Computerised tomography of acute traumatic intracranial haematoma: reliability of neurosurgeons' interpretations.
Two neurosurgeons concerned with the emergency management of patients with head injury correctly diagnosed the presence or absence of an acute intracranial haematoma in 97 scans that were presented to them without knowledge of the patients' clinical details. There were no false-positives or false-negatives, although identification of the type of haematoma was not always possible. The impact of the EMI scan on patient management demands new approaches to the care of head injuries. (+info)
Abrupt exacerbation of acute subdural hematoma mimicking benign acute epidural hematoma on computed tomography--case report.
A 75-year-old male was hit by a car, when riding a bicycle. The diagnosis of acute epidural hematoma was made based on computed tomography (CT) findings of lentiform hematoma in the left temporal region. On admission he had only moderate occipitalgia and amnesia of the accident, so conservative therapy was administered. Thirty-three hours later, he suddenly developed severe headache, vomiting, and anisocoria just after a positional change. CT revealed typical acute subdural hematoma (ASDH), which was confirmed by emergent decompressive craniectomy. He was vegetative postoperatively and died of pneumonia one month later. Emergent surgical exploration is recommended for this type of ASDH even if the symptoms are mild due to aged atrophic brain. (+info)
Heading injury precipitating subdural hematoma associated with arachnoid cysts--two case reports.
A 14-year-old boy and a 11-year-old boy presented with subdural hematomas as complications of preexisting arachnoid cysts in the middle cranial fossa, manifesting as symptoms of raised intracranial pressure. Both had a history of heading the ball in a soccer game about 7 weeks and 2 days before the symptom occurred. There was no other head trauma, so these cases could be described as "heading injury." Arachnoid cysts in the middle cranial fossa are often associated with subdural hematomas. We emphasize that mild trauma such as heading of the ball in a soccer game may cause subdural hematomas in patients with arachnoid cysts. (+info)
Angiographically occult dural arteriovenous malformation in the anterior cranial fossa--case report.
A 62-year-old male presented with a dural arteriovenous malformation located in anterior cranial fossa manifesting as acute right frontal intracerebral and subdural hematomas. Cerebral angiography showed only mass sign, but surgical exploration disclosed the dural arteriovenous malformation in the anterior cranial fossa. Anterior cranial fossa dural arteriovenous malformation should be considered if computed tomography reveals intracranial bleeding involving the frontal base, even if cerebral angiography does not demonstrate vascular anomalies. (+info)
Lumbar spinal subdural hematoma following craniotomy--case report.
A 52-year-old female complained of lumbago and weakness in the lower extremities 6 days after craniotomy for clipping an aneurysm. Neurological examination revealed symptoms consistent with lumbosacral cauda equina compression. The symptoms affecting the lower extremities spontaneously disappeared within 3 days. Magnetic resonance (MR) imaging 10 days after the operation demonstrated a lumbar spinal subdural hematoma (SSH). She had no risk factor for bleeding at this site, the symptoms appeared after she began to walk, and MR imaging suggested the SSH was subacute. Therefore, the SSH was probably due to downward movement of blood from the cranial subdural space under the influence of gravity. SSH as a complication of cranial surgery is rare, but should be considered if a patient develops symptoms consistent with a lumbar SSH after craniotomy. (+info)
Spontaneous spinal subdural hematoma in a young adult with hemophilia.
Spontaneous spinal subdural hemorrhage is a rare clinical problem that usually manifests with a sudden onset of pain and paralysis. This article reports on an 18-year-old male with hemophilia A and cerebral palsy, who experienced a several month history of transient back, hip, and leg pain accompanied by gait difficulties that ultimately culminated in a more striking episode of lower extremity weakness, irritability, and diffuse pain involving the neck, back, and legs. In the absence of any clinical or radiographic evidence of hemarthrosis, osteomyelitis, or intracranial hemorrhage, imaging of the spine disclosed a large, apparently multicompartmentalized intraspinal lesion, consistent with old hemorrhage. This extended from the thoracic to the sacral region, with the largest extent at the lumbosacral junction. Following correction of factor VIII levels, surgical exploration was undertaken and demonstrated liquefied blood within the subdural space without violation of the underlying arachnoid. Because the chronic subdural blood flowed quite easily through the dural opening by simply angling the operating table, a limited exposure was required to achieve a substantial evacuation of the clot. This case calls attention to the often protean manifestations of this process, the potential for a chronic course to the clinical symptoms, and the possibility of achieving substantial clot evacuation and clinical recovery with a limited operative approach. (+info)
Intracystic hemorrhage of the middle fossa arachnoid cyst and subdural hematoma caused by ruptured middle cerebral artery aneurysm.
We report a case of a cerebral aneurysm arising from the bifurcation of the left middle cerebral artery that ruptured into a left middle cranial fossa arachnoid cyst, associated with acute subdural hematoma. We discuss the relationships of aneurysm, arachnoid cyst, and subdural hematoma. (+info)
Bilateral chronic subdural hematomas resulting in unilateral oculomotor nerve paresis and brain stem symptoms after operation--case report.
An 85-year-old male presented with bilateral chronic subdural hematomas (CSDHs) resulting in unilateral oculomotor nerve paresis and brainstem symptoms immediately after removal of both hematomas in a single operation. Initial computed tomography on admission demonstrated marked thick bilateral hematomas buckling the brain parenchyma with a minimal midline shift. Almost simultaneous removal of the hematomas was performed with the left side was decompressed first with a time difference of at most 2 minutes. However, the patient developed right oculomotor nerve paresis, left hemiparesis, and consciousness disturbance after the operation. The relatively marked increase in pressure on the right side may have caused transient unilateral brain stem compression and herniation of unilateral medial temporal lobe during the short time between the right and left procedures. Another factor was the vulnerability of the oculomotor nerve resulting from posterior replacement of the brain stem and stretching of the oculomotor nerves as seen on sagittal magnetic resonance (MR) images. Axial MR images obtained at the same time demonstrated medial deflection of the distal oculomotor nerve after crossing the posterior cerebral artery, which indicates previous transient compression of the nerve and the brain stem. Gradual and symmetrical decompression without time lag is recommended for the treatment of huge bilateral CSDHs. (+info)