301/885. Traumatic aneurysm of the middle meningeal artery presenting as delayed onset of acute subdural hematoma. A case is presented in which recurrence of acute subdural hematoma developed 29 days after head trauma. An emergency craniotomy was complicated by intraoperative profuse bleeding, which was caused by the rupture of a large false aneurysm of the middle meningeal artery. A pitfall in the surgical treatment of this rare lesion is discussed. ( info) |
302/885. Iatrogenic arteriovenous fistula presenting as a recurrent subdural hematoma. Case report. An unusual case of an iatrogenic dural arteriovenous fistula is reported. The patient presented with a history of progressive generalized headache over a period of 3 to 4 weeks. Computerized tomography demonstrated a chronic subdural hematoma that was successfully evacuated by burr-hole drainage. The patient's postoperative course was complicated by recurrent acute subdural hematomas at the drainage site. Coagulation studies were unremarkable. Selective external carotid angiography demonstrated a small dural arteriovenous fistula adjacent to the burr hole used for the initial operative procedure. Extension of the bone flap and coagulation of the fistula resulted in a good outcome. In the patient with recurrent acute subdural hematoma, the possibility of a vascular malformation must be considered. Selective internal and external carotid angiography is key to the correct diagnosis. ( info) |
303/885. Cerebral blood flow imaging with technetium-99m-HMPAO SPECT in a patient with chronic subdural hematoma: relationship with neuropsychological test. We report the relationship between cerebral blood flow (CBF) and neuropsychologic tests in a patient with a chronic subdural hematoma suffering from severe dementia and left hemiparesis. Regional CBF was quantified using 99mTc-HMPAO SPECT and 133Xe-CBF. CBF-SPECT could detect the hematoma which was isodense by CT scan and the neuropsychological test improved remarkably with the increase in CBF after surgery. We conclude that if there is a strong clinical suspicion of subdural hematoma and CT scan is not diagnostic then CBF-SPECT may be valuable in localizing the hematoma and monitoring the effect of operation. ( info) |
304/885. Acute spontaneous subdural haematoma. Description of four clinical cases. Four cases of acute spontaneous subdural haematoma are described. A review of the literature reveals the rarity of this pathology. The several etiological possibilities are discussed. The clinical onset may simulate other cerebrovascular diseases. The prognosis is correlate to the neurological findings at the operations. ( info) |
305/885. Intracranial subdural hematoma after spinal anesthesia. We describe a 68-year old male patient with late onset signs of an intracranial subdural hematoma after repetitive spinal anesthesia procedures for urethral dilatation. The proposed mechanism is that of cerebrospinal fluid efflux. The potential for the development of such complications is so important, that it must be considered in every patient. ( info) |
306/885. Spontaneous resolution of subdural hematomas. From a series of 35 cases of subdural hematomas in a 12 months span, 6 cases of subdural hematomas which spontaneously resolved were found. The sizes of these hematomas ranged from the relatively small to the huge. All of these cases displayed little if any neurological deficit when seen by us. It is thought that the mechanisms of resorption are: co-mingling with CSF and redistribution in the more acute variety and in instances of subdural hydromas; and thru the healing and reparative process in the chronic type. ( info) |
307/885. The value of repeat cerebral arteriography in the evaluation of trauma. In most patients with head or neck trauma, a single angiogram is sufficient to guide therapy. For those who improve slowly or not at all, however, this is not an adequate basis for diagnosis. angiography should be repeated after an interval of time to exclude development of a surgically correctable lesion, such as pseudoaneurysm or intracerebral or extracerebral fluid collection. ( info) |
308/885. Spinal subdural hematoma. The authors report a case of spinal subdural hematoma in a 51-year-old man who experienced a sudden onset of back pain accompanied by vomiting and headache without paralysis or paraparesis. CT Scan, myelography and MRI revealed a subdural hematoma at the levels of 6th, 7th and 8th thoracic vertebrales. laminectomy allowed the removal of an encapsulated cyst formation filled with xanthochromic fluid and some blood clots. The follow-up was uneventful. ( info) |
309/885. The importance of MRI findings for the diagnosis of nontraumatic lumbar subacute subdural haematomas. Spinal subdural haematoma (SSH) is a rare cause of spinal cord or cauda equina compression which occurs mainly in patients with a bleeding diathesis. This report presents a case of subacute lumbar subdural haematoma demonstrated by magnetic resonance imaging. MRI appears to be more sensitive than myelography and CT. ( info) |
310/885. Interhemispheric subdural hematoma (ISH). Case report. Interhemispheric subdural hematoma (ISH) is a rare form of post-traumatic intracranial hemorrhage. The Authors report a further case and review the relevant literature. ISH most frequently gives a clinical picture corresponding to the falx syndrome. The possibility of an interhemispheric hematoma evolving into a chronic subdural hematoma of the convexity is considered together with both surgical and medical therapeutic indications. ( info) |