Spontaneous subdural hematoma in a young adult with hemophilia.
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We report a case of spontaneous acute subdural hematoma in a 30-year-old man, who was diagnosed with hemophilia during his hospital stay. He developed an extradural hematoma following evacuation of the acute SDH, which was also evacuated. He had a good outcome. Management of such a patient is discussed. (+info)
Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage.
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BACKGROUND AND PURPOSE: Hyperglycemia has a deleterious effect on brain ischemia. However, the effect of hyperglycemia in intracerebral hemorrhage (ICH) is not well known. We investigated the effect of hyperglycemia on the development of brain edema and perihematomal cell death in ICH. METHODS: Hyperglycemia was induced by intraperitoneal injection of streptozotocin (60 mg/kg) in adult Sprague-Dawley male rats. ICH was induced by stereotaxic infusion of 0.23 U of collagenase into the left striatum. Seventy-two hours after ICH, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) staining was performed for perihematomal cell death. We also measured brain water content to evaluate edema formation. RESULTS: The serum glucose level of the hyperglycemic group was 394.0+/-180.3 mg/dL (n=31), and that of the normoglycemic group was 97.5+/-27.4 mg/dL (n=31). The size of hemorrhage was similar between groups, without any significant difference (n=8 in each group). The brain water content of hyperglycemic rats (n=17) increased in both lesioned (81.0+/-0.5%) and nonlesioned hemispheres (78.7+/-0.6%) compared with the normoglycemic group (n=17; lesioned: 78.9+/-0.8%; nonlesioned: 77.3+/-1.1%). In the hyperglycemic group, more TUNEL-positive cells were found in the perihematomal regions (n=6). CONCLUSIONS: Hyperglycemia caused more profound brain edema and perihematomal cell death in experimental ICH. (+info)
Pneumocystis carinii, cytomegalovirus, and severe transient immunodeficiency.
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Pneumocystis carinii infection is rare in infants, and raises strong concerns of immune deficiency. This report describes the unusual case of a male infant with concurrent chest infections caused by P carinii and cytomegalovirus. Investigation was complicated by the strong suspicion of non-accidental injury, including subdural haematomas. The case illustrates how to investigate for possible immunodeficiency. Low immune function tests at presentation slowly improved and have remained normal on longterm follow up. Possible explanations for the transient severe clinical immunodeficiency in this case are discussed. (+info)
Medial longitudinal fasciculus syndrome associated with a subdural hygroma and an arachnoid cyst in the middle cranial fossa.
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A 60-year-old man complaining of diplopia and vertigo showed bilateral medial longitudinal fasciculus (MLF) syndrome. The CT scan revealed a space-occupying lesion with watery fluid in the left cranial fossa, which was divided into two parts by a thin septum. Surgical trepanation was performed followed by 4 weeks of prednisolone therapy. He was completely cured 5 months later. The plausible causes of MLF syndrome relevant to preexisting space-occupying lesions are discussed. (+info)
Acute subdural hematoma in young patient with moyamoya disease--case report.
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A 17-year-old boy with known moyamoya disease developed an acute subdural hematoma after a mild head trauma. He had been confined to a wheelchair with contracture in the upper and lower extremities due to juvenile rheumatoid arthritis since age 1 year. He had undergone encephalo-duro-arterio-synangiosis (EDAS) on the right and encephalo-myo-synangiosis (EMS) on the left at 13 years of age. He was admitted with headache, nausea, and vomiting after a fall from his wheelchair at age 17. Computed tomography on admission showed a large acute subdural hematoma in the right fronto-temporal region but no bleeding at the EDAS or EMS sites. Cerebral angiography 12 weeks after the head trauma revealed a remarkable reduction in the spontaneous transdural external-internal carotid anastomoses in the right frontal region. The acute subdural hematoma was probably caused by rupture of the spontaneous transdural anastomoses. (+info)
Chronic subdural hematoma in elderly people: present status on Awaji Island and epidemiological prospect.
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The epidemiological aspect of chronic subdural hematoma (CSH) in the elderly who are 65 years old or elder was evaluated on Awaji Island with about 170,000 inhabitants. The overall incidence of CSH was 13.1 per 100,000/year, 3.4 in people under 65 years old, and 58.1 in the elderly. The elderly were 17.7% of all inhabitants. If these incidences of CSH are extrapolated to all of Japan in the year 2020, the incidence will be 16.3 per 100,000/year. This suggests that CSH may become the most common neurosurgical condition. (+info)
Chronic subdural hematoma following bypass surgery--report of three cases.
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Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery. (+info)
Giant aneurysm of the azygos anterior cerebral artery associated with acute subdural hematoma--case report.
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A ruptured giant aneurysm of the azygos anterior cerebral artery (ACA) associated with an acute subdural hematoma (SDH) occurred in a 67-year-old male with two episodes of sudden severe headache and transient loss of consciousness. Neurologically, he had mild weakness of the left lower extremity. Computed tomography showed an elliptical heterogeneous hyperdense mass in the interhemispheric fissure in front of the corpus callosum and an acute SDH on the right. Angiography disclosed a giant aneurysm (2.8 x 2.0 cm) at the distal end of the azygos ACA. Removal of the SDH and aneurysmal neck clipping achieved a good outcome. Successive small bleedings may allow the aneurysmal dome to develop adhesions to the arachnoid membrane, and the final rupture will occur into the subdural space, resulting in a SDH. (+info)