Sample records for accompanying isodense subdural

  1. Subdural Hematoma Mimickers: A Systematic Review.

    PubMed

    Catana, Dragos; Koziarz, Alex; Cenic, Aleksa; Nath, Siddharth; Singh, Sheila; Almenawer, Saleh A; Kachur, Edward

    2016-09-01

    A variety of subdural pathologies that may mimic hematomas are reported in the literature. We aimed to identify the atypical clinical and radiologic presentations of subdural masses that may mimic subdural hematomas. A systematic review of MEDLINE and Embase was conducted independently by 2 reviewers to identify articles describing subdural hematoma mimickers. We also present a patient from our institution with a subdural pathology mimicking a subdural hematoma. We analyzed patient clinical presentations, underlying pathologies, radiologic findings, and clinical outcomes. We included 43 articles totaling 48 patients. The mean ± SD patient age was 55.7 ± 16.8 years. Of the 45 cases describing patient history, 13 patients (27%) had a history of trauma. The underlying pathologies of the 48 subdural collections were 10 metastasis (21%), 14 lymphoma (29%), 7 sarcoma (15%), 4 infectious (8%), 4 autoimmune (8%), and 9 miscellaneous (19%). Findings on computed tomography (CT) scan were 18 hyperdense (41%), 11 hypodense (25%), 9 isodense (20%), 3 isodense/hyperdense (7%), and 3 hypodense/isodense (7%). Thirty-four patients (71%) were treated surgically; among these patients, 65% had symptom resolution. Neither the pathology (P = 0.337) nor the management strategy (P = 0.671) was correlated with improved functional outcomes. Identification of atypical history and radiologic features should prompt further diagnostic tests, including magnetic resonance imaging (MRI), to elucidate the proper diagnosis, given that certain pathologies may be managed nonsurgically. A subdural collection that is hyperdense on CT scan and hyperintense on T2-weighted MRI, along with a history of progressive headache with no trauma, may raise the suspicion of an atypical subdural pathology. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. [A case of infected subdural hematoma accompanied by cerebral infarction].

    PubMed

    Fujii, Norio; Naito, Yuichiro; Takanashi, Shigehiko; Ueno, Toshiaki; Nakagomi, Tadayoshi

    2013-05-01

    Infected subdural hematoma(ISH)is a rare disease caused by hematogenous infection of a preexisting subdural hematoma. We report a rare case of ISH accompanied by cerebral infarction. A 76-year-old man who had suffered a closed head injury 3 months before presented fever, headache and left hemiparesis during the medical treatment of acute cholangitis and obstructive jaundice with pancreatic cancer at the department of surgical gastroenterology. At the consultation, computed tomography(CT)scan indicated right chronic subdural hematoma. We performed a burr hole opening surgery on the same day. Abscess and hematoma was aspirated from the subdural space, and methicillin-resistant Staphylococcus aureus(MRSA)was detected in this specimen. Thus the diagnosis of the infected subdural hematoma was confirmed. However, despite the antibiotics therapy, follow-up CT showed a low-density area close to the residual abscess, which suggested cerebral infarction. Cerebral angiography showed a vasospasm at the cortical segment of the right middle cerebral artery near the residual abscess. Eventually we carried out a small craniotomy to evacuate the abscess. Our case showed that prompt surgical treatment is required in case of ISH and the whole hematoma and abscess should be removed as soon as possible with an image diagnosis and an additional surgical operation.

  3. Clinical profile of subdural hematomas: dangerousness of subdural subacute hematoma.

    PubMed

    Kpelao, E; Beketi, K A; Moumouni, A K; Doleagbenou, A; Ntimon, B; Egbohou, P; Mouzou, T; Tomta, K; Sama, D H; Abalo, A; Walla, A; Dossim, A

    2016-04-01

    Subacute subdural hematomas are a poorly individualized nosological entity, often equated clinically to chronic subdural hematomas. Yet, their neurological deterioration which is usually rapid seems to distinguish them from chronic subdural hematomas. We wanted to show this dangerousness by establishing the clinically evolving profile of the three types of subdural hematomas. This was a prospective and retrospective study of 63 subdural hematoma (18 acute, 13 subacute, and 32 chronic) patients admitted between 2012 and 2014 in the neurosurgery unit of Lomé University Hospital. Hematomas were classified according to the elapsed time after head injury and blood density on CT. The main parameter studied was the evolution of the Glasgow Coma Score (GCS) in the 3 months following the trauma, enabling to establish an evolving profile of each type of hematoma. The average age of patients was 58.1 years for chronic subdural hematomas and 47.6 years for subacute subdural hematomas. Disease duration before admission was 13.1 days for chronic against 36.6 h for subacute hematoma. The clinical profile shows acute worsening within hours during the second week for patients with subacute hematoma, while it is progressive for patients with chronic hematoma. We noted two deaths, all victims of a subacute hematoma (one operated, one patient waiting for surgery). Iso-density hematoma on CT, especially in a young person, must be considered as a predictive factor of rapid neurological aggravation suggesting an urgent care or increased monitoring by paramedics.

  4. Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level

    PubMed Central

    Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

    2015-01-01

    Context We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. Findings A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5–S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. Conclusion We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions. PMID:24976137

  5. Hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level.

    PubMed

    Ikeda, Osamu; Minami, Norihiko; Yamazaki, Masashi; Koda, Masao; Morinaga, Tatsuo

    2015-03-01

    We present a rare and interesting case of hemorrhagic lumbar facet cysts accompanying a spinal subdural hematoma at the same level suggesting a possible mechanism by which spinal subdural hematomas can arise. A 71-year-old man presented with persistent sciatic pain and intermittent claudication. Magnetic resonance imaging demonstrated a multilocular mass lesion that showed high signal intensity in both T1- and T2-weighted images, and was located both inside and outside of the spinal canal. Computed tomographic myelography showed a cap-shaped block of the dural tube at L5 and computed tomography with L5-S facet arthrography demonstrated cystic masses. The patient was diagnosed with lumbar radiculopathy caused by hemorrhagic facet cysts, and then progressed to surgical treatment. Surgery revealed that the cysts contained blood clots, and intraoperative findings that the inside of the dural tube appeared blackish and that the dural tube was tensely ballooned after removal of the cysts led us to explorative durotomy. The durotomy demonstrated concentrated old blood pooling both in the dorsal and ventral subdural space, and these spaces were subsequently drained. After surgery, his sciatic pain and intermittent claudication resolved. There was no evidence of cyst mass recurrence at 2 years of follow-up. We propose a newly described mechanism for the formation of spinal subdural hematomas. We recommend surgeons be alert to epidural lesions causing repeated acute compression of the dural tube, which can cause spinal subdural hematoma, and consider the possible coexistence of these lesions in diagnosis and strategic surgical decisions.

  6. Predictors for Recurrence of Chronic Subdural Hematoma.

    PubMed

    Hammer, Alexander; Tregubow, Alexander; Kerry, Ghassan; Schrey, Michael; Hammer, Christian; Steiner, Hans-Herbert

    2017-01-01

    This prospective study was designed to analyze the dependence of different factors on the recurrence rate of chronic subdural hematoma (cSDH) after surgical treatment. Seventy-three consecutive patients, who were surgically treated at our department due to cSDH between 2009 and 2012, were included. The following parameters were analyzed: patient age and gender, occurrence of trauma, time between trauma and admission, neurological symptoms, presence of minor diseases, intake of anticoagulation medication. We classified the results of diagnostic imaging and determined the space-consuming effect via the cerebral midline shift. In addition, we scrutinized intraoperative findings and the dependence of the position of subdural drainage on the recurrence rate of cSDH. In our patient group, cSDH recurrence was significantly associated with aphasia (p=0.008). Moreover an increased cSDH recurrence rate was observed in the patient group that had a separated manifestation of the cSDH in the preoperative diagnostic imaging (p=0.048) and received no drainage implant (p=0.016). Homogeneous isodense cSDH was associated with no apparent recurrence (p=0.037). Within the scope of this study, we detected aphasia and separated cSDH as predictors of cSDH recurrence. Homogeneous isodense cSDH seems to be a good prognostic sign regarding the risk of recurrence development. Furthermore, our data clearly emphasize the importance of surgically applied drainage implants to prevent a recurrence of cSDH.

  7. [Management of arachnoid cysts of the middle cranial fossa accompanied by subdural effusions].

    PubMed

    Abderrahmen, K; Saadaoui, K; Bouhoula, A; Boubaker, A; Jemel, H

    2012-10-01

    Subdural effusions are uncommon but known complications of arachnoid cysts of the middle cranial fossa. They mainly occur after minor head traumas in young patients. Here, we report eight cases of arachnoid cyst of the middle cranial fossa associated with subdural hematoma in five cases and hygroma in three cases. Major symptoms are signs of raised intracranial pressure. CT scan and MRI showed the cyst and the subdural effusion. An excellent therapeutic result was achieved with evacuation of the subdural fluid via burr holes in the five cases of subdural hematoma while in the two cases of hygroma a subduro-peritoneal shunt was necessary. In the last case, a temporal craniotomy was performed with evacuation of the hygroma and fenestration of the cyst. We suggest treating only the complicating event in the case of a subdural hematoma via burr holes evacuation. Whereas, in the case of hygroma we think that craniotomy with fenestration of the cyst or the use of a subdural shunt are more often needed. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  8. Chronic subdural hematoma

    MedlinePlus

    Subdural hemorrhage - chronic; Subdural hematoma - chronic; Subdural hygroma ... A subdural hematoma develops when bridging veins tear and leak blood. These are the tiny veins that run between the ...

  9. Chronic subdural haematoma evolving from traumatic subdural hydroma.

    PubMed

    Wang, Yaodong; Wang, Chuanwei; Liu, Yuguang

    2015-01-01

    This study aimed to investigate the incidence and clinical characteristics of chronic subdural haematoma (CSDH) evolving from traumatic subdual hydroma (TSH). The clinical characteristics of 44 patients with CSDH evolving from TSH were analysed retrospectively and the relevant literature was reviewed. In 22.6% of patients, TSH evolved into CSDH. The time required for this evolution was 14-100 days after injury. All patients were cured with haematoma drainage. TSH is one possible origin of CSDH. The clinical characteristics of TSH evolving into CSDH include polarization of patient age and chronic small effusion. The injuries usually occur during deceleration and are accompanied by mild cerebral damage.

  10. Scalability of transport parameters with pore sizes in isodense disordered media

    NASA Astrophysics Data System (ADS)

    Reginald, S. William; Schmitt, V.; Vallée, R. A. L.

    2014-09-01

    We study light multiple scattering in complex disordered porous materials. High internal phase emulsion-based isodense polystyrene foams are designed. Two types of samples, exhibiting different pore size distributions, are investigated for different slab thicknesses varying from L = 1 \\text{mm} to 10 \\text{mm} . Optical measurements combining steady-state and time-resolved detection are used to characterize the photon transport parameters. Very interestingly, a clear scalability of the transport mean free path \\ellt with the average size of the pores S is observed, featuring a constant velocity of the transport energy in these isodense structures. This study strongly motivates further investigations into the limits of validity of this scalability as the scattering strength of the system increases.

  11. Local hypercoagulative activity precedes hyperfibrinolytic activity in the subdural space during development of chronic subdural haematoma from subdural effusion.

    PubMed

    Suzuki, M; Kudo, A; Kitakami, A; Doi, M; Kubo, N; Kuroda, K; Ogawa, A

    1998-01-01

    The involvement of coagulation and fibrinolysis in the development of chronic subdural haematoma (CSH) from subdural effusion was investigated. Subdural fluid and venous blood samples were obtained from 34 patients with CSH and 9 patients with subdural effusion, and analyzed using enzyme-linked immunosorbent assays for thrombin-antithrombin III complex (TAT), prothrombin fragment F1 + 2 (F1 + 2), tissue factor, tissue factor pathway inhibitor (TFPI) and D-dimer. CSH was classified into the layering type, believed to be active, and other types according to x-ray computed tomography. All markers in the blood of both patient groups were similar to the values of normal subjects. Levels of TAT and F1 + 2 were much higher in the subdural fluid than in the blood of patients with CSH (P < 0.001, P < 0.001) and with subdural effusion (P < 0.05, P < 0.05). The level of D-dimer in the subdural fluid was significantly higher than in the blood (P < 0.001) in patients with CSH, but not in patients with subdural effusion. All markers in the subdural fluid of layering type CSH, except TFPI, were significantly higher than in the other types (P < 0.05). Local hypercoagulative activity in the subdural space is present in subdural effusion and precedes hyperfibrinolytic activity in CSH. Thrombin generation as indicated by TAT and F1 + 2 might be involved in the development of CSH. Propagation of CSH may be modulated by the coagulation system including the extrinsic pathway and fibrinolysis.

  12. Chronic subdural hematoma

    PubMed Central

    Yadav, Yad R.; Parihar, Vijay; Namdev, Hemant; Bajaj, Jitin

    2016-01-01

    Chronic subdural hematoma (CSDH) is one of the most common neurosurgical conditions. There is lack of uniformity in the treatment of CSDH amongst surgeons in terms of various treatment strategies. Clinical presentation may vary from no symptoms to unconsciousness. CSDH is usually diagnosed by contrast-enhanced computed tomography scan. Magnetic resonance imaging (MRI) scan is more sensitive in the diagnosis of bilateral isodense CSDH, multiple loculations, intrahematoma membranes, fresh bleeding, hemolysis, and the size of capsule. Contrast-enhanced CT or MRI could detect associated primary or metastatic dural diseases. Although definite history of trauma could be obtained in a majority of cases, some cases may be secondary to coagulation defect, intracranial hypotension, use of anticoagulants and antiplatelet drugs, etc., Recurrent bleeding, increased exudates from outer membrane, and cerebrospinal fluid entrapment have been implicated in the enlargement of CSDH. Burr-hole evacuation is the treatment of choice for an uncomplicated CSDH. Most of the recent trials favor the use of drain to reduce recurrence rate. Craniotomy and twist drill craniostomy also play a role in the management. Dural biopsy should be taken, especially in recurrence and thick outer membrane. Nonsurgical management is reserved for asymptomatic or high operative risk patients. The steroids and angiotensin converting enzyme inhibitors may also play a role in the management. Single management strategy is not appropriate for all the cases of CSDH. Better understanding of the nature of the pathology, rational selection of an ideal treatment strategy for an individual patient, and identification of the merits and limitations of different surgical techniques could help in improving the prognosis. PMID:27695533

  13. Rapid resolution of acute subdural hematoma and effects on the size of existent subdural hygroma: a case report.

    PubMed

    Coşar, Murat; Eser, Olcay; Aslan, Adem; Ela, Yüksel

    2007-07-01

    The diagnosis and management of acute subdural hematoma is important in neurosurgery practice. Rapid spontaneous resolution of acute subdural hematoma within a few hours is seen rarely on the CT scan. We present a case that enlarged the existent subdural hygroma showing rapid resolution of acute subdural hematoma with resolution in 9 hours after the trauma. Additionally, the follow-up CT scans in the 1st month showed the decrease of enlargement of subdural hygroma. The resolution of acute subdural hematoma and effect of acute subdural hematoma on subdural hygroma must be considered during management. The relation of acute subdural hematoma and subdural hygroma is important for the resolution and management of acute subdural hematoma.

  14. Imaging isodensity contours of molecular states with STM

    NASA Astrophysics Data System (ADS)

    Reecht, Gaël; Heinrich, Benjamin W.; Bulou, Hervé; Scheurer, Fabrice; Limot, Laurent; Schull, Guillaume

    2017-11-01

    We present an improved way for imaging the density of states of a sample with a scanning tunneling microscope, which consists in mapping the surface topography while keeping the differential conductance (dI/dV) constant. When archetypical C60 molecules on Cu(111) are imaged with this method, these so-called iso-dI/dV maps are in excellent agreement with theoretical simulations of the isodensity contours of the molecular orbitals. A direct visualization and unambiguous identification of superatomic C60 orbitals and their hybridization is then possible.

  15. Spinal subdural hematoma following cranial subdural hematoma : a case report with a literature review.

    PubMed

    Ji, Gyu Yeul; Oh, Chang Hyun; Chung, Daeyeong; Shin, Dong Ah

    2013-12-01

    Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.

  16. Spinal Subdural Hematoma Following Cranial Subdural Hematoma : A Case Report with a Literature Review

    PubMed Central

    Ji, Gyu Yeul; Oh, Chang Hyun; Chung, Daeyeong

    2013-01-01

    Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space. PMID:24527196

  17. Comparision between Brain Atrophy and Subdural Volume to Predict Chronic Subdural Hematoma: Volumetric CT Imaging Analysis

    PubMed Central

    Ju, Min-Wook; Kwon, Hyon-Jo; Choi, Seung-Won; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun

    2015-01-01

    Objective Brain atrophy and subdural hygroma were well known factors that enlarge the subdural space, which induced formation of chronic subdural hematoma (CSDH). Thus, we identified the subdural volume that could be used to predict the rate of future CSDH after head trauma using a computed tomography (CT) volumetric analysis. Methods A single institution case-control study was conducted involving 1,186 patients who visited our hospital after head trauma from January 1, 2010 to December 31, 2014. Fifty-one patients with delayed CSDH were identified, and 50 patients with age and sex matched for control. Intracranial volume (ICV), the brain parenchyme, and the subdural space were segmented using CT image-based software. To adjust for variations in head size, volume ratios were assessed as a percentage of ICV [brain volume index (BVI), subdural volume index (SVI)]. The maximum depth of the subdural space on both sides was used to estimate the SVI. Results Before adjusting for cranium size, brain volume tended to be smaller, and subdural space volume was significantly larger in the CSDH group (p=0.138, p=0.021, respectively). The BVI and SVI were significantly different (p=0.003, p=0.001, respectively). SVI [area under the curve (AUC), 77.3%; p=0.008] was a more reliable technique for predicting CSDH than BVI (AUC, 68.1%; p=0.001). Bilateral subdural depth (sum of subdural depth on both sides) increased linearly with SVI (p<0.0001). Conclusion Subdural space volume was significantly larger in CSDH groups. SVI was a more reliable technique for predicting CSDH. Bilateral subdural depth was useful to measure SVI. PMID:27169071

  18. Comparision between Brain Atrophy and Subdural Volume to Predict Chronic Subdural Hematoma: Volumetric CT Imaging Analysis.

    PubMed

    Ju, Min-Wook; Kim, Seon-Hwan; Kwon, Hyon-Jo; Choi, Seung-Won; Koh, Hyeon-Song; Youm, Jin-Young; Song, Shi-Hun

    2015-10-01

    Brain atrophy and subdural hygroma were well known factors that enlarge the subdural space, which induced formation of chronic subdural hematoma (CSDH). Thus, we identified the subdural volume that could be used to predict the rate of future CSDH after head trauma using a computed tomography (CT) volumetric analysis. A single institution case-control study was conducted involving 1,186 patients who visited our hospital after head trauma from January 1, 2010 to December 31, 2014. Fifty-one patients with delayed CSDH were identified, and 50 patients with age and sex matched for control. Intracranial volume (ICV), the brain parenchyme, and the subdural space were segmented using CT image-based software. To adjust for variations in head size, volume ratios were assessed as a percentage of ICV [brain volume index (BVI), subdural volume index (SVI)]. The maximum depth of the subdural space on both sides was used to estimate the SVI. Before adjusting for cranium size, brain volume tended to be smaller, and subdural space volume was significantly larger in the CSDH group (p=0.138, p=0.021, respectively). The BVI and SVI were significantly different (p=0.003, p=0.001, respectively). SVI [area under the curve (AUC), 77.3%; p=0.008] was a more reliable technique for predicting CSDH than BVI (AUC, 68.1%; p=0.001). Bilateral subdural depth (sum of subdural depth on both sides) increased linearly with SVI (p<0.0001). Subdural space volume was significantly larger in CSDH groups. SVI was a more reliable technique for predicting CSDH. Bilateral subdural depth was useful to measure SVI.

  19. Outcome in Chronic Subdural Hematoma After Subdural vs. Subgaleal Drain.

    PubMed

    Ishfaq, Asim

    2017-07-01

    To compare the outcome after surgery for chronic subdural hematoma when the drain is placed in subdural space or subgaleal space. Quasi experimental study. Combined Military Hospital, Lahore, from July 2015 to June 2016. Patients with chronic subdural hematoma of both genders and age, ranging between 55 to 85 years, were included. Patients on antiplatelet/anticoagulant therapy and acute on chronic subdural hematoma were excluded. Patients were divided in two equal groups each depending on whether drain was placed in subgaleal space (Group 1), and subdual space (Group 2), (n=31 patients each). Patients were positioned flat in bed after surgery. Clinical and radiological parameters and clinical outcome were compared between the two groups. Statistical test with significance of p <0.05 was utilized using Statistical Package of Social Sciences (SPSS version 17). Median age of the 62 patients was 72 ±12.5 years. Headache was the most common symptom reported in both groups, (n=47,75.8%) patients. Median thickness of hematoma was 15 ±6.5 mm. Patients with subdural drain placement had more complications such as pneumocephalus 11 (35.4%) vs. 6 (19.3%), and intracerebral hemorrhage 4 (12.9%) vs. 2 (6.4%). Clinical outcome was good in both groups 27 (87%) in Group 1 and 28 (90%) in Group 2. Patients of both groups had good outcome after surgery. Complications like pneumocephalus and intracerebral hemorrhage were more common in subdural location of drain, though not reaching statistically significance level to favor one technique over another.

  20. Large calcified subdural empyema.

    PubMed

    Sarkar, S; Mazumder, U; Chowdhury, D; Dey, S K; Hossain, M; Nag, U K; Riaz, B K

    2012-04-01

    Subdural empyema is a known disease entity; however, calcified subdural empyema is uncommon. The authors present a case of an 11-year-old boy in whom there was diagnosed a chronic calcified subdural empyema 10 years after an attack of meningitis. The patient had suffered from generalized tonic clonic seizures occurring 2-6 times in a month. A large fronto-temporo-parietal craniotomy was carried out and the subdural empyema filled with numerous uncharacteristic tissue fragments with thick pus together with the partially calcified and ossified capsule was removed. The empyema mass was found to be sterile for bacteria. After the operation, no epileptic seizure occurred and the boy is on sodium valporate. We must emphasize the unusual occurrence of the chronic subdural empyema presenting with calcification-ossification and large size as observed in our case.

  1. Simultaneous cranioplasty and subdural-peritoneal shunting for contralateral symptomatic subdural hygroma following decompressive craniectomy.

    PubMed

    Lin, Muh-Shi; Chen, Tzu-Hsuan; Kung, Woon-Man; Chen, Shuo-Tsung

    2015-01-01

    Contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. Nine patients who underwent one-stage, simultaneous cranioplasty and contralateral subdural-peritoneal shunting were included in this study. Clinical outcome was assessed by Glasgow Outcome Scale as well as Glasgow Coma Scale, muscle power scoring system, and complications. Postoperative computed tomography scans demonstrated completely resolved subdural hygroma and reversed midline shifts, indicating excellent outcome. Among these 9 patients, 4 patients (44%) had improved GOS following the proposed surgery. Four out of 4 patients with lethargy became alert and orientated following surgical intervention. Muscle strength improved significantly 5 months after surgery in 7 out of 7 patients with weakness. Two out of 9 patients presented with drowsiness due to hydrocephalus at an average time of 65 days after surgery. Double gradient shunting is useful to eliminate the respective hydrocephalus and contralateral subdural hygroma. The described surgical technique is effective in treating symptomatic contralateral subdural hygroma following decompressive craniectomy and is associated with an excellent structural and functional outcome. However, subdural-peritoneal shunting plus cranioplasty thoroughly resolves the subdural hygroma collection, which might deteriorate the cerebrospinal fluid circulation, leading to hydrocephalus.

  2. [Transformation from chronic subdural hematoma into subdural empyema following cat bites: a case report].

    PubMed

    Konno, Takuya; Yamada, Kei; Kasahara, Sou; Umeda, Yoshitaka; Oyake, Mutsuo; Fujita, Nobuya

    2015-01-01

    A 69-year-old man developed motor aphasia and right hemiparesis with severe headache, during the treatment of cellulitis and sepsis due to cat bites. Brain CT showed a low density, crescent-shaped lesion in the left subdural space, which was hypointense on brain diffusion-weighted imaging (DWI). One week later, when his neurological symptoms had worsened, the signal of the subdural lesion had changed to hyperintense on DWI. The lesion was capsule-shaped when enhanced by Gadolinium. The signal changes on DWI of the lesion indicated the existing hematoma had changed to an empyema, or so-called infected subdural hematoma, due to a hematogenous bacterial infection. Pasteurella multocida, a resident microbe in the oral cavity of cats, could be the responsible pathogen in this case. The patient recovered completely after treatment with intravenous high dose antibiotics. This is an important case report describing the transformation from a chronic subdural hematoma into a subdural empyema by DWI.

  3. Cerebrospinal fluid leakage into the subdural space: possible influence on the pathogenesis and recurrence frequency of chronic subdural hematoma and subdural hygroma.

    PubMed

    Kristof, Rudolf A; Grimm, Jochen M; Stoffel-Wagner, Birgit

    2008-02-01

    The purpose of this study was to clarify whether cerebrospinal fluid (CSF) leakage into the subdural space is involved in the genesis of chronic subdural hematoma (CSDH) and subdural hygroma (SH) and to clarify whether this leakage of CSF into the subdural space influences the postoperative recurrence rate of CSDH and SH. In this prospective observational study, 75 cases involving patients treated surgically for CSDH (67 patients) or SH (8 patients) were evaluated with respect to clinical and radiological findings at presentation, the content of beta -trace protein (beta TP) in the subdural fluid (betaTPSF) and serum (betaTPSER), and the CSDH/SH recurrence rate. The betaTPSF was considered to indicate an admixture of CSF to the subdural fluid if betaTPSF/betaTPSER>2. The median beta TPSF level for the whole patient group was 4.29 mg/L (range 0.33-51 mg/L). Cerebrospinal fluid leakage, as indicated by betaTPSF/betaTPSER>2, was found to be present in 93% of the patients with CSDH and in 100% of the patients with SH (p=0.724). In patients who later had to undergo repeated surgery for recurrence of CSDH/SH, the betaTPSF concentrations (median 6.69 mg/L, range 0.59-51 mg/L) were significantly higher (p=0.04) than in patients not requiring reoperation (median 4.12 mg/L, range 0.33-26.8 mg/L). As indicated by the presence of betaTP in the subdural fluid, CSF leakage into the subdural space is present in the vast majority of patients with CSDH and SH. This leakage could be involved in the pathogenesis of CSDH and SH. Patients who experience recurrences of CSDH and SH have significantly higher concentrations of betaTPSF at initial presentation than patients not requiring reoperation for recurrence. These findings are presented in the literature for the first time and have to be confirmed and expanded upon by further studies.

  4. Traumatic subdural hematoma in the lumbar spine.

    PubMed

    Song, Jenn-Yeu; Chen, Yu-Hao; Hung, Kuang-Chen; Chang, Ti-Sheng

    2011-10-01

    Traumatic spinal subdural hematoma is rare and its mechanism remains unclear. This intervention describes a patient with mental retardation who was suffering from back pain and progressive weakness of the lower limbs following a traffic accident. Magnetic resonance imaging of the spine revealed a lumbar subdural lesion. Hematoma was identified in the spinal subdural space during an operation. The muscle power of both lower limbs recovered to normal after surgery. The isolated traumatic spinal subdural hematoma was not associated with intracranial subdural hemorrhage. A spinal subdural hematoma should be considered in the differential diagnosis of spinal cord compression, especially for patients who have sustained spinal trauma. Emergency surgical decompression is usually the optimal treatment for a spinal subdural hematoma with acute deterioration and severe neurological deficits. Copyright © 2011. Published by Elsevier B.V.

  5. [Infected subdural hematoma having a surgery of chronic subdural hematoma 1 year ago:a case report].

    PubMed

    Nagao, Takaaki; Miyazaki, Chikao; Ando, Shunpei; Haga, Daisuke; Kuroki, Takao; Sugo, Nobuo; Nagao, Takeki

    2015-02-01

    We report a case of an infected subdural hematoma that occurred 1 year after burr-hole irrigation for chronic subdural hematoma. A 78-year-old woman who had developed left hemiparesis was admitted to our hospital. A computed tomography(CT)scan revealed the presence of a chronic subdural hematoma in the right hemisphere. Her clinical symptoms improved immediately after emergency burr-hole irrigation, which allowed her discharge from the hospital. One year after the initial surgery, she developed an infection of the urinary tract infection, which led to severe pyelonephritis and septic shock. Treatment of the urological symptoms eliminated the systemic inflammation. One month after the urinary infection, the patient was readmitted to the hospital in a comatose state. A CT scan showed regrowth of a residual subdural hematoma surrounded by a thick capsule, causing a midline shift in the brain. An emergency operation for removal of the subdural hematoma by burr-hole irrigation was performed, and pus was drained from the subdural mass. Microbiological cultures of the abscess revealed the presence of Proteus mirabilis. After surgery, the patient was administered an antibiotic treatment for three weeks and she was discharged with no neurological deficits. Cultures of blood from the septic shock as well as from the abscess both revealed the presence of Proteus mirabilis. Therefore, a diagnosis of infected subdural hematoma, which was caused by hematogenous infection, was made. We conclude that attention should be paid to the risk of infection of the hematoma capsule in subdural hematomas.

  6. Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images.

    PubMed

    Bodanapally, U K; Dreizin, D; Issa, G; Archer-Arroyo, K L; Sudini, K; Fleiter, T R

    2017-10-01

    Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma. We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images. Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60-78 years; P < .001) and had a higher incidence of intracranial hemorrhage ( P = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81-1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%-100%) and the specificity was 91.67% (95% CI, 73%-99%). Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual

  7. Association of subdural hematoma with increased mortality in lobar intracerebral hemorrhage.

    PubMed

    Patel, Pratik V; FitzMaurice, Emilie; Nandigam, R N Kaveer; Auluck, Pavan; Viswanathan, Anand; Goldstein, Joshua N; Rosand, Jonathan; Greenberg, Steven M; Smith, Eric E

    2009-01-01

    To determine the prevalence of subdural hematoma (SDH) in patients presenting with primary nontraumatic lobar intracerebral hemorrhage (ICH) and characteristics associated with the presence of SDH. Retrospective analysis of data collected in a prospective cohort study. Hospital. Consecutive sample of 200 patients with primary lobar ICH and 75 patients with deep hemispheric ICH. Presence of SDH and mortality. Subdural hematoma was present in 40 of 200 patients (20%) with primary lobar ICH. By contrast, SDH was not present in any of 75 consecutive patients with deep hemispheric ICH (P < .001 for comparison with lobar ICH). Intracerebral hemorrhage volume higher than 60 cm3 was the only independent predictor of SDH (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.14-6.34; P = .02). Subdural hematoma thickness more than 5 mm was an independent predictor of increased 30-day mortality (OR, 7.60; 95% CI, 1.86-30.99; P = .005) after controlling for other factors including ICH volume. Further analysis showed that the effect of SDH on mortality depended on ICH volume, with larger odds for mortality in those with low ICH volume (OR, 12.85; 95% CI, 2.42-68.23; P = .003 for those with ICH volume <30 cm3). Cerebral amyloid angiopathy was present in 8 of 9 patients with pathological specimens. Nontraumatic SDH frequently accompanies primary lobar ICH and is associated with higher 30-day mortality, particularly when the ICH volume is relatively low. Rupture of an amyloid-laden leptomeningeal vessel, with extravasation into the brain parenchyma and subdural space, may be the pathogenic mechanism.

  8. Age determination of subdural hematomas: survey among radiologists.

    PubMed

    Postema, F A M; Sieswerda-Hoogendoorn, Tessa; Majoie, C B L M; van Rijn, R R

    2014-08-01

    Abusive head trauma is a severe form of child abuse. One important diagnostic finding is the presence of a subdural hematoma. Age determination of subdural hematomas is important to relate radiological findings to the clinical history presented by the caregivers. In court this topic is relevant as dating subdural hematomas can lead to identification of a suspect. The aim of our study is to describe the current practice among radiologists in the Netherlands regarding the age determination of subdural hematomas in children. This is a cross-sectional study, describing the results of an online questionnaire regarding dating subdural hematomas among pediatric and neuro-radiologists in the Netherlands. The questionnaire consisted of sociodemographic questions, theoretical questions and eight pediatric cases in which the participants were asked to date subdural hematomas based on imaging findings. Fifty-one out of 172 radiologists (30 %) filled out the questionnaire. The percentage of participants that reported it was possible to date the subdural hematoma varied between 58 and 90 % for the eight different cases. In four of eight cases (50 %), the age of the subdural hematoma as known from clinical history fell within the range reported by the participants. None of the participants was "very certain" of their age determination. The results demonstrate that there is a considerable practice variation among Dutch radiologists regarding the age determination of subdural hematomas. This implicates that dating of subdural hematomas is not suitable to use in court, as no uniformity among experts exists.

  9. Hemispheric Chronic Subdural Hematoma Concealing Subdural Metastases: Terrible Surprise Behind Routine Emergency Department Consultation.

    PubMed

    Caruso, Riccardo; Pesce, Alessandro; Martines, Valentina

    2017-10-01

    The patient is a 79-year-old male, suffering from advanced metastatic prostate cancer, who developed a progressively worsening ideomotor slowing and was therefore referred to the emergency department of our institution. A plain axial computed tomography (CT) scan revealed a vast hemispheric subdural fluid collection, apparently a subdural hematoma. On closer inspection, and most of all, in hindsight, a tenuously isohyperdense signal irregularity at the frontal aspect of the fluid collection appears. Because of the declined general medical conditions and the paucity of the neurologic impairment, a high-dose, corticosteroid-based conservative strategy was performed. The total body CT scan for the routine oncologic follow-up of the prostate cancer scan fell at 20 days from the first CT of the emergency department. A second contrast-enhanced axial CT scan demonstrated the presence of 2 subdural metastases, presumably the initial pathogenesis of the subdural fluid collection. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Quantitative computer tomography analysis of post-operative subdural fluid volume predicts recurrence of chronic subdural haematoma.

    PubMed

    Xu, Fei-Fan; Chen, Jin-Hong; Leung, Gilberto Ka Kit; Hao, Shu-Yu; Xu, Long; Hou, Zong-Gang; Mao, Xiang; Shi, Guang-Zhi; Li, Jing-Sheng; Liu, Bai-Yun

    2014-01-01

    Post-operative volume of subdural fluid is considered to correlate with recurrence in chronic subdural haematoma (CSDH). Information on the applications of computer-assisted volumetric analysis in patients with CSDHs is lacking. To investigate the relationship between haematoma recurrence and longitudinal changes in subdural fluid volume using CT volumetric analysis. Fifty-four patients harbouring 64 CSDHs were studied prospectively. The association between recurrence rate and CT findings were investigated. Eleven patients (20.4%) experienced post-operative recurrence. Higher pre-operative (over 120 ml) and/or pre-discharge subdural fluid volumes (over 22 ml) were significantly associated with recurrence; the probability of non-recurrence for values below these thresholds were 92.7% and 95.2%, respectively. CSDHs with larger pre-operative (over 15.1 mm) and/or residual (over 11.7 mm) widths also had significantly increased recurrence rates. Bilateral CSDHs were not found to be more likely to recur in this series. On receiver-operating characteristic curve, the areas under curve for the magnitude of changes in subdural fluid volume were greater than a single time-point measure of either width or volume of the subdural fluid cavity. Close imaging follow-up is important for CSDH patients for recurrence prediction. Using quantitative CT volumetric analysis, strong evidence was provided that changes in the residual fluid volume during the 'self-resolution' period can be used as significantly radiological predictors of recurrence.

  11. Complications and results of subdural grid electrode implantation in epilepsy surgery.

    PubMed

    Lee, W S; Lee, J K; Lee, S A; Kang, J K; Ko, T S

    2000-11-01

    We assessed the risk of delayed subdural hematoma and other complications associated with subdural grid implantation. Forty-nine patients underwent subdural grid implantation with/without subdural strips or depth electrodes from January 1994 to August 1998. To identify the risk associated with subdural grid implantation, a retrospective review of all patients' medical records and radiological studies was performed. The major complications of 50 subdural grid electrode implantations were as follows: four cases (7.8%) of delayed subdural hematoma at the site of the subdural grid, requiring emergency operation; two cases (3.9%) of infection; one case (2.0%) of epidural hematoma; and one case (2.0%) of brain swelling. After subdural hematoma removal, the electrodes were left in place. CCTV monitoring and cortical stimulation studies were continued thereafter. No delayed subdural hematoma has occurred since routine placement of subdural drains was begun. In our experience the worst complication of subdural grid implantation has been delayed subdural hematoma. Placement of subdural drains and close observation may be helpful to prevent this serious complication.

  12. Spinal Subdural Haematoma.

    PubMed

    Manish K, Kothari; Chandrakant, Shah Kunal; Abhay M, Nene

    2015-01-01

    Spinal Subdural hematoma is a rare cause of radiculopathy and spinal cord compression syndromes. It's early diagnosis is essential. Chronological appearance of these bleeds vary on MRI. A 56 year old man presented with progressive left lower limb radiculopathy and paraesthesias with claudication of three days duration. MRI revealed a subdural space occupying lesion compressing the cauda equina at L5-S1 level producing a 'Y' shaped dural sac (Y sign), which was hyperintense on T1W imaging and hypointense to cord on T2W image. The STIR sequence showed hyperintensity to cord. There was no history of bleeding diathesis. The patient underwent decompressive durotomy and biopsy which confirmed the diagnosis. Spinal subdural hematoma may present with rapidly progressive neurological symptoms. MRI is the investigation of choice. The knowledge of MRI appearance with respect to the chronological stage of the bleed is essential to avoid diagnostic and hence surgical dilemma.

  13. Association of Subdural Hematoma With Increased Mortality in Lobar Intracerebral Hemorrhage

    PubMed Central

    Patel, Pratik V.; FitzMaurice, Emilie; Kaveer Nandigam, R. N.; Auluck, Pavan; Viswanathan, Anand; Goldstein, Joshua N.; Rosand, Jonathan; Greenberg, Steven M.; Smith, Eric E.

    2011-01-01

    Objective To determine the prevalence of subdural hematoma (SDH) in patients presenting with primary non-traumatic lobar intracerebral hemorrhage (ICH) and characteristics associated with the presence of SDH. Design Retrospective analysis of data collected in a prospective cohort study. Setting Hospital. Patients Consecutive sample of 200 patients with primary lobar ICH and 75 patients with deep hemispheric ICH. Main Outcome Measures Presence of SDH and mortality. Results Subdural hematoma was present in 40 of 200 patients (20%) with primary lobar ICH. By contrast, SDH was not present in any of 75 consecutive patients with deep hemispheric ICH (P<.001 for comparison with lobar ICH). Intracerebral hemorrhage volume higher than 60 cm3 was the only independent predictor of SDH (odds ratio [OR], 2.69; 95% confidence interval [CI], 1.14–6.34; P=.02). Subdural hematoma thickness more than 5 mm was an independent predictor of increased 30-day mortality (OR, 7.60; 95% CI, 1.86–30.99; P=.005) after controlling for other factors including ICH volume. Further analysis showed that the effect of SDH on mortality depended on ICH volume, with larger odds for mortality in those with low ICH volume (OR, 12.85; 95% CI, 2.42–68.23; P=.003 for those with ICH volume <30 cm3). Cerebral amyloid angiopathy was present in 8 of 9 patients with pathological specimens. Conclusions Nontraumatic SDH frequently accompanies primary lobar ICH and is associated with higher 30-day mortality, particularly when the ICH volume is relatively low. Rupture of an amyloid-laden leptomeningeal vessel, with extravasation into the brain parenchyma and subdural space, may be the pathogenic mechanism. PMID:19139303

  14. Prevalence of subdural collections in children with macrocrania.

    PubMed

    Greiner, M V; Richards, T J; Care, M M; Leach, J L

    2013-12-01

    The relationship between enlarged subarachnoid spaces and subdural collections is poorly understood and creates challenges for clinicians investigating the etiology of subdural collections. The purpose of this study was to determine the prevalence of subdural collections on cross sectional imaging in children with macrocephaly correlating with subarachnoid space enlargement. The radiology information system of a large pediatric medical center was reviewed for "macrocrania" and "macrocephaly" on reports of cranial MRI/CT examinations in children <24 months of age, over a 24-month period. Head circumference was obtained from the clinical record. Studies were reviewed blindly for subdural collection presence and subarachnoid space size. Children with prior cranial surgery, parenchymal abnormalities, hydrocephalus, or conditions predisposing to parenchymal volume loss were excluded. Chart review was performed on those with subdural collections. Imaging from 177 children with enlarged head circumference was reviewed. Nine were excluded, for a final cohort of 168 subjects (108 with enlarged subarachnoid space). Subdural collections were identified in 6 (3.6%), all with enlarged subarachnoid space (6/108, 5.6%). In 4, subdural collections were small, homogeneous, and nonhemorrhagic. In 2, the collections were complex (septations or hemorrhage). Two children were reported as victims of child abuse (both with complex collections). No definitive etiology was established in the other cases. The prevalence of subdural collections in imaged children with macrocrania was 3.6%, all occurring in children with enlarged subarachnoid space. Our results suggest that enlarged subarachnoid space can be associated with some subdural collections in this cohort. Despite this, we believe that unexpected subdural collections in children should receive close clinical evaluation for underlying causes, including abusive head trauma.

  15. Case report: treatment of subdural hematoma in the emergency department utilizing the subdural evacuating port system.

    PubMed

    Asfora, Wilson T; Klapper, Hendrik B

    2013-08-01

    Patients with acute or chronic subdural hematomas may present with rapidly deteriorating neurological function and are at risk for irreversible brainstem injury. In such cases, rapid surgical intervention is required to evacuate the hematoma and reverse critically elevated intracranial pressure. A variety of surgical drainage methods are in existence, none of which are clearly superior to the others. This report presents the case of a 74-year-old woman who suffered an acute-on-chronic subdural hematoma which was evacuated in the emergency department utilizing the subdural evacuating port system (SEPS). The SEPS provides for a minimally invasive technique to drain subdural hematomas and is advantageous in that it can be performed at the bedside. The SEPS is relatively simple to use and may be especially useful to emergency department staff in outlying areas where there is a shortage of neurosurgical coverage.

  16. Management of Recurrent Subdural Hematomas.

    PubMed

    Desai, Virendra R; Scranton, Robert A; Britz, Gavin W

    2017-04-01

    Subdural hematomas commonly recur after surgical evacuation, at a rate of 2% to 37%. Risk factors for recurrence can be patient related, radiologic, or surgical. Patient-related risk factors include alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt. Radiologic factors include poor brain reexpansion postoperatively, significant subdural air, greater midline shift, heterogeneous hematomas (layered or multi-loculated), and higher-density hematomas. Surgical factors include lack of or poor postoperative drainage. Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage. Refractory hematomas may be managed with a variety of techniques, including craniotomy or subdural-peritoneal shunt placement. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Subdural hematomas: an analysis of 1181 Kashmiri patients.

    PubMed

    Nayil, Khursheed; Ramzan, Altaf; Sajad, Arif; Zahoor, Sheikh; Wani, Abrar; Nizami, Furqan; Laharwal, Masood; Kirmani, Altaf; Bhat, Rashid

    2012-01-01

    We endeavored to analyze patients of subacute and chronic subdural hematomas studied in a 4-year period at the Sher-i-Kashmir Institute of Medical Sciences, Kashmir, India. The study was a retrospective analysis of 1181 patients of subdural hematomas. Demographic characteristics, clinico-radiologic features, operative modalities, and outcome were studied. Acute subdural hematomas were excluded from the study. The mean age was 60.4 ± 12.4 and males outnumbered females. Chronic subdural collections were more common than subacute subdural hematomas and left side predominated. Two burr holes with closed-system drainage was used in most patients. Incidence of postoperative seizures is very low. Overall recurrence rates were low; however, multilocular hematomas had the highest incidence of recurrence. Morbidity and mortality were 7.53% and 2.96%, respectively. Preoperative neurologic grade correlated with outcome. Subdural hematomas are common in elderly males. Preoperative neurologic grade dictates the outcome. Multilocular hematomas have a higher chance of recurrence. Craniotomy should be reserved for recurrent hematomas, and there may be a scope of craniotomy for multilocular chronic subdural hematomas at the outset. Antiepileptic prophylaxis is not routinely recommended. Copyright © 2012 Elsevier Inc. All rights reserved.

  18. Vascular Endothelial Growth Factor Concentration in Chronic Subdural Hematoma Fluid Is Related to Computed Tomography Appearance and Exudation Rate

    PubMed Central

    Weigel, Ralf; Hohenstein, Axel

    2014-01-01

    Abstract Chronic subdural hematoma (CSH) is characterized by a net increase of volume over time. Major underlying mechanisms appear to be hemorrhagic episodes and a continuous exudation, which may be studied using labeled proteins to yield an exudation rate in a given patient. We tested the hypothesis that the concentration of vascular endothelial growth factor (VEGF) in hematoma fluid correlates with the rate of exudation. Concentration of VEGF was determined in 51 consecutive patients with CSH by the sandwich immune enzyme-linked immunosorbent assay technique. Mean values were correlated with exudation rates taken from the literature according to the appearance of CSH on computed tomography (CT) images. The CT appearance of each CSH was classified as hypodense, isodense, hyperdense, or mixed density. Mean VEGF concentration was highest in mixed-density hematomas (22,403±4173 pg/mL; mean±standard error of the mean; n=27), followed by isodense (9715±1287 pg/mL; n=9) and hypodense (5955±610 pg/mL; n=18) hematomas. Only 1 patient with hyperdense hematoma fulfilled the inclusion criteria, and the concentration of VEGF found in this patient was 24,200 pg/mL. There was a statistically significant correlation between VEGF concentrations and exudation rates in the four classes of CT appearance (r=0.98). The current report is the first to suggest a pathophysiological link between the VEGF concentration and the exudation rate underlying the steady increase of hematoma volume and CT appearance.With this finding, the current report adds another piece of evidence in favor of the pathophysiological role of VEGF in the development of CSH, including mechanisms contributing to hematoma growth and CT appearance. PMID:24245657

  19. Subdural drainage versus subperiosteal drainage in burr-hole trepanation for symptomatic chronic subdural hematomas.

    PubMed

    Bellut, David; Woernle, Christoph Michael; Burkhardt, Jan-Karl; Kockro, Ralf Alfons; Bertalanffy, Helmut; Krayenbühl, Niklaus

    2012-01-01

    Symptomatic chronic subdural hematoma (scSDH) is one of the most frequent diseases in neurosurgical practice, and its incidence is increasing. However, treatment modalities are still controversial. The aim of this retrospective single-center study is to compare for the first time two surgical methods in the treatment of subdural hematoma that have been proven to be efficient in previous studies in a direct comparison. We analyzed the data of 143 scSDHs in 113 patients undergoing surgery for subdural hematoma with placement of subperiosteal or subdural drainage after double burr-hole trepanation for hematoma evacuation. Overall, there were no statistically significant differences regarding general patient characteristics, preoperative and postoperative symptoms, postoperative hematoma remnant, rates of recurrences, mortality, complications, and outcome at discharge and at 3-month follow up between the groups. There was a close to significant tendency of lower mortality after placement of subperiosteal drainage system and a tendency towards lower rate of recurrent hematoma after placement of subdural drainage system. Our study shows for the first time a direct comparison of two mainly used surgical techniques in the treatment of scSDH. Both methods proved to be highly effective, and general patient data, complications, outcome and mortality of both groups are equal or superior compared with previously published series. Because there is a clear tendency to less mortality and fewer serious complications, treatment with double burr-hole trepanation, irrigation, and placement of subperiosteal drainage is our treatment of choice in patients with predictable high risk of complications. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Subdural Instillation of a Thrombolytic Agent for Treatment of Recurrent Subdural Hematoma.

    PubMed

    Frenkel, Mark B; Sarwal, Aarti; Wren, Mary Petrulis; Newey, Christopher R; Couture, Daniel E

    This study aims to report the case of a patient with recurrent subdural hemorrhage (SDH) who was administered tissue plasminogen activator through a subdural drain to enhance drainage and prevent recurrence. An 85-year-old man was treated for subacute over chronic SDH that kept on reaccumulating despite serial twist drill drainage, burr hole drainage, and craniotomy. No coagulopathy was identified with adequate blood pressure control. Treatment with tissue plasminogen activator resulted in successful drainage of the SDH, and the patient had no further recurrence at 9-month follow-up.

  1. Chronic Subdural Hematoma Preceded by High-Impact Trauma: Does the Intensity of Trauma Influence the Pathogenesis of Traumatic Chronic Subdural Hematoma?

    PubMed

    Park, Ki-Su; Lee, Chang-Heon; Park, Seong-Hyun; Hwang, Sung-Kyoo; Hwang, Jeong-Hyun

    2017-01-01

    The purpose of this study was to investigate whether the intensity of trauma influences the pathogenesis of traumatic chronic subdural hematoma (CSDH). Thirty-one patients treated surgically for traumatic CSDH were divided into high-impact and lowimpact groups according to the intensity of trauma. They were respectively evaluated with respect to clinical and radiological findings at presentation, and the subdural concentrations of interleukin-6 (IL-6), interleukin-8 (IL-8), vascular endothelial growth factor (VEGF), basic fibroblast growth factor, and beta-trace protein (ΒTP) [a highly specific protein in the cerebrospinal fluid (CSF)] related to the pathogenesis of CSDH. If ΒTP (subdural fluid/serum) was > 2, an admixture of CSF to the subdural fluid was indicated. The ΒTP (subdural fluid/serum) was > 2 in all patients with a traumatic CSDH. The mean concentration of subdural ΒTP in the high-impact group was higher than in the low-impact group (6.1 mg/L versus 3.9 mg/L), and the difference was statistically significant (p=0.02). In addition, mean concentrations of IL-6, IL-8 and VEGF were higher in the high-impact group, as compared to the low-impact group, though the differences did not reach statistical significance. Trauma may be related to CSF leakage into the subdural space in CSDH, and the intensity of trauma may influence the amount of CSF leakage. Although there is no direct correlation between the amount of CSF leakage and other subdural molecules, the intensity of trauma may be associated with larger concentrations of molecules in traumatic CSDH.

  2. Cerebral and subdural abscess with spatio-temporal multiplicity 12 years after initial craniotomy for acute subdural hematoma. Case report.

    PubMed

    Wakui, Daisuke; Nagashima, Goro; Takada, Tatsuro; Ueda, Toshihiro; Itoh, Hidemichi; Tanaka, Yuichiro; Hashimoto, Takuo

    2012-01-01

    A 34-year-old man presented with a case of subdural empyema and cerebral abscess that developed 12 years after initial neurosurgical intervention for a traffic accident in 1998. Under a diagnosis of acute subdural hematoma and cerebral contusion, several neurosurgical procedures were performed at another hospital, including hematoma removal by craniotomy, external decompression, duraplasty, and cranioplasty. The patient experienced an epileptic seizure, and was referred to our hospital in March 2010. Magnetic resonance imaging revealed a cerebral abscess extending to the subdural space just under the previous surgical field. Surgical intervention was refused and antimicrobial treatment was initiated, but proved ineffective. Surgical removal of artificial dura and cranium with subdural empyema, and resection of a cerebral abscess were performed on May 12, 2010. No organism was recovered from the surgical samples. Meropenem and vancomycin were selected as perioperative antimicrobial agents. No recurrence of infection has been observed. Postneurosurgical subdural empyema and cerebral abscess are recently emerging problems. Infections of neurosurgical sites containing implanted materials occur in 6% of cases, usually within several months of the surgery. Subdural empyema and cerebral abscess developing 12 years after neurosurgical interventions are extremely rare. The long-term clinical course suggests less pathogenic organisms as a cause of infection, and further investigations to develop appropriate antimicrobial selection and adequate duration of antimicrobial administration for these cases are needed.

  3. The Nelaton Catheter Guard for Safe and Effective Placement of Subdural Drain for Two-Burr-Hole Trephination in Chronic Subdural Hematoma: A Technical Note.

    PubMed

    Fichtner, Jens; Beck, Jürgen; Raabe, A; Stieglitz, Lennart Henning

    2015-09-01

    For chronic subdural hematoma, placement of a Blake drain with a two-burr-hole craniotomy is often preferred. However, the placement of such drains carries the risk of penetrating the brain surface or damaging superficial venous structures. To describe the use of a Nelaton catheter for the placement of a subdural drain in two-burr-hole trephination for chronic subdural hematoma. A Nelaton catheter was used to guide placement of a Blake drain into the subdural hematoma cavity and provide irrigation of the hematoma cavity. With the two-burr-hole method, the Nelaton catheter could be removed easily via the frontal burr hole after the Blake drain was in place. We used the Nelaton catheters in many surgical procedures and found it a safe and easy technique. This method allows the surgeon to safely direct the catheter into the correct position in the subdural space. This tool has two advantages. First, the use of a small and flexible Nelaton catheter is a safe method for irrigation of a chronic subdural hematoma cavity. Second, in comparison with insertion of subdural drainage alone through a burr hole, the placement of the Nelaton catheter in subdural space is easier and the risk of damaging relevant structures such as cortical tissue or bridging veins is lower. Thus this technique may help to avoid complications when placing a subdural drain. Georg Thieme Verlag KG Stuttgart · New York.

  4. Malignant Subdural Hematoma Associated with High-Grade Meningioma

    PubMed Central

    Teramoto, Shinichiro; Tsunoda, Akira; Kawamura, Kaito; Sugiyama, Natsuki; Saito, Rikizo; Maruki, Chikashi

    2018-01-01

    A 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously. PMID:29896565

  5. Independent predictors for recurrence of chronic subdural hematoma.

    PubMed

    Chon, Kyu-Hyon; Lee, Jong-Myong; Koh, Eun-Jeong; Choi, Ha-Young

    2012-09-01

    Chronic subdural hematoma is characterized by blood in the subdural space that evokes an inflammatory reaction. Numerous factors potentially associated with recurrence of chronic subdural hematoma have been reported, but these factors have not been sufficiently investigated. In this study, we evaluated the independent risk factors of recurrence. We analyzed data for 420 patients with chronic subdural hematoma treated by the standard surgical procedure for hematoma evacuation at our institution. Ninety-two (21.9 %) patients experienced at least one recurrence of chronic subdural hematoma during the study period. We did not identify any significant differences between chronic subdural hematoma recurrence and current antiplatelet therapy. The recurrence rate was 7 % for the homogeneous type, 21 % for the laminar type, 38 % for the separated type, and 0 % for the trabecular type. The rate of recurrence was significantly lower in the homogeneous and trabecular type than in the laminar and separated type. We performed a multivariate logistic regression analysis and found that postoperative midline shifting (OR, 3.6; 95 % CI, 1.618-7.885; p = 0.001), diabetes mellitus (OR, 2.2; 95 % CI, 1.196-3.856; p = 0.010), history of seizure (OR, 2.6; 95 % CI, 1.210-5.430; p = 0.014), width of hematoma (OR, 2.1; 95 % CI, 1.287-3.538; p = 0.003), and anticoagulant therapy (OR, 2.7; 95 % CI, 1.424-6.960; p = 0.005) were independent risk factors for the recurrence of chronic subdural hematoma. We have shown that postoperative midline shifting (≥5 mm), diabetes mellitus, preoperative seizure, preoperative width of hematoma (≥20 mm), and anticoagulant therapy were independent predictors of the recurrence of chronic subdural hematoma. According to internal architecture of hematoma, the rate of recurrence was significantly lower in the homogeneous and the trabecular type than the laminar and separated type.

  6. Recurrent subdural hematoma secondary to headbanging: A case report.

    PubMed

    Nitta, Naoki; Jito, Junya; Nozaki, Kazuhiko

    2015-01-01

    "Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma. A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging. Headbanging has the hazardous potential to cause a subdural hematoma.

  7. Dissapearance of arachnoid cyst after rupturing into subdural space.

    PubMed

    Yilmaz, C; Cetinalp, E; Caner, H; Altinors, N

    2007-01-01

    Arachnoid cysts are developmental anomalies usually diagnosed in childhood. The most important complications of arachnoid cysts are subdural haematomas and hygromas and intracystic haemorrhage. In our case we present a 7-year-old boy whose arachnoid cyst ruptured into the subdural space following a mild head injury and disappeared after draining the subdural haematoma by burr-holes.

  8. Chronic Subdural Hematoma in the Aged, Trauma or Degeneration?

    PubMed

    Lee, Kyeong-Seok

    2016-01-01

    Chronic subdural hematomas (CSHs) are generally regarded to be a traumatic lesion. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. From 20th century, it became a traumatic lesion. CSH frequently occur after a trauma, however, it cannot occur when there is no enough subdural space even after a severe head injury. CSH may occur without trauma, when there is sufficient subdural space. The author tried to investigate trends in the causation of CSH. By a review of literature, the author suggested a different view on the causation of CSH. CSH usually originated from either a subdural hygroma or an acute subdural hematoma. Development of CSH starts from the separation of the dural border cell (DBC) layer, which induces proliferation of DBCs with production of neomembrane. Capillaries will follow along the neomembrane. Hemorrhage would occur into the subdural fluid either by tearing of bridge veins or repeated microhemorrhage from the neomembrane. That is the mechanism of hematoma enlargement. Trauma or bleeding tendency may precipitate development of CSH, however, it cannot lead CSH, if there is no sufficient subdural space. The key determinant for development of CSH is a sufficient subdural space, in other words, brain atrophy. The most common and universal cause of brain atrophy is the aging. Modifying Virchow's description, CSH is sometimes traumatic, but most often caused by degeneration of the brain. Now, it is reasonable that degeneration of brain might play pivotal role in development of CSH in the aged persons.

  9. Chronic Subdural Hematoma in the Aged, Trauma or Degeneration?

    PubMed Central

    2016-01-01

    Chronic subdural hematomas (CSHs) are generally regarded to be a traumatic lesion. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. From 20th century, it became a traumatic lesion. CSH frequently occur after a trauma, however, it cannot occur when there is no enough subdural space even after a severe head injury. CSH may occur without trauma, when there is sufficient subdural space. The author tried to investigate trends in the causation of CSH. By a review of literature, the author suggested a different view on the causation of CSH. CSH usually originated from either a subdural hygroma or an acute subdural hematoma. Development of CSH starts from the separation of the dural border cell (DBC) layer, which induces proliferation of DBCs with production of neomembrane. Capillaries will follow along the neomembrane. Hemorrhage would occur into the subdural fluid either by tearing of bridge veins or repeated microhemorrhage from the neomembrane. That is the mechanism of hematoma enlargement. Trauma or bleeding tendency may precipitate development of CSH, however, it cannot lead CSH, if there is no sufficient subdural space. The key determinant for development of CSH is a sufficient subdural space, in other words, brain atrophy. The most common and universal cause of brain atrophy is the aging. Modifying Virchow's description, CSH is sometimes traumatic, but most often caused by degeneration of the brain. Now, it is reasonable that degeneration of brain might play pivotal role in development of CSH in the aged persons. PMID:26885279

  10. Use of Subdural Evacuating Port System Following Open Craniotomy with Excision of Native Dura and Membranes for Management of Chronic Subdural Hematoma.

    PubMed

    Cage, Tene; Bach, Ashley; McDermott, Michael W

    2017-04-26

    An 86-year-old woman was admitted to the intensive care unit with a chronic subdural hematoma (CSDH) and rapid onset of worsening neurological symptoms. She was taken to the operating room for a mini-craniotomy for evacuation of the CSDH including excision of the dura and CSDH membrane. Postoperatively, a subdural evacuation port system (SEPS) was integrated into the craniotomy site and left in place rather than a traditional subdural catheter drain to evacuate the subdural space postoperatively. The patient had a good recovery and improvement of symptoms after evacuation and remained clinically well after the SEPS was removed. We offer the technique of dura and CSDH membrane excision plus SEPS drain as an effective postoperative alternative to the standard craniotomy leaving the native dura intact with traditional subdural drain that overlies the cortical surface of the brain in treating patients with CSDH.

  11. Use of Subdural Evacuating Port System Following Open Craniotomy with Excision of Native Dura and Membranes for Management of Chronic Subdural Hematoma

    PubMed Central

    Bach, Ashley; McDermott, Michael W.

    2017-01-01

    An 86-year-old woman was admitted to the intensive care unit with a chronic subdural hematoma (CSDH) and rapid onset of worsening neurological symptoms. She was taken to the operating room for a mini-craniotomy for evacuation of the CSDH including excision of the dura and CSDH membrane. Postoperatively, a subdural evacuation port system (SEPS) was integrated into the craniotomy site and left in place rather than a traditional subdural catheter drain to evacuate the subdural space postoperatively. The patient had a good recovery and improvement of symptoms after evacuation and remained clinically well after the SEPS was removed. We offer the technique of dura and CSDH membrane excision plus SEPS drain as an effective postoperative alternative to the standard craniotomy leaving the native dura intact with traditional subdural drain that overlies the cortical surface of the brain in treating patients with CSDH. PMID:28560123

  12. Chronic subdural electrodes in the management of epilepsy.

    PubMed

    Nair, Dileep R; Burgess, Richard; McIntyre, Cameron C; Lüders, Hans

    2008-01-01

    Subdural electrodes play a very important role in the evaluation of a percentage of patients being considered for epilepsy surgery. Electrical activity at very low and very high frequencies, beyond the practical range of scalp EEG, can be recorded subdurally and may contain considerable information not available non-invasively. The recording and stimulating procedures for using chronically implanted subdural electrodes to localize the epileptogenic zone and map eloquent functions of the human cortex are well established, and complication rates are low. Complications include infections, CSF leak, and focal neurologic deficits, all of which tend to be increased with a higher number of electrodes and longer duration of recordings. Careful consideration of the risks and benefits should be coupled with a firm hypothesis about the epileptogenic zone derived from the non-invasive components of the epilepsy workup to guide the decision about whether and where to implant subdural electrodes. When they are employed to answer a specific question in an individual patient, subdural electrodes can optimize the clinical outcome of a candidate for epilepsy surgery.

  13. Subdural empyema in bacterial meningitis.

    PubMed

    Jim, Kin K; Brouwer, Matthijs C; van der Ende, Arie; van de Beek, Diederik

    2012-11-20

    To evaluate the occurrence, treatment, and outcome of subdural empyema complicating community-acquired bacterial meningitis in adults. Case series from a prospective nationwide cohort study from Dutch hospitals from 2006 to 2011. Subdural empyema was diagnosed in 28 of 1,034 episodes (2.7%), and was present on admission in 10 episodes and diagnosed during admission in 18. Predisposing conditions were present in 26 patients (93%), and consisted of otitis or sinusitis in 21 patients (75%). In all these patients the otitis or sinusitis spread to the subdural space. Twenty-three patients (82%) presented with neurologic symptoms (paresis, focal seizures, dysesthesia contralateral to the empyema). Streptococcus pneumoniae was identified in 26 patients (93%) and Streptococcus pyogenes in 1 (3%); 1 patient had negative CSF cultures. Clinical course was frequently complicated with seizures (50%), focal neurologic abnormalities (54%), and hearing impairment (39%), causing an unfavorable outcome in 19 episodes (68%). Neurosurgical evacuation of the empyema was performed in 5 patients, all with considerable midline shift. Although rare, subdural empyema must be considered in patients with community-acquired bacterial meningitis and otitis or sinusitis, focal neurologic deficits, or epileptic seizures. S pneumoniae is the predominant causative organism and neurosurgical intervention should be regarded as first-choice therapy in patients with empyema causing midline shift and focal neurologic abnormalities or a decreased level of consciousness.

  14. Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma.

    PubMed

    Kim, Chang Hyeun; Song, Geun Sung; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon

    2017-10-01

    Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.

  15. Remote Hemorrhage after Burr Hole Drainage of Chronic Subdural Hematoma

    PubMed Central

    Kim, Chang Hyeun; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Son, Dong Wuk; Lee, Sang Weon

    2017-01-01

    Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination. PMID:29201850

  16. Rapid Spontaneously Resolving Acute Subdural Hematoma

    PubMed Central

    Gan, Qi; Zhao, Hexiang; Zhang, Hanmei; You, Chao

    2017-01-01

    Introduction: This study reports a rare patient of a rapid spontaneously resolving acute subdural hematoma. In addition, an analysis of potential clues for the phenomenon is presented with a review of the literature. Patient Presentation: A 1-year-and-2-month-old boy fell from a height of approximately 2 m. The patient was in a superficial coma with a Glasgow Coma Scale of 8 when he was transferred to the authors’ hospital. Computed tomography revealed the presence of an acute subdural hematoma with a midline shift beyond 1 cm. His guardians refused invasive interventions and chose conservative treatment. Repeat imaging after 15 hours showed the evident resolution of the hematoma and midline reversion. Progressive magnetic resonance imaging demonstrated the complete resolution of the hematoma, without redistribution to a remote site. Conclusions: Even though this phenomenon has a low incidence, the probability of a rapid spontaneously resolving acute subdural hematoma should be considered when patients present with the following characteristics: children or elderly individuals suffering from mild to moderate head trauma; stable or rapidly recovered consciousness; and simple acute subdural hematoma with a moderate thickness and a particularly low-density band in computed tomography scans. PMID:28468224

  17. Improved long-term survival with subdural drains following evacuation of chronic subdural haematoma.

    PubMed

    Guilfoyle, Mathew R; Hutchinson, Peter J A; Santarius, Thomas

    2017-05-01

    Chronic subdural haematoma (CSDH) is a common condition that is effectively managed by burrhole drainage but requires repeat surgery in a significant minority of patients. The Cambridge Chronic Subdural Haematoma Trial (CCSHT) was a randomised controlled study that showed placement of subdural drains for 48 h following burrhole evacuation significantly reduces the incidence of reoperation and improves survival at 6 months. The present study examined the long-term survival of the patients in the trial. In the original trial patients at a single neurosurgical centre from 2004-2007 were randomly assigned to receive a drain (n = 108) or no drain (n = 107) following burrhole drainage of CSDH. We ascertained whether the trial patients were alive in February 2016-a minimum of 8 years following enrollment-via the UK NHS tracing service. Survival was compared between the trial groups and against expected survival for the UK general population matched for age and sex. At 5 years following surgery the drain group continued to have significantly better survival than the no drain patients (p = 0.027), but this was no longer apparent at 10 years. Survival of patients in the drain group did not differ significantly from that of the general population whereas patients who did not receive a drain had significantly lower survival than expected (p = 0.0006). Subdural drains following CSDH evacuation are associated with improved long-term survival, which appears similar to that expected for the general population of the same age and sex. All patients having burrhole CSDH evacuation should receive a drain as standard practice unless specifically contraindicated.

  18. Macrocephaly in infancy: benign enlargement of the subarachnoid spaces and subdural collections.

    PubMed

    Tucker, Jacqueline; Choudhary, Arabinda Kumar; Piatt, Joseph

    2016-07-01

    OBJECTIVE Benign enlargement of the subarachnoid spaces (BESS) is a common finding on imaging studies indicated by macrocephaly in infancy. This finding has been associated with the presence of subdural fluid collections that are sometimes construed as suggestive of abusive head injury. The prevalence of BESS among infants with macrocephaly and the prevalence of subdural collections among infants with BESS are both poorly defined. The goal of this study was to determine the relative frequencies of BESS, hydrocephalus, and subdural collections in a large consecutive series of imaging studies performed for macrocephaly and to determine the prevalence of subdural fluid collections among patients with BESS. METHODS A text search of radiology requisitions identified studies performed for macrocephaly in patients ≤ 2 years of age. Studies of patients with hydrocephalus or acute trauma were excluded. Studies that demonstrated hydrocephalus or chronic subdural hematoma not previously recognized but responsible for macrocephaly were noted but not investigated further. The remaining studies were reviewed for the presence of incidental subdural collections and for measurement of the depth of the subarachnoid space. A 3-point scale was used to grade BESS: Grade 0, < 5 mm; Grade 1, 5-9 mm; and Grade 2, ≥ 10 mm. RESULTS After exclusions, there were 538 studies, including 7 cases of hydrocephalus (1.3%) and 1 large, bilateral chronic subdural hematoma (0.2%). There were incidental subdural collections in 21 cases (3.9%). Two hundred sixty-five studies (49.2%) exhibited Grade 1 BESS, and 46 studies (8.6%) exhibited Grade 2 BESS. The prevalence of incidental subdural collections among studies with BESS was 18 of 311 (5.8%). The presence of BESS was associated with a greater prevalence of subdural collections, and higher grades of BESS were associated with increasing prevalence of subdural collections. After controlling for imaging modality, the odds ratio of the association of

  19. Arachnoid cyst with rupture into the subdural space.

    PubMed Central

    Cullis, P A; Gilroy, J

    1983-01-01

    Arachnoid cysts which develop in relation to the cerebral hemispheres are usually found in the middle cranial fossa. These cysts are usually asymptomatic but can produce symptoms if there is haemorrhage into the cyst or the development of an associated subdural hematoma. Recent publications have emphasised the association of arachnoid cysts of the middle fossa with subdural haematomas. This report describes a case of an asymptomatic arachnoid cyst which ruptured into the subdural space. This event was followed by the development of symptoms despite the lack of haemorrhage. Images PMID:6101185

  20. Experimental models of chronic subdural hematoma.

    PubMed

    D'Abbondanza, Josephine A; Loch Macdonald, R

    2014-02-01

    Chronic subdural hematoma (CSDH) is a common neurosurgical problem. Most studies of pathogenesis and treatment involve humans. Advances in understanding of human diseases may be made using animal models. We reviewed all animal models of CSDH and report here their results, conclusions and limitations in order to set a baseline upon which further advanced experimental work related to this disease can be made. PubMed, Medline, Embase and ISI Web of Knowledge were searched with no time limits using the keyword 'chronic subdural hematoma' and MeSH term 'hematoma, subdural, chronic'. The authors reviewed all papers written related to this disease and selected all publications involving animals. There were no other restrictions. The findings and conclusions of the papers are summarized here. No formal analysis was done because of the variation in species used, methods for induction of CSDH, times of assessment and reporting of results. Attempts to create CSDH have been made in mice, rats, cats, dogs and monkeys. Methods include injection or surgical implantation of clotted blood or various other blood products and mixtures into the potential subdural space or the subcutaneous space. No intracranial model produced a progressively expanding CSDH. Transient hematoma expansion with liquification could be produced by subcutaneous injections in some models. Spontaneous subdural blood collections were found after creation of hydrocephalus in mice by systemic injection of the neurotoxin, 6-aminonicotinamide. The histology of the hematoma membranes in several models resembles the appearance in humans. None of the models has been replicated since its first description. We did not find a report of a reproducible, well-described animal model of human CSDH.

  1. Developing a model of chronic subdural hematoma.

    PubMed

    Tang, Jingyang; Ai, Jinglu; Macdonald, R Loch

    2011-01-01

    Chronic subdural hematoma (CSDH) is a common neurosurgical condition that has a high incidence in the increasing elderly population of many countries. Pathologically, it is defined as a persistent liquefied hematoma in the subdural space more than 3 weeks old that is generally encased by a membraneous capsule. CSDHs likely originate after minor head trauma, with a key factor in its development being the potential for a subdural cavity to permit its expansion within, which is usually due to craniocerebral disproportion. The pathogenesis of CSDH has been attributed to osmotic or oncotic pressure differences, although measurements of these factors in the CSDH fluid do not support this theory. Current belief is that CSDH arises from recurrent bleeding in the subdural space, caused by a cycle of local angiogenesis, inflammation, coagulation and ongoing fibrinolysis. However, because of a lack of detailed knowledge about the precise mechanisms, treatment is often limited to surgical interventions that are invasive and often prone to recurrence. Thus, it is possible that an easily reproducible and representative animal model of CSDH would facilitate research in the pathogenesis of CSDH and aid with development of treatment options.

  2. Subdural Hematoma

    DTIC Science & Technology

    2006-07-01

    characterization of more subtle associated CNS injuries. Treatment of nonacute subdural hematoma may involve craniotomy -guided hematoma evacuation...nature of this process. Note the ventricular shunt (arrow) in place for drainage of hydrocephalus, caused by significant mass effect on the...collections may require craniotomy . Because SDH may be under high intracranial pressure resultant from associated injuries, patients with the acute form

  3. Volume fraction instability in an oscillating non-Brownian iso-dense suspension.

    NASA Astrophysics Data System (ADS)

    Roht, Y. L.; Gauthier, G.; Hulin, J. P.; Salin, D.; Chertcoff, R.; Auradou, H.; Ippolito, I.

    2017-06-01

    The instability of an iso-dense non-Brownian suspension of polystyrene beads of diameter 40 μm dispersed in a water-glycerol mixture submitted to a periodic square wave oscillating flow in a Hele-Shaw cell is studied experimentally. The instability gives rise to stationary bead concentration waves transverse to the flow. It has been observed for average particle volume fractions between 0.25 and 0.4, for periods of the square wave flow variation between 0.4 and 10 s and in finite intervals of the amplitude of the fluid displacement. The study shows that the wavelength λ increases roughly linearly with the amplitude of the oscillatory flow; on the other hand, λ is independent of the particle concentration and of the period of oscillation of the flow although the minimum threshold amplitude for observing the instability increases with the period.

  4. [Three cases of acute interhemispheric subdural hematoma].

    PubMed

    Takeda, N; Kurihara, E; Matsuoka, H; Kose, S; Tamaki, N; Matsumoto, S

    1988-01-01

    Traumatic acute subdural hematomas over the convexity of the cerebral hemispheres are often encountered, but acute interhemispheric subdural hematomas are rare. Fourty-eight cases of acute subdural hematomas was admitted to our hospital between 1977 and 1986, and three cases of them (6%) were located in the interhemispheric subdural space. In this paper, these three cases are reported with 20 documented cases. Case 1: an 81-year-old female was admitted to our hospital because of headache, nausea and vomiting. She hit her occiput a week ago. CT scan demonstrated contusion in the right frontal lobe and a high density in the interhemispheric space of the right frontal region. Her complaints disappeared gradually by conservative therapy and she returned to her social life. Case 2: a 50-year-old male fell downstairs and hit his vertex. As he lost consciousness, he was admitted to our hospital. He was stuporous and had left-hemiparesis. Skull X-ray film showed fracture line extending from the right temporal bone to the left parietal bone across the midline. CT scan revealed intracerebral hematoma in both frontal lobe and right parietal lobe and subarachnoid hemorrhage in the basal cistern and Sylvian fissure of the right side. And interhemispheric subdural hematoma in the right parietal region was visualized. Angiography demonstrated a lateral displacement of the right callosomarginal artery and an avascular area between the falx and the callosomarginal artery. After admission his consciousness recovered and convulsion was controlled by drug. Left-hemiparesis was improved by conservative therapy and he was discharged on foot.(ABSTRACT TRUNCATED AT 250 WORDS)

  5. Parkinsonsim due to a Chronic Subdural Hematoma

    PubMed Central

    Park, Bosuk; Song, Sook Keun; Hong, Jin Yong; Lee, Phil Hyu

    2009-01-01

    Subdural hematoma is a rare cause of parkinsonism. We present the case of a 78-year-old man with right-side dominant parkinsonism about 3 months after a minor head injury. MRI reveals a chronic subdural hematoma on the left side with mildly displaced midline structures. The parkinsonian features were almost completely disappeared after neurosurgical evacuation of the hematoma without any anti-parkinson drug. PMID:24868353

  6. Venous or arterial blood components trigger more brain swelling, tissue death after acute subdural hematoma compared to elderly atrophic brain with subdural effusion (SDE) model rats.

    PubMed

    Wajima, Daisuke; Sato, Fumiya; Kawamura, Kenya; Sugiura, Keisuke; Nakagawa, Ichiro; Motoyama, Yasushi; Park, Young-Soo; Nakase, Hiroyuki

    2017-09-01

    Acute subdural hematoma (ASDH) is a frequent complication of severe head injury, whose secondary ischemic lesions are often responsible for the severity of the disease. We focused on the differences of secondary ischemic lesions caused by the components, 0.4ml venous- or arterial-blood, or saline, infused in the subdural space, evaluating the differences in vivo model, using rats. The saline infused rats are made for elderly atrophic brain with subdural effusion (SDE) model. Our data showed that subdural blood, both venous- and arterial-blood, aggravate brain edema and lesion development more than SDE. This study is the first study, in which different fluids in rats' subdural space, ASDH or SDE are compared with the extension of early and delayed brain damage by measuring brain edema and histological lesion volume. Blood constituents started to affect the degree of ischemia underneath the subdural hemorrhage, leading to more pronounced breakdown of the blood-brain barrier and brain damage. This indicates that further strategies to treat blood-dependent effects more efficiently are in view for patients with ASDH. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Intracranial subdural hematomas with elevated rivaroxaban concentration and subsequently detected spinal subdural hematoma: A case report.

    PubMed

    Yamaguchi, Yoshitaka; Koga, Masatoshi; Matsuki, Takayuki; Hino, Tenyu; Yokota, Chiaki; Toyoda, Kazunori

    2016-07-01

    A 79-year-old lean man with a height of 157cm and weight of 42kg (body mass index, 17.2kg/m(2)) receiving rivaroxaban developed an intracranial subdural hematoma and was treated conservatively. Because he had a reduced creatinine clearance of 44mL/min, his dosage of rivaroxaban was reduced from 15 to 10mg daily according to official Japanese prescribing information. However, he developed bilateral intracranial subdural hematomas 2weeks later. Plasma rivaroxaban concentration on anti-factor Xa chromogenic assay was elevated at 301ng/mL, suggesting excessive accumulation. He underwent burr hole drainage and resumed anticoagulation with warfarin. Subsequently, he developed a lumbosacral hematoma. He was treated conservatively and discharged without neurological sequelae. The main cause of the increased concentration of rivaroxaban was believed to be his older age and low body weight. The etiology of the spinal hematoma was suspected to be the migration of intracranial hematoma to the spinal subdural space. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Mechanism of subdural effusion evolves into chronic subdural hematoma: IL-8 inducing neutrophil oxidative burst.

    PubMed

    Tao, Zhiqiang; Lin, Yingying; Hu, Maotong; Ding, Shenghong; Li, Jianwei; Qiu, Yongming

    2016-01-01

    Chronic subdural hematoma (CSDH) is still a mysterious disease. Though great success has been has achieved by neuro-surgery treatment, the origin and development of CSDH remains unknown. Tremendous clinical observations have found the correlation of subdural effusion (SDE) and CSDH. However, systematic elucidation of CSDH's origin and progression is lacking while almost all the current hypothesis only explained partial phenomenon. This hypothesis proposes Interleukin (IL)-8 inducing neutrophil respiratory burst is the crucial impact when SDE evolves into CSDH. IL-8 initially secreted by dural border layer cells, accumulates and the concentration of IL-8 rises in the SDE cavity. Accompanied by the formation of neo-membrane under the dura meninges, IL-8 firstly prompts to establish the neo-vasculature in it, and then attracts lymphocytes aggregation in the neo-membrane. Both the newly recruited lymphocytes and endothelial cells assist the further elevation of local IL-8 concentration. When the IL-8 concentration elevated to a particular level, it attracts neutrophils to the inner wall of neo-vessels and primes them to oxidative burst. Lysosomes and superoxide released by these neutrophils make the fragile neo-capillary became leaky, and subsequently the plasma and blood cells run into SDE. However, as long as the erythrocytes come into the cavity, they shall bind large quantity of IL-8 and decrease IL-8 concentration to a lower level relatively that reduce the neutrophils recruit. When this negative feedback is stagnancy, for example, the SDE space is so large in elder man who is experiencing brain atrophy, the neo-vessels have to release more erythrocytes to bind IL-8, the liquid cavity will expand and the high intracranial pressure symptoms appeared. Our hypothesis holds potential for the proper therapeutic intervention of CSDH. IL-8 antagonist and other anti-inflammation drugs like macrolides antibiotics, glucocorticoid and atorvastatin might be optional to resist

  9. Epidural Hematoma Complication after Rapid Chronic Subdural Hematoma Evacuation: A Case Report

    PubMed Central

    Akpinar, Aykut; Ucler, Necati; Erdogan, Uzay; Yucetas, Cem Seyho

    2015-01-01

    Patient: Male, 41 Final Diagnosis: Healty Symptoms: Headache Medication: — Clinical Procedure: Chronic subdural hematoma Specialty: Neurosurgery Objective: Diagnostic/therapeutic accidents Background: Chronic subdural hematoma generally occurs in the elderly. After chronic subdural hematoma evacuation surgery, the development of epidural hematoma is a very rare entity. Case Report: We report the case of a 41-year-old man with an epidural hematoma complication after chronic subdural hematoma evacuation. Under general anesthesia, the patient underwent a large craniotomy with closed system drainage performed to treat the chronic subdural hematoma. After chronic subdural hematoma evacuation, there was epidural leakage on the following day. Conclusions: Although trauma is the most common risk factor in young CSDH patients, some other predisposing factors may exist. Intracranial hypotension can cause EDH. Craniotomy and drainage surgery can usually resolve the problem. Because of rapid dynamic intracranial changes, epidural leakages can occur. A large craniotomy flap and silicone drainage in the operation area are key safety points for neurosurgeons and hydration is essential. PMID:26147957

  10. Chronic Subdural Hematoma Infected by Propionibacterium Acnes: A Case Report

    PubMed Central

    Yamamoto, Shusuke; Asahi, Takashi; Akioka, Naoki; Kashiwazaki, Daina; Kuwayama, Naoya; Kuroda, Satoshi

    2015-01-01

    We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage. PMID:25759659

  11. The risk factors for recurrence of chronic subdural hematoma.

    PubMed

    Ohba, Shigeo; Kinoshita, Yu; Nakagawa, Toru; Murakami, Hideki

    2013-01-01

    Chronic subdural hematoma (CSDH) is a common disease in the elderly, and the recurrence rate of CSDH is reported to range from 2.3 to 33%. We performed a retrospective review of a number of CSDH cases and the potential factors associated with CSDH recurrence. The patient population comprised 112 men and 65 women with a mean age of 74.7 years. We analyzed the following factors: age, sex, antiplatelet and anticoagulant use, hematoma laterality, hematoma thickness, degree of midline shift and internal architecture of the hematoma in the preoperative CT films, use of irrigation, direction of the drainage tube, width of the subdural space, and degree of midline shift and the presence of a massive subdural air collection in the postoperative CT films. Univariate analysis revealed that there was a trend for different rates of recurrence among the different types of hematomas. The presence of a postoperative massive subdural air collection tended to be associated with the recurrence of hematoma. Multivariate analysis revealed that separated hematomas were significantly associated with CSDH recurrence, whereas the presence of postoperative massive subdural air collection tended to be associated with hematoma recurrence. Neither univariate nor multivariate analysis could demonstrate an association between the direction of the drainage tube and the recurrence of CSDH.

  12. Ruptured Intrasellar Superior Hypophyseal Artery Aneurysm Presenting with Pure Subdural Haematoma

    PubMed Central

    Hornyak, M.; Hillard, V.; Nwagwu, C.; Zablow, B. C.; Murali, R.

    2004-01-01

    Summary Subdural haemorrhage from a ruptured intracranial aneurysm is a well-known entity when associated with subarachnoid haemorrhage. However, haemorrhage confined only to the subdural space is rare because there are limited anatomical sites where extravasation can be purely subdural. We report the rare case of a patient who suffered pure subdural haematoma after the rupture of a left superior hypophyseal artery aneurysm located within the sella turcica. The patient was treated with endovascular coil embolization of the aneurysm. Angiography immediately after treatment and one month later revealed complete obliteration of the aneurysm. Six months after treatment, the patient remained symptom free. PMID:20587264

  13. Zero drift of intraventricular and subdural intracranial pressure monitoring systems.

    PubMed

    Chen, Li; Du, Hang-gen; Yin, Li-chun; He, Min; Zhang, Guo-jun; Tian, Yong; Wang, Cheng; Hao, Bi-lie; Li, Hong-yu

    2013-01-01

    To assess zero drift of intraventricular and subdural intracranial pressure (ICP) monitoring systems. A prospective study was conducted in patients who received Codman ICP monitoring in the neurosurgical department from January 2010 to December 2011. According to the location of sensors, the patients were categorized into two groups: intraventricular group and subdural group. Zero drift between the two groups and its association with the duration of ICP monitor were analyzed. Totally, 22 patients undergoing intraventricular ICP monitoring and 27 receiving subdural ICP monitoring were enrolled. There was no significant difference in duration of ICP monitoring, zero drift value and its absolute value between intraventricular and subdural groups (5.38 d+/-2.58 d vs 4.58 d+/-2.24 d, 0.77 mm Hg+/-2.18 mm Hg vs 1.03 mm Hg+/-2.06 mm Hg, 1.68 mm Hg+/-1.55 mm Hg vs 1.70 mm Hg+/-1.53 mm Hg, respectively; all P larger than 0.05). Absolute value of zero drift in both groups significantly rose with the increased duration of ICP monitoring (P less than 0.05) while zero drift value did not. Moreover, daily absolute value in the intraventricular group was significantly smaller than that in the subdural group (0.27 mm Hg+/-0.32 mm Hg vs 0.29 mm Hg+/-0.18 mm Hg, P less than 0.05). This study demonstrates that absolute value of zero drift significantly correlates with duration of both intraventricular and subdural ICP monitoring. Due to the smaller daily absolute value, ICP values recorded from intraventricular system may be more reliable than those from subdural system.

  14. Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child.

    PubMed

    Glenn, Chad A; Fung, Kar-Ming; Tullos, Hurtis J; McNall-Knapp, Rene Y; Gunda, Divya; Mapstone, Timothy B

    2016-02-01

    Chronic subdural hematoma in the pediatric population often results from trauma. Asymptomatic and benign-appearing subdural collections are generally managed conservatively without operative intervention. Primary intracranial sarcomas are uncommon entities. Diagnosis of sarcoma can be difficult because these lesions often manifest as apparent hematoma. Presented is the case of a primary intracranial mucoid spindle cell sarcoma that arose in a child with a history of benign-appearing bilateral subdural fluid collections in the setting of nonaccidental trauma. The patient was initially managed conservatively because her neurological examination result was normal and her subdural collections decreased in size on repeated imaging. The collections did not resolve completely. Years later, she exhibited weakness, seizure, and an increase in the size of her subdural fluid collection. Subdural drainage was attempted without significant effect. Cytologic assessment of fluid was negative for malignant cells. Magnetic resonance imaging revealed multiple enhancing masses along the subdural collection. The patient eventually underwent craniotomy in which a diagnosis of sarcoma was obtained. Pathological and radiographic findings as well as oncological management are reviewed. The authors also review the natural history and treatment of primary intracranial sarcoma in the pediatric population. Early contrasted magnetic resonance imaging should be obtained in patients with subdural fluid collections that appear asymmetric or do not resolve in the expected time course, despite having a normal neurologic examination result. Negative cytologic assessment does not exclude sarcoma diagnosis. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Bilateral Acute Subdural Hematoma from Ruptured Posterior Communicating Artery Aneurysm

    PubMed Central

    Boujemâa, H.; Góngora-Rivera, F.; Barragán-Campos, H.; Karachi, K.; Chiras, J.; Sourour, N.

    2006-01-01

    Summary Brain tumors, hematological diseases and vascular malformations like fistulas or arteriovenous malformations are the most well known causes of non-traumatic subdural hematoma (SDH) 1. Although spontaneous subdural hematoma from ruptured intracranial aneurysm has been reported 2, SDH with non radiographic evidence of subarachnoid hemorrhage is very rare 3,4. Moreover, a patient with acute and bilateral spontaneous subdural hematoma secondary to ruptured left posterior communicating artery aneurysm has not been reported to date. The clinical findings and etiologic mechanisms are discussed. PMID:20569549

  16. Spectrophotometry of cerebrospinal fluid in subacute and chronic subdural haematomas

    PubMed Central

    Kjellin, K. G.; Steiner, L.

    1974-01-01

    Spectrophotometric examinations were performed on cerebrospinal and subdural fluids in subacute (five patients) and chronic (20 patients) subdural haematomas, with special reference to the diagnostic aid of CSF spectrophotometry. Spectrophotometric xanthochromia of haemorrhagic origin was found in all CSFs examined, while definite visible xanthochromia was observed in only 28% and the CSF was judged as colourless in 52% of those cases. Characteristic bleeding patterns were found spectrophotometrically in all the 20 CSFs examined within 24 hours after lumbar puncture, haematoma patterns being detected in 90-95% of the cases. In many cases the electrophoretically separated protein fractions of CSF and subdural fluids were spectrophotometrically examined. In conclusion, CSF spectrophotometry is a simple, fast, and extremely sensitive method, which in our opinion should be used routinely in the diagnosis of suspected subdural haematomas, if lumbar puncture is not contraindicated. PMID:4140892

  17. Subdural abscess secondary to covert dental sepsis

    PubMed Central

    Sprott, Mae S.; Hall, K.; Newman, P. K.; Welbury, R. R.; Ingham, H. R.

    1981-01-01

    The bacterial flora of a subdural abscess in a 17-year-old male, with radiological evidence of unilateral infection of the maxillary and frontal air sinuses, was typical of that encountered in the dental sulcus. Extensive examination revealed no primary focus of infection other than apical infection in the 2 upper first molar teeth, which were extracted. Treatment with ampicillin, gentamicin and metronidazole rapidly controlled the subdural infection, and resolution, as evidenced by computerized tomography, was complete at 10 months. PMID:7335566

  18. Epidural Hematoma Complication after Rapid Chronic Subdural Hematoma Evacuation: A Case Report.

    PubMed

    Akpinar, Aykut; Ucler, Necati; Erdogan, Uzay; Yucetas, Cem Seyho

    2015-07-06

    Chronic subdural hematoma generally occurs in the elderly. After chronic subdural hematoma evacuation surgery, the development of epidural hematoma is a very rare entity. We report the case of a 41-year-old man with an epidural hematoma complication after chronic subdural hematoma evacuation. Under general anesthesia, the patient underwent a large craniotomy with closed system drainage performed to treat the chronic subdural hematoma. After chronic subdural hematoma evacuation, there was epidural leakage on the following day. Although trauma is the most common risk factor in young CSDH patients, some other predisposing factors may exist. Intracranial hypotension can cause EDH. Craniotomy and drainage surgery can usually resolve the problem. Because of rapid dynamic intracranial changes, epidural leakages can occur. A large craniotomy flap and silicone drainage in the operation area are key safety points for neurosurgeons and hydration is essential.

  19. The Effectiveness of Subdural Drains Using Urokinase after Burr Hole Evacuation of Subacute Subdural Hematoma in Elderly Patients: A Prelimilary Report

    PubMed Central

    Yeo, Chang-Gi; Jeon, Woo-Yeol; Kim, Seong-Ho; Kim, Oh-Lyong

    2016-01-01

    Objective A subdural drain using urokinase after a burr hole hematoma evacuation was performed for subacute subdural hematoma (SASDH), and its effectiveness and safety in elderly patients were evaluated. Methods Between January 2013 and May 2015, subdural drains using urokinase after burr hole hematoma evacuation were performed in 19 elderly patients. The inclusion criteria were as follows: 1) a subdural hematoma occurring between 4 and 20 days after injury; 2) worsening neurological symptoms, from mild to moderate or severe, due to injury during the subacute stage; 3) a mix of solid clots (high-density lighter shadow) and fluid hematoma (low-density darker shadow) on the computed tomography (CT) scan; 4) a score of ≥9 on the Glasgow Coma Scale (GCS) assessed immediately before surgery; and 5) an age of ≥65 years. When the majority of the hematoma was evacuated on the CT, we removed the catheter. Results Under local anesthesia, a catheter was inserted into the hematoma through a burr hole. The mean age of the patients was 73.7 years (range, 65-87 years). The mean preoperative GCS score was 11.2 (range, 10-13), and the mean Glasgow Outcome Scale score for all patients was 5 at discharge. No recurrences of hematomas or surgical complications were observed. Conclusion A subdural drain using urokinase after burr hole hematoma evacuation under local anesthesia is thought to be an effective and safe method of blood clot removal with low morbidity. This surgical method is less invasive for treating elderly patients with SASDH. PMID:27857916

  20. Chronic subdural hematoma preceded by traumatic subdural hygroma.

    PubMed

    Park, Seong-Hyun; Lee, Sun-Ho; Park, Jaechan; Hwang, Jeong-Hyun; Hwang, Sung-Kyoo; Hamm, In-Suk

    2008-08-01

    Patients with traumatic subdural hygroma (SDG) are at an increased risk of developing chronic subdural hematoma (CSDH). However, the mechanism by which this occurs is still not fully understood. The purpose of this paper is to investigate the clinical characteristics and pathogenesis of CSDH, as well as the relationship between CSDH and SDG. We review the pertinent literature and retrospectively examine a series of cases in which CSDH had been preceded by SDG to understand the natural history and developmental mechanisms of these lesions. We discuss the cases of 24 patients in whom CSDH developed from traumatic SDG between 2001 and 2005. Headache was the most common symptom, and the mean Glasgow Coma Scale score was 14.1. Increases in SDG volume were observed in CT scans of 17 patients, and increased density and volume was observed in five patients. The mean interval between the two diseases was 57.6 days, and 13 patients developed new symptoms after the development of CSDH. The most common symptoms at that time were headache and hemiparesis. All patients underwent an operation, which resulted in good recovery in all but one case. The cycle of persistent SDG, rebleeding, coagulation and fibrinolysis contributes to the development of CSDH from SDG. It is important to understand the natural history of CSDH and carefully follow up patients with head injury, especially if it is associated with SDG, and the potential for the development of CSDH should be considered.

  1. An unusual complication of invasive video-EEG monitoring: subelectrode hematoma without subdural component: case report.

    PubMed

    Bozkurt, Gokhan; Ayhan, Selim; Dericioglu, Nese; Saygi, Serap; Akalan, Nejat

    2010-08-01

    The potential complications of the subdural electrode implantation providing identification of the seizure focus and direct stimulation of the cerebral cortex for defining the eloquent cortical areas are epidural and subdural hematoma, cortical contusions, infection, brain edema, raised intracranial pressure, CSF leakage, and venous infarction have been previously reported in the literature. To present the first case of subelectrode hematoma without subdural component that was detected during invasive EEG monitoring after subdural electrode implantation. A 19-year-old female with drug resistant seizures was decided to undergo invasive monitoring with subdural electrodes. While good quality recordings had been initially obtained from all electrodes placed on the right parietal convexity, no cerebral cortical activity could be obtained from one electrode 2 days after the first operation. Explorative surgery revealed a circumscribed subelectrode hematoma without a subdural component. Awareness of the potential complications of subdural electrode implantation and close follow-up of the clinical findings of the patient are of highest value for early detection and successful management.

  2. Subdural hematoma caused by intracranial hypotension after syringosubarachnoid shunting--case report.

    PubMed

    Yamazaki, Tomosato; Yanaka, Kiyoyuki; Uemura, Kazuya; Tsukada, Atsuro

    2004-09-01

    A 32-year-old man developed an extremely rare subdural hematoma after syringosubarachnoid shunting for syringomyelia. He presented with a 4-year history of neck pain and spastic paraparesis resulting from T-7 and T-8 vertebral body fracture suffered in a traffic accident at age 22 years. Magnetic resonance imaging revealed syringomyelia between the craniocervical junction and the T-10 level. The symptoms were slowly progressive, and a syringosubarachnoid shunting was performed. His spasticity improved after surgery, but he developed orthostatic headache 7 days after surgery. Magnetic resonance imaging of the brain demonstrated a thin subdural hematoma over the right cerebral convexity. The subdural hematoma resolved spontaneously within a week with conservative treatment. Vigorous cerebrospinal fluid outflow observed during surgery presumably lowered the pressure in the syrinx cavity, leading to significant but transient intracranial hypotension and consequently the formation of subdural hematoma.

  3. Influence of Postoperative Thrombosis Prophylaxis on the Recurrence of Chronic Subdural Hematoma After Burr-Hole Drainage.

    PubMed

    Licci, Maria; Kamenova, Maria; Guzman, Raphael; Mariani, Luigi; Soleman, Jehuda

    2018-01-01

    Chronic subdural hematoma is a commonly encountered disease in neurosurgic practice, whereas its increasing prevalence is compatible with the ageing population. Recommendations concerning postoperative thrombosis prophylaxis after burr-hole drainage of chronic subdural hematoma are lacking. The aim of this study was to analyze the correlation between recurrence of chronic subdural hematoma and postoperative application of thrombosis prophylaxis. Retrospective, consecutive sample of patients undergoing burr-hole drainage for chronic subdural hematoma over 3 years. Single, academic medical center. All patients undergoing surgical evacuation of a chronic subdural hematoma with burr-hole drainage. Exclusion: patients under the age of 18 years, who presented with an acute subdural hematoma and those who underwent a craniotomy. We compared patients receiving thrombosis prophylaxis treatment after burr-hole drainage of chronic subdural hematoma with those who were not treated. Primary outcome measure was reoperation of chronic subdural hematoma due to recurrence. Secondary outcome measures were thromboembolic and cardiovascular events, hematologic findings, morbidity, and mortality. In addition, a subanalysis comparing recurrence rate dependent on the application time of thrombosis prophylaxis (< 48 vs > 48 hr) was undertaken. Overall recurrence rate of chronic subdural hematoma was 12.7%. Out of the 234 analyzed patients, 135 (57.3%) received postoperative thrombosis prophylaxis (low-molecular-weight heparin) applied subcutaneously. Recurrence of chronic subdural hematoma occurred in the thrombosis prophylaxis group and control group in 12 patients (8.9%) and 17 patients (17.2%), respectively, showing no significant difference (odds ratio, 0.47 [95% CI, 0.21 - 1.04]). A subanalysis comparing recurrence rate of chronic subdural hematoma dependent on the application time of thrombosis prophylaxis (< 48 vs > 48 hr) showed no significant difference either (odds ratio, 2

  4. Spontaneous resolution of traumatic acute subdural haematomas: A systematic review.

    PubMed

    Vital, Roberto Bezerra; Hamamoto Filho, Pedro Tadao; Oliveira, Victor Azevedo de; Romero, Flávio Ramalho; Zanini, Marco Antônio

    2016-01-01

    Traumatic subdural haematomas often require emergency surgical evacuation. Spontaneous resolution of traumatic acute subdural haematomas (TASDH) is under-reported. Two patients are described with spontaneous resolution of TASDH correlating with previous reports. A discussion is presented on the clinical, pathological and radiological features of TASDH. A review of the literature was performed using PubMed (Medline), Embase, and Cochrane Library for similar cases. A total 21 articles were included, involving 27 cases well detailed of TASDH with spontaneous resolution or neurological and radiological improvement in less than 24 h. There are two main mechanisms for the spontaneous resolution of acute subdural haematomas: dilution in subarachnoid space and redistribution of the haematoma in the subdural space. The primary radiological characteristic of these lesions is a hypodense rim on the outer surface of the clot. Spontaneous resolution of TASDH is unusual. Clinical and radiological surveillance is essential for appropriate management of these patients. Copyright © 2015 Sociedad Española de Neurocirugía. Published by Elsevier España. All rights reserved.

  5. Interictal spike detection comparing subdural and depth electrodes during electrocorticography.

    PubMed

    Privitera, M D; Quinlan, J G; Yeh, H S

    1990-11-01

    We compared the ability of subdural and depth electrodes to detect and localize interictal epileptiform discharges (IEDs) in the temporal lobe. Sixteen patients had simultaneous intraoperative recordings with depth and subdural electrodes while undergoing anterior temporal lobe resections under local anesthesia for medically intractable seizures. IEDs that were focal (detected at just 1 or 2 electrode contacts) typically registered at the nearest contact, regardless of type. IEDs that were regional (engaging more than 2 electrode contacts) typically appeared simultaneously at both electrode types. Neither method was better able to indicate whether an IED was mesial or lateral, posterior or anterior. Subdural and depth electrodes seem to provide complementary information on the location of IEDs within the temporal lobe.

  6. Effect of addition of clopidogrel to aspirin on subdural hematoma: meta-analysis of randomized clinical trials.

    PubMed

    Bakheet, Majid F; Pearce, Lesly A; Hart, Robert G

    2015-06-01

    Clopidogrel combined with aspirin is routinely prescribed after coronary artery stenting, in patients with acute coronary syndromes, and recently to prevent stroke in patients with acute minor ischemic stroke and TIA. Subdural hematomas are an important complication of antithrombotic treatment, but the risk associated with clopidogrel plus aspirin has not been previously defined. To quantify the risk of subdural hematoma associated with dual antiplatelet therapy with clopidogrel plus aspirin. Randomized clinical trials comparing clopidogrel plus aspirin with aspirin alone were identified by searching the Cochrane Central Register of Controlled Trials from 1990 to 2014, and restricted to those with more than 7 days of treatment. Two reviewers independently extracted data about subdural hematomas. Of 24 randomized trials testing clopidogrel added to aspirin, results for subdural hematoma were available for 11 trials, of which eight did not identify any subdural hematomas. The three trials reporting subdural hematomas were double-blind and included patients with recent lacunar stroke, acute coronary syndromes or atrial fibrillation with a total of 23,136 patients (mean age 66 years) and reported 39 subdural hematomas during a mean follow-up 2.1 years per patient. Clopidogrel plus aspirin was associated with a significantly increased risk of subdural hematoma compared with aspirin alone (risk ratio 2.0, 95% CI 1.0, 3.8; P = 0.04; fixed effects model; I2 for heterogeneity of 0%, P = 0.51). The average absolute incidence of subdural hematoma averaged 1.1 (95% CI 0.7,1.6) per 1000 patient - years among those assigned clopidogrel plus aspirin in 11 randomized trials. The absolute rate of subdural hematoma during dual antiplatelet therapy is low, averaging 1.1 per 1000 patient-years. Chronic treatment with clopidogrel plus aspirin significantly increases the risk of subdural hematoma compared with aspirin alone. © 2014 World Stroke Organization.

  7. Predicting recurrence after chronic subdural haematoma drainage.

    PubMed

    Jack, Andrew; O'Kelly, Cian; McDougall, Cameron; Findlay, J Max

    2015-01-01

    Recurrence of chronic subdural haematomas (CSDHs) after surgical drainage is a significant problem with rates up to 20%. This study focuses on determining factors predictive of haematoma recurrence and presents a scoring system stratifying recurrence risk for individual patients. Between the years 2005 and 2009, 331 consecutive patients with CSDHs treated with surgery were included in this study. Univariate and multivariate analyses were performed searching for risk factors of increased post-operative haematoma volume and haematoma recurrence requiring repeat drainage. We found a 12% reoperation rate. CSDH septation (seen on computed tomogram scan) was found to be an independent risk factor for recurrence requiring reoperation (p=0.04). Larger post-operative subdural haematoma volume was also significantly associated with requiring a second drainage procedure (p<0.001). Independent risk factors of larger post-operative haematoma volume included septations within a CSDH (p<0.01), increased pre-operative haematoma volume (p<0.01), and a greater amount of parenchymal atrophy (p=0.04). A simple scoring system for quantifying recurrence risk was created and validated based on patient age (< or ≥ 80 years), haematoma volume (< or ≥ 160 cc), and presence of septations within the subdural collection (yes or no). Septations within CSDHs are associated with larger post-operative residual haematoma collections requiring repeat drainage. When septations are clearly visible within a CSDH, craniotomy might be more suitable as a primary procedure as it allows greater access to a septated subdural collection. Our proposed scoring system combining haematoma volume, age, and presence of septations might be useful in identifying patients at higher risk for recurrence.

  8. Acute Intracranial and Spinal Subdural Hematoma Associated with Vardenafil.

    PubMed

    Nakamura, Takaaki; Watanabe, Genya; Harada, Ryuhei; Kawasaki, Emiko; Tsukita, Kenichi; Suzuki, Yasushi

    2018-05-02

    A 28-year-old healthy man was admitted to our hospital because of right-sided headache, vomiting, and lower back pain after the administration of vardenafil. Computed tomography and magnetic resonance imaging of the brain showed a small, right-sided, subdural hematoma. A lumbar magnetic resonance imaging showed a longitudinally extended subdural hematoma. He had no history of trauma. We speculated that vardenafil might have had an association with the bleeding. Several reports have suggested a relationship between phosphodiesterase-5 inhibitors and intracerebral or subarachnoid hemorrhage. Our case suggested that there may also be risks of bleeding into the subdural space. Although headache and nausea are common side effects of vardenafil, hemorrhagic diseases should also be considered when symptoms are severe or prolonged. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  9. Spontaneous delayed brain herniation through a subdural membrane after tumor surgery.

    PubMed

    Van Dycke, Annelies; Okito, Jean-Pierre Kalala; Acou, Marjan; Deblaere, Karel; Hemelsoet, Dimitri; Van Roost, Dirk

    2013-12-01

    We report on a rare case of spontaneous cerebral herniation through a subdural membrane in a 54-year-old patient. Brain herniation in adults as a complication of chronic subdural hematomas shortly after a neurosurgical intervention is rare. We are the first to report a case of delayed local herniation in an adult patient more than 1 year after a neurosurgical procedure. The patient suffered from a low-grade oligodendroglioma since 1993. Radiotherapy was then applied, followed by resective surgery and chemotherapy in 2008 because of tumor progression. Subsequently, he developed a symptomatic subdural hygroma treated with a subduro-atrial cerebrospinal fluid shunt. In January 2010, the shunt was occluded. Follow-up brain imaging showed a stable situation after tumor resection, with a cyst in the temporal resection cavity and a stable subdural hygroma. In February 2011, the patient visited the emergency department because of an acute right hemiparesis and progressive motor aphasia. Urgent magnetic resonance imaging was suspicious of a herniation of brain parenchyma in the left middle cranial fossa. Explorative surgery showed a locally incarcerated brain herniation through a membrane with a ring-like aperture. Resection of this membrane led to normalization of the position of the brain tissue and to clinical improvement. Brain herniation through a subdural membrane is an extremely rare complication, but must be a differential diagnosis in patients with a known chronic subdural hematoma or hygroma and clinical deterioration, even in the absence of recent surgery. Urgent surgical intervention of the herniated brain is recommended to reduce the risk of permanent neurological damage. Georg Thieme Verlag KG Stuttgart · New York.

  10. Delayed chronic intracranial subdural hematoma complicating resection of a tanycytic thoracic ependymoma.

    PubMed

    Maugeri, Rosario; Giugno, Antonella; Graziano, Francesca; Visocchi, Massimiliano; Giller, Cole; Iacopino, Domenico Gerardo

    2016-01-01

    To demonstrate that the diagnosis of an intracranial subdural hematoma should be considered for patients presenting with acute or delayed symptoms of intracranial pathology following resection of a spinal tumor. We present a case of a 57-year-old woman found to have a chronic subdural hematoma 1 month following resection of a thoracic extramedullary ependymoma. Evacuation of the hematoma through a burr hole relieved the presenting symptoms and signs. Resolution of the hematoma was confirmed with a computed tomography (CT) scan. Headache and other symptoms not referable to spinal pathology should be regarded as a warning sign of an intracranial subdural hematoma, and a CT scan of the head should be obtained. The mechanism of the development of the hematoma may be related to the leakage of cerebrospinal fluid with subsequent intracranial hypotension leading to an expanding subdural space and hemorrhage.

  11. Visualization of an actively bleeding cortical vessel into the subdural space by CT angiography.

    PubMed

    Dalfino, John C; Boulos, Alan S

    2010-10-01

    Spontaneous subdural hematomas of arterial origin are rare with only a few published case reports in the literature. In the CT era, vessel imaging of extra-axial hematomas is not commonly performed. In this case report we present a patient with a large, spontaneous acute subdural hematoma that demonstrated active contrast extravasation from a small cortical vessel on CT angiography. During surgical evacuation the vessel was confirmed to be a small cortical artery that was bulging through the arachnoid membrane and bleeding into the subdural space. The historical, radiographic, and clinical aspects of this unusual cause of subdural hematoma are discussed. (c) 2010 Elsevier B.V. All rights reserved.

  12. Symptomatic Acute-on-Chronic Subdural Hematoma: A Clinicopathological Study.

    PubMed

    Castellani, Rudy J; Mojica-Sanchez, Gruschenka; Schwartzbauer, Gary; Hersh, David S

    2017-06-01

    The pathophysiology of acute-on-chronic subdural hematoma (ACSDH) is complex and incompletely understood. Evidence to date indicates that the overall process is initiated by rotational force with movement of the brain inside the skull, which exerts tensile strain and rupture of bridging veins, leading in turn to acute hemorrhage in the subdural potential space. This is followed by the proliferation of mesenchymal elements with angiogenesis and inflammation, which in turn becomes a substrate for repeated hemorrhage and expansion of the lesion. Given the prevalence of traumatic subdural processes in the forensic setting and the importance of proper assessment of timing, etiology, risk factors, and clinicopathological correlation, we studied 47 patients presenting to the University of Maryland Shock Trauma Center, all of whom underwent craniotomy with resection of the outer membrane due to symptomatic ACSDH. The surgically resected tissue was examined for histopathologic features in all cases. Our findings highlight that ACSDH is a condition precipitated by trauma that affects middle-aged and older adults, is relatively indolent, is unilateral or asymmetric, and has a low in-hospital mortality rate. Pathological analysis demonstrates a substantial outer membrane in all cases with varying degrees of inflammation and organization that cannot be precisely dated as a function of clinical presentation. The extrapolation of adult ACSDH to mixed acute and chronic subdural hemorrhage in the pediatric setting is problematic due to substantial differences in clinical presentation, severity of underlying brain injury, gross and microscopic findings, and outcome.

  13. Percutaneous evacuation for treatment of subdural hematoma and outcome in 28 patients.

    PubMed

    Mostofi, Keyvan; Marnet, Dominique

    2011-01-01

    Chronic subdural hematoma is a frequently encountered entity in neurosurgery in particular in elderly patients. There in a high variance in the treatment in literature. We report our experience of percutaneous evacuation of chronic subdural hematoma in 28 patients. From January 2007 to July 2009, 28 patients underwent percutaneous evacuation. 27 of the 28 patients (96.4%) became asymptomatic or improved clinically. Six weeks later, the scan showed the hematoma had completely disappeared in 18 of the cases. We did not have any postoperative infection. Treatment of chronic subdural hematoma using a percutaneous operative technique is a minimally invasive method with sufficient outcome and a therapeutic alternative to the craniotomy.

  14. Drain Insertion in Chronic Subdural Hematoma: An International Survey of Practice.

    PubMed

    Soleman, Jehuda; Kamenova, Maria; Lutz, Katharina; Guzman, Raphael; Fandino, Javier; Mariani, Luigi

    2017-08-01

    To investigate whether, after the publication of grade I evidence that it reduces recurrence rates, the practice of drain insertion after burr-hole drainage of chronic subdural hematoma has changed. Further, we aimed to document various practice modalities concerning the insertion of a drain adopted by neurosurgeons internationally. We administered a survey to neurosurgeons worldwide with questions relating to the surgical treatment of chronic subdural hematoma, with an emphasis on their practices concerning the use of a drain. The preferred surgical technique was burr-hole drainage (89%). Most surgeons prefer to place a drain (80%), whereas in 56% of the cases the reason for not placing a drain was brain expansion after evacuation. Subdural drains are placed by 50% and subperiosteal drains by 27% of the responders, whereas 23% place primarily a subdural drain if possible and otherwise a subperiosteal drain. Three quarters of the responders leave the drain for 48 hours and give prophylactic antibiotic treatment, mostly a single-shot dose intraoperatively (70%). Routine postoperative computed tomography is done by 59% mostly within 24-48 hours after surgery (94%). Adjunct treatment to surgery rarely is used (4%). The publication of grade I evidence in favor of drain use influenced positively this practice worldwide. Some surgeons are still reluctant to insert a drain, especially when the subdural space is narrow after drainage of the hematoma. The insertion of a subperiosteal drain could be a good alternative solution. However, its outcome and efficacy must be evaluated in larger studies. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Postoperative intraspinal subdural collections after pediatric posterior fossa tumor resection: incidence, imaging, and clinical features.

    PubMed

    Harreld, J H; Mohammed, N; Goldsberry, G; Li, X; Li, Y; Boop, F; Patay, Z

    2015-05-01

    Postoperative intraspinal subdural collections in children after posterior fossa tumor resection may temporarily hinder metastasis detection by MR imaging or CSF analysis, potentially impacting therapy. We investigated the incidence, imaging and clinical features, predisposing factors, and time course of these collections after posterior fossa tumor resection. Retrospective review of postoperative spine MRI in 243 children (5.5 ± 4.6 years of age) from our clinical data base postresection of posterior fossa tumors from October 1994 to August 2010 yielded 37 (6.0 ± 4.8 years of age) subjects positive for postoperative intraspinal subdural collections. Their extent and signal properties were recorded for postoperative (37/37), preoperative (15/37), and follow-up spine (35/37) MRI. Risk factors were compared with age-matched internal controls (n = 37, 5.9 ± 4.5 years of age). Associations of histology, hydrocephalus and cerebellar tonsillar herniation, and postoperative intracranial subdural collections with postoperative intraspinal subdural collections were assessed by the Fisher exact test or χ(2) test. The association between preoperative tumor volume and postoperative intraspinal subdural collections was assessed by the Wilcoxon rank sum test. The overall incidence of postoperative intraspinal subdural collections was 37/243 (15.2%), greatest ≤7 days postoperatively (36%); 97% were seen 0-41 days postoperatively (12.9 ± 11.0 days). They were T2 hyperintense and isointense to CSF on T1WI, homogeneously enhanced, and resolved on follow-up MR imaging (35/35). None were symptomatic. They were associated with intracranial subdural collections (P = .0011) and preoperative tonsillar herniation (P = .0228). Postoperative intraspinal subdural collections are infrequent and clinically silent, resolve spontaneously, and have a distinctive appearance. Preoperative tonsillar herniation appears to be a predisposing factor. In this series, repeat MR imaging by 4 weeks

  16. Dating of Early Subdural Haematoma: A Correlative Clinico-Radiological Study

    PubMed Central

    Rao, Murali Gundu; Khandelwal, Niranjan; Sharma, Suresh Kumar

    2016-01-01

    Introduction Determination of post-traumatic interval remains one of the foremost important goals of any forensic investigation related to human crimes. The estimation of time since injury in cases of subdural haemorrhage has been studied only by a few investigators on the histological and radiological front. Aim The purpose of this study was to determine the post-traumatic interval of Subdural Haemorrhage (SDH) based on Hounsfield Unit measurements (HU) on Computed Tomography (CT) in surviving victims of head injury. Materials and Methods The study included a total of 100 cases of closed head injury with subdural haemorrhage. The Post-traumatic Time Interval (PTI) varied from 0.5 hours to a maximum of 249 hours, with a mean of 54.2 hours. Results Statistically significant results were obtained between the HU measurements of the SDH and the post-traumatic intervals and were found to be statistically significant. A rough attempt was made to determine the effect of haematoma volume on attenuation and was found out to be statistically insignificant. Conclusion The density of the subdural haematoma decreases with increase in the post-traumatic interval that concurs with the limited number of studies being conducted in the past. We concluded that further sorting of cases could be done according to its age with additional research and uniformity in the methodology. PMID:27190831

  17. [Retrospective statistical analysis of clinical factors of recurrence in chronic subdural hematoma: correlation between univariate and multivariate analysis].

    PubMed

    Takayama, Motoharu; Terui, Keita; Oiwa, Yoshitsugu

    2012-10-01

    Chronic subdural hematoma is common in elderly individuals and surgical procedures are simple. The recurrence rate of chronic subdural hematoma, however, varies from 9.2 to 26.5% after surgery. The authors studied factors of the recurrence using univariate and multivariate analyses in patients with chronic subdural hematoma We retrospectively reviewed 239 consecutive cases of chronic subdural hematoma who received burr-hole surgery with irrigation and closed-system drainage. We analyzed the relationships between recurrence of chronic subdural hematoma and factors such as sex, age, laterality, bleeding tendency, other complicated diseases, density on CT, volume of the hematoma, residual air in the hematoma cavity, use of artificial cerebrospinal fluid. Twenty-one patients (8.8%) experienced a recurrence of chronic subdural hematoma. Multiple logistic regression found that the recurrence rate was higher in patients with a large volume of the residual air, and was lower in patients using artificial cerebrospinal fluid. No statistical differences were found in bleeding tendency. Techniques to reduce the air in the hematoma cavity are important for good outcome in surgery of chronic subdural hematoma. Also, the use of artificial cerebrospinal fluid reduces recurrence of chronic subdural hematoma. The surgical procedures can be the same for patients with bleeding tendencies.

  18. The minimally invasive endoscopic management of septated chronic subdural hematomas: surgical technique.

    PubMed

    Berhouma, M; Jacquesson, T; Jouanneau, E

    2014-12-01

    Fibrin membranes and compartmentalization within the subdural space are a frequent cause of failure in the treatment of chronic subdural hematomas (CSH). This specific subtype of CSH classically requires craniotomy, which carries significant morbidity and mortality rates, particularly in elderly patients. In this work, we describe a minimally invasive endoscopic alternative. Under local scalp anesthesia, a rigid endoscope is inserted through a parietal burr hole in the subdural space to collapse fibrin septa and cut the internal membrane. It also allows cauterization of active bleedings and the placement of a drain under direct visualization. The endoscopic treatment of septated CSH represents a minimally invasive alternative to craniotomy especially for the internal membranectomy.

  19. Surgical options for treatment of traumatic subdural hematomas in children younger than 2 years of age.

    PubMed

    Melo, José Roberto Tude; Di Rocco, Federico; Bourgeois, Marie; Puget, Stephanie; Blauwblomme, Thomas; Sainte-Rose, Christian; Meyer, Philippe G; Zerah, Michel

    2014-04-01

    Subdural hematoma (SDH) is the most common finding on cranial CT in pediatric victims of abusive head trauma (AHT). The hematomas are commonly bilateral and sometimes associated with interhemispheric hyperdensity and/or convexity hemorrhages. There is no consensus regarding the best surgical treatment in such cases nor are there standardized surgical protocols. The authors report their experience and discuss the routine surgical options in the management of traumatic SDH at a Level 1 Pediatric Trauma Center. In this paper, the authors describe a cross-sectional study with consecutive revision of data described in the medical records of Hôpital Universitaire Necker-Enfants Malades between January 2008 and January 2013. During this period, all children younger than 2 years of age who were admitted with a traumatic SDH identified on CT scans were included in this study. One hundred eighty-four children who had SDH and were younger than 2 years of age were included. Their median age was 5.8 months (range 5 days-23 months), and 70% of the children were male. On admission CT scans, the SDH was bilateral in 52% of cases and homogeneously hypodense in 77%. Neurosurgical treatment was undertaken in 111 children (60%) with an admission Glasgow Coma Scale score of 12 or less, bulging fontanels, or other signs suggestive of intracranial hypertension. The first surgical option was craniotomy in 1.8% (2) of these 111 cases, decompressive craniectomy in 1.8% (2), transcutaneous subdural puncture in 15% (17), external subdural drainage in 16% (18), subdural-subgaleal shunt placement in 17% (19), and subdural-peritoneal shunt placement in 48% (53). In 82% of the children initially treated with transcutaneous subdural puncture and in 50% of those treated with external subdural drainage, increase or persistence of the SDH, CSF or skin infection, or shunt system malfunction was observed and further surgical intervention was required. There was a 26% rate of complications in patients

  20. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia

    PubMed Central

    Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R. Shane

    2017-01-01

    Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation. PMID:28357164

  1. Subdural Thoracolumbar Spine Hematoma after Spinal Anesthesia: A Rare Occurrence and Literature Review of Spinal Hematomas after Spinal Anesthesia.

    PubMed

    Maddali, Prasanthi; Walker, Blake; Fisahn, Christian; Page, Jeni; Diaz, Vicki; Zwillman, Michael E; Oskouian, Rod J; Tubbs, R Shane; Moisi, Marc

    2017-02-16

    Spinal hematomas are a rare but serious complication of spinal epidural anesthesia and are typically seen in the epidural space; however, they have been documented in the subdural space. Spinal subdural hematomas likely exist within a traumatically induced space within the dural border cell layer, rather than an anatomical subdural space. Spinal subdural hematomas present a dangerous clinical situation as they have the potential to cause significant compression of neural elements and can be easily mistaken for spinal epidural hematomas. Ultrasound can be an effective modality to diagnose subdural hematoma when no epidural blood is visualized. We have reviewed the literature and present a full literature review and a case presentation of an 82-year-old male who developed a thoracolumbar spinal subdural hematoma after spinal epidural anesthesia. Anticoagulant therapy is an important predisposing risk factor for spinal epidural hematomas and likely also predispose to spinal subdural hematomas. It is important to consider spinal subdural hematomas in addition to spinal epidural hematomas in patients who develop weakness after spinal epidural anesthesia, especially in patients who have received anticoagulation.

  2. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion.

    PubMed

    Mattei, Tobias A; Rehman, Azeem A; Dinh, Dzung H

    2015-10-01

    Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas.

  3. Acute Spinal Subdural Hematoma after Vertebroplasty: A Case Report Emphasizing the Possible Etiologic Role of Venous Congestion

    PubMed Central

    Mattei, Tobias A.; Rehman, Azeem A.; Dinh, Dzung H.

    2015-01-01

    Study Design Case report and literature review. Objective Spinal subdural hematomas are rare events that often progress with severe neurologic deficits. Although there have been several case reports in the literature of spontaneous spinal subdural hematomas in the setting of anticoagulation, antiplatelet therapy, or coagulation disorders, the exact pathophysiology of such phenomena remains obscure. Methods We present the first report of a subdural hematoma after a percutaneous vertebroplasty and provide a comprehensive review on the anatomy of venous drainage of the vertebral bodies with emphasis on the possible effects of venous congestion caused by cement obstruction. Results Because the subdural hematoma occurred in the absence of major cement extravasation to the spinal canal and two levels above the site of the vertebroplasty, we discuss the possible role of venous congestion as the main etiologic factor leading to rupture of the fragile, valveless radiculomedullary veins into the subdural space. Conclusions The reported case supports a possible new pathophysiological scheme for the development of spinal subdural hematoma in which venous congestion plays a pivotal etiologic role. The reported findings suggests that future anatomical and histologic studies investigating the response of the radiculomedullary veins to congestive venous hypertension may shed new light into the pathophysiology of spinal subdural hematomas. PMID:26430602

  4. 'Subarachnoid cyst' after evacuation of chronic subdural hematoma: Case report of an unusual postoperative morbidity.

    PubMed

    Sharon, Low Y Y; Wai Hoe, N G

    2016-01-01

    Burr-hole drainage of chronic subdural hematomas are routine operative procedures done by neurosurgical residents. Common postoperative complications include acute epidural and/or subdural bleeding, tension pneumocephalus, intracranial hematomas and ischemic cerebral infarction. We report an interesting post-operative complication of a 'subarachnoid cyst' after burr-hole evacuation of a chronic subdural hematoma. The authors hypothesize that the 'cyst' is likely secondary to the splitting of the adjacent neomembrane within its arachnoid-brain interface by iatrogenic irrigation of the subdural space. Over time, this 'cyst' develops into an area of gliosis which eventually causes long-term scar epilepsy in the patient. As far as we are aware, this is the first complication of such a 'subarachnoid cyst' post burr-hole drainage reported in the literature.

  5. Do Age and Anticoagulants Affect the Natural History of Acute Subdural Hematomas?

    PubMed

    Lucke-Wold, Brandon P; Turner, Ryan C; Josiah, Darnell; Knotts, Chelsea; Bhatia, Sanjay

    2016-01-01

    Acute subdural hematoma is a serious complication following traumatic brain injury. Large volume hematomas or those with underlying brain injury can cause mass effect, midline shift, and eventually herniation of the brain. Acute subdural hematomas in the young are associated with high-energy trauma and often have underlying contusions, while acute subdural hematomas in the elderly are associated with minor trauma and an absence of underlying contusions, even though the elderly are more likely to be on anticoagulants or anti-platelet therapy. In the young patients with high impact injuries the hematomas tend to be small and the underlying brain injury and swelling is responsible for the increased intracranial pressure and midline shift. In the elderly, the injuries are low impact (e.g fall from standing), the underlying brain is intact, and the volume of the hematoma itself produces symptoms. In addition the use of anticoagulants and antiplatelet agents in the elderly population has been thought to be a poor prognostic indicator and is considered to be responsible for larger hematomas and poor outcome. When managed conservatively, acute subdural hematomas can sometimes progress to chronic subdural hematoma formation, further enlargement, seizures, and progressive midline shift. Another potential difference in the young and the elderly is brain atrophy, which increases the potential space to accommodate a larger hematoma. It is not known if these two groups differ in other ways that might have implications for treatment or prognosis. In this paper, we investigate the clinical course of 80 patients admitted to our institution with acute subdural hematomas, to identify differences in patients above or below the age of 65 years. The natural progression/resolution of acute subdural hematomas was mapped by measuring volume expansion/regression over time. In this retrospective chart review, we investigated clinical baseline metrics and subsequent volumetric expansion

  6. Do Age and Anticoagulants Affect the Natural History of Acute Subdural Hematomas?

    PubMed Central

    Lucke-Wold, Brandon P.; Turner, Ryan C.; Josiah, Darnell; Knotts, Chelsea; Bhatia, Sanjay

    2016-01-01

    Acute subdural hematoma is a serious complication following traumatic brain injury. Large volume hematomas or those with underlying brain injury can cause mass effect, midline shift, and eventually herniation of the brain. Acute subdural hematomas in the young are associated with high-energy trauma and often have underlying contusions, while acute subdural hematomas in the elderly are associated with minor trauma and an absence of underlying contusions, even though the elderly are more likely to be on anticoagulants or anti-platelet therapy. In the young patients with high impact injuries the hematomas tend to be small and the underlying brain injury and swelling is responsible for the increased intracranial pressure and midline shift. In the elderly, the injuries are low impact (e.g fall from standing), the underlying brain is intact, and the volume of the hematoma itself produces symptoms. In addition the use of anticoagulants and antiplatelet agents in the elderly population has been thought to be a poor prognostic indicator and is considered to be responsible for larger hematomas and poor outcome. When managed conservatively, acute subdural hematomas can sometimes progress to chronic subdural hematoma formation, further enlargement, seizures, and progressive midline shift. Another potential difference in the young and the elderly is brain atrophy, which increases the potential space to accommodate a larger hematoma. It is not known if these two groups differ in other ways that might have implications for treatment or prognosis. In this paper, we investigate the clinical course of 80 patients admitted to our institution with acute subdural hematomas, to identify differences in patients above or below the age of 65 years. The natural progression/resolution of acute subdural hematomas was mapped by measuring volume expansion/regression over time. In this retrospective chart review, we investigated clinical baseline metrics and subsequent volumetric expansion

  7. Chronic Subdural Hematoma: A Questionnaire Survey of Management Practice in India and Review of Literature.

    PubMed

    Avanali, Raghunath; Bhadran, Biju; Krishna Kumar, P; Vijayan, Abhishek; Arun, S; Musthafa, Aneeze M; Panchal, Sunil; Gopal, Vinu V

    2016-12-01

    To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. A questionnaire was prepared for the survey and sent via e-mail to neurosurgeons. It covered the following aspects of managing chronic subdural hematoma: 1) demographic and institutional details; 2) choice of surgical procedure; 3) surgical adjutants such as placing a subdural drain; 4) pre- and postoperative care; and 5) recurrences and management. Responses obtained were entered in a SPSS data sheet and analyzed. Response rate of the survey was 9.3%. The majority of neurosurgeons (75%) preferred to do burr whole drainage for primary chronic subdural hematoma and also for recurrences. Only one third of routinely placed a subdural drain. Considerable practice variations exist for medical and perioperative management. Bedside twist drill drainage, which is effective and less costly than operative room procedures, has not gained popularity in practice. The present survey points towards the importance of making management guidelines for this common neurosurgical entity. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Acute spinal subdural hematoma after vigorous back massage: a case report and review of literature.

    PubMed

    Maste, Praful; Paik, Sang-Hoon; Oh, Jae-Keun; Kim, Yong-Chan; Park, Moon-Soo; Kim, Tae-Hwan; Kwak, Yoon-Hae; Jung, Jae-Kyun; Lee, Ho-Won; Kim, Seok Woo

    2014-12-01

    A case report and review of literature. We report on a patient with traumatic spinal subdural hematoma after vigorous back massage while on vacation. Traumatic spinal subdural hematoma is extremely rare, and to our knowledge, this is the first case reported after violent back massage. We emphasize a high index of suspicion for early recognition and treatment for a good neurological recovery. A 41-year-old male was brought to our hospital with severe back pain, motor and sensory impairments of the bilateral lower extremities, and urinary dysfunction after vigorous back massage. Magnetic resonance images revealed an acute spinal subdural hematoma in the thoracolumbar region. After careful monitoring of his neurological status, the patient was successfully managed with conservative treatment. After 2 weeks of hospitalization, complete motor power recovery was achieved with only minor sensory deficit. At a follow-up of more than 12 months, the patient has no residual neurological deficits. Spinal subdural hematoma secondary to physical trauma is quite rare. This case brings new information that traumatic spinal subdural hematoma can be caused by violent massage. N/A.

  9. Reversible Parkinson-Like Symptoms in Patient with Bilateral Chronic Subdural Hematomas and Cervical Spinal Stenosis.

    PubMed

    Guppy, Kern H; Khandhar, Suketu M; Ochi, Calvin

    2018-01-01

    Gait abnormalities have been seen in patients with Parkinson disease or Parkinson-like (P-L) disorders and cervical spinal stenosis. Acute presentation of P-L symptoms has been reported in 24 cases caused by chronic subdural hematomas with 11 cases due to bilateral chronic subdural hematomas. When a patient also presents with cervical spinal stenosis, the correct therapeutic decision between P-L disorders and myelopathy is challenging. An 80-year-old male presented with a 2-week history of weakness in his left leg. A few days before presentation, his gait had deteriorated quite dramatically. Neurologic examination showed mild leg weakness, hyperreflexia, and a gait that was slow and wide based, at times festinating but with relatively spared arm movement. He also had masked facial features with increased tone in his extremities. Magnetic resonance imaging of the cervical spine showed cervical stenosis at C5-6, and computed tomography of the head showed large bilateral subdural hematomas. The subdural hematomas were drained. Immediate improvement in his symptoms was observed with complete resolution by his third month of follow-up. The patient never had a history of Parkinson disease. This paper reports for the first time a patient who presented with acute P-L symptoms and cervical myelopathy with findings of both bilateral chronic subdural hematomas and cervical spinal stenosis. The decision to drain the subdural hematoma in our case resulted in full recovery of the patient's gait and other extrapyramidal symptoms. This paper reviews the literature on reversible P-L symptoms caused by bilateral chronic subdural hematomas. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. A single center's experience with the bedside subdural evacuating port system: a useful alternative to traditional methods for chronic subdural hematoma evacuation.

    PubMed

    Safain, Mina; Roguski, Marie; Antoniou, Alexander; Schirmer, Clemens M; Schirmer, Clemens S; Malek, Adel M; Riesenburger, Ron

    2013-03-01

    Object The traditional methods for managing symptomatic chronic subdural hematoma (SDH) include evacuation via a bur hole or craniotomy, both with or without drain placement. Because chronic SDH frequently occurs in elderly patients with multiple comorbidities, the bedside approach afforded by the subdural evacuating port system (SEPS) is an attractive alternative method that is performed under local anesthesia and conscious sedation. The goal of this study was to evaluate the radiographic and clinical outcomes of SEPS as compared with traditional methods. Methods A prospectively maintained database of 23 chronic SDHs treated by bur hole or craniotomy and of 23 chronic SDHs treated by SEPS drainage at Tufts Medical Center was compiled, and a retrospective chart review was performed. Information regarding demographics, comorbidities, presenting symptoms, and outcome was collected. The volume of SDH before and after treatment was semiautomatically measured using imaging software. Results There was no significant difference in initial SDH volume (94.5 cm(3) vs 112.6 cm(3), respectively; p = 0.25) or final SDH volume (31.9 cm(3) vs 28.2 cm(3), respectively; p = 0.65) between SEPS drainage and traditional methods. In addition, there was no difference in mortality (4.3% vs 9.1%, respectively; p = 0.61), length of stay (11 days vs 9.1 days, respectively; p = 0.48), or stability of subdural evacuation (94.1% vs 83.3%, respectively; p = 0.60) for the SEPS and traditional groups at an average follow-up of 12 and 15 weeks, respectively. Only 2 of 23 SDHs treated by SEPS required further treatment by bur hole or craniotomy due to inadequate evacuation of subdural blood. Conclusions The SEPS is a safe and effective alternative to traditional methods of evacuation of chronic SDHs and should be considered in patients presenting with a symptomatic chronic SDH.

  11. A prospective randomised study to compare the utility and outcomes of subdural and subperiosteal drains for the treatment of chronic subdural haematoma.

    PubMed

    Kaliaperumal, Chandrasekaran; Khalil, Ayman; Fenton, Eoin; Okafo, Uchenna; Kaar, George; O'Sullivan, Michael; Marks, Charles

    2012-11-01

    The usage of a drain following evacuation of a chronic subdural haematoma (CSDH) is known to reduce recurrence. In this study we aim to compare the clinical outcomes and recurrence rate of utilising two different types of drains (subperiosteal and subdural drain) following drainage of a CSDH. Prospective randomised single-centre study analysing 50 patients who underwent CSDH treatment. Two types of drains, subperiosteal (SPD) and subdural (SDD), were utilised on consecutive alternate patients following burr-hole craniostomy, with a total of 25 patients in each group. The drains were left in for 48-h duration and then removed. The modified Rankin Scale (mRS) was used for outcome measurement at 3 and 6 months. Data analysis was performed by unpaired t test with Welch's correction. It was observed that none of the patients in either group had haematoma recurrence during a 6-month follow-up, and a significant difference in outcome was noted at 6 months (p = 0.0118) more than at 3 months (p = 0.0493) according to the statistical analysis. Postoperative seizure and inadvertent placement of the subdural drain into the brain parenchyma were the two complications noted in this study. Anticoagulant use prior to the surgery did not affect the outcome in either group. We conclude there was no recurrence of CSDH utilising the SDD and SPD following burr-hole craniostomy. The mRS measurement at the 6-month follow-up was found to be statistically significant, with better outcomes with utilisation of the SPD. The SPD may thus prove to be more beneficial than the SDD in the treatment of CSDH. A multi-centre study with a larger group of patients is recommended to reinforce the results from our study.

  12. Anticonvulsants for preventing seizures in patients with chronic subdural haematoma.

    PubMed

    Ratilal, Bernardo O; Pappamikail, Lia; Costa, João; Sampaio, Cristina

    2013-06-06

    Anticonvulsant therapy is sometimes used prophylactically in patients with chronic subdural haematoma, although the benefit is unclear. To assess the effects of prophylactic anticonvulsants in patients with chronic subdural haematoma, in both the pre- and post-operative periods. We searched the Cochrane Injuries Group's Specialised Register, CENTRAL (The Cochrane Library), MEDLINE (OvidSP), EMBASE (OvidSP), PubMed, LILACS, and the databases clinicaltrials.gov, the WHO International Clinical Trials Registry Platform, and Current Controlled Trials. The search was through 27th March 2013. Randomised controlled trials comparing any anticonvulsant versus placebo or no intervention. Three authors screened the search results to identify relevant studies. No studies met the inclusion criteria for the review. No randomised controlled trials were identified. No formal recommendations can be made about the use of prophylactic anticonvulsants in patients with chronic subdural haematoma based on the literature currently available. There are no randomised controlled trials on this topic, and non-controlled studies have conflicting results. There is an urgent need for well-designed randomised controlled trials.

  13. Current diagnosis and treatment of chronic subdural haematomas

    PubMed Central

    Iliescu, IA

    2015-01-01

    A developed society is usually also characterized by an elderly population, which has a continuous percentage growth. This population frequently presents a cumulus of medical pathologies. With the development of the medication and surgical treatment of different affections, the life span has increased and the pathology of an old patient has diversified as far as the cumulus of various pathological diseases in the same person is concerned. Chronic subdural pathologies represent an affection frequently met in neurosurgery practice. Any neurosurgeon, neurologist and not only, has to be aware of the possibility of the existence of a chronic subdural haematoma, especially when the patient is old and is subjected to an anticoagulant or antiaggregant treatment, these 2 causes being by far the etiological factors most frequently met in chronic subdural haematomas. With an adequate diagnosis and treatment, usually surgical, the prognosis is favorable. Although the surgical treatment presents a categorical indication in most of the cases, the fact that there are many surgical techniques, a great relapse rate, as well as the numerous studies, which try to highlight the efficiency of a technique as compared to another, demonstrate that the treatment of these haematomas is far from reaching a consensus among the neurosurgeons. The latest conservatory treatment directions are still being studied and need many years to be confirmed. Abbreviations: CT = computerized tomography, MRI = magnetic resonance imaging PMID:26351527

  14. Hypothermia for Patients Requiring Evacuation of Subdural Hematoma: Effect on Spreading Depolarizations

    DTIC Science & Technology

    2017-10-01

    AWARD NUMBER: W81XWH-16-C-0161 TITLE: Hypothermia for Patients Requiring Evacuation of Subdural Hematoma: Effect on Spreading Depolarizations...4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER W81XWH-16-C-0161 Hypothermia for Patients Requiring Evacuation of Subdural Hematoma: Effect on Spreading...in a sub-study of the HOPES trial to assess the effects of hypothermia on the pathologic mechanism of spreading depolarizations (SD). HOPES is a

  15. Subdural empyema in Africans in Rhodesia.

    PubMed

    Glasauer, F E; Coots, D; Levy, L F; Auchterlonie, W C

    1978-01-01

    Subdural empyema was encountered in 44 African patients in Rhodesia during the period from 1970 to 1974. Subdural empyema seems to be a relatively frequent occurrence in Africans. Sixty-eight per cent of the patients were below the age of 20 years, and males predominated. More than half of the patients had either a history or evidence of an infectious process outside the central nervous system, and about 60% demonstrated focal neurological signs. The diagnosis was confirmed by either surgery or postmortem examination. Cultures of available specimens were positive in 50%. The predominant organisms identified were Streptococcus, followed by Staphylococcus. Surgical treatment consisted mainly of multiple burr holes, drainage of the empyema, and irrigation. The mortality rate in this study was 59%, and some recognizable contributing factors are elaborated. In the discussion the authors compare these observations with pertinent reviews from the literature. Some of these findings correlate well with other reports, whereas other observations are attributed to factors partly inherent in the socio-economic structure of the African population in Rhodesia.

  16. Subarachnoid, subdural and interdural spaces at the clival region: an anatomical study.

    PubMed

    Ayberk, Giyas; Ozveren, Mehmet Faik; Aslan, Sevil; Yaman, Mesut Emre; Yaman, Onur; Kayaci, Selim; Tekdemir, Ibrahim

    2011-01-01

    We aimed to show the significance of the anterior pontine membrane as a determining structure between the subdural and subarachnoid space in the clival region. Five adult cadaver heads and five cerebral hemispheres were used. The skull vault and hemipheres were removed by sectioning through the pontomesencephalic junction. Five other heads hemispheres were removed but the arachnoid membrane was protected and the cerebral side of the clival dura mater was dissected. In another specimen, the dural porus of the abducens nerve was sectioned for histological evaluation. Three cases of hematoma at the clivus were presented to support our findings. The anterior pontine membrane is the arachnoid membrane forming the anterior wall of the prepontine cistern with its lateral extension at the skull base. This membrane forms the subdural and subarachnoid spaces by forming a barrier between the clival dura mater and neurovascular structures of the brainstem. There were rigid fibrous trabeculations between both cerebral and periosteal dural layers forming the basilar plexus as the interdural space in the clivus. The anterior pontine membrane separates the subdural and subarachnoid spaces at the clival region. The hematomas of the clival region require to be evaluated with consideration given to the existance of the subdural space.

  17. [Metastasis of Hepatocellular Carcinoma to the Membrane of Chronic Subdural Hematomas:A Case Report].

    PubMed

    Oshita, Jumpei; Ohba, Shinji; Itou, Yoko; Yonezawa, Koki; Hosogai, Masahiro

    2017-10-01

    An 81-year-old man presented with gait disturbance. Two months previously, he suffered from hepatocellular carcinoma and transarterial chemoembolization was performed. A head computed tomography(CT)scan revealed bilateral chronic subdural hematomas. The patient's gait disturbance was improved after achievement of bilateral burr hole drainage. A head CT two months after treatment revealed no recurrence of the hematomas. However, head CT images obtained four months after treatment revealed an abnormal mass in the right parietal region attached to the internal surface of the skull. The mass was located in the same region from where the chronic subdural hematomas were previously removed via burr hole drainage, and was suspected to have originated from the dura mater. We performed craniotomy and total removal of the mass. The dura mater was intact, and macroscopically, the mass originated from the organized membrane of the chronic subdural hematoma. A pathological examination revealed metastasis of hepatocellular carcinoma to the membrane of the chronic subdural hematomas. Head magnetic resonance imaging(MRI)performed 39 days after craniotomy presented a new lesion in the left parietal region attached to the internal surface of the skull. The patient subsequently died 46 days post-operation. When examining chronic subdural hematomas in cancer patients, histological examination of the dura mater, hematoma, and membrane of the hematoma are important. The possibility of metastasis to the capsule of the hematoma should be considered.

  18. Stripes instability of an oscillating non-Brownian iso-dense suspension of spheres

    NASA Astrophysics Data System (ADS)

    Roht, Y. L.; Ippolito, I.; Hulin, J. P.; Salin, D.; Gauthier, G.

    2018-03-01

    We analyze experimentally the behavior of a non-Brownian, iso-dense suspension of spheres submitted to periodic square wave oscillations of the flow in a Hele-Shaw cell of gap H. We do observe an instability of the initially homogeneous concentration in the form of concentration variation stripes transverse to the flow. The wavelength of these regular spatial structures scales roughly as the gap of the cell and is independent of the particle concentration and of the period of oscillation. This instability requires large enough particle volume fractions φ≥ 0.25 and a gap large enough compared to the sphere diameter (H/d ≥ 8) . Mapping the domain of the existence of this instability in the space of the control parameters shows that it occurs only in a limited range of amplitudes of the fluid displacement. The analysis of the concentration distribution across the gap supports a scenario of particle migration towards the wall followed by an instability due to a particle concentration gradient with a larger concentration at the walls. In order to account for the main features of this stripes instability, we use the theory of longitudinal instability due to normal stresses difference and recent observations of a dependence of the first normal stresses difference on the particle concentration.

  19. ‘Subarachnoid cyst’ after evacuation of chronic subdural hematoma: Case report of an unusual postoperative morbidity

    PubMed Central

    Sharon, Low Y. Y.; Wai Hoe, NG

    2016-01-01

    Burr-hole drainage of chronic subdural hematomas are routine operative procedures done by neurosurgical residents. Common postoperative complications include acute epidural and/or subdural bleeding, tension pneumocephalus, intracranial hematomas and ischemic cerebral infarction. We report an interesting post-operative complication of a ‘subarachnoid cyst’ after burr-hole evacuation of a chronic subdural hematoma. The authors hypothesize that the ‘cyst’ is likely secondary to the splitting of the adjacent neomembrane within its arachnoid-brain interface by iatrogenic irrigation of the subdural space. Over time, this ‘cyst’ develops into an area of gliosis which eventually causes long-term scar epilepsy in the patient. As far as we are aware, this is the first complication of such a ‘subarachnoid cyst’ post burr-hole drainage reported in the literature. PMID:27366276

  20. Refractory diabetes insipidus following drainage of chronic subdural haematoma.

    PubMed

    Won, Yu Deok; Kim, Choong Hyun; Cheong, Jin Hwan; Kim, Jae Min

    2013-01-01

    Post-traumatic diabetes insipidus (DI) is a relatively common complication after head injury. The authors report a fatal case of refractory DI, which developed in a patient with chronic subdural haematoma. A 38-year-old woman presented to the emergency room with a headache for over a week. She was alert and neurological examination demonstrated no significant deficits or external wounds in her head. Brain computed tomography (CT) scans revealed a small amount of chronic subdural haematoma bilaterally. She was treated conservatively and her hospital course was uneventful until she developed a convulsive seizure and mental change on the 3rd day after admission. Immediate follow-up CT scans showed no significant change in the amount of haemorrhage except effacement of gyral marking. Bilateral trephination and drainage of the haematoma were performed immediately. Post-operatively, she developed a refractory DI and was managed in the intensive care unit. However, she died on the 6th day after the operation ultimately. The authors emphasize the importance of timely drainage of chronic subdural haematoma to prevent a fatal endocrinologic complication after head injury. This study also discusses the possible mechanism of DI after head injury, management and review of the pertinent literatures.

  1. A prospective randomized study of use of drain versus no drain after burr-hole evacuation of chronic subdural hematoma.

    PubMed

    Singh, Amit Kumar; Suryanarayanan, Bhaskar; Choudhary, Ajay; Prasad, Akhila; Singh, Sachin; Gupta, Laxmi Narayan

    2014-01-01

    Chronic subdural hematoma (CSDH) recurs after surgical evacuation in 5-30% of patients. Inserting subdural drain might reduce the recurrence rate, but is not commonly practiced. There are few prospective studies to evaluate the effect of subdural drains. A prospective randomized study to investigate the effect of subdural drains in the on recurrence rates and clinical outcome following burr-hole drainage (BHD) of CSDH was undertaken. During the study period, 246 patients with CSDH were assessed for eligibility. Among 200 patients fulfilling the eligibility criteria, 100 each were assigned to "drain group" (drain inserted into the subdural space following BHD) and "without drain group" (subdural drain was not inserted following BHD) using random allocation software. The primary end point was recurrence needing re-drainage up to a period of 6 months from surgery. Recurrence occurred in 9 of 100 patients with a drain, and 26 of 100 patients in without drain group (P = 0.002). The mortality was 5% in patients with drain and 4% in patients without drain group (P = 0.744). The medical and surgical complications were comparable between the two study groups. Use of a subdural drain after burr-hole evacuation of a CSDH reduces the recurrence rate and is not associated with increased complications.

  2. Superficial subarachnoid cerebrospinal fluid space expansion after surgical drainage of chronic subdural hematoma.

    PubMed

    Tosaka, Masahiko; Tsushima, Yoshito; Watanabe, Saiko; Sakamoto, Kazuya; Yodonawa, Masahiko; Kunimine, Hideo; Fujita, Haruyasu; Fujii, Takashi

    2015-07-01

    The present study examined the computed tomography (CT) findings after surgery and overnight drainage for chronic subdural hematoma (CSDH) to clear the significance of inner superficial subarachnoid CSF space and outer subdural hematoma cavity between the brain surface and the inner skull. A total of 73 sides in 60 patients were evaluated. Head CT was performed on the day after surgery and overnight drainage (1st CT), within 3 weeks of surgery (2nd CT), and more than 3 weeks after surgery (3rd CT). Subdural and subarachnoid spaces were identified to focus on density of fluid, shape of air collection, and location of silicone drainage tube, etc. Cases with subdural space larger than the subarachnoid CSF space were classified as Group SD between the brain and the skull. Cases with subarachnoid CSF space larger than the subdural space were classified as Group SA. Cases with extremely thin (<3 mm) spaces between the brain and the skull were classified as Group NS. Group SA, SD, and NS accounted for 31.9, 55.6 and 12.5% of cases on the 1st CT. No statistical differences were found between Groups SA, SD, and NS in any clinical factors, including recurrence. Group SA were found significantly more on 1st CT than on 2nd and 3rd CT. Subarachnoid CSF space sometimes expands between the brain and skull on CT after surgical overnight drainage. Expansion of the arachnoid space may be a passive phenomenon induced by overnight drainage and delayed re-expansion of the brain parenchyma.

  3. Primary Enlarged Craniotomy in Organized Chronic Subdural Hematomas

    PubMed Central

    CALLOVINI, Giorgio Maria; BOLOGNINI, Andrea; CALLOVINI, Gemma; GAMMONE, Vincenzo

    2014-01-01

    The aim of the study is to evaluate the efficacy of craniotomy and membranectomy as initial treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 34 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or contrast computer tomography (CCT) in order to establish the degree of organization and determine the intrahematomal architecture. The indication to perform a primary enlarged craniotomy as initial treatment for non-liquefied chronic subdural hematoma (CSDH) with multilayer loculations was based on the hematoma MRI appearance—mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity. The reason why some hematomas evolve towards a complex and organized architecture remains unclear; the most common aspect to come to light was the “long standing” of the CSDHs which, in our series, had an average interval of 10 weeks between head injury and initial scan. Recurrence was found to have occurred in 2 patients (6% of cases) in the form of acute subdural hematoma. One patient died as the result of an intraventricular and subarachnoid haemorrhage, while 2 patients (6%) suffered an haemorrhagic stroke ipsilateral to the OCSH. Eighty-nine percent of cases had a good recovery, while 11% remained unchanged or worsened. In select cases, based on the MRI appearance, primary enlarged craniotomy seems to be the treatment of choice for achieving a complete recovery and a reduced recurrence rate in OCSH. PMID:24305027

  4. Twist drill craniostomy with closed drainage for chronic subdural haematoma in the elderly: an effective method.

    PubMed

    Ramnarayan, R; Arulmurugan, B; Wilson, Paul M; Nayar, Rani

    2008-09-01

    Chronic subdural haematoma is a disease of the elderly and surgery in these patients carries a much higher risk. The common surgical procedures for chronic subdural haematoma include twist drill craniostomy, burr hole evacuation or craniotomy. The aim of this study was to analyse the results of twist drill craniostomy with drainage in elderly patients with chronic subdural haematoma. Forty-two elderly patients (>65 years) with radiologically proven chronic subdural haematoma were analysed. All the patients underwent twist drill craniostomy and continuous drainage of the haematoma under local anaesthesia and total intravenous anaesthesia (TIVA). There were 24 males and 18 females. Headache and cognitive decline was seen in 50% and weakness of limbs in 60% of patients. CT scan was done in all cases. All patients underwent twist drill 2-3 cm in front of the parietal eminence under local anaesthesia. The drain was left for 24-72 h depending on the drainage. At 1 week, 88% of patients had a good outcome. Twist drill craniostomy with drainage under local anaesthesia is a safe and effective procedure for chronic subdural haematoma in the elderly and could be used as the first and only option in these people.

  5. The value of programmable shunt valves for the management of subdural collections in patients with hydrocephalus.

    PubMed

    Pachatouridis, Dimitrios; Alexiou, George A; Mihos, Evaggelos; Fotakopoulos, George; Voulgaris, Spyridon

    2013-01-01

    The aim of the present study was to assess the value of electromagnetic programmable shunt valves for the treatment of subdural collections. Adult patients with hydrocephalus of various causes that were treated with programmable shunt valves during the last ten years were retrospectively studied. In 127 patients, 139 electromagnetic programmable shunt valves were implanted. A nontraumatic subdural fluid collection was detected in 12 patients. The treatment of these patients consisted of reprogramming of the valve's opening pressure. In 5 patients small subdural hematomas were detected; 4 of these patients were treated by raising the opening pressure alone and one patient required surgical drainage and change of the pressure setting. Traumatic chronic subdural hematomas were detected in 6 patients. These patients were treated by surgical drainage and readjustment of the valve's opening pressure. The ability to treat a shunt-related complication, such as a subdural fluid collection, by reprogramming the valve's opening pressure to a higher setting is an advantage over nonprogrammable valves, and it enables the opening pressure to be slowly lowered once the fluid collection is reabsorbed. Based on our results, we believe that programmable shunt valves should be preferred.

  6. The Value of Programmable Shunt Valves for the Management of Subdural Collections in Patients with Hydrocephalus

    PubMed Central

    Alexiou, George A.; Mihos, Evaggelos; Fotakopoulos, George; Voulgaris, Spyridon

    2013-01-01

    Background. The aim of the present study was to assess the value of electromagnetic programmable shunt valves for the treatment of subdural collections. Methods. Adult patients with hydrocephalus of various causes that were treated with programmable shunt valves during the last ten years were retrospectively studied. In 127 patients, 139 electromagnetic programmable shunt valves were implanted. Results. A nontraumatic subdural fluid collection was detected in 12 patients. The treatment of these patients consisted of reprogramming of the valve's opening pressure. In 5 patients small subdural hematomas were detected; 4 of these patients were treated by raising the opening pressure alone and one patient required surgical drainage and change of the pressure setting. Traumatic chronic subdural hematomas were detected in 6 patients. These patients were treated by surgical drainage and readjustment of the valve's opening pressure. Conclusion. The ability to treat a shunt-related complication, such as a subdural fluid collection, by reprogramming the valve's opening pressure to a higher setting is an advantage over nonprogrammable valves, and it enables the opening pressure to be slowly lowered once the fluid collection is reabsorbed. Based on our results, we believe that programmable shunt valves should be preferred. PMID:24453855

  7. Suprasellar arachnoid cyst after subdural haemorrhage in an infant. A case based update.

    PubMed

    Sonnet, M-H; Joud, A; Marchal, J-C; Klein, O

    2014-01-01

    Brain arachnoid cysts (AC) are congenital or acquired malformations. Their prevalence in children ranges between 0.2 and 2.3% of the studied populations. Few reported studies exist where AC appears after a subdural haemorrhage. We present one case of a symptomatic suprasellar AC after post-traumatic subdural haemorrhage in an infant. After endoscopic ventriculocystostomy, the child quickly improved and the cyst reduced in size. The child was monitored for 22 months and his neurocognitive development remained normal. Our case led us to the hypothesis that the inflammatory process due to subdural haemorrhage may locally result in arachnoiditis, and thus to the creation of a neomembrane, and eventually to cyst formation. This is also the case with the development of post-traumatic spinal AC. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  8. A case of loss of consciousness with contralateral acute subdural haematoma during awake craniotomy

    PubMed Central

    Kamata, Kotoe; Maruyama, Takashi; Nitta, Masayuki; Ozaki, Makoto; Muragaki, Yoshihiro; Okada, Yoshikazu

    2014-01-01

    We are reporting the case of a 56-year-old woman who developed loss of consciousness during awake craniotomy. A thin subdural haematoma in the contralateral side of the craniotomy was identified with intraoperative magnetic resonance imaging and subsequently removed. Our case indicates that contralateral acute subdural haematoma could be a cause of deterioration of the conscious level during awake craniotomy. PMID:25301378

  9. The Pathogenesis of Subacute Subdural Hematoma: A Report of 3 Cases and Literature Review.

    PubMed

    Tao, Zhi-Qiang; Ding, Sheng-Hong; Huang, Jian-Yue; Zhu, Zhi-Gang

    2018-06-01

    To discuss the pathologic mechanism of subacute subdural hematoma (sASDH). Three typical cases of sASDH were reported, and related literature in Chinese published in the past 15 years was reviewed. Intervals from onset of acute subdural hematoma to surgery or symptom deterioration resulting in sASDH were 12.5-15.5 days (mean 14.1 days). Delayed liquefaction of hematoma clots occurred in all 3 reported cases. One patient achieved good curative effect after administration of dexamethasone, and another patient relapsed owing to poor drainage after evacuation of hematoma. The conversion of acute subdural hematoma to sASDH is an inflammatory reaction process with very regular in time, and it is speculated that the pathologic mechanism may be a delayed hypersensitivity reaction. Antigen released during the liquefaction process of blood clot, with subdural neomembrane cells as antigen-presenting cells, is presented to the T lymphocytes released from the capillaries in the neomembrane and forms sensitized T lymphocytes. When the subsequent antigen is released from the blood clots with a delayed liquefaction and is exposed to sensitized T lymphocytes, the delayed hypersensitivity process occurs. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. The efficacy and safety of burr-hole craniotomy without continuous drainage for chronic subdural hematoma and subdural hygroma in children under 2 years of age.

    PubMed

    Matsuo, Kazuya; Akutsu, Nobuyuki; Otsuka, Kunitoshi; Yamamoto, Kazuki; Kawamura, Atsufumi; Nagashima, Tatsuya

    2016-12-01

    Various treatment modalities have been used in the management of chronic subdural hematoma and subdural hygroma (CSDH/SDHy) in children. However, few studies have examined burr-hole craniotomy without continuous drainage in such cases. Here, we retrospectively evaluated the efficacy and safety of burr-hole craniotomy without continuous drainage for CSDH/SDHy in children under 2 years old. We also aimed to determine the predictors of CSDH/SDHy recurrence. We conducted a retrospective chart review of 25 children under 2 years old who underwent burr-hole craniotomy without continuous drainage for CSDH/SDHy at a pediatric teaching hospital over a 10-year period. We analyzed the relationship between CSDH/SDHy recurrence and factors such as abusive head trauma, laterality of CSDH/SDHy, and subdural fluid collection type (hematoma or hygroma). CSDH/SDHy recurred in 5 of the 25 patients (20 %), requiring a second operation at an average of 0.92 ± 1.12 months after the initial procedure. The mean follow-up period was 25.1 ± 28.6 months. There were no complications related to either operation. None of the assessed factors were statistically associated with recurrence. Burr-hole craniotomy without continuous drainage for CSDH/SDHy appears safe in children aged under 2 years and results in a relatively low recurrence rate. No predictors of CSDH/SDHy recurrence were identified. Advantages of this method include avoiding external subdural drainage-related complications. However, burr-hole drainage may be more effective for CSDH, which our data suggests is more likely to recur than SDHy, providing the procedure is performed with specific efforts to reduce complications.

  11. Membranectomy in Chronic Subdural Hematoma: Meta-Analysis.

    PubMed

    Sahyouni, Ronald; Mahboubi, Hossein; Tran, Peter; Roufail, John S; Chen, Jefferson W

    2017-08-01

    Initial management strategies of chronic subdural hematoma (cSDH) are controversial and range from bedside twist-drill or burr-hole drainage to craniotomy with membranectomy (CWM). We aim to 1) perform a meta-analysis of the available data on the outcomes of CWM for treatment of cSDH in published English-language literature and 2) evaluate collective outcomes of CWM with respect to morbidity, mortality, and recurrence rates. A search of English-language literature performed in PubMed, Ovid, and Cochrane databases using key words ("subdural hematoma" or "chronic subdural hematoma") and ("membrane" or "membranectomy") from inception to December 2016 was conducted. Studies reporting outcomes of CWM in cSDH were included. Mortality, morbidity, follow-up duration, and recurrence rate data were extracted and analyzed. Pooled estimates and confidence intervals (CIs) were calculated for all outcomes using a random-effects model. Of 301 articles found, 17 articles containing 5369 patients met our eligibility criteria. Mean follow-up duration ranged from 1-30.8 months. Collective mean mortality and morbidity rates were 3.7% and 6.9%, respectively (95% CI 2-5.4% and 2.1-11.6%; P < 0.001 and P = 0.004). The collective mean recurrence rate was 7.6% (95% CI: 5%-10.2%; P < 0.001). Clinical data on outcomes of CWM in cSDH are limited to single institutional analyses, with considerable variation in recurrence rates and follow-up time. The rates we reported are comparable with the 5% mortality and 3%-12% morbidity rates and lower than the 10%-21% recurrence rate in the literature for burr holes or craniotomy without membranectomy. This meta-analysis provides an in-depth analysis of available data and reviews reported outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Smaller but denser: postmortem changes alter the CT characteristics of subdural hematomas.

    PubMed

    Berger, Nicole; Ebert, Lars C; Ampanozi, Garyfalia; Flach, Patricia M; Gascho, Dominic; Thali, Michael J; Ruder, Thomas D

    2015-03-01

    The aim of this study was to investigate if (1) the volume of subdural hematomas (SDH), midline shift, and CT density of subdural hematomas are altered by postmortem changes and (2) if these changes are dependent on the postmortem interval (PMI). Ante mortem computed tomography (AMCT) of the head was compared to corresponding postmortem CT (PMCT) in 19 adults with SDH. SDH volume, midline shift, and hematoma density were measured on both AMCT and PMCT and their differences assessed using Wilcoxon-Signed Rank Test. Spearman's Rho Test was used to assess significant correlations between the PMI and the alterations of SDH volume, midline shift, and hematoma density. Mean time between last AMCT and PMCT was 109 h, mean PMI was 35 h. On PMCT mean midline displacement was decreased by 57% (p < 0.001); mean SDH volume was decreased by 38% (p < 0.001); and mean hematoma density was increased by 18% (p < 0.001) in comparison to AMCT. There was no correlation between the PMI and the normalization of the midline shift (p = 0.706), the reduction of SDH volume (p = 0.366), or the increase of hematoma density (p = 0.140). This study reveals that normal postmortem changes significantly affect the extent and imaging characteristics of subdural hematoma and may therefore affect the interpretation of these findings on PMCT. Radiologists and forensic pathologists who use PMCT must be aware of these phenomena in order to correctly interpret PMCT findings in cases of subdural hemorrhages.

  13. Clinical evolutional aspects of chronic subdural haematomas – literature review

    PubMed Central

    Iliescu, IA; Constantinescu, AI

    2015-01-01

    Apparently trivial, one of the most frequent pathologies in neurosurgical practice, chronic subdural haematoma, continues to be a challenge for the neurosurgeons both from the therapeutic and postoperatory complications point of view, taking into account that it is frequently met in elders, who usually present a complex pathology. The fact that, by definition, there is a latent period between the moment the brain injury, usually minor, occurs and the appearance of clinical symptomatology, frequently makes the trauma be ignored, this complicating the diagnosis and most of the times delaying the application of the adequate treatment. Developing slowly in time, in weeks or months, the aspect that chronic subdural haematoma usually occurs in elders should not be neglected, its clinical symptomatology often debuting with memory and attention disorders, so that the patient is usually referred to psychiatrists or neurologists, only a paraclinical investigation (CT scan or MRI) being able to establish the diagnosis. Even the appearance of the lateral signs is subjected to many diagnosis confusions because patients deny the existence of a trauma in over 50% of the cases. Abbreviations: CT = computed tomography, MRI = magnetic resonance imaging, CSDH = chronic subdural haematoma, HMW = high molecular weight, F = frontal, T = temporal, P = parietal PMID:26361507

  14. Severe Acute Subdural Hemorrhage in a Patient With Glutaric Aciduria Type I After Minor Head Trauma: A Case Report.

    PubMed

    Zielonka, Matthias; Braun, Katrin; Bengel, Andreas; Seitz, Angelika; Kölker, Stefan; Boy, Nikolas

    2015-07-01

    Glutaric aciduria type I is a rare metabolic disorder caused by deficiency of glutaryl-coenzyme A dehydrogenase. Chronic subdural hematomas have been reported in glutaric aciduria type I and are considered as important differential diagnosis of nonaccidental head trauma. However, chronic subdural hematomas are usually thought to remain clinically silent in these patients. Here we report on a hitherto asymptomatic glutaric aciduria type I patient who developed severe, acute subdural hemorrhage after minor accidental head injury at age 23 months. Computed tomography confirmed significant mass effect on the brain necessitating decompressive hemicraniectomy. Subdural hemorrhage caused large hypoxic lesions of the cerebral cortex and subcortical regions resulting in spastic tetraplegia, dystonia, and loss of developmental milestones. This report emphasizes that acute subdural hemorrhage may be a life-threatening complication in glutaric aciduria type I patients after minor head trauma and should be considered in those patients presenting with neurologic deterioration after accidental head injury. © The Author(s) 2014.

  15. Chronic subdural hematomas treated by burr hole trepanation and a subperiostal drainage system.

    PubMed

    Zumofen, Daniel; Regli, Luca; Levivier, Marc; Krayenbühl, Niklaus

    2009-06-01

    Most symptomatic chronic subdural hematomas are treated by subdural drainage. However, a subperiostal (i.e., extracranial) passive closed-drainage system in combination with double burr hole trepanation is used at our institution. Therefore, we wanted to analyze our results and compare them with the alternate treatment strategies reported in the current literature. In a retrospective single-center study, we analyzed the data of all patients undergoing double burr hole trepanation with a subperiostal passive closed-drainage system. Data analysis included general patient data, complications, postoperative seizure rate, and outcome. One hundred forty-seven patients underwent surgery for 183 symptomatic chronic subdural hematomas. The perioperative mortality rate was 3.4%. Hematoma persistence or recurrence occurred in 13.1% of the cases. The postoperative seizure rate was 6.6%, and the infection rate was 1.6%, including 3 cases of superficial wound infection and 1 case with deep infection. The reintervention rate was 9.3%, including trepanation in 8.2% of the patients and craniotomy in 1.1%. The overall complication rate was 10.9%. Double burr hole trepanation combined with a subperiostal passive closed-drainage system is a technically easy, highly effective, safe, and cost-efficient treatment strategy for symptomatic chronic subdural hematomas. The absence of a drain in direct contact with the hematoma capsule may moderate the risk of postoperative seizure and limit the secondary spread of infection to intracranial compartments.

  16. Acute non-traumatic spinal subdural haematoma: an unusual aetiology.

    PubMed

    Seizeur, Romuald; Ahmed, Seddik Sid; Simon, Alexandre; Besson, Gérard; Forlodou, Pierre

    2009-06-01

    We report an unusual case of a spinal subdural haematoma associated with a ruptured spinal aneurysm. The delayed diagnosis or misdiagnosis of this rare entity can have disastrous consequences. We discuss various possible aetiologies and its association with spinal aneurysms.

  17. Tuberculous brain abscess and subdural empyema in an immunocompetent child: Significance of AFB staining in aspirated pus

    PubMed Central

    Vijayakumar, B.; Sarin, K.; Mohan, Girija

    2012-01-01

    Tuberculous brain abscess and subdural empyema are extremely rare manifestations of central nervous system tuberculosis. Here, we report a case of an 11-year-old immunocompetent child who developed temporal lobe abscess and subdural empyema following chronic otitis media. A right temporal craniotomy was performed and the abscess was excised. The Ziehl Nielsen staining of the aspirated pus from the temporal lobe abscess yielded acid fast bacilli. Prompt administration of antituberculous treatment resulted in complete recovery of the child. Even though the subdural abscess was not drained, we presume that to be of tubercular aetiology. Ours is probably the first case of brain abscess and subdural empyema due to Mycobacterium tuberculosis reported in the same child. This case is being reported because of its rarity and to stress the importance of routine staining for tubercle bacilli in all cases of brain abscess, especially in endemic areas, as it is difficult to differentiate tuberculous from pyogenic abscess clinically as well as histopathologically. PMID:22566728

  18. Tuberculous brain abscess and subdural empyema in an immunocompetent child: Significance of AFB staining in aspirated pus.

    PubMed

    Vijayakumar, B; Sarin, K; Mohan, Girija

    2012-04-01

    Tuberculous brain abscess and subdural empyema are extremely rare manifestations of central nervous system tuberculosis. Here, we report a case of an 11-year-old immunocompetent child who developed temporal lobe abscess and subdural empyema following chronic otitis media. A right temporal craniotomy was performed and the abscess was excised. The Ziehl Nielsen staining of the aspirated pus from the temporal lobe abscess yielded acid fast bacilli. Prompt administration of antituberculous treatment resulted in complete recovery of the child. Even though the subdural abscess was not drained, we presume that to be of tubercular aetiology. Ours is probably the first case of brain abscess and subdural empyema due to Mycobacterium tuberculosis reported in the same child. This case is being reported because of its rarity and to stress the importance of routine staining for tubercle bacilli in all cases of brain abscess, especially in endemic areas, as it is difficult to differentiate tuberculous from pyogenic abscess clinically as well as histopathologically.

  19. Occurrence of subdural hematomas in Dutch glutaric aciduria type 1 patients.

    PubMed

    Vester, Marloes E M; Visser, Gepke; Wijburg, Frits A; van Spronsen, Francjan J; Williams, Monique; van Rijn, Rick R

    2016-07-01

    Patients with glutaric aciduria type 1 (GA1), a rare inherited metabolic disorder, have an increased risk for subdural hematomas (SDHs). GA1 is therefore generally included in the differential diagnosis of children presenting with SDHs. This retrospective cohort study reviews all 25 registered, in the Dutch Diagnosis Registration for Metabolic Disorders, GA1 patients in the Netherlands. This was done between May 2014 and November 2014 to determine the lifetime incidence of SDHs in this population. Seventeen patients were diagnosed either due to clinical symptoms or because of family members with GA1. One out of these 17 had a SDH. This patient showed widened Sylvian fissures on MRI, characteristic for GA1. Eight patients were diagnosed by newborn screening. Three of them had neuroimaging results, and none of them had SDHs. This study shows an overall lower incidence (4.0 %) of SDHs in patients with GA1 than reported in the literature (20-30 %). This finding, in combination with the fact that SDHs in GA1 appear to occur only in the presence of characteristic brain abnormalities on imaging, we recommend that GA1 should not routinely be a part of the differential diagnosis of children with unexplained SDHs in the absence of imaging characteristics suggestive of GA1. • Glutaric aciduria type 1 is a rare metabolic disorder predisposing children to subdural hematoma development due to brain abnormalities. • Because of these subdural hematomas, glutaric aciduria type 1 testing is part of abusive head trauma work-up. What is new: • The overall subdural hematoma incidence in glutaric aciduria type 1 patients is much lower than previously reported and only occurs in case of predisposing brain abnormalities.

  20. A case of acute subdural hematoma due to ruptured aneurysm detected by postmortem angiography.

    PubMed

    Inokuchi, Go; Makino, Yohsuke; Yajima, Daisuke; Motomura, Ayumi; Chiba, Fumiko; Torimitsu, Suguru; Hoshioka, Yumi; Iwase, Hirotaro

    2016-03-01

    Acute subdural hematoma (ASDH) is mostly caused by head trauma, but intrinsic causes also exist such as aneurysm rupture. We describe here a case involving a man in his 70s who was found lying on the bedroom floor by his family. CT performed at the hospital showed ASDH and a forensic autopsy was requested. Postmortem cerebral angiography showed dilatation of the bifurcation of the middle cerebral artery, which coincided with the dilated part of the Sylvian fissure. Extravasation of contrast medium into the subdural hematoma from this site was suggestive of a ruptured aneurysm. Autopsy revealed a fleshy hematoma (total weight 110 g) in the right subdural space and findings of brain herniation. As indicated on angiography, a ruptured saccular aneurysm was confirmed at the bifurcation of the middle cerebral artery. Obvious injuries to the head or face could not be detected on either external or internal examination, and intrinsic ASDH due to a ruptured middle cerebral artery aneurysm was determined as the cause of death. One of the key points of forensic diagnosis is the strict differentiation between intrinsic and extrinsic onset for conditions leading to death. Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases.

  1. History of Chronic Subdural Hematoma

    PubMed Central

    2015-01-01

    Trephination or trepanation is an intentional surgical procedure performed from the Stone Age. It looks like escaping a black evil from the head. This technique is still used for treatment of chronic subdural hematoma (SDH). Now, we know the origin, pathogenesis and natural history of this lesion. The author try to explore the history of trephination and modern discovery of chronic SDH. The author performed a detailed electronic search of PubMed. By the key word of chronic SDH, 2,593 articles were found without language restriction in May 2015. The author reviewed the fact and way, discovering the present knowledge on the chronic SDH. The first authentic report of chronic SDH was that of Wepfer in 1657. Chronic SDH was regarded as a stroke in 17th century. It was changed as an inflammatory disease in 19th century by Virchow, and became a traumatic lesion in 20th century. However, trauma is not necessary in many cases of chronic SDHs. The more important prerequisite is sufficient potential subdural space, degeneration of the brain. Modifying Virchow's description, chronic SDH is sometimes traumatic, but most often caused by severe degeneration of the brain. From Wepfer's first description, nearly 350 years passed to explore the origin, pathogenesis, and fate of chronic SDH. The nature of the black evil in the head of the Stone Age is uncovering by many authors riding the giant's shoulder. Chronic SDH should be categorized as a degenerative lesion instead of a traumatic lesion. PMID:27169062

  2. Importance of frailty evaluation in the prediction of the prognosis of patients with chronic subdural hematoma.

    PubMed

    Shimizu, Kiyoharu; Sadatomo, Takashi; Hara, Takeshi; Onishi, Shumpei; Yuki, Kiyoshi; Kurisu, Kaoru

    2018-05-17

    The present study aimed to clarify the relationship between frailty and prognosis of patients with chronic subdural hematoma. This retrospective study involved 211 patients aged ≥65 years with chronic subdural hematoma, who underwent surgery at Higashihiroshima Medical Center, Hiroshima, Japan, between July 2011 and May 2017. The study outcome was the patient's modified Rankin Scale score at 3 months after surgery. A logistic regression analysis was carried out to analyze factors that influenced the outcome. Chronic subdural hematoma patients with frailty had a poorer prognosis than those without (median modified Rankin Scale: 4 and 2, P < 0.001; proportions of patients discharged to home: 35% and 91%, P < 0.001, respectively). After adjusting for patients' background, the patients' modified Rankin Scale scores at 3 months after surgery were found to be associated with age, controlling nutritional status score and recurrence, but not with frailty. However, receiver operating characteristic curves of the model with the Clinical Frailty Scale were more accurately correlated with prognosis than those of the model without this scale (area under the curve 0.98, 95% confidence interval 0.96-0.99; and 0.87, 95% confidence interval 0.82-0.91, respectively.) CONCLUSIONS: Chronic subdural hematoma patients with frailty had poorer prognosis than those without. The evaluation of the presence of frailty on admission can be an important factor in the prediction of the prognosis of chronic subdural hematoma patients. Geriatr Gerontol Int 2018; ••: ••-••. © 2018 Japan Geriatrics Society.

  3. The role of external drains and peritoneal conduits in the treatment of recurrent chronic subdural hematoma.

    PubMed

    Santarius, Thomas; Qureshi, Hammad U; Sivakumaran, Ram; Kirkpatrick, Peter J; Kirollos, Ramez W; Hutchinson, Peter J

    2010-06-01

    A considerable body of evidence supporting the use of external drainage after evacuation of primary chronic subdural hematoma (CSDH) exists in the literature. However, no systematic study of the value of postoperative drainage in the treatment of recurrent CSDH has been published. The aim of the study was to investigate external drains and subdural-to-peritoneal conduit in the treatment of recurrent CSDH. A retrospective review of cases of CSDH treated in our institution between October 2002 and October 2006 was conducted. During the study period, 408 patients had burr hole evacuation. Sixty-four patients (15.9%) had treatment for recurrence. One patient had craniotomy, and the remaining 63 had another burr hole evacuation: 36 without placement of a drain (BHO), 14 with external drainage (SED), and 13 with placement of subdural-peritoneal catheter (SPC). Fifteen patients (24%) developed a secondary recurrence requiring a third drainage procedure. Postoperative drainage (SED or SPC) was associated with a significantly lower secondary recurrence rate when compared to BHO: 3/27 (11%) versus 12/36 (33%) (χ(2), P=.040). There was no significant difference in recurrence rates between SED and SPC. Postoperative complications included acute subdural hematoma (2), subdural empyema (2), brain edema (2), pneumonia (3), and in-hospital death (2). None of the complications was associated with the use of a specific technique. The results indicate that, as in the treatment of primary CSDHs, the use of drain (SED or SPC) with burr hole evacuation is safe and is associated with lower recurrence rate. Further investigation is needed to clarify the indications of currently available surgical techniques in the treatment of recurrent CSDH. Copyright © 2010 Elsevier Inc. All rights reserved.

  4. Delayed intracranial subdural empyema following burr hole drainage: Case series and literature review.

    PubMed

    Kim, You-Sub; Joo, Sung-Pil; Song, Dong-Jun; Kim, Sung-Hyun; Kim, Tae-Sun

    2018-05-01

    A subdural empyema (SDE) following burr hole drainage of a chronic subdural hematoma (CSDH) can be difficult to distinguish from a recurrence of the CSDH, especially when imaging data is limited to a computed tomography (CT) scan. All patients underwent burr hole drainage of the CSDH at first, and the appearance of the SDE occurred within one month. A contrast-enhanced magnetic resonance imaging (MRI) scan, with diffusion-weighted imaging (DWI), revealed both the SDE and diffuse meningitis in all patients. In Case 1, because the patient was very young, burr hole drainage of the SDE, rather than craniotomy, was performed. However, subsequent craniotomy was required due to recurrence of the SDE. In Cases 2 and 3, an initial craniotomy was performed without burr hole drainage. Symptoms improved for all patients, and each was discharged without any neurologic deficits or subsequent recurrence. Neurosurgeons should consider the possibility of infection if recurrence of CSDH occurs within 1 month following drainage of a subdural hematoma. A contrast-enhanced MRI with DWI should be performed to differentiate SDE from CSDH. In addition, surgical evacuation of the empyema via wide craniotomy is preferred to burr hole drainage.

  5. Cortical gluing and Ringer lactate solution inflation to avoid cortical mantle collapse and subdural fluid collections in pediatric neurosurgery: safety and feasibility.

    PubMed

    Mirone, Giuseppe; Ruggiero, Claudio; Spennato, Pietro; Aliberti, Ferdinando; Trischitta, Vincenzo; Cinalli, Giuseppe

    2015-06-01

    Subdural fluid collections following intraventricular and/or paraventricular procedures in pediatric neurosurgery are common and can be hard to treat. We describe our technique to close cortical defects by the aid of a fibrin adhesive and subsequent Ringer inflation with the aim to avoid cortical mantle collapse and to prevent the development of subdural fluid collections. We report the preliminary results of a prospective study on a consecutive series of 29 children who underwent 37 transcortical or transcallosal surgical procedures since 2008 in our department. In 17 procedures, we performed a transcortical approach on lesions, and in other 19 operations, we operated by a transcallosal. In 5/17 transcortical approaches (29%) and in 3/20 transcallosal approaches (15%), we observed a 5-mm-thick subdural fluid collection of the 5 patients with subdural fluid collections in the transcortical group, 3 patients (17%) underwent surgery for symptomatic or progressive subdural fluid collections. Of the 3 patients in the transcallosal group, a subduro-peritoneal shunt was necessary only for 1 patient (5%). At the very end of the treatment (including chemotherapy and radiotherapy), it was possible to remove the subduro-peritoneal shunt in all these patients because of disappearance of the subdural fluid collections. In pediatric patients after transcortical or transcallosal procedures, the use of a fibrin adhesive to seal surgical opening and subsequent inflation of the residual cavity with Ringer lactate solution to avoid cortical mantle collapse seems safe and appears to prevent the development of subdural fluid collections.

  6. Analysis of Risk Factor for the Development of Chronic Subdural Hematoma in Patients with Traumatic Subdural Hygroma.

    PubMed

    Ahn, Jun Hyong; Jun, Hyo Sub; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho; Chang, In Bok

    2016-11-01

    Although a high incidence of chronic subdural hematoma (CSDH) following traumatic subdural hygroma (SDG) has been reported, no study has evaluated risk factors for the development of CSDH. Therefore, we analyzed the risk factors contributing to formation of CSDH in patients with traumatic SDG. We retrospectively reviewed patients admitted to Hallym University Hospital with traumatic head injury from January 2004 through December 2013. A total of 45 patients with these injuries in which traumatic SDG developed during the follow-up period were analyzed. All patients were divided into two groups based on the development of CSDH, and the associations between the development of CSDH and independent variables were investigated. Thirty-one patients suffered from bilateral SDG, whereas 14 had unilateral SDG. Follow-up computed tomography scans revealed regression of SDG in 25 of 45 patients (55.6%), but the remaining 20 patients (44.4%) suffered from transition to CSDH. Eight patients developed bilateral CSDH, and 12 patients developed unilateral CSDH. Hemorrhage-free survival rates were significantly lower in the male and bilateral SDG group (log-rank test; p =0.043 and p =0.013, respectively). Binary logistic regression analysis revealed male (OR, 7.68; 95% CI 1.18-49.78; p =0.033) and bilateral SDG (OR, 8.04; 95% CI 1.41-45.7; p =0.019) were significant risk factors for development of CSDH. The potential to evolve into CSDH should be considered in patients with traumatic SDG, particularly male patients with bilateral SDG.

  7. Rapid spontaneous resolution of acute subdural haematoma in a patient with chronic alcoholism.

    PubMed

    Hadjigeorgiou, Georgios; Chamilos, Christos; Petsanas, Adamantios; Vranos, Georgios; Foteas, Pavlos; Spiridakis, Filokypros

    2012-06-01

    Acute subdural haematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery. There are only several reports that show the rapid disappearance of ASDH without surgical intervention. We report a case of a 64-year-old alcoholic man who had a traumatic subdural haematoma after a fall from a height of about eight meters on level ground. The computed tomography (CT) of the brain on admission demonstrated a left parietooccipital ASDH. A follow-up CT scan after 8 hours showed resolution of the hematoma. The patient was discharged 9 days later with no neurological deficit. We discuss the possible mechanisms of the rapid resolution of the ASDH.

  8. Traumatic acute subdural hematoma localized on the superior surface of the tentorium cerebelli--two case reports.

    PubMed

    Matsumoto, K; Houri, T; Yamaki, T; Ueda, S

    1996-06-01

    An 8-year-old boy, who fell downstairs and struck his head, and a 62-year-old female, who hit her head in the automobile accident, presented with unusual traumatic acute subdural hematoma localized on the superior surface of the tentorium cerebelli. Magnetic resonance imaging was useful for determination of the anatomical location of the hematoma, and confirmation of absence of significant parenchymal contusion. Injury of the variant bridging vein possibly caused subdural hematoma over the tentorium.

  9. Predicting Factors of Chronic Subdural Hematoma Following Surgical Clipping in Unruptured and Ruptured Intracranial Aneurysm.

    PubMed

    Kwon, Min-Yong; Kim, Chang-Hyun; Lee, Chang-Young

    2016-09-01

    The aim of this study is to analyze the differences in the incidence, predicting factors, and clinical course of chronic subdural hematoma (CSDH) following surgical clipping between unruptured (UIA) and ruptured intracranial aneurysm (RIA). We conducted a retrospective analysis of 752 patients (UIA : 368 and RIA : 384) who underwent surgical clipping during 8 years. The incidence and predicting factors of CSDH development in the UIA and RIA were compared according to medical records and radiological data. The incidence of postoperative CSDH was higher in the UIA (10.9%) than in the RIA (3.1%) (p=0.000). In multivariate analysis, a high Hounsfield (HF) unit (blood clots) for subdural fluid collection (SFC), persistence of SFC ≥5 mm and male sex in the UIA and A high HF unit for SFC and SFC ≥5 mm without progression to hydrocephalus in the RIA were identified as the independent predicting factors for CSDH development (p<0.05). There were differences in the incidence and predicting factors for CSDH following surgical clipping between UIA and RIA. Blood clots in the subdural space and persistence of SFC ≥5 mm were predicting factors in both UIA and RIA. However, progression to hydrocephalus may have in part contributed to low CSDH development in the RIA. We suggest that cleaning of blood clots in the subdural space and efforts to minimize SFC ≥5 mm at the end of surgery is helpful to prevent CSDH following aneurysmal clipping.

  10. A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a Pourfour du Petit syndrome and review of the literature.

    PubMed

    Balik, Vladimir; Kolembus, Petr; Svajdler, Marian; Sulla, Igor; Vaverka, Miroslav; Hrabalek, Lumir

    2013-07-01

    This report illustrates the rare rapid spontaneous redistribution of an acute intracranial supratentorial subdural hematoma (AISSDH) to the entire spinal subdural space (SSS). The study is also unique in that the spinal subdural hematoma (SSH) manifested by the extremely rare Pourfour du Petit Syndrome (PPS). A 66-year-old man sustained blunt head trauma. On admission to the regional hospital, he scored 6 on GCS and his pupils were of equal size reacting to light. Initial computed tomography (CT) scan showed a unilateral AISSDH. The patient was referred to our department and arrived 16 h following the accident, at which time a repeat CT scan revealed almost complete resolution of the AISSDH without clinical improvement. On the 9th postinjury day transient anisocoria and tachycardia without spinal symptomatology developed. Since neither neurological examination nor follow-up CT scans showed intracranial pathology explaining the anisocoria, the patient was treated further conservatively. During the next 3 days circulatory instability developed and the patient succumbed to primary traumatic injury. Autopsy revealed a SSH occupying the entire SSS. This case calls attention to the unique combination of the displacement of an AISSDH to the SSS and the presentation of this clinical entity by the PPS. Copyright © 2012 Elsevier B.V. All rights reserved.

  11. Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study)

    PubMed Central

    Chih, Adrian Ng Wei; Hieng, Albert Wong Sii; Rahman, Noor Azman A.; Abdullah, Jafri Malin

    2017-01-01

    Introduction Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. Materials and Methods The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Results Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, post-operative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Conclusions Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH. PMID:28381926

  12. Subperiosteal Drainage versus Subdural Drainage in the management of Chronic Subdural Hematoma (A Comparative Study).

    PubMed

    Chih, Adrian Ng Wei; Hieng, Albert Wong Sii; Rahman, Noor Azman A; Abdullah, Jafri Malin

    2017-03-01

    Symptomatic chronic subdural hematomas (CSDH) remain one of the most frequent diagnoses in current neurosurgical practice. Burr-hole craniostomy with irrigation and placement of close-system drainage is the current recommended surgery for symptomatic CSDH. The aim of this study is to perform a direct comparison between two surgical techniques in the treatment of symptomatic CSDH, which have been proven in previous studies to be efficient. Our main objective was to compare the efficacy of placement of a subperiosteal drain (SPD) and a subdural drain (SDD) following single burr-hole craniostomy and irrigation, and to demonstrate any significant differences in terms of overall surgical complications, functional outcome at three months and mortality rate. The study was carried out in two local neurosurgical centres. The SPD group was performed in Hospital Umum Sarawak (HUS) and the SDD group was performed in Hospital Sultanah Aminah Johor Bahru (HSAJB), from 1 January 2012 till 30 January 2014 with a total of 30 patients in both treatment groups. Overall, there were no statistically significant difference in terms of patient general characteristics, pre-operative and post-operative symptoms, Markwalder grades, post-operative hematoma volume and recurrence, mortality and functional outcome at discharge and at three month follow-up between both groups. Albeit not achieving statistical significance, we observed a lower rate of surgical complication especially for post-operative intracranial hematoma with placement of the SPD system. Our study concludes that both treatment methods proved to be highly effective in the treatment of CSDH. However, with a lower overall surgical complication rate, treatment with single burr-hole craniostomy, irrigation and placement of the SPD system can be considered a treatment of choice for the management of symptomatic CSDH.

  13. Analysis of Risk Factor for the Development of Chronic Subdural Hematoma in Patients with Traumatic Subdural Hygroma

    PubMed Central

    Ahn, Jun Hyong; Jun, Hyo Sub; Kim, Ji Hee; Oh, Jae Keun; Song, Joon Ho

    2016-01-01

    Objective Although a high incidence of chronic subdural hematoma (CSDH) following traumatic subdural hygroma (SDG) has been reported, no study has evaluated risk factors for the development of CSDH. Therefore, we analyzed the risk factors contributing to formation of CSDH in patients with traumatic SDG. Methods We retrospectively reviewed patients admitted to Hallym University Hospital with traumatic head injury from January 2004 through December 2013. A total of 45 patients with these injuries in which traumatic SDG developed during the follow-up period were analyzed. All patients were divided into two groups based on the development of CSDH, and the associations between the development of CSDH and independent variables were investigated. Results Thirty-one patients suffered from bilateral SDG, whereas 14 had unilateral SDG. Follow-up computed tomography scans revealed regression of SDG in 25 of 45 patients (55.6%), but the remaining 20 patients (44.4%) suffered from transition to CSDH. Eight patients developed bilateral CSDH, and 12 patients developed unilateral CSDH. Hemorrhage-free survival rates were significantly lower in the male and bilateral SDG group (log-rank test; p=0.043 and p=0.013, respectively). Binary logistic regression analysis revealed male (OR, 7.68; 95% CI 1.18–49.78; p=0.033) and bilateral SDG (OR, 8.04; 95% CI 1.41–45.7; p=0.019) were significant risk factors for development of CSDH. Conclusion The potential to evolve into CSDH should be considered in patients with traumatic SDG, particularly male patients with bilateral SDG. PMID:27847577

  14. Spontaneous acute subdural hematoma: A rare presentation of a dural intracranial fistula.

    PubMed

    de Aguiar, Guilherme Brasileiro; Veiga, José Carlos Esteves; Silva, João Miguel de Almeida; Conti, Mario Luiz Marques

    2016-03-01

    Dural arteriovenous fistulas are acquired lesions between the meningeal arteries and their associated draining veins. They may have highly variable clinical presentations and evolution, from severe neurological deficit to no or trivial symptoms. Intracranial hemorrhage occurs in less than 24% of all dural fistulas, and the bleeding is usually subarachnoid, more infrequently intracerebral, and rarely in the subdural space. Here, we present a rare case of a patient who presented with a subdural spontaneous hemorrhage. After investigation by cerebral angiography, the diagnosis of a dural arteriovenous fistula was made. The patient underwent uneventful endovascular treatment. As there are with only a few reports in the literature of such a presentation, we present this patient and perform a brief review of the literature. Copyright © 2015 Elsevier Ltd. All rights reserved.

  15. Evidence based diagnosis and management of chronic subdural hematoma: A review of the literature.

    PubMed

    Mehta, Vikram; Harward, Stephen C; Sankey, Eric W; Nayar, Gautam; Codd, Patrick J

    2018-04-01

    Chronic subdural hematomas are encapsulated blood collections within the dural border cells with characteristic outer "neomembranes". Affected patients are more often male and typically above the age of 70. Imaging shows crescentic layering of fluid in the subdural space on a non-contrast computed tomography (CT) scan, best appreciated on sagittal or coronal reformats. Initial medical management involves reversing anticoagulant/antiplatelet therapies, and often initiation of anti-epileptic drugs (AEDs). Operative interventions, such as twist-drill craniostomy (TDC), burr-hole craniostomy (BHC), and craniotomy are indicated if imaging implies compression (maximum fluid collection thickness >1 cm) or the patient is symptomatic. The effectiveness of various surgical techniques remains poorly characterized, with sparse level 1 evidence, variable outcome measures, and various surgical techniques. Postoperatively, subdural drains can decrease recurrence and sequential compression devices can decrease embolic complications, while measures such as early mobilization and re-initiation of anticoagulation need further study. Non-operative management, including steroid therapy, etizolam, tranexamic acid, and angiotensin converting enzyme inhibitors (ACEI) also remain poorly studied. Recurrent hemorrhages are a major complication affecting around 10-20% of patients, and therefore close follow-up is essential. Copyright © 2018 Elsevier Ltd. All rights reserved.

  16. Empyema of preexisting subdural hemorrhage caused by a rare salmonella species after exposure to bearded dragons in a foster home.

    PubMed

    Tabarani, Christy M; Bennett, Nicholas J; Kiska, Deanna L; Riddell, Scott W; Botash, Ann S; Domachowske, Joseph B

    2010-02-01

    An infant had a subdural empyema caused by the rare Salmonella species enterica subspecies houtenae (IV) serotype 44:z4,z23:- after only indirect exposure to exotic reptiles in her foster home. Infants recovering from preexisting subdural hematoma are at risk for development of empyema. Copyright 2010 Mosby, Inc. All rights reserved.

  17. Subdural hemorrhage: A unique case involving secondary vitamin K deficiency bleeding due to biliary atresia.

    PubMed

    Miyao, Masashi; Abiru, Hitoshi; Ozeki, Munetaka; Kotani, Hirokazu; Tsuruyama, Tatsuaki; Kobayashi, Naho; Omae, Tadaki; Osamura, Toshio; Tamaki, Keiji

    2012-09-10

    Extrahepatic biliary atresia (EHBA) is a rare disease characterized by progressive and obliterative cholangiopathy in infants and is one of the major causes of secondary vitamin K deficiency bleeding (VKDB) due to cholestasis-induced fat malabsorption. Breast feeding increases the tendency of bleeding in EHBA patients because breast milk contains low amounts of vitamin K. A 2-month-old female infant unexpectedly died, with symptoms of vomiting and jaundice prior to death. She had been born by uncomplicated vaginal delivery and exhibited normal growth and development with breastfeeding. There was no history of trauma. She received vitamin K prophylaxis orally. In an emergency hospital, a CT scan showed a right intracranial hematoma and mass effect with midline shift to the left. In the postmortem examination, severe atresia was observed in the whole extrahepatic bile duct. Histologically, cholestasis, periductal fibrosis, and distorted bile ductules were noted. The gallbladder was not identified. A subdural hematoma and cerebellar tonsillar herniation were found; however, no traumatic injury in any part of the body was observed. Together, these findings suggest that the subdural hemorrhage was caused by secondary vitamin K deficiency resulting from a combination of cholestasis-induced fat malabsorption and breastfeeding. Subdural hemorrhage by secondary VKDB sometimes occurs even when vitamin K prophylaxis is continued. This case demonstrated that intrinsic factors, such as secondary VKDB (e.g., EHBA, neonatal hepatitis, chronic diarrhea), should also be considered in infant autopsy cases presenting with subdural hemorrhage. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

  18. Predicting Factors of Chronic Subdural Hematoma Following Surgical Clipping in Unruptured and Ruptured Intracranial Aneurysm

    PubMed Central

    Kwon, Min-Yong; Kim, Chang-Hyun

    2016-01-01

    Objective The aim of this study is to analyze the differences in the incidence, predicting factors, and clinical course of chronic subdural hematoma (CSDH) following surgical clipping between unruptured (UIA) and ruptured intracranial aneurysm (RIA). Methods We conducted a retrospective analysis of 752 patients (UIA : 368 and RIA : 384) who underwent surgical clipping during 8 years. The incidence and predicting factors of CSDH development in the UIA and RIA were compared according to medical records and radiological data. Results The incidence of postoperative CSDH was higher in the UIA (10.9%) than in the RIA (3.1%) (p=0.000). In multivariate analysis, a high Hounsfield (HF) unit (blood clots) for subdural fluid collection (SFC), persistence of SFC ≥5 mm and male sex in the UIA and A high HF unit for SFC and SFC ≥5 mm without progression to hydrocephalus in the RIA were identified as the independent predicting factors for CSDH development (p<0.05). Conclusion There were differences in the incidence and predicting factors for CSDH following surgical clipping between UIA and RIA. Blood clots in the subdural space and persistence of SFC ≥5 mm were predicting factors in both UIA and RIA. However, progression to hydrocephalus may have in part contributed to low CSDH development in the RIA. We suggest that cleaning of blood clots in the subdural space and efforts to minimize SFC ≥5 mm at the end of surgery is helpful to prevent CSDH following aneurysmal clipping. PMID:27651863

  19. Boxing sparring complicated by an acute subdural haematoma and brainstem haemorrhage.

    PubMed

    Hart, Michael G; Trivedi, Rikin A; Hutchinson, Peter J

    2012-10-01

    A professional boxer developed an acute subdural haematoma after boxing sparring. Despite timely surgical decompression, he had a poor overall outcome predominantly from a delayed brainstem haematoma. Magnetic resonance imaging (MRI) was used to elucidate the pathophysiology of the patients' injury and clinical condition.

  20. Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion.

    PubMed

    Wang, Xianshu; Zhang, Xiaoru; Cao, Hongbin; Jing, Shiyuan; Yang, Zhiguo; Cheng, Zhenghai; Liu, Ye; Li, Xin; Gao, Feifei; Ji, Yuanqi

    2015-10-20

    Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. Patients who had PM complicated by SE in the Children's Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases.

  1. Surgical Treatments for Infantile Purulent Meningitis Complicated by Subdural Effusion

    PubMed Central

    Wang, Xianshu; Zhang, Xiaoru; Cao, Hongbin; Jing, Shiyuan; Yang, Zhiguo; Cheng, Zhenghai; Liu, Ye; Li, Xin; Gao, Feifei; Ji, Yuanqi

    2015-01-01

    Background Infantile purulent meningitis (PM) is a commonly severe intracranial infectious disease in infants under age 1 year. In recent years, several diagnostic and treatment methods were reported, but in these cases the neurological complications and sequel were often observed, among which subdural effusion (SE) is the most common complication in PM. Timely diagnosis and early intervention are vital for better outcomes. In this study, the surgical treatments for infantile PM complicated by SE were investigated. Material/Methods Patients who had PM complicated by SE in the Children’s Hospital of Hebei Province from June 2000 to June 2012 were retrospectively analyzed and 170 patients were enrolled in the study. Surgical treatment for each patient was adopted according to producing effusion time, leucocyte count, protein content, intracranial pressure, and bacteria culture, coupled with cranial ultrasound examination, CT, and MRI scans. Results Nearly, 15 patients were cured using serial taps, with a 50% cure rate. Seventeen out of 30 (56.6%) patients receiving subcutaneous reservoir drainage had better outcome. Nearly 80% of patients (55/69) who underwent minimally invasive trepanation and drainage were positive. Surgical procedure of minimally invasive trepanation and drainage combined with drug douche was effective in 63% of patients (19/30). In addition, 6 patients were cured with subdural-peritoneal shunt. Only 1 patient died, after the recurrence of meningitis, and the remaining 4 patients were cured by craniotomy. Conclusions For infantile PM complicated with SE, treatment needs be chosen according to the specific situation. Surgical procedure of minimally invasive trepanation and drainage is a very effective treatment in curing PM complicated by SE. The treatment was highly effective with the use of drug douche. Subdural-peritoneal shunt and craniotomy were as effective as in refractory cases. PMID:26482715

  2. Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: case report.

    PubMed

    Wong, Sui To; Yuen, Ming Keung; Fok, Kam Fuk; Yuen, Shing Chau; Yam, Kwong Yui; Fong, Dawson

    2009-01-01

    Rapid spontaneous resolution of posttraumatic intracranial ASDH has been reported in the literature since 1986. We report a case to demonstrate that redistribution of hematoma to the spinal subdural space is a mechanism for the rapid spontaneous resolution of posttraumatic intracranial ASDH. A 73-year-old woman with a slipped-and-fell injury had a worst GCS score of 8/15. Computerized tomography of the brain demonstrated a large intracranial ASDH with mass effect. Conservative management was decided because of her poor premorbid general condition. Rapid clinical improvement was observed within 5 hours after the CT. Progress CT of the brain at 45 hours postinjury showed that the size of the intracranial ASDH was markedly diminished. The CT findings apparently demonstrated a caudal distribution of the intracranial ASDH over the tentorium and then into the posterior fossa. To investigate this further, an MRI of the spine was performed, which showed that there was spinal SDH in the cervical and thoracic spine. This is the first report demonstrating that redistribution of posttraumatic intracranial ASDH to the spinal subdural space is one of the mechanisms behind the rapid spontaneous resolution of posttraumatic intracranial ASDH in the acute phase.

  3. Lumbar subdural cerebrospinal fluid collection with acute cauda equina syndrome after posterior fossa decompression for Chiari malformation Type I: case report.

    PubMed

    Darwish, Houssein A; Oldfield, Edward H

    2016-09-01

    This report describes the circumstances of a patient with a cauda equina syndrome due to the development of a lumbar subdural CSF collection with ventral displacement of the cauda equina shortly following posterior fossa decompression for Chiari malformation Type I (CM-I). This unusual, but clinically significant, complication was successfully treated with percutaneous drainage of the extraarachnoid CSF collection. Although there are a few cases of intracranial subdural hygroma developing after surgery for CM-I, often attributed to a pinhole opening in the arachnoid, as far as the authors can determine, a spinal subdural hygroma associated with surgery for CM-I has not been recognized.

  4. Nontraumatic spinal subdural hematoma complicating direct factor Xa inhibitor treatment (rivaroxaban): a challenging management.

    PubMed

    Dargazanli, Cyril; Lonjon, Nicolas; Gras-Combe, Guillaume

    2016-05-01

    We report on a 72-year-old male patient who developed a nontraumatic spinal subdural hematoma (SSDH) during rivaroxaban therapy, a relatively new orally administered direct factor Xa inhibitor. The patient sustained a sudden onset of interscapular pain, followed by gait impairment and paraplegia. Magnetic resonance imaging (MRI) of the spine demonstrated SSDH from T6 to T8. Laboratory tests revealed a high rivaroxaban level, associated with a major hemorrhagic risk. Surgery was, therefore, performed the following morning, after normalization of coagulation parameters. Determining the time of safe surgery remains challenging when hemorrhagic complications happen with direct factor Xa inhibitor, especially when neurological prognosis is engaged. Spinal subdural hematoma has not previously been reported following rivaroxaban therapy.

  5. Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction.

    PubMed

    Cariati, Paolo; Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-10-01

    Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words: Meningitis, subdural empyema, odontogenic infections.

  6. Meningitis and subdural empyema as complication of pterygomandibular space abscess upon tooth extraction

    PubMed Central

    Cabello-Serrano, Almudena; Monsalve-Iglesias, Fernando; Roman-Ramos, Maria; Garcia-Medina, Blas

    2016-01-01

    Complication of dental infections might be various and heterogeneous. The most common complications are represented by maxilar celulitis, canine space celulitis, infratemporal space celulitis, temporal celulitis and bacteremia. Among rarest complications we found: sepsis, bacterial endocarditis, mediastinitis, intracranial complications, osteomyelitis, etc. Although dental infections are often considered trivial entities, sometimes they can reach an impressive gravity. In this regard, the present study describes a case of dental infection complicated by meningitis, subdural empiema and cerebral vasculitis. Furthermore, we observed other neurological complications, like thalamic ischemic infarction, during the disease evolution. Noteworthy, these entities were not presented when the patient was admitted to hospital. Therefore, the main aim of this report is to highlight the serious consequences that an infection of dental origin could cause. Key words:Meningitis, subdural empyema, odontogenic infections. PMID:27703619

  7. Spontaneous rapid reduction of a large acute subdural hematoma.

    PubMed

    Lee, Chul-Hee; Kang, Dong Ho; Hwang, Soo Hyun; Park, In Sung; Jung, Jin-Myung; Han, Jong Woo

    2009-12-01

    The majority of acute post-traumatic subdural hematomas (ASDH) require urgent surgical evacuation. Spontaneous resolution of ASDH has been reported in some cases. We report here on a case of a patient with a large amount of ASDH that was rapidly reduced. A 61-yr-old man was found unconscious following a high speed motor vehicle accident. On initial examination, his Glasgow Coma Score scale was 4/15. His pupils were fully dilated and non-reactive to bright light. Brain computed tomography (CT) showed a massive right-sided ASDH. The decision was made to treat him conservatively because of his poor clinical condition. Another brain CT approximately 14 hr after the initial scan demonstrated a remarkable reduction of the previous ASDH and there was the new appearance of high density in the subdural space adjacent to the falx and the tentorium. Thirty days after his admission, brain CT revealed chronic SDH and the patient underwent surgery. The patient is currently able to obey simple commands. In conclusion, spontaneous rapid resolution/reduction of ASDH may occur in some patients. The mechanisms are most likely the result of dilution by cerebrospinal fluid and the redistribution of hematoma especially in patients with brain atrophy.

  8. Spontaneous Rapid Reduction of a Large Acute Subdural Hematoma

    PubMed Central

    Kang, Dong Ho; Hwang, Soo Hyun; Park, In Sung; Jung, Jin-Myung; Han, Jong Woo

    2009-01-01

    The majority of acute post-traumatic subdural hematomas (ASDH) require urgent surgical evacuation. Spontaneous resolution of ASDH has been reported in some cases. We report here on a case of a patient with a large amount of ASDH that was rapidly reduced. A 61-yr-old man was found unconscious following a high speed motor vehicle accident. On initial examination, his Glasgow Coma Score scale was 4/15. His pupils were fully dilated and non-reactive to bright light. Brain computed tomography (CT) showed a massive right-sided ASDH. The decision was made to treat him conservatively because of his poor clinical condition. Another brain CT approximately 14 hr after the initial scan demonstrated a remarkable reduction of the previous ASDH and there was the new appearance of high density in the subdural space adjacent to the falx and the tentorium. Thirty days after his admission, brain CT revealed chronic SDH and the patient underwent surgery. The patient is currently able to obey simple commands. In conclusion, spontaneous rapid resolution/reduction of ASDH may occur in some patients. The mechanisms are most likely the result of dilution by cerebrospinal fluid and the redistribution of hematoma especially in patients with brain atrophy. PMID:19949689

  9. Subdural fluid collection and hydrocephalus following cervical schwannoma resection: hydrocephalus resolution after spinal pseudomeningocele repair: case report.

    PubMed

    Benedetto, Nicola; Cagnazzo, Federico; Gambacciani, Carlo; Perrini, Paolo

    2016-12-01

    The authors report the case of a 31-year-old man who developed neck pain and headache 2 months after the uncomplicated resection of a cervical schwannoma. MR imaging revealed infratentorial subdural fluid collections and obstructive hydrocephalus associated with cervical pseudomeningocele. The clinical symptoms, subdural fluid collections, and ventricular dilation resolved after surgical correction of the pseudomeningocele. This report emphasizes that hydrocephalus may be related to disorders of cerebrospinal fluid flow dynamics induced by cervical pseudomeningocele. In these rare cases, both the hydrocephalus and the symptoms are resolved by the simple correction of the pseudomeningocele.

  10. Accuracy of frame-based stereotactic depth electrode implantation during craniotomy for subdural grid placement.

    PubMed

    Munyon, Charles N; Koubeissi, Mohamad Z; Syed, Tanvir U; Lüders, Hans O; Miller, Jonathan P

    2013-01-01

    Frame-based stereotaxy and open craniotomy may seem mutually exclusive, but invasive electrophysiological monitoring can require broad sampling of the cortex and precise targeting of deeper structures. The purpose of this study is to describe simultaneous frame-based insertion of depth electrodes and craniotomy for placement of subdural grids through a single surgical field and to determine the accuracy of depth electrodes placed using this technique. A total of 6 patients with intractable epilepsy underwent placement of a stereotactic frame with the center of the planned cranial flap equidistant from the fixation posts. After volumetric imaging, craniotomy for placement of subdural grids was performed. Depth electrodes were placed using frame-based stereotaxy. Postoperative CT determined the accuracy of electrode placement. A total of 31 depth electrodes were placed. Mean distance of distal electrode contact from the target was 1.0 ± 0.15 mm. Error was correlated to distance to target, with an additional 0.35 mm error for each centimeter (r = 0.635, p < 0.001); when corrected, there was no difference in accuracy based on target structure or method of placement (prior to craniotomy vs. through grid, p = 0.23). The described technique for craniotomy through a stereotactic frame allows placement of subdural grids and depth electrodes without sacrificing the accuracy of a frame or requiring staged procedures.

  11. Local brain herniation after partial membranectomy for organized chronic subdural hematoma in an adult patient: case report and review of the literature.

    PubMed

    Kusano, Yoshikazu; Horiuchi, Tetsuyoshi; Seguchi, Tatsuya; Kakizawa, Yukinari; Tanaka, Yuichiro; Hongo, Kazuhiro

    2010-01-01

    Local brain herniation after removal of chronic subdural haematoma is extremely rare, especially in adult patients. This study reports a case of local brain herniation after partial membranectomy for organized chronic subdural haematoma. A 77-year-old man presented with dysarthria and dysphasia caused by local brain herniation of the right frontal lobe through a defect of the inner membrane. The herniated brain was detected by magnetic resonance (MR) imaging. The patient underwent a craniotomy to release the herniated and strangulated brain, which were consistent with the MR imaging findings. The patient recovered fully within 1 month after surgery. To date, five cases of brain herniation through the internal subdural membrane have been reported as complications of chronic subdural haematomas. All but one case occurred in the paediatric population. Urgent surgery should be performed, even if an adult patient suffers from local brain herniation, for preservation of brain function. This is the sixth reported case of brain herniation through a defect of the inner membrane and the second reported case in the adult population.

  12. Chronic subdural hematoma: A survey of neurosurgeons’ practices in Nigeria

    PubMed Central

    Rabiu, Taopheeq B.

    2013-01-01

    Background: Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons’ practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. Methods: An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July–December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Results: Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of

  13. Chronic subdural hematoma: A survey of neurosurgeons' practices in Nigeria.

    PubMed

    Rabiu, Taopheeq B

    2013-01-01

    Chronic subdural hematoma (CSDH) is a commonly encountered condition in neurosurgical practice. In Nigeria, a developing country, patients with CSDH are less likely to be diagnosed and treated by surgical drainage early. Aware of the reported variations in neurosurgeons' practices regarding CSDH in many parts of the world, we sought to determine the current practices of Nigerian neurosurgeons in managing CSDH. An Internet-based survey was carried out in which all Nigerian neurosurgeons listed in the Nigerian Academy of Neurological Surgeons directory during the July-December 2012 time period were asked to participate. Questions asked in the survey were: (1) Type of treatment used in patients with CSDH, (2) Use of drains postoperatively, (3) Postoperative patient positioning, (4) Postoperative mobilization, (5) Postoperative complications, and (6) Postoperative computed tomography (CT) scan monitoring. Survey information was sent to the 25 practicing neurosurgeons in Nigeria who met the criteria listed above for being included in this study. Each of the 14 neurosurgeons who responded reported that CSDH is often misdiagnosed initially, usually as a stroke having occurred. Once a diagnosis of CSDH was made, the most common method of treatment reported was placement of one or two burr-holes for drainage of the hematoma. Reported, but used in only a few cases, were twist drill craniostomy, craniectomy, and craniotomy. Each neurosurgeon who responded reported irrigation of the subdural space with sterile saline, and in some cases an antibiotic had been added to the irrigation solution. Six of the 14 neurosurgeons left drains in the subdural space for 24-72 hours. Seven neurosurgeons reported positioning patients with their heads elevated 30° during the immediate postoperative period. No neurosurgeon responding reported use of steroids, and only one acknowledged routine use of anticonvulsive medication for patients with CSDH. Only 3 of the 14 neurosurgeons taking part in

  14. Acute Aneurismal Bilateral Subdural Haematoma without Subarachnoid Haemorrhage: A Case Report and Review of the Literature

    PubMed Central

    Mansour, Ossama; Hassen, Tamer; Fathy, Sameh

    2014-01-01

    Spontaneous pure acute bilateral subdural haematoma (ASDH) without intraparenchymal or subarachnoid haemorrhage caused by a ruptured cerebral aneurysm is extremely rare. It can follow rupture of different aneurysms specially located in anterior incisural space; the most frequently encountered location is the PcoA aneurysms as demonstrated in the present case. We present a case report of a PcoA aneurysm presenting as pure bilateral ASDH. A high level of suspicion for bleeding of arterial origin should be maintained in all cases of acute subdural haematoma without history of trauma. The neurological status on admission dictates the appropriate timing and methodology of the neuroradiological investigations. PMID:25045554

  15. Non-traumatic subdural hematoma secondary to septic brain embolism: A rare cause of unexpected death in a drug addict suffering from undiagnosed bacterial endocarditis.

    PubMed

    Geisenberger, D; Huppertz, L M; Büchsel, M; Kramer, L; Pollak, S; Große Perdekamp, M

    2015-12-01

    Acute subdural hematomas are mostly due to blunt traumatization of the head. In rare instances, subdural bleeding occurs without evidence of a previous trauma following spontaneous hemorrhage, e.g. from a ruptured aneurysm or an intracerebral hematoma perforating the brain surface and the arachnoid. The paper presents the morphological, microbiological and toxicological findings in a 38-year-old drug addict who was found by his partner in a dazed state. When brought to a hospital, he underwent trepanation to empty a right-sided subdural hematoma, but he died already 4h after admission. Autopsy revealed previously undiagnosed infective endocarditis of the aortic valve as well as multiple infarctions of brain, spleen and kidneys obviously caused by septic emboli. The subdural hematoma originated from a subcortical brain hemorrhage which had perforated into the subdural space. Microbiological investigation of the polypous vegetations adhering to the aortic valve revealed colonization by Streptococcus mitis and Klebsiella oxytoca. According to the toxicological analysis, no psychotropic substances had contributed to the lethal outcome. The case reported underlines that all deaths of drug addicts should be subjected to complete forensic autopsy, as apart from intoxications also natural and traumatic causes of death have to be taken into consideration. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  16. Use of drains versus no drains after burr-hole evacuation of chronic subdural haematoma: a randomised controlled trial.

    PubMed

    Santarius, Thomas; Kirkpatrick, Peter J; Ganesan, Dharmendra; Chia, Hui Ling; Jalloh, Ibrahim; Smielewski, Peter; Richards, Hugh K; Marcus, Hani; Parker, Richard A; Price, Stephen J; Kirollos, Ramez W; Pickard, John D; Hutchinson, Peter J

    2009-09-26

    Chronic subdural haematoma causes serious morbidity and mortality. It recurs after surgical evacuation in 5-30% of patients. Drains might reduce recurrence but are not used routinely. Our aim was to investigate the effect of drains on recurrence rates and clinical outcomes. We did a randomised controlled trial at one UK centre between November, 2004, and November, 2007. 269 patients aged 18 years and older with a chronic subdural haematoma for burr-hole drainage were assessed for eligibility. 108 were randomly assigned by block randomisation to receive a drain inserted into the subdural space and 107 to no drain after evacuation. The primary endpoint was recurrence needing redrainage. The trial was stopped early because of a significant benefit in reduction of recurrence. Analyses were done on an intention-to-treat basis. This study is registered with the International Standard Randomised Controlled Trial Register (ISRCTN 97314294). Recurrence occurred in ten of 108 (9.3%) people with a drain, and 26 of 107 (24%) without (p=0.003; 95% CI 0.14-0.70). At 6 months mortality was nine of 105 (8.6%) and 19 of 105 (18.1%), respectively (p=0.042; 95% CI 0.1-0.99). Medical and surgical complications were much the same between the study groups. Use of a drain after burr-hole drainage of chronic subdural haematoma is safe and associated with reduced recurrence and mortality at 6 months. Academy of Medical Sciences, Health Foundation, and NIHR Biomedical Research Centre (Neurosciences Theme).

  17. "Rabbit ear" scalp deformity caused by massive subdural effusion in infant following bilateral bur-hole drainage failure: successfully managed with subduro-peritoneal shunt.

    PubMed

    Satyarthee, Guru Dutta; Dawar, Pankaj; Sharma, Bhawani Shanker

    2013-11-01

    Subdural effusion in an infant is a rare clinical scenario which may be secondary to a variety of etiologies. Massive subdural effusion is an extremely rare complication of head injury. Authors report a rare case of progressive massive subdural effusion which, despite bilateral bur-hole placement and drainage, failed and presented with visual deterioration and massive bulge of the scalp at bur-hole sites, producing a rabbit ear appearance in a 10-month-old infant. Ultimately, cystoperitoneal shunt was carried out in a desperate attempt to prevent impending rupture of scalp sutures at sites of previous bur-hole placement. This was followed by not only complete resolution of hygroma but also visual recovery. The patient is doing well at 6 months following shunt, regaining normal vision and appropriate developmental milestones. A MRI scan of the brain was carried out at last follow-up, which revealed mild ventriculomegaly with the rest of the brain being unremarkable, and subduro-peritoneal shunt in situ. Such a case has not been reported in the literature till date. Subdural effusion usually runs a self-limiting course. Though neurosurgical intervention is occasionally needed, different methods of surgical procedure for management include bur hole alone, bur holes with subdural drain placement, twist drill craniotomy with drain, and even craniotomy. Various methods of management are discussed along with a review of pertinent literature.

  18. Blood Aggravates Histological and Functional Damage after Acute Subdural Hematoma in Rats.

    PubMed

    Jussen, Daniel; Krenzlin, Harald; Papaioannou, Chrysostomos; Ens, Swetlana; Kempski, Oliver; Alessandri, Beat

    2017-02-15

    Acute subdural hematoma (ASDH) is associated with high morbidity and mortality. Whether the volume effect of the hematoma and increase of intracranial pressure (ICP) or the local effect of blood are responsible for this severe pathophysiology is unclear. Therefore, we compared subdural infusion of autologous blood and paraffin oil in a rat model of ASDH. In a histological study, we investigated the effects on acute ICP, cerebral perfusion pressure (CPP), cerebral blood flow (CBF), tissue oxygen changes, and brain damage at 2, 24, and 96 h post-infusion. Inflammatory reaction was analyzed by immuno-staining for microglia (ionized calcium binding adaptor molecule 1 [Iba1]) and activated astrocytes (glial fibrillary acidic protein [GFAP]). Besides acute ICP and CBF changes, we investigated the development of behavior (neuroscore and beamwalk test) for up to 4 days after injury in a behavioral study. Despite comparably increased ICP, there was a more pronounced lesion growth in the blood infusion group during the first 96 h. Further, there was an increased peri-lesional immunoreactive area of Iba1 and GFAP 96 h post-infusion, primarily in the blood infusion group, whereas hippocampal damage was comparable in both infusion groups. In the behavioral evaluation, paraffin-infused animals showed a better recovery, compared with the blood infusion group. In conclusion, comparable acute time-course of ICP, CPP, and CBF clearly indicates that the differences in lesion size, inflammatory reaction, and behavioral deficits after blood- and paraffin oil-induced ASDH are partially due to blood constituents. Therefore, current data suggest that subdural hematomas should be completely removed as quickly as possible; decompression alone may not be sufficient to prevent secondary brain damage.

  19. Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

    PubMed Central

    Zhang, J.; Chen, Z.; Xie, L.; Zhao, C.; Zhao, H.; Fu, C.; Chen, G.; Hao, Z.; Wang, L.; Li, W.

    2017-01-01

    A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species. PMID:28380194

  20. Advantages of soft subdural implants for the delivery of electrochemical neuromodulation therapies to the spinal cord

    NASA Astrophysics Data System (ADS)

    Capogrosso, Marco; Gandar, Jerome; Greiner, Nathan; Moraud, Eduardo Martin; Wenger, Nikolaus; Shkorbatova, Polina; Musienko, Pavel; Minev, Ivan; Lacour, Stephanie; Courtine, Grégoire

    2018-04-01

    Objective. We recently developed soft neural interfaces enabling the delivery of electrical and chemical stimulation to the spinal cord. These stimulations restored locomotion in animal models of paralysis. Soft interfaces can be placed either below or above the dura mater. Theoretically, the subdural location combines many advantages, including increased selectivity of electrical stimulation, lower stimulation thresholds, and targeted chemical stimulation through local drug delivery. However, these advantages have not been documented, nor have their functional impact been studied in silico or in a relevant animal model of neurological disorders using a multimodal neural interface. Approach. We characterized the recruitment properties of subdural interfaces using a realistic computational model of the rat spinal cord that included explicit representation of the spinal roots. We then validated and complemented computer simulations with electrophysiological experiments in rats. We additionally performed behavioral experiments in rats that received a lateral spinal cord hemisection and were implanted with a soft interface. Main results. In silico and in vivo experiments showed that the subdural location decreased stimulation thresholds compared to the epidural location while retaining high specificity. This feature reduces power consumption and risks of long-term damage in the tissues, thus increasing the clinical safety profile of this approach. The hemisection induced a transient paralysis of the leg ipsilateral to the injury. During this period, the delivery of electrical stimulation restricted to the injured side combined with local chemical modulation enabled coordinated locomotor movements of the paralyzed leg without affecting the non-impaired leg in all tested rats. Electrode properties remained stable over time, while anatomical examinations revealed excellent bio-integration properties. Significance. Soft neural interfaces inserted subdurally provide the

  1. Flexible endoscope-assisted evacuation of chronic subdural hematomas.

    PubMed

    Májovský, Martin; Masopust, Václav; Netuka, David; Beneš, Vladimír

    2016-10-01

    Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing incidence. Standard treatment of CSDHs is surgical evacuation. The objective of this study is to present a modification of standard burr-hole hematoma evacuation using a flexible endoscope and to assess the advantages and risks. Prospectively, 34 consecutive patients diagnosed with CSDH were included in the study. Epidemiological, clinical and radiographical data were collected and reviewed. All patients underwent a burr-hole evacuation of CSDH. A flexible endoscope was inserted and subdural space inspected during surgery. The surgeon was looking specifically for the presence of septations, draining catheter position and acute bleeding. Thirty-four patients underwent 37 endoscope-assisted surgeries. Presenting symptoms were hemiparesis (79%), decreased level of consciousness (18%), gait disturbances (15%), headache (12%), aphasia (6%), cognitive disturbances (6%) and epileptic seizure (3%). Average operative time was 43 min, and the average increase in operative time due to the use of the endoscope was 6 min. Recurrence rate was 8.8%, and clinical outcome was favorable (defined as mRS ≤ 2) in 97% of the cases. To our knowledge, the present cohort of 34 patients is the largest group of patients with CSDH treated using an endoscope. This technique allows decent visualization of the hematoma cavity while retaining the advantages of a minimally invasive approach under a local anesthesia. The main advantages are correct positioning of the catheter under visual control, identification of septations and early detection of cortex or vessel injury during surgery.

  2. Encapsulated Unresolved Subdural Hematoma Mimicking Acute Epidural Hematoma: A Case Report

    PubMed Central

    Park, Sang-Soo; Kim, Hyo-Joon; Kwon, Chang-Young

    2014-01-01

    Encapsulated acute subdural hematoma (ASDH) has been uncommonly reported. To our knowledge, a few cases of lentiform ASDH have been reported. The mechanism of encapsulated ASDH has been studied but not completely clarified. Encapsulated lentiform ASDH on a computed tomography (CT) scan mimics acute epidural hematoma (AEDH). Misinterpretation of biconvex-shaped ASDH on CT scan as AEDH often occurs and is usually identified by neurosurgical intervention. We report a case of an 85-year-old man presenting with a 2-day history of mental deterioration and right-sided weakness. CT scan revealed a biconvex-shaped hyperdense mass mixed with various densities of blood along the left temporoparietal cerebral convexity, which was misinterpreted as AEDH preoperatively. Emergency craniectomy was performed, but no AEDH was found beneath the skull. In the subdural space, encapsulated ASDH was located. En block resection of encapsulated ASDH was done. Emergency craniectomy confirmed that the preoperatively diagnosed AEDH was an encapsulated ASDH postoperatively. Radiologic studies of AEDH-like SDH allow us to establish an easy differential diagnosis between AEDH and ASDH by distinct features. More histological studies will provide us information on the mechanism underlying encapsulated ASDH. PMID:27169052

  3. Anatomy and development of the meninges: implications for subdural collections and CSF circulation.

    PubMed

    Mack, Julie; Squier, Waney; Eastman, James T

    2009-03-01

    The dura is traditionally viewed as a supportive fibrous covering of the brain containing the dural venous sinuses but otherwise devoid of vessels and lacking any specific function. However, review of the embryology and anatomy reveals the dura to be a complex, vascularized and innervated structure, not a simple fibrous covering. The dura contains an inner vascular plexus that is larger in the infant than in the adult, and this plexus likely plays a role in CSF absorption. This role could be particularly important in the infant whose arachnoid granulations are not completely developed. Although subdural hemorrhage is frequently traumatic, there are nontraumatic conditions associated with subdural hemorrhage, and the inner dural plexus is a likely source of bleeding in these nontraumatic circumstances. This review outlines the development and age-specific vascularity of the dura and offers an alternative perspective on the role of the dura in homeostasis of the central nervous system.

  4. Rapid reduction of acute subdural hematoma and redistribution of hematoma: case report.

    PubMed

    Watanabe, Arata; Omata, Tomohiro; Kinouchi, Hiroyuki

    2010-01-01

    An 88-year-old woman presented with acute subdural hematoma (ASDH) which showed rapid resolution on computed tomography (CT) and magnetic resonance (MR) imaging. She was transferred to our hospital after falling out of bed. On admission, she was comatose with Japan Coma Scale score of 200 and Glasgow Coma Scale score of E1V1M2. Brain CT showed a thick left frontotemporal ASDH. Conservative treatment consisted of 200 ml of glycerol administered intravenously twice a day, and maintenance in the approximately 20 degree head-up position to reduce intracranial pressure. Three days later, her consciousness recovered to Japan Coma Scale score of 30 and Glasgow Coma Scale score of E2V4M5. CT showed obvious reduction of the hematoma without brain or scalp swelling. Spinal MR imaging detected no redistribution of hematoma to the spine. The present case illustrates that rapid spontaneous reduction of ASDH may occur by redistribution of hematoma, mainly to the supratentorial subdural space because of brain atrophy.

  5. The surgical management of chronic subdural hematoma.

    PubMed

    Ducruet, Andrew F; Grobelny, Bartosz T; Zacharia, Brad E; Hickman, Zachary L; DeRosa, Peter L; Andersen, Kristen N; Anderson, Kristen; Sussman, Eric; Carpenter, Austin; Connolly, E Sander

    2012-04-01

    Chronic subdural hematoma (cSDH) is an increasingly common neurological disease process. Despite the wide prevalence of cSDH, there remains a lack of consensus regarding numerous aspects of its clinical management. We provide an overview of the epidemiology and pathophysiology of cSDH and discuss several controversial management issues, including the timing of post-operative resumption of anticoagulant medications, the effectiveness of anti-epileptic prophylaxis, protocols for mobilization following evacuation of cSDH, as well as the comparative effectiveness of the various techniques of surgical evacuation. A PubMed search was carried out through October 19, 2010 using the following keywords: "subdural hematoma", "craniotomy", "burr-hole", "management", "anticoagulation", "seizure prophylaxis", "antiplatelet", "mobilization", and "surgical evacuation", alone and in combination. Relevant articles were identified and back-referenced to yield additional papers. A meta-analysis was then performed comparing the efficacy and complications associated with the various methods of cSDH evacuation. There is general agreement that significant coagulopathy should be reversed expeditiously in patients presenting with cSDH. Although protocols for gradual resumption of anti-coagulation for prophylaxis of venous thrombosis may be derived from guidelines for other neurosurgical procedures, further prospective study is necessary to determine the optimal time to restart full-dose anti-coagulation in the setting of recently drained cSDH. There is also conflicting evidence to support seizure prophylaxis in patients with cSDH, although the existing literature supports prophylaxis in patients who are at a higher risk for seizures. The published data regarding surgical technique for cSDH supports primary twist drill craniostomy (TDC) drainage at the bedside for patients who are high-risk surgical candidates with non-septated cSDH and craniotomy as a first-line evacuation technique for c

  6. Continuous decoding of human grasp kinematics using epidural and subdural signals

    NASA Astrophysics Data System (ADS)

    Flint, Robert D.; Rosenow, Joshua M.; Tate, Matthew C.; Slutzky, Marc W.

    2017-02-01

    Objective. Restoring or replacing function in paralyzed individuals will one day be achieved through the use of brain-machine interfaces. Regaining hand function is a major goal for paralyzed patients. Two competing prerequisites for the widespread adoption of any hand neuroprosthesis are accurate control over the fine details of movement, and minimized invasiveness. Here, we explore the interplay between these two goals by comparing our ability to decode hand movements with subdural and epidural field potentials (EFPs). Approach. We measured the accuracy of decoding continuous hand and finger kinematics during naturalistic grasping motions in five human subjects. We recorded subdural surface potentials (electrocorticography; ECoG) as well as with EFPs, with both standard- and high-resolution electrode arrays. Main results. In all five subjects, decoding of continuous kinematics significantly exceeded chance, using either EGoG or EFPs. ECoG decoding accuracy compared favorably with prior investigations of grasp kinematics (mean ± SD grasp aperture variance accounted for was 0.54 ± 0.05 across all subjects, 0.75 ± 0.09 for the best subject). In general, EFP decoding performed comparably to ECoG decoding. The 7-20 Hz and 70-115 Hz spectral bands contained the most information about grasp kinematics, with the 70-115 Hz band containing greater information about more subtle movements. Higher-resolution recording arrays provided clearly superior performance compared to standard-resolution arrays. Significance. To approach the fine motor control achieved by an intact brain-body system, it will be necessary to execute motor intent on a continuous basis with high accuracy. The current results demonstrate that this level of accuracy might be achievable not just with ECoG, but with EFPs as well. Epidural placement of electrodes is less invasive, and therefore may incur less risk of encephalitis or stroke than subdural placement of electrodes. Accurately decoding motor

  7. Continuous decoding of human grasp kinematics using epidural and subdural signals

    PubMed Central

    Flint, Robert D.; Rosenow, Joshua M.; Tate, Matthew C.; Slutzky, Marc W.

    2017-01-01

    Objective Restoring or replacing function in paralyzed individuals will one day be achieved through the use of brain-machine interfaces (BMIs). Regaining hand function is a major goal for paralyzed patients. Two competing prerequisites for the widespread adoption of any hand neuroprosthesis are: accurate control over the fine details of movement, and minimized invasiveness. Here, we explore the interplay between these two goals by comparing our ability to decode hand movements with subdural and epidural field potentials. Approach We measured the accuracy of decoding continuous hand and finger kinematics during naturalistic grasping motions in five human subjects. We recorded subdural surface potentials (electrocorticography; ECoG) as well as with epidural field potentials (EFPs), with both standard- and high-resolution electrode arrays. Main results In all five subjects, decoding of continuous kinematics significantly exceeded chance, using either EGoG or EFPs. ECoG decoding accuracy compared favorably with prior investigations of grasp kinematics (mean± SD grasp aperture variance accounted for was 0.54± 0.05 across all subjects, 0.75± 0.09 for the best subject). In general, EFP decoding performed comparably to ECoG decoding. The 7–20 Hz and 70–115 Hz spectral bands contained the most information about grasp kinematics, with the 70–115 Hz band containing greater information about more subtle movements. Higher-resolution recording arrays provided clearly superior performance compared to standard-resolution arrays. Significance To approach the fine motor control achieved by an intact brain-body system, it will be necessary to execute motor intent on a continuous basis with high accuracy. The current results demonstrate that this level of accuracy might be achievable not just with ECoG, but with EFPs as well. Epidural placement of electrodes is less invasive, and therefore may incur less risk of encephalitis or stroke than subdural placement of electrodes

  8. Risk Factors for Chronic Subdural Hematoma Recurrence Identified Using Quantitative Computed Tomography Analysis of Hematoma Volume and Density.

    PubMed

    Stavrinou, Pantelis; Katsigiannis, Sotirios; Lee, Jong Hun; Hamisch, Christina; Krischek, Boris; Mpotsaris, Anastasios; Timmer, Marco; Goldbrunner, Roland

    2017-03-01

    Chronic subdural hematoma (CSDH), a common condition in elderly patients, presents a therapeutic challenge with recurrence rates of 33%. We aimed to identify specific prognostic factors for recurrence using quantitative analysis of hematoma volume and density. We retrospectively reviewed radiographic and clinical data of 227 CSDHs in 195 consecutive patients who underwent evacuation of the hematoma through a single burr hole, 2 burr holes, or a mini-craniotomy. To examine the relationship between hematoma recurrence and various clinical, radiologic, and surgical factors, we used quantitative image-based analysis to measure the hematoma and trapped air volumes and the hematoma densities. Recurrence of CSDH occurred in 35 patients (17.9%). Multivariate logistic regression analysis revealed that the percentage of hematoma drained and postoperative CSDH density were independent risk factors for recurrence. All 3 evacuation methods were equally effective in draining the hematoma (71.7% vs. 73.7% vs. 71.9%) without observable differences in postoperative air volume captured in the subdural space. Quantitative image analysis provided evidence that percentage of hematoma drained and postoperative CSDH density are independent prognostic factors for subdural hematoma recurrence. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Role of Subdural Electrocorticography in Prediction of Long-Term Seizure Outcome in Epilepsy Surgery

    ERIC Educational Resources Information Center

    Asano, Eishi; Juhasz, Csaba; Shah, Aashit; Sood, Sandeep; Chugani, Harry T.

    2009-01-01

    Since prediction of long-term seizure outcome using preoperative diagnostic modalities remains suboptimal in epilepsy surgery, we evaluated whether interictal spike frequency measures obtained from extraoperative subdural electrocorticography (ECoG) recording could predict long-term seizure outcome. This study included 61 young patients (age…

  10. Prediction of Chronic Subdural Hematoma in Minor Head Trauma Patients

    PubMed Central

    Han, Sang-Beom; Song, Shi-Hun; Youm, Jin-Young; Koh, Hyeon-Song; Kim, Seon-Hwan; Kwon, Hyon-Jo

    2014-01-01

    Objective Chronic subdural hematoma (CSDH) is relatively common in neurosurgical field. However not all patients develop CSDH after minor head trauma. In this study, we evaluate the risk factors of post-traumatic CSDH. Methods Two-hundred and seventy-seven patients were enrolled and analyzed in this study from January 2012 to December 2013. Of those, 20 participants had minor head trauma developed CSDH afterward. We also included 257 patients with minor head trauma who did not develop CSDH during the same follow-up period as the control group. We investigated the risk factors related to the development of CSDH after minor head trauma. Results Old age (p=0.014), preexisting diabetes mellitus (p=0.010), hypertension (p=0.026), history of cerebral infarction (p=0.035), antiplatelet agents (p=0.000), acute subdural hematoma in the convexity (p=0.000), encephalomalacia (p=0.029), and long distance between skull and brain parenchyma (p=0.000) were significantly correlated with the development of CSDH after trauma. Multivariate analysis revealed that only the maximum distance between the skull and the cerebral parenchyma was the independent risk factor for the occurrence of CSDH (hazard ratio 2.55, p=0.000). Conclusion We should consider the possibility of developing CSDH in the post-traumatic patients with the identified risk factors. PMID:27169043

  11. A hemorrhagic complication after Onyx embolization of a tentorial dural arteriovenous fistula: A caution about subdural extension with pial arterial supply.

    PubMed

    Sato, Kenichi; Matsumoto, Yasushi; Endo, Hidenori; Tominaga, Teiji

    2017-06-01

    We report a case of tentorial dural arteriovenous fistula (DAVF) with a severe intracranial hemorrhage occurring after Onyx embolization. A 40-year-old man presented with an asymptomatic tentorial DAVF on angiography. Transarterial embolization with Onyx was performed via the middle meningeal artery, and the cast filled the fistula itself and its proximal draining vein. Postoperative angiography confirmed complete occlusion of the DAVF. A computed tomography scan performed immediately after the procedure demonstrated an acute subdural hematoma with the temporal hemorrhage. Emergency craniotomy revealed continuous arterial bleeding from a viable glomus-like vascular structure around the proximal part of the embolized draining vein, fed by a pial artery arising from the posterior cerebral artery. Pathologic findings suggested diagnosis of vascular malformation extending into the subdural space. Tentorial DAVFs can extend to the subdural space along their drainage route, and may be involved in severe hemorrhagic complications of curative endovascular treatment using Onyx, particularly those with pial arterial supply.

  12. Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report.

    PubMed

    Kwon, O Ik; Son, Dong Wuk; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

    2015-09-01

    A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits.

  13. Migration of an Intracranial Subdural Hematoma to the Spinal Subdural Space: A Case Report

    PubMed Central

    Kwon, O Ik; Kim, Young Ha; Kim, Young Soo; Sung, Soon Ki; Lee, Sang Weon; Song, Geun Sung

    2015-01-01

    A 57-year-old man complained of severe lower back pain and radicular pain in both legs for 1 week after falling from a ladder. Magnetic resonance imaging (MRI) of the spine showed a subdural hematoma (SDH), which was surgically removed. The patient had no back pain or the radicular leg pain at 2 weeks post-surgery. However, he complained of diffuse headaches upon follow-up. Brain computed tomography (CT) and MRI revealed an intracranial SDH, which was immediately removed by surgery. During his 1-year follow-up, he reported that the pain had resolved without recurrence. Simultaneous spinal and intracranial SDH are rare and no standard treatment exists for this condition. This case suggests that it is possible that an intracranial SDH can migrate into the cerebrospinal fluid (CSF) space through an arachnoid tear. CSF circulation allows the intracranial SDH to enter subarachnoid spaces encasing the spinal cord. In order to prevent irreversible damage, surgical intervention should be considered for case of spinal SDH with progressive neurological deficits. PMID:26512286

  14. Posttraumatic Intracranial Tuberculous Subdural Empyema in a Patient with Skull Fracture

    PubMed Central

    Kim, Jiha; Kim, Choonghyo; Ryu, Young-Joon

    2016-01-01

    Intracranial tuberculous subdural empyema (ITSE) is extremely rare. To our knowledge, only four cases of microbiologically confirmed ITSE have been reported in the English literature to date. Most cases have arisen in patients with pulmonary tuberculosis regardless of trauma. A 46-year-old man presented to the emergency department after a fall. On arrival, he complained of pain in his head, face, chest and left arm. He was alert and oriented. An initial neurological examination was normal. Radiologic evaluation revealed multiple fractures of his skull, ribs, left scapula and radius. Though he had suffered extensive skull fractures of his cranium, maxilla, zygoma and orbital wall, the sustained cerebral contusion and hemorrhage were mild. Eighteen days later, he suddenly experienced a general tonic-clonic seizure. Radiologic evaluation revealed a subdural empyema in the left occipital area that was not present on admission. We performed a craniotomy, and the empyema was completely removed. Microbiological examination identified Mycobacterium tuberculosis (M. tuberculosis). After eighteen months of anti-tuberculous treatment, the empyema disappeared completely. This case demonstrates that tuberculosis can induce empyema in patients with skull fractures. Thus, we recommend that M. tuberculosis should be considered as the probable pathogen in cases with posttraumatic empyema. PMID:27226867

  15. Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy.

    PubMed

    Edlmann, Ellie; Giorgi-Coll, Susan; Whitfield, Peter C; Carpenter, Keri L H; Hutchinson, Peter J

    2017-05-30

    Chronic subdural haematoma (CSDH) is an encapsulated collection of blood and fluid on the surface of the brain. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. This review focuses on several key processes involved in CSDH development: angiogenesis, fibrinolysis and inflammation. The characteristic membrane surrounding the CSDH has been identified as a source of fluid exudation and haemorrhage. Angiogenic stimuli lead to the creation of fragile blood vessels within membrane walls, whilst fibrinolytic processes prevent clot formation resulting in continued haemorrhage. An abundance of inflammatory cells and markers have been identified within the membranes and subdural fluid and are likely to contribute to propagating an inflammatory response which stimulates ongoing membrane growth and fluid accumulation. Currently, the mainstay of treatment for CSDH is surgical drainage, which has associated risks of recurrence requiring repeat surgery. Understanding of the underlying pathophysiological processes has been applied to developing potential drug treatments. Ongoing research is needed to identify if these therapies are successful in controlling the inflammatory and angiogenic disease processes leading to control and resolution of CSDH.

  16. Acute subdural hemorrhage while traveling by bus: a risk factor in the elderly?

    PubMed

    Soysal, Suna; Topacoglu, Hakan; Acarbay, Sabiha; Ozbas, Kerem

    2005-01-01

    A 71-year-old man was delivered to our emergency department by an intercity bus. About 4 hours into a journey, he had complained of a headache to his wife. After one more hour, she noted a change in his level of alertness and notified the bus driver. A computed tomography scan of the head showed a subdural hemorrhage.

  17. Sport-Related Structural Brain Injury: 3 Cases of Subdural Hemorrhage in American High School Football.

    PubMed

    Yengo-Kahn, Aaron M; Gardner, Ryan M; Kuhn, Andrew W; Solomon, Gary S; Bonfield, Christopher M; Zuckerman, Scott L

    2017-10-01

    The risk of sport-related concussion (SRC) has emerged as a major public health concern. In rare instances, sport-related head injuries can be even more severe, such as subdural hemorrhage, epidural hemorrhage, or malignant cerebral edema. Unlike SRCs, sport-related structural brain injury (SRSBI) is rare, may require neurosurgical intervention, and can lead to permanent neurologic deficit or death. Data characterizing SRSBI are limited, and many have recognized the need to better understand these catastrophic brain injuries. The goal of the current series is to describe, in detail, the presentation, management, and outcomes of examples of these rare injuries. During the fall of 2015, three high school football players presented with acute subdural hemorrhages following in-game collisions and were treated at our institution within a span of 2 months. For the 2 athletes who required surgical intervention, a previous SRC was sustained within 4 weeks before the catastrophic event. One year after injury, 2 players have returned to school, though with persistent deficits. One patient remains nonverbal and wheelchair bound. None of the athletes has returned to sports. Acute subdural hemorrhage resultant from an in-game football collision is rare. The temporal proximity of the reported SRSBIs to recent SRCs emphasizes the importance of return-to-play protocols and raises questions regarding the possibility of second impact syndrome. Although epidemiologic conclusions cannot be drawn from this small sample, these cases provide a unique opportunity to demonstrate the presentation, management, and long-term outcomes of SRSBI in American high school football. Copyright © 2017 Elsevier Inc. All rights reserved.

  18. Effect of Inner Membrane Tearing in the Treatment of Adult Chronic Subdural Hematoma: A Comparative Study

    PubMed Central

    KAYACI, Selim; KANAT, Ayhan; KOKSAL, Vaner; OZDEMIR, Bulent

    2014-01-01

    The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays. PMID:24477064

  19. Effect of inner membrane tearing in the treatment of adult chronic subdural hematoma: a comparative study.

    PubMed

    Kayaci, Selim; Kanat, Ayhan; Koksal, Vaner; Ozdemir, Bulent

    2014-01-01

    The postoperative results of chronic subdural hematoma (CSDH) procedures using catheterization and tearing of inner membrane (CTIM) technique have not previously been discussed in the literature. This article compares the effects of CTIM technique on brain re-expansion and re-accumulation with cases operated on with a burr-hole craniotomy and outer membrane incision (BCOMI) technique. The study involved operations on 144 patients (Group 1) using the CTIM technique and 108 patients (Group 2) using the BCOMI technique. In the operations using the CTIM technique in Group 1, the mean effusion measured in the subdural space (SDS) was 10.0 ± 0.2 mm, and for Group 2, 14.3 ± 0.6 mm in the postoperative period on the first and third days and this difference was found to be significant (p < 0.05). The means were 6.6 ± 0.2 mm for Group 1 and 10.3 ± 0.5 mm for Group 2 on the seventh day (p < 0.05). Recurrence rate was 8.3% in Group 2 and 0 in Group 1. This difference was statistically significant (p = 0001). The length of hospital stay was 7.0 ± 0.1 days for the Group 1 and 8.8 ± 0.2 days for Group 2 and this difference was significant (p < 0.05). These results indicate that the CTIM technique is preferable because it results in earlier re-expansion, lower recurrence, less subdural effusion and pneumocephalus, and shorter hospital stays.

  20. Subdural hematomas: glutaric aciduria type 1 or abusive head trauma? A systematic review.

    PubMed

    Vester, Marloes E M; Bilo, Rob A C; Karst, Wouter A; Daams, Joost G; Duijst, Wilma L J M; van Rijn, Rick R

    2015-09-01

    Glutaric aciduria type 1 (GA1) is a rare metabolic disorder of glutaryl-CoA-dehydrogenase enzyme deficiency. Children with GA1 are reported to be predisposed to subdural hematoma (SDH) development due to stretching of cortical veins secondary to cerebral atrophy and expansion of CSF spaces. Therefore, GA1 testing is part of the routine work-up in abusive head trauma (AHT). This systematic review addresses the coexistence of GA1 and SDH and the validity of GA1 in the differential diagnosis of AHT. A systematic literature review, with language restriction, of papers published before 1 Jan 2015, was performed using Pubmed, PsychINFO, and Embase. Inclusion criteria were reported SDHs, hygromas or effusions in GA1 patients up to 18 years of age. Of 1599 publications, 20 publications were included for analysis. In total 20 cases, 14 boys and 6 girls, were included. In eight cases (40%) a child abuse work-up was performed, which was negative in all cases. Clinical history revealed the presence of trauma in eight cases (40%). In only one case neuroradiology revealed no abnormalities related to GA1 according to the authors, although on evaluation we could not exclude AHT. From this systematic review we conclude that SDHs in 19/20 children with GA1 are accompanied by other brain abnormalities specific for GA1. One case with doubtful circumstances was the exception to this rule.

  1. Endoscopic Evacuation of Subdural Collections.

    PubMed

    Boyaci, Suat; Gumustas, Oguzhan Guven; Korkmaz, Serdar; Aksoy, Kaya

    2016-01-01

    Intraoperative use of the endoscope is a hot topic in neurosurgery and it gives broader visualization of critical and hardlyreached areas. Endoscope-assisted surgical approach to chronic subdural haematoma (SDH) is a minimally invasive technique and may give an expansion to the regular method of burr-hole haematoma drainage. Endoscope-assisted haematoma drainage with mini-craniotomy was performed over a 24-month period, and prospectively collected data is reviewed. A total of 10 procedures (8 patients) were performed using the endoscopeassisted technique. Four of them were chronic SDH and six were subacute SDH. Procedures were extended 20 minutes in average because of endoscopic intervention. There was no extra-morbidity through the study as a consequence of endoscopic assessment. Endoscope-assisted techniques can make the operation safe in selected circumstances with improved intraoperative visualization. It may likewise take into consideration the identification and destruction of neo-membranes, septums and solid clots. In addition, the source of bleeding can be easily coagulated. The endoscope-assisted techniques, with all of these features, can alter the pre- and intra-operative decision-making for selected patients.

  2. Syringomyelia following surgery for a spontaneous spinal subdural hematoma in a 13-year-old girl with congenital von Willebrand disease: case report and literature review.

    PubMed

    Ben Nsir, A; Boubaker, A; Jemel, H

    2016-04-01

    Spontaneous spinal subdural hematomas are rare. Their occurrence in a child with congenital von Willebrand disease and the complication of their surgery by a large secondary syringomyelia have never been previously reported. A 13-year-old girl with congenital von Willebrand disease presented to our emergency department in January 2011 for sudden onset of severe back pain centered in her thoracic spine rapidly aggravated by signs of acute myelopathy without any precipitating factor. MRI scan revealed a thoracic subdural collection anterior to the spinal cord at the T7-T9 level, hyperintense on T1- and T2-weighted sequences consistent with an acute spinal subdural hemorrhage. Evacuation of the subdural hematoma was realized immediately after hemostasis parameter correction, and post-operative course was uneventful with full functional recovery. One year later, the patient presented once again but with progressive and more severe myelopathy caused by a large syringomyelia extending from the T5 level to the conus medullaris. A syringopleural shunting was performed and the patient was unrolled under an intensive care and rehabilitation program. Her condition remarkably improved and she became able to walk independently within 2 weeks post-operatively. von Willebrand disease should be included as a possible factor of spontaneous spinal subdural hemorrhage. Surgery is advised in emergency and can be associated with remarkable recovery especially in children. Delayed syringomyelia can complicate the post-operative course and can be successfully addressed by syringopleural shunting. Long-term clinical and radiological follow-up is advocated.

  3. Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series

    PubMed Central

    Lim, Grace; Zorn, Jamie M.; Dong, Yuanxu J.; DeRenzo, Joseph S.; Waters, Jonathan H.

    2016-01-01

    Objective This report describes the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. Case Reports Eleven obstetric patients had subdural hematomas (SDH) associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with post-dural puncture headache (PDPH) prior to the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed an average of 4.1 (range 1–7) days after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten of 11 (91%) cases had a second hospital stay for an average of 2.8 (range 2–4) days for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, about 1:3900), and the rate of SDH was 1.1% (5 in 437, about 1:87) if a recognized dural puncture occurred during epidural catheter placement. Conclusions SDH after labor epidural anesthesia is rare, but potentially more common than historically estimated. Cases of PDPH after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH. PMID:27512937

  4. Subdural Hematoma Associated With Labor Epidural Analgesia: A Case Series.

    PubMed

    Lim, Grace; Zorn, Jamie M; Dong, Yuanxu J; DeRenzo, Joseph S; Waters, Jonathan H

    2016-01-01

    This report aimed to describe the characteristics and impact of subdural hematoma (SDH) after labor epidural analgesia. Eleven obstetric patients had SDHs associated with the use of labor epidural analgesia over 7 years at a tertiary care hospital. Ten of 11 patients had signs consistent with postdural puncture headache before the diagnosis of SDH. Five patients (45%) had a recognized unintentional dural puncture, 1 (9%) had a combined spinal-epidural with a 24-gauge needle, and 5 (45%) had no recognized dural puncture. For 10 of the 11 cases, SDH was diagnosed at a mean of 4.1 days (range, 1-7 days) after performance of labor epidural analgesia; one case was diagnosed at 25 days. Ten (91%) of 11 cases had a second hospital stay for a mean of 2.8 days (range, 2-4 days) for observation, without further requirement for neurosurgical intervention. One case (9%) had decompressive hemicraniectomy after becoming unresponsive. The observed rate of labor epidural analgesia-associated SDH was 0.026% (11 in 42,969, approximately 1:3900), and the rate of SDH was 1.1% (5 in 437, approximately 1:87) if a recognized dural puncture occurred during epidural catheter placement. Subdural hematoma after labor epidural anesthesia is rare but potentially more common than historically estimated. Cases of postdural puncture headache after labor epidural anesthesia should be monitored closely for severe neurologic signs and symptoms that could herald SDH.

  5. Subdural Hematomas in Children under 2 Years. Accidental or Inflicted? A 10-Year Experience.

    ERIC Educational Resources Information Center

    Tzioumi, Dimitra; Oates, R. Kim

    1998-01-01

    Analysis of 38 children under 2 with subdural hematomas found the most common causes were nonaccidental injury (55%), accidents (39%), and nontraumatic causes (6%). Also, the frequent presence of retinal hemorrhages, bone and rib fractures, delay in presentation, and young age suggests child abuse as the most common cause of these injuries.…

  6. The interactive electrode localization utility: software for automatic sorting and labeling of intracranial subdural electrodes

    PubMed Central

    Tang, Wei; Peled, Noam; Vallejo, Deborah I.; Borzello, Mia; Dougherty, Darin D.; Eskandar, Emad N.; Widge, Alik S.; Cash, Sydney S.; Stufflebeam, Steven M.

    2018-01-01

    Purpose Existing methods for sorting, labeling, registering, and across-subject localization of electrodes in intracranial encephalography (iEEG) may involve laborious work requiring manual inspection of radiological images. Methods We describe a new open-source software package, the interactive electrode localization utility which presents a full pipeline for the registration, localization, and labeling of iEEG electrodes from CT and MR images. In addition, we describe a method to automatically sort and label electrodes from subdural grids of known geometry. Results We validated our software against manual inspection methods in twelve subjects undergoing iEEG for medically intractable epilepsy. Our algorithm for sorting and labeling performed correct identification on 96% of the electrodes. Conclusions The sorting and labeling methods we describe offer nearly perfect performance and the software package we have distributed may simplify the process of registering, sorting, labeling, and localizing subdural iEEG grid electrodes by manual inspection. PMID:27915398

  7. Subdural hematoma in infants without accidental or nonaccidental injury: benign external hydrocephalus, a risk factor.

    PubMed

    Ghosh, Partha S; Ghosh, Debabrata

    2011-10-01

    Benign external hydrocephalus (BEH) is considered a self-limiting condition in infants. Subdural hematoma (SDH) in infants without a history of trauma indicates nonaccidental injury (NAI). The authors studied whether SDH can complicate BEH without apparent trauma. Out of 45 children younger than 3 years with nontraumatic SDH, 9 (7 boys) with mean age 6 months had BEH as risk factor. Symptoms included increasing head size (8), fussiness, and irritability (3). Three had up-gaze restriction, 1 axial hypotonia, and 6 normal examination. Neuroimaging showed prominent extra-axial spaces; SDH was bilateral (6), subacute (5). Other etiological workup for SDH was negative except NAI in 1. Two required evacuation of SDH and subdural-peritoneal shunt; others managed conservatively. Development was normal in 8 on follow-up. On follow-up imaging of 8, SDH completely resolved in 3, markedly reduced in 3, and remained stable in 2. BEH is a risk factor for SDH in infants, thus not always benign.

  8. Subdural empyema following lumbar facet joint injection: An exceeding rare complication.

    PubMed

    Fayeye, Oluwafikayo; Silva, Adikarige Haritha Dulanka; Chavda, Swarupsinh; Furtado, Navin Raoul

    2016-01-01

    Chronic low back pain is extremely common with a life time prevalence estimated at greater than 70%. Facet joint arthrosis is thought to be the causative aetiological substrate in approximately 25% of chronic low back pain cases. Facet joint injection is a routine intervention in the armamentarium for both the diagnostic and therapeutic management of chronic low back pain. In fact, a study by Carrino et al. reported in excess of 94,000 facet joint injection procedures were carried out in the US in 1999. Although generally considered safe, the procedure is not entirely without risk. Complications including bleeding, infection, exacerbation of pain, dural puncture headache, and pneumothorax have been described. We report a rare case of a 47-year-old female patient who developed a left L4/5 facet septic arthrosis with an associated subdural empyema and meningitis following facet joint injection. This case is unique, as to the best of our knowledge no other case of subdural empyema following facet joint injection has been reported in the literature. Furthermore this case serves to highlight the potential serious adverse sequelae of a routine and apparently innocuous intervention. The need for medical practitioners to be alert to and respond rapidly to the infective complications of facet joint injection cannot be understated. Copyright © 2016 Polish Neurological Society. Published by Elsevier Urban & Partner Sp. z o.o. All rights reserved.

  9. [Research on the application of "H shaped" single-tube double-lumen drainage tube in the treatment of chronic subdural hematoma].

    PubMed

    Sun, T; Jiang, Z Q; Zhang, S J; Lou, F Y; Zhang, T; Han, Y; Zheng, X L

    2016-04-05

    To explore the effect of chronic subdural hematoma external drainage surgery using self-made "H shaped" flush type single-tube double-lumen drainage tube. There were 56 cases chosen from the First Affiliated Hospital of Bengbu Medical College between Jan 2013 and Aug 2015. These patients with unilateral chronic subdural hematoma requiring surgery to place drilling external drainage catheter were randomly divided into group A (21 cases, using self-made single-tube double lumen "H shaped" drainage tube) and group B (35 cases, traditional silicone drainage tube), then the residual liquid volume after drainage on the first day, the days that the tube stay in body and the residual fluid volume after removing the tube were compared between the two groups. The residual liquid volume after drainage on the first day in group A was (23±15)ml, in group B was (31±15)ml. The days that the tube stay in body in group A was (2.7±1.0)d, in group B was (3.3±1.1)d, the two groups had statistical differences (P<0.05). The residual fluid volume after removing the tube in group A was (13±7) ml, in group B was (16±8)ml, but the data in these two groups had no significantly statistical differences (P>0.05). The effect of self-made "H shaped" flush type single-tube double-lumen drainage tube in the drainage of chronic subdural hematoma drainage is good, with short tube stay in the body; therefore, it is a safe and effective way to treat chronic subdural hematoma, and is worthy of clinical application.

  10. Predictors of rapid spontaneous resolution of acute subdural hematoma.

    PubMed

    Fujimoto, Kenji; Otsuka, Tadahiro; Yoshizato, Kimio; Kuratsu, Jun-ichi

    2014-03-01

    Acute subdural hematoma (ASDH) usually requires emergency surgical decompression, but rare cases exhibit rapid spontaneous resolution. The aim of this retrospective study was to identify factors predictive of spontaneous ASDH resolution. A total of 366 consecutive patients with ASDH treated between January 2006 and September 2012 were identified in our hospital database. Patients with ASDH clot thickness >10mm in the frontoparietotemporal region and showing a midline shift >10mm on the initial computed tomography (CT) scan were divided into two groups according to subsequent spontaneous resolution. Univariate and multivariate logistic regression analyses were used to identify factors predictive of rapid spontaneous ASDH resolution. Fifty-six ASDH patients met study criteria and 18 demonstrated rapid spontaneous resolution (32%). Majority of these patients were not operated because of poor prognosis/condition and in accordance to family wishes. Univariate analysis revealed significant differences in use of antiplatelet agents before head injury and in the incidence of a low-density band between the hematoma and inner wall of the skull bone on the initial CT. Use of antiplatelet agents before head injury (OR 19.6, 95% CI 1.5-260.1, p=0.02) and the low-density band on CT images (OR 40.3, 95% CI 3.1-520.2, p=0.005) were identified as independent predictive factors by multivariate analysis. Our analysis suggested that use of antiplatelet agents before head injury and a low-density band between the hematoma and inner skull bone on CT images (indicative of cerebrospinal fluid infusion into the subdural space) increase the probability of rapid spontaneous resolution. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Acute epidural-like appearance of an encapsulated solid non-organized chronic subdural hematoma.

    PubMed

    Prieto, Ruth; Pascual, José M; Subhi-Issa, Issa; Yus, Miguel

    2010-01-01

    We report the exceptional case of an encapsulated solid non-organized chronic subdural hematoma (SDH) in a 67-year-old woman that was admitted with acute hemiplegia followed by rapid deterioration in consciousness 5 months after a minor head trauma. Computed tomography (CT) showed an extracerebral biconvex shaped hyperdense mass that led to the misdiagnosis of an acute epidural hematoma. Urgent craniotomy revealed an encapsulated mass filled with solid fresh clot in the subdural space. Complete evacuation of this SDH, including both its inner and outer membranes, was achieved, and the patient recovered successfully. Histological analysis confirmed that the content of the hematoma corresponded to a newly formed clot that was enclosed between an inner membrane, composed of two collagen layers, and an outer membrane with a three layered structure. Chronic SDH may seldom present as an encapsulated solid non-organized lesion that consists of a fibrous capsule enclosing a fresh clot and lacking the thick fibrous septations that typically connect the inner and outer membranes of organized chronic SDH. This entity mimics the clinical course and radiological appearance of acute epidural hematomas and should be considered in the differential diagnosis of extracerebral hyperdense biconvex shaped lesions.

  12. A Motion Simulator Ride Associated With Headache and Subdural Hematoma: First Case Report.

    PubMed

    Scranton, Robert A; Evans, Randolph W; Baskin, David S

    2016-02-01

    We report the first case report of symptomatic bilateral subdural hematomas (SDH) associated with riding a centrifugal motion simulator ride. A previously healthy 55-year-old male developed new onset daily headaches 1 week after going on the ride that were due to symptomatic bilateral SDH requiring operative intervention with a full recovery. There was no history of other trauma or other systemic or intracranial abnormality to account for the development of the SDH. We review the headaches and other clinical features associated with chronic SDH. Twelve cases of roller coaster headaches due to SDH associated with riding roller coasters have been reported. The pathophysiology is reviewed, which we believe is the same mechanism that may be responsible in this case. Although it is possible that this neurovascular injury is truly rare, it is also possible that this injury is underreported as patients and physicians may not make the association or physicians have not reported additional cases. The risk of this injury likely increases with age, as the size of the subdural space increases, and may support the maxim that "roller coasters and simulators are for kids." © 2015 American Headache Society.

  13. Spontaneous acute spinal subdural hematoma: spontaneous recovery from severe paraparesis--case report and review.

    PubMed

    Payer, Michael; Agosti, Reto

    2010-11-01

    Spontaneous idiopathic acute spinal subdural hematomas are highly exceptional. Neurological symptoms are usually severe, and rapid diagnosis with MRI is mandatory. Surgical evacuation has frequently been used therapeutically; however, spontaneous recovery in mild cases has also been reported. We present a case of spontaneous recovery from severe paraparesis after spontaneous acute SSDH, and review the English-speaking literature.

  14. Tranexamic Acid for Treatment of Residual Subdural Hematoma After Bedside Twist-Drill Evacuation.

    PubMed

    Tanweer, Omar; Frisoli, Fabio A; Bravate, Crystal; Harrison, Gillian; Pacione, Donato; Kondziolka, Douglas; Huang, Paul P

    2016-07-01

    Management of nonemergent, nonacute subdural hematomas (SDHs) ranges from observation to burr-hole evacuation or craniotomy, but recurrence rates are high. We evaluated the safety and efficacy of tranexamic acid (TXA) for the treatment of residual SDHs after bedside twist-drill evacuation. We performed a retrospective analysis of a prospectively maintained database from November 2013 to November 2014 for all patients who underwent placement of a bedside subdural evacuating port system (SEPS) followed by treatment with oral TXA (650 mg daily). All demographics, evidence of venous thromboembolism, and volumes of pertinent computed tomography were obtained. Twenty subdural hematomas in 14 patients met the inclusion criteria for this study. Most SDHs were mixed density. Mean SDH volume on presentation was 145.96 ± 40.22 cm(3) with a mean midline shift of 9.44 ± 4.84 mm. Mean volumes decreased to 80.00 ± 31.96 cm(3) and midline shift improved to 4.44 ± 3.29 mm after SEPS placement (P < 0.0001 and P = 0.0046). All patients were placed on TXA after their procedure. Mean follow-up with computed tomography was 92.1 ± 27.5 days, and mean SDH volume at last follow-up was 7.41 ± 15.54 cm(3) with a mean midline shift of 0.19 ± 0.69 mm (P < 0.0001 and P = 0.0002). Percent volume reduction was significantly higher after TXA than after SEPS (91.31% vs. 40.74%; P < 0.0001). No increase or delayed recurrence of the SDH was noted during TXA treatment. All but 1 clinical presenting symptom improved at follow-up. No venous thromboembolisms were noted among the patients. In our pilot study, chronic SDH volumes were reduced by 40.74% after SEPS drainage. The residual volume was reduced by an additional 91.31% during oral TXA treatment. No patients developed delayed recurrence or expansion of their SDHs. Further prospective studies are needed to evaluate the role of TXA for adjunctive treatment of chronic SDHs. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Risk factors for reoperation after initial burr hole trephination in chronic subdural hematomas.

    PubMed

    Schwarz, Falko; Loos, Franz; Dünisch, Pedro; Sakr, Yasser; Safatli, Diaa Al; Kalff, Rolf; Ewald, Christian

    2015-11-01

    The optimal management of chronic subdural hematomas remains a challenge. Twist drill craniotomy or burr hole trephination are considered optimal initial treatments, but the reoperation rate for hematoma recurrence and other complications is still high. Therefore, evaluation of possible risk factors for initial treatment failure is crucial. In this context, we performed a study to define a possible subpopulation that may benefit from a more invasive initial treatment regime. We retrospectively reviewed the medical charts of 193 patients with 250 chronic subdural hematomas who had undergone burr hole trephination as first-line therapy in our institution between January 2005 and October 2012. To identify risk factors for reoperation, a multivariable logistic regression analysis was performed with reoperation as the dependent variable. Surgical complications, including acute rebleeding, infection and chronic hematoma recurrence, were analyzed separately using a logistic regression model. The mean age of the cohort was 71.4 years. The male/female ratio was 137:56. Reoperation was necessary in 56 cases (29%) for recurrent hematomas and surgical complications. Predictors for reoperation for surgical complications were midline shift (odds ratio [OR] (per mm) 1.16, 95% confidence interval [CI]: 1.05-1.29, p=0.006), arterial hypertension (OR 5.44, 95% CI: 1.45-20.41, p=0.012) and bilateral hematomas (OR 4.22, 95% CI: 1.22-14.58, p=0.023). There was a trend toward a higher risk of surgically-relevant hematoma recurrence in patients with prior treatment with vitamin K antagonists (OR 1.76, 95% CI: 0.75-4.13, p=0.191). Burr hole trephination is the therapy of choice in most chronic subdural hematomas, but the rate of recurrent hematomas is high. Every hematoma should be treated individually especially in relation to midline-shift and pre-existing conditions. Further prospective studies evaluating types of treatment and hematoma density are needed. Copyright © 2015 Elsevier B

  16. Long-term survival after chronic subdural haematoma.

    PubMed

    Manickam, Appukutty; Marshman, Laurence A G; Johnston, Ross

    2016-12-01

    Outcome after chronic subdural haematoma (CSDH) is invariably assumed favourable: however, little data regarding long term survival (LTS) exists. One study reported excess mortality restricted to year 1, but with expected actuarial rates thereafter. We aimed to determine LTS after CSDH in a retrospective analysis relative to actuarial data from age-matched controls. Data was obtained in n=155, (M:F 97:58, 69.3±2.3years). Follow-up maxima was 14.19years (mean: 4.02±3.07years, median: 5.2years). Mortality in-hospital, at 6months, 1year, 2years and 5years was n=13 (8.39%), n=22 (14.19%), n=31 (20.35%), n=42 (27.1%) and n=54 (34.84%). LTS was significantly worse than controls (5.29±0.59years vs. 17.74±1.8years, hazard ratio [HR]: 3.52, P<0.0001). Death most frequently related to pneumonia/sepsis and ischemic heart disease (IHD). Median modified Rankin score (mRS) in those discharged home (n=94, 60.65%) was 2 [IQR: 1-3]. Discharge mRS in those who died at 6months, 1year, 2years and 5years was 5 [IQR: 3-6], 5 [IQR: 4-6], 3 [IQR: 1-3], 4 [IQR: 2-5]. Discharge mRS was significantly worse with year 1 mortality (P=0.014). LTS related to discharge mRS (HR: 37.006, P<0.001), post-operative motor-score (HR: 0.581, P=0.0026), IHD (HR: 5.186, P=0.005), warfarin-use (HR: 5.93, P=0.036) and dementia (HR: 5.39, P=0.031). No long term recurrences (LTR) were recorded. Although most were discharged home with mRS=2, LTS was markedly less than previously reported: peers lived 12.4years longer. Although greater in year 1, excess mortality was not restricted to year 1, but continued throughout prolonged follow-up. LTS related to discharge disability and dependence, and co-morbid risk factors for cerebral atrophy. No LTR suggests that, once ultimately closed, the 'subdural space' remains closed. CSDH patients represent a vulnerable group who require continued long-term medical surveillance. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  17. A Case of Tranexamic Acid as Adjunctive Treatment for Chronic Subdural Hematoma with Multiple Recurrences

    PubMed Central

    Mikkelsen, Ronni; Anker-Møller, Thorkil; Hvas, Anne-Mette; Sunde, Niels

    2017-01-01

    Patient: Male, 64 Final Diagnosis: Chronic subdural hematoma Symptoms: Aphasia • headache • paresis Medication: — Clinical Procedure: Burr hole evacuation • Tranexamic acid Specialty: Neurosurgery Objective: Unusual clinical course Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that is treated using a cranial burr hole evacuation procedure, but recurrence is common. The use of anticoagulant therapy can increase the risk of developing a recurrent subdural hematoma. We present a challenging case of a patient on long-term anticoagulant therapy following previous aortic and aortic valve surgery who had CSDH with multiple recurrences and was ultimately treated with tranexamic acid as an adjunct to surgery. Case Report: A male patient in his mid-sixties presented with a headache and bilateral CSDH. Apart from a mechanical heart valve, he was otherwise healthy. A standard burr hole evacuation was performed, but the left hematoma and symptoms recurred after three months, and he presented with additional symptoms of aphasia and right-hand weakness. He had an additional three procedures followed by recurrences over a period of six weeks. Following his fifth and final surgical procedure, he was given postoperative intravenous tranexamic acid 10 mg/kg four times during the first 24 hours with dalteparin sodium 9,500 international units (IU) twice daily. His symptoms resolved, and after nine months he had no residual hematoma, and no thromboembolic complications occurred. Conclusions: This case has demonstrated that tranexamic acid can be used as an adjunctive treatment to surgery when dealing with recurring CSDH, even in patients who require concomitant anticoagulant therapy. Although clinical trials are underway to evaluate tranexamic acid as a medical treatment for CSDH, this case report may support further studies that include patients with risk factors for thromboembolic disease. PMID:28912416

  18. Paradoxical Brain Herniation After Decompressive Craniectomy Provoked by Drainage of Subdural Hygroma.

    PubMed

    Nasi, Davide; Dobran, Mauro; Iacoangeli, Maurizio; Di Somma, Lucia; Gladi, Maurizio; Scerrati, Massimo

    2016-07-01

    Paradoxical brain herniation (PBH) is a rare and potentially life-threatening complication of decompressive craniectomy (DC) and results from the combined effects of brain gravity, atmospheric pressure and intracranial hypotension causing herniation in the direction opposite to the site of the DC with subsequent brainstem compression. To date, the cases of PBH reported in literature are spontaneous or provoked by a lumbar puncture, a cerebrospinal fluid (CSF) shunt, or ventriculostomy. We present an uncommon case of PBH provoked by percutaneous drainage of a huge subdural hygroma (SH) ipsilateral to the decompressive craniectomy causing mass effect and neurologic deterioration. After percutaneous evacuation of SH, the patient became unresponsive with dilated and fixed left pupil. A brain computed tomography scan showed marked midline shift in the direction opposite to the craniectomy site with subfalcine herniation and effacement of the peripontine cisterns. Paradoxical brain herniation (PBH) was diagnosed. Conservative treatment failed, and the patient required an emergency cranioplasty for reverse PBH. The present case highlights the possibility that all forms of CSF depletion, including percutaneous drainage of subdural CSF collection and not only CSF shunting and/or lumbar puncture, can be dangerous for patients with large craniotomies and result in PBH. Moreover, an emergency cranioplasty could represent a safe and effective procedure in patients not responding to conservative treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Challenging the Pathophysiologic Connection between Subdural Hematoma, Retinal Hemorrhage and Shaken Baby Syndrome

    PubMed Central

    Gabaeff, Steven C.

    2011-01-01

    Child abuse experts use diagnostic findings of subdural hematoma and retinal hemorrhages as near-pathognomonic findings to diagnose shaken baby syndrome. This article reviews the origin of this link and casts serious doubt on the specificity of the pathophysiologic connection. The forces required to cause brain injury were derived from an experiment of high velocity impacts on monkeys, that generated forces far above those which might occur with a shaking mechanism. These forces, if present, would invariably cause neck trauma, which is conspicuously absent in most babies allegedly injured by shaking. Subdural hematoma may also be the result of common birth trauma, complicated by prenatal vitamin D deficiency, which also contributes to the appearance of long bone fractures commonly associated with child abuse. Retinal hemorrhage is a non-specific finding that occurs with many causes of increased intracranial pressure, including infection and hypoxic brain injury. The evidence challenging these connections should prompt emergency physicians and others who care for children to consider a broad differential diagnosis before settling on occult shaking as the de-facto cause. While childhood non-accidental trauma is certainly a serious problem, the wide exposure of this information may have the potential to exonerate some innocent care-givers who have been convicted, or may be accused, of child abuse. PMID:21691518

  20. Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report.

    PubMed

    Tropeano, Maria Pia; La Pira, Biagia; Pescatori, Lorenzo; Piccirilli, Manolo

    2017-08-16

    Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky.

  1. Vertebroplasty and delayed subdural cauda equina hematoma: Review of literature and case report

    PubMed Central

    Tropeano, Maria Pia; La Pira, Biagia; Pescatori, Lorenzo; Piccirilli, Manolo

    2017-01-01

    Vertebroplasy is considered an alternative and effective treatment of painful oncologic spine disease. Major complications are very rare, but with high morbidity and occur in less than 1% of patients who undergo vertebroplasty. Spinal subdural hematoma (SDH) is an extremely rare complication, usual developing within 12 h to 24 h after the procedure. We report the case of a tardive SDH in an oncologic patient who underwent VP for Myxoid Liposarcoma metastasis. Trying to explain the pathogenesis, we support the hypothesis that both venous congestion of the vertebral venous plexus of the vertebral body and venous congestion due to a traumatic injury can provoke SDH. To our best knowledge, only 4 cases of spinal subdural hematoma following a transpedicular vertebroplasty have been previously described in International literature and only one of them occurred two weeks after that surgical procedures. Percutaneous verteboplasty is a well-known treatment of pain oncologic spine disease, used to provide pain relief and improvement of quality life and is considered a simple surgical procedure, involving a low risk of complications, but related to high morbidity, such as SDH. Therefore it has to be performed by experienced and skilled surgeons, that should also recognize possible risk factors, making SDH more risky. PMID:28868305

  2. [Rapid resolution of acute subdural haematoma with significant impact on clinical outcome].

    PubMed

    Capion, Tenna; Lilja-Cyron, Alexander; Kelsen, Jesper

    2017-09-04

    A 73-year-old woman was admitted to hospital due to anaemia. She suffered a minor head trauma and deteriorated to deep unconsciousness. A CT revealed an acute subdural haematoma (ASDH). Initially, she was not found to be a candidate for neurosurgical intervention, but within 24 hours her level of consciousness improved dramatically, and a renewed CT showed resolution of the ASDH. She underwent acute craniotomy with good outcome. This illustrates the importance of re-evaluation of patients with intracranial haemorrhage.

  3. Shedding new light on rapidly resolving traumatic acute subdural hematomas.

    PubMed

    Brooke, Magdalene; Patel, Atul; Castro-Moure, Federico; Victorino, Gregory P

    2017-11-01

    Rapidly resolving acute subdural hematomas (RRASDHs) have been described in case reports and case series but are still poorly understood. We hypothesized that a cohort analysis would confirm previously reported predictors of RRASDH including coagulopathy, additional intracranial hemorrhage, and low-density band on imaging. We also hypothesized that rapid resolution would be associated with improved trauma outcomes. We reviewed all nonoperative acute subdural hematomas (ASDHs) treated at our center from 2011 to 2015. Inclusion criteria were ASDH on computed tomography (CT), admission Glasgow coma score >7, and repeat CT to evaluate ASDH change. RRASDH was defined as reduced hematoma thickness by 50% within 72 h. Clinical data, CT findings, and trauma end points were analyzed for the RRASDH and nonresolving groups. There were 154 ASDH patients included, with 29 cases of RRASDH. The RRASDH group had a lower rate of comorbidities than the nonresolving group (58.6% versus 78.4%, P = 0.03) and a lower rate of prehospital anticoagulation (7.7% versus 37.1%, P = 0.004). Previously reported predictors of RRASDH did not differ between the groups, nor did any clinical outcome measures. When compared with patients who experienced rapid growth (>50% increased width in 72 h), the RRASDH group had lower mortality (3.4% versus 23.5%, P = 0.04). To our knowledge, this is the largest review of RRASDHs. We identified two previously unrecognized factors that may predict resolution; however, previously reported predictors were not associated with resolution. We also found no relationship between RRASDHs and improved standard trauma outcomes, calling into question the clinical significance of RRASDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Effects of Dexamethasone in the Treatment of Recurrent Chronic Subdural Hematoma.

    PubMed

    Zhang, Yu; Chen, Shiping; Xiao, Yangchun; Tang, Wenhua

    2017-09-01

    Recurrent chronic subdural hematoma (CSDH) is not rare. Some studies have demonstrated the role of dexamethasone in the medical management of chronic subdural hematoma. However, no systematic study in the treatment of recurrent CSDH has been published. The aim of our study is to evaluate the efficacy and safety of dexamethasone in patients with recurrent CSDH. We retrospectively reviewed medical records of consecutive patients from July 2010 to September 2014. A total of 27 patients with symptomatic recurrent CSDH were included in the analysis. Follow-up for each patient consisted of computed tomography or magnetic resonance imaging every 28 days from admission to the resolution of hematoma. Data were collected on hematoma volume, complications, and outcome. Among the 27 patients, 3 patients with recurrent CSDH were only treated by burr hole surgery. Of the other 24 patients who primarily underwent dexamethasone treatment, 17 (70.8%) patients were treated successfully with medical treatment, whereas 7 patients required reoperation. Complications were noted in 3 (12.5%) patients (1 hyperglycemia, 1 urinary tract infection, and 1 pneumonia). There was 1 mortality (4.2%) for massive brain infarction. Twenty-one of the 24 patients (87.5%) recovered to their previous functional levels. There was no statistical significance in Fisher text between surgery and dexamethasone regarding success, complication, and functional recovery rate. Patients with recurrent CSDH can be treated successfully and safely with the nonsurgical medical treatment of dexamethasone. By use of this method, reoperation may be avoided. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Factors predicting recurrence of chronic subdural haematoma: the influence of intraoperative irrigation and low-molecular-weight heparin thromboprophylaxis.

    PubMed

    Tahsim-Oglou, Yasemin; Beseoglu, Kerim; Hänggi, Daniel; Stummer, Walter; Steiger, Hans-Jakob

    2012-06-01

    Burr-hole drainage has become the accepted treatment of choice for chronic subdural haematoma (cSDH), although still burdened with a major recurrence rate. The current analysis was initiated to determine management-related risk factors for recurrence, i.e. postoperative low-molecular-weight heparin thromboprophylaxis, and the importance of rinsing the subdural space. Two-hundred and forty-seven patients with computerised tomography (CT) defined symptomatic cSDH were managed by two burr-hole trepanations and drainage between January 2005 and November 2008. Postoperative thromboprophylaxis with 40 mg enoxaparine daily was given only during the first half of the study period. For the current analysis the amount of rinsing fluid, postoperative low-dose thromboprophylaxis, as well as age and gender, bilaterality, preoperative and postoperative blood coagulation studies, platelet counts and decrease of subdural fluid on early postoperative CT, were recorded and correlated with recurrence. Statistical calculation was done by univariate and multivariate analysis. A total of 62 of 247 patients needed revision surgery for recurrence (25.1 %). Recurrence rates were significantly lower in the patients treated without postoperative enoxaparine (18.84 %) than in the group with postoperative low-dose enoxaparine thromboprophylaxis (32.11 %) and enoxaparine was administered in a higher proportion of the patients suffering recurrence (P = 0.013). A median intraoperative irrigation volume of 863 ml saline was used in the patients suffering recurrence and 1,500 ml in patients without recurrence (P < 0.001). The median age was slightly higher in the patients suffering from recurrence. Male gender predominated in both groups but was slightly more pronounced in the recurrence group. Preoperative and postoperative platelet counts and plasmatic coagulation indices did not differ significantly between the groups. Relative residual subdural fluid collection on early postoperative CT

  6. Spinal Subdural Abscess Following Laminectomy for Symptomatic Stenosis: A Report of 2 Cases and Review of the Literature.

    PubMed

    Ramos, Alexander D; Rolston, John D; Gauger, Grant E; Larson, Paul S

    2016-07-12

    BACKGROUND Spinal subdural abscesses, also known as empyemas, are rare infectious lesions, the exact incidence of which is unknown. Presentation is typically dramatic, with back pain, fever, motor, and sensory deficits. Rapid identification and surgical intervention with laminectomy, durotomy, and washout provides the best outcomes. While hematogenous spread of an extra-spinal infection is the most common cause of this condition, a significant number of cases result from iatrogenic mechanisms, including lumbar punctures, epidural injections, and surgery. CASE REPORT Here we present 2 cases: 1) an 87-year-old man with type 2 diabetes, schizophrenia, mild cognitive impairment, and symptomatic lumbar spinal stenosis and 2) a 62-year-old man with a prior L3-4 spinal fusion with symptomatic lumbar spinal stenosis. In both cases, patients underwent laminectomy for spinal stenosis and developed epidural abscess. Following successful drainage of the epidural abscess, they continued to be symptomatic, and repeat imaging revealed the presence of a subdural abscess that was subsequently evacuated. Case 1 had significant improvement with residual lower-extremity weakness, while Case 2 made a complete neurological recovery. CONCLUSIONS These cases illustrate patients at increased risk for developing this rare spinal infection, and demonstrate that rapid recognition and surgical treatment is key to cure and recovery. Review of the literature highlights pertinent risk factors and demonstrates nearly one-third of reported cases have an iatrogenic etiology. The cases presented here demonstrate that a subdural process should be suspected in any patient with intractable pain following treatment of an epidural abscess.

  7. Complications of invasive video-EEG monitoring with subdural grid electrodes.

    PubMed

    Hamer, H M; Morris, H H; Mascha, E J; Karafa, M T; Bingaman, W E; Bej, M D; Burgess, R C; Dinner, D S; Foldvary, N R; Hahn, J F; Kotagal, P; Najm, I; Wyllie, E; Lüders, H O

    2002-01-08

    To evaluate the risk factors, type, and frequency of complications during video-EEG monitoring with subdural grid electrodes. The authors retrospectively reviewed the records of all patients who underwent invasive monitoring with subdural grid electrodes (n = 198 monitoring sessions on 187 patients; median age: 24 years; range: 1 to 50 years) at the Cleveland Clinic Foundation from 1980 to 1997. From 1980 to 1997, the complication rate decreased (p = 0.003). In the last 5 years, 19/99 patients (19%) had complications, including two patients (2%) with permanent sequelae. In the last 3 years, the complication rate was 13.5% (n = 5/37) without permanent deficits. Overall, complications occurred during 52 monitoring sessions (26.3%): infection (n = 24; 12.1%), transient neurologic deficit (n = 22; 11.1%), epidural hematoma (n = 5; 2.5%), increased intracranial pressure (n = 5; 2.5%), and infarction (n = 3; 1.5%). One patient (0.5%) died during grid insertion. Complication occurrence was associated with greater number of grids/electrodes (p = 0.021/p = 0.052; especially >60 electrodes), longer duration of monitoring (p = 0.004; especially >10 days), older age of the patient (p = 0.005), left-sided grid insertion (p = 0.01), and burr holes in addition to the craniotomy (p = 0.022). No association with complications was found for number of seizures, IQ, anticonvulsants, or grid localization. Invasive monitoring with grid electrodes was associated with significant complications. Most of them were transient. Increased complication rates were related to left-sided grid insertion and longer monitoring with a greater number of electrodes (especially more than 60 electrodes). Improvements in grid technology, surgical technique, and postoperative care resulted in significant reductions in the complication rate.

  8. Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment.

    PubMed

    Balevi, Mustafa

    2017-01-01

    The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance - mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24-72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients ( n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Large craniotomy and extended membrane excision for OSDH

  9. Acute Subdural Hematoma and Subarachnoid Hemorrhage Caused by Ruptured Cortical Artery Aneurysm: Case Report and Review of Literature

    PubMed Central

    Shekarchizadeh, Ahmad; Masih, Saburi; Reza, Pourkhalili; Seif, Bahram

    2017-01-01

    The present report describes an acute subdural hematoma (ASDH) associated with subarachnoid hemorrhage (SAH), due to ruptured cortical aneurysm. To our knowledge, extremely rare cases of this sort have been reported so far. A 23-year-old male patient without previous trauma presented with severe headache and rapidly decreasing level of consciousness to decerebrate status. Computed tomography (CT) scan has demonstrated an ASDH together with SAH. Hematoma has immediately been evacuated without any evaluation by angiography. After evacuation of the thick subdural clot, a 10-mm aneurysm was revealed on a precentral artery of frontal cortex, which was ligated. However, after 35 days the patient discharged with left side hemiparesis and dysphasia, and just after several months of admission he got symptom free. Ruptured cortical aneurysm should be considered as one of the causes of spontaneous ASDH. Vascular anomaly investigations are suggested for these cases, thus CT angiography or digital subtraction angiography has to be considered if clinical condition allows. PMID:28503501

  10. Life-threatening subdural hematoma after aortic valve replacement in a patient with Heyde syndrome: a case report.

    PubMed

    Uchida, Tetsuro; Hamasaki, Azumi; Ohba, Eiichi; Yamashita, Atsushi; Hayashi, Jun; Sadahiro, Mitsuaki

    2017-08-08

    Heyde syndrome is known as a triad of calcific aortic stenosis, anemia due to gastrointestinal bleeding from angiodysplasia, and acquired type 2A von Willebrand disease. This acquired hemorrhagic disorder is characterized by the loss of the large von Willebrand factor multimers due to the shear stress across the diseased aortic valve. The most frequently observed type of bleeding in these patients is mucosal or skin bleeding, such as epistaxis, followed by gastrointestinal bleeding. On the other hand, intracranial hemorrhage complicating Heyde syndrome is extremely rare. A 77-year-old woman presented to our hospital with severe aortic stenosis and severe anemia due to gastrointestinal bleeding and was diagnosed with Heyde syndrome. Although aortic valve replacement was performed without recurrent gastrointestinal bleeding, postoperative life-threatening acute subdural hematoma occurred with a marked midline shift. Despite prompt surgical evacuation of the hematoma, she did not recover consciousness and she died 1 month after the operation. Postoperative subdural hematoma is rare, but it should be kept in mind as a devastating hemorrhagic complication, especially in patients with Heyde syndrome.

  11. Effects of atorvastatin on chronic subdural hematoma

    PubMed Central

    Qiu, Sheng; Zhuo, Wang; Sun, Chunming; Su, Zhongzhou; Yan, Ai; Shen, Liang

    2017-01-01

    Abstract Background: The high recurrent rate of chronic subdural hematoma (CSDH) has consistently confused the neurosurgeons, and the role of atorvastatin in the management of CSDH has remained unclear over past decade, and atorvastatin seems to be a safe and cost-effective treatment to CSDH. Therefore, it is necessary to conduct a systematic review to discuss the effect of atorvastatin in CSDH. Method: We searched the PubMed, EMBASE, Cochrane Library, and the China Biology Medicine disc, up to March 2017, for published studies on the effects of atorvastatin in the management of CSDH, and reviewers performed a brief qualitative descriptive analysis of atorvastatin's efficacy in the management of CSDH. Results: Three eligible studies were included in this systematic review. Results indicated that atorvastatin accelerated hematoma absorption, decreased recurrence risk, and surgical requirement. Conclusion: Limited evidence suggests that oral atorvastatin may be beneficial in the management of CSDH. Further high-quality studies focused on dosage, duration, hematoma size are needed to further elucidate the role of atorvastatin in the management of CSDH. PMID:28658127

  12. Traumatic acute subdural haematomas of the posterior fossa: clinicoradiological analysis of 24 patients.

    PubMed

    d'Avella, D; Servadei, F; Scerrati, M; Tomei, G; Brambilla, G; Massaro, F; Stefini, R; Cristofori, L; Conti, A; Cardali, S; Tomasello, F

    2003-12-01

    We report 24 patients with a traumatic acute subdural haematoma of the posterior fossa managed between 1997 and 1999 at 8 Italian neurosurgical centres. Each centre provided data about patients' clinico-radiological findings, management, and outcomes, which were retrospectively reviewed. A poor result occurred in 14 patients (58.3%). Ten patients (41.7%) had favourable results. Patients were divided into two groups according to their admission Glasgow Coma Scale (GCS) scores. In Group 1 (12/24 cases; GCS score, > or =8), the outcome was favourable in 75% of cases. In Group 2 (12/12 cases; GCS score, <8), the outcome was poor in 91.6% of cases. Nineteen patients underwent posterior fossa surgery. Factors correlating to outcome were GCS score, status of the basal cisterns and the fourth ventricle, and the presence of supratentorial hydrocephalus. Multivariate analysis showed significant independent prognostic effect only for GCS score (P<0.05). acute posterior fossa subdural haematomas can be divided into two distinct groups: those patients admitted in a comatose state and those with a moderate/mild head injury on admission. Comatose patients present usually with signs of posterior fossa mass effect and have a high percentage of bad outcomes. On the contrary, patients admitted with a GCS of 8 or higher are expected to recover. In these patients the thickness of the haematoma (<1 cm) seems to be a guide to indicate surgical evacuation of the haematoma.

  13. Comparison between UBV- and RGU-photometrically determined density functions for the photometric disk and halo and between the corresponding mean isodensity behaviour in the halo close to the galactic north-pole (SA 57)

    NASA Astrophysics Data System (ADS)

    Fenkart, R.; Esin-Yilmaz, F.

    1985-10-01

    SA 57, RG U-photometrically treated by Fenkart (1967), is the third field of the Basle Halo Program (BHP) we investigate by applying the RG U-methods for the separation of the (photometric) populations disk and halo and for the determination of their space densities analogously in UBV in order to compare the results independently obtained in both systems. Figures 1 and 2 give the V- and G-fractioned two-colour diagrams of the same 1179 stars treated in UBV and RG U, respectively. On their basis, the logarithmic space density functions of both populations have been calculated for the overall (3m to 8m ) and for the 1m -intervals absolute magnitudes M(V) and M(G). They are tabulated in tables II and III and plotted in figures 3 and 4, respectively (a : disk, b : halo). The overall density functions for the disk and for the halo are compared between the systems in figures Sa and b, respectively. The mean misidentification-rate per system (MMRS) is 7.3 %, lying between the ones for SA 54(9.2 %) and for SA 82(4.5 %) (Fenkart and Esin-Yilmaz, 1983 and 1984, respectively) and close to the mean for all three investigations (7.0 ± 2.4 %) The direction to SA 57 lies almost in the middle of the sector of the northern galactic meridian which is limited by the directions to SA 54 and to SA 82. Our results permit, together with the ones obtained in these limiting directions, the comparison of the mean isodensity-patterns obtained in both systems within this sector. They are completely parallel and blend in perfectly with the mean (RG U-) isodensity-pattern of the - partly overlapping - sector between SA 51 and SA 57 obtained by Fenkart and Karaall (1984) (Fig. 6). The appendices describe shortly the involved methods (A) and refer to related work by other authors in the direction to the galactic north-pole (B).

  14. Organized Chronic Subdural Hematomas Treated by Large Craniotomy with Extended Membranectomy as the Initial Treatment

    PubMed Central

    Balevi, Mustafa

    2017-01-01

    Objective: The aim of this retrospective study is to evaluate the efficacy and incidence of complications of craniotomy and membranectomy in elderly patients for the treatment of organized chronic subdural hematoma (OCSH). Materials and Methods: We retrospectively reviewed a series of 28 consecutive patients suffering from OCSH, diagnosed by magnetic resonance imaging (MRI) or computer tomography (CT) to establish the degree of organization and determine the intrahematomal architecture including inner membrane ossification. The indication to perform a primary enlarged craniotomy as initial treatment for nonliquefied OCSH with multilayer loculations was based on the hematoma MRI appearance – mostly hyperintense in both T1- and T2-weighted images with a hypointense web- or net-like structure within the hematoma cavity or inner membrane calcification CT appearance - hyperdense. These cases have been treated by a large craniotomy with extended membranectomy as the initial treatment. However, the technique of a burr hole with closed system drainage for 24–72 h was chosen for cases of nonseptated and mostly liquefied Chronic Subdural Hematoma (CSDH). Results: Between 1998 and 2015, 148 consecutive patients were surgically treated for CSDH at our institution. Of these, 28 patients which have OSDH underwent a large craniotomy with extended membranectomy as the initial treatment. The average age of the patients was 69 (69.4 ± 12.1). Tension pneumocephalus (TP) has occurred in 22.8% of these patients (n = 28). Recurring subdural hemorrhage (RSH) in the operation area has occurred in 11.9% of these patients in the first 24 h. TP with RSH was seen in 4 of 8 TP patients (50%). Large epidural air was seen in one case. Postoperative seizures requiring medical therapy occurred in 25% of our patients. The average stay in the department of neurosurgery was 11 days, ranging from 7 to 28 days. Four patients died within 28 days after surgery; mortality rate was 14.28%. Conclusion

  15. Effects of an alveolar recruitment maneuver on subdural pressure, brain swelling, and mean arterial pressure in patients undergoing supratentorial tumour resection: a randomized crossover study.

    PubMed

    Flexman, Alana M; Gooderham, Peter A; Griesdale, Donald E; Argue, Ruth; Toyota, Brian

    2017-06-01

    Although recruitment maneuvers have been advocated as part of a lung protective ventilation strategy, their effects on cerebral physiology during elective neurosurgery are unknown. Our objectives were to determine the effects of an alveolar recruitment maneuver on subdural pressure (SDP), brain relaxation score (BRS), and cerebral perfusion pressure among patients undergoing supratentorial tumour resection. In this prospective crossover study, patients scheduled for resection of a supratentorial brain tumour were randomized to undergo either a recruitment maneuver (30 cm of water for 30 sec) or a "sham" maneuver (5 cm of water for 30 sec), followed by the alternative intervention after a 90-sec equilibration period. Subdural pressure was measured through a dural perforation following opening of the cranium. Subdural pressure and mean arterial pressure (MAP) were recorded continuously. The blinded neurosurgeon provided a BRS at baseline and at the end of each intervention. During each treatment, the changes in SDP, BRS, and MAP were compared. Twenty-one patients underwent the study procedure. The increase in SDP was higher during the recruitment maneuver than during the sham maneuver (difference, 3.9 mmHg; 95% confidence interval [CI], 2.2 to 5.6; P < 0.001). Mean arterial pressure decreased further in the recruitment maneuver than in the sham maneuver (difference, -9.0 mmHg; 95% CI, -12.5 to -5.6; P < 0.001). Cerebral perfusion pressure decreased 14 mmHg (95% CI, 4 to 24) during the recruitment maneuver. The BRS did not change with either maneuver. Our results suggest that recruitment maneuvers increase subdural pressure and reduce cerebral perfusion pressure, although the clinical importance of these findings is thus far unknown. This trial was registered with ClinicalTrials.gov, NCT02093117.

  16. Dengue fever with diffuse cerebral hemorrhages, subdural hematoma and cranial diabetes insipidus.

    PubMed

    Jayasinghe, Nayomi Shermila; Thalagala, Eranga; Wattegama, Milanka; Thirumavalavan, Kanapathipillai

    2016-05-10

    Neurological manifestations in dengue fever occur in <1 % of the patients and known to be due to multisystem dysfunction secondary to vascular leakage. Occurrence of wide spread cerebral haemorrhages with subdural hematoma during the leakage phase without profound thrombocytopenia and occurrence of cranial diabetes insipidus are extremely rare and had not been reported in published literature earlier, thus we report the first case. A 24 year old previously healthy lady was admitted on third day of fever with thrombocytopenia. Critical phase started on fifth day with evidence of pleural effusion and moderate ascites. Thirty one hours into critical phase she developed headache, altered level of consciousness, limb rigidity and respiratory depression without definite seizures. Non-contrast CT brain done at tertiary care level revealed diffuse intracranial haemorrhages and sub arachnoid haemorrhages in right frontal, parietal, occipital lobes and brainstem, cerebral oedema with an acute subdural hematoma in right temporo- parietal region. Her platelet count was 40,000 at this time with signs of vascular leakage. She was intubated and ventilated with supportive care. Later on she developed features of cranial diabetes insipidus and it responded to intranasal desmopressin therapy. In spite of above measures signs of brainstem herniation developed and she succumbed to the illness on day 8. Dengue was confirmed serologically. Exact pathophysiological mechanism of diffuse cerebral haemorrhages without profound thrombocytopenia is not well understood. Increased awareness and high degree of clinical suspicion is needed among clinicians for timely diagnosis of this extremely rare complication of dengue fever. We postulate that immunological mechanisms may play a role in pathogenesis. However further comprehensive research and studies are needed to understand the pathophysiological mechanisms leading to this complication.

  17. Delayed Retroclival and Cervical Spinal Subdural Hematoma Complicated by Preexisting Chiari Malformation in Adult Trauma Patient.

    PubMed

    Nguyen, Ha Son; Choi, Hoon; Kurpad, Shekar; Soliman, Hesham

    2017-09-01

    Traumatic spinal subdural hematoma involving the retroclival region and upper cervical spine is a rare pathology. To our knowledge, there have only been 2 prior cases in an adult trauma patient. We describe a patient with preexisting Chiari 1 malformation, who recently sustained a unilateral type 1 occipital condyle fracture with associated disruption of the tectorial membrane and transverse ligament, which returned with a retroclival subdural hematoma extending down to C7, causing spinal cord compression and symptomatic obstructive hydrocephalus. A 30-year-old female sustained a motor vehicle collision. Computed tomography C spine revealed a type I occipital condyle fracture. Magnetic resonance imaging C spine demonstrated disruption of the tectorial membrane and avulsion of the transverse ligament at its attachment to the left C1 tubercle; moreover, there was a Chiari 1 malformation. The patient was neurologically intact. A halo was recommended, but the patient opted for an aspen collar with close management. She was discharged but returned 3 days later with apneic episodes, along with bradycardia and hypertension. She was promptly intubated. Computed tomography head showed interval ventricular enlargement. Magnetic resonance imaging C spine revealed a new ventral hematoma spanning the retroclival region to C7, most pronounced at C2-C3. On examination, she opened her eyes to pain, her pupils were equal and reactive, and she withdrew in all extremities. An external ventricular drain was emergently placed. She underwent a suboccipital craniectomy, C1-3 laminectomies, and occiput-C4 instrumented fusion. The dura was significantly tense, and no epidural hematoma was observed during lateral exploration. Postoperatively, she woke up well, exhibiting a nonfocal neurologic examination. A diagnostic angiogram was negative. She was extubated uneventfully, and the external ventricular drain was weaned off in 4 days. Traumatic spinal subdural hematoma involving both the

  18. Treatment of chronic subdural hematomas with subdural evacuating port system placement in the intensive care unit: evolution of practice and comparison with bur hole evacuation in the operating room.

    PubMed

    Flint, Alexander C; Chan, Sheila L; Rao, Vivek A; Efron, Allen D; Kalani, Maziyar A; Sheridan, William F

    2017-12-01

    OBJECTIVE The aims of this study were to evaluate a multiyear experience with subdural evacuating port system (SEPS) placement for chronic subdural hematoma (cSDH) in the intensive care unit at a tertiary neurosurgical center and to compare SEPS placement with bur hole evacuation in the operating room. METHODS All cases of cSDH evacuation were captured over a 7-year period at a tertiary neurosurgical center within an integrated health care delivery system. The authors compared the performance characteristics of SEPS and bur hole placement with respect to recurrence rates, change in recurrence rates over time, complications, length of stay, discharge disposition, and mortality rates. RESULTS A total of 371 SEPS cases and 659 bur hole cases were performed (n = 1030). The use of bedside SEPS placement for cSDH treatment increased over the 7-year period, from 14% to 80% of cases. Reoperation within 6 months was higher for the SEPS (15.6%) than for bur hole drainage (9.1%) across the full 7-year period (p = 0.002). This observed overall difference was due to a higher rate of reoperation during the same hospitalization (7.0% for SEPS vs 3.2% for bur hole; p = 0.008). Over time, as the SEPS procedure became more common and modifications of the SEPS technique were introduced, the rate of in-hospital reoperation after SEPS decreased to 3.3% (p = 0.02 for trend), and the difference between SEPS and bur hole recurrence was no longer significant (p = 0.70). Complications were uncommon and were similar between the groups. CONCLUSIONS Overall performance characteristics of bedside SEPS and bur hole drainage in the operating room were similar. Modifications to the SEPS technique over time were associated with a reduced reoperation rate.

  19. A closed system irrigation & drainage technique for surgical evacuation of chronic subdural haematomas

    PubMed Central

    Kareem, Haider; Adams, Hadie

    2018-01-01

    Background: Chronic subdural haematoma (CSDH), is a common neurosurgical disorder that is associated with morbidity and mortality affecting the ageing population. The aim is to present the treatment experience of CSDH patients treated with a technique that combines the classical single burr-hole irrigation and the continuous closed system drainage: The closed system irrigation & drainage (CSID) technique. Methods: The cases undergoing CSDH evacuation with the CSID method were captured over a 4-year period at a tertiary neurosurgical centre. The authors describe the performance of this methods with respect to post-operative clinical and radiological features, including recurrence rates, complications, and length of stay. Results: A total of 36 cases undergoing 42 CSID procedures (30 unilateral and 6 bilateral CSDHs) were performed, in cases ranging between 55-95 years old (median age 79 years). The rate of recurrence or significant ruminant blood in the subdural space on post-operative imaging was 11% (n=4). No cases of pneumocephalus were observed in this series (n=0). The mean (SD) skin-to-skin time for this procedure was 13.4 (4.4) minutes, with a mean (SD) length of stay of 4 (1.9) days. Conclusion: We conclude that the one burr-hole closed system irrigation and drainage technique with a sub-periosteal drain seems to be a simple, effective and safe procedure for treatment of CSDH. It’s well tolerated under local anaesthesia for patients with high co-morbidities and these preliminary results indicated it may potentially be a better option for treatment of CSDH with a lower rate of post-operative complications. PMID:29904602

  20. Pathophysiology and Nonsurgical Treatment of Chronic Subdural Hematoma: From Past to Present to Future.

    PubMed

    Holl, Dana C; Volovici, Victor; Dirven, Clemens M F; Peul, Wilco C; van Kooten, Fop; Jellema, Korné; van der Gaag, Niels A; Miah, Ishita P; Kho, Kuan H; den Hertog, Heleen M; Lingsma, Hester F; Dammers, Ruben

    2018-05-14

    Chronic subdural hematoma (CSDH) is one of the more frequent pathologic entities in daily neurosurgical practice. Historically, CSDH was considered progressive recurrent bleeding with a traumatic cause. However, recent evidence has suggested a complex intertwined pathway of inflammation, angiogenesis, local coagulopathy, recurrent microbleeds, and exudates. The aim of the present review is to collect existing data on pathophysiology of CSDH to direct further research questions aiming to optimize treatment for the individual patient. We performed a thorough literature search in PubMed, Ovid, EMBASE, CINAHL, and Google scholar, focusing on any aspect of the pathophysiology and nonsurgical treatment of CSDH. After a (minor) traumatic event, the dural border cell layer tears, which leads to the extravasation of cerebrospinal fluid and blood in the subdural space. A cascade of inflammation, impaired coagulation, fibrinolysis, and angiogenesis is set in motion. The most commonly used treatment is surgical drainage. However, because of the pathophysiologic mechanisms, the mortality and high morbidity associated with surgical drainage, drug therapy (dexamethasone, atorvastatin, tranexamic acid, or angiotensin-converting enzyme inhibitors) might be a beneficial alternative in many patients with CSDH. Based on pathophysiologic mechanisms, animal experiments, and small patient studies, medical treatment may play a role in the treatment of CSDH. There is a lack of level I evidence in the nonsurgical treatment of CSDH. Therefore, randomized controlled trials, currently lacking, are needed to assess which treatment is most effective in each individual patient. Copyright © 2018 The Author(s). Published by Elsevier Inc. All rights reserved.

  1. Active extravasation of gadolinium-based contrast agent into the subdural space following lumbar puncture.

    PubMed

    Kothari, Pranay D; Hanser, Evelyn M; Wang, Harrison; Farid, Nikdokht

    2016-01-01

    A 38year-old male presented with cauda equina syndrome following multiple lumbar puncture attempts. Lumbar spine magnetic resonance imaging (MRI) showed a subdural hematoma and an area of apparent contrast enhancement in the spinal canal on sagittal post-contrast images. Axial post-contrast images obtained seven minutes later demonstrated an increase in size and change in shape of the region of apparent contrast enhancement, indicating active extravasation of the contrast agent. This is the first reported case of active extravasation of gadolinium-based contrast agent in the spine. Copyright © 2016 Elsevier Inc. All rights reserved.

  2. The subdural evacuation port system: outcomes from a single institution experience and predictors of success.

    PubMed

    Neal, Matthew T; Hsu, Wesley; Urban, Jillian E; Angelo, Nicole M; Sweasey, Thomas A; Branch, Charles L

    2013-06-01

    Numerous surgical options for treatment of chronic subdural hematomas (cSDH) exist. Several reports have examined the Subdural Evacuating Port System (SEPS), a variation of the twist drill craniotomy (TDC) technique. Although high success rates have been reported, a significant portion of patients treated with SEPS fail and require additional procedures. This report examines the largest single institution experience with the SEPS and explores patient and imaging characteristics associated with successful procedures. A retrospective chart review was performed to identify all patients who have undergone SEPS drainage of cSDH. Demographic and radiographic characteristics were evaluated. Demographic data included patient's age, sex, presenting symptoms, pre-procedural GCS score, and use of anticoagulation or antiplatelet agents. The volume of drainage per procedure and radiographic data including laterality, density, and maximal diameter of the collection, presence of septations, midline shift, resolution of the collection 3 weeks post procedure, and measurements to assess atrophy were collected. Total length of stay and time in the intensive care unit was also recorded. Results were classified as a success or failure based on the need for additional procedures including craniotomy or burr hole craniotomy in the operating room. Patients treated with two SEPS procedures during the same hospitalization and no other procedures were included in the success group for statistical analyses. 171 subdural collections were treated in 159 patients (147 unilateral and 12 bilateral). One hundred thirty three collections (77.8%) were successfully drained. In a comparison of the success and failure groups, there were no statistically significant differences (p<0.05) in the patients' mean age, sex, presenting Glasgow Coma Scale score, coagulation profile, presenting symptoms (except altered mental status and language disturbance), subdural diameter or laterality, midline shift

  3. A preliminary study of aquaporin 1 immunolocalization in chronic subdural hematoma membranes.

    PubMed

    Basaldella, Luca; Perin, Alessandro; Orvieto, Enrico; Marton, Elisabetta; Itskevich, David; Dei Tos, Angelo Paolo; Longatti, Pierluigi

    2010-07-01

    Aquaporin 1 (AQP1) is a molecular water channel expressed in many anatomical locations, particularly in epithelial barriers specialized in water transport. The aim of this study was to investigate AQP1 expression in chronic subdural hematoma (CSDH) membranes. In this preliminary study, 11 patients with CSDH underwent burr hole craniectomy and drainage. Membrane specimens were stained with a monoclonal antibody targeting AQP1 for immunohistochemical analysis. The endothelial cells of the sinusoid capillaries of the outer membranes exhibited an elevated immunoreactivity to AQP1 antibody compared to the staining intensity of specimens from the inner membrane and normal dura. These findings suggest that the outer membrane might be the source of the increased fluid accumulation responsible for chronic hematoma enlargement.

  4. A piecewise probabilistic regression model to decode hand movement trajectories from epidural and subdural ECoG signals

    NASA Astrophysics Data System (ADS)

    Farrokhi, Behraz; Erfanian, Abbas

    2018-06-01

    Objective. The primary concern of this study is to develop a probabilistic regression method that would improve the decoding of the hand movement trajectories from epidural ECoG as well as from subdural ECoG signals. Approach. The model is characterized by the conditional expectation of the hand position given the ECoG signals. The conditional expectation of the hand position is then modeled by a linear combination of the conditional probability density functions defined for each segment of the movement. Moreover, a spatial linear filter is proposed for reducing the dimension of the feature space. The spatial linear filter is applied to each frequency band of the ECoG signals and extract the features with highest decoding performance. Main results. For evaluating the proposed method, a dataset including 28 ECoG recordings from four adult Japanese macaques is used. The results show that the proposed decoding method outperforms the results with respect to the state of the art methods using this dataset. The relative kinematic information of each frequency band is also investigated using mutual information and decoding performance. The decoding performance shows that the best performance was obtained for high gamma bands from 50 to 200 Hz as well as high frequency ECoG band from 200 to 400 Hz for subdural recordings. However, the decoding performance was decreased for these frequency bands using epidural recordings. The mutual information shows that, on average, the high gamma band from 50 to 200 Hz and high frequency ECoG band from 200 to 400 Hz contain significantly more information than the average of the rest of the frequency bands ≤ft( p<0.001 \\right) for both subdural and epidural recordings. The results of high resolution time-frequency analysis show that ERD/ERS patterns in all frequency bands could reveal the dynamics of the ECoG responses during the movement. The onset and offset of the movement can be clearly identified by the ERD/ERS patterns

  5. The effectiveness of simple drainage technique in improvement of cerebral blood flow in patients with chronic subdural hemorrhage.

    PubMed

    Kaplan, Metin; Erol, Fatih Serhat; Bozgeyik, Zülküf; Koparan, Mehmet

    2007-07-01

    In the present study, the clinical effectiveness of a surgical procedure in which no draining tubes are installed following simple burr hole drainage and saline irrigation is investigated. 10 patients, having undergone operative intervention for unilateral chronic subdural hemorrhage, having a clinical grade of 2 and a hemorrhage thickness of 2 cm, were included in the study. The cerebral blood flow rates of middle cerebral artery were evaluated bilaterally with Doppler before and after the surgery. All the cases underwent the operation using the simple burr hole drainage technique without the drain and consequent saline irrigation. Statistical analysis was performed by Wilcoxon signed rank test (p<0.05). There was a pronounced decrease in the preoperative MCA blood flow in the hemisphere the hemorrhage had occurred (p=0.008). An increased PI value on the side of the hemorrhage drew our attention (p=0.005). Postoperative MCA blood flow measurements showed a statistically significant improvement (p=0.005). Furthermore, the PI value showed normalization (p<0.05). The paresis and the level of consciousness improved in all cases. Simple burr hole drainage technique is sufficient for the improvement of cerebral blood flow and clinical recovery in patients with chronic subdural hemorrhage.

  6. A safe and effective method for treatment of chronic subdural haematoma.

    PubMed

    Gurelik, Mustafa; Aslan, Adem; Gurelik, Bilge; Ozum, Unal; Karadag, Ozen; Kars, H Zafer

    2007-02-01

    Burr-hole irrigation and burr-hole drainage without irrigation are the most popular methods for treatment of chronic subdural haematoma. It is not well known if irrigation is necessary or which method has a higher recurrence rate. We compared the recurrence rates of those two methods. Forty-two patients were treated by burr-hole irrigation (irrigation group), whereas 38 patients were treated by burr-hole drainage (drainage group). Recurrence rate and its relation with sex, age, haematoma localization and aetiology were investigated in both groups. There was no significant difference between recurrence rates of the two groups. There was also no correlation between recurrence rate and age, sex, haematoma localization, or aetiology. There was no significant difference between recurrence rates of the two groups. Since the burr-hole drainage method is simpler to carry out, its use may be preferable.

  7. Contralateral acute interdural haematoma occurring after burr hole drainage of chronic subdural haematoma.

    PubMed

    Eom, Ki Seong; Kim, Tae Young; Park, Jong Tae

    2009-04-01

    We report the case of a 78-year-old man with chronic subdural haematoma (CSDH) who presented with impairment in recent memory and gait disturbance. He underwent burr-hole craniostomy with a closed-drainage system. A computed tomography scan conducted on postoperative day 3 demonstrated an acute epidural haematoma over the contralateral frontoparietal convexity. Craniotomy and haematoma evacuation were immediately performed. The haematoma was located between the outer and inner dura mater that each comprise a single layer. To our knowledge, this is the first reported case of an acute haematoma located between the separated dura mater that occurred following drainage of a contralateral CSDH, and it is the second reported case of interdural haematoma over the cerebral convexity.

  8. Long-term subdural strip electrocorticographic monitoring of ictal déjà vu.

    PubMed

    Weinand, M E; Hermann, B; Wyler, A R; Carter, L P; Oommen, K J; Labiner, D; Ahern, G; Herring, A

    1994-01-01

    We report a series of 8 patients with ictal déjà vu. Subdural strip electrocorticographic (ECoG) monitoring localized the ictal epileptogenic focus as follows: right (n = 6) and left (n = 2) mesiotemporal lobe. In all 8 patients, the left hemisphere was dominant for language function based on intracarotid amytal testing. In 6 right-handed patients, ictal déjà vu was associated with a right temporal lobe focus. However, in the 2 left-handed patients, the ictal focus was left temporal lobe. Although ictal déjà vu localizes the epileptic focus to temporal lobe, this experimental phenomenon appears to lateralize to the hemisphere nondominant for handedness.

  9. Upper-limb muscle responses to epidural, subdural and intraspinal stimulation of the cervical spinal cord

    NASA Astrophysics Data System (ADS)

    Sharpe, Abigail N.; Jackson, Andrew

    2014-02-01

    Objective. Electrical stimulation of the spinal cord has potential applications following spinal cord injury for reanimating paralysed limbs and promoting neuroplastic changes that may facilitate motor rehabilitation. Here we systematically compare the efficacy, selectivity and frequency-dependence of different stimulation methods in the cervical enlargement of anaesthetized monkeys. Approach. Stimulating electrodes were positioned at multiple epidural and subdural sites on both dorsal and ventral surfaces, as well as at different depths within the spinal cord. Motor responses were recorded from arm, forearm and hand muscles. Main results. Stimulation efficacy increased from dorsal to ventral stimulation sites, with the exception of ventral epidural electrodes which had the highest recruitment thresholds. Compared to epidural and intraspinal methods, responses to subdural stimulation were more selective but also more similar between adjacent sites. Trains of stimuli delivered to ventral sites elicited consistent responses at all frequencies whereas from dorsal sites we observed a mixture of short-latency facilitation and long-latency suppression. Finally, paired stimuli delivered to dorsal surface and intraspinal sites exhibited symmetric facilitatory interactions at interstimulus intervals between 2-5 ms whereas on the ventral side interactions tended to be suppressive for near-simultaneous stimuli. Significance. We interpret these results in the context of differential activation of afferent and efferent roots and intraspinal circuit elements. In particular, we propose that distinct direct and indirect actions of spinal cord stimulation on motoneurons may be advantageous for different applications, and this should be taken into consideration when designing neuroprostheses for upper-limb function.

  10. 19 CFR 148.4 - Accompanying articles.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 2 2011-04-01 2011-04-01 false Accompanying articles. 148.4 Section 148.4 Customs... (CONTINUED) PERSONAL DECLARATIONS AND EXEMPTIONS General Provisions § 148.4 Accompanying articles. (a) Generally. Articles shall be considered as accompanying a passenger or brought in by him if the articles...

  11. 19 CFR 148.4 - Accompanying articles.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 2 2012-04-01 2012-04-01 false Accompanying articles. 148.4 Section 148.4 Customs... (CONTINUED) PERSONAL DECLARATIONS AND EXEMPTIONS General Provisions § 148.4 Accompanying articles. (a) Generally. Articles shall be considered as accompanying a passenger or brought in by him if the articles...

  12. 19 CFR 148.4 - Accompanying articles.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 2 2014-04-01 2014-04-01 false Accompanying articles. 148.4 Section 148.4 Customs... (CONTINUED) PERSONAL DECLARATIONS AND EXEMPTIONS General Provisions § 148.4 Accompanying articles. (a) Generally. Articles shall be considered as accompanying a passenger or brought in by him if the articles...

  13. 19 CFR 148.4 - Accompanying articles.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 2 2013-04-01 2013-04-01 false Accompanying articles. 148.4 Section 148.4 Customs... (CONTINUED) PERSONAL DECLARATIONS AND EXEMPTIONS General Provisions § 148.4 Accompanying articles. (a) Generally. Articles shall be considered as accompanying a passenger or brought in by him if the articles...

  14. 19 CFR 148.4 - Accompanying articles.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 19 Customs Duties 2 2010-04-01 2010-04-01 false Accompanying articles. 148.4 Section 148.4 Customs... (CONTINUED) PERSONAL DECLARATIONS AND EXEMPTIONS General Provisions § 148.4 Accompanying articles. (a) Generally. Articles shall be considered as accompanying a passenger or brought in by him if the articles...

  15. Bilateral Ossified Chronic Subdural Hematoma Presenting as Diabetes Insipidus-Case Report and Literature Review.

    PubMed

    Siddiqui, Saquib A; Singh, Pankaj Kumar; Sawarkar, Dattaraj; Singh, Manmohanjit; Sharma, Bhawani S

    2017-02-01

    Calcified chronic subdural hematomas are an occurrence rarely seen in neurosurgical clinical practice. And when they occur bilaterally, the radiologic image they present is fascinating, as is the clinical presentation, but their management may be challenging. They have been reported to present with a multitude of neurologic deficits but never with diabetes insipidus, which is described here. Due to the rarity of this pathology, the management protocol is not well defined, though there have been quite a few papers on this condition. This review article gathers information published over the years on this rare entity to suggest a treatment protocol. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Subdural and intracerebral hemorrhage caused by spontaneous bleeding in the middle meningeal artery after coil embolization of a cerebral aneurysm.

    PubMed

    Kohyama, Shinya; Kakehi, Yoshiaki; Yamane, Fumitaka; Ooigawa, Hidetoshi; Kurita, Hiroki; Ishihara, Shoichiro

    2014-10-01

    Nontraumatic acute subdural hemorrhage (SDH) with intracerebral hemorrhage (ICH) is rare and is usually caused by severe bleeding from aneurysms or arteriovenous fistulas. We encountered a very rare case of spontaneous bleeding from the middle meningeal artery (MMA), which caused hemorrhage in the temporal lobe and subdural space 2 weeks after coil embolization of an ipsilateral, unruptured internal cerebral artery aneurysm in the cavernous portion. At onset, the distribution of hematoma on a computed tomography scan led us to believe that the treated intracavernous aneurysm could bleed into the intradural space. Emergency craniotomy revealed that the dura of the middle fossa was intact except for the point at the foramen spinosum where the exposed MMA was bleeding. Retrospectively, angiography just before and after embolization of the aneurysm did not show any aberrations in the MMA. Although the MMA usually courses on the outer surface of the dura and is unlikely to rupture without an external force, physicians should be aware that the MMA may bleed spontaneously and cause SDH and ICH. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

  17. Acute subdural hematoma because of boxing.

    PubMed

    Kushi, Hidehiko; Saito, Takeshi; Sakagami, Yuichiro; Ohtsuki, Jyoji; Tanjoh, Katsuhisa

    2009-02-01

    To identify factors determining the clinical characteristics and prognosis of acute subdural hematoma (ASDH) arising from boxing injuries by comparing with ASDH due to any nonboxing cause. Two groups were selected for this study: 10 patients with ASDH because of boxing injuries and 26 patients with nonboxer ASDH. All of the patients underwent neurologic examination by neurosurgeons. Primary resuscitation and stabilization as well as operative therapy were performed to all patients according to the European Brain Injury Consortium Guidelines. Two groups were compared in terms of age, the Glasgow Coma Scale at admission, neurologic findings, craniogram and brain computed tomography scan findings, operative findings, and prognosis. As potential prognostic indicators for boxers, the time interval until surgery, the Glasgow Outcome Scale, hematoma thickness, midline shift, and the site of bleeding were analyzed. The characteristics of patients because of boxing injuries are that patients were younger, had lucid interval, and had no cerebral contusion or contralateral brain injury. There was no significant difference in initial Glasgow Coma Scale, hematoma thickness, midline shift, and their prognosis. The most peculiar clinical presentation of boxers' ASDH was that all bleedings were limited from "bridging veins" or "cortical veins." The prognosis of boxers was most closely correlated with the site of bleeding (r2 = 0.81; p = 0.0001) and the midline shift (r2 = 0.67; p = 0.007). Our study shows that ASDH because of boxing is characterized by bleeding from bridging or cortical veins, and that the site of bleeding is a significant determinant of their prognosis.

  18. Chronic subdural hematoma associated with arachnoid cyst. Two case histories with pathological observations.

    PubMed

    Takayasu, Takeshi; Harada, Kunyu; Nishimura, Shigeru; Onda, Jun; Nishi, Tohru; Takagaki, Hisashi

    2012-01-01

    Arachnoid cysts are well known to induce chronic subdural hematoma (CSDH) after head injury. However, histological observations of the arachnoid cyst and hematoma membrane have only been rarely described. An 8-year-old boy and a 3-year-old boy presented with CSDH associated with arachnoid cyst. Surgical removal of the hematoma and biopsy of the hematoma membrane and cyst wall were performed. Clinical courses were good and without recurrence more than 1.5 years after surgery. Histological examination suggested that the cysts did not contribute to hematoma development. Pediatric hematoma membranes, similar to adult hematoma membranes, are key in the growth of CSDH. Therefore, simple hematoma evacuation is adequate as a first operation for CSDH associated with arachnoid cyst.

  19. Retrospective analysis of operative treatment of a series of 100 patients with subdural hematoma.

    PubMed

    Godlewski, Bartosz; Pawelczyk, Agnieszka; Pawelczyk, Tomasz; Ceranowicz, Katarzyna; Wojdyn, Maciej; Radek, Maciej

    2013-01-01

    This retrospective study of medical records, surgical protocols, patient observation cards, and imaging files of 100 patients treated for subdural hematoma analyzed the type of hematoma, patient age and sex, operative technique, neurological status, cause of injury, duration of hospital stay, mortality rate, and the number of and reasons for reoperations to determine the effects on treatment outcomes. The time between the head injury and onset of neurological symptoms was analyzed versus the type of hematoma determined from computed tomography (CT) scans. Acute hematomas accounted for 38% of the cases, with subacute hematomas representing 20%, and chronic ones accounting for 42%. In trauma patients, the mean time interval between the injury and onset of neurological symptoms was 0.38 days for acute hematomas, 13.8 days for subacute hematomas, and 23.75 days for chronic hematomas. Repeat surgery was carried out in 26% of the cases. Improvement was obtained in 44% of cases, deterioration in 20%, and no change in neurological status in 36%. Timing of the operations was between 15:00 and 23:00 in 45%, between 23:00 and 7:00 in 33%, and between 7:00 and 15:00 in 22%. The classification of hematomas based on CT presentation corresponds to the classification based on the time elapsed between injury and onset of symptoms, and appears to be appropriate and useful in everyday practice. No preceding injury was identified in 31.6% of acute hematomas, 50% of subacute hematomas, and 61.9% of chronic hematomas. Analysis of reoperations indicates that trepanation may be superior to craniotomy as primary surgery for subacute and chronic hematomas. Subdural hematoma surgeries take place at all times of the day, with most carried out outside the usual working hours.

  20. Routine postoperative CT-scans after burr hole trepanation for chronic subdural hematoma - better before or after drainage removal?

    PubMed

    Brokinkel, Benjamin; Ewelt, Christian; Holling, Markus; Hesselmann, Volker; Heindel, Walter Leonard; Stummer, Walter; Fischer, Bernhard Robert

    2013-01-01

    To evaluate timing of scheduled CT-scans after burr hole trepanation for chronic subdural hematoma (cSDH). 131 patients with primary cSDH were included. Scheduled CT-scans were performed after burr hole trepanation and placement of a subdural drain. The influence of CT-scanning with or without indwelling drain was analysed regarding subsequent surgery and CT-scans, duration of hospitalization, short- and middle-term follow up by single factor analyses. Subgroup analyses were performed for patients receiving anticoagulant drugs. Median age was 74 years. Routine CT-scans with indwelling drainage were not shown to be beneficial regarding subsequent burr hole trepanations (p=0.243), craniotomies (p=1.000) and outcome at discharge (p=0.297). Mean duration of hospitalization (11 vs. 8 days, p=0.013) was significantly longer and number of subsequent CT-scans was higher when CT scan was performed with indwelling drain (2.3 vs. 1.4, p=0.001). In middle-term follow-up, beneficial effects of CT-scanning with inlaying drainage could neither be shown. Moreover, advantageous effects of CT-scans with indwelling drains could neither be shown for patients receiving anticoagulant drugs. Scheduled postoperative cranial imaging with indwelling drains was not shown to be beneficial and misses information of intracranial damage inflicted by removal of drains. We thus recommend CT-scanning after drainage removal.

  1. Suction forces generated by passive bile bag drainage on a model of post-subdural hematoma evacuation.

    PubMed

    Tenny, Steven O; Thorell, William E

    2018-05-05

    Passive drainage systems are commonly used after subdural hematoma evacuation but there is a dearth of published data regarding the suction forces created. We set out to quantify the suction forces generated by a passive drainage system. We created a model of passive drainage after subdural hematoma evacuation. We measured the maximum suction force generated with a bile bag drain for both empty drain tubing and fluid-filled drain tube causing a siphoning effect. We took measurements at varying heights of the bile bag to analyze if bile bag height changed suction forces generated. An empty bile bag with no fluid in the drainage tube connected to a rigid, fluid-filled model creates minimal suction force of 0.9 mmHg (95% CI 0.64-1.16 mmHg). When fluid fills the drain tubing, a siphoning effect is created and can generate suction forces ranging from 18.7 to 30.6 mmHg depending on the relative position of the bile bag and filled amount of the bile bag. The suction forces generated are statistically different if the bile bag is 50 cm below, level with or 50 cm above the experimental model. Passive bile bag drainage does not generate significant suction on a fluid-filled rigid model if the drain tubing is empty. If fluid fills the drain tubing then siphoning occurs and can increase the suction force of a passive bile bag drainage system to levels comparable to partially filled Jackson-Pratt bulb drainage.

  2. Chronic subdural hematoma: Surgical management and outcome in 986 cases: A classification and regression tree approach

    PubMed Central

    Rovlias, Aristedis; Theodoropoulos, Spyridon; Papoutsakis, Dimitrios

    2015-01-01

    Background: Chronic subdural hematoma (CSDH) is one of the most common clinical entities in daily neurosurgical practice which carries a most favorable prognosis. However, because of the advanced age and medical problems of patients, surgical therapy is frequently associated with various complications. This study evaluated the clinical features, radiological findings, and neurological outcome in a large series of patients with CSDH. Methods: A classification and regression tree (CART) technique was employed in the analysis of data from 986 patients who were operated at Asclepeion General Hospital of Athens from January 1986 to December 2011. Burr holes evacuation with closed system drainage has been the operative technique of first choice at our institution for 29 consecutive years. A total of 27 prognostic factors were examined to predict the outcome at 3-month postoperatively. Results: Our results indicated that neurological status on admission was the best predictor of outcome. With regard to the other data, age, brain atrophy, thickness and density of hematoma, subdural accumulation of air, and antiplatelet and anticoagulant therapy were found to correlate significantly with prognosis. The overall cross-validated predictive accuracy of CART model was 85.34%, with a cross-validated relative error of 0.326. Conclusions: Methodologically, CART technique is quite different from the more commonly used methods, with the primary benefit of illustrating the important prognostic variables as related to outcome. Since, the ideal therapy for the treatment of CSDH is still under debate, this technique may prove useful in developing new therapeutic strategies and approaches for patients with CSDH. PMID:26257985

  3. A review of sub acute subdural hematoma (SASDH) with our institutional experience and its management by double barrel technique (DbT): A novel technique.

    PubMed

    Tripathy, Soubhagya R; Swarnakar, Pankaj K; Mishra, Sanjib; Mishra, Sudhanshu S; Dhir, Manmath K; Behera, Sanjay K; Nath, Pratap C; Jena, Somnath P; Mohanta, Itibrata; Das, Deepak; Satapathy, Mani C; Rout, Sitansu K; Behera, Bikash R; Parida, Deepak K; Rath, Tanushree S

    2016-01-01

    Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel "double barrel technique (DbT)" over the conventional burrhole drainage are also presented. This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3-24 months. 46.87% of the patients belonged to the 35-54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features. SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that "DbT" is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.

  4. Clinically silent subdural hemorrhage causes bilateral vocal fold paralysis in newborn infant.

    PubMed

    Alshammari, Jaber; Monnier, Yan; Monnier, Philippe

    2012-10-01

    Bilateral congenital vocal fold paralysis (BVFP) may result from multiple etiologies or remain idiopathic when no real cause can be identified. If obstructive dyspnea is significant and requires urgent stabilization of the airway, then intubation is performed first and an MRI of the brain is conducted to rule out an Arnold-Chiari malformation that can benefit from a shunt procedure and thus alleviate the need for a tracheostomy. Clinically silent subdural hemorrhage without any birth trauma represents another cause of neonatal BVFP that resolves spontaneously within a month. It is of clinical relevance to recognize this potential cause of BVFP as its short duration may alleviate the need for a tracheostomy. In this article, we present such a case and review the literature to draw the otolaryngologist's attention to this possible etiology. Copyright © 2012. Published by Elsevier Ireland Ltd.

  5. CYP2C9*3 polymorphism presenting as lethal subdural hematoma with low-dose warfarin

    PubMed Central

    Karnik, Niteen D.; Sridharan, Kannan; Tiwari, D.; Gupta, V.

    2014-01-01

    Warfarin is the most common and cheap oral anticoagulant currently used in clinical practice. A high inter-individual variation is seen in the response to warfarin. Recently, pharmacogenetics has gained importance in managing patients on warfarin, both in predicting the optimum required dose as well as in decreasing the risk of bleeding. This case report is a description of a 49-year-old patient who had a lethal subdural hematoma with low-dose warfarin. He was subsequently found to have CYP2C9 gene polymorphism (*1/*3). This case report stresses the importance of pre-prescription assessment of genetic analysis for those initiated on warfarin. PMID:25298588

  6. Hypothalamo-pituitary dysfunction in patients with chronic subdural hematoma.

    PubMed

    Hána, V; Kosák, M; Masopust, V; Netuka, D; Lacinová, Z; Kršek, M; Marek, J; Pecen, L

    2012-01-01

    Relatively frequent pituitary hormone deficiencies are observed after traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) and according to the published studies the neuroendocrine consequenses of traumatic brain injury are underdiagnosed. In a cohort of 59 patients (49 males, mean age 68.3 years, 36-88 years) after evacuation of subdural hematoma (SDH) were evaluated hypothalamo-pituitary functions one week after surgery, after three months and after one year. Hypogonadism was present in 26 % of patients in an acute phase, but in the majority had a transient character. Less than half of patients was GH deficient (GHD) according to the GHRH+arginine test. We did not find any serious case of hypocortisolism, hypothyroidism, diabetes insipidus centralis nor syndrome of inappropriate secretion of ADH (SIADH). Transient partial hypocortisolism was present in two cases, but resolved. We did not find relation between extension of SDH or clinical severity and development of hypopituitarism. In conclusion, in some patients with SDH growth hormone deficiency or hypogonadism was present. No serious hypocortisolism, hypothyroidism, diabetes insipidus nor SIADH was observed. The possibility of neuroendocrine dysfunction should be considered in patients with SDH, although the deficits are less frequent than in patients after TBI or SAH.

  7. Micro-field evoked potentials recorded from the porcine sub-dural cortical surface utilizing a microelectrode array.

    PubMed

    Kitzmiller, Joseph P; Hansford, Derek J; Fortin, Linda D; Obrietan, Karl H; Bergdall, Valerie K; Beversdorf, David Q

    2007-05-15

    A sub-dural surface microelectrode array designed to detect micro-field evoked potentials has been developed. The device is comprised of an array of 350-microm square gold contacts, with bidirectional spacing of 150 microm, contained within a polyimide Kapton material. Cytotoxicity testing suggests that the device is suitable for use with animal and human patients. Implementation of the device in animal studies revealed that reliable evoked potentials could be acquired. Further work will be needed to determine how these micro-field potentials, which demonstrate selectivity for one eye, relate to the distribution of the ocular dominance columns of the occipital cortex.

  8. Micro-Field Evoked Potentials Recorded from the Porcine Sub-Dural Cortical Surface Utilizing a Microelectrode Array

    PubMed Central

    Kitzmiller, Joseph P.; Hansford, Derek J.; Fortin, Linda D.; Obrietan, Karl H.; Bergdall, Valerie K.

    2007-01-01

    A sub-dural surface microelectrode array designed to detect microfield evoked potentials has been developed. The device is comprised of an array of 350-micron square gold contacts, with bi-directional spacing of 150 microns, contained within a polyimide Kapton material. Cytotoxicity testing suggests that the device is suitable for use with animal and human patients. Implementation of the device in animal studies revealed that reliable evoked potentials could be acquired. Further work will be needed to determine how these microfield potentials, which demonstrate selectivity for one eye, relate to the distribution of the ocular dominance columns of the occipital cortex. PMID:17298849

  9. Automated detection of extradural and subdural hematoma for contrast-enhanced CT images in emergency medical care

    NASA Astrophysics Data System (ADS)

    Hara, Takeshi; Matoba, Naoto; Zhou, Xiangrong; Yokoi, Shinya; Aizawa, Hiroaki; Fujita, Hiroshi; Sakashita, Keiji; Matsuoka, Tetsuya

    2007-03-01

    We have been developing the CAD scheme for head and abdominal injuries for emergency medical care. In this work, we have developed an automated method to detect typical head injuries, rupture or strokes of brain. Extradural and subdural hematoma region were detected by comparing technique after the brain areas were registered using warping. We employ 5 normal and 15 stroke cases to estimate the performance after creating the brain model with 50 normal cases. Some of the hematoma regions were detected correctly in all of the stroke cases with no false positive findings on normal cases.

  10. Acute Subdural Hematoma in a Judo Player with Repeated Head Injuries.

    PubMed

    Yokota, Hiroshi; Ida, Yuki

    2016-07-01

    Acute subdural hematoma (ASDH) is the most important cause of severe head injuries occurring during judo practice in Japan. Repeated head injuries have been reported as a cause of fatal ASDH, although the mechanism remains unknown. A 16-year-old boy visited an emergency department with vomiting 3 days after a strong blow to the occipital region during judo practice. Although computed tomography was performed at that time, a small interhemispheric ASDH was overlooked. The patient sustained another head injury 19 days after the first, which led to convulsions and disturbance of consciousness. The ASDH was increased in size on computed tomography. We performed a surgical evacuation, which revealed tearing of a bridging vein, after which the patient showed a good recovery. It is important to be aware of the possibility of a small ASDH in concussed judo players after an initial impact, which may lead to subsequent fatal ASDH after another impact incident. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Growth Potential of Subdural Hematomas Under Clinical Observation: Which Subdural Hematomas Tend to Grow and Why They Do.

    PubMed

    Asan, Ziya

    2018-05-01

    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. 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. 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. 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. Copyright © 2018 Elsevier Inc. All rights reserved.

  12. Automated extraction of subdural electrode grid from post-implant MRI scans for epilepsy surgery

    NASA Astrophysics Data System (ADS)

    Pozdin, Maksym A.; Skrinjar, Oskar

    2005-04-01

    This paper presents an automated algorithm for extraction of Subdural Electrode Grid (SEG) from post-implant MRI scans for epilepsy surgery. Post-implant MRI scans are corrupted by the image artifacts caused by implanted electrodes. The artifacts appear as dark spherical voids and given that the cerebrospinal fluid is also dark in T1-weigthed MRI scans, it is a difficult and time-consuming task to manually locate SEG position relative to brain structures of interest. The proposed algorithm reliably and accurately extracts SEG from post-implant MRI scan, i.e. finds its shape and position relative to brain structures of interest. The algorithm was validated against manually determined electrode locations, and the average error was 1.6mm for the three tested subjects.

  13. Risk factors associated with subdural hygroma after decompressive craniectomy in patients with traumatic brain injury : a comparative study.

    PubMed

    Jeon, Sei Woong; Choi, Jong Hun; Jang, Tae Won; Moon, Seung-Myung; Hwang, Hyung-Sik; Jeong, Je Hoon

    2011-06-01

    Subdural hygroma (SDG) is a complication occurring after head trauma that may occur secondary to decompressive craniectomy (DC). However, the mechanism underlying SDG formation is not fully understood. Also, the relationship between the operative technique of DC or the decompressive effect and the occurrence and pathophysiology of SDG has not been clarified. Purpose of this study was to investigate the risk factors of SDG after DC in our series. From January 2004 to December 2008, DC was performed in 85 patients who suffered from traumatic brain injury. We retrospectively reviewed the clinical and radiological features. For comparative analysis, we divided the patients into 2 groups : one group with SDG after craniectomy (19 patients; 28.4% of the total sample), the other group without SDG (48 patients; 71.6%). The risk factors for developing SDG were then analyzed. The mean Glasgow Outcome Scale (GOS) scores at discharge of the groups with and without SDG were 2.8 and 3.1, respectively (p<0.0001). Analysis of radiological factors showed that a midline shift in excess of 5 mm on CT scans was present in 19 patients (100%) in the group with SDG and in 32 patients (66.7%) in the group without SDG (p<0.05). An accompanying subarachnoid hemorrhage (SAH) was seen in 17 patients (89.5%) in the group with SDG and in 29 patients (60.4%) in the group without SDG (p<0.05). Delayed hydrocephalus accompanied these findings in 10 patients (52.6%) in the group with SDG, versus 5 patients (10.4%) in the group without SDG (p<0.05). On CT, compression of basal cisterns was observed in 14 members (73.7%) in the group with SDG and in 18 members of the group without SDG (37.5%) (p<0.007). Furthermore, tearing of the arachnoid membrane, as observed on CT, was more common in all patients in the group with SDG (100%) than in the group without SDG (31 patients; 64.6%) (p<0.05). GOS showed statistically significant difference in the clinical risk factors for SDG between the group with SDG

  14. A Tortuous Process of Surgical Treatment for a Large Calcified Chronic Subdural Hematoma.

    PubMed

    Li, Huan; Mao, Xiang; Tao, Xiao-Gang; Li, Jing-Sheng; Liu, Bai-Yun; Wu, Zhen

    2017-12-01

    Calcified chronic subdural hematoma (CCSDH) is a rare disease for which no standard approach to treatment has been established. Reports covering both burr hole trepanation and craniotomy for CCSDH are rare. Furthermore, infection of CCSDH after the burr hole trepanation has not been reported in the literature. A 61-year-old man presented with left frontotemporoparietal CCSDH demonstrated on computed tomography (CT) scan. The patient underwent 2 separate burr hole trepanations with intraoperative irrigation and postoperative drainage. These procedures led to infection of the CCSDH. The patient eventually underwent an open craniotomy to provide complete removal of the hematoma. Owing to the complex contents of a CCSDH, burr hole trepanation cannot adequately drain the hematoma or relieve the mass effect. Craniotomy is a much more reliable approach for achieving complete resection of a CCSDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Bacterial sinusitis and its frightening complications: subdural empyema and Lemierre syndrome.

    PubMed

    Benevides, Gabriel Núncio; Salgado, German Alcoba; Ferreira, Cristiane Rúbia; Felipe-Silva, Aloísio; Gilio, Alfredo Elias

    2015-01-01

    The symptoms of a previously healthy 14-year-old female with an initial history of tooth pain and swelling of the left maxillary evolved to a progressive headache and altered neurological findings characterized by auditory hallucinations, sleep disturbances, and aggressiveness. She was brought to the emergency department after 21 days of the initial symptoms. An initial computed tomography (CT) scan showed frontal subdural empyema with bone erosion. The symptoms continued to evolve to brain herniation 24 hours after admission. A second CT scan showed a left internal jugular vein thrombosis. The outcome was unfavorable and the patient died on the second day after admission. The autopsy findings depicted rarefaction of the cranial bone at the left side of the frontal sinus, and overt meningitis. The severe infection was further complicated by thrombophlebitis of the left internal jugular vein up to the superior vena cava with septic embolization to the lungs, pneumonia, and sepsis. This case report highlights the degree of severity that a trivial infection can reach. The unusual presentation of the sinusitis may have wrongly guided the approach of this unfortunate case.

  16. Blood constituents trigger brain swelling, tissue death, and reduction of glucose metabolism early after acute subdural hematoma in rats.

    PubMed

    Baechli, Heidi; Behzad, Melika; Schreckenberger, Matthias; Buchholz, Hans-Georg; Heimann, Axel; Kempski, Oliver; Alessandri, Beat

    2010-03-01

    Outcome from acute subdural hematoma is often worse than would be expected from the pure increase of intracranial volume by bleeding. The aim was to test whether volume-independent pathomechanisms aggravate damage by comparing the effects of blood infusion with those of an inert fluid, paraffin oil, on intracranial pressure (ICP), cerebral perfusion pressure (CPP), local cerebral blood flow (CBF), edema formation, glucose metabolism ([18F]-deoxyglucose, MicroPET ), and histological outcome. Rats were injured by subdural infusion of 300 muL venous blood or paraffin. ICP, CPP, and CBF changes, assessed during the first 30 mins after injury, were not different between the injury groups at most time points (n=8 per group). Already at 2 h after injury, blood caused a significantly more pronounced decrease in glucose metabolism in the injured cortex when compared with paraffin (P<0.001, n=5 per group). Ipsilateral brain edema did not differ between groups at 2 h, but was significantly more pronounced in the blood-treated groups at 24 and 48 h after injury (n=8 per group). These changes caused a 56.2% larger lesion after blood when compared with paraffin (48.1+/-23.0 versus 21.1+/-11.8 mm(3); P<0.02). Blood constituent-triggered pathomechanisms aggravate the immediate effects due to ICP, CPP, and CBF during hemorrhage and lead to early reduction of glucose metabolism followed by more severe edema and histological damage.

  17. Evolving Management of Symptomatic Chronic Subdural Hematoma: Experience of a Single Institution and Review of the Literature

    PubMed Central

    Balser, David; Rodgers, Shaun D.; Johnson, Blair; Shi, Chen; Tabak, Esteban; Samadani, Uzma

    2015-01-01

    Objective Chronic subdural hematoma has an increasing incidence and results in high morbidity and mortality. We review here the ten-year experience of a single institution and the literature regarding the treatment and major associations of chronic subdural hematoma (cSDH). Methods We retrospectively reviewed all cSDHs surgically treated from 2000 to 2010 at our institution to evaluate duration from admission to treatment, type of treatment, length of stay in critical care, length of stay in the hospital and recurrence. The literature was reviewed with regards to incidence, associations and treatment of cSDH. Results From 2000–2008, 44 patients were treated with burr holes. From 2008 to 2010, 29 patients were treated with twist drill evacuation (SEPS). 4 patients from each group were readmitted for reoperation (9% vs. 14%; p=.53). The average time to intervention for SEPS (11.2±15.3 hrs) was faster than for burr holes (40.3±69.1 hrs) (p=.02). The total hospital LOS was shorter for SEPS (9.3±6.8 days) versus burr holes (13.4±10.2 days) (p=.04); both were significantly longer than for a brain tumor patient undergoing craniotomy (7.0±0.5 days, n=94, P<.01). Conclusion Despite decreasing lengths of stay over time as treatment for cSDH evolved from burr holes to SEPS, the length of stay for a cSDH is still greater than that of a patient undergoing craniotomy for brain tumor. We noted 11% recurrence in our series of patients, which included individuals who recurred as late as 3 years after initial diagnosis. PMID:23485050

  18. Restoration of Functional Integrity After Evacuation of Chronic Subdural Hematoma-An Age-Adjusted Analysis of 697 Patients.

    PubMed

    Schoedel, Petra; Bruendl, Elisabeth; Hochreiter, Andreas; Scheitzach, Judith; Bele, Sylvia; Brawanski, Alexander; Schebesch, Karl-Michael

    2016-10-01

    Although chronic subdural hematoma (CSH) can be treated by surgery, little is known about age-dependent symptoms and age-adjusted rates of restoring functional integrity. To evaluate the clinical symptoms and the course of CSH in patients of different age groups (AGs), we reviewed patients with CSH treated at our department over the past 22 years. This retrospective analysis included 697 patients with CSH (461 men, 236 women; mean age 70.1 years). Subgroup analysis was done according to AG 1) <65 years, 2) 66-75 years, 3) 76-85 years, 4) 86-95 years, and 5) >95 years. Most patients had been treated with burr-hole trephination and implantation of a subdural drain (96.5%; n = 673). No significant difference concerning surgical morbidity and mortality was found between the AGs, but patients >75 years more frequently required reoperation (P = 0.001). Preoperatively, the most common symptoms were headache in AGs 1 and 2 (56.3% and 48.5%) and mnestic deficits in AGs 3-5 (54.9%, 51.9%, and 50.0%). After surgery, the clinical symptoms of CSH had significantly abated in all age groups. The most common clinical residuals were motor deficits in AG 1 (10.4%), mnestic deficits in AG 2 (10.7%), AG 4 (24.1%), and AG 5 (50.0%), and organic brain syndrome in AG 3 (15.0%). CSH predominantly caused unspecific symptoms such as headache and cognitive decline. CSH surgery immediately relieved symptoms in patients of all AGs. However, improvement rates significantly depended on patient age. This should be taken into consideration when advising on surgical treatment of CSH. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage

    PubMed Central

    Lee, Seong-Jong; Im, Soo Bin

    2016-01-01

    Objective Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. Methods CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. Results Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. Conclusion When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients. PMID:27857917

  20. Twist-Drill or Burr Hole Craniostomy for Draining Chronic Subdural Hematomas: How to Choose It for Chronic Subdural Hematoma Drainage.

    PubMed

    Lee, Seong-Jong; Hwang, Sun-Chul; Im, Soo Bin

    2016-10-01

    Although twist-drill craniostomy (TDC) has a number of procedural advantages and an equivalent outcome compared to burr hole craniostomy (BHC) for the treatment of chronic subdural hematomas (CSDHs), the latter technique remains the preferred method. We analyzed symptomatic CSDHs in whom TDC at the pre-coronal suture entry point (PCSEP) was the primary method for hematoma drainage and BHC on the parietal was the secondary option. CSDHs in 86 consecutive patients were included. TDC at the PCSEP, which is 1 cm anterior to coronal suture at the level of the superior temporal line, was the primary operational technique when the hematoma thickness was suitable, and BHC was performed via the parietal when TDC was unreasonable or failed. The clinical feasibility and outcomes of these approaches were analyzed. Of the 86 patients, 68 (79.1%) were treated by TDC, and 18 (20.9%) by BHC. All patients showed improvements in their symptoms after hematoma drainage. Neither morbidity nor mortality was associated with either technique, and there were no differences in drainage days between the groups. Ten patients had bilateral hematomas and were treated using TDC. Two patients were not sufficiently treated by TDC and, as a result, BHC was applied. Only six hematomas (7% of 86 hematomas) exhibited insufficient thickness on the computed tomography to perform TDC. When the hematoma was thick enough, a majority of the CSDHs were drained using TDC at the PCSEP as the first procedure, which was especially useful for bilateral hematomas and in elderly patients.

  1. Results of single burr hole drainage for acute subdural hematoma with non-reactive pupil.

    PubMed

    Yanagawa, Youichi; Sakamoto, Toshihisa

    2012-01-01

    To investigate the effects of emergency burr hole drainage for acute subdural hematoma (ASDH) with bilateral non-reactive pupils. A retrospective study was conducted by reviewing medical records from 1998 to 2007. Patients meeting the following criteria were included: 1) head injury with unconsciousness (Glasgow Coma Scale score 8); 2) bilateral non-reactive pupils on arrival; 3) ASDH with disappearance of basal cistern on computed tomography (CT); and 4) performance of emergency single burr hole drainage. Subjects were divided into survival and non-survival groups. Pupil size on the small side was significantly smaller in the survival group than in the non-survival group. All pupils on the small side in the survival group were 4 mm. Emergency burr hole drainage should still be considered in patients with ASDH showing bilateral non-reactive pupils and one pupil 4 mm.

  2. Risk factors for chronic subdural haematoma formation do not account for the established male bias.

    PubMed

    Marshman, Laurence A G; Manickam, Appukutty; Carter, Danielle

    2015-04-01

    The 'subdural space' is an artefact of inner dural border layer disruption: it is not anatomical but always pathological. A male bias has long been accepted for chronic subdural haematomas (CSDH), and increased male frequencies of trauma and/or alcohol abuse are often cited as likely explanations: however, no study has validated this. We investigated to see which risk factors accounted for the male bias with CSDH. Retrospective review of prospectively collected data. A male bias (M:F 97:58) for CSDH was confirmed in n=155 patients. The largest risk factor for CSDH was cerebral atrophy (M:F 94% vs. 91%): whilst a male bias prevailed in mild-moderate cases (M:F 58% vs. 41%), a female bias prevailed for severe atrophy (F:M 50% vs. 36%) (χ(2)=3.88, P=0.14). Risk factors for atrophy also demonstrated a female bias, some approached statistical significance: atrial fibrillation (P=0.05), stroke/TIA (P=0.06) and diabetes mellitus (P=0.07). There was also a trend for older age in females (F:M 72±13 years vs. 68±15 years, P=0.09). The third largest risk factor, after atrophy and trauma (i.e. anti-coagulant and anti-platelet use) was statistically significantly biased towards females (F:M 50% vs. 33%, P=0.04). No risk factor accounted for the established male bias with CSDH. In particular, a history of trauma (head injury or fall [M:F 50% vs. 57%, P=0.37]), and alcohol abuse (M:F 17% vs. 16%, P=0.89) was remarkably similar between genders. No recognised risk factor for CSDH formation accounted for the established male bias: risk factor trends generally favoured females. In particular, and in contrast to popular belief, a male CSDH bias did not relate to increased male frequencies of trauma and/or alcohol abuse. Crown Copyright © 2015. Published by Elsevier B.V. All rights reserved.

  3. Subdural Fluid Collection and Hydrocephalus After Foramen Magnum Decompression for Chiari Malformation Type I: Management Algorithm of a Rare Complication.

    PubMed

    Rossini, Zefferino; Milani, Davide; Costa, Francesco; Castellani, Carlotta; Lasio, Giovanni; Fornari, Maurizio

    2017-10-01

    Chiari malformation type I is a hindbrain abnormality characterized by descent of the cerebellar tonsils beneath the foramen magnum, frequently associated with symptoms or brainstem compression, impaired cerebrospinal fluid circulation, and syringomyelia. Foramen magnum decompression represents the most common way of treatment. Rarely, subdural fluid collection and hydrocephalus represent postoperative adverse events. The treatment of this complication is still debated, and physicians are sometimes uncertain when to perform diversion surgery and when to perform more conservative management. We report an unusual occurrence of subdural fluid collection and hydrocephalus that developed in a 23-year-old patient after foramen magnum decompression for Chiari malformation type I. Following a management protocol, based on a step-by-step approach, from conservative therapy to diversion surgery, the patient was managed with urgent external ventricular drainage, and then with conservative management and wound revision. Because of the rarity of this adverse event, previous case reports differ about the form of treatment. In future cases, finding clinical and radiologic features to identify risk factors that are useful in predicting if the patient will benefit from conservative management or will need to undergo diversion surgery is only possible if a uniform form of treatment is used. Therefore, we believe that a management algorithm based on a step-by-step approach will reduce the use of invasive therapies and help to create a standard of care. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Social norms of accompanied young children and observed crossing behaviors.

    PubMed

    Rosenbloom, Tova; Sapir-Lavid, Yael; Hadari-Carmi, Ofri

    2009-01-01

    Social norms for accompanied young children and crossing behaviors were examined in two studies conducted in an Ultra-Orthodox Jewish community in Israel. In Study 1, road behaviors of young children crossing with and without accompaniment and older children were observed, and the actual social norm for accompanied school children younger than 9-years-old was examined. In Study 2, the perceived norm of accompaniment was tested by questionnaires. Young children who crossed without accompaniment exhibited poorer crossing skills compared to older children and to young children crossing with accompaniment. In the four locations observed, the actual accompaniment rate ranged between 15%-60%. The perceived social norm for child accompaniment was lower than the actual norm. The discussion refers to both theoretical issues and their practical implications.

  5. Concomitant Intracranial and Lumbar Chronic Subdural Hematoma Treated by Fluoroscopic Guided Lumbar Puncture: A Case Report and Literature Review

    PubMed Central

    ICHINOSE, Daisuke; TOCHIGI, Satoru; TANAKA, Toshihide; SUZUKI, Tomoya; TAKEI, Jun; HATANO, Keisuke; KAJIWARA, Ikki; MARUYAMA, Fumiaki; SAKAMOTO, Hiroki; HASEGAWA, Yuzuru; TANI, Satoshi; MURAYAMA, Yuichi

    2018-01-01

    A 40-year-old man presented with a severe headache, lower back pain, and lower abdominal pain 1 month after a head injury caused by falling. Computed tomography (CT) of the head demonstrated bilateral chronic subdural hematoma (CSDH) with a significant amount in the left frontoparietal region. At the same time, magnetic resonance imaging (MRI) of the lumbar spine also revealed CSDH from L2 to S1 level. A simple drainage for the intracranial CSDH on the left side was performed. Postoperatively, the headache was improved; however, the lower back and abdominal pain persisted. Aspiration of the liquefied spinal subdural hematoma was performed by a lumbar puncture under fluoroscopic guidance. The clinical symptoms were dramatically improved postoperatively. Concomitant intracranial and spinal CSDH is considerably rare so only 23 cases including the present case have been reported in the literature so far. The etiology and therapeutic strategy were discussed with a review of the literature. Therapeutic strategy is not established for these two concomitant lesions. Conservative follow-up was chosen for 14 cases, resulting in a favorable clinical outcome. Although surgical evacuation of lumbosacral CSDH was performed in seven cases, an alteration of cerebrospinal fluid (CSF) pressure following spinal surgery should be reminded because of the intracranial lesion. Since CSDH is well liquefied in both intracranial and spinal lesion, a less invasive approach is recommended not only for an intracranial lesion but also for spinal lesion. Fluoroscopic-guided lumbar puncture for lumbosacral CSDH following burr hole surgery for intracranial CSDH could be a recommended strategy. PMID:29479039

  6. 9 CFR 93.409 - Articles accompanying ruminants.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Articles accompanying ruminants. 93.409 Section 93.409 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...; REQUIREMENTS FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Ruminants § 93.409 Articles accompanying ruminants...

  7. 9 CFR 93.409 - Articles accompanying ruminants.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Articles accompanying ruminants. 93.409 Section 93.409 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...; REQUIREMENTS FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Ruminants § 93.409 Articles accompanying ruminants...

  8. 9 CFR 93.409 - Articles accompanying ruminants.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Articles accompanying ruminants. 93.409 Section 93.409 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...; REQUIREMENTS FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Ruminants § 93.409 Articles accompanying ruminants...

  9. 9 CFR 93.409 - Articles accompanying ruminants.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Articles accompanying ruminants. 93.409 Section 93.409 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...; REQUIREMENTS FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Ruminants § 93.409 Articles accompanying ruminants...

  10. 9 CFR 93.409 - Articles accompanying ruminants.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Articles accompanying ruminants. 93.409 Section 93.409 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT...; REQUIREMENTS FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Ruminants § 93.409 Articles accompanying ruminants...

  11. Role of subdural electrocorticography in prediction of long-term seizure outcome in epilepsy surgery

    PubMed Central

    Juhász, Csaba; Shah, Aashit; Sood, Sandeep; Chugani, Harry T.

    2009-01-01

    Since prediction of long-term seizure outcome using preoperative diagnostic modalities remains suboptimal in epilepsy surgery, we evaluated whether interictal spike frequency measures obtained from extraoperative subdural electrocorticography (ECoG) recording could predict long-term seizure outcome. This study included 61 young patients (age 0.4–23.0 years), who underwent extraoperative ECoG recording prior to cortical resection for alleviation of uncontrolled focal seizures. Patient age, frequency of preoperative seizures, neuroimaging findings, ictal and interictal ECoG measures were preoperatively obtained. The seizure outcome was prospectively measured [follow-up period: 2.5–6.4 years (mean 4.6 years)]. Univariate and multivariate logistic regression analyses determined how well preoperative demographic and diagnostic measures predicted long-term seizure outcome. Following the initial cortical resection, Engel Class I, II, III and IV outcomes were noted in 35, 6, 12 and 7 patients, respectively. One child died due to disseminated intravascular coagulation associated with pseudomonas sepsis 2 days after surgery. Univariate regression analyses revealed that incomplete removal of seizure onset zone, higher interictal spike-frequency in the preserved cortex and incomplete removal of cortical abnormalities on neuroimaging were associated with a greater risk of failing to obtain Class I outcome. Multivariate logistic regression analysis revealed that incomplete removal of seizure onset zone was the only independent predictor of failure to obtain Class I outcome. The goodness of regression model fit and the predictive ability of regression model were greatest in the full regression model incorporating both ictal and interictal measures [R2 0.44; Area under the receiver operating characteristic (ROC) curve: 0.81], slightly smaller in the reduced model incorporating ictal but not interictal measures (R2 0.40; Area under the ROC curve: 0.79) and slightly smaller

  12. 16 CFR 1500.125 - Labeling requirements for accompanying literature.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 16 Commercial Practices 2 2011-01-01 2011-01-01 false Labeling requirements for accompanying literature. 1500.125 Section 1500.125 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL... REGULATIONS § 1500.125 Labeling requirements for accompanying literature. When any accompanying literature...

  13. 16 CFR 1500.125 - Labeling requirements for accompanying literature.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 16 Commercial Practices 2 2014-01-01 2014-01-01 false Labeling requirements for accompanying literature. 1500.125 Section 1500.125 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL... REGULATIONS § 1500.125 Labeling requirements for accompanying literature. When any accompanying literature...

  14. 16 CFR 1500.125 - Labeling requirements for accompanying literature.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 16 Commercial Practices 2 2012-01-01 2012-01-01 false Labeling requirements for accompanying literature. 1500.125 Section 1500.125 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL... REGULATIONS § 1500.125 Labeling requirements for accompanying literature. When any accompanying literature...

  15. 16 CFR 1500.125 - Labeling requirements for accompanying literature.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 16 Commercial Practices 2 2010-01-01 2010-01-01 false Labeling requirements for accompanying literature. 1500.125 Section 1500.125 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL... REGULATIONS § 1500.125 Labeling requirements for accompanying literature. When any accompanying literature...

  16. 9 CFR 93.307 - Articles accompanying horses.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Articles accompanying horses. 93.307 Section 93.307 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Horses § 93.307 Articles accompanying horses. No...

  17. 9 CFR 93.208 - Articles accompanying poultry.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Articles accompanying poultry. 93.208 Section 93.208 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Poultry § 93.208 Articles accompanying poultry. No...

  18. 9 CFR 93.307 - Articles accompanying horses.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Articles accompanying horses. 93.307 Section 93.307 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Horses § 93.307 Articles accompanying horses. No...

  19. 9 CFR 93.208 - Articles accompanying poultry.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Articles accompanying poultry. 93.208 Section 93.208 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Poultry § 93.208 Articles accompanying poultry. No...

  20. 9 CFR 93.307 - Articles accompanying horses.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Articles accompanying horses. 93.307 Section 93.307 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Horses § 93.307 Articles accompanying horses. No...

  1. 9 CFR 93.508 - Articles accompanying swine.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Articles accompanying swine. 93.508 Section 93.508 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Swine § 93.508 Articles accompanying swine. No litter...

  2. 9 CFR 93.508 - Articles accompanying swine.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 9 Animals and Animal Products 1 2011-01-01 2011-01-01 false Articles accompanying swine. 93.508 Section 93.508 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Swine § 93.508 Articles accompanying swine. No litter...

  3. 9 CFR 93.508 - Articles accompanying swine.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... 9 Animals and Animal Products 1 2012-01-01 2012-01-01 false Articles accompanying swine. 93.508 Section 93.508 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Swine § 93.508 Articles accompanying swine. No litter...

  4. 9 CFR 93.208 - Articles accompanying poultry.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Articles accompanying poultry. 93.208 Section 93.208 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Poultry § 93.208 Articles accompanying poultry. No...

  5. 9 CFR 93.208 - Articles accompanying poultry.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Articles accompanying poultry. 93.208 Section 93.208 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Poultry § 93.208 Articles accompanying poultry. No...

  6. 9 CFR 93.508 - Articles accompanying swine.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Articles accompanying swine. 93.508 Section 93.508 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Swine § 93.508 Articles accompanying swine. No litter...

  7. 9 CFR 93.208 - Articles accompanying poultry.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Articles accompanying poultry. 93.208 Section 93.208 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Poultry § 93.208 Articles accompanying poultry. No...

  8. 9 CFR 93.307 - Articles accompanying horses.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 9 Animals and Animal Products 1 2013-01-01 2013-01-01 false Articles accompanying horses. 93.307 Section 93.307 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Horses § 93.307 Articles accompanying horses. No...

  9. 9 CFR 93.307 - Articles accompanying horses.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 9 Animals and Animal Products 1 2014-01-01 2014-01-01 false Articles accompanying horses. 93.307 Section 93.307 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Horses § 93.307 Articles accompanying horses. No...

  10. 9 CFR 93.508 - Articles accompanying swine.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Articles accompanying swine. 93.508 Section 93.508 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION SERVICE, DEPARTMENT OF... FOR MEANS OF CONVEYANCE AND SHIPPING CONTAINERS Swine § 93.508 Articles accompanying swine. No litter...

  11. [Functional mapping using subdural electrodes combined with monitoring during awake craniotomy enabled preservation of function and extensive resection of a glioma adjacent to the parietal lobe language sites: a case report].

    PubMed

    Takebayashi, Kento; Saito, Taiichi; Nitta, Masayuki; Tamura, Manabu; Maruyama, Takashi; Muragaki, Yoshihiro; Okada, Yoshikazu

    2015-01-01

    Surgical resection of gliomas located in the dominant parietal lobe is difficult because this lesion is surrounded by multiple functional areas. Although functional mapping during awake craniotomy is very useful for resection of gliomas adjacent to eloquent areas, the limited time available makes it difficult to sufficiently evaluate multiple functions, such as language, calculative ability, distinction of right and left sides, and finger recognition. Here, we report a case of anaplastic oligodendroglioma, which was successfully treated with a combination of functional mapping using subdural electrodes and monitoring under awake craniotomy for glioma. A 32-year-old man presented with generalized seizure. Magnetic resonance imaging revealed a non-enhanced tumor in the left angular and supramarginal gyri. In addition, the tumor showed high accumulation on 11C-methionine positron emission tomography(PET)(tumor/normal brain tissue ratio=3.20). Preparatory mapping using subdural electrodes showed absence of brain function on the tumor lesion. Surgical removal was performed using cortical mapping during awake craniotomy with an updated navigation system using intraoperative magnetic resonance imaging(MRI). The tumor was resected until aphasia was detected by functional monitoring, and the extent of tumor resection was 93%. The patient showed transient transcortical aphasia and Gerstmann's syndrome after surgery but eventually recovered. The pathological diagnosis was anaplastic oligodendroglioma, and the patient was administered chemo-radiotherapy. The patient has been progression free for more than 2 years. The combination of subdural electrode mapping and monitoring during awake craniotomy is useful in order to achieve preservation of function and extensive resection for gliomas in the dominant parietal lobe.

  12. The use of endoscopic-assisted burr-hole craniostomy for septated chronic subdural haematoma: A retrospective cohort comparison study.

    PubMed

    Zhang, Jibo; Liu, Xuemeng; Fan, Xingyue; Fu, Kai; Xu, Chengshi; Hu, Qin; Jiang, Pucha; Chen, Jincao; Wang, Wei

    2018-01-01

    To complete a retrospective comparison of endoscope-assisted burr-hole craniostomy (EBHC) and ordinary burr-hole craniostomy (OBHC) in the treatment of septated chronic subdural hematoma (SCSH). A retrospective case note review comparing EBHC and OBHC of SCSH was therefore performed. Data of patients with a SCSH for EBHC or OBHC during the period from January 2011 to December 2016 were retrospectively collected and analysed. Of 73 patients, 42 underwent EBHC and 31 patients were treated by OBHC. The primary outcome measure was recurrence rate and secondary outcome measures were clinical outcome at first postoperative day, discharge and 6 months, the length of hospital stay for neurosurgery, the operative time, and the placement time of drainage tube. The rate of recurrence was significantly lower in the EBHC (0/42 0%) than in the OBHC (8/31, 25.8%) group (p = .0030). The rate of morbidity was significantly lower in the EBHC (2/42, 4.8%) than in the OBHC (11/31, 35.5%) group (p = .0121). At 30 days, mortality did not differ between groups. Significantly more patients treated with EBHC were alive at 6 months than were those with OBHC. No patient died as a consequence of the operative procedure in the both groups. A discharge GCS of 15 was recorded in more participants with EBHC than in those with OBHC. Gross neurological deficit was significantly less frequent in those with EBHC than in those with OBHC at first postoperative day and discharge, but did not differ at 6 month follow-up. The mean placement time of drainage tube was significantly less in those with EBHC (27.2 h) than in those with OBHC (52.0 h, p = .0055). The mean length of hospital stay for neurosurgery was 4 days in the EBHC group, while it was 5 days in the OBHC group (p = .0015). The mean hematoma reduction rate was significantly higher in those with EBHC than in those with OBHC at first postoperative day (85.3% vs 72.5%, p = .0037) and discharge (90.3% vs 85.1%, p

  13. The accompanying adult: authority to give consent in the UK.

    PubMed

    Lal, Seema Madhur Lata; Parekh, Susan; Mason, Carol; Roberts, Graham

    2007-05-01

    Children may be accompanied by various people when attending for dental treatment. Before treatment is started, there is a legal requirement that the operator obtain informed consent for the proposed procedure. In the case of minors, the person authorized to give consent (parental responsibility) is usually a parent. To ascertain if accompanying persons of children attending the Department of Paediatric Dentistry at the Eastman Dental Hospital, London were empowered to give consent for the child's dental treatment. A total of 250 accompanying persons of children attending were selected, over a 6-month period. A questionnaire was used to establish whether the accompanying person(s) were authorized to give consent. The study showed that 12% of accompanying persons had no legal authority to give consent for the child's dental treatment. Clinicians need to be aware of the status of persons accompanying children to ensure valid consent is obtained.

  14. Focal extra-axial hemorrahagic mass with subdural hemorrhage secondare to extramedullary hematopoiesis in idiopathic myelodysplastic sindrome.

    PubMed

    Di Ieva, A; Di Lieva, A; Aimar, E; Tancioni, F; Levi, D; Debernardi, A; Pisano, P; Rahal, D; Nozza, A; Magagnoli, M; Gaetani, P

    2007-03-01

    Idiopathic myelodysplastic syndrome is a disease characterized by a clonal stem cell disorder in which megacaryocitic and granulocytic lineages are mainly involved; extramedullary myeloid metaplasia is due to abnormal location of myeloid tissue in other organs than bone marrow. Rarely the central nervous system is involved. When it happens, it is typical to find masses around the brain and pachymeningeal thickening, but it is very rare to find it associated with subdural haemorrhage, as in the case we describe in the present article. Considering our case and the literature we can suggest that radiological images associated with the clinical history of the patient suggestive for extramedullary hematopoiesis can be sufficient for a correct diagnosis and for a radiotherapy treatment, demanding surgery in the case of diagnostic doubts, massive hemorrahages or neurological decifits caused by the focal lesions.

  15. 16 CFR § 1500.125 - Labeling requirements for accompanying literature.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... 16 Commercial Practices 2 2013-01-01 2013-01-01 false Labeling requirements for accompanying literature. § 1500.125 Section § 1500.125 Commercial Practices CONSUMER PRODUCT SAFETY COMMISSION FEDERAL... REGULATIONS § 1500.125 Labeling requirements for accompanying literature. When any accompanying literature...

  16. Chronic subdural haematoma treated by craniotomy, durectomy, outer membranectomy and subgaleal suction drainage. Personal experience in 39 patients.

    PubMed

    Mohamed, E E H Hussein

    2003-06-01

    According to the CT and MRI appearances, 39 chronic subdural haematoma (CSDH) patients were suspected of having solid clots and/or a high likelihood of loculation. Craniotomy was planned from the start. Beside the better exposure, excision of the dura and outer membrane, assumed to be the source of haematoma fluid, this is an additional step to minimize the incidence of significant recollection. There were no additional operative or postoperative cranial and/or systemic complications when compared with other minor procedures. Two patients (5%) required once percutaneous tapping and aspiration. Accordingly, if a case is considered to be better managed with craniotomy, durectomy and outer membranectomy this is an easy and safe technique with minimal incidence of recollection, morbidity and mortality.

  17. Study on feasibility of laser reflective tomography with satellite-accompany

    NASA Astrophysics Data System (ADS)

    Gu, Yu; Hu, Yi-hua; Hao, Shi-qi; Gu, You-lin; Zhao, Nan-xiang; Wang, Yang-yang

    2015-10-01

    Laser reflective tomography is a long-range, high-resolution active detection technology, whose advantage is that the spatial resolution is unrelated with the imaging distance. Accompany satellite is a specific satellite around the target spacecraft with encircling movement. When using the accompany satellite to detect the target aircraft, multi-angle echo data can be obtained with the application of reflective tomography imaging. The feasibility of such detection working mode was studied in this article. Accompany orbit model was established with horizontal circular fleet and the parameters of accompany flight was defined. The simulation of satellite-to-satellite reflective tomography imaging with satellite-accompany was carried out. The operating mode of reflective tomographic data acquisition from monostatic laser radar was discussed and designed. The flight period, which equals to the all direction received data consuming time, is one of the important accompany flight parameters. The azimuth angle determines the plane of image formation while the elevation angle determines the projection direction. Both of the azimuth and elevation angles guide the satellite attitude stability controller in order to point the laser radar spot on the target. The influences of distance between accompany satellite and target satellite on tomographic imaging consuming time was analyzed. The influences of flight period, azimuth angle and elevation angle on tomographic imaging were analyzed as well. Simulation results showed that the satellite-accompany laser reflective tomography is a feasible and effective method to the satellite-to-satellite detection.

  18. Measurement of inflammatory cytokines and thrombomodulin in chronic subdural hematoma.

    PubMed

    Kitazono, Masatoshi; Yokota, Hiroyuki; Satoh, Hidetaka; Onda, Hidetaka; Matsumoto, Gaku; Fuse, Akira; Teramoto, Akira

    2012-01-01

    Inflammation and the coagulation system may influence the genesis of chronic subdural hematoma (CSDH). The appearance of CSDH on computed tomography (CT) varies with the stage of the hematoma. This study investigated the pathogenesis and the recurrence of CSDH by comparing cytokine levels with the CT features of CSDH in 26 patients with 34 CSDHs who underwent single burr-hole surgery at our hospital between October 2004 and November 2006. The hematoma components removed during the procedure were examined, and the hematoma serum levels of cytokines measured such as thrombomodulin (TM), interleukin-6 (IL-6), tumor necrosis factor-α (TNFα), and interleukin-10 (IL-10). Using CT, mixed density hematomas were distinguished from other homogeneous hematomas, and found that the TM level was significantly higher in mixed density hematomas than in homogeneous hematomas (p = 0.043). Mixed density hematomas were classified into three subtypes (laminar, separated, and trabecular hematomas). The TM level was significantly higher in laminar and separated hematomas than in other hematomas (p = 0.01). The levels of IL-6, TNFα, and IL-10 were extremely high, but showed no significant differences in relation to the CT features. Mixed density hematomas had high recurrence rate, as reported previously, and TM level was high in mixed density hematomas such as laminar and separated mixed density hematomas. The present findings suggest that the types of CSDH associated with high TM levels tend to have higher recurrence rate.

  19. Midline Shift Threshold Value for Hemiparesis in Chronic Subdural Hematoma.

    PubMed

    Juković, Mirela F; Stojanović, Dejan B

    2015-01-01

    Chronic subdural hematoma (CSDH) has a variety of clinical presentations, with numerous neurological symptoms and signs. Hemiparesis is one of the leading signs that potentially indicates CSDH. Purpose of this study was to determine the threshold (cut-off) value of midsagittal line (MSL) shift after which hemiparesis is likely to appear. The study evaluated 83 patients with 53 unilateral and 30 bilateral CSDHs in period of three years. Evaluated computed tomography (CT) findings in patients with CSDH were diameter of the hematoma and midsagittal line shift, measured on non-contrast CT scan in relation with occurrence of hemiparesis. Threshold values of MSL shift for both types of CSDHs were obtained as maximal (equal) sensitivity and specificity (intersection of the curves). MSL is a good predictor for hemiparesis occurrence (total sample, AUROC 0.75, p=0.0001). Unilateral and bilateral CSDHs had different threshold values of the MSL for hemiparesis development. Results suggested that in unilateral CSDH the threshold values of MSL could be at 10 mm (AUROC=0.65; p=0.07). For bilateral CSDH the threshold level of MSL shift was 4.5 mm (AUROC=0.77; p=0.01). Our study pointed on the phenomenon that midsagittal line shift can predict hemiparesis occurrence. Hemiparesis in patients with bilateral CSDH was more related to midsagittal line shift compared with unilateral CSDH. When value of midsagittal line shift exceed the threshold level, hemiparesis occurs with certain probability.

  20. Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy.

    PubMed

    Wayhs, Sâmia Yasin; Wottrich, Joise; Uggeri, Douglas Prestes; Dias, Fernando Suparregui

    2013-01-01

    Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.

  1. Spontaneous acute subdural hematoma and intracerebral hemorrhage in a patient with thrombotic microangiopathy during pregnancy

    PubMed Central

    Wayhs, Sâmia Yasin; Wottrich, Joise; Uggeri, Douglas Prestes; Dias, Fernando Suparregui

    2013-01-01

    Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and severe liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia, HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure appropriate management and treatment success. PMID:23917984

  2. Who accompanies children to a dental hospital appointment?

    PubMed

    Virdee, P K; Rodd, H D

    2007-06-01

    To determine who accompanies paediatric dental patients to their appointments, in a teaching hospital setting. Data were recorded prospectively for children attending the Paediatric Dentistry clinic of the Charles Clifford Dental Hospital, Sheffield, England, over 4 months which included two school holiday periods. The data were recorded on a standardised data collection sheet, which included age and gender of the patient; number/s of accompanying adults and children and their relationship to the patient; the appointment session and appointment type. A total of 394 paediatric dental visits were recorded. Patients were of a mean age of 10 (range 1-17 years). Most visits were for treatment (44.7%) and review (39.8%), with a much smaller proportion being new patient assessments (8.9%) and emergency appointments (6.6%). The numbers of afternoon and morning sessions recorded were approximately similar and 35% of the visits were recorded in a school holiday day. The majority of patients attended with at least one parent (91.6%). A parent was most likely to attend a new patient assessment (97.1%) or review visit (94.3%). Parental presence was less likely for treatment (89%) and least likely for emergency visits (84%). Most patients attended with their mother (62.1%). Patients were less frequently accompanied by parents (13.1%), their father (12.1%) and one or both grandparents (4.3%). Smaller proportions were accompanied by older siblings, a step parent, other relatives or foster carers. Two patients attended unaccompanied. The time of day, or whether it was a school holiday period or not, did not influence parental presence or the numbers of adults accompanying patients. However the additional presence of other children (non patients) was more likely on morning sessions and during school holidays. One way analysis of variance (ANOVA), an independent sample t-test or chi-squared tests were undertaken as appropriate to determine whether there were any significant

  3. Outcomes of Subdural Grid Electrode Monitoring in the Stereoelectroencephalography Era.

    PubMed

    Mullin, Jeffrey P; Sexton, Daniel; Al-Omar, Soha; Bingaman, William; Gonzalez-Martinez, Jorge

    2016-05-01

    Subdural grid (SDG) electrodes have been the gold standard of invasive monitoring in medically refractory epilepsy; however, in some centers, application of SDGs has been reduced by the progressive application of stereoelectroencephalography (SEEG). This study reviews the efficacy of SDG electrode monitoring after the incorporation of the SEEG methodology at our institution. We retrospectively reviewed 102 patients undergoing intracranial monitoring via SDG electrodes during the years 2010-2013 at our institution. The series includes all patients who underwent SDG placement after the incorporation of SEEG in our extraoperative invasive monitoring armamentarium. Average patient age was 29.9 years old; the series included 31 pediatric patients. There were 49 male patients and 53 female patients. The mean length of follow-up was 21.5 months. The epileptogenic zone was localized in 99 (97%) patients. Surgical resection was performed in 84 patients, and 70% experienced Engel class I freedom from seizures. Invasive monitoring via SDG electrodes continues to be an efficacious option for select patients with medically refractory epilepsy, mainly when the hypothetical epileptogenic zone is anatomically restricted to superficial cortical areas and in close relation with eloquent cortex. This is the first report of epilepsy outcomes after SDG monitoring at a center that also performs SEEG monitoring. Our results suggest a complementary benefit of performing both techniques at 1 institution. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Delayed intracerebral and subdural hematomas after ventriculo-peritoneal shunt in a child: A case report and review of the literature.

    PubMed

    Coulibaly, O; Dama, M; Diallo, O; Li, G; Sogoba, Y; Kanikomo, D

    2016-04-01

    Ventriculo-peritoneal shunt (VPS) continues to remain the main diverted method to drain the cerebrospinal fluid (CSF) from the ventricles to the peritoneal cavity. It has some complications that must be managed promptly to avoid any eventual fatal evolution. The association of delayed intracerebral and subdural hematomas after VPS insertion is a very rare complication and has, to our knowledge, never previously been reported in the literature. We report a very uncommon association of this entity occurring 11months after a shunt placement in a 13-year-old boy and discuss the likely pathogenesis, as well as the clinical and the radiological data. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  5. Pigmentary glaucoma accompanied by Usher syndrome.

    PubMed

    Koucheki, Behrooz; Jalali, Kamran Hodjat

    2012-08-01

    To report a case of pigmentary glaucoma (PG) accompanied by Usher syndrome. Case report. The results were presented after standard ocular examination, visual field test, anterior segment and fundus photography, electroretinography, and otolaryngology consultation were conducted. Typical retinitis pigmentosa, flat electroretinography, congenital sensorineural hearing loss, high intraocular pressure, Krukenberg spindle, iris concavity, radial iris transillumination defect, severe pigment deposition on the trabecular meshwork, and glaucomatous optic nerve damage were indicative of PG accompanied by Usher syndrome. In some rare cases, PG may coexist with Usher syndrome. Common findings of Usher syndrome, including night blindness, impaired vision, visual field defects, and retinal changes may distract the clinician from considering the diagnosis of glaucoma. Such association should be borne in mind to make a timely diagnosis and treatment possible.

  6. 5 CFR 581.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... accompany legal process. 581.203 Section 581.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Process § 581.203 Information minimally required to accompany legal process. (a) Sufficient identifying information must accompany the legal process in order to enable processing by the governmental entity named...

  7. 5 CFR 581.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... accompany legal process. 581.203 Section 581.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Process § 581.203 Information minimally required to accompany legal process. (a) Sufficient identifying information must accompany the legal process in order to enable processing by the governmental entity named...

  8. 5 CFR 581.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... accompany legal process. 581.203 Section 581.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Process § 581.203 Information minimally required to accompany legal process. (a) Sufficient identifying information must accompany the legal process in order to enable processing by the governmental entity named...

  9. 5 CFR 581.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... accompany legal process. 581.203 Section 581.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Process § 581.203 Information minimally required to accompany legal process. (a) Sufficient identifying information must accompany the legal process in order to enable processing by the governmental entity named...

  10. 5 CFR 581.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... accompany legal process. 581.203 Section 581.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT... Process § 581.203 Information minimally required to accompany legal process. (a) Sufficient identifying information must accompany the legal process in order to enable processing by the governmental entity named...

  11. Critical thinking of student nurses during clinical accompaniment.

    PubMed

    Uys, B Y; Meyer, S M

    2005-08-01

    The purpose of this study was to investigate the methods of clinical accompaniment used by clinical facilitators in practice. The findings of the study also reflected facilitators' perceptions regarding critical thinking and the facilitation thereof. A quantitative research design was used. A literature study was conducted to identify the methods of accompaniment that facilitate critical thinking. Data was collected by means of a questionnaire developed for that purpose. Making a content-related validity judgment, and involving seven clinical facilitators in an academic institution, ensured the validity of the questionnaire. The results of the study indicated that various clinical methods of accompaniment were used. To a large extent, these methods correlated with those discussed in the literature review. The researcher further concluded that the concepts 'critical thinking' and 'facilitation' were not interpreted correctly by the respondents, and would therefore not be implemented in a proper manner in nursing practice. Furthermore, it seemed evident that tutor-driven learning realised more often than student-driven learning. In this regard, the requirement of outcomes-based education was not satisfied. The researcher is therefore of the opinion that a practical programme for the development of critical thinking skills during clinical accompaniment must be developed within the framework of outcomes-based education.

  12. Ocular myasthenia gravis accompanied by anosmia.

    PubMed

    Chen, Ying; Wang, Li; Zhou, Li; Gao, Ying

    2016-02-01

    We report a case of ocular myasthenia gravis (MG) accompanied by anosmia. A 76-year-old man had idiopathic anosmia of 2-year duration. Four months before consultation, he began to have drooping in the right upper eyelid along with muscle soreness, distension, and pain in the nape. His tongue was dark-red with a thin and white coating; his pulse was wiry and slippery. According to Traditional Chinese Medicine, eyelid drooping and anosmia are the main signs of liver constraint and spleen deficiency. In Western Medicine, the diagnosis was ocular MG and idiopathic anosmia. Our patient, along with the literature, suggests that anosmia may be an early symptom before MG. MG accompanied by anosmia could be a special subtype of MG according to antibody production and symptoms.

  13. Meningitis complicated by subdural empyema and deafness caused by pneumoccoccal serotype 7F in a 17-month-old child: a case report.

    PubMed

    Bosis, S; Semino, M; Picciolli, I; Pinzani, R; Genitori, L; Principi, N; Esposito, S

    2012-06-01

    Despite the availability of effective antibacterial agents and vaccines, pneumococcal meningitis and sepsis are still associated with high mortality rates and a high risk of neurological sequelae. We describe the case of a 17-month-old boy vaccinated with heptavalent pneumococcal conjugate vaccine (PCV7) who developed bacterial meningitis complicated by subdural empyema and deafness caused by Streptococcus pneumoniae serotype 7F. The 7F strain is not contained in PCV7 (the only vaccine on the market at the time of the onset of meningitis) but is included in the new pediatric 13-valent PCV, which may therefore prevent cases such as this in the future.

  14. Nonsurgical acute traumatic subdural hematoma: what is the risk?

    PubMed

    Bajsarowicz, Paul; Prakash, Ipshita; Lamoureux, Julie; Saluja, Rajeet Singh; Feyz, Mitra; Maleki, Mohammad; Marcoux, Judith

    2015-11-01

    The Brain Trauma Foundation has published guidelines on the surgical management of traumatic subdural hematoma (SDH). However, no data exist on the proportion of patients with SDH that can be selected for conservative management and what is the outcome of these patients. The goals of this study were as follows: 1) to establish what proportion of patients are initially treated conservatively; 2) to determine what proportion of patients will deteriorate and require surgical evacuation; and 3) to identify risk factors associated with deterioration and delayed surgery. All cases of acute traumatic SDH (869 when inclusion criteria were met) presenting over a 4-year period were reviewed. For all conservatively treated SDH, the proportion of delayed surgical intervention and the Glasgow Outcome Scale score were taken as outcome measures. Multiple factors were compared between patients who required delayed surgery and patients without surgery. Of the 869 patients with acute traumatic SDH, 646 (74.3%) were initially treated conservatively. A good outcome was achieved in 76.7% of the patients. Only 6.5% eventually required delayed surgery, and the median delay for surgery was 9.5 days. Factors associated with deterioration were as follows: 1) thicker SDH (p<0.001); 2) greater midline shift (p<0.001); 3) location at the convexity (p=0.001); 4) alcohol abuse (p=0.0260); and 5) history of falls (p=0.018). There was no significant difference in regard to age, sex, Glasgow Coma Scale score, Injury Severity Score, abnormal coagulation, use of blood thinners, and presence of cerebral atrophy or white matter disease. The majority of patients with SDH are treated conservatively. Of those, only 6.5% later required surgery, for raised intracranial pressure or SDH progression. Patients at risk can be identified and followed more carefully.

  15. 9 CFR 93.314 - Horses, certification, and accompanying equipment.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ..., certification, and accompanying equipment. (a) Horses offered for importation from any part of the world shall... region of origin, or if exported from Mexico, shall be accompanied either by such a certificate or by a... were imported from regions affected with CEM. (b) If a horse is presented for importation from a region...

  16. Metastatic Basal cell carcinoma accompanying gorlin syndrome.

    PubMed

    Bilir, Yeliz; Gokce, Erkan; Ozturk, Banu; Deresoy, Faik Alev; Yuksekkaya, Ruken; Yaman, Emel

    2014-01-01

    Gorlin-Goltz syndrome or basal cell nevus syndrome is an autosomal dominant syndrome characterized by skeletal anomalies, numerous cysts observed in the jaw, and multiple basal cell carcinoma of the skin, which may be accompanied by falx cerebri calcification. Basal cell carcinoma is the most commonly skin tumor with slow clinical course and low metastatic potential. Its concomitance with Gorlin syndrome, resulting from a mutation in a tumor suppressor gene, may substantially change morbidity and mortality. A 66-year-old male patient with a history of recurrent basal cell carcinoma was presented with exophthalmus in the left eye and the lesions localized in the left lateral orbita and left zygomatic area. His physical examination revealed hearing loss, gapped teeth, highly arched palate, and frontal prominence. Left orbital mass, cystic masses at frontal and ethmoidal sinuses, and multiple pulmonary nodules were detected at CT scans. Basal cell carcinoma was diagnosed from biopsy of ethmoid sinus. Based on the clinical and typical radiological characteristics (falx cerebri calcification, bifid costa, and odontogenic cysts), the patient was diagnosed with metastatic skin basal cell carcinoma accompanied by Gorlin syndrome. Our case is a basal cell carcinoma with aggressive course accompanying a rarely seen syndrome.

  17. Two occurrences of delayed epidural hematoma in different areas following decompressive craniectomy for acute subdural hematoma in a single patient: a case report.

    PubMed

    Wu, Ruhong; Shi, Jia; Cao, Jiachao; Mao, Yumin; Dong, Bo

    2017-12-04

    Delayed epidural hematoma (DEH) following evacuation of traumatic acute subdural hematoma (ASDH) or acute epidural hematoma (EDH) is a rare but devastating complication, especially when it occurs sequentially in a single patient. A 19-year-old man who developed contralateral DEH following craniotomy for evacuation of a traumatic right-side ASDH and then developed a left-side DEH of the posterior cranial fossa after craniotomy for evacuation of the contralateral DEH. He was immediately returned to the operating room for additional surgeries and his neurological outcome was satisfactory. Although DEH occurring after evacuation of ASDH or acute EDH is a rare event, timely recognition is critical to prognosis.

  18. Does Early Resumption of Low-Dose Aspirin After Evacuation of Chronic Subdural Hematoma With Burr-Hole Drainage Lead to Higher Recurrence Rates?

    PubMed

    Kamenova, Maria; Lutz, Katharina; Schaedelin, Sabine; Fandino, Javier; Mariani, Luigi; Soleman, Jehuda

    2016-11-01

    Antiplatelet therapy in patients with chronic subdural hematoma (cSDH) presents significant neurosurgical challenges. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, it is difficult to balance the patient's increased cardiovascular risk and prevalence of cSDH. To better understand the risk and recurrence rates related to resuming low-dose acetylsalicylic acid (ASA) by evaluating our patients' resumption of low-dose ASA at various times after burr-hole drainage of the hematoma. In our retrospective study, 140 consecutive patients taking low-dose ASA undergoing surgical evacuation of cSDH were included. Data included baseline characteristics and rates of recurrence, morbidity, and mortality. A multivariate logistic regression model analyzed the association between ASA resumption time and recurrence rates. No statistically significant association was observed between early postoperative resumption of low-dose ASA and recurrence of cSDH (odds ratio, 1.01; 95% confidence interval, 1.001-1.022; P = .06). Corresponding odds ratios and risk differences for restarting ASA treatment on postoperative days 1, 7, 14, 21, 28, 35, or 42 were estimated at 1.53 and 5.9%, 1.42 and 5.1%, 1.33 and 4.1%, 1.23 and 3.2%, 1.15 and 2.2%, 1.07 and 1.1%, and 1.01 and 0.2%, respectively (P > .05). Cardiovascular event rates, surgical morbidity, and mortality did not significantly differ between patients with or without ASA therapy. Given the few published studies regarding ASA use in cranial neurosurgery, our findings elucidate one issue, showing comparable recurrence rates with early or late resumption of low-dose ASA after burr-hole evacuation of cSDH. ASA, acetylsalicylic acidCAD, coronary artery diseaseCI, confidence intervalcSDH, chronic subdural hematomaGCS, Glasgow Coma ScalemRS, modified Rankin ScaleOR, odds ratioRD, risk difference.

  19. Metastatic Basal Cell Carcinoma Accompanying Gorlin Syndrome

    PubMed Central

    Bilir, Yeliz; Gokce, Erkan; Ozturk, Banu; Deresoy, Faik Alev; Yuksekkaya, Ruken; Yaman, Emel

    2014-01-01

    Gorlin-Goltz syndrome or basal cell nevus syndrome is an autosomal dominant syndrome characterized by skeletal anomalies, numerous cysts observed in the jaw, and multiple basal cell carcinoma of the skin, which may be accompanied by falx cerebri calcification. Basal cell carcinoma is the most commonly skin tumor with slow clinical course and low metastatic potential. Its concomitance with Gorlin syndrome, resulting from a mutation in a tumor suppressor gene, may substantially change morbidity and mortality. A 66-year-old male patient with a history of recurrent basal cell carcinoma was presented with exophthalmus in the left eye and the lesions localized in the left lateral orbita and left zygomatic area. His physical examination revealed hearing loss, gapped teeth, highly arched palate, and frontal prominence. Left orbital mass, cystic masses at frontal and ethmoidal sinuses, and multiple pulmonary nodules were detected at CT scans. Basal cell carcinoma was diagnosed from biopsy of ethmoid sinus. Based on the clinical and typical radiological characteristics (falx cerebri calcification, bifid costa, and odontogenic cysts), the patient was diagnosed with metastatic skin basal cell carcinoma accompanied by Gorlin syndrome. Our case is a basal cell carcinoma with aggressive course accompanying a rarely seen syndrome. PMID:25506011

  20. Postoperative hematoma involving brainstem, peduncles, cerebellum, deep subcortical white matter, cerebral hemispheres following chronic subdural hematoma evacuation

    PubMed Central

    Patibandla, Mohana Rao; Thotakura, Amit K.; Shukla, Dinesh; Purohit, Anirudh K.; Addagada, Gokul Chowdary; Nukavarapu, Manisha

    2017-01-01

    Among the intracranial hematomas, chronic subdural hematomas (CSDH) are the most benign with a mortality rate of 0.5-4.0%. The elderly and alcoholics are commonly affected by CSDH. Even though high percentage of CSDH patients improves after the evacuation, there are some unexpected potential complications altering the postoperative course with neurological deterioration. Poor outcome in postoperative period is due to complications like failure of brain to re-expand, recurrence of hematoma and tension pneumocephalus. We present a case report with multiple intraparenchymal hemorrhages in various locations like brainstem, cerebral and cerebellar peduncles, right cerebellar hemisphere, right thalamus, right capsulo-ganglionic region, right corona radiata and cerebral hemispheres after CSDH evacuation. Awareness of this potential problem and the immediate use of imaging if the patient does not awake from anesthesia or if he develops new onset focal neurological deficits, are the most important concerns to the early diagnosis of this rare complication. PMID:28484546

  1. A case of peribiliary cysts accompanying bile duct carcinoma

    PubMed Central

    Miura, Fumihiko; Takada, Tadahiro; Amano, Hodaka; Yoshida, Masahiro; Isaka, Takahiro; Toyota, Naoyuki; Wada, Keita; Takagi, Kenji; Kato, Kenichiro

    2006-01-01

    A rare case of peribiliary cysts accompanying bile duct carcinoma is presented. A 54-year-old man was diagnosed as having lower bile duct carcinoma and peribiliary cysts by diagnostic imaging. He underwent pylorus preserving pancreatoduodenectomy. As for the peribiliary cysts, a course of observation was taken. Over surgery due to misdiagnosis of patients with biliary malignancy accompanied by peribiliary cysts should be avoided. PMID:16874882

  2. 7 CFR 319.37-12 - Prohibited articles accompanying restricted articles.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... 7 Agriculture 5 2010-01-01 2010-01-01 false Prohibited articles accompanying restricted articles... Stock, Plants, Roots, Bulbs, Seeds, and Other Plant Products 1,2 § 319.37-12 Prohibited articles accompanying restricted articles. A restricted article for importation into the United States shall not be...

  3. 7 CFR 319.37-12 - Prohibited articles accompanying restricted articles.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... 7 Agriculture 5 2011-01-01 2011-01-01 false Prohibited articles accompanying restricted articles... Stock, Plants, Roots, Bulbs, Seeds, and Other Plant Products 1,2 § 319.37-12 Prohibited articles accompanying restricted articles. A restricted article for importation into the United States shall not be...

  4. Magnetic Resonance Imaging Findings Predict the Recurrence of Chronic Subdural Hematoma

    PubMed Central

    GOTO, Haruo; ISHIKAWA, Osamu; NOMURA, Masashi; TANAKA, Kentaro; NOMURA, Seiji; MAEDA, Keiichiro

    2015-01-01

    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. PMID:25746312

  5. 31 CFR 560.507 - Accompanied baggage authorized.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... the United States directly or indirectly from Iran are authorized to import into the United States... Iran are authorized to export from the United States accompanied baggage normally incident to travel...

  6. 31 CFR 560.507 - Accompanied baggage authorized.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... the United States directly or indirectly from Iran are authorized to import into the United States... Iran are authorized to export from the United States accompanied baggage normally incident to travel...

  7. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  8. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  9. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  10. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  11. 22 CFR 40.102 - Guardian required to accompany excluded alien.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Guardian required to accompany excluded alien. 40.102 Section 40.102 Foreign Relations DEPARTMENT OF STATE VISAS REGULATIONS PERTAINING TO BOTH... Guardian required to accompany excluded alien. INA 212(a)(9)(B) is not applicable at the time of visa...

  12. 30 CFR 250.212 - What information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... management information required by § 250.226; (o) Environmental impact analysis information required by § 250... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What information must accompany the EP? 250.212... and Information Contents of Exploration Plans (ep) § 250.212 What information must accompany the EP...

  13. Motor vehicle crash-related subdural hematoma from real-world head impact data.

    PubMed

    Urban, Jillian E; Whitlow, Christopher T; Edgerton, Colston A; Powers, Alexander K; Maldjian, Joseph A; Stitzel, Joel D

    2012-12-10

    Abstract Approximately 1,700,000 people sustain a traumatic brain injury (TBI) each year and motor vehicle crashes (MVCs) are a leading cause of hospitalization from TBI. Acute subdural hematoma (SDH) is a common intracranial injury that occurs in MVCs associated with high mortality and morbidity rates. In this study, SDH volume and midline shift have been analyzed in order to better understand occupant injury by correlating them to crash and occupant parameters. Fifty-seven head computed tomography (CT) scans were selected from the Crash Injury Research Engineering Network (CIREN) with Abbreviated Injury Scale (AIS) level 3+ SDH. Semi-automated methods were used to isolate the intracranial volume. SDH and additional occupant intracranial injuries were segmented across axial CT images, providing a total SDH injury volume. SDH volume was correlated to crash parameters and occupant characteristics. Results show a positive correlation between SDH volume and crash severity in near-side and frontal crashes. Additionally, the location of the resulting hemorrhage varied by crash type. Those with greater SDH volumes had significantly lower Glasgow Coma Scale (GCS) scores at the crash site in near-side crashes. Age and fracture type were found to be significant contributors to SDH volume. This study is a volumetric analysis of real world brain injuries and known MVC impacts. The results of this study demonstrate a relationship among SDH volume, crash mechanics, and occupant characteristics that provide a better understanding of the injury mechanisms of MVC-associated TBI.

  14. Postoperative rehabilitation for chronic subdural hematoma in the elderly. An observational study focusing on balance, ambulation and discharge destination.

    PubMed

    Carlisi, Ettore; Feltroni, Lucia; Tinelli, Carmine; Verlotta, Mariarosaria; Gaetani, Paolo; Dalla Toffola, Elena

    2017-02-01

    Chronic subdural hematoma (CSDH) can have a negative impact on autonomy of the elderly. Ambulatory and functional status may remain limited despite successful surgical evacuation. To evaluate the outcome of a postoperative assisted rehabilitation program. Single-institution short-term observational study. Inpatient (Neurosurgery Unit of a University Hospital). Thirty-five patients, aged 65 or older, who underwent burr-hole drainage for chronic subdural hematoma. Postoperatively all participants underwent a rehabilitation program, described in details, aimed at recovering standing position and gait as soon as possible. The program involved daily 30-minute individual sessions assisted by a physiotherapist, until discharge from hospital. The Markwalder's Grading Scale was used to assess the neurological status preoperatively and at discharge. The Trunk Control Test, the Standing Balance by Bohannon Scale and the Modified Rankin Scale were used to evaluate balance and general function (primary outcome) in the immediate postoperative and at discharge. We also recorded the rate of pre-CSDH walking patients who maintained ambulation at discharge and the discharge destination (secondary outcome). Total scores of Markwalder's Grading Scale, Trunk Control Test, Standing Balance by Bohannon Scale and Modified Rankin Scale improved (P<0.05), indicating a global favorable outcome, especially for balance. Excluding the patients who were dependent pre-CSDH, the others maintained gait function in 74.2% of cases. Only 45.7% of the patients were discharged home, the others being divided between inpatient medical settings and rehabilitation. The rehabilitation program was well tolerated by the patients. Our study showed a clear improvement in trunk control and standing balance and an overall favorable outcome for neurological and ambulatory status at discharge. Despite an assisted postoperative rehabilitation program, the residual impairment in general function was the main factor

  15. 5 CFR 582.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... accompany legal process. 582.203 Section 582.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS COMMERCIAL GARNISHMENT OF FEDERAL EMPLOYEES' PAY Service of Legal Process § 582.203 Information minimally required to accompany legal process. (a) Sufficient identifying...

  16. 5 CFR 582.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... accompany legal process. 582.203 Section 582.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS COMMERCIAL GARNISHMENT OF FEDERAL EMPLOYEES' PAY Service of Legal Process § 582.203 Information minimally required to accompany legal process. (a) Sufficient identifying...

  17. 5 CFR 582.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... accompany legal process. 582.203 Section 582.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS COMMERCIAL GARNISHMENT OF FEDERAL EMPLOYEES' PAY Service of Legal Process § 582.203 Information minimally required to accompany legal process. (a) Sufficient identifying...

  18. 5 CFR 582.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... accompany legal process. 582.203 Section 582.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS COMMERCIAL GARNISHMENT OF FEDERAL EMPLOYEES' PAY Service of Legal Process § 582.203 Information minimally required to accompany legal process. (a) Sufficient identifying...

  19. 5 CFR 582.203 - Information minimally required to accompany legal process.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... accompany legal process. 582.203 Section 582.203 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS COMMERCIAL GARNISHMENT OF FEDERAL EMPLOYEES' PAY Service of Legal Process § 582.203 Information minimally required to accompany legal process. (a) Sufficient identifying...

  20. In vivo imaging of twist drill drainage for subdural hematoma: a clinical feasibility study on electrical impedance tomography for measuring intracranial bleeding in humans.

    PubMed

    Dai, Meng; Li, Bing; Hu, Shijie; Xu, Canhua; Yang, Bin; Li, Jianbo; Fu, Feng; Fei, Zhou; Dong, Xiuzhen

    2013-01-01

    Intracranial bleeding is one of the most severe medical emergencies in neurosurgery. Early detection or diagnosis would largely reduce the rate of disability and mortality, and improve the prognosis of the patients. Electrical Impedance Tomography (EIT) can non-invasively image the internal resistivity distribution within a human body using a ring of external electrodes, and is thus a promising technique to promptly detect the occurrence of intracranial bleedings because blood differs from other brain tissues in resistivity. However, so far there is no experimental study that has determined whether the intracranial resistivity changes in humans could be repeatedly detected and imaged by EIT. Hence, we for the first time attempt to clinically validate this by in vivo imaging the influx and efflux of irrigating fluid (5% dextrose in water, D5W) during the twist-drill drainage operation for the patients with subdural hematoma (SDH). In this study, six patients (four male, two female) with subacute or chronic SDH received the surgical operation in order to evacuate the hematoma around subdural region, and EIT measurements were performed simultaneously on each patient's head. The results showed that the resistivity significantly increased on the corresponding position of EIT images during the influx of D5W and gradually decreased back to baseline during the efflux. In the quantitative analysis, the average resistivity values demonstrated the similar results and had highly linear correlation (R(2) = 0.93 ± 0.06) with the injected D5W volumes, as well as the area of the resistivity gain(R(2) = 0.94 ± 0.05). In conclusion, it was clinically validated that intracranial resistivity changes in humans were detectable and quantifiable by the EIT method. After further technical improvements, EIT has the great potential of being a routine neuroimaging tool for early detection of intracranial bleedings.

  1. In Vivo Imaging of Twist Drill Drainage for Subdural Hematoma: A Clinical Feasibility Study on Electrical Impedance Tomography for Measuring Intracranial Bleeding in Humans

    PubMed Central

    Xu, Canhua; Yang, Bin; Li, Jianbo; Fu, Feng; Fei, Zhou; Dong, Xiuzhen

    2013-01-01

    Intracranial bleeding is one of the most severe medical emergencies in neurosurgery. Early detection or diagnosis would largely reduce the rate of disability and mortality, and improve the prognosis of the patients. Electrical Impedance Tomography (EIT) can non-invasively image the internal resistivity distribution within a human body using a ring of external electrodes, and is thus a promising technique to promptly detect the occurrence of intracranial bleedings because blood differs from other brain tissues in resistivity. However, so far there is no experimental study that has determined whether the intracranial resistivity changes in humans could be repeatedly detected and imaged by EIT. Hence, we for the first time attempt to clinically validate this by in vivo imaging the influx and efflux of irrigating fluid (5% dextrose in water, D5W) during the twist-drill drainage operation for the patients with subdural hematoma (SDH). In this study, six patients (four male, two female) with subacute or chronic SDH received the surgical operation in order to evacuate the hematoma around subdural region, and EIT measurements were performed simultaneously on each patient’s head. The results showed that the resistivity significantly increased on the corresponding position of EIT images during the influx of D5W and gradually decreased back to baseline during the efflux. In the quantitative analysis, the average resistivity values demonstrated the similar results and had highly linear correlation (R2 = 0.93±0.06) with the injected D5W volumes, as well as the area of the resistivity gain(R2 = 0.94±0.05). In conclusion, it was clinically validated that intracranial resistivity changes in humans were detectable and quantifiable by the EIT method. After further technical improvements, EIT has the great potential of being a routine neuroimaging tool for early detection of intracranial bleedings. PMID:23372808

  2. Separation of Singing Voice from Music Accompaniment for Monaural Recordings

    DTIC Science & Technology

    2005-09-01

    Directory: pub/tech-report/2005 File in pdf format: TR61.pdf Separation of Singing Voice from Music Accompaniment for Monaural Recordings Yipeng Li...Abstract Separating singing voice from music accompaniment is very useful in many applications, such as lyrics recognition and alignment, singer...identification, and music information retrieval. Although speech separation has been extensively studied for decades, singing voice separation has been little

  3. 30 CFR 250.228 - What administrative information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What administrative information must accompany the EP? 250.228 Section 250.228 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE... Contents of Exploration Plans (ep) § 250.228 What administrative information must accompany the EP? The...

  4. Spontaneous Resolution of Chronic Subdural Hematoma : Close Observation as a Treatment Strategy

    PubMed Central

    Kim, Hyung Chan; Yoo, Dong Soo; Lee, Sang-Koo

    2016-01-01

    Objective Chronic subdural hematoma (cSDH) is common condition in neurosurgical field. It is difficult to select the treatment modality between the surgical method and the conservative method when patients have no or mild symptoms. The purpose of this study is to provide a suggestion that the patients could be cured with conservative treatment modality. Methods We enrolled 16 patients who had received conservative treatment for cSDH without special medications which could affect hematoma resolution such as mannitol, steroids, tranexamic acid and angiotensin converting enzyme inhibitors. The patients were classified according to the Markwalder's Grading Scale. Results Among these 16 patients, 13 (81.3%) patients showed spontaneously resolved cSDH and 3 (18.7%) patients received surgery due to symptom aggravation and growing hematoma. They were categorized into two groups based on whether they were cured with conservative treatment or not. The first group was the spontaneous resolution group. The second group was the progression-surgery group. The mean hematoma volume in the spontaneous resolution group was 43.1 mL. The mean degree of midline shift in the spontaneous resolution group was 5.3 mm. The mean hematoma volume in the progression-surgery group was 62.0 mL. The mean degree of midline shift in the second group was 6 mm. Conclusion We suggest that the treatment modality should be determined according to the patient's symptoms and clinical condition and close observation could be performed in patients who do not have any symptoms or in patients who have mild to moderate headache without neurological deterioration. PMID:27847578

  5. 49 CFR 591.6 - Documents accompanying declarations.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) IMPORTATION OF VEHICLES AND EQUIPMENT SUBJECT TO FEDERAL SAFETY, BUMPER AND THEFT PREVENTION STANDARDS § 591.6 Documents accompanying... public roads, or that the equipment item was not manufactured for use on a motor vehicle or is not an...

  6. Clinical characteristics of 15 cases of chronic subdural hematomas due to spontaneous intracranial hypotension with spinal cerebrospinal fluid leak.

    PubMed

    Wan, Yingfeng; Xie, Jixi; Xie, Dajiang; Xue, Zhaoliang; Wang, Yirong; Yang, Shuxu

    2016-12-01

    The etiology of chronic subdural hematoma (CSDH) in patients is diverse. The primary objective of this article was to discuss one of the causes, spontaneous intracranial hypotension with spinal cerebrospinal fluid (CSF) leak, which is usually neglected by the neurosurgeon. All the consecutive 15 patients who underwent operation for CSDHs between June 2012 and June 2014 at Sir Run Run Shaw Hospital of Zhejiang University were included in this retrospective cohort study. The clinical and imaging data of these patients with CSDHs due to spinal CSF leak were retrospectively studied. Fifteen patients, with a mean age of 53.8 ± 8.3 years, underwent operations for CSDH. Hematomas were unilateral in 4 patients and bilateral in 11 patients. Among these patients, eight patients had recurrence of hematomas after operation due to neglect of spinal CSF leak. All patients had fully recovery. Spinal CSF leak is a cause of cSDH, which is overlooked by the doctor.

  7. 39 CFR 320.7 - Suspension for advertisements accompanying parcels or periodicals.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 39 Postal Service 1 2010-07-01 2010-07-01 false Suspension for advertisements accompanying parcels or periodicals. 320.7 Section 320.7 Postal Service UNITED STATES POSTAL SERVICE RESTRICTIONS ON PRIVATE CARRIAGE OF LETTERS SUSPENSION OF THE PRIVATE EXPRESS STATUTES § 320.7 Suspension for advertisements accompanying parcels or periodicals. (a) Th...

  8. 41 CFR 101-25.110-3 - Tires accompanying new motor vehicles.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 41 Public Contracts and Property Management 2 2010-07-01 2010-07-01 true Tires accompanying new...-GENERAL 25.1-General Policies § 101-25.110-3 Tires accompanying new motor vehicles. The tire... vehicle manufacturer or his designee to maintain a record of tires on or in each vehicle shipped by him...

  9. Acute, Nontraumatic Spontaneous Spinal Subdural Hematoma: A Case Report and Systematic Review of the Literature

    PubMed Central

    Abel, Taylor J.

    2017-01-01

    Spontaneous spinal subdural hematoma (sSDH) is a rare condition outright. Moreover, cases that occur spontaneously in the absence of an identifiable etiology are considerably less common and remain poorly understood. Here, we present the case of a 43-year-old man with spontaneous sSDH presenting with acute onset low back pain and paraplegia. Urgent magnetic resonance imaging identified a dorsal SDH from T8 to T11 with compression of the spinal cord. Emergent T8–T10 laminectomies with intradural exploration and hematoma evacuation were performed. However, despite prompt identification and appropriate action, the patient's recovery was modest and significant disability remained at discharge. This unique and unusual case demonstrates that spontaneous sSDH requires prompt surgical treatment to minimize associated morbidity and supports the association between the presence of severe neurological deficits upon initial presentation with less favorable outcomes. We performed a comprehensive systematic review of spontaneous sSDH of unknown etiology, which demonstrates that emergent surgical intervention is indicated for patients presenting with severe neurological deficits and the presence of these deficits is predictive of poor neurological outcome. Furthermore, conservative management should be considered in patients presenting with mild neurological deficits as spontaneous resolution followed by favorable neurological outcomes is often observed in these patients. PMID:29441210

  10. iElectrodes: A Comprehensive Open-Source Toolbox for Depth and Subdural Grid Electrode Localization.

    PubMed

    Blenkmann, Alejandro O; Phillips, Holly N; Princich, Juan P; Rowe, James B; Bekinschtein, Tristan A; Muravchik, Carlos H; Kochen, Silvia

    2017-01-01

    The localization of intracranial electrodes is a fundamental step in the analysis of invasive electroencephalography (EEG) recordings in research and clinical practice. The conclusions reached from the analysis of these recordings rely on the accuracy of electrode localization in relationship to brain anatomy. However, currently available techniques for localizing electrodes from magnetic resonance (MR) and/or computerized tomography (CT) images are time consuming and/or limited to particular electrode types or shapes. Here we present iElectrodes, an open-source toolbox that provides robust and accurate semi-automatic localization of both subdural grids and depth electrodes. Using pre- and post-implantation images, the method takes 2-3 min to localize the coordinates in each electrode array and automatically number the electrodes. The proposed pre-processing pipeline allows one to work in a normalized space and to automatically obtain anatomical labels of the localized electrodes without neuroimaging experts. We validated the method with data from 22 patients implanted with a total of 1,242 electrodes. We show that localization distances were within 0.56 mm of those achieved by experienced manual evaluators. iElectrodes provided additional advantages in terms of robustness (even with severe perioperative cerebral distortions), speed (less than half the operator time compared to expert manual localization), simplicity, utility across multiple electrode types (surface and depth electrodes) and all brain regions.

  11. iElectrodes: A Comprehensive Open-Source Toolbox for Depth and Subdural Grid Electrode Localization

    PubMed Central

    Blenkmann, Alejandro O.; Phillips, Holly N.; Princich, Juan P.; Rowe, James B.; Bekinschtein, Tristan A.; Muravchik, Carlos H.; Kochen, Silvia

    2017-01-01

    The localization of intracranial electrodes is a fundamental step in the analysis of invasive electroencephalography (EEG) recordings in research and clinical practice. The conclusions reached from the analysis of these recordings rely on the accuracy of electrode localization in relationship to brain anatomy. However, currently available techniques for localizing electrodes from magnetic resonance (MR) and/or computerized tomography (CT) images are time consuming and/or limited to particular electrode types or shapes. Here we present iElectrodes, an open-source toolbox that provides robust and accurate semi-automatic localization of both subdural grids and depth electrodes. Using pre- and post-implantation images, the method takes 2–3 min to localize the coordinates in each electrode array and automatically number the electrodes. The proposed pre-processing pipeline allows one to work in a normalized space and to automatically obtain anatomical labels of the localized electrodes without neuroimaging experts. We validated the method with data from 22 patients implanted with a total of 1,242 electrodes. We show that localization distances were within 0.56 mm of those achieved by experienced manual evaluators. iElectrodes provided additional advantages in terms of robustness (even with severe perioperative cerebral distortions), speed (less than half the operator time compared to expert manual localization), simplicity, utility across multiple electrode types (surface and depth electrodes) and all brain regions. PMID:28303098

  12. 31 CFR 538.511 - Accompanied baggage authorized.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Accompanied baggage authorized. 538.511 Section 538.511 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... only articles that are necessary for personal use incident to travel, are not intended for any other...

  13. 31 CFR 538.511 - Accompanied baggage authorized.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Accompanied baggage authorized. 538.511 Section 538.511 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... only articles that are necessary for personal use incident to travel, are not intended for any other...

  14. 31 CFR 538.511 - Accompanied baggage authorized.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Accompanied baggage authorized. 538.511 Section 538.511 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... only articles that are necessary for personal use incident to travel, are not intended for any other...

  15. 31 CFR 538.511 - Accompanied baggage authorized.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Accompanied baggage authorized. 538.511 Section 538.511 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... only articles that are necessary for personal use incident to travel, are not intended for any other...

  16. 31 CFR 538.511 - Accompanied baggage authorized.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Accompanied baggage authorized. 538.511 Section 538.511 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... only articles that are necessary for personal use incident to travel, are not intended for any other...

  17. 31 CFR 545.507 - Accompanied baggage authorized.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Accompanied baggage authorized. 545.507 Section 545.507 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... that are necessary for personal use incident to travel, that are not intended for any other person or...

  18. 31 CFR 560.507 - Accompanied baggage authorized.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Accompanied baggage authorized. 560.507 Section 560.507 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... for personal use incident to travel, not intended for any other person or for sale, and are not...

  19. 30 CFR 250.221 - What environmental monitoring information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What environmental monitoring information must... monitoring information must accompany the EP? The following environmental monitoring information, as applicable, must accompany your EP: (a) Monitoring systems. A description of any existing and planned...

  20. Concept and design philosophy of a person-accompanying robot

    NASA Astrophysics Data System (ADS)

    Mizoguchi, Hiroshi; Shigehara, Takaomi; Goto, Yoshiyasu; Hidai, Ken-ichi; Mishima, Taketoshi

    1999-01-01

    This paper proposes a person accompanying robot as a novel human collaborative robot. The person accompanying robot is such legged mobile robot that is possible to follow the person utilizing its vision. towards future aging society, human collaboration and human support are required as novel applications of robots. Such human collaborative robots share the same space with humans. But conventional robots are isolated from humans and lack the capability to observe humans. Study on human observing function of robot is crucial to realize novel robot such as service and pet robot. To collaborate and support humans properly human collaborative robot must have capability to observe and recognize humans. Study on human observing function of robot is crucial to realize novel robot such as service and pet robot. The authors are currently implementing a prototype of the proposed accompanying robot.As a base for the human observing function of the prototype robot, we have realized face tracking utilizing skin color extraction and correlation based tracking. We also develop a method for the robot to pick up human voice clearly and remotely by utilizing microphone arrays. Results of these preliminary study suggest feasibility of the proposed robot.

  1. Real-time implementation of an interactive jazz accompaniment system

    NASA Astrophysics Data System (ADS)

    Deshpande, Nikhil

    Modern computational algorithms and digital signal processing (DSP) are able to combine with human performers without forced or predetermined structure in order to create dynamic and real-time accompaniment systems. With modern computing power and intelligent algorithm layout and design, it is possible to achieve more detailed auditory analysis of live music. Using this information, computer code can follow and predict how a human's musical performance evolves, and use this to react in a musical manner. This project builds a real-time accompaniment system to perform together with live musicians, with a focus on live jazz performance and improvisation. The system utilizes a new polyphonic pitch detector and embeds it in an Ableton Live system - combined with Max for Live - to perform elements of audio analysis, generation, and triggering. The system also relies on tension curves and information rate calculations from the Creative Artificially Intuitive and Reasoning Agent (CAIRA) system to help understand and predict human improvisation. These metrics are vital to the core system and allow for extrapolated audio analysis. The system is able to react dynamically to a human performer, and can successfully accompany the human as an entire rhythm section.

  2. 30 CFR 550.221 - What environmental monitoring information must accompany the EP?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What environmental monitoring information must... Information Contents of Exploration Plans (ep) § 550.221 What environmental monitoring information must accompany the EP? The following environmental monitoring information, as applicable, must accompany your EP...

  3. 30 CFR 250.221 - What environmental monitoring information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What environmental monitoring information must... Contents of Exploration Plans (ep) § 250.221 What environmental monitoring information must accompany the EP? The following environmental monitoring information, as applicable, must accompany your EP: (a...

  4. 30 CFR 550.221 - What environmental monitoring information must accompany the EP?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What environmental monitoring information must... Information Contents of Exploration Plans (ep) § 550.221 What environmental monitoring information must accompany the EP? The following environmental monitoring information, as applicable, must accompany your EP...

  5. 30 CFR 550.221 - What environmental monitoring information must accompany the EP?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What environmental monitoring information must... Information Contents of Exploration Plans (ep) § 550.221 What environmental monitoring information must accompany the EP? The following environmental monitoring information, as applicable, must accompany your EP...

  6. Peroneal tendon displacement accompanying intra-articular calcaneal fractures.

    PubMed

    Toussaint, Rull James; Lin, Darius; Ehrlichman, Lauren K; Ellington, J Kent; Strasser, Nicholas; Kwon, John Y

    2014-02-19

    Peroneal tendon displacement (subluxation or dislocation) accompanying an intra-articular calcaneal fracture is often undetected and under-treated. The goals of this study were to determine (1) the prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures, (2) the association of tendon displacement with fracture classifications, (3) the association of tendon displacement with heel width, and (4) the rate of missed diagnosis of the tendon displacement on radiographs and computed tomography (CT) scans and the resulting treatment rate. A retrospective radiographic review of all calcaneal fractures presenting at three institutions from June 30, 2006, to June 30, 2011, was performed. CT imaging of 421 intra-articular calcaneal fractures involving the posterior facet was available for review. The prevalence of peroneal tendon displacement was noted and its associations with fracture classification and heel width were evaluated. Peroneal tendon displacement was identified in 118 (28.0%) of the 421 calcaneal fracture cases. The presence of tendon displacement was significantly associated with joint-depression fractures compared with tongue-type fractures (p < 0.001). Only twelve (10.2%) of the 118 cases of peroneal tendon displacement had been identified in the radiology reports. Although sixty-five (55.1%) of the fractures with tendon displacement had been treated with internal fixation, the tendon displacement was treated surgically in only seven (10.8%) of these cases. Analysis of CT images showed a 28% prevalence of peroneal tendon displacement accompanying intra-articular calcaneal fractures. Surgeons and radiologists are encouraged to consider this association.

  7. 30 CFR 250.223 - What mitigation measures information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What mitigation measures information must accompany the EP? 250.223 Section 250.223 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE... Contents of Exploration Plans (ep) § 250.223 What mitigation measures information must accompany the EP? (a...

  8. 30 CFR 250.222 - What lease stipulations information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What lease stipulations information must accompany the EP? 250.222 Section 250.222 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE... Contents of Exploration Plans (ep) § 250.222 What lease stipulations information must accompany the EP? A...

  9. No association between seniority of surgeon and postoperative recurrence of chronic subdural haematoma

    PubMed Central

    Phang, I; Sivakumaran, R; Papadopoulos, MC

    2015-01-01

    Introduction Neurosurgical trainees should achieve competency in chronic subdural haematoma (CSDH) drainage at an early stage in training. The effect of surgeon seniority on recurrence following surgical drainage of CSDH was examined. Methods All CSDH cases performed at St George’s Hospital in London between March 2009 and March 2012 were analysed. Recurrence was defined as clinical deterioration with computed tomography evidence of CSDH requiring reoperation within six months. The following risk factors were considered: seniority of primary and supervising surgeons, timing of surgery (working hours, outside working hours), patient related factors (age, antiplatelets, warfarin) and operative factors (general vs local anaesthesia, burr holes vs craniotomy, drain use). For recurrent cases, we examined the distance of the cranial opening from the thickest part of the CSDH. Results A total of 239 patients (median age: 79 years, range: 33–98 years) had 275 CSDH drainage operations. The overall recurrence rate was 13.1%. The median time between the initial procedure and reoperation was 16 days (range: 1–161 days). The only statistically significant risk factor for recurrence was antiplatelets (odds ratio: 2.62, 95% confidence interval: 1.13–6.10, p<0.05). Warfarin, grade of surgeon, timing of surgery, type of anaesthesia, type of operation and use of drains were not significant risk factors. In 26% of recurrent CSDH cases, the burr holes or craniotomy flaps were placed with borderline accuracy. Conclusions CSDH drainage is a suitable case for neurosurgical trainees to perform without increasing the chance of recurrence. PMID:26492904

  10. Neurologic Deterioration Due to Brain Sag After Bilateral Craniotomy for Subdural Hematoma Evacuation.

    PubMed

    Liu, James K C

    2018-06-01

    Intracranial hypotension from cerebrospinal fluid (CSF) hypovolemia resulting in cerebral herniation is a rare but known complication that can occur after neurosurgical procedures, usually encountered in correlation with perioperative placement of a lumbar subarachnoid drain. Decrease in CSF volume resulting in loss of buoyancy results in downward herniation of the brain without contributing mass effect, causing a phenomenon known as brain sag. Unreported previously is brain sag occurring without concomitant occult CSF leak or lumbar drainage. This case report describes a patient who underwent bilateral craniotomies for subacute on chronic subdural hematoma with successful decompression but experienced acute neurologic deterioration secondary to brain sag. Despite an initial improvement in neurologic function, he subsequently experienced progressive neurologic deterioration with evidence of cerebral herniation on neuroimaging, without evidence of continued mass effect on the brain parenchyma. After a diagnosis of brain sag was determined based on imaging criteria, the patient was placed in a flat position, which resulted in rapid improvement in his neurologic function without any further intervention. This case is unique in comparison with previous reports of intracranial hypotension after craniotomy in that the symptoms were completely reversed with positioning alone, without any evidence of active or occult CSF drainage. This report emphasizes that the diagnosis of brain sag should be taken into consideration when there is an unknown reason for neurologic decline after craniotomy, particularly bilateral craniotomies, if the imaging indicates herniation with imaging findings consistent with intracranial hypotension, without evidence of overlying mass effect. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Predictive factors for recurrence and clinical outcomes in patients with chronic subdural hematoma.

    PubMed

    Han, Myung-Hoon; Ryu, Je Il; Kim, Choong Hyun; Kim, Jae Min; Cheong, Jin Hwan; Yi, Hyeong-Joong

    2017-11-01

    OBJECTIVE Chronic subdural hematoma (CSDH) is a common type of intracranial hemorrhage in elderly patients. Many studies have suggested various factors that may be associated with the recurrence of CSDH. However, the results are inconsistent. The purpose of this study was to determine the associations among patient factors, recurrence, and clinical outcomes of CSDH after bur hole surgery performed during an 11-year period at twin hospitals. METHODS Kaplan-Meier analysis was performed to evaluate the risk factors for CSDH recurrence. Univariate and multivariate Cox proportional hazards regression analyses were used to calculate hazard ratios with 95% CIs for CSDH recurrence based on many variables. One-way repeated-measures ANOVA was used to assess the differences in the mean modified Rankin Scale score between categories for each risk factor during each admission and at the last follow-up. RESULTS This study was a retrospective analysis of 756 consecutive patients with CSDH who underwent bur hole surgery at the Hanyang University Medical Center (Seoul and Guri) between January 1, 2004, and December 31, 2014. During the 6-month follow-up, 104 patients (13.8%) with recurrence after surgery for CSDH were identified. Independent risk factors for recurrence were as follows: age > 75 years (HR 1.72, 95% CI 1.03-2.88; p = 0.039), obesity (body mass index ≥ 25.0 kg/m 2 ), and a bilateral operation. CONCLUSIONS This study determined the risk factors for recurrence of CSDH and their effects on outcomes. Further studies are needed to account for these observations and to determine their underlying mechanisms.

  12. 76 FR 44926 - Renewal of Declaration Regarding Emergency Use of Doxycycline Hyclate Tablets Accompanied by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-27

    ... Emergency Use of Doxycycline Hyclate Tablets Accompanied by Emergency Use Information and Amendment To... hyclate tablets accompanied by emergency use information subject to the terms of any authorization issued... authorization of the emergency use of doxycycline hyclate tablets accompanied by emergency use information...

  13. 75 FR 61489 - Renewal of Declaration Regarding Emergency Use of Doxycycline Hyclate Tablets Accompanied by...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-05

    ... Emergency Use of Doxycycline Hyclate Tablets Accompanied by Emergency Use Information AGENCY: Office of the... the authorization of emergency use of doxycycline hyclate tablets accompanied by emergency use... authorization of the emergency use of doxycycline hyclate tablets accompanied by emergency use information...

  14. Bedside Treatment of Chronic Subdural Hematoma: Using Radiographic Characteristics to Revisit the Twist Drill.

    PubMed

    Garber, Sarah; McCaffrey, Jamie; Quigley, Edward P; MacDonald, Joel D

    2016-05-01

    Conventional treatment strategies for the management of symptomatic chronic subdural hematoma (cSDH) in the elderly include observation, operative burr holes or craniotomy, and bedside twist drill drainage. The decision on which technique to use should be determined by weighing the comorbidities and symptoms of the patient with the potential risks and benefits. The goal of this study was to identify radiographic characteristics on computed tomography scan that might be used to guide surgical decision making in terms of operative versus bedside removal of cSDH. We retrospectively reviewed clinical and radiographic features in patients who underwent bedside twist drill evacuation of a cSDH and those for a cohort of patients who underwent operative intervention via burr holes. We did not identify any clinical features or preoperative imaging characteristics to suggest an advantage of one procedure over the other. Additionally, complete radiographic resolution of cSDH on postoperative imaging is not required to relieve patient symptoms. Although bedside twist drill evacuation may avoid operating room costs and anesthetic complications in an elderly patient population and allow earlier resumption of anticoagulation treatment if necessary, there is also a risk of morbidity if uncontrolled bleeding is encountered or the patient is unable to tolerate the bedside procedure. However, bedside twist drill craniostomy is a reasonable and effective option for the treatment of subacute/chronic SDH in patients who may not be optimal surgical candidates. Georg Thieme Verlag KG Stuttgart · New York.

  15. Chronic Subdural Hematoma Treated by Small or Large Craniotomy with Membranectomy as the Initial Treatment

    PubMed Central

    Kim, Jae-Hong; Kim, Jung-Hee; Kong, Min-Ho; Song, Kwan-Young

    2011-01-01

    Objective There are few studies comparing small and large craniotomies for the initial treatment of chronic subdural hematoma (CSDH) which had non-liquefied hematoma, multilayer intrahematomal loculations, or organization/calcification on computed tomography and magnetic resonance imaging. These procedures were compared to determine which would produce superior postoperative results. Methods Between 2001 and 2009, 317 consecutive patients were surgically treated for CSDH at our institution. Of these, 16 patients underwent a small craniotomy with partial membranectomy and 42 patients underwent a large craniotomy with extended membranectomy as the initial treatment. A retrospective review was performed to compare the postoperative outcomes of these two techniques, focusing on improvement of neurological status, complications, reoperation rate, and days of post-operative hospitalization. Results The mean ages were 69.4±12.1 and 55.6±9.3 years in the small and large craniotomy groups, respectively. The recurrence of hematomas requiring reoperation occurred in 50% and 10% of the small and large craniotomy patients, respectively (p<0.001). There were no significant differences in postoperative neurological status, complications, or days of hospital stay between these two groups. Conclusion Among the cases of CSDH initially requiring craniotomy, the large craniotomy with extended membranectomy technique reduced the reoperation rate, compared to that of the small craniotomy with partial membranectomy technique. PMID:22053228

  16. A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures.

    PubMed

    Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

    2015-01-01

    First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity.

  17. A Rare Entity: Bilateral First Rib Fractures Accompanying Bilateral Scapular Fractures

    PubMed Central

    Gulbahar, Gultekin; Kaplan, Tevfik; Turker, Hasan Bozkurt; Gundogdu, Ahmet Gokhan; Han, Serdar

    2015-01-01

    First rib fractures are scarce due to their well-protected anatomic locations. Bilateral first rib fractures accompanying bilateral scapular fractures are very rare, although they may be together with scapular and clavicular fractures. According to our knowledge, no case of bilateral first rib fractures accompanying bilateral scapular fractures has been reported, so we herein discussed the diagnosis, treatment, and complications of bone fractures due to thoracic trauma in bias of this rare entity. PMID:26175916

  18. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom.

    PubMed

    Brennan, Paul M; Kolias, Angelos G; Joannides, Alexis J; Shapey, Jonathan; Marcus, Hani J; Gregson, Barbara A; Grover, Patrick J; Hutchinson, Peter J; Coulter, Ian C

    2017-10-01

    OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. METHODS Data on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4-6) at NSU discharge < 30%. RESULTS Data from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not. CONCLUSIONS This

  19. The management and outcome for patients with chronic subdural hematoma: a prospective, multicenter, observational cohort study in the United Kingdom.

    PubMed

    Brennan, Paul M; Kolias, Angelos G; Joannides, Alexis J; Shapey, Jonathan; Marcus, Hani J; Gregson, Barbara A; Grover, Patrick J; Hutchinson, Peter J; Coulter, Ian C

    2017-03-17

    OBJECTIVE Symptomatic chronic subdural hematoma (CSDH) will become an increasingly common presentation in neurosurgical practice as the population ages, but quality evidence is still lacking to guide the optimal management for these patients. The British Neurosurgical Trainee Research Collaborative (BNTRC) was established by neurosurgical trainees in 2012 to improve research by combining the efforts of trainees in each of the United Kingdom (UK) and Ireland's neurosurgical units (NSUs). The authors present the first study by the BNTRC that describes current management and outcomes for patients with CSDH throughout the UK and Ireland. This provides a resource both for current clinical practice and future clinical research on CSDH. METHODS Data on management and outcomes for patients with CSDH referred to UK and Ireland NSUs were collected prospectively over an 8-month period and audited against criteria predefined from the literature: NSU mortality < 5%, NSU morbidity < 10%, symptomatic recurrence within 60 days requiring repeat surgery < 20%, and unfavorable functional status (modified Rankin Scale score of 4-6) at NSU discharge < 30%. RESULTS Data from 1205 patients in 26 NSUs were collected. Bur-hole craniostomy was the most common procedure (89%), and symptomatic recurrence requiring repeat surgery within 60 days was observed in 9% of patients. Criteria on mortality (2%), rate of recurrence (9%), and unfavorable functional outcome (22%) were met, but morbidity was greater than expected (14%). Multivariate analysis demonstrated that failure to insert a drain intraoperatively independently predicted recurrence and unfavorable functional outcome (p = 0.011 and p = 0.048, respectively). Increasing patient age (p < 0.00001), postoperative bed rest (p = 0.019), and use of a single bur hole (p = 0.020) independently predicted unfavorable functional outcomes, but prescription of high-flow oxygen or preoperative use of antiplatelet medications did not. CONCLUSIONS This

  20. Accompaniment and Quality in Childcare Services: The Emergence of a Culture of Professionalization

    ERIC Educational Resources Information Center

    Pirard, Florence; Barbier, Jean-Marie

    2012-01-01

    This article addresses various educational cultures observed today in a variety of training and professional development contexts in the field of early childhood education. The paper also analyses methods of developing and implementing training or professional "accompaniment". This notion of "accompaniment" has been developed…

  1. Computer Literacy: Handbook to Accompany VESL Vocabulary Cards.

    ERIC Educational Resources Information Center

    Siefer, Nancy; Lenhart, Debra

    This manual is one of four self-contained components of a larger handbook designed to assist secondary and postsecondary instructors and support staff in meeting the needs of limited-English-proficiency (LEP) students in vocational training programs. Together with an accompanying set of vocational English as a second language (VESL) vocabulary…

  2. Burr-hole Irrigation with Closed-system Drainage for the Treatment of Chronic Subdural Hematoma: A Meta-analysis

    PubMed Central

    XU, Chen; CHEN, Shiwen; YUAN, Lutao; JING, Yao

    2016-01-01

    There is controversy among neurosurgeons regarding whether irrigation or drainage is necessary for achieving a lower revision rate for the treatment of chronic subdural hematoma (CSDH) using burr-hole craniostomy (BHC). Therefore, we performed a meta-analysis of all available published reports. Multiple electronic health databases were searched to identify all studies published between 1989 and June 2012 that compared irrigation and drainage. Data were processed by using Review Manager 5.1.6. Effect sizes are expressed as pooled odds ratio (OR) estimates. Due to heterogeneity between studies, we used the random effect of the inverse variance weighted method to perform the meta-analysis. Thirteen published reports were selected for this meta-analysis. The comprehensive results indicated that there were no statistically significant differences in mortality or complication rates between drainage and no drainage (P > 0.05). Additionally, there were no differences in recurrence between irrigation and no irrigation (P > 0.05). However, the difference between drainage and no drainage in recurrence rate reached statistical significance (P < 0.01). The results from this meta-analysis suggest that burr-hole surgery with closed-system drainage can reduce the recurrence of CSDH; however, irrigation is not necessary for every patient. PMID:26377830

  3. [CT pulmonary density mapping: surgical utility].

    PubMed

    Gavezzoli, D; Caputo, P; Manelli, A; Zuccon, W; Faccini, M; Bonandrini, L

    2002-04-01

    The present paper considers the technique of CT scan maps of pulmonary isodensity, examining lung density differences as a function of the type of disease and considering their significance for the purposes of refined, useful diagnosis in a surgical context. METHODS. The method is used to examine 3 groups of subjects selected on a clinical/anamnestic basis and a further group already admitted for surgery. For each patient we obtained 2 thoracic density scans during the phase of maximum inspiration and expiration. On each scan we constructed 50 isodensity maps, the equivalent of more than 2500 measurements: the preliminary standard was represented by 100 wide windows to produce total "illumination" of the pulmonary fields. The isodensity windows were then codified differently. Subsequently, the density scans were analysed with the technique of scalar decomposition. The CT scan maps of lung isodensity proved useful for certain lung diseases in which early diagnosis, topographic extent of the pathology and the refined definition of the pathological picture provide important solutions as regards the indication and planning of surgical treatment and for the evaluation of the operative risk and prognosis. We consider that the technique is rapidly performed, not complex and inexpensive and is able to supply detailed information on the lung parenchyma such as to be used not only as a routine technique but also in emergencies.

  4. Spinal cerebrospinal fluid leak as the cause of chronic subdural hematomas in nongeriatric patients.

    PubMed

    Beck, Jürgen; Gralla, Jan; Fung, Christian; Ulrich, Christian T; Schucht, Philippe; Fichtner, Jens; Andereggen, Lukas; Gosau, Martin; Hattingen, Elke; Gutbrod, Klemens; Z'Graggen, Werner J; Reinert, Michael; Hüsler, Jürg; Ozdoba, Christoph; Raabe, Andreas

    2014-12-01

    The etiology of chronic subdural hematoma (CSDH) in nongeriatric patients (≤ 60 years old) often remains unclear. The primary objective of this study was to identify spinal CSF leaks in young patients, after formulating the hypothesis that spinal CSF leaks are causally related to CSDH. All consecutive patients 60 years of age or younger who underwent operations for CSDH between September 2009 and April 2011 at Bern University Hospital were included in this prospective cohort study. The patient workup included an extended search for a spinal CSF leak using a systematic algorithm: MRI of the spinal axis with or without intrathecal contrast application, myelography/fluoroscopy, and postmyelography CT. Spinal pathologies were classified according to direct proof of CSF outflow from the intrathecal to the extrathecal space, presence of extrathecal fluid accumulation, presence of spinal meningeal cysts, or no pathological findings. The primary outcome was proof of a CSF leak. Twenty-seven patients, with a mean age of 49.6 ± 9.2 years, underwent operations for CSDH. Hematomas were unilateral in 20 patients and bilateral in 7 patients. In 7 (25.9%) of 27 patients, spinal CSF leakage was proven, in 9 patients (33.3%) spinal meningeal cysts in the cervicothoracic region were found, and 3 patients (11.1%) had spinal cysts in the sacral region. The remaining 8 patients (29.6%) showed no pathological findings. The direct proof of spinal CSF leakage in 25.9% of patients suggests that spinal CSF leaks may be a frequent cause of nongeriatric CSDH.

  5. Is the recurrence rate of chronic subdural hematomas dependent on the duration of drainage?

    PubMed

    Kale, Aydemir; Öz, İbrahim İlker; Gün, Eren Görkem; Kalaycı, Murat; Gül, Şanser

    2017-05-01

    Chronic subdural hematoma (CSDH) is the most frequent type of intracranial hemorrhage which especially affects the elderly. Various surgical techniques have been reported for CSDH treatment; optimal treatment methods are still controversial. In this study, the effects of long drainage durations on results and recurrences were investigated in patients on whom closed system drainage with burr hole craniotomy was applied due to CSDH. 90 patients with 105 CSDH were operated between 2008 and 2016. Patients were divided into two groups based on the duration of drainage. Group A (n = 40) was determined as 2-4 days of closed-system drainage, while Group B (n = 50) was recorded as 5-7 days of closed-system drainage. Recurrence was defined as accumulation of blood in the operation area and recurrence of symptoms within the monitoring period of six months. Recurrence was observed in 7 (15.6) of the Group A patients and 2 (3.3%) of the Group B patients. There was a statistically significant difference between groups in terms of recurrence rate (p = 0.04). Postoperative thickness of hematoma was measured in the first month follow-up computerized tomography. There was a statistically significant difference between groups in terms of postoperative thickness of residual hematoma (p = 0.05). 2-4 days of closed system drainage following burr hole craniotomy is an effective and reliable choice of treatment in CSDH. Nevertheless, increasing the duration of drainage to 5-7 days provided better results without increasing the risk of complication.

  6. The Global Education Practicum: Perspectives from Accompanying Academics

    ERIC Educational Resources Information Center

    Lang, Catherine; Cacciattolo, Marcelle; Kidman, Gillian

    2017-01-01

    The benefits of international education experiences for students are well documented. The effect on the individual of international experiences has been researched and theorised by authors for at least the last 20 years. In this paper the experiences of three academics who accompanied pre-service teachers on a 3 week international practicum are…

  7. 30 CFR 250.261 - What environmental impact analysis (EIA) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... analysis (EIA) information must accompany the DPP or DOCD? The following EIA information must accompany... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What environmental impact analysis (EIA) information must accompany the DPP or DOCD? 250.261 Section 250.261 Mineral Resources BUREAU OF OCEAN ENERGY...

  8. Usefulness of interventional embolization of the middle meningeal artery for recurrent chronic subdural hematoma: Five cases and a review of the literature

    PubMed Central

    Yamauchi, Shigeru; Ikeda, Hidetoshi; Tsubota, Nobuyuki; Furukawa, Hironori; Maeda, Daisuke; Kondo, Kimito; Nishio, Akimasa

    2015-01-01

    Purpose Although several strategies against recurrent chronic subdural hematoma (CSDH) have been proposed, no consensus has been established. Recently, middle meningeal artery (MMA) embolization has been proposed as radical treatment for recurrent CSDH. We wanted to estimate the usefulness of MMA embolization for recurrent CSDH. Methods From February 2012 to June 2013, 110 patients with CSDH underwent single burr-hole surgery with irrigation and drainage. Among these patients, 13 showed recurrent hematoma formation and were retreated surgically. Furthermore, repeated recurrence of CSDH was observed in six patients. Five of these six patients underwent middle meningeal artery (MMA) embolization with polyvinyl alcohol particles. All five patients with interventional treatment were observed for four to 60 weeks. Results No more recurrence of CSDH was observed in any of the patients. During the follow-up period, no patients suffered from any side effects or complications from the interventional treatment. Conclusion MMA embolization with careful attention paid to the procedure might be a treatment of choice for recurrent CSDH. PMID:26015518

  9. Mulberry hypertrophy and accompanying sinonasal pathologies: A review of 68 cases.

    PubMed

    Akduman, Davut; Haksever, Mehmet; Yanilmaz, Muhammed; Solmaz, Fevzi

    2016-08-01

    Mulberry hypertrophy occasionally coexists with sinonasal pathologies. There are very few reports in the literature on this clinical entity. We conducted a retrospective study to draw attention to this condition in the context of accompanying sinonasal pathologies. Our study group was made up of 68 patients-51 males and 17 females, aged 13 to 57 years (mean: 34.9)-who had been diagnosed with mulberry hypertrophy and at least one accompanying sinonasal pathology. All patients had a long-standing chronic discharge. Forty-nine of these patients (72.1%) had unilateral mulberry hypertrophy. The most common concomitant pathologies were chronic rhinosinusitis and ostiomeatal complex disease; others included septal deviation, nasal polyposis, allergic rhinitis, and concha bullosa. Thirty-six patients (52.9%) with varying degrees of choanal/nasal obstruction were operated on with endoscopic excision to treat the mulberry hypertrophy. In all, most patients underwent some sort of surgery to treat either the mulberry hypertrophy or the accompanying sinonasal pathology. Based on our findings, we suggest a clinical staging system to serve as a way to standardize management and guide future basic and clinical research.

  10. Pinealitis accompanying equine recurrent uveitis.

    PubMed Central

    Kalsow, C M; Dwyer, A E; Smith, A W; Nifong, T P

    1993-01-01

    There is no direct verification of pineal gland involvement in human uveitis. Specimens of pineal tissue are not available during active uveitis in human patients. Naturally occurring uveitis in horses gives us an opportunity to examine tissues during active ocular inflammation. We examined the pineal gland of a horse that was killed because it had become blind during an episode of uveitis. The clinical history and histopathology of the eyes were consistent with post-leptospiral equine recurrent uveitis. The pineal gland of this horse had significant inflammatory infiltration consisting mainly of lymphocytes with some eosinophils. This observation of pinealitis accompanying equine uveitis supports the animal models of experimental autoimmune uveoretinitis with associated pinealitis and suggests that the pineal gland may be involved in some human uveitides. Images PMID:8435400

  11. 30 CFR 250.252 - What environmental monitoring information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What environmental monitoring information must... Development Operations Coordination Documents (docd) § 250.252 What environmental monitoring information must accompany the DPP or DOCD? The following environmental monitoring information, as applicable, must accompany...

  12. Right sided weakness with right subdural hematoma: motor deafferentation of left hemisphere resulted in paralysis of the right side.

    PubMed

    Derakhshan, Iraj

    2009-08-01

    A right handed man with trauma to the head was admitted with headache and seizures. A severe right sided weakness was noted after a blunt trauma to the right side of his head. MRI of brain revealed a right-sided subdural hematoma and a normal left hemisphere and downstream motor pathways. Bimanual simultaneous drawing and manual reaction times indicated that the patient was right hemispheric in laterality of his major hemisphere. The right sided weakness in this patient was due to temporary transcallosal disconnection (diaschisis) of the minor hemisphere (left, in this case) from the excitatory signals arising from those structures of his major hemisphere devoted to movements occurring on nondominant side, transmitted via the corpus callosum to his left hemisphere. This case draws attention to disparity between neural and behavioral handedness (laterality of major hemisphere versus that of the preferred hand). Drawing longer lines by the left hand in simultaneous bimanual tasks and a slower simple reaction time to central visual stimuli by the ostensible dominant hand permitted lateralization of the major hemisphere to the right. Thus, the neurally nondominant side (right) lagged behind the dominant (left) by an interval equal to interhemispheric transfer time.

  13. 30 CFR 550.252 - What environmental monitoring information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What environmental monitoring information must... Coordination Documents (docd) § 550.252 What environmental monitoring information must accompany the DPP or DOCD? The following environmental monitoring information, as applicable, must accompany your DPP or...

  14. 30 CFR 550.252 - What environmental monitoring information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What environmental monitoring information must... Coordination Documents (docd) § 550.252 What environmental monitoring information must accompany the DPP or DOCD? The following environmental monitoring information, as applicable, must accompany your DPP or...

  15. 30 CFR 550.252 - What environmental monitoring information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What environmental monitoring information must... Coordination Documents (docd) § 550.252 What environmental monitoring information must accompany the DPP or DOCD? The following environmental monitoring information, as applicable, must accompany your DPP or...

  16. 30 CFR 250.252 - What environmental monitoring information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What environmental monitoring information must... Documents (docd) § 250.252 What environmental monitoring information must accompany the DPP or DOCD? The following environmental monitoring information, as applicable, must accompany your DPP or DOCD: (a...

  17. 30 CFR 550.249 - What air emissions information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... and Information Contents of Development and Production Plans (dpp) and Development Operations Coordination Documents (docd) § 550.249 What air emissions information must accompany the DPP or DOCD? The... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What air emissions information must accompany...

  18. 30 CFR 550.249 - What air emissions information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... and Information Contents of Development and Production Plans (dpp) and Development Operations Coordination Documents (docd) § 550.249 What air emissions information must accompany the DPP or DOCD? The... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What air emissions information must accompany...

  19. 30 CFR 550.249 - What air emissions information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... and Information Contents of Development and Production Plans (dpp) and Development Operations Coordination Documents (docd) § 550.249 What air emissions information must accompany the DPP or DOCD? The... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What air emissions information must accompany...

  20. 30 CFR 250.227 - What environmental impact analysis (EIA) information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... environmental impact analysis (EIA) information must accompany the EP? The following EIA information must... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What environmental impact analysis (EIA) information must accompany the EP? 250.227 Section 250.227 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT...

  1. Accompanying Partners of International Students: Reflections on Three Issues

    ERIC Educational Resources Information Center

    Cui, Dan; Arthur, Nancy; Domene, José F.

    2017-01-01

    This paper reviews and critiques the existing literature on accompanying partners of international students (APIS), who are often an ignored population in programs and services for the internationalization of Canadian higher education. Particularly, we identify three issues. First, we argue that current research on this group overwhelmingly…

  2. Effects of voice timbre and accompaniment on working memory as measured by sequential monosyllabic digit recall performance.

    PubMed

    Silverman, Michael J; Schwartzberg, Edward T

    2014-01-01

    Information is often paired with music in an attempt to facilitate recall and enhance learning. However, there is a lack of basic research investigating how music carrying information might facilitate recall and subsequent learning. The purpose of the current study was to determine the effects of voice timbre and accompaniment on working memory as measured by recall performance on a sequential digit recall task. Specific research questions were as follows: (a) How might female and male voice timbres affect serial recall? (b) How might piano, guitar, and no accompaniment affect serial recall? (c) Do music majors have enhanced recall accuracy when compared to nonmusic majors? The recall of information paired with six different melodies was tested on 60 university students. Melodies were composed and recorded using female and male voices with three levels of accompaniment: guitar, piano, and no accompaniment. Participants had more accurate recall during the male voice and piano and no accompaniment conditions and least accurate recall during the female voice and guitar accompaniment conditions. As participants had most accurate recall during the male voice and with piano or no accompaniment, clinicians are encouraged to consider using no accompaniment or piano accompaniment when initially teaching social and academic information paired with music for later recall. When possible, vocal timbre (i.e., the potential benefit of male voicing) should also be considered. Implications for clinical practice, limitations of the study, and suggestions for future research are provided. © the American Music Therapy Association 2014. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. The dangerous gamble of heparinization within two weeks of nonoperative traumatic acute subdural hematoma in patients with increased stroke risk: a case series.

    PubMed

    McClelland, S; Mackey, S J; Kim, S S

    2014-01-01

    In traumatic acute subdural hematoma (aSDH) management, systemic anticoagulation is contraindicated, particularly during the first 2 weeks. We present two cases of patients with nonoperative aSDH whose stroke risk led to heparinization within 2 weeks of the initial hemorrhage and examine their outcomes to illustrate the risks and benefits associated with systemic anticoagulation. Two elderly males, on warfarin at baseline who developed traumatic nonoperative aSDH were heparinized within 2 weeks of aSDH onset. One patient showed a decreased SDH volume on Day 19. The second patient developed sudden onset headache with fixed/dilated pupils on Day 5. In this patient, a CT scan of the brain revealed marked enlargement of the aSDH from 0.9 to 2.4 cm with midline shift of 1.5 cm, and uncal herniation that was incompatible with life. Heparinization within two weeks of aSDH may cause SDH enlargement resulting in rapidly fatal neurologic deterioration. Further study is needed to more definitively address this issue.

  4. Prognosis of patients in coma after acute subdural hematoma due to ruptured intracranial aneurysm.

    PubMed

    Torné, Ramon; Rodríguez-Hernández, Ana; Romero-Chala, Fabián; Arikan, Fuat; Vilalta, Jordi; Sahuquillo, Juan

    2016-04-01

    Acute subdural hematomas (aSDH) secondary to intracranial aneurysm rupture are rare. Most patients present with coma and their functional prognosis has been classically considered to be very poor. Previous studies mixed good-grade and poor-grade patients and reported variable outcomes. We reviewed our experience by focusing on patients in coma only and hypothesized that aSDH might worsen initial mortality but not long-term functional outcome. Between 2005 and 2013, 440 subarachnoid hemorrhage (SAH) patients were admitted to our center. Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. Their prospectively collected clinical and outcome data were reviewed and compared with that of 104 SAH patients without aSDH who presented with coma during the same period. Median aSDH thickness was 10mm. Four patients presented with an associated aneurysmal cortical laceration and only one had good recovery. Overall, we observed good long-term outcomes in both SAH patients in coma with aSDH and those without aSDH (38.5% versus 26.4%). Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. Anisocoria and brain herniation are observed in patients with aSDH thicknesses that are smaller than those observed in trauma patients. Despite a high initial mortality, early surgery to remove the aSDH results in a good outcome in over 60% of survivors. Aneurysmal cortical laceration appears to be an independent entity which shows a poorer prognosis than other types of aneurysmal aSDH. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. The Risk Factors for Hydrocephalus and Subdural Hygroma after Decompressive Craniectomy in Head Injured Patients.

    PubMed

    Ki, Hee Jong; Lee, Hyung-Jin; Lee, Hong-Jae; Yi, Jin-Seok; Yang, Ji-Ho; Lee, Il-Woo

    2015-09-01

    The present study aims to investigate 1) the risk factors for hydrocephalus and subdural hygroma (SDG) occurring after decompressive craniectomy (DC), and 2) the association between the type of SDG and hydrocephalus. We retrospectively reviewed the clinical and radiological features of 92 patients who underwent DC procedures after severe head injuries. The risk factors for developing post-traumatic hydrocephalus (PTH) and SDG were analyzed. Types of SDGs were classified according to location and their relationship with hydrocephalus was investigated. Ultimately, 26.09% (24/92) of these patients developed PTH. In the univariate analyses, hydrocephalus was statically associated with large bone flap diameter, large craniectomy area, bilateral craniectomy, intraventricular hemorrhage, contralateral or interhemisheric SDGs, and delayed cranioplasty. However, in the multivariate analysis, only large craniectomy area (adjusted OR=4.66; p=0.0239) and contralateral SDG (adjusted OR=6.62; p=0.0105) were significant independent risk factors for developing hydrocephalus after DC. The incidence of overall SDGs after DC was 55.43% (51/92). Subgroup analysis results were separated by SDG types. Statistically significant associations between hydrocephalus were found in multivariate analysis in the contralateral (adjusted OR=5.58; p=0.0074) and interhemispheric (adjusted OR=17.63; p=0.0113) types. For patients who are subjected to DC following severe head trauma, hydrocephalus is associated with a large craniectomy area and contralateral SDG. For SDGs after DC that occur on the interhemispherical or controlateral side of the craniectomy, careful follow-up monitoring for the potential progression into hydrocephalus is needed.

  6. 78 FR 66357 - Proposed Changes to FCC Form 499-A, FCC Form 499-Q, and Accompanying Instructions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-05

    ... 499-A, FCC Form 499-Q, and Accompanying Instructions AGENCY: Federal Communications Commission. ACTION..., FCC Form 499-Q (Form 499-Q) and accompanying instructions (Form 499-Q Instructions) to be used in 2014... Worksheet, FCC Form 499-Q (Form 499-Q) and accompanying instructions (Form 499-Q Instructions) to be used in...

  7. 76 FR 69738 - Revised 2011 Annual Telecommunications Reporting Worksheet (FCC Form 499-A) and Accompanying...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-09

    ... Telecommunications Reporting Worksheet (FCC Form 499-A) and Accompanying Instructions AGENCY: Federal Communications... Telecommunications Reporting Worksheet (FCC Form 499-A) and accompanying instructions that have been approved by the... INFORMATION CONTACT: Ernesto Beckford, Wireline Competition Bureau, Telecommunications Access Policy Division...

  8. 9 CFR 93.314 - Horses, certification, and accompanying equipment.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    .... (c) Following the port-of-entry inspection required by § 93.306 of this part, and before a horse offered for importation from any part of the world is released from the port of entry, an inspector may..., certification, and accompanying equipment. (a) Horses offered for importation from any part of the world shall...

  9. [A Case of Ruptured Internal Carotid-Posterior Communicating Artery Aneurysm Associated with Acute Subdural Hematoma, Extending from the Interhemispheric Space to the Posterior Fossa].

    PubMed

    Otsuka, Hiroaki; Fukuda, Yuhtaka; Yoshimura, Shouta; Somagawa, Chika; Hiu, Takeshi; Ono, Tomonori; Ushijima, Ryujirou; Toda, Keisuke; Tsutsumi, Keisuke

    2016-06-01

    A 69-year-old woman was admitted to our hospital because of a sudden severe headache without a history of head trauma. CT and MRI revealed an acute subdural hematoma (ASDH) extending from the right interhemispheric space to the posterior fossa bilaterally, with a small amount of subarachnoid hemorrhage that was predominantly localized to the left side of the basal cistern. CT angiogram demonstrated a long protruding ruptured aneurysm at the junction of the right internal carotid and posterior communicating arteries (IC/PC AN) with a posteroinferior projection, associated with a small bleb located near the tentorial edge close to the ipsilateral posterior clinoid process, for which she received clipping surgery. Though rare, IC/PC AN could cause pure or nearly pure ASDH in the above-mentioned distribution. Therefore, in patients with such ASDH, especially without a history of head injury or precise information regarding the situation at the time of onset, urgent imaging evaluation and early intervention are essential to prevent devastating re-rupture events.

  10. No smile like another: adult age differences in identifying emotions that accompany smiles.

    PubMed

    Riediger, Michaela; Studtmann, Markus; Westphal, Andrea; Rauers, Antje; Weber, Hannelore

    2014-01-01

    People smile in various emotional contexts, for example, when they are amused or angry or simply being polite. We investigated whether younger and older adults differ in how well they are able to identify the emotional experiences accompanying smile expressions, and whether the age of the smiling person plays a role in this respect. With this aim, we produced 80 video episodes of three types of smile expressions: positive-affect smiles had been spontaneously displayed by target persons as they were watching amusing film clips and cartoons. Negative-affect smiles had been displayed spontaneously by target persons during an interaction in which they were being unfairly accused. Affectively neutral smiles were posed upon request. Differences in the accompanying emotional experiences were validated by target persons' self-reports. These smile videos served as experimental stimuli in two studies with younger and older adult participants. In Study 1, older participants were less likely to attribute positive emotions to smiles, and more likely to assume that a smile was posed. Furthermore, younger participants were more accurate than older adults at identifying emotional experiences accompanying smiles. In Study 2, both younger and older participants attributed positive emotions more frequently to smiles shown by older as compared to younger target persons, but older participants did so less frequently than younger participants. Again, younger participants were more accurate than older participants in identifying emotional experiences accompanying smiles, but this effect was attenuated for older target persons. Older participants could better identify the emotional state accompanying smiles shown by older than by younger target persons. Taken together, these findings indicate that there is an age-related decline in the ability to decipher the emotional meaning of smiles presented without context, which, however, is attenuated when the smiling person is also an older adult.

  11. No smile like another: adult age differences in identifying emotions that accompany smiles

    PubMed Central

    Riediger, Michaela; Studtmann, Markus; Westphal, Andrea; Rauers, Antje; Weber, Hannelore

    2014-01-01

    People smile in various emotional contexts, for example, when they are amused or angry or simply being polite. We investigated whether younger and older adults differ in how well they are able to identify the emotional experiences accompanying smile expressions, and whether the age of the smiling person plays a role in this respect. With this aim, we produced 80 video episodes of three types of smile expressions: positive-affect smiles had been spontaneously displayed by target persons as they were watching amusing film clips and cartoons. Negative-affect smiles had been displayed spontaneously by target persons during an interaction in which they were being unfairly accused. Affectively neutral smiles were posed upon request. Differences in the accompanying emotional experiences were validated by target persons' self-reports. These smile videos served as experimental stimuli in two studies with younger and older adult participants. In Study 1, older participants were less likely to attribute positive emotions to smiles, and more likely to assume that a smile was posed. Furthermore, younger participants were more accurate than older adults at identifying emotional experiences accompanying smiles. In Study 2, both younger and older participants attributed positive emotions more frequently to smiles shown by older as compared to younger target persons, but older participants did so less frequently than younger participants. Again, younger participants were more accurate than older participants in identifying emotional experiences accompanying smiles, but this effect was attenuated for older target persons. Older participants could better identify the emotional state accompanying smiles shown by older than by younger target persons. Taken together, these findings indicate that there is an age-related decline in the ability to decipher the emotional meaning of smiles presented without context, which, however, is attenuated when the smiling person is also an older adult

  12. Bias in Examination Test Banks that Accompany Cost Accounting Texts.

    ERIC Educational Resources Information Center

    Clute, Ronald C.; McGrail, George R.

    1989-01-01

    Eight text banks that accompany cost accounting textbooks were evaluated for the presence of bias in the distribution of correct responses. All but one were found to have considerable bias, and three of eight were found to have significant choice bias. (SK)

  13. Effect of Anatomically Realistic Full-Head Model on Activation of Cortical Neurons in Subdural Cortical Stimulation—A Computational Study

    NASA Astrophysics Data System (ADS)

    Seo, Hyeon; Kim, Donghyeon; Jun, Sung Chan

    2016-06-01

    Electrical brain stimulation (EBS) is an emerging therapy for the treatment of neurological disorders, and computational modeling studies of EBS have been used to determine the optimal parameters for highly cost-effective electrotherapy. Recent notable growth in computing capability has enabled researchers to consider an anatomically realistic head model that represents the full head and complex geometry of the brain rather than the previous simplified partial head model (extruded slab) that represents only the precentral gyrus. In this work, subdural cortical stimulation (SuCS) was found to offer a better understanding of the differential activation of cortical neurons in the anatomically realistic full-head model than in the simplified partial-head models. We observed that layer 3 pyramidal neurons had comparable stimulation thresholds in both head models, while layer 5 pyramidal neurons showed a notable discrepancy between the models; in particular, layer 5 pyramidal neurons demonstrated asymmetry in the thresholds and action potential initiation sites in the anatomically realistic full-head model. Overall, the anatomically realistic full-head model may offer a better understanding of layer 5 pyramidal neuronal responses. Accordingly, the effects of using the realistic full-head model in SuCS are compelling in computational modeling studies, even though this modeling requires substantially more effort.

  14. Burr Hole Washout versus Craniotomy for Chronic Subdural Hematoma: Patient Outcome and Cost Analysis

    PubMed Central

    Regan, Jacqueline M.; Worley, Emmagene; Shelburne, Christopher; Pullarkat, Ranjit; Watson, Joseph C.

    2015-01-01

    Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients’ clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings. PMID:25611468

  15. Burr hole washout versus craniotomy for chronic subdural hematoma: patient outcome and cost analysis.

    PubMed

    Regan, Jacqueline M; Worley, Emmagene; Shelburne, Christopher; Pullarkat, Ranjit; Watson, Joseph C

    2015-01-01

    Chronic subdural hematomas (CSDH), which are frequently encountered in neurosurgical practice, are, in the majority of cases, ideally treated with surgical drainage. Despite this common practice, there is still controversy surrounding the best surgical procedure. With lack of clear evidence of a superior technique, surgeons are free to base the decision on other factors that are not related to patient care. A retrospective chart review of 119 patients requiring surgical drainage of CSDH was conducted at a large tertiary care center over a three-year period. Of the cases reviewed, 58 patients underwent craniotomy, while 61 patients underwent burr hole washout. The study focused on re-operation rates, mortality, and morbidity, as measured by Glasgow coma scores (GCS), discharge Rankin disability scores, and discharge disposition. Secondary endpoints included length of stay and cost of procedure. Burr hole washout was superior to craniotomy with respect to patient outcome, length of stay and recurrence rates. In both study groups, patients required additional surgical procedures (6.6% of burr hole patients and 24.1% of craniotomy patients) (P = 0.0156). Of the patients treated with craniotomy, 51.7% were discharged home, whereas 65.6% of the burr hole patients were discharged home. Patients who underwent burr hole washout spent a mean of 78.8 minutes in the operating suite while the patients undergoing craniotomy spent 129.4 minutes (P < 0.001). The difference in mean cost per patient, based solely on operating time, was $2,828 (P < 0.001). This does not include the further cost due to additional procedures and hospital stay. The mean length of stay after surgical intervention was 3 days longer for the craniotomy group (P = 0.0465). Based on this retrospective study, burr hole washout is superior for both patients' clinical and financial outcome; however, prospective long-term multicenter clinical studies are required to verify these findings.

  16. Correlation of vascular endothelial growth factor with magnetic resonance imaging in chronic subdural hematomas.

    PubMed

    Li, Fubin; Hua, Cong; Feng, Yan; Yuan, Hongyan; Bie, Li

    2017-06-15

    Chronic subdural hematoma (CSDH) is an inflammatory angiogenic disease. It is believed that vascular endothelial growth factor (VEGF) plays an important role in pathological CSDH angiogenesis. In this study, magnetic resonance imaging (MRI) results were used to assign 115 primary CSDH patients to four MRI types. The four MRI types are described as follows: type 1 (T1-weighted low, T2-weighted low), type 2 (T1-weighted high, T2-weighted low), type 3 (T1-weighted mixed, T2-weighted mixed), and type 4 (T1-weighted low/high, T2-weighted high). The four MRI types were then correlated with CSDH stage and patient hematoma fluid and serum VEGH concentrations that were measured using an enzyme-linked immunosorbent assay (ELISA). Neurological status was assessed by Markwalder scoring at admission and six-month follow-up. The mean VEGF concentration was significantly higher in CDSH hematoma fluid samples than in patient sera (p<0.01). In unilateral CSDH hematoma fluid samples, VEGF concentration was highest in type 1 (21,613.5±1473.3pg/ml), next highest in type 2 (18,071.8±1737.1pg/ml), lower in type 3, and lowest in type 4 patients (13,153.7±3854.4pg/ml, 7265.7±726.2pg/ml, respectively). High VEGF concentrations strongly correlated with MRI type (unilateral CSDH group r=0.838, bilateral CSDH group r=0.851, p<0.01). Moreover, higher hematoma fluid VEGF concentrations correlated with markedly higher recurrence in type 1 (3/19, 15.8%) vs. type 4 unilateral CSDH patients (1/27, 3.7%). The present study reports a significant correlation between CSDH hematoma fluid VEGF concentration and MRI results. Therefore, MRI results could be used to predict hematoma fluid VEGF concentrations in CSDH patients. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. 30 CFR 250.226 - What Coastal Zone Management Act (CZMA) information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What Coastal Zone Management Act (CZMA) information must accompany the EP? 250.226 Section 250.226 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT... Zone Management Act (CZMA) information must accompany the EP? The following CZMA information must...

  18. Role of Matrix Metalloproteinase-2, Matrix Metalloproteinase-9, and Vascular Endothelial Growth Factor in the Development of Chronic Subdural Hematoma

    PubMed Central

    Hua, Cong; Feng, Yan; Yuan, Hongyan; Song, Hongmei

    2016-01-01

    Abstract Chronic subdural hematoma (CSDH) is an inflammatory and angiogenic disease. Vascular endothelial growth factor (VEGF) has an important effect on the pathological progression of CSDH. The matrix metalloproteinases (MMPs) and VEGF also play a significant role in pathological angiogenesis. Our research was to investigate the level of MMPs and VEGF in serum and hematoma fluid. Magnetic Resonance Imaging (MRI) shows the characteristics of different stages of CSDH. We also analyzed the relationship between the level of VEGF in subdural hematoma fluid and the appearances of the patients' MRI. We performed a study comparing serum and hematoma fluid in 37 consecutive patients with primary CSDHs using enzyme-linked immunosorbent assay (ELISA). MMP-2 and MMP-9 activity was assayed by the gelatin zymography method. The patients were divided into five groups according to the appearance of the hematomas on MRI: group 1 (T1-weighted low, T2-weighted low, n=4), group 2 (T1-weighted high, T2-weighted low, n=11), group 3 (T1-weighted mixed, T2-weighted mixed, n=9), group 4 (T1-weighted high, T2-weighted high, n=5), and group 5 (T1-weighted low, T2-weighted high, n=8). Neurological status was assessed by Markwalder score on admission and at follow-up. The mean age, sex, and Markwalder score were not significantly different among groups. The mean concentration of VEGF, MMP-2, and MMP-9 were significantly higher in hematoma fluid than in serum (p<0.01). The level of pro-MMP-2 was higher in hematoma fluid (p<0.01). Measurement of MMP-9 showed both pro and active forms in both groups, but levels were higher in hematoma fluid (p<0.01 and p<0.01, respectively). Mean VEGF concentration was highest in group 1 (21,979.3±1387.3 pg/mL), followed by group 2 (20,060.1±1677.2 pg/mL), group 3 (13,746.5±3529.7 pg/mL), group 4 (7523.2±764.9 pg/mL), and lowest in group 5 (6801.9±618.7 pg/mL). There was a significant correlation between VEGF concentrations and MRI type (r=0

  19. The auditory scene: an fMRI study on melody and accompaniment in professional pianists.

    PubMed

    Spada, Danilo; Verga, Laura; Iadanza, Antonella; Tettamanti, Marco; Perani, Daniela

    2014-11-15

    The auditory scene is a mental representation of individual sounds extracted from the summed sound waveform reaching the ears of the listeners. Musical contexts represent particularly complex cases of auditory scenes. In such a scenario, melody may be seen as the main object moving on a background represented by the accompaniment. Both melody and accompaniment vary in time according to harmonic rules, forming a typical texture with melody in the most prominent, salient voice. In the present sparse acquisition functional magnetic resonance imaging study, we investigated the interplay between melody and accompaniment in trained pianists, by observing the activation responses elicited by processing: (1) melody placed in the upper and lower texture voices, leading to, respectively, a higher and lower auditory salience; (2) harmonic violations occurring in either the melody, the accompaniment, or both. The results indicated that the neural activation elicited by the processing of polyphonic compositions in expert musicians depends upon the upper versus lower position of the melodic line in the texture, and showed an overall greater activation for the harmonic processing of melody over accompaniment. Both these two predominant effects were characterized by the involvement of the posterior cingulate cortex and precuneus, among other associative brain regions. We discuss the prominent role of the posterior medial cortex in the processing of melodic and harmonic information in the auditory stream, and propose to frame this processing in relation to the cognitive construction of complex multimodal sensory imagery scenes. Copyright © 2014 Elsevier Inc. All rights reserved.

  20. Family member accompaniment to routine medical visits is associated with better self-care in heart failure patients.

    PubMed

    Cené, Crystal W; Haymore, Laura Beth; Lin, Feng-Chang; Laux, Jeffrey; Jones, Christine Delong; Wu, Jia-Rong; DeWalt, Darren; Pignone, Mike; Corbie-Smith, Giselle

    2015-03-01

    To examine the association between frequency of family member accompaniment to medical visits and heart failure (HF) self-care maintenance and management and to determine whether associations are mediated through satisfaction with provider communication. Cross-sectional survey of 150 HF patients seen in outpatient clinics. HF self-care maintenance and management were assessed using the Self-Care of Heart Failure Index. Satisfaction with provider communication was assessed using a single question originally included in the American Board of Internal Medicine Patient Satisfaction Questionnaire. Frequency of family member accompaniment to visits was assessed using a single-item question. We performed regression analyses to examine associations between frequency of accompaniment and outcomes. Mediation analysis was conducted using MacKinnon's criteria. Overall, 61% reported accompaniment by family members to some/most/every visit. Accompaniment to some/most/every visit was associated with higher self-care maintenance (β = 6.4, SE 2.5; p = 0.01) and management (β = 12.7, SE 4.9; p = 0.01) scores. Satisfaction with provider communication may mediate the association between greater frequency of accompaniment to visits and self-care maintenance (1.092; p = 0.06) and self-care management (1.428; p = 0.13). Accompaniment to medical visits is associated with better HF self-care maintenance and management, and this effect may be mediated through satisfaction with provider communication. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. High-frequency cortical subdural stimulation enhanced plasticity in surgery of a tumor in Broca's area.

    PubMed

    Barcia, Juan A; Sanz, Ana; Balugo, Paloma; Alonso-Lera, Pedro; Brin, Juan Raúl; Yus, Miguel; Gonzalez-Hidalgo, Mercedes; Acedo, Victoria M; Oliviero, Antonio

    2012-03-28

    Functional areas located near or within brain gliomas prevent the complete resection of these tumors. It has recently been described that slow tumor invasion promotes neural reorganization, and even topographic plasticity, allowing a staged resection of those tumors. Thus, our aim was to promote plasticity by mimicking the tumor's capability to displace brain function. This proceeded through the production of a 'virtual lesion' in eloquent areas within a tumor using continuous high-frequency cortical electrical stimulation (cHFCS). An anaplastic astrocytoma located in Broca's area progressed in a patient whose lateralization of language to the side of the lesion was demonstrated with functional MRI. After partial tumor resection using awake cortical monitoring, we implanted a subdural grid over the eloquent cortex located within residual tumor. We then applied cHFCS for 25 days, using a frequency of 130 Hz and a pulse width of 1 ms. Stimulus intensity was set to the threshold wherein mild speech disturbance was evident without any other neurological effects. This treatment successfully achieved the displacement of speech functions, and a more radical resection of the tumor was possible in a second surgery. Critically, a reorganization of motor language areas was demonstrated both with functional MRI and cortical stimulation. Furthermore, motor language areas were also identified in the right hemisphere, where previously they were absent. The patient's speech fluency improved both after stimulation and resection. We therefore demonstrate the first evidence of induced topographic plasticity using cHFCS in eloquent areas within a tumor, which allowed for increased tumor removal. Our results open the possibility to induce plasticity before the resection of brain tumors near eloquent areas, in order to increase the extent of resection.

  2. 30 CFR 250.215 - What hydrogen sulfide (H2S) information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What hydrogen sulfide (H2S) information must accompany the EP? 250.215 Section 250.215 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE... Contents of Exploration Plans (ep) § 250.215 What hydrogen sulfide (H2S) information must accompany the EP...

  3. 30 CFR 250.212 - What information must accompany the EP?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... support facilities information required by § 250.225; (n) Coastal zone management information required by... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What information must accompany the EP? 250.212 Section 250.212 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR OFFSHORE OIL AND...

  4. 19 CFR 133.3 - Documents and fee to accompany application.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 1 2011-04-01 2011-04-01 false Documents and fee to accompany application. 133.3 Section 133.3 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY TRADEMARKS, TRADE NAMES, AND COPYRIGHTS Recordation of Trademarks § 133.3...

  5. 19 CFR 133.13 - Documents and fee to accompany application.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 19 Customs Duties 1 2011-04-01 2011-04-01 false Documents and fee to accompany application. 133.13 Section 133.13 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY; DEPARTMENT OF THE TREASURY TRADEMARKS, TRADE NAMES, AND COPYRIGHTS Recordation of Trade Names § 133.13...

  6. 30 CFR 550.212 - What information must accompany the EP?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... § 550.226; (o) Environmental impact analysis information required by § 550.227; and (p) Administrative... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What information must accompany the EP? 550.212... OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Contents of...

  7. 30 CFR 550.212 - What information must accompany the EP?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... § 550.226; (o) Environmental impact analysis information required by § 550.227; and (p) Administrative... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What information must accompany the EP? 550.212... OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Contents of...

  8. 30 CFR 550.212 - What information must accompany the EP?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... § 550.226; (o) Environmental impact analysis information required by § 550.227; and (p) Administrative... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What information must accompany the EP? 550.212... OIL AND GAS AND SULPHUR OPERATIONS IN THE OUTER CONTINENTAL SHELF Plans and Information Contents of...

  9. Length of stay for patients undergoing invasive electrode monitoring with stereoelectroencephalography and subdural grids correlates positively with increased institutional profitability.

    PubMed

    Chan, Alvin Y; Kharrat, Sohayla; Lundeen, Kelly; Mnatsakanyan, Lilit; Sazgar, Mona; Sen-Gupta, Indranil; Lin, Jack J; Hsu, Frank P K; Vadera, Sumeet

    2017-06-01

    Lowering the length of stay (LOS) is thought to potentially decrease hospital costs and is a metric commonly used to manage capacity. Patients with epilepsy undergoing intracranial electrode monitoring may have longer LOS because the time to seizure is difficult to predict or control. This study investigates the effect of economic implications of increased LOS in patients undergoing invasive electrode monitoring for epilepsy. We retrospectively collected and analyzed patient data for 76 patients who underwent invasive monitoring with either subdural grid (SDG) implantation or stereoelectroencephalography (SEEG) over 2 years at our institution. Data points collected included invasive electrode type, LOS, profit margin, contribution margins, insurance type, and complication rates. LOS correlated positively with both profit and contribution margins, meaning that as LOS increased, both the profit and contribution margins rose, and there was a low rate of complications in this patient group. This relationship was seen across a variety of insurance providers. These data suggest that LOS may not be the best metric to assess invasive monitoring patients (i.e., SEEG or SDG), and increased LOS does not necessarily equate with lower or negative institutional financial gain. Further research into LOS should focus on specific specialties, as each may differ in terms of financial implications. Wiley Periodicals, Inc. © 2017 International League Against Epilepsy.

  10. 19 CFR 133.33 - Documents and fee to accompany application.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 19 Customs Duties 1 2013-04-01 2013-04-01 false Documents and fee to accompany application. 133.33 Section 133.33 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... matter readily identifiable by title and author or if it covers a sound recording. Five likenesses of a...

  11. 19 CFR 133.33 - Documents and fee to accompany application.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 19 Customs Duties 1 2014-04-01 2014-04-01 false Documents and fee to accompany application. 133.33 Section 133.33 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... matter readily identifiable by title and author or if it covers a sound recording. Five likenesses of a...

  12. 19 CFR 133.33 - Documents and fee to accompany application.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 19 Customs Duties 1 2012-04-01 2012-04-01 false Documents and fee to accompany application. 133.33 Section 133.33 Customs Duties U.S. CUSTOMS AND BORDER PROTECTION, DEPARTMENT OF HOMELAND SECURITY... matter readily identifiable by title and author or if it covers a sound recording. Five likenesses of a...

  13. Middleware Design for Swarm-Driving Robots Accompanying Humans.

    PubMed

    Kim, Min Su; Kim, Sang Hyuck; Kang, Soon Ju

    2017-02-17

    Research on robots that accompany humans is being continuously studied. The Pet-Bot provides walking-assistance and object-carrying services without any specific controls through interaction between the robot and the human in real time. However, with Pet-Bot, there is a limit to the number of robots a user can use. If this limit is overcome, the Pet-Bot can provide services in more areas. Therefore, in this study, we propose a swarm-driving middleware design adopting the concept of a swarm, which provides effective parallel movement to allow multiple human-accompanying robots to accomplish a common purpose. The functions of middleware divide into three parts: a sequence manager for swarm process, a messaging manager, and a relative-location identification manager. This middleware processes the sequence of swarm-process of robots in the swarm through message exchanging using radio frequency (RF) communication of an IEEE 802.15.4 MAC protocol and manages an infrared (IR) communication module identifying relative location with IR signal strength. The swarm in this study is composed of the master interacting with the user and the slaves having no interaction with the user. This composition is intended to control the overall swarm in synchronization with the user activity, which is difficult to predict. We evaluate the accuracy of the relative-location estimation using IR communication, the response time of the slaves to a change in user activity, and the time to organize a network according to the number of slaves.

  14. Middleware Design for Swarm-Driving Robots Accompanying Humans

    PubMed Central

    Kim, Min Su; Kim, Sang Hyuck; Kang, Soon Ju

    2017-01-01

    Research on robots that accompany humans is being continuously studied. The Pet-Bot provides walking-assistance and object-carrying services without any specific controls through interaction between the robot and the human in real time. However, with Pet-Bot, there is a limit to the number of robots a user can use. If this limit is overcome, the Pet-Bot can provide services in more areas. Therefore, in this study, we propose a swarm-driving middleware design adopting the concept of a swarm, which provides effective parallel movement to allow multiple human-accompanying robots to accomplish a common purpose. The functions of middleware divide into three parts: a sequence manager for swarm process, a messaging manager, and a relative-location identification manager. This middleware processes the sequence of swarm-process of robots in the swarm through message exchanging using radio frequency (RF) communication of an IEEE 802.15.4 MAC protocol and manages an infrared (IR) communication module identifying relative location with IR signal strength. The swarm in this study is composed of the master interacting with the user and the slaves having no interaction with the user. This composition is intended to control the overall swarm in synchronization with the user activity, which is difficult to predict. We evaluate the accuracy of the relative-location estimation using IR communication, the response time of the slaves to a change in user activity, and the time to organize a network according to the number of slaves. PMID:28218650

  15. Intracranial Hematoma

    MedlinePlus

    ... hematoma — subdural hematoma, epidural hematoma and intraparenchymal hematoma. Subdural hematoma This occurs when blood vessels — usually veins — rupture ... brain damage can be prevented. The risk of subdural hematoma increases as you age. The risk is also ...

  16. Evaluating the Epidemiology of Inflicted Traumatic Brain Injury in Infants of U.S. Military Families

    DTIC Science & Technology

    2008-01-01

    subdural hematoma and whiplash injuries. Caffey3 in 1972 theorized that shaking was responsible for retinal hemorrhages and subdural or subarachnoid...and contusion 852.xx Subarachnoid, subdural , and extradural hemorrhage after injury 853.xx Other and unspecified intracranial hemorrhage following

  17. Bell's Palsy: Symptoms Preceding and Accompanying the Facial Paresis

    PubMed Central

    Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

    2014-01-01

    This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy. PMID:25544960

  18. Seizure Correlates with Prolonged Hospital Stay, Increased Costs, and Increased Mortality in Nontraumatic Subdural Hematoma.

    PubMed

    Joseph, Jacob R; Smith, Brandon W; Williamson, Craig A; Park, Paul

    2016-08-01

    Nontraumatic subdural hematoma (NTSDH) is a common neurosurgical disease process, with mortality reported as high as 13%. Seizure has a known association with NTSDH, although patient outcomes have not previously been well studied in this population. The purpose of this study was to examine the relationship between in-hospital seizure and inpatient outcomes in NTSDH. Using the University HealthSystem Consortium (UHC) database, we performed a retrospective cohort study of adults with a principal diagnosis of NTSDH (International Classification of Diseases, Ninth Revision code 43.21) between 2011 and 2015. Patients with in-hospital seizure (International Classification of Diseases, Ninth Revision codes 34500-34591, 78033, 78039) were compared with those without. Patients with a history of seizure before arrival were excluded. Patient demographics, hospital length of stay (LOS), intensive care unit stay, in-hospital mortality, and direct costs were recorded. A total 16,928 patients with NTSDH were identified. Mean age was 69.2 years, and 64.7% were male. In-hospital seizure was documented in 744 (4.40%) patients. Hospital LOS was 17.64 days in patients with seizure and 6.26 days in those without (P < 0.0001). Mean intensive care unit stay increased from 3.36 days without seizure to 9.36 days with seizure. In-hospital mortality was 9.19% in patients without seizure and 16.13% in those with seizure (P < 0.0001). Direct costs were $12,781 in patients without seizure and $38,110 in those with seizure (P < 0.0001). Seizure in patients with NTSDH correlates with significantly increased total LOS and increased mortality. Direct costs are similarly increased. Further studies accounting for effects of illness severity are necessary to validate these results. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. Investigation of subdural electrode displacement in invasive epilepsy surgery workup using neuronavigation and intraoperative MRI.

    PubMed

    Sommer, Bjoern; Rampp, Stefan; Doerfler, Arnd; Stefan, Hermann; Hamer, Hajo M; Buchfelder, Michael; Roessler, Karl

    2018-06-19

    One of the main obstacles of electrode implantation in epilepsy surgery is the electrode shift between implantation and the day of explantation. We evaluated this possible electrode displacement using intraoperative MRI (iopMRI) data and CT/MRI reconstruction. Thirteen patients (nine female, four male, median age 26 ± 9.4 years) suffering from drug-resistant epilepsy were examined. After implantation, the position of subdural electrodes was evaluated by 3.0 T-MRI and thin-slice CCT for 3D reconstruction. Localization of electrodes was performed with the volume-rendering technique. Post-implantation and pre-explantation 1.5 T-iopMRI scans were coregistered with the 3D reconstructions to determine the extent of electrode dislocation. Intraoperative MRI at the time of explantation revealed a relevant electrode shift in one patient (8%) of 10 mm. Median electrode displacement was 1.7 ± 2.6 mm with a coregistration error of 1.9 ± 0.7 mm. The median accuracy of the neuronavigation system was 2.2 ± 0.9 mm. Six of twelve patients undergoing resective surgery were seizure free (Engel class 1A, median follow-up 37.5 ± 11.8 months). Comparison of pre-explantation and post-implantation iopMRI scans with CT/MRI data using the volume-rendering technique resulted in an accurate placement of electrodes. In one patient with a considerable electrode dislocation, the surgical approach and extent was changed due to the detected electrode shift. ECoG: electrocorticography; EZ: epileptogenic zone; iEEG: invasive EEG; iopMRI: intraoperative MRI; MEG: magnetoencephalography; PET: positron emission tomography; SPECT: single photon emission computed tomography; 3D: three-dimensional.

  20. The Effects of Harmonic Accompaniment on the Tonal Improvisations of Students in First through Sixth Grade

    ERIC Educational Resources Information Center

    Guilbault, Denise Marie

    2009-01-01

    The purpose of this research was to examine the effects of harmonic accompaniment on the tonal improvisations of elementary school students. Specifically, this study was designed to (a) determine if the addition of a root melody accompaniment to song instruction affects the implied harmonic changes and harmonic rhythm in the tonal improvisations…

  1. A comparative study of treatments for chronic subdural hematoma: burr hole drainage versus burr hole drainage with irrigation.

    PubMed

    Ishibashi, Akira; Yokokura, Yoshitake; Adachi, Hisashi

    2011-01-01

    Although chronic subdural hematoma (CSDH) is one of the most common entities encountered in neurosurgical practice, optimal surgical treatment for CSDH remains controversial. This study retrospectively compared results for CSDH between burr hole drainage alone and burr hole drainage with irrigation. Ninety-two patients with CSDH underwent surgery at our institution from January 1998 through December 2009. Fifty-eight patients received burr hole drainage alone (Group A), while 34 patients were treated using burr hole drainage with irrigation (Group B). Outcomes, recurrence rates, and death rates for the two groups were analyzed. Age, sex ratio, consciousness level on admission, radiodensity of hematoma on computed tomography before surgery, and duration of hospitalization were nearly the same in both groups. No significant differences were seen in good outcomes or death rates between groups, but poor outcomes were significantly more frequent in Group A (p=0.009). The recurrence rate was higher in Group A compared to Group B (10.3% vs. 2.9%). The authors used logistic regression analysis to identify factors associated with the outcome of CSDH, and found that duration of hospital stay, anti-coagulant therapy, presence of dementia and burr hole drainage alone were significantly associated with poor outcome of CSDH. These results indicate that burr hole drainage with irrigation has a significantly stronger association with good outcomes compared to drainage alone, and could be a reliable and effective operative method for the treatment of CSDH with a lower recurrence rate.

  2. Intraoperative Ultrasonography during Drainage for Chronic Subdural Hematomas: A Technique to Release Isolated Deep-seated Hematomas—Technical Note

    PubMed Central

    SHIMIZU, Satoru; MOCHIZUKI, Takahiro; OSAWA, Shigeyuki; KUMABE, Toshihiro

    2015-01-01

    After the drainage of chronic subdural hematomas (CSDHs), residual isolated deep-seated hematomas (IDHs) may recur. We introduce intraoperative ultrasonography to detect and remove such IDHs. Intra-operative ultrasonography is performed with fine transducers introduced via burr holes. Images obtained before dural opening show the CSDHs, hyper- and/or hypoechoic content, and mono- or multilayers. Images are also acquired after irrigation of the hematoma under the dura. Floating hyperechoic spots (cavitations) on the brain cortex created by irrigation confirm the release of all hematoma layers; areas without spots represent IDHs. Their overlying thin membranes are fenestrated with a dural hook for irrigation. Ultrasonographs were evaluated in 43 CSDHs (37 patients); 9 (21%) required IDH fenestration. On computed tomography scans, 17 were homogeneous-, 6 were laminar-, 16 were separated-, and 4 were trabecular type lesions. Of these, 2 (11.8%), 3 (50%), 4 (25%), and 0, respectively, manifested IDHs requiring fenestration. There were no technique-related complications. Patients subjected to IDH fenestration had lower recurrence rates (11.1% vs. 50%, p = 0.095) and required significantly less time for brain re-expansion (mean 3.78 ± 1.62 vs. 18 ± 5.54 weeks, p = 0.0009) than did 6 patients whose IDHs remained after 48 conventional irrigation and drainage procedures. Intraoperative ultrasonography in patients with CSDHs facilitates the safe release of hidden IDHs. It can be expected to reduce the risk of postoperative hematoma recurrence and to shorten the brain re-expansion time. PMID:26345671

  3. Subdural empyema: Clinical presentations and management options for an uncommon neurosurgical emergency in a developing country.

    PubMed

    Chikani, M C; Mezue, W; Okorie, E; Mbachu, C; Ndubisi, C; Chikani, U N

    2017-10-01

    Controversy regarding the best management strategy for subdural empyema (SDE) attests to the persisting poor outcomes for this uncommon life threatening intracranial suppurative process. Late presentation confounds the problem in developed countries. While craniotomy is commonly recommended, it is not always possible in late presentation with advanced morbidity. The aim of this study was to identify the pattern of clinical presentation and explore the outcomes following management of SDE using burr hole, aspiration, and drainage (BAAD) in resource poor settings. This is a retrospective review of prospectively collected data of 18 patients presenting with SDE over a period of 10 years from two neurosurgical centers. Data was abstracted on patients' demographic characteristics, sources of SDE, clinical presentation and site of infection, methods of diagnosis, organisms isolated, treatments received, and outcome. Collected data was entered into the Statistical Package for the Social Sciences version 17 software and subjected to descriptive analysis for all variables. Majority of the patients presented late with Glasgow Coma Scale score GCS of 9/15. Altered sensorium was noted in 14 (77.8%) of the patients, 11 (61.1%) out of the 14 patients had ≤ grade 3 of Bannister and Williams level of consciousness. The mainstay of treatment for all patients was BAAD of abscess and administration of appropriate antibiotics. Fourteen patients (77.8%) were discharged on grade A of H.W. Mauser's grading system. Three mortalities were recorded only in patients who had grade 4 Bannister and Williams grading. BAAD is the near approximated option to standard craniotomy management in a limited resource facility and it has a very good clinical outcome. However, more studies are required to draw the final conclusion.

  4. Exploratory analysis of meal composition in Australia: meat and accompanying foods.

    PubMed

    Sui, Zhixian; Raubenheimer, David; Rangan, Anna

    2017-08-01

    The study of meal patterns and overall diet in relation to health outcomes may be more important than focusing on single nutrients or food groups. The present study aimed to explore the composition of main meals and snacks in the Australian population and examine associations between meat/poultry/fish and other foods. The study utilised 24 h recalls. Meal composition was defined based on average intakes of food groups per meal disaggregated from all food sources. 2011-12 National Nutrition and Physical Activity Survey. Australian people (n12153) aged 2 years or above. Overall, breakfast was the smallest meal of the day, typically consisting of grains, dairy products and fruit. Lunch was the second largest meal, consisting mostly of grains, non-starchy vegetables and meat/poultry/fish. The largest meal was dinner, comprising meat/poultry/fish, vegetables (starchy and non-starchy), grains and often including discretionary beverages (children) or alcohol (adults). The main food groups consumed at snacking occasions were dairy, fruit, discretionary foods and beverages (including alcohol for adults). The most frequently consumed meat types were beef and chicken at dinner and ham at lunch. Non-starchy vegetables were accompanying foods for red meat, poultry and fish/seafood consumed in varying portion sizes, but did not accompany processed meat. The present study considered meat, poultry and fish as the meal centre and their accompaniments of other food groups at different eating occasions. These findings expand the background evidence for health professionals developing meal-based framework/guidelines and public health messages.

  5. Clinical Investigation of Refractory Chronic Subdural Hematoma: A Comparison of Clinical Factors Between Single and Repeated Recurrences.

    PubMed

    Matsumoto, Hiroaki; Hanayama, Hiroaki; Okada, Takashi; Sakurai, Yasuo; Minami, Hiroaki; Masuda, Atsushi; Tominaga, Shogo; Miyaji, Katsuya; Yamaura, Ikuya; Yoshida, Yasuhisa; Yoshida, Kozo

    2017-11-01

    Chronic subdural hematoma (CSDH) is sometimes refractory, and this is troublesome for neurosurgeons. Although many studies have reported risk factors or treatments in efforts to prevent recurrence, those have focused on single recurrence, and few cumulative data are available to analyze refractory CSDH. We defined refractory CSDH as ≥2 recurrences, then analyzed and compared clinical factors between patients with single recurrence and those with refractory CSDH in a cohort study, to clarify whether patients with refractory CSDH experience different or more risk factors than patients with single recurrence, and whether burr-hole irrigation with closed-system drainage reduces refractory CSDH. Seventy-five patients had at least 1 recurrence, with single recurrence in 62 patients and ≥2 recurrences in 13 patients. In comparing clinical characteristics, patients with refractory CSDH were significantly younger (P = 0.04) and showed shorter interval to first recurrence (P < 0.001). Organized CSDH was also significantly associated with refractory CSDH (P = 0.02). Multivariate logistic regression analysis identified first recurrence interval <1 month (odds ratio, 6.66, P < 0.001) and age <71 years (odds ratio, 4.16, P < 0.001) as independent risk factors for refractory CSDH. On the other hand, burr-hole irrigation with closed-system drainage did not reduce refractory CSDH. When patients with risk factors for refractory CSDH experience recurrence, alternative surgical procedures may be considered as the second surgery, because burr-hole irrigation with closed-system drainage did not reduce refractory CSDH in our study. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Burr-Hole Drainage for Chronic Subdural Hematoma Under Low-Dose Acetylsalicylic Acid: A Comparative Risk Analysis Study.

    PubMed

    Kamenova, Maria; Nevzati, Edin; Lutz, Katharina; Dolp, Armando; Fandino, Javier; Mariani, Luigi; Soleman, Jehuda

    2017-04-01

    Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases typically affecting older people. Many of these patients have coronary artery disease and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite growing clinical relevance, there is still a lack of data focusing on the perioperative management of such patients. The aim of this study is to compare the perioperative and postoperative bleeding and cardiovascular complication rates of patients undergoing burr-hole drainage for cSDH with and without discontinuation of low-dose ASA. Of 963 consecutive patients undergoing burr-hole drainage for cSDH, 198 (20.5%) patients were receiving low-dose ASA treatment. In 26 patients (13.1%), ASA was not discontinued (ASA group; ASA discontinuation ≤7 days); in the remaining patients (n = 172; 86.9%), ASA was discontinued at least for 7 days (control group). The primary outcome measure was recurrent cSDH that required revision surgery owing to clinical symptoms, whereas secondary outcome measures were postoperative cardiovascular and thromboembolic events, other complications, operation and hospitalization time, morbidity, and mortality. No statistically significant difference was observed between the 2 groups regarding recurrence of cSDH (P = 1). Cardiovascular event rates, surgical morbidity, and mortality did not significantly differ between patients with and without discontinuation of low-dose ASA. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, our findings elucidate one issue, showing comparable recurrence rates with and without discontinuation of low-dose ASA in patients undergoing burr-hole drainage for cSDH. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Therapeutic Suggestions for Chronic Subdural Hematoma Associated with Idiopathic Thrombocytopenic Purpura: A Case Report and Literature Review

    PubMed Central

    Takase, Hajime; Tatezuki, Junya; Ikegaya, Naoki; Yamamoto, Daisuke; Hashimoto, Mizuki; Takagi, Makoto; Mochimatsu, Yasuhiko; Kawahara, Nobutaka

    2015-01-01

    A 66-year-old woman who was previously diagnosed with idiopathic thrombocytopenic purpura (ITP) presented with mild right-sided hemiparesis and drowsiness. Head computed tomography (CT) imaging demonstrated a massive left chronic subdural hematoma (CSDH) with a midline shift. Because initial laboratory data showed a significantly decreased blood platelet count (0.3 × 104/mm3), medical treatments such as platelet transfusion, intravenous immunoglobulin (IVIG), and high-dose corticosteroid therapy, were initiated. She clinically and radiologically responded well to these treatments without any surgical intervention. In addition to presenting our case, we searched the PubMed and Ichushi Web databases to comprehensively illustrate clinical characteristics and treatment outcomes of similar cases. Including the present case, we found 19 reports and 23 cases of CSDH associated with ITP in the literature, and assessed 17 reports and 21 cases that were written in English and Japanese. None or mild neurological symptom were seen in 13 cases, and severe, such as coma and hemiparesis, were described in the younger 8 cases with significant difference. All except one were first treated with medical therapies. Most cases of the former group responded well to conservative therapy. On the other hand, most in the latter eventually needed surgical treatment in addition except recent two cases including the present case. CSDH associated with ITP is rarely described, and its management remains controversial. However, this report highlights multiple continuous medical treatments under strict observation and general care might be a useful alternative to avoid surgery in cases presenting with severe neurological deficits and extremely low platelet counts. PMID:28663980

  8. Natural Course of Initially Non-Operated Cases of Acute Subdural Hematoma : The Risk Factors of Hematoma Progression

    PubMed Central

    Son, Seong; Lee, Sang Gu; Kim, Eun Young; Park, Chan Woo; Kim, Woo Kyung

    2013-01-01

    Objective The objectives of the present study were to characterize the natural course of initially non-operated traumatic acute subdural hematoma (ASDH) and to identify the risk factors of hematoma progression. Methods Retrospective analysis was performed using sequential computed tomography (CT) images maintained in a prospective observational database containing 177 ASDH cases treated from 2005 to 2011. Patients were allocated to four groups as followings; 136 (76.8%) patients to the spontaneous resolution group, 12 (6.8%) who underwent operation between 4 hours and 7 days to the rapid worsening group (RWG), 24 (13.6%) who experienced an increase of hematoma and that underwent operation between 7 and 28 days to the subacute worsening group (SWG), and 5 (2.8%) who developed delayed aggravation requiring surgery from one month after onset to the delayed worsening group (DWG). Groups were compared with respect to various factors. Results No significant intergroup difference was found with respect to age, mechanism of injury, or initial Glasgow Coma Scale. The presence of combined cerebral contusion or subarachnoid hemorrhage was found to be a significant prognostic factor. Regarding CT findings, mixed density was common in the RWG and the SWG. Midline shifting, hematoma thickness, and numbers of CT slices containing hematoma were significant prognostic factors of the RWG and the SWG. Brain atrophy was more severe in the SWG and the DWG. Conclusion A large proportion of initially non-operated ASDHs worsen in the acute or subacute phase. Patients with risk factors should be monitored carefully for progression by repeat CT imaging. PMID:24278650

  9. Accuracy of immunization histories provided by adults accompanying preschool children to a pediatric emergency department.

    PubMed

    Goldstein, K P; Kviz, F J; Daum, R S

    1993-11-10

    Because some have advocated the use of emergency departments to administer delayed childhood immunizations, we evaluated the accuracy of immunization histories obtained in this setting by comparison with medical records of inner-city health care facilities. Questionnaires were orally administered to adults accompanying children to the emergency department. Individual medical records were reviewed. Pediatric emergency department at Wyler Children's Hospital, University of Chicago and 68 inner-city primary care clinics. Children aged 3 to 65 months registering for medical care. Of the sample, 98% were African American; 75% were Medicaid recipients. Adults' knowledge of immunization histories, immunization cards, and medical records compared with American Academy of Pediatrics/Immunization Practices Advisory Committee recommendations. Of the accompanying adults, 64% stated that their child's general immunization status was "up-to-date"; 65% of these had clinic records confirming that status. Only 8% of specific regimens stated by these adults accurately matched those found in clinic records. Moreover, 45% of adults accompanying children at least 16 months and older provided inaccurate information regarding previous receipt of measles immunization. Information provided by accompanying adults (from recall or from immunization cards) is inadequate to determine accurately which preschoolers in the pediatric emergency department are delayed in immunizations.

  10. [Tension hemothorax accompanying rupture of the descending aortic aneurysm].

    PubMed

    Inafuku, Kenji; Imoto, Kiyotaka; Kano, Kazuki; Amano, Shinya; Cho, Tomoki; Minami, Tomoyuki; Uchida, Keiji; Masuda, Munetaka

    2014-11-01

    Although, tension hemothorax appears along with thoracic injuries in many cases, the incidence is rare and the concept itself has not yet been established. Moreover, reports on tension hemothorax caused by the rupture of thoracic aortic aneurysms are very rare. Herein, we report a case in which thoracic endovascular aortic repair( TEVAR) was carried out following chest drainage in order to treat tension hemothorax accompanying rupture of the descending aortic aneurysm, thus leading to the survival of the patient.

  11. 30 CFR 250.228 - What administrative information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What administrative information must accompany the EP? 250.228 Section 250.228 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION, AND... SHELF Plans and Information Contents of Exploration Plans (ep) § 250.228 What administrative information...

  12. 41 CFR 101-25.110-3 - Tires accompanying new motor vehicles.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... motor vehicles. 101-25.110-3 Section 101-25.110-3 Public Contracts and Property Management Federal...-GENERAL 25.1-General Policies § 101-25.110-3 Tires accompanying new motor vehicles. The tire identifications and recordkeeping regulations issued by the Department of Transportation require each motor...

  13. 77 FR 74010 - Proposed Changes to FCC Form 499-A, FCC Form 499-Q, and Accompanying Instructions

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-12

    ... 499-A, FCC Form 499-Q, and Accompanying Instructions AGENCY: Federal Communications Commission. ACTION... revenues, and the quarterly Telecommunications Reporting Worksheet, FCC Form 499-Q (Form 499-Q) and accompanying instructions (Form 499-Q Instructions) to be used in 2013 to report projected collected revenues...

  14. 30 CFR 250.213 - What general information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What general information must accompany the EP? 250.213 Section 250.213 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION, AND... SHELF Plans and Information Contents of Exploration Plans (ep) § 250.213 What general information must...

  15. Using MIDI Accompaniments for Music Learning at School and at Home

    ERIC Educational Resources Information Center

    Kersten, Fred

    2004-01-01

    This article discusses how MIDI and other computer technologies can help students build their musical skills in the classroom and at home. MIDI (Musical Instrument Digital Interface) has provided music teachers with increasing opportunity to use quality computer-developed musical accompaniments in teaching music to children. Standard MIDI files…

  16. Direct Exploration of the Role of the Ventral Anterior Temporal Lobe in Semantic Memory: Cortical Stimulation and Local Field Potential Evidence From Subdural Grid Electrodes

    PubMed Central

    Shimotake, Akihiro; Matsumoto, Riki; Ueno, Taiji; Kunieda, Takeharu; Saito, Satoru; Hoffman, Paul; Kikuchi, Takayuki; Fukuyama, Hidenao; Miyamoto, Susumu; Takahashi, Ryosuke; Ikeda, Akio; Lambon Ralph, Matthew A.

    2015-01-01

    Semantic memory is a crucial higher cortical function that codes the meaning of objects and words, and when impaired after neurological damage, patients are left with significant disability. Investigations of semantic dementia have implicated the anterior temporal lobe (ATL) region, in general, as crucial for multimodal semantic memory. The potentially crucial role of the ventral ATL subregion has been emphasized by recent functional neuroimaging studies, but the necessity of this precise area has not been selectively tested. The implantation of subdural electrode grids over this subregion, for the presurgical assessment of patients with partial epilepsy or brain tumor, offers the dual yet rare opportunities to record cortical local field potentials while participants complete semantic tasks and to stimulate the functionally identified regions in the same participants to evaluate the necessity of these areas in semantic processing. Across 6 patients, and utilizing a variety of semantic assessments, we evaluated and confirmed that the anterior fusiform/inferior temporal gyrus is crucial in multimodal, receptive, and expressive, semantic processing. PMID:25491206

  17. Direct Exploration of the Role of the Ventral Anterior Temporal Lobe in Semantic Memory: Cortical Stimulation and Local Field Potential Evidence From Subdural Grid Electrodes.

    PubMed

    Shimotake, Akihiro; Matsumoto, Riki; Ueno, Taiji; Kunieda, Takeharu; Saito, Satoru; Hoffman, Paul; Kikuchi, Takayuki; Fukuyama, Hidenao; Miyamoto, Susumu; Takahashi, Ryosuke; Ikeda, Akio; Lambon Ralph, Matthew A

    2015-10-01

    Semantic memory is a crucial higher cortical function that codes the meaning of objects and words, and when impaired after neurological damage, patients are left with significant disability. Investigations of semantic dementia have implicated the anterior temporal lobe (ATL) region, in general, as crucial for multimodal semantic memory. The potentially crucial role of the ventral ATL subregion has been emphasized by recent functional neuroimaging studies, but the necessity of this precise area has not been selectively tested. The implantation of subdural electrode grids over this subregion, for the presurgical assessment of patients with partial epilepsy or brain tumor, offers the dual yet rare opportunities to record cortical local field potentials while participants complete semantic tasks and to stimulate the functionally identified regions in the same participants to evaluate the necessity of these areas in semantic processing. Across 6 patients, and utilizing a variety of semantic assessments, we evaluated and confirmed that the anterior fusiform/inferior temporal gyrus is crucial in multimodal, receptive, and expressive, semantic processing. © The Author 2014. Published by Oxford University Press.

  18. 30 CFR 550.244 - What geological and geophysical (G&G) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What geological and geophysical (G&G... Operations Coordination Documents (docd) § 550.244 What geological and geophysical (G&G) information must accompany the DPP or DOCD? The following G&G information must accompany your DPP or DOCD: (a) Geological...

  19. 30 CFR 550.244 - What geological and geophysical (G&G) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What geological and geophysical (G&G... Operations Coordination Documents (docd) § 550.244 What geological and geophysical (G&G) information must accompany the DPP or DOCD? The following G&G information must accompany your DPP or DOCD: (a) Geological...

  20. 30 CFR 550.244 - What geological and geophysical (G&G) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What geological and geophysical (G&G... Operations Coordination Documents (docd) § 550.244 What geological and geophysical (G&G) information must accompany the DPP or DOCD? The following G&G information must accompany your DPP or DOCD: (a) Geological...

  1. The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective.

    PubMed

    Cowley, Alan; Durge, Neal

    2014-05-13

    Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has been done on parental presence it often focuses primarily on the parents or staff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the emotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping with post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental accompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether accompaniment would be of benefit to their patient population. The lack of published data does not enable a formal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the preference in land based conveyance. Future research is needed into the emotional recovery of children after trauma, as well as the experiences of patient, parent and staff during conveyance.

  2. The impact of parental accompaniment in paediatric trauma: a helicopter emergency medical service (HEMS) perspective

    PubMed Central

    2014-01-01

    Major trauma remains a significant cause of mortality and morbidity in young people and adolescents throughout the western world. Both the physical and psychological consequences of trauma are well documented and it is shown that peri-traumatic factors play a large part in the emotional recovery of children involved in trauma. Indeed, parental anxiety levels may play one of the biggest roles. There are no publically available guidelines on pre-hospital accompaniment, and where research has been done on parental presence it often focuses primarily on the parents or staff, rather than the child themselves. Whilst acknowledging the impact on parents and staff, the importance of the emotional wellbeing of the child should be reinforced, to reduce the likelihood of developing symptoms in keeping with post-traumatic stress disorder. This non-systematic literature review, aims to examine the impact of parental accompaniment to hospital, following paediatric trauma, and to help pre-hospital clinicians decide whether accompaniment would be of benefit to their patient population. The lack of published data does not enable a formal recommendation of parental accompaniment in the helicopter to be mandated, though it should be the preference in land based conveyance. Future research is needed into the emotional recovery of children after trauma, as well as the experiences of patient, parent and staff during conveyance. PMID:24887082

  3. The Mechanism of Atomization Accompanying Solid Injection

    NASA Technical Reports Server (NTRS)

    Castleman, R A , Jr

    1933-01-01

    A brief historical and descriptive account of solid injection is followed by a detailed review of the available theoretical and experimental data that seem to throw light on the mechanism of this form of atomization. It is concluded that this evidence indicates that (1) the atomization accompanying solid injection occurs at the surface of the liquid after it issues as a solid stream from the orifice; and (2) that such atomization has a mechanism physically identical with the atomization which takes place in an air stream, both being due merely to the formation, at the gas-liquid interface, of fine ligaments under the influence of the relative motion of gas and liquid, and to their collapse, under the influence of surface tension, to form the drops in the spray.

  4. Steam thermolysis of tire shreds: modernization in afterburning of accompanying gas with waste steam

    NASA Astrophysics Data System (ADS)

    Kalitko, V. A.

    2010-03-01

    On the basis of experience in the commercial operation of tire-shred steam thermolysis in EnresTec Inc. (Taiwan) producing high-grade commercial carbon, liquid pyrolysis fuel, and accompanying fuel gas by this method, we have proposed a number of engineering solutions and calculated-analytical substantiations for modernization and intensification of the process by afterburning the accompanying gas with waste steam condensable in the scrubber of water gas cleaning of afterburning products. The condensate is completely freed of the organic pyrolysis impurities and the necessity of separating it from the liquid fuel, as is the case with the active process, is excluded.

  5. Multiple tenting techniques improve dead space obliteration in the surgical treatment for patients with giant calcified chronic subdural hematoma.

    PubMed

    Juan, Wei-Sheng; Tai, Shih-Huang; Hung, Yu-Chang; Lee, E-Jian

    2012-04-01

    Calcified chronic subdural hematoma (CCSDH), or "armored brain," is a rare disease entity. The optimal surgical procedure for CCSDH has not been established because it is hard to obtain brain re-expansion after surgery. In particular, a large CCSDH is difficult to completely extirpate, and the residual rigid inner and outer membranes facilitates dead space retention and hematoma recurrence. We introduce the use a multiple suturing technique to tent the residual outer and inner membranes onto the dura matter so as to obliterate dead space after surgical treatment for CCSDH. Neuroimaging and surgical reports with illustrative images from two cases are shown. Two patients were admitted to our intensive care unit more than 10 years apart from their ventriculoperitoneal (V-P) shunt placements. The first patient presented with clinical signs of increased intracranial pressure. The second patient had a large CCSDH as a concomitant finding with ruptured aneurysmal subarachnoid hemorrhage. Computerized cranial tomography demonstrated large hematoma cavities with thick calcified inner membranes. After neurosurgical intervention by craniotomy and optimal resection of calcified membranes and muddy blood clot, we tented the residual calcified inner and outer membranes onto the dura matter by multiple sutures to reduce dead space accumulation. Postoperatively, the two patients had improved clinical symptoms along with much reduced hematoma cavity in imaging examinations. We reported an alternative technique using multiple tenting procedures to improve dead space obliteration after surgical treatment for patients with a large CCSDH presenting as a late complication after V-P shunting.

  6. 30 CFR 550.245 - What hydrogen sulfide (H2S) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What hydrogen sulfide (H2S) information must accompany the DPP or DOCD? 550.245 Section 550.245 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT... Coordination Documents (docd) § 550.245 What hydrogen sulfide (H2S) information must accompany the DPP or DOCD...

  7. 30 CFR 550.245 - What hydrogen sulfide (H2S) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 2 2013-07-01 2013-07-01 false What hydrogen sulfide (H2S) information must accompany the DPP or DOCD? 550.245 Section 550.245 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT... Coordination Documents (docd) § 550.245 What hydrogen sulfide (H2S) information must accompany the DPP or DOCD...

  8. 30 CFR 550.245 - What hydrogen sulfide (H2S) information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What hydrogen sulfide (H2S) information must accompany the DPP or DOCD? 550.245 Section 550.245 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT... Coordination Documents (docd) § 550.245 What hydrogen sulfide (H2S) information must accompany the DPP or DOCD...

  9. [Diagnosis and treatment of adipsic diabetes insipidus accompanied with intracranial calcification].

    PubMed

    Hu, Ming-ming; Liu, Min; Liu, Wei

    2013-04-01

    To summarize our experience in the management of adipsic central diabetes insipidus(ADI) accompanied with intracranial calcification. The clinical data of one ADI patient accompanied with intracranial calcification who was treated in our hospital since December 2011 were retrospectively summarized. The 24-hour urine volume was 800 ml. She didn't feel thirsty even with increased plasma sodium concentration(153 mmol/L) and blood osmotic pressure(333 mmol/L) . Combined water deprivation and vasopressin test revealed the diagnosis of central diabetes insipidus. The high intensity signal(on T1-weighted magnetic resonance imaging) in the posterior lobe of pituitary gland was found. Computed tomography showed calcifications in the bilateral basal ganglia.Serum cytomegalovirus IgG was positive. She was treated with desmopressin and asked for regular water intake regardless of the adipsia. The plasma sodium concentration was still below 150 mmol/L during the 4-month follow-up. Routine adipsia evaluation and combined water deprivation and vasopressin test are critical for the diagnosis and treatment of ADI. Past insidious intracranial cytomegalovirus infection may explain the cause of ADI and calcification.

  10. 30 CFR 250.242 - What information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...) Coastal zone management information required by § 250.260; (s) Environmental impact analysis information... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What information must accompany the DPP or DOCD... SHELF Plans and Information Contents of Development and Production Plans (dpp) and Development...

  11. [Is there any deontology of accompanying people at the end of life?].

    PubMed

    Glorion, B

    1999-01-01

    The thought on ethics, enhances by accompanying patients or human-beings reaching end of life, belong to major themes which have for years been dealt with by philosophers and monks. The physicians, who by nature accompany and live with their patient this life period a sometimes close relationship, have conceived within deontology a wonderful expression of what ethics inspired them. Reading articles 37 and 38 of the Code of Ethics brings a clear, precise and qualified answer to the question raised by the title. We easily find out the main principles which would be the guideline to the doctor's behaviour coping with this situation: providing suitable and continue cares to maintain the quality of a life which comes to end, respecting dignity. Relieving suffers, morally assisting, comforting the family, knowing to limit the cares reasonably. The sensitive and human expression sums up pretty well the particularities essential to all (physicians, health professionals or volunteers) who have accepted this heavy task.

  12. Changes in energy metabolism accompanying pitting in blueberries stored at low temperature.

    PubMed

    Zhou, Qian; Zhang, Chunlei; Cheng, Shunchang; Wei, Baodong; Liu, Xiuying; Ji, Shujuan

    2014-12-01

    Low-temperature storage and transport of blueberries is widely practiced in commercial blueberry production. In this research, the storage life of blueberries was extended at low temperature, but fruit stored for 30 d at 0°C pitted after 2d at room-temperature. Fruit cellular structure and physiological parameters accompanying pitting in blueberries were changed. The objective of this research was to characterise properties of energy metabolism accompanying pitting in blueberries during storage, including adenosine phosphates and mitochondrial enzymes involved in stress responses. Physiological and metabolic disorders, changes in cell ultrastructure, energy content and ATPase enzyme activity were observed in pitting blueberries. Energy shortages and increased activity of phenylalanine ammonia lyase (PAL) and lipoxygenase (LOX) were observed in fruit kept at shelf life. The results suggested that sufficient available energy status and a stable enzymatic system in blueberries collectively contribute to improve chilling tolerance, thereby alleviating pitting and maintaining quality of blueberry fruit in long-term cold storage. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. 31 CFR 537.511 - Importation of accompanied baggage and household effects of U.S. diplomatic and consular officials.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... products of Burma as accompanied baggage or household effects, provided that such products are not intended... household effects of U.S. diplomatic and consular officials. 537.511 Section 537.511 Money and Finance... Policy § 537.511 Importation of accompanied baggage and household effects of U.S. diplomatic and consular...

  14. 31 CFR 537.511 - Importation of accompanied baggage and household effects of U.S. diplomatic and consular officials.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... products of Burma as accompanied baggage or household effects, provided that such products are not intended... household effects of U.S. diplomatic and consular officials. 537.511 Section 537.511 Money and Finance... Policy § 537.511 Importation of accompanied baggage and household effects of U.S. diplomatic and consular...

  15. 31 CFR 537.511 - Importation of accompanied baggage and household effects of U.S. diplomatic and consular officials.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... products of Burma as accompanied baggage or household effects, provided that such products are not intended... and household effects of U.S. diplomatic and consular officials. 537.511 Section 537.511 Money and... Policy § 537.511 Importation of accompanied baggage and household effects of U.S. diplomatic and consular...

  16. 31 CFR 537.511 - Importation of accompanied baggage and household effects of U.S. diplomatic and consular officials.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... products of Burma as accompanied baggage or household effects, provided that such products are not intended... household effects of U.S. diplomatic and consular officials. 537.511 Section 537.511 Money and Finance... Policy § 537.511 Importation of accompanied baggage and household effects of U.S. diplomatic and consular...

  17. 30 CFR 250.242 - What information must accompany the DPP or DOCD?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ....258; (q) Sulphur operations information required by § 250.259; (r) Coastal zone management information... 30 Mineral Resources 2 2010-07-01 2010-07-01 false What information must accompany the DPP or DOCD? 250.242 Section 250.242 Mineral Resources MINERALS MANAGEMENT SERVICE, DEPARTMENT OF THE INTERIOR...

  18. 30 CFR 250.222 - What lease stipulations information must accompany the EP?

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 2 2011-07-01 2011-07-01 false What lease stipulations information must accompany the EP? 250.222 Section 250.222 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, REGULATION... CONTINENTAL SHELF Plans and Information Contents of Exploration Plans (ep) § 250.222 What lease stipulations...

  19. 30 CFR 550.223 - What mitigation measures information must accompany the EP?

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 2 2012-07-01 2012-07-01 false What mitigation measures information must accompany the EP? 550.223 Section 550.223 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF... under the ESA; and (2) Marine mammals, as appropriate, if you have not already received authorization...

  20. 30 CFR 550.223 - What mitigation measures information must accompany the EP?

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 2 2014-07-01 2014-07-01 false What mitigation measures information must accompany the EP? 550.223 Section 550.223 Mineral Resources BUREAU OF OCEAN ENERGY MANAGEMENT, DEPARTMENT OF... under the ESA; and (2) Marine mammals, as appropriate, if you have not already received authorization...