1/13. eosinophilic granuloma with acute epidural hematoma: a case report.The most common symptoms of eosinophilic granuloma are local tenderness and an enlarged skull mass. The presence of epidural hematoma is a very rare symptom of eosinophilic granuloma. To our knowledge, this is only the second reported case of eosinophilic granuloma with epidural hematoma. A 2-year-old boy with a soft tumor on the occipital scalp, palpable at the age of 3 months, yet with no obvious history of trauma, was admitted due to a sudden onset of loss of consciousness. A brain computed tomography scan showed a lytic lesion on the occipital skull with a large epidural and subcutaneous hematoma, causing brain compression. He underwent an emergency craniectomy with removal of both the tumor and hematoma. The patient regained consciousness and had no residual neurological damage. Pathological reports showed abnormal proliferation of Langerhans' cells, eosinophilic cells and multinucleated cells. A whole-body bone nuclide scan revealed no other bone lesions. The patient was discharged uneventfully. The causes of hematomas are not very clear. They may be due to tumor necrosis or minor trauma. In our presented case, the cause of the epidural hematoma may have been tumor bleeding which ruptured into the epidural space. A solitary eosinophilic granuloma of the skull with acute epidural hematoma and loss of consciousness is extremely uncommon. Craniectomy with removal of the tumor and hematoma decompression may produce good results.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
2/13. Neurologic complications of sit-ups associated with the valsalva maneuver: 2 case reports.We present 2 cases of potentially catastrophic neurologic consequences occurring in healthy individuals engaged in sit-up exercises. Two young healthy men were engaged in sit-ups when one developed a stroke and the other developed a spinal epidural hematoma. The valsalva maneuver involved in the sit-up exercise can produce supraphysiologic increases in blood pressure, which can lead to vascular injury and serious neurologic consequences. Proper breathing should be encouraged and patients with known predisposing factors should avoid such exercises. Prompt recognition of neurologic signs and symptoms during exercise can be life saving. This is the first report of the neurologic complications of sit-ups.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
3/13. Epidural haematoma. A retrospective study of 100 patients.A retrospective study was made of 100 consecutive patients with an epidural haematoma in order to establish which clinically demonstrable factors had influenced the prognosis quoad vitam et sanationem. Operations were performed on 92 of these patients, 29 (32%) of whom died; 8 patients died without operation, and in 2 of these cases the diagnosis was not made during life. A lucid interval was observed in 57 patients; absence of a lucid interval in combination with a lowered sensory level indicated associated intradural lesions (cerebral contusion, acute subdural haematoma), with consequently a less good prognosis. The prognosis was also adversely affected by deeper coma, occurrence of extensor spasms, bilateral stiff pupils, bilateral pyramidal symptoms and an age over 50. Some 33% of the patients treated by operation showed marked symptoms of compression (extensor spasms and/or bilateral stiff pupils); although these symptoms are usually described as indicative of a hopeless prognosis, 40% of the patients in this catagory survived. Contrary to the data in the literature, the interval between accident and operation within the first 24 hours did not influence the mortality, which was 50%. All patients operated on more than 24 hours after the accident, survived. A cranial fracture was absent in 13 patients, 11 of whom were under 30; absence of a cranial fracture was prognostically favourable. A catamnestic study revealed that 7 of the 58 accessible survivors had residual neurological dysfunctions; all these patients were up and about. The residual morbidity after early operation (within 24 hours) was the same as that after later operation. The data obtained were compared with those on a number of series recently published in the literature.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
4/13. Camel racing: a new cause of extradural haemorrhage in australia.Camel racing is a relatively new sport in australia. A 52 year old woman fell from her camel during a country race. Although she was wearing an approved equestrian helmet, she suffered a skull fracture and a life-threatening extradural haematoma. Her treatment highlights the key issues of management of head injuries in remote places. A paramount requirement is close collaboration between country medical practitioner, neurosurgeon and retrieval specialist.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
5/13. Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
6/13. Multiple supratentorial epidural haematomas after posterior fossa surgery.Postoperative epidural haematoma distant to a site of craniotomy is a rare but possibly hazardous complication. We report a 31-year-old female who presented with a history of chronic hydrocephalus due to fourth-ventricular plexus papilloma. Following resection of the posterior fossa tumour with intraoperative placement of a ventricular drainage, she consecutively developed four supratentorial epidural haematomas at different locations, all necessitating evacuation. The clinical manifestations ranged from subtle neurological deficits to signs of tentorial herniation; the ultimate outcome was complete recovery. Rapid tapering of CSF pressure after long-standing hydrocephalus and clotting disorders could be implicated as causative factors. We stress the importance of early postoperative CT scan and optimal management of ventricular pressure and coagulation status to detect and prevent this possibly life-threatening complication.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
7/13. Acute spinal epidural hematoma and systemic mastocytosis.BACKGROUND: Systemic mastocytosis is a mast cell proliferative disorder affecting many organs that is rarely associated with internal bleeding. OBJECTIVE: To describe a case of spinal epidural hematoma in a patient with past medical history of urticaria pigmentosa and osteoporosis diagnosed with systemic mastocytosis. CASE REPORT: A 63-year-old woman with urticaria pigmentosa was admitted to hospital for severe back pain after minor trauma. physical examination showed pain on pressing T12 and L1 spinous processes, bilateral Lasegue sign, absent ankle jerk, and extensor plantar response. Computed tomography disclosed L3 fracture, and magnetic resonance imaging revealed spinal epidural hematoma and T2 hyperintensive scattered vertebral foci that suggested malignancy. The 24-hour urine histamine was very high. Mast cell infiltration was found in bone marrow biopsy. Because power was normal and there was no clinical sphincter disorder, the patient was successfully treated with conservative care. CONCLUSIONS: To our knowledge, acute intraspinal epidural hematoma has never been associated with mastocytosis. The hematoma was likely related to the vertebral fracture as well as a hemorrhagic diathesis due to anticoagulants released by local mast cells.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
8/13. Epidural hematoma after cochlear implantation in a 2.5-year-old boy.OBJECTIVE: Report a case of an epidural hematoma after cochlear implantation in a 2.5-year-old boy, the diagnostic and therapeutical emergency management, as well as the postinterventional course and rehabilitation of the child. STUDY DESIGN: Retrospective case review. PATIENT: Two and a half-year-old boy, suffering from early onset, profound sensorineural hearing loss had been diagnosed at an age of 1.5 years, which had been more severe on the right side initially, but had progressed to bilateral deafness. INTERVENTION AND COMPLICATION: cochlear implantation on the left side, followed up by an extensive epidural hematoma, causing intracranial compression with a midline shift of 15 mm to the right side. This initial complication was followed up by arterial infarction not only of the middle but also the posterior as well as the anterior cerebral artery, most likely caused by incarceration through the tentorium. RESULTS: After immediate neurosurgical intervention and intensive care treatment including low-dose anticoagulation and high doses of corticosteroids, the child recuperated completely within 3 weeks without any remaining neurologic deficits. CONCLUSION: In cochlear implantation, especially if placement of the implant housing is associated with considerable bone work, epidural hematoma has to be considered as an extremely rare, but life-threatening, complication.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
9/13. Epidural hemorrhage complicating extracorporeal life support in a neonate with respiratory failure.Whereas bleeding represents the most common complication of a patient on extracorporeal life support, intracranial hemorrhage represents the most common bleeding complication. We report the first known case in the English literature of an epidural hemorrhage complicating extracorporeal life support in a neonate with respiratory failure. Ultrasound findings closely mimic those of a posterior fossa hemorrhage. We speculate that the coagulopathy associated with the use of ECLS may have contributed to the formation of the epidural hemorrhage.- - - - - - - - - - ranking = 6keywords = life (Clic here for more details about this article) |
10/13. Contralateral acute epidural haematoma following evacuation of a chronic subdural haematoma with burr-hole craniostomy and continuous closed system drainage: a rare complication.Chronic subdural haematoma (CSDH) is one of the most frequent causes for neurosurgical intervention. Although the prognosis is generally good and treatment modalities are well established, some devastating intracranial haematomas can complicate its evacuation. The authors report here a case of an acute epidural haematoma occurring after evacuation of a contralateral chronic subdural haematoma (CSDH) with burr-hole craniostomy and continuous closed system drainage without irrigation. Since this is a rare, but potentially life-threatening, complication, clinicians should suspect its occurrence when an unexpected postoperative course is demonstrated.- - - - - - - - - - ranking = 1keywords = life (Clic here for more details about this article) |
| | Next -> |