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1.
Dtsch Med Wochenschr ; 113(13): 961-964, 2018 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-29972840

RESUMO

HISTORY AND CLINICAL FINDINGS: 82-year old male patient suspected of having cerebral hemorrhage under anticoagulation therapy with Dabigatran due to atrial fibrillation. INVESTIGATIONS: CT scan showed bilateral chronic subdural hematomas with fresh blood in left-subdural hematoma and midline shift. Laboratory analysis shows only a moderately high Dabigatran level but thrombin time was high out of range. DIAGNOSIS: Fall-related intracerebral haemorrhage and subdural hematoma under anticoagulation therapy. THERAPY AND COURSE: Neurosurgical hematoma evacuation and trepanation after preoperative use of Idarucizumab as an antidote for Dabigatran to stop anticoagulative effects and secure normal bleeding conditions, led to reduced midline shift. We started heparin-based anticoagulation first followed by Dabigatran again in clinical steady state and after rehabilitation with neurologically low-grade residuals.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Hemorragia Cerebral/induzido quimicamente , Hemorragia Cerebral/tratamento farmacológico , Dabigatrana/efeitos adversos , Idoso de 80 Anos ou mais , Fibrilação Atrial/tratamento farmacológico , Testes de Coagulação Sanguínea , Dabigatrana/uso terapêutico , Traumatismos Cranianos Fechados/complicações , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Trepanação
2.
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
3.
World Neurosurg ; 109: 432-435, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29054780

RESUMO

BACKGROUND: Chronic subdural hematoma (CSDH) is a common intracranial hematoma. The number of patients who undergo anticoagulant therapy including a direct oral anticoagulant (DOAC) is expected to increase. Recently, idarucizumab, the antidote for dabigatran, which is a DOAC, has been developed. We successfully treated CSDH with dabigatran using emergency burr hole surgery and idarucizumab. CASE DESCRIPTION: A 79-year-old Japanese man severely hit his head and visited the emergency department. Computed tomography (CT) showed tiny traumatic acute subdural hematoma, for which he was admitted. At that time, atrial fibrillation was newly detected, for which dabigatran, having a specific antidote (idarucizumab), was chosen and started 2 weeks after the discharge. Two months after the trauma episode, he revisited the emergency department because of acute left upper and lower limb motor weakness. CT revealed a midline shifted CSDH. Considering rush course of motor weakness and shifted brain, we performed emergency surgery using an antidote for dabigatran, idarucizumab. He was discharged 5 days after surgery without any complications or excessive perioperative hemorrhage. CONCLUSION: Dabigatran should be used for atrial fibrillation detected after head trauma. Emergency surgery can be safely performed for CSDH with dabigatran using idarucizumab.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Antídotos/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Dabigatrana/efeitos adversos , Dabigatrana/uso terapêutico , Emergências , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/cirurgia , Trepanação/métodos , Idoso , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Masculino , Tomografia Computadorizada por Raios X
4.
Neurosurg Rev ; 41(2): 439-445, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28550627

RESUMO

In view of their age and vascular co-morbidities, people are often taking an antithrombotic drug when diagnosed with chronic subdural haematoma (CSDH). It is unclear whether antithrombotic use at CSDH diagnosis, or resumption afterwards, is associated with recurrent CSDH or vaso-occlusive events. We systematically reviewed the literature for studies reporting CSDH recurrence or vaso-occlusive events after drainage of CSDH associated with antithrombotic drug use. We searched Medline 1946-2016 and Embase 1974-2016 inclusive for cohort studies reporting the risk of CSDH recurrence or vaso-occlusive events after CSDH associated with antithrombotic (anticoagulant or antiplatelet) drug use. We meta-analysed outcome data using a random effect model and assessed inconsistency between studies using the I-squared (I 2) statistic. We found 20 studies reporting outcome after drainage of CSDH associated with antithrombotic drug use. Before CSDH drainage, 337 (11.5%) of 2941 patients in 12 studies used an anticoagulant drug and 600 (19%) of 3150 patients in 11 studies used an antiplatelet drug. The association between antithrombotic drug use and CSDH recurrence was significant for antiplatelet drug use (relative risk [RR] 1.36, 95% CI 1.05 to 1.75; I 2 = 36.3%), but marginally significant for anticoagulant drug use (RR 1.38 95% CI 1.00-1.91; I 2 = 37.5%). Two studies including 30 patients reported one vaso-occlusive outcome event after CSDH. Antithrombotic drug use at CSDH diagnosis may be associated with post-operative CSDH recurrence. It is unclear whether this is attributable to confounding factors, antithrombotic reversal strategies or antithrombotic drug resumption. Further observational studies and randomised controlled trials of antithrombotic drug resumption are needed.


Assuntos
Anticoagulantes/efeitos adversos , Drenagem , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Adulto , Idoso , Anticoagulantes/uso terapêutico , Arteriopatias Oclusivas/tratamento farmacológico , Estudos de Coortes , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Fatores de Risco
5.
Oper Neurosurg (Hagerstown) ; 14(5): 556-562, 2018 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-28973653

RESUMO

BACKGROUND: Traditional treatment for symptomatic subdural hematoma (SDH) has been surgical evacuation, but recurrence rates are high and patients often harbor complex medical comorbidities. Growth and recurrence is thought to be due to the highly friable nature of the vascularized membrane that forms after initial injury. There have been reported cases of middle meningeal artery (MMA) embolization for treatment of recurrent SDH after surgical evacuation with the goal of eliminating the arterial supply to this vascularized membrane. OBJECTIVE: To present the first known case series of MMA embolization as upfront treatment for symptomatic chronic SDHs that have failed conservative management in lieu of surgical evacuation. METHODS: Five patients with symptomatic chronic SDHs underwent MMA embolization using PVA microparticles at our institution. Size of SDH was recorded in maximum diameter and total volume. RESULTS: Four patients underwent unilateral and 1 underwent bilateral MMA embolization successfully. All cases had significant reduction in total volume of SDH at longest follow-up scan: 81.4 to 13.8 cc (7 wk), 48.5 to 8.7 cc (3 wk), 31.7 and 88 to 0 and 17 cc (14 wk, bilateral), 79.3 to 24.2 cc (8 wk), and 53.5 to 0 cc (6 wk). All patients had symptomatic relief with no complications. Histologic analysis of the chronic SDH membrane in a separate patient that required surgery revealed rich neovascularization with many capillaries and few small arterioles. CONCLUSION: MMA embolization could present a minimally invasive and low-risk initial treatment alternative to surgery for symptomatic chronic SDH when clinically appropriate.


Assuntos
Embolização Terapêutica/métodos , Hematoma Subdural Crônico/terapia , Artérias Meníngeas , Acidentes por Quedas , Idoso , Aspirina/efeitos adversos , Clopidogrel/efeitos adversos , Feminino , Seguimentos , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
J Clin Neurosci ; 38: 79-83, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28038831

RESUMO

Antithrombotic agents (AT), including anticoagulants and antiplatelets, are risk factors of chronic subdural hematomas (CSDHs). However, the use of AT has not been clearly associated with postoperative recurrence (PR) in the literature before. Furthermore, the association between the resumption of AT and postoperative complications also requests research. Databases including Pubmed, Embase and Cochrane were searched for patients presenting with CSDH on anticoagulant or antiplatelet medication. Ten studies were included to analyze the association between the use of AT and PR: The meta-analysis showed that the use of AT, both anticoagulants (OR=2.20, 95%CI [1.45, 3.33]; P=0.0002) and antiplatelets (OR=1.64, 95%CI [1.17, 2.30]; P=0.004), could increase the PR rate. Two studies were included to analyze the relationship between the resumption of AT and postoperative complications. The meta-analysis showed that after the patients on AT resumed their medication, the risk of PR did not increase (OR=0.33, 95%Cl [0.13, 0.80]; P=0.01), and the occurrence of thromboembolism events had no statistical significance (OR=1.30, 95%CI [0.26, 6.50]; P=0.75). This meta-analysis demonstrated that AT were risk factors for the recurrence of CSDH. Recommencement of AT did not appear to increase the risk of postoperative hemorrhage, and could reduce the risk of thromboembolism. Thus, appropriate postoperative resumption of anticoagulants or antiplatelets may be safe. Still, more evidence is needed to answer the question about whether and how to resume AT.


Assuntos
Fibrinolíticos/administração & dosagem , Fibrinolíticos/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Complicações Pós-Operatórias/induzido quimicamente , Anticoagulantes/efeitos adversos , Anticoagulantes/uso terapêutico , Hematoma Subdural Crônico/diagnóstico , Humanos , Inibidores da Agregação de Plaquetas/efeitos adversos , Inibidores da Agregação de Plaquetas/uso terapêutico , Complicações Pós-Operatórias/diagnóstico , Recidiva , Fatores de Risco , Tromboembolia/diagnóstico , Tromboembolia/tratamento farmacológico
7.
J Clin Neurosci ; 28: 82-6, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26898577

RESUMO

The aim of this study is to analyze the association of preoperative usage of angiotensin converting enzyme (ACE) inhibitors with the initial presentation and clinical outcome of patients with chronic subdural hematoma (cSDH). Patients treated for cSDH between 2009 and 2013 at our institution were included in this retrospective case-control study. Medical charts were reviewed retrospectively and data were analyzed using descriptive and inferential statistics. Out of 203 patients (58 females, mean age 73.2years), 53 (26%) patients were on ACE inhibitors before their presentation with cSDH. Median initial hematoma volume in individuals with ACE inhibitors (179.2±standard error of the mean [SEM] 13.0ml) was significantly higher compared to patients without ACE inhibitors (140.4±SEM 6.2ml; p=0.007). There was an increased probability of surgical reintervention in the ACE inhibitor group (12/53, 23% versus 19/153, 12%; p=0.079), especially in patients older than 80years (6/23, 26% versus 3/45, 7%; p=0.026). ACE inhibitors are associated with higher hematoma volume in patients with cSDH and with a higher frequency of recurrences requiring surgery (especially in the very old). We hypothesize that these effects are due to ACE inhibitor induced bradykinin elevation causing increased vascular permeability of the highly vascularized neomembranes in cSDH.


Assuntos
Inibidores da Enzima Conversora de Angiotensina/efeitos adversos , Hematoma Subdural Crônico , Avaliação de Resultados em Cuidados de Saúde , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Humanos , Masculino , Recidiva , Estudos Retrospectivos
8.
Neurol Med Chir (Tokyo) ; 55(2): 173-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25746312

RESUMO

The exact predictive factors for postoperative recurrence of chronic subdural hematoma (CSDH) are still unknown. Based on the preoperative magnetic resonance imaging (MRI), low recurrence rate of T1-hyperintensity hematoma was previously reported. We investigated the other types of radiological findings which are related to the recurrence rate of CSDH in large number of patients analyzed by multivariate logistic regression model. Preoperative MRI and postoperative computed tomography (CT) were performed and the influence of the preoperative use of antiplatelet or anticoagulant drugs was also studied. The overall recurrence rate was 9.3% (47 of 505 hematomas). The MRI T1-iso/hypointensity group showed a significantly higher recurrence rate (18.2%, 29 of 159) compared to the other groups (5.2%, 18 of 346; p < 0.001). Multivariate logistic regression analysis showed T1 classification was the solo significant prognostic predictor among various factors such as bilateral hematoma, antiplatelet or anticoagulant drug usage, residual hematoma on postoperative CT, and MRI classification (p < 0.001): adjusted odds ratio for the recurrence in T1-iso/hypointensity group relative to the T1-hyperintensity group was 5.58 [95% confidence interval (CI), 2.09-14.86] (p = 0.001). Postoperative residual hematoma and antiplatelet or anticoagulant drug usage did not increase the recurrence risk. The preoperative MRI findings, especially T1WI findings, have predictive value for postoperative recurrence of CSDH and the T1-iso/hypointensity group can be assumed to be a high recurrence risk group.


Assuntos
Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Anticoagulantes/efeitos adversos , Criança , Feminino , Hematoma Subdural Crônico/induzido quimicamente , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Prognóstico , Recidiva , Fatores de Risco , Tomografia Computadorizada por Raios X , Adulto Jovem
10.
Clin Neurol Neurosurg ; 120: 49-54, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24731576

RESUMO

OBJECTIVE: The present study tested the hypothesis of whether antiplatelet agents (APA) induce chronic subdural hematoma (CSDH) recurrence via a platelet aggregation inhibitory effect. METHOD: We examined risk factors for CSDH recurrence, focusing on APA, in 719 consecutive patients who admitted to three tertiary hospitals and underwent burr-hole craniostomy and irrigation for CSDH. This was a multicenter, retrospective, observational study. RESULTS: Age, sex, history of diabetes mellitus, hypertension, chronic renal failure, alcohol consumption habits, consciousness disturbance on admission, or preoperative CT density was not associated with recurrence. Subdural drainage was significantly associated with less recurrence. Preoperative oral APA administration was significantly associated with more recurrence. The recurrence rate of CSDH in non-APA group was 11% if surgery was performed on admission. However, if surgery was performed immediately after discontinuation of oral APA administration, the recurrence rate in APA group significantly increased to 32% (p value<0.0001; odds ratio, 3.77; 95% confidence interval, 1.72-8.28). The effect of APA on CSDH recurrence gradually diminished as the number of days until initial surgery, after stopping APA, increased. CONCLUSION: Antiplatelet therapy significantly influences the recurrence of CSDH.


Assuntos
Craniotomia/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/cirurgia , Inibidores da Agregação de Plaquetas/efeitos adversos , Complicações Pós-Operatórias/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/epidemiologia , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Recidiva , Estudos Retrospectivos , Fatores de Risco
11.
Neurol Med Chir (Tokyo) ; 54(5): 401-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24477063

RESUMO

A 78-year-old man who had a history of myocardial and cerebral infarction and who was treated with aspirin and warfarin, presented with left chronic subdural hematoma. Cerebral computed tomography showed severe brain compression of hematoma with midline shift, indicating the need for emergent surgery. The hematology and clotting tests upon admission revealed severe thrombocytopenia (platelet count, 1.3 × 10(4)/µL) with normal clotting activity. Because platelet aggregation was evident in the smear, we re-examined the patient for hematology using tubes that contained heparin, showing also low platelet count (2.3 × 10(4)/µL). The day on admission, we performed irrigation and drainage of the chronic subdural hematoma through single burr-hole craniostomy. During surgery, we used 10 units of platelet concentrates (PCs) for the reason that the patient was taking aspirin and coagulopathy derived from low platelet count could not be excluded. After surgery, we re-evaluated the hematology of the blood stored in tubes that contained ethylenediaminetetraacetic acid (EDTA) with or without kanamycin (KM). Treatment with KM dissociated EDTA-induced platelet aggregation and revealed platelet counts with highest accuracy (no KM treatment, 1.3 × 10(4)/µL; KM treatment, 15.2 × 10(4)/µL). This phenomenon is called EDTA-Dependent Pseudothrombocytopenia (PTCP) defined as falsely low platelet counts reported by automated hematology analyzers due to platelet aggretgation. Awareness of the phenomenon will enable neurosurgeons to manage patients with PTCP appropriately and clinical laboratory especially in emergency hospital is recommended to prepare for the hematological tubes being added KM in routine analysis, resulting in preventing mistaken diagnosis.


Assuntos
Anticoagulantes/efeitos adversos , Aspirina/efeitos adversos , Quelantes/farmacologia , Erros de Diagnóstico , Ácido Edético/farmacologia , Hematoma Subdural Crônico/etiologia , Contagem de Plaquetas , Varfarina/efeitos adversos , Idoso , Anticoagulantes/uso terapêutico , Aspirina/uso terapêutico , Cálcio , Diagnóstico Diferencial , Reações Falso-Negativas , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/diagnóstico por imagem , Heparina/farmacologia , Humanos , Masculino , Agregação Plaquetária/efeitos dos fármacos , Contagem de Plaquetas/instrumentação , Cuidados Pré-Operatórios , Trombocitopenia/diagnóstico , Tomografia Computadorizada por Raios X , Varfarina/uso terapêutico
12.
PLoS One ; 8(7): e68732, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23874740

RESUMO

BACKGROUND AND PURPOSE: In the last decade there has been an increasing use of antiplatelet/anticoagulant agents in the elderly. The aim of the study was to evaluate the association between exposure to anticoagulant/antiplatelet therapy and chronic subdural haematoma-CSDH. METHODS: Single institution case-control study involving 138786 patients older than 60 years who visited our academic tertiary care Emergency Department from January 1st 2001 to December 31st 2010. 345 patients with CSDH (cases) were identified by review of ICD-9 codes 432.1 and 852.2x. Case and controls were matched with a 1:3 ratio for gender, age (± 5 years), year of admission and recent trauma. A conditional logistic model was built. A stratified analysis was performed with respect to the presence (842 patients) or absence (536 patients) of recent trauma. RESULTS: There were 345 cases and 1035 controls. Both anticoagulant and antiplatelet agents were associated with an increased risk of CSDH with an OR of 2.46 (CI 95% 1.66-3.64) and 1.42 (CI 95% 1.07-1.89), respectively. OR was 2.70 (CI 95% 1.75-4.15), 1.90 (CI 95% 1.13-3.20), and 1.37(CI 95% 0.99-1.90) for patients receiving oral anticoagulants, ADP-antagonists, or Cox-inhibitors, respectively. History of recent trauma was an effect modifier of the association between anticoagulants and CSDH, with an OR 1.71 (CI 95% 0.99-2.96) for patients with history of trauma and 4.30 (CI 95% 2.23-8.32) for patients without history of trauma. CONCLUSIONS: Anticoagulant and antiplatelet therapy have a significant association with an increased risk of CSDH. This association, for patients under anticoagulant therapy, appears even stronger in those patients who develop a CSDH in the absence of a recent trauma.


Assuntos
Anticoagulantes/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Inibidores da Agregação de Plaquetas/efeitos adversos , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Análise de Regressão
13.
Clin Neurol Neurosurg ; 115(7): 981-4, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23128014

RESUMO

OBJECTIVE: Chronic subdural hematoma (CSDH) is a common disease among the elderly and with increasing incidence we have chosen to focus on associations between development and recurrence of CSDH and anticoagulation and/or antiplatelet agent therapy. METHODS: We conducted a retrospective review of 239 patients undergoing surgery for CSDH over a period of six years (2006-2011). Risk factors such as age, head trauma, anticoagulant and/or antiplatelet agent therapy and co-morbidity were investigated along with gender, coagulation status, laterality, surgical method and recurrence. RESULTS: Seventy-two percent of the patients were male and the mean age was 71.8 years (range 28-97 years). Previous fall with head trauma was reported in 60% of the patients while 16% were certain of no previous head trauma. The majority of patients (63%) in the non-trauma group were receiving anticoagulants and/or antiplatelet agent therapy prior to CSDH presentation, compared to 42% in the trauma group. Twenty-four percent experienced recurrence of the CSDH. There was no association between recurrence and anticoagulant and/or antiplatelet agent therapy. CONCLUSION: Anticoagulant and/or antiplatelet aggregation agent therapy is more prevalent among non-traumatic CSDH patients but does not seem to influence the rate of CSDH recurrence.


Assuntos
Anticoagulantes/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Traumatismos Craniocerebrais/complicações , Feminino , Lateralidade Funcional/fisiologia , Hematoma Subdural Crônico/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Recidiva , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
Pediatr Transplant ; 16(5): E135-9, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-22332723

RESUMO

Pediatric patients bridged to heart transplant with LVADs require chronic anticoagulation and are at increased risk of hemorrhagic complications, including intracranial hemorrhage. In this population, intracranial hemorrhage is often fatal. We report a case of successful management of a five-yr-old-boy with DCM on an LVAD who developed a subdural hematoma. We initially chose medical management, weighing the patient's high risk of thromboembolism from anticoagulation reversal against the risk of his chronic subdural hematoma. When head CT showed expansion of the hemorrhage with increasing midline shift, we chose prompt surgical evacuation of the hematoma with partial reversal of anticoagulation, given the increased risk of acute deterioration. The patient ultimately received an orthotopic heart transplant and was discharged with no permanent neurological complications. This represents a case of a pediatric patient on an LVAD who survived a potentially fatal subdural hematoma and was successfully bridged to cardiac transplantation.


Assuntos
Anticoagulantes/efeitos adversos , Insuficiência Cardíaca/cirurgia , Coração Auxiliar , Hematoma Subdural Crônico/terapia , Anticoagulantes/uso terapêutico , Pré-Escolar , Quimioterapia Combinada/efeitos adversos , Insuficiência Cardíaca/complicações , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/diagnóstico por imagem , Humanos , Masculino , Radiografia , Trombose/etiologia , Trombose/prevenção & controle
15.
Neurol Med Chir (Tokyo) ; 51(7): 515-8, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21785247

RESUMO

A 78-year-old Japanese man with a history of colon cancer was referred to our department of neurosurgery for the management of asymptomatic left chronic subdural hematoma (CSDH). He was receiving bevacizumab therapy for colon cancer, and the size of the CSDH increased or decreased depending on bevacizumab administration. Simple drainage was performed because of the risk of a critical increase in the size of CSDH during bevacizumab therapy, but since the CSDH was organized and firm, the drainage was insufficient. Therefore, neuroendoscope-assisted craniotomy was performed, and the organized CSDH was almost completely removed. The present case indicates the possible involvement of bevacizumab in the occurrence of CSDH and the efficacy of the neuroendoscopic approach in the surgical treatment of organized CSDH.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Craniotomia/métodos , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/cirurgia , Neuroendoscopia/métodos , Idoso , Inibidores da Angiogênese/efeitos adversos , Bevacizumab , Neoplasias do Colo/tratamento farmacológico , Craniotomia/instrumentação , Hematoma Subdural Crônico/diagnóstico , Humanos , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neuroendoscopia/instrumentação
16.
J Neurochem ; 114(4): 1063-73, 2010 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-20497302

RESUMO

A growing body of experimental evidence suggests that an intracerebral hematoma is toxic to neighboring cells. However, injury mechanisms remain largely undefined, due in part to conflicting results from in vivo studies. In order to investigate blood toxicity in a more controlled environment, murine clots were co-cultured on porous membrane inserts with primary neurons and glia. Erythrocyte lysis was apparent within 48 h, but was reduced by almost 80% in cultures lacking neurons, and by over 90% in the absence of both neurons and glial cells. By 72 h, most released hemoglobin had oxidized to methemoglobin or its hemichrome degradation products. At this time point, approximately 50% of neurons were non-viable, as detected by propidium iodide staining; glia were not injured. Deferoxamine, Trolox and the NMDA receptor antagonist MK-801 prevented most neuronal death, but had no effect on hemolysis at neuroprotective concentrations. The 27-fold increase in culture malondialdehyde and 5.8-fold increase in heme oxygenase-1 expression were also attenuated by deferoxamine and Trolox, but not by MK-801. These results suggest that hemoglobin release from clotted blood is accelerated by adjacent neurons and glia. Subsequent neurotoxicity is mediated by both iron-dependent and excitotoxic injury pathways.


Assuntos
Hematoma Subdural Crônico/patologia , Hemólise/fisiologia , Neuroglia/patologia , Neurônios/patologia , Neurotoxinas/toxicidade , Animais , Morte Celular/efeitos dos fármacos , Morte Celular/fisiologia , Células Cultivadas , Técnicas de Cocultura , Maleato de Dizocilpina/administração & dosagem , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/fisiopatologia , Heme Oxigenase-1/biossíntese , Hemoglobinas/toxicidade , Hemólise/efeitos dos fármacos , Ferro/metabolismo , Ferro/toxicidade , Malondialdeído/metabolismo , Camundongos , Neuroglia/efeitos dos fármacos , Neuroglia/metabolismo , Neurônios/efeitos dos fármacos , Fatores de Tempo
17.
J Clin Neurosci ; 16(10): 1287-90, 2009 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-19564115

RESUMO

Seventy-one patients from northern Sweden were diagnosed with chronic subdural haematomas (CSDH) and treated at the Department of Neurosurgery at Umeå University Hospital over 12 months. Fifty-four patients with CSDH had a history of head trauma (trauma group), while 17 patients had no previous head trauma (non-trauma group). In the non-trauma group 71% of patients were treated with anticoagulants or antiplatelet aggregation agents (AAA) compared to 18% in the trauma group. Considering only AAA, 59% of the non-trauma patients were treated with these drugs versus 17% of patients in the trauma group. The recurrence rate for all patients was 17%. These findings confirm that the use of anticoagulants and AAA is over-represented in patients with non-traumatic CSDH. In our study, recurrence was not associated with previous use of anticoagulants or AAA.


Assuntos
Anticoagulantes/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/tratamento farmacológico , Inibidores da Agregação de Plaquetas/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Risco , Suécia/epidemiologia
18.
Neurosurgery ; 61(4): 788-92; discussion 792-3, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17986940

RESUMO

OBJECTIVE: Chronic subdural hematoma (CSH) is characterized by pathological vascularization of the parietal membrane. Plasma leakage from immature vessels may be involved in hematoma enlargement and recurrence. We tested the hypothesis that the antiangiogenic side-effect of angiotensin converting enzyme (ACE)-inhibitor treatment for the control of arterial hypertension reduces the risk of recurrence in CSH. METHODS: We analyzed the data of 438 patients with CSH treated by a standard surgical procedure for hematoma evacuation in our department between 1995 and 2003. Patients with coagulopathies, malignancies, and independent neurological disorders were excluded from this study. Patient records were screened for age, sex, pre- and postoperative Markwalder score, arterial hypertension, medication with ACE-inhibitors, and recurrence of CSH. The rate of ACE-inhibitor treatment in our CSH patients was compared with an age-matched control group treated for herniated lumbar disc at the same time. The concentration of vascular endothelial growth factor was analyzed in hematoma samples and corresponding venous blood in 40 consecutive patients. RESULTS: A total of 310 patients were included in this study. The demographic data of Group A (with ACE-inhibition) and Group B (without ACE-inhibition) were comparable. In Group A, 5% (four out of 81) of the patients experienced recurrence as opposed to 18% (42 out of 229) in Group B (P = 0.00345). A negative correlation was found between the yearly rates of medication with ACE-inhibitors and recurrence (r = -0.8488; P = 0.0044). The rate of ACE-inhibitor treatment was lower in the CSH patients (25%) than in the control group (40%). The VEGF content was significantly lower in the hematoma in patients with ACE-inhibition (mean, 8891 pg/ml; range, 4300-18,300 pg/ml) than in patients without (mean, 22,565 pg/ml; range, 4200-89,650 pg/ml; P = 0.0116). CONCLUSION: Our data suggest that ACE-inhibitor treatment for the control of arterial hypertension lowers the risk of recurrence in patients undergoing operation for CSH and possibly even the development of CSH. This effect might be the result of an antiangiogenic mechanism of ACE-inhibitors.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Hematoma Subdural Crônico/tratamento farmacológico , Hipertensão/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Feminino , Hematoma Subdural Crônico/induzido quimicamente , Hematoma Subdural Crônico/epidemiologia , Hematoma Subdural Crônico/prevenção & controle , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Prevenção Secundária
20.
J Clin Neurosci ; 13(8): 823-7, 2006 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16997707

RESUMO

Eighty-one cases of chronic subdural haematomas (CSDH) admitted to the neurosurgical unit of the Royal Hobart Hospital, Tasmania, Australia, over a 5-year period were reviewed. The use of anticoagulant therapy as a causative agent in the development of CSDH was investigated. We suspected a high incidence of anticoagulant or anti-thrombotic therapy. We found that anticoagulant therapy was used by a significant percentage of CSDH patients. In the patient group presenting to our unit the risk of developing a CSDH was at least 42.5 times higher in warfarinised patients and also increased for patients on aspirin, although this risk could not be quantified.


Assuntos
Anticoagulantes/efeitos adversos , Fibrinolíticos/efeitos adversos , Hematoma Subdural Crônico/induzido quimicamente , Idoso , Idoso de 80 Anos ou mais , Aspirina/efeitos adversos , Feminino , Escala de Coma de Glasgow , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Varfarina/efeitos adversos
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