1/25. Falx meningioma presenting as acute subdural hematoma: case report.BACKGROUND: Acute subdural hematomas caused by meningiomas have been rarely encountered. Pathophysiologic mechanisms and clinical considerations in these patients have not been sufficiently explored. We addressed the possible mechanism of spontaneous hemorrhage in our case and briefly discuss the optimal treatment. CASE DESCRIPTION: This case of falx meningioma presenting as an acute subdural hematoma in a 78-year-old woman is described. On initial computed tomography (CT), an enhancing tumor of the falx appeared to be the cause of hemorrhage. Only faint contrast staining in the periphery of the tumor was seen on right external carotid arteriograms, with no evidence of other vascular supply. Extravasation of contrast material during the procedure occurred suddenly and was successfully treated by endovascular embolization using a microcatheter. The hematoma was emergently evacuated with gross total removal of the tumor. Pathologic examination confirmed a transitional meningioma with abundant hyalinized structures. Disruption of a thin-walled vessel adjacent to the tumor capsule was assumed to be the site of hemorrhage. CONCLUSIONS: The longstanding ischemia of the tumor was considered to have produced the deposition of hyalin in the tissue, which changed the hemodynamics within the tumor, producing vascular stress leading to rupture. The prognosis of patients with meningiomas complicated by acute subdural hematoma is generally poor, with mortality reported in approximately one-half of such patients. Surgical exploration is the most effective treatment and should be conducted before irreversible brain damage has occurred.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/25. Transcranial color Doppler sonography in the emergency diagnosis of middle cerebral artery occlusion in a patient after head injury.The purpose of this report is to highlight the utility of transcranial color Doppler sonography (TCCDS) in the emergency diagnosis of an ischemic stroke in a 64-year-old patient after head injury. An emergency CT identified a subdural hematoma, subarachnoid hemorrhage, a brain contusion and edema. The patient's status deteriorated after admission, and a second CT revealed an intracerebral hematoma and marked mass effect. Transcranial color sonography revealed no flow in the ipsilateral middle and anterior cerebral arteries, which was consistent with ischemic stroke. This case demonstrates that transcranial color Doppler sonography performed early after head injury may be useful in detecting associated occlusion of cerebral vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/25. Intracranial meningiomas revealed by non-traumatic subdural haematomas: a series of four cases.OBJECTIVE: A review of the literature shows 33 cases of ipsilateral subdural haematomas (SDH) associated with meningiomas. We suggest that physiopathological mechanisms could be primary haemorrhages from abnormal vessels in the tumours and the opening of the intratumoral haematomas into the subdural space. Our working hypothesis relies on a series of 300 meningiomas operated upon in our department since 1990; of these, 4 were revealed by SDH. CLINICAL PRESENTATION: The four patients surgically treated in our department had developed a progressive impairment of consciousness. There was no history of trauma, blood dyscrasia or anticoagulant therapy. After diagnosis, the SDH was drained, and the meningeal tumour was totally resected once it had been discovered. In one case, the presence of a tumour was demonstrated by magnetic resonance imaging (MRI) performed only after the evacuation of a recurrent SDH. INTERVENTION: In each case, an acute SDH showing signs of recent bleeding was evacuated. The meningeal tumour discovered proved to be the source of the haemorrhage because of the numerous fresh blood clots both around and inside it. histology: In the four cases histology showed fresh intratumoral haemorrhages (ITH), large blood vessels with thin endothelial linings and haemosiderin deposits. In this review, SDH is associated with other haemorrhage sites in 24 of 37 cases (33 our 4 cases). ITH was present in 14 cases (40%). CONCLUSION: The treatment should consist of the extirpation of the meningioma at the same time as the evacuation of the haematoma. If primary ITH from abnormal vessels is the source of SDH, complete meningioma resection should prevent the recurrence of SDH. Subdural membranes and haematomas should therefore be inspected for their intrinsic pathology, especially when there is no history of trauma.- - - - - - - - - - ranking = 3keywords = vessel (Clic here for more details about this article) |
4/25. A spinal haematoma occurring in the subarachnoid as well as in the subdural space in a patient treated with anticoagulants.A 75-year-old man on anticoagulant therapy suddenly experienced an excruciating back pain and subsequently developed a paraplegia. At operation a subarachnoid and a subdural haematoma were found, extending between the levels of the vertebrae T3 and L2. This extremely rare combination of haematomas may have been caused either by rupture of a small vessel in the arachnoid membrane or by rupture of the arachnoid membrane itself, secondary to a massive haemorrhage in the subarachnoid space.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/25. Subdural hematoma due to dural metastasis: case report and review of the literature.A case of chronic subdural hematoma associated with dural metastasis from gastric cancer is reported. It is compatible with the concept that subdural bleeding may result from obstruction of dural vessels by neoplastic cells. Other possible pathogenetic mechanisms of this rare complication are discussed and a literature review is given. For proper diagnosis of this condition histologic investigation of the subdural membrane is mandatory.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/25. Severe delayed diffuse cerebral vasospasm and cerebral infarctions following spinal subdural hemorrhage.BACKGROUND: We report a rare case of severe delayed cerebral vasospasm with cerebral infarctions after spinal subdural hemorrhage. CASE REPORT: A 56-year-old woman presented with an acute onset of paraplegia. MR-imaging revealed an extensive intraspinal hemorrhage reaching from T1 to L1. The hematoma was evacuated via a T8-laminectomy. At the 7th postoperative day the patient developed visual disturbances. MR-scanning revealed extensive infarctions and cerebral angiography showed severe diffuse vasospasms. INTERPRETATION: This case demonstrates that cerebral vasospasm may be caused by a spinal subdural hemorrhage, supporting the hypothesis that cerebral vasospasm may be triggered by factors from a remote site and that a direct contact of blood clots with the vessel is not mandatory.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/25. Traumatic neonatal intracranial bleeding and stroke.Ischaemia within the regions supplied by vertebral and posterior cerebral arteries has been described as a complication of birth injury, either by direct trauma or by compression from a herniated temporal uncus. Ischaemia within the territory of the middle cerebral artery has been documented after a stretch injury of the vessel's elastica interna. From a series of seven personal observations on birth trauma and related cerebral stroke, we describe three neonates with the uncal herniation type of occipital stroke and four infants with hypoperfusion of the middle cerebral artery or one of its major branches. In three of the latter a basal convexity subdural haemorrhage probably induced the ischaemia, whereas in the other it was associated with haemorrhagic contusion of the parietal lobe. Experimental work and reports on older children support the idea that vasospasm due to surrounding extravasated blood can be one of the responsible mechanisms. Both forceps delivery and difficult vacuum extraction can be implicated in this supratentorial injury, leading to permanent neurological damage in at least half of the survivors in this series.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
8/25. A case of unknown origin subarachnoid hemorrhage immediately following drainage for chronic subdural hematoma.A 56-year-old man treated with anticoagulants complained of a gradually worsening headache. A left chronic subdural hematoma (CSH) was shown by head computed tomographic (CT) scans and the operation, one burr hole surgery under local anesthesia, itself was performed uneventfully. However, immediately after we began draining the hematoma at the patient's bedside, the patient complained of a sudden headache. CT scans showed a subarachnoid hemorrhage (SAH). cerebral angiography was immediately performed, but the source of hemorrhage could not be found. The next day, a CT scan showed that most of the SAH had disappeared. To our knowledge, there are no previous reports of SAH of unknown origin following surgery for CSH. The likely mechanism for the occurrence of the SAH, in addition to a coagulopathy due to anticoagulant therapy, could include the possibility that the drainage of the hematoma produced a movement of the hemisphere along with hyperperfusion that resulted in the rupture of a weak subarachnoid vessel, such as a perforating artery.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/25. Case report: acute subdural hematoma due to angiographically unvisualized ruptured aneurysm.BACKGROUND: We report a case of acute subdural hematoma (SDH) due to angiographically unvisualized ruptured aneurysm. CASE DESCRIPTION: A 57-year-old man presented with sudden-onset headache and nausea. Computed tomography revealed right acute SDH and cerebral angiography revealed no abnormal vessels, but at operation, we found an aneurysm arising from the precentral artery causing an acute SDH. CONCLUSION: In a case of spontaneous acute SDH, the possibility of a cortical artery aneurysm should be considered even if no aneurysm is recognized at angiography.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/25. Mucopolysaccharidosis IIIB, cerebral vasculopathy and recurrent subdural hematoma.mucopolysaccharidoses are characterized by involvement of multiple organs, including blood vessels. We present a case of mucopolysaccharidosis IIIB admitted with recurrent subdural hematoma; further evaluation and dural biopsy revealed an association with cerebral vasculopathy.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
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