than the control group (p = 0.0014). The patients in the 60-69 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0519), ACTh treatment (p = 0.0292) and alcoholism (p = 0.0300) than the control group. The patients in the 70-79 years age group diagnosed with SCSDHs had significantly higher rates of HTA (p = 0.0071) and ACTh treatment (p = 0.0158) than the control group. In the subgroup of patients older than 80 years, there were no statistical differences. CONCLUSION: The incidence of HTA had borderline significance in the patients aged 60-69 years with SCSDHs and statistical significance in the patients aged 70-79 years with SCSDHs. Anticoagulant therapy was the most significant risk factor. Among the patients with SCSDHs aged 60-69 years, the percentage of heavy drinkers was significantly higher than in the control group.


Assuntos
Hematoma Subdural Crônico/etiologia , Hipertensão/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/complicações , Anticoagulantes/efeitos adversos , Complicações do Diabetes/etiologia , Feminino , Humanos , Masculino , Inibidores da Agregação de Plaquetas/efeitos adversos , Fatores de Risco
13.
World Neurosurg ; 115: 338-340, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29751185

RESUMO

BACKGROUND: Cerebral atrium diverticula are focal enlargements of the ventricular system that may develop in the presence of persistent intracranial hypertension, but they are rarely described in cases of acute intracranial hypertension. Here we present a unique case of obstructive hydrocephalus in a newborn due to the formation of a cerebral atrium diverticulum compressing the ventricular system. CASE DISCUSSION: A preterm 38-week-old boy was born with urgent caesarian section due to severe hydrocephalus. Magnetic resonance imaging showed the presence of a subacute right subdural hematoma with secondary obstructive hydrocephalus. The cystic lesion was characterized as a right ventricular atrium diverticulum. The child underwent urgent burr-hole evacuation of the right subdural hematoma with complete regression of the obstructive hydrocephalus and right atrial diverticulum. CONCLUSION: Cerebral atrium diverticula are rare focal dilatations of the ventricular system, and their radiologic diagnosis may be challenging. Accurate diagnosis of atrial diverticula and understanding of the underlying physiopathology is mandatory to establish the appropriate operative strategy.


Assuntos
Ventrículos Cerebrais/diagnóstico por imagem , Ventrículos Cerebrais/cirurgia , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Hidrocefalia/diagnóstico por imagem , Hidrocefalia/cirurgia , Ventrículos Cerebrais/anormalidades , Cesárea/métodos , Feminino , Hematoma Subdural Crônico/etiologia , Humanos , Hidrocefalia/etiologia , Recém-Nascido , Masculino , Gravidez , Resultado do Tratamento , Ultrassonografia Pré-Natal/métodos
14.
World Neurosurg ; 116: e266-e272, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29730098

RESUMO

OBJECTIVE: We evaluated the clinical course and significance of postoperative subdural fluid collection (SFC) and identified the patients who were at risk of developing postoperative chronic subdural hematoma (CSDH) after the clipping of unruptured intracranial aneurysms (UIAs). METHODS: Between January 2012 and June 2014, we retrospectively reviewed 298 patients with UIAs treated by microsurgical clipping. Among them, 257 patients were enrolled in the present study. Subdural lesions (SDLs) were defined as SFC at 1-month follow-up computed tomography (CT) and a CSDH at any time within 1 month after the clipping of UIAs. We examined the volume changes, Hounsfield unit (HU) values, and the end results of SFC in serial CT scans. RESULTS: The incidence of postoperative CSDH that needed burr hole surgery was 2.5%. Changes in SFC volume that occurred within 1 week of surgery were a risk factor for the occurrence of SDL at the 1-month follow-up CT (odds ratio 34.039; P < 0.001). The corrected average HU value of SCF (cut-off value: 11.9, with a sensitivity of 83.3% and specificity of 73.7%) on postoperative day 7 was an independent risk factor for development of a CSDH at the 1-month follow-up CT (odds ratio 19.261; P = 0.003). CONCLUSIONS: SDLs seen during 1-month follow-up may be associated with the occurrence of increased SFC volume within a week after the clipping of UIAs. The corrected average HU value of the SFC on postoperative day 7 was the only risk factor for the development of CSDHs at 1-month follow-up CT.


Assuntos
Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/cirurgia , Microcirurgia/efeitos adversos , Microcirurgia/instrumentação , Complicações Pós-Operatórias/etiologia , Instrumentos Cirúrgicos/efeitos adversos , Idoso , Feminino , Seguimentos , Humanos , Incidência , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/epidemiologia , Masculino , Pessoa de Meia-Idade , Curva ROC , Análise de Regressão , Estudos Retrospectivos , Fatores de Tempo , Tomografia Computadorizada por Raios X
15.
Neurol Med Chir (Tokyo) ; 58(6): 247-253, 2018 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-29760311

RESUMO

The precise mechanism of the development of chronic subdural hematoma (CSDH) as a postoperative complication after aneurysmal clipping remains unclear. The purpose of this study was to identify the independent risk factors for CSDH after craniotomy for aneurysmal clipping and to elucidate the relationship between CSDH and subdural air (SDA) collection immediately after surgery. The medical records and radiologic data of 344 patients who underwent surgical clipping of unruptured aneurysms from July 2010 to July 2016 were retrospectively evaluated. Patient characteristics, aneurysm characteristics, and operation data were statistically analyzed to reveal their relationships with CSDH development. Among the 344 patients, 46 (13.4%) developed CSDH and 13 (3.8%) required subsequent burr-hole surgery for evacuation and irrigation. Multivariate analyses showed that advanced age (P < 0.0001), male sex (P = 0.035), and surgical clipping of multiple aneurysms (P = 0.037) were independent preoperative predictors of CSDH development. Advanced age (P = 0.0005) and postoperative SDA after clipping surgery (P < 0.0001) were independent postoperative predictors of CSDH development. Postoperative SDA and CSDH were not associated with the individual surgeon or operation time. Postoperative severe SDA was significantly associated with the ipsilateral development of CSDH, irrespective of the side of craniotomy. Postoperative SDA is an independent risk factor for CSDH after surgical clipping of unruptured aneurysms and is as important as advanced age, male sex, and surgical clipping of multiple aneurysms in predicting CSDH.


Assuntos
Craniotomia/efeitos adversos , Hematoma Subdural Crônico/etiologia , Aneurisma Intracraniano/cirurgia , Complicações Pós-Operatórias/etiologia , Espaço Subdural , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
16.
World Neurosurg ; 114: 335-338, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29631078

RESUMO

BACKGROUND: Even though rarely reported as a cause of pure subdural hematoma (SDH), aneurysmal rupture should be suspected in patients with spontaneous SDH without coagulopathy. CASE DESCRIPTION: We report a case of acute-on-chronic SDH in a 55-year-old lady with cerebral herniation due to a ruptured posterior communicating artery aneurysm. She was managed with single-stage SDH evacuation along with clipping of the aneurysm. CONCLUSIONS: Computed tomography angiography of the head is advisable in patients with spontaneous SDH without coagulopathy. Pure SDH as compared with SDH associated with subacute hemorrhage, intraventricular hemorrhage, or intracerebral hemorrhage due to aneurysmal rupture has a good outcome.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Crônico/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Roto/complicações , Aneurisma Roto/cirurgia , Feminino , Hematoma Subdural Agudo/etiologia , Hematoma Subdural Agudo/cirurgia , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Aneurisma Intracraniano/complicações , Aneurisma Intracraniano/cirurgia , Pessoa de Meia-Idade
17.
World Neurosurg ; 113: e598-e603, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29486314

RESUMO

OBJECTIVE: To study the prognoses of patients with subdural hematoma (SDH) who were not operated on at the time of the first diagnosis and the causes of enlarged hematomas in some patients during the follow-up period. MATERIALS AND METHODS: The records, service files, and radiologic examination results of the patients with diagnoses of SDH were reviewed. The SDH patients were recorded under 5 different categories: acute SDH (ASDH), subacute SDH (SSDH), chronic SDH (CSDH), acute component with chronic SDH (A-CSDH), and subacute component with chronic SDH (S-CSDH). The symptoms, clinical findings, and progression in the patients were correlated with radiologic examinations. RESULTS: A total of 291 patients received diagnoses of SDHs: 80 patients with acute, 29 patients with subacute, and 163 patients with chronic hematoma. Thirty-five patients had diagnoses of SDH with a combination of different components. It was determined that in the follow-up period, patients with A-CSDH showed the greatest increase in hematoma size over time and required surgical intervention the most often. CONCLUSION: SDHs reveal different prognoses in different age groups. Multicomponent SDHs are within the group that shows the greatest increase in size in the follow-up period. SDHs and CSDHs cause recurrent hemorrhages by sustaining the tension on the bridging veins. The greater the hematoma volume, the greater the growth potential of the hematoma tends to be. CSDHs that do not manifest changes in volume for a long time can be monitored without surgical intervention as long as the clinical picture remains stable.


Assuntos
Progressão da Doença , Hematoma Subdural Agudo/diagnóstico por imagem , Hematoma Subdural Crônico/diagnóstico por imagem , Adolescente , Adulto , Anticoagulantes/efeitos adversos , Criança , Pré-Escolar , Feminino , Seguimentos , Hematoma Subdural Agudo/etiologia , Hematoma Subdural Crônico/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
18.
Clin Neurol Neurosurg ; 166: 56-60, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29408774

RESUMO

OBJECTIVES: Pneumocephalus is a common operative complication of chronic subdural hematoma. This study is to analyze the relationship between postoperative pneumocephalus and the recurrence and surgical outcomes. PATIENTS AND METHODS: This is a retrospective case-cohort study, including a pneumocephalus group (n = 46) and a control group (n = 181). Their recurrence rates, CT attenuation values, hospital stay, healing time and the neurological status were recorded and analyzed. RESULTS: The pneumocephalus group had a recurrence rate of 32.6%, significantly higher than the control (17.7%). In addition, the pneumocephalus group had a higher rate of postoperative epilepsy (21.7% vs 3.3%), longer hospital stay (11.5 ±â€¯2.8 vs 7.8 ±â€¯1.2 days), longer healing time (10.8 ±â€¯5.4 vs 6.5 ±â€¯2.3 months), and worse neurological scores than the control. CONCLUSION: Pneumocephalus increases the recurrence rate of chronic subdural hematoma, and it not only prolongs the hospital stay and healing time, but also leads to deterioration of the neurological status.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Tempo de Internação/tendências , Pneumocefalia/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Seguimentos , Hematoma Subdural Crônico/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumocefalia/etiologia , Complicações Pós-Operatórias/etiologia , Recidiva , Estudos Retrospectivos
19.
World Neurosurg ; 111: 201-206, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29288848

RESUMO

BACKGROUND: The recurrence rate of chronic subdural hematoma (CSDH) after trepanation is relatively high and involves various factors. We encountered an extremely rare case in which metastasis of an extracranial malignant tumor to the hematoma capsule was thought to be causing short-term repeated recurrences of CSDH. CASE DESCRIPTION: The patient was a 74-year-old man who had undergone bur hole evacuation of left CSDH 7 months earlier and had been receiving chemotherapy for stage IV gastric cancer for the preceding 6 months. He presented with symptoms of right hemiparesis and was diagnosed with left CSDH. Bur hole evacuation was performed twice, but the hematoma enlarged again both times within a short period. A third bur hole evacuation was performed after middle meningeal artery embolization, but the hematoma again enlarged shortly thereafter. Hematoma enlargement was finally suppressed by extracting the hematoma capsule under craniotomy. In histopathologic examinations, hematoxylin-eosin staining showed poorly differentiated adenocarcinoma primarily along the luminal side of the hematoma capsule and immunohistochemical staining showed results identical to findings from the existing gastric cancer. Pathologic results confirmed metastasis of the gastric cancer to the hematoma capsule, and this was considered to be the cause of short-term repeated recurrence of CSDH. CONCLUSIONS: To the best of our knowledge, this is the first report of metastasis to a hematoma capsule originating from an extracranial malignant tumor. The clinical course in the present case suggests metastasis of extracranial malignant tumor to the CSDH capsule as an extremely rare cause of recurrence.


Assuntos
Adenocarcinoma/secundário , Neoplasias Encefálicas/secundário , Hematoma Subdural Crônico/etiologia , Neoplasias Gástricas/patologia , Idoso , Hematoma Subdural Crônico/patologia , Humanos , Masculino , Recidiva
20.
Neurosurg Rev ; 41(2): 447-455, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28528493

RESUMO

Chronic subdural hematoma (CSDH) with brain herniation signs is rarely seen in the emergent department. As such, there are few cumulative data to analyze such cases. In this study, we evaluated the clinical features, risk factors, and rates of completion with impending brain herniation on arrival in a cohort study. We analyzed 492 consecutive patients with CSDH between January 2010 and October 2015. First, we analyzed the clinical factors and compared them between patients with or without brain herniation signs on admission. Second, we compared clinical factors between patients with or without completion of brain herniation after operation among patients who had brain herniation signs on arrival. Eleven (2.2%) patients showed brain herniation signs on arrival, and six patients (1.2%) progressed to complete brain herniation. Patients with brain herniation signs on arrival were significantly older (P = 0.03) and more frequently hospitalized with a concomitant illness (P < 0.0001). Niveau formation (P = 0.0005) and acute-on CSDH (P = 0.0001) on computed tomography were also more frequently seen in patients with brain herniation signs. Multivariate logistic regression analysis showed that age older than 75 years (OR 2.16, P < 0.0001), niveau formation (OR 3.09, P < 0.0001), acute-on CSDH (OR 14, P < 0.0001), and admitted to another hospital (OR 52.6, P < 0.0001) were independent risk factors for having had brain herniation signs on arrival. On the other hand, having a history of head injury (P = 0.02) and disappearance of the ambient cistern (P = 0.0009) were significantly associated with completion of brain herniation. The prognosis was generally poor if the patient had presented with brain herniation signs on admission. Our results demonstrate that the diagnosis is often made late, despite hospitalization for a concomitant illness. When the elderly show mild disturbance of consciousness, physicians except neurosurgeons need to consider the possibility of CSDH regardless of a recent history of head injury.


Assuntos
Serviço Hospitalar de Emergência , Encefalocele/diagnóstico , Hematoma Subdural Crônico/diagnóstico , Idoso , Estudos de Coortes , Diagnóstico Tardio , Encefalocele/cirurgia , Feminino , Hematoma Subdural Crônico/etiologia , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
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