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1.
Medicine (Baltimore) ; 100(2): e24231, 2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33466204

RESUMO

INTRODUCTION: Thrombocytopenia (TP) is a common complication of childhood-onset systemic lupus erythematosus (SLE), and can range from mild to life-threatening. However, severe TP with multiple hemorrhagic complications is very rare and often predicts a poor prognosis. We describe a 12-year-old Chinese girl who had a history of idiopathic thrombocytopenic purpura who developed SLE that presented as subdural hemorrhage and retinal hemorrhage because of severe TP. PATIENT CONCERNS: A 12-year-old girl was admitted into our hospital because of fever, purpura, and gum bleeding lasting for 12 days. She had a history of idiopathic thrombocytopenic purpura 2 years ago previously. DIAGNOSIS: SLE was diagnosed according to American College of Rheumatology classification criteria. Subdural hemorrhage and retinal hemorrhage were diagnosed based on brain MRI and funduscopy. Severe TP was defined as platelet count <20 × 109/L. INTERVENTIONS: She was treated first with intravenous immunoglobulin, but it was not efficacious. High-dose methylprednisolone showed short-term efficacy. Then, she was given a glucocorticoid and cyclosporine A plus mycophenolate mofetil. OUTCOMES: Fever, purpura, and gum bleeding were resolved before hospital discharge. Subdural hemorrhage and left hemorrhagic retinopathy were improved remarkably. She had a durable response to refractory TP with no adverse effects during >1-year follow-up. CONCLUSION: Isolated TP may be an early symptom of childhood-onset SLE . A child with severe TP is prone to develop life-threatening hemorrhagic complications. Glucocorticoids and combined immunosuppressive drugs had a durable response to refractory TP in this patient with no adverse effects.


Assuntos
Glucocorticoides/uso terapêutico , Hematoma Subdural/tratamento farmacológico , Imunossupressores/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Hemorragia Retiniana/tratamento farmacológico , Criança , Ciclosporina/uso terapêutico , Feminino , Hematoma Subdural/etiologia , Humanos , Imunoglobulinas Intravenosas/uso terapêutico , Metilprednisolona/uso terapêutico , Ácido Micofenólico , Púrpura Trombocitopênica Idiopática/etiologia , Hemorragia Retiniana/etiologia
2.
J Trauma Acute Care Surg ; 89(2): 405-410, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32744835

RESUMO

INTRODUCTION: Organ dysfunction following traumatic brain injury (TBI) is common and has been associated with unpredictable outcomes. The aim of our study is to describe the incidence of non-neurological organ dysfunction (NNOD) and its impact on outcomes in patients with severe TBI admitted to our intensive care unit (ICU). METHODS: We performed a 3-year (2015-2017) review of our Level 1 trauma center's prospectively maintained TBI database and included all adult (age ≥18y) patients with isolated severe TBI (head abbreviated injury severity (AIS) ≥3 and other AIS <3) and an ICU stay >48 hours. Organ dysfunction (OD) was measured by multiple organ dysfunction scores. Organ system failure was defined as a non-neurological component score of ≥3 on any day during the ICU stay. Outcomes measured were the incidence of NNOD and its effect on outcomes. Multivariate regression analysis was performed. RESULTS: A total of 285 patients were included. The mean age was 48 ± 22 years, 72% were males, median [IQR] Glasgow Coma Scale (GCS) was 8[5-10], and median Injury Severity Score (ISS) was 17[10-26]. Epidural hematoma was the most common intracranial hemorrhage (49%) followed by subdural hematoma (46%). The overall incidence of NNOD was 33%, with the most common dysfunctional organ system being the respiratory (23%) followed by the cardiovascular (12%) and hepatic system (8%). The overall in-hospital mortality rate was 19% (NNOD:36% vs. No-NNOD:9%, p< 0.01). On regression analysis, NNOD was associated with higher in-hospital mortality (aOR: 2.0 [1.6-2.7]), discharge to skilled nursing facility (SNF) (aOR: 1.8 [1.4-2.2]), and Glasgow Outcome Scale-Extended (GOS-E) ≤4 (OR: 1.7 [1.3-2.3]) and p-values <0.01. CONCLUSION: One in every three isolated severe TBI patients develop NNOD. NNOD is independently associated with worse outcomes. Understanding the mechanisms associated with NNOD in the setting of TBI may promote prevention practices and improve outcomes in TBI. LEVEL OF EVIDENCE: Prognostic, level III.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Escores de Disfunção Orgânica , Adulto , Idoso , Cuidados Críticos , Feminino , Hematoma Epidural Craniano/etiologia , Hematoma Subdural/etiologia , Mortalidade Hospitalar , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Centros de Traumatologia , Estados Unidos
3.
Ideggyogy Sz ; 73(05-06): 213-216, 2020 05 30.
Artigo em Inglês | MEDLINE | ID: mdl-32579312

RESUMO

The cause of intracerebral, subarachnoid and subdural haemorrhage is different, and the simultaneous appearance in the same case is extremely rare. We describe the case of a patient with a ruptured aneurysm on the distal segment of the middle cerebral artery, with a concomitant subdural and intracerebral haemorrhage, and a subsequent secondary brainstem (Duret) haemorrhage. The 59-year-old woman had hypertension and diabetes in her medical history. She experienced anomic aphasia and left-sided headache starting one day before admission. She had no trauma. A few minutes after admission she suddenly became comatose, her breathing became superficial. Non-contrast CT revealed left sided fronto-parietal subdural and subarachnoid and intracerebral haemorrhage, and bleeding was also observed in the right pontine region. The patient had leucocytosis and hyperglycemia but normal hemostasis. After the subdural haemorrhage had been evacuated, the patient was transferred to intensive care unit. Sepsis developed. Echocardiography did not detect endocarditis. Neurological status, vigilance gradually improved. The rehabilitation process was interrupted by epileptic status. Control CT and CT angiography proved an aneurysm in the peripheral part of the left middle cerebral artery, which was later clipped. Histolo-gical examination excluded mycotic etiology of the aneu-rysm and "normal aneurysm wall" was described. The brain stem haemorrhage - Duret bleeding - was presumably caused by a sudden increase in intracranial pressure due to the supratentorial space occupying process and consequential trans-tentorial herniation. This case is a rarity, as the patient not only survived, but lives an active life with some residual symptoms.


Assuntos
Aneurisma Roto/diagnóstico por imagem , Cerebelo/irrigação sanguínea , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Aneurisma Intracraniano/diagnóstico por imagem , Aneurisma Intracraniano/cirurgia , Angiografia Cerebral , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/cirurgia , Angiografia por Tomografia Computadorizada , Feminino , Cefaleia , Humanos , Aneurisma Intracraniano/complicações , Pessoa de Meia-Idade , Resultado do Tratamento
5.
BMC Neurol ; 20(1): 151, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326909

RESUMO

BACKGROUND: Intracranial hypotension is a disorder characterized by low cerebrospinal fluid (CSF) pressure typically caused by loss of CSF. Although some mechanisms account for the CSF leakage have been elucidated, spinal canal stenosis has never been reported as a pathological cause of intracranial hypotension. C1-C2 sign is a characteristic imaging feature, which indicates CSF collection between the spinous processes of C1 and C2, occasionally observed on magnetic resonance imaging (MRI) in patients with intracranial hypotension. CASE PRESENTATION: A 58-year-old man was presented to our institute with complaints of posterior cervical pain persisting for 3 months, along with numbness and muscle weakness of extremities. A fat suppression T2-weighted image of MRI illustrated fluid collection in the retrospinal region at C1-C2 level, and an 111In-DTPA cisternoscintigram clearly revealed the presence of CSF leakage into the same region. The MRI also showed stenosis in spinal canal at C3/4 level, and a computed tomography (CT) myelogram suggested a blockage at the same level. We gave a diagnosis as intracranial hypotension due to the CSF leakage, which might be caused by the spinal canal stenosis at C3/4 level. Despite 72 h of conservative therapy, a brain CT showed the development of bilateral subdural hematomas. We, therefore, performed burr-hole drainage of the subdural hematoma, blood-patch therapy at C1/2 level, and laminoplasty at C3-4 at the same time. Improvement of symptoms and imaging features which suggested the CSF leak and subdural hematoma were obtained post-operatively. CONCLUSION: The present case suggested the mechanism where the CSF leakage was revealed as fluid collection in the retrospinal region at C1-C2 level. Increased intradural pressure due to the spinal canal stenosis resulted in dural tear. CSF leaked into the epidural space and subsequently to the retrospinal region at C1-C2 level, due to the presence of spinal canal stenosis caudally as well as the vulnerability of the tissue structure in the retrospinal region at C1-C2 level. Thus, our theory supports the mechanisms of previously reported CSF dynamics associated to C1-C2 sign, and also, we suggest spinal canal stenosis as a novel etiology of intracranial hypotension.


Assuntos
Vazamento de Líquido Cefalorraquidiano , Vértebras Cervicais , Canal Vertebral , Estenose Espinal , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/fisiopatologia , Vértebras Cervicais/cirurgia , Drenagem , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Canal Vertebral/diagnóstico por imagem , Canal Vertebral/fisiopatologia , Canal Vertebral/cirurgia , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Estenose Espinal/cirurgia
7.
BMC Neurol ; 20(1): 102, 2020 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-32188416

RESUMO

BACKGROUND: Ruptured intracranial aneurysms are often associated with subarachnoid or intraparenchymal hemorrhage. However, the prevalence of subdural hemorrhage post aneurysmal rupture is low and rarely reported in scientific studies. Here, we report an unusual case of a ruptured posterior communicating artery aneurysm resulting in an isolated subdural hematoma located in the tentorial and spinal canal without subarachnoid or intraparenchymal hemorrhage. CASE PRESENTATION: In this case, a 34-year-old woman with no history of trauma or coagulopathy was diagnosed with a subdural hematoma in the tentorium cerebellum tracing to the subdural space of the spinal column. Computed tomography angiography was used to identify the source of the bleeding, which revealed a ruptured left-sided posterior communicating artery saccular aneurysm. The aneurysm was clipped, and the hematoma was evacuated. The patient recovered without any neurological complications. CONCLUSIONS: Our results suggest that a diagnosis of ruptured intracranial aneurysm should be considered in patients with nontraumatic subdural hematoma. Prompt diagnostic imaging and interventional diagnostic procedures are required to ensure proper management of these patients and to avoid unnecessary complications.


Assuntos
Aneurisma Roto/complicações , Hematoma Subdural/etiologia , Aneurisma Intracraniano/complicações , Adulto , Aneurisma Roto/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Feminino , Hematoma Subdural/diagnóstico por imagem , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Tomografia Computadorizada por Raios X
8.
Doc Ophthalmol ; 141(2): 111-126, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32052259

RESUMO

PURPOSE: To investigate retinal function and visual outcomes in infants with retinal hemorrhages due to non-accidental trauma (NAT). METHODS: This is a retrospective review of full-field or multifocal electroretinogram (ERG) recordings, visual acuity in log minimum angle of resolution (logMAR), clinical status, and neuroimaging. Multifocal ERGs from the central 40° were compared to corresponding fundus imaging. Visual acuity was measured by Teller cards at follow-up. ERGs were compared to controls recorded under anesthesia. RESULTS: Sixteen children met inclusion criteria (14 recorded during the acute phase and 2 during long-term follow-up). During the acute phase, ERGs (n = 4 full field; n = 10 multifocal ERG) showed abnormal amplitude, latency, or both in at least one eye. Ten subjects had significantly reduced responses in both eyes, 3 of which had an ERG dominated by a negative waveform (absent b-wave or P1). The remaining six subjects had responses in one eye that were near normal (≥ 50% of controls). ERGs were sometimes abnormal in local areas without hemorrhage. ERGs could be preserved in local areas adjacent to traumatic retinoschisis. Two subjects with reduced visual acuity had belated ERGs: One had an abnormal macular ERG and the other had a normal macular ERG implying cortical visual impairment. At follow-up, 10 of 14 subjects had significant visual acuity loss (≥ 0.7 age-corrected logMAR); four subjects had mild vision loss (≤ 0.5 age-corrected logMAR). Visual acuity outcome was not reliably associated with the fundus appearance in the acute phase. All subjects with a negative ERG waveform had severe vision loss on follow-up. CONCLUSIONS: Retinal dysfunction was common during the acute phase of NAT. A near normal appearing fundus did not imply normal retinal function, and ERG abnormality did not always predict a poor visual acuity outcome. However, a negative ERG waveform was associated severe visual acuity loss. Potential artifacts of retinal hemorrhages and anesthesia could not fully account for multifocal ERG abnormalities. Retinal function can be preserved in areas adjacent to traumatic retinoschisis.


Assuntos
Síndrome da Criança Espancada/complicações , Hematoma Subdural/fisiopatologia , Retina/fisiopatologia , Hemorragia Retiniana/fisiopatologia , Acuidade Visual/fisiologia , Pré-Escolar , Eletrorretinografia/métodos , Feminino , Fundo de Olho , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/etiologia , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Tomografia de Coerência Óptica , Transtornos da Visão/fisiopatologia
10.
J Surg Res ; 249: 99-103, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31926402

RESUMO

BACKGROUND: Guidelines for management of intracranial hemorrhage do not account for bleed location. We hypothesize that parafalcine subdural hematoma (SDH), as compared to convexity SDH, is a distinct clinical entity and these patients do not benefit from critical care monitoring or repeat imaging. METHODS: We identified patients presenting to a single level I trauma center with isolated head injuries from February 2016 to August 2017. We identified 88 patients with isolated blunt traumatic parafalcine SDH and 228 with convexity SDH. RESULTS: Demographics, comorbidities, and use of antiplatelet and anticoagulant agents were similar between the groups. As compared to patients with convexity SDH, patients with parafalcine SDH had a significantly lower incidence of radiographic progression, and had no cases of neurologic deterioration, neurosurgical intervention, or mortality (all P < 0.005). Compared to patients admitted to the intensive care unit, patients with parafalcine SDH admitted to the floor had a shorter length of stay (2.0 ± 1.6 versus 3.8 ± 2.9 d, P < 0.005) with no difference in outcomes. CONCLUSIONS: Patients presenting with a parafalcine SDH are a distinct and relatively benign clinical entity as compared to convexity SDH and do not benefit from repeat imaging or intensive care unit admission.


Assuntos
Traumatismos Cranianos Fechados/complicações , Hematoma Subdural/diagnóstico , Hemorragia Intracraniana Traumática/diagnóstico , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Feminino , Escala de Coma de Glasgow , Hematoma Subdural/etiologia , Hematoma Subdural/mortalidade , Humanos , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Hemorragia Intracraniana Traumática/etiologia , Hemorragia Intracraniana Traumática/mortalidade , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Neuroimagem/normas , Neuroimagem/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Centros de Traumatologia/normas , Centros de Traumatologia/estatística & dados numéricos
11.
Br J Neurosurg ; 34(1): 24-27, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31771378

RESUMO

In any neonate or infant presenting with an acute onset of encephalopathy, and/or retinal haemorrhages with no history of major trauma and imaging showing subdural haemorrhage (SDH), the diagnostic priority is to exclude a non-accidental injury (NAI), given the association of these clinical features with the shaken baby syndrome. However, other causes of SDH may present in a similar manner in neonates and infants, in particular vascular lesions such as aneurysms. A four week old neonate presenting with seizures and retinal haemorrhages, was diagnosed with an acute subdural haemorrhage (ASDH) on imaging with significant midline shift needing surgical evacuation. As there was some blood extending into the left sylvian fissure, further imaging was considered before surgical intervention. This showed a distally located middle cerebral artery aneurysm, which was successfully treated and the neonate made a remarkable recovery. We present a case of a neonate presenting with spontaneous acute subdural haematoma in the absence of classical diffuse subarachnoid haemorrhage, intracerebral haemorrhage or intraventricular haemorrhage, secondary to a ruptured middle cerebral artery aneurysm. The distribution of aneurysms in the neonatal age group is different to adults, with middle cerebral artery aneurysms and more distally located peripheral aneurysms being more common. Vigilance should be borne to exclude the aforementioned as causes for this presentation especially prior to undertaking surgical intervention.


Assuntos
Hematoma Subdural/etiologia , Angiografia Cerebral , Feminino , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/cirurgia , Humanos , Recém-Nascido , Artéria Cerebral Média/diagnóstico por imagem , Procedimentos Neurocirúrgicos/métodos , Hemorragia Retiniana/diagnóstico por imagem , Hemorragia Retiniana/etiologia , Convulsões/diagnóstico por imagem , Convulsões/etiologia , Convulsões/cirurgia , Estado Epiléptico/diagnóstico por imagem , Estado Epiléptico/etiologia , Estado Epiléptico/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
12.
World Neurosurg ; 135: e393-e404, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31821915

RESUMO

OBJECTIVE: Primary decompressive craniectomy (DC) is indicated to evacuate the hematoma and reduce intracranial pressure in traumatic brain injury (TBI). However, there are a myriad of complications because of absence of the bone flap. A novel technique, four-quadrant osteoplastic decompressive craniotomy (FoQOsD) retains the bone flap while achieving adequate cerebral decompression. METHODS: A single-center randomized controlled trial of 115 patients with TBI needing decompressive surgery was conducted. Of these patients, 59 underwent DC and 56 underwent FoQOsD. The primary outcome determined was functional status at 6 months using the Glasgow Outcome Scale-Extended. RESULTS: No significant differences were identified in baseline characteristics between both groups. Mean Glasgow Outcome Scale-Extended score was comparable at 6 months (4.28 in DC vs. 4.38 in FoQOsD; P = 0.856). Further, 22 of 58 patients in the DC group had died (38%) compared with 25 of 55 patients in the FoQOsD group (44.6%) (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.6-2.36; P = 0.6) (1 patient lost to follow-up in each group). A favorable outcome was seen in 56.8% of patients in the DC group versus 54.4% of patients in the FoQOsD group (P = 0.74). Presence of intraventricular hemorrhage and subarachnoid hemorrhage (OR, 7.17; 95% CI, 1.364-37.7; P = 0.020), opposite side contusions (OR, 3.838; 95% CI, 1.614-9.131; P = 0.002) and anisocoria (OR, 3.235; 95% CI, 1.490-7.026; P = 0.003) preoperatively were individual factors that played a significant role in final outcome. CONCLUSIONS: FoQOsD is as efficacious as conventional DC with the added benefit of avoiding a second surgery. The procedure is associated with better cosmesis and fewer complications.


Assuntos
Lesões Encefálicas Traumáticas/cirurgia , Craniectomia Descompressiva/métodos , Adulto , Hemorragia Cerebral Intraventricular/etiologia , Feminino , Hematoma Subdural/etiologia , Humanos , Hemorragia Intracraniana Traumática/cirurgia , Hipertensão Intracraniana/prevenção & controle , Masculino , Hemorragia Subaracnóidea/etiologia , Resultado do Tratamento
13.
Turk Neurosurg ; 30(4): 520-526, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31353434

RESUMO

AIM: To find a more practical and effective formula than simple ABC/2 (sABC/2) to calculate the hematoma volume in patients with subdural and parenchymal haemorrhage. MATERIAL AND METHODS: We reviewed the records of 157 patients who underwent brain computed tomography examinations for stroke from January to October 2017. Our method, sABC/2 formula, and the planimetric method (the gold standard) were used for measuring the volumes of hematoma. RESULTS: The concordance in brain hematoma volumes calculated by sABC/2 and the proposed method as compared to planimetry were 0.92 and 0.93, respectively (p < 0.05). The proposed method calculates the subdural hematoma volumes much better than the conventional one, and the root mean square error (RMSE) values were 32.17 and 20.62 ml for sABC/2 and our new method, respectively, whereas the RMSE values for parenchymal hematomas were 25.01 and 20.46 ml for sABC/2 and our new method, respectively. CONCLUSION: Our new formula for calculating the volume of subdural and parenchymal hematomas is as practical as sABC/2 and allows the clinician to apply the method bedside.


Assuntos
Hemorragia Cerebral/diagnóstico por imagem , Hematoma Subdural/diagnóstico por imagem , Interpretação de Imagem Assistida por Computador/métodos , Neuroimagem/métodos , Tomografia Computadorizada por Raios X/métodos , Idoso , Algoritmos , Hemorragia Cerebral/complicações , Feminino , Hematoma Subdural/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Acidente Vascular Cerebral/etiologia
16.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488446

RESUMO

We present the unusual case of a middle-aged woman who developed a spontaneous subdural haematoma (SSH) while on oral anticoagulation therapy for a total artificial heart (TAH). Headache was followed by paraesthesia and numbness of the left hand. The diagnosis was made from a CT scan. Symptoms resolved with conservative management and careful control of anticoagulation. In this case report, the risk factors and pathophysiology behind this condition are explored. TAHs in their own entity are a rare phenomenon. Coupled with the highly unusual presentation of an SSH in which only a few cases have been documented, we hope to highlight the management of such a difficult case. After navigating this complication, we were able to successfully bridge this patient to a heart transplant 26 days after the SSH.


Assuntos
Coração Artificial , Hematoma Subdural/etiologia , Varfarina/efeitos adversos , Anticoagulantes/administração & dosagem , Feminino , Hematoma Subdural/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Tomografia Computadorizada por Raios X , Varfarina/administração & dosagem
17.
J Clin Neurosci ; 69: 61-66, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31451377

RESUMO

Age is an important prognostic factor for patients with traumatic brain injury (TBI), and worse treatment outcomes have been reported in elderly patients. Therefore, proper treatment is needed for the increasing number of elderly patients with TBI. We aimed to analyze predictive factors of favorable treatment outcomes (FTO) in elderly patients. Clinical and radiological data from 493 patients with TBI who visited a single institute were retrospectively collected from January 2014 to December 2015. We compared the characteristics of the elderly group (individuals above 65 years) and younger group (16-65 years). We analyzed the characteristics and outcomes in both groups and the factors related to the Glasgow outcome scale-extended score at 6 months after injury in 170 elderly patients. The treatment outcomes were dichotomized into favorable and unfavorable groups. In the elderly group, the proportion of female patients and the incidence of subdural hemorrhage (SDH) were higher than in the younger group. Among the 170 elderly patients, 62 had pure SDH, and 21 of the 62 with pure SDH had undergone surgical treatment. Compared with other types of intracranial hemorrhage, FTO was as high as 85.5%, and mortality was as low as 11.3% in patients with pure SDH. High initial Glasgow coma scale score, low injury severity score, and normal pupillary reflex were significantly related to FTO in multivariate analysis. Therefore, active therapeutic strategies, including surgery should be considered for elderly patients with pure SDH without intra-parenchymal injury.


Assuntos
Lesões Encefálicas Traumáticas/patologia , Resultado do Tratamento , Adulto , Idoso , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/cirurgia , Feminino , Escala de Resultado de Glasgow , Hematoma Subdural/epidemiologia , Hematoma Subdural/etiologia , Hematoma Subdural/cirurgia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos
19.
Ulus Travma Acil Cerrahi Derg ; 25(4): 383-388, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31297771

RESUMO

BACKGROUND: The impact of decompressive craniectomy (DC) on the overall outcome of pediatric acute subdural hematoma patients has not been fully determined to date. In this paper, we aimed to investigate the role of decompressive craniectomy performed to treat traumatic subdural hematoma in patients from the pediatric age group. METHODS: We described our experience with DC in pediatric acute subdural hematoma patients and analyzed the outcomes. RESULTS: Eleven (7 unilateral and 4 bilateral) DCs were performed. The patients' ages ranged from 8 months to 15 years. The mean GCS score at admission was 7.8. All patients underwent DC with duraplasty within 2 hours of injury. All the patients were admitted to the intensive care unit for 10 days postoperatively. The mean hospital stay was 22 days and the mean follow-up period was 3.7 years. CONCLUSION: Early DC for pediatric subdural hematoma patients, independent of their initial GCS, was recommended. Larger studies are needed to define the indications, surgical techniques, and timing of DC in the pediatric population.


Assuntos
Craniectomia Descompressiva , Hematoma Subdural/cirurgia , Acidentes por Quedas , Adolescente , Criança , Pré-Escolar , Craniectomia Descompressiva/métodos , Craniectomia Descompressiva/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Hematoma Subdural/epidemiologia , Hematoma Subdural/etiologia , Hospitalização , Humanos , Lactente , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Meningite/epidemiologia , Meningite/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Convulsões/epidemiologia , Convulsões/etiologia , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia
20.
J Nerv Ment Dis ; 207(7): 575-576, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31259792

RESUMO

Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by disruption of normal collagen formation resulting in varying degrees of ligamentous laxity and skeletal vulnerability; the low bleeding potential is easily overlooked. Subdural hematoma (SDH) is a common neurosurgical condition, classically related to the rupture of bridging cortico-dural veins after trauma. In the pediatric population, the age distribution shows a massive preponderance for children in their early first decade. We report a very unusual case of SDH in a 10-year-old boy with OI type I, with history of minor trauma. SDH remains exceedingly rare in OI, and its pathophysiology is unclear. To the best of our knowledge, this is the first report of a unilateral subacute SDH associated with OI in a child of such advanced age. These cases may also carry legal ramifications, including misdiagnosis of child abuse in ambiguous situations that are not thoroughly investigated.


Assuntos
Traumatismos Craniocerebrais/diagnóstico , Hematoma Subdural/diagnóstico , Osteogênese Imperfeita/diagnóstico , Criança , Traumatismos Craniocerebrais/complicações , Hematoma Subdural/etiologia , Humanos , Masculino , Osteogênese Imperfeita/complicações , Tomografia Computadorizada por Raios X
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