RESUMO
Background: One of the most commonly encountered surgical pathologies in neurosurgical practice worldwide is subdural hematoma. The use of prefabricated drains following surgical procedures is widely recommended. However, their availability can be inconsistent due to various issues. Methods: An intensive search was conducted regarding the availability and cost of subdural drains. The Medtronic subdural evacuating port system costs between 100 and 150 USD, the Blake drain costs between 35 and 40 USD, and the Jackson-Pratt drain costs between 25 and 35 USD. We present a low-cost alternative and describe how it can be implemented using materials available in almost every hospital. Results: A simple step-by-step guide for crafting handmade subdural drains has been created, aiming to make this affordable alternative accessible to every surgeon who may need one due to the unavailability of prefabricated drains in developing countries. Conclusion: The benefits associated with using a subdural drain during the evacuation of subdural hematomas are well-documented. In cases where prefabricated drains are not available, a handmade alternative can always be utilized. Materials are often readily available in every hospital, and the cost may not exceed 100 MXN (5 USD), making it at least 5 times cheaper than the cheapest prefabricated alternative. This solution is particularly beneficial for developing countries without access to prefabricated drains.
RESUMO
Chronic subdural hematoma (cSDH) is an increasingly prevalent condition, particularly among elderly population and is associated with elevated morbidity. The pathophysiology of cSDH involves proliferation of dural edge cells, fibroblasts, and release of vascular angiogenic factors leading to angiogenesis of a vascularized neomembrane perfused by the middle meningeal artery (MMA). MMA embolization is a technique that can be employed as treatment in conjunction with surgery or as a standalone therapy. Our aim is to describe our experience with treating selective cSDH patients with embolization of MMA in a university hospital in Argentina. We deployed this procedure in 6 patients over a period of one year and a half years with a median age of 72.5, with a median SDH thickness of 12.5 mm and four of them had a midline deviation greater than 5mm. The decision of the embolization was done due to minor symptoms and the necessity of restart antiplatelet therapy or anticoagulation, formal contraindication for surgery or as adjuvant of surgery because of cSDH recurrence. After discharge, no patient required a new surgical intervention. MMA embolization is impressive to be a safe and an option to treat cSDH. We present our experience in six patients in a hospital in Argentina.
Los hematomas subdurales crónicos (HSDc) son una afección con una prevalencia en aumento, en particular en pacientes añosos, asociado a una elevada morbilidad. La patofisiología del HSDc incluye la proliferación de la células durales, de fibroblastos y de liberación de factores de crecimiento vascular que conllevan a angiogénesis de una neomembrana vascularizada irrigada por la arteria meníngea media (AMM). La embolización de dicha arteria es una técnica que puede ser empleada en conjunto con la cirugía o como tratamiento único. Nuestro objetivo es describir nuestra experiencia con la embolización de la AMM en pacientes seleccionados con HSDc en un hospital universitario de Argentina. Realizamos dicho procedimiento en 6 pacientes a lo largo de un año y medio, con una edad promedio de 72.5 años, con un grosor medio de 12.5 mm de HSDc y de los cuales en 4 pacientes presentaban desviación de la línea media mayor a 5 mm. La elección de esta terapéutica en estos pacientes se debió a la poca sintomatología que generaban el HSD asociado al requerimiento de inicio precoz de terapia antiagregante o anticoagulante, a contraindicaciones formales para la cirugía o como adyuvante al tratamiento quirúrgico por la recurrencia del HSD. Luego del alta hospitalaria, ningún paciente requirió nueva intervención por recaída del HSD. La embolización de la AMM impresiona ser segura y ser una opción en el tratamiento del HSDc y presentamos nuestra experiencia en 6 pacientes en un hospital de Argentina.
Assuntos
Embolização Terapêutica , Hematoma Subdural Crônico , Artérias Meníngeas , Humanos , Hematoma Subdural Crônico/terapia , Hematoma Subdural Crônico/diagnóstico por imagem , Embolização Terapêutica/métodos , Artérias Meníngeas/diagnóstico por imagem , Idoso , Masculino , Feminino , Pessoa de Meia-Idade , Resultado do Tratamento , Idoso de 80 Anos ou mais , ArgentinaRESUMO
OBJECTIVE: To describe a simple variation of burr hole craniostomy for the management of chronic subdural hematoma (CSDH) that uses a frontal drainage system to facilitate timely decompression in the event of tension pneumocephalus and spares the need for additional surgery. METHODS: We conducted a retrospective analysis of 20 patients with CSDH who underwent burr hole craniostomy and 20 patients who underwent the same procedure alongside the placement of a 5 Fr neonatal feeding tube as a backup drainage for the anterior craniostomy. Depending on the situation, the secondary drain stayed for a maximum of 72 hours to be opened and used in emergency settings for drainage, aspiration, or as a 1-way valve with a water seal. RESULTS: The outcomes of 20 patients who underwent this procedure and 20 controls are described. One patient from each group presented tension pneumocephalus. One was promptly resolved by opening the backup drain under a water seal to evacuate pneumocephalus and the other patient had to undergo a reopening of the craniostomy. CONCLUSIONS: The described variation of burr hole craniostomy represents a low-cost and easy-to-implement technique that can be used for emergency decompression of tension pneumocephalus. It also has the potential to reduce reoperation rates and CSDH recurrence. Prospective controlled research is needed to validate this approach further.
Assuntos
Drenagem , Hematoma Subdural Crônico , Pneumocefalia , Complicações Pós-Operatórias , Humanos , Hematoma Subdural Crônico/cirurgia , Pneumocefalia/etiologia , Pneumocefalia/cirurgia , Pneumocefalia/diagnóstico por imagem , Drenagem/métodos , Masculino , Estudos Retrospectivos , Feminino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos de Coortes , Craniotomia/métodos , Resultado do Tratamento , Descompressão Cirúrgica/métodos , AdultoRESUMO
Introduction Optimal surgical treatment for chronic subdural hematoma (CSDH) in the elderly has been controversial. Whenever possible, a less invasive technique should be used to avoid complications. Case Report The patient was 82-years-old, with JPS; with diagnosis of liver cirrhosis due to alcohol abuse and history of recent myocardial infarction. He was admitted to the emergency room with temporal-spatial disorientation. The Glasgow coma scale (GCS) value on admission was 9. Left hemiparesis and osteotendinous hyperreflexia in the left side of the body. Noncontrast-enhanced cranial computed tomography (CT) showed right frontoparietal hypodense lesion with mass effect. Due to the clinical conditions of the patient, drainage of the hematoma was indicated through local anesthesia and sedation with midazolam. He was discharged after 8 days with improvement in his mental and neurological condition. Conclusion Drainage of CSDH using local anesthesia in an elderly person with severe comorbidity can reach excellent results.
Introdução O tratamento cirúrgico ideal para hematoma subdural crônico (HSDC) em idosos tem sido controverso. Sempre que possível uma técnica menos invasiva deve ser utilizada para evitar complicações. Relato do Caso Paciente de 82 anos portadora de JPS; com diagnóstico de cirrose hepática por abuso de álcool e história de infarto do miocárdio recente. Foi admitido no pronto-socorro com desorientação espaço-temporal. O valor da escala de coma de Glasgow (ECG) na admissão era 9. Hemiparesia esquerda e hiperreflexia osteotendinosa no lado esquerdo do corpo. A tomografia computadorizada (TC) de crânio sem contraste mostrou lesão frontoparietal hipodensa direita com efeito de massa. Devido às condições clínicas do paciente foi indicada drenagem do hematoma através de anestesia local e sedação com midazolam. Teve alta após 8 dias com melhora do quadro mental e neurológico. Conclusão A drenagem do HDC com anestesia local em idoso com comorbidade grave pode alcançar excelentes resultados.
RESUMO
Traumatic subdural hemorrhage (TSH) is an injury between the meningeal membranes, caused by traumas, especially traffic accidents. OBJECTIVE: To describe the mortality rate (MR) due to TSH in the period 2018-2022 in Chile. MATERIALS AND METHODS: Descriptive, observational, and cross-sectional study on MR due to TSH in the period 2018-2022 in Chile, according to gender, age group, regional distribution, place of death, and month of death. Anonymous and public databases were used. No ethics committee approval was required. RESULTS: The average MR due to TSH in Chile from 2018 to 2022 was 0.45/100,000 inhabitants, with a peak in 2018 (0.75) and a minimum in 2021 (0.31). Men had higher rates. Mortality increased with age, especially in those over 80 years. The Metropolitan Region accounted for 35.2% of TSH-related deaths. Hospitals and clinics were the main places of death (67.1%), with more deaths in March, July, and August. DISCUSSION: The MR due to TSH progressively decreased due to medical improvements. Men have higher rates, possibly due to risk factors or biological differences. The reduction in MR in hospitals is linked to changes in the severity and categorization of the place of death. The connection with traffic accidents is significant, especially between March and August, due to the return to academic activities and weather conditions. Additionally, TSH-related deaths are concentrated in densely populated regions with more traffic accidents.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hematoma Subdural Agudo/mortalidade , Hemorragia Subaracnoídea Traumática/mortalidade , Estudos Transversais , Mortalidade , Fatores Etários , Distribuição por Idade e SexoRESUMO
BACKGROUND: Chronic subdural hematomas (CSDHs) are common in the elderly, with a relatively high rate of recurrence after initial surgical intervention. Our research team previously created a predictive grading system, the Puerto Rico Recurrence Scale (PRRS), to identify patients at high risk of CSDH recurrence. In this study, we introduce a modification of the (mPRRS) that includes pneumocephalus volume, which has been independently associated with recurrence. METHODS: A single-center Puerto Rican population-based retrospective study was performed to analyze data for patients treated for CSDH at 1 institution between July 1, 2017, and December 31, 2019. Univariate and multivariate analyses were used to create a grading scale predictive of recurrence. Retrospective validation was conducted for the cohort. RESULTS: Of 108 patients included in the study, 42 had recurrence, and 66 had nonrecurrence. Postoperative subdural space, postoperative midline shift, and pneumocephalus volume were all higher with recurrence (P = 0.002, P = 0.009, and P < 0.001, respectively). Multivariate analysis was used to create a 6-point grading scale comprising 3 variables (pneumocephalus volume [< 10, 10-20, 21-30, and > 30 cm3], postoperative midline shift [< 0.4, 0.41-1.0, and > 1.0 cm], and laterality [unilateral and bilateral]). Recurrence rates progressively increased in low-risk to high-risk groups (2/18 [11%] vs 21/34 [62%]; P < 0.003). CONCLUSION: The mPRRS incorporating pneumocephalus measurement improves CSDH recurrence prediction. The mPRRS indicated that patients with higher scores have a greater risk of recurrence and emphasized the importance of measuring postoperative variables for prediction. The mPRRS grading scale for CSDHs may be applicable not only to the Puerto Rican population but also to the general population.
Assuntos
Hematoma Subdural Crônico , Pneumocefalia , Humanos , Idoso , Estudos Retrospectivos , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Crônico/complicações , Pneumocefalia/diagnóstico por imagem , Pneumocefalia/cirurgia , Porto Rico , RecidivaRESUMO
Introduction: Chronic subdural hematoma is a frequent type of intracranial hemorrhage. Treatment for symptomatic cases is generally surgical. Burr-hole completion is the method of choice. Objective: To analyze the placement of a single versus double drain in patients with chronic subdural hematoma operated through burr-holes. Methods: An analytical correlational retrospective study was carried out in patients who underwent surgery for chronic subdural hematoma, between January 2018 and December 2020. The patients were divided into 2 groups based on the number of drains used: double or single. The variables were: age, morbidities, preoperative Glasgow Score, hematoma characteristics (laterality, internal architecture, maximum diameter, and midline shift), complications, and hospital stay. The probability value < 0.05 was considered statistically significant. Results: Of the 99 patients in the study, 39 were older than 75 years. The most frequent pattern was B with 25 cases (25,3 %). The diameter of the chronic subdural hematoma was more than 20 mm in 61 cases, and in 32 cases the displacement of the midline structures was greater than 10 mm. The average hospital stays 5,8 days. The most frequent complication was nosocomial pneumonia with eleven cases (11,11 %). The double drainage group showed fewer complications at 30 days. Conclusions: The placement of double subdural drainage in patients with chronic subdural hematoma operated through single or double burr-holes, and is related to fewer complications than those with single drainage.
Introducción: El hematoma subdural crónico es un tipo frecuente de hemorragia intracraneal. El tratamiento de los casos sintomáticos es generalmente quirúrgico. La terminación con agujeros de trépano es el método de elección. Objetivo: Analizar la colocación de drenaje simple versus doble en pacientes con hematoma subdural crónico operados mediante trepanación. Métodos: Se realizó un estudio retrospectivo correlacional analítico en pacientes operados de hematoma subdural crónico, entre enero de 2018 y diciembre de 2020. Los pacientes se dividieron en 2 grupos según el número de drenajes utilizados: doble o simple. Las variables fueron: edad, morbilidades, puntaje de Glasgow preoperatorio, características del hematoma (lateralidad, arquitectura interna, diámetro máximo y desviación de la línea media), complicaciones y estancia hospitalaria. El valor de probabilidad < 0,05 se consideró estadísticamente significativo. Resultados: De los 99 pacientes del estudio, 39 eran mayores de 75 años. El patrón más frecuente fue el B con 25 casos (25,3 %). El diámetro del hematoma subdural crónico fue mayor de 20 mm en 61 casos, y en 32 casos el desplazamiento de las estructuras de la línea media fue mayor de 10 mm. La estancia hospitalaria media fue de 5,8 días. La complicación más frecuente fue la neumonía nosocomial con once casos (11,11 %). El grupo de doble drenaje presentó menos complicaciones a los 30 días. Conclusiones: La colocación de drenaje subdural doble en pacientes con hematoma subdural crónico operados mediante trepanación simple o doble, se relaciona con menos complicaciones que aquellos con drenaje simple.
RESUMO
Chronic subdural hematoma (CSDH) is a frequent neurosurgical disease which mainly affects elderly patients. Tranexamic acid (TXA) has been hypothesized as an oral agent to avoid CSDH progression and/or recurrence. We performed an evaluation to determine whether the postoperative use of TXA reduces recurrence rate. A prospective, randomized, and controlled trial. Patients with unilateral or bilateral chronic subdural hematoma undergoing surgical treatment by burr-hole were randomized as to whether or not to use TXA in the postoperative period. We evaluated image and clinical recurrence of CSDH at follow up of 6 months and potential clinical and/or surgical complications impact of TXA. Twenty-six patients were randomized to the control group (52%) and twenty-four patients to the TXA group (48%). Follow-up ranged from 3 to 16 months. There were no significant difference between baseline data in groups regarding to age, gender, use of antiplatelet or anticoagulants, smoking, alcoholism, systemic arterial hypertension, diabetes mellitus, hematoma laterality, hematoma thickness, and drain use. Clinical and radiological recurrence occurred in three patients (6%), being two cases in TXA group (8.3%) and 1 in control group (3.8%). Postoperative complications occurred in two patients during follow-up (4%), being both cases in TXA group (8.3%), and none in the control group. Although TXA group had a higher recurrence rate (8.3%), there was no statistically significant difference between the two groups. Moreover, TXA group had two complications while control group had no complications. Although limited by experimental nature of study and small sample, our current data suggest that TXA should not be used as a potential agent to avoid recurrences of CSDH and might increase complication odds.
Assuntos
Hematoma Subdural Crônico , Ácido Tranexâmico , Humanos , Idoso , Ácido Tranexâmico/uso terapêutico , Estudos Prospectivos , Hematoma Subdural Crônico/tratamento farmacológico , Hematoma Subdural Crônico/cirurgia , Trepanação/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/tratamento farmacológico , Drenagem/métodos , Período Pós-Operatório , Recidiva , Resultado do Tratamento , Estudos RetrospectivosRESUMO
OBJECTIVE: The aim of this study was to investigate the impact of the US-Mexico border wall height extension on traumatic brain injuries (TBIs) and related costs. METHODS: In this retrospective cohort study, patients who presented to the UC San Diego Health Trauma Center for injuries from falling at the border wall between 2016 and 2021 were considered. Patients in the pre-height extension period (January 2016-May 2018) were compared with those in the post-height extension period (January 2020-December 2021). Demographic characteristics, clinical data, and hospital charges were analyzed. RESULTS: A total of 383 patients were identified: 51 (0 TBIs, 68.6% male) in the pre-height extension cohort and 332 (14 TBIs, 77.1% male) in the post-height extension cohort, with mean ages of 33.5 and 31.5 years, respectively. There was an increase in the average number of TBIs per month (0.0 to 0.34) and operative TBIs per month (0.0 to 0.12). TBIs were associated with increased Injury Severity Score (8.8 vs 24.2, p < 0.001), median (IQR) hospital length of stay (5.0 [2-11] vs 8.5 [4-45] days, p = 0.03), and median (IQR) hospital charges ($163,490 [$86,369-$277,918] vs $243,658 [$136,769-$1,127,920], p = 0.04). TBIs were normalized for changing migration rates on the basis of Customs and Border Protection apprehensions. CONCLUSIONS: This heightened risk of intracranial injury among vulnerable immigrant populations poses ethical and economic concerns to be addressed regarding border wall infrastructure.
Assuntos
Lesões Encefálicas Traumáticas , Humanos , Masculino , Feminino , Estudos Retrospectivos , México/epidemiologia , Lesões Encefálicas Traumáticas/epidemiologia , Morbidade , Escala de Gravidade do FerimentoRESUMO
Introducción: La hemorragia subdural aguda no traumática (HSDNT) es una patología relacionada a factores de riesgo cardiovascular (RCV). Por falta de estudios epidemiológicos nacionales, se plantea estudiar la tasa de mortalidad (TM) y defunciones por HSDNT entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, transversal, sobre defunciones por HSDNT entre los años 2017-2021 en Chile (N=878), según grupo etario, sexo y lugar de defunción, usando datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva y cálculo de TM. No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 0,99/100.000 habitantes entre los años 2017-2021, siendo la mayor los años 2017-2019 y 2020 con TM de 1/100.000. El sexo masculino presentó TM de 1,27/100.000, el grupo etario mayor a 80 años presentó una TM de 19,28/100.000 habitantes. Según lugar de defunción, el año 2020 un 83% (148) de las defunciones fue en hospital o clínica. Discusión: La prevalencia del RCV hace relevante el estudio de mortalidad por HSDNT, donde la principal hipótesis de su mortalidad en Chile estaría basada en estos factores riesgo latentes. Según lugar de defunción, se podría suponer dadas mayores complicaciones en aquellos pacientes hospitalizados por HSDNT. Conclusión: Dada la nula existencia de datos sobre esta patología en Chile, se realizó una caracterización epidemiológica en conjunto a un análisis de defunciones según el lugar, aportando una perspectiva nacional de mortalidad sobre este cuadro en particular.
Introduction: Non-traumatic acute subdural hemorrhage (NTSDH) is related to cardiovascular risk factors (CVR). Due to lack of national epidemiological studies, it is proposed to study mortality rate (MR) and deaths from HSD between the years 2017-2021 in Chile. Methodology: Descriptive, observational, cross-sectional study on deaths due to SDH between the years 2017-2021 in Chile (N=878), in a population older than 15 years, according to age group, sex and place of death, using data obtained from Departamento de estadísticas e información en salud. Descriptive statistics and MR calculation were used. It did not require approval by an ethics committee. Results: A MR of 0.99/100,000 inhabitants was calculated between the years 2017-2021, the year being the highest in the years 2017-2019 and 2020 with MR of 1/100,000. Male sex presented a MR of 1.27/100,000, the age group over 80 years presented a MR of 19.28/100,000 inhabitants. By place of death, in 2020 there were 148 deaths in hospitals or clinics. Discussion: The prevalence of CVR makes the study of mortality from NTSDH relevant, where the hypothesis of its mortality in Chile would be based on these risk factors. Depending on the place of death, it could be assumed that there are greater complications in those patients hospitalized for NTSDH. Conclusion: Given the null existence of data on this pathology in Chile, an epidemiological characterization was carried out together with an analysis of deaths according to the place, providing a national perspective of mortality about this disease.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Hematoma Subdural Agudo/mortalidade , Hematoma Subdural Agudo/epidemiologia , Chile/epidemiologia , Epidemiologia Descritiva , Distribuição por Idade e SexoRESUMO
Calcified chronic subdural hematomas (CCSDHs) are rare entities, whose yearly incidence ranges from 1.72 to 20.6 per every 100 thousand persons. Several different approaches to their management are reported in the literature, ranging from conservative treatment to craniotomy with full removal of the neomembranes. Currently, there are no guidelines or consensus that establish the best technique. We herein report a case of symptomatic CCSDH initially drained through a burr-hole craniotomy, with no resolution of the symptoms. Later, our patient underwent a craniotomy and partial membranectomy, which resulted in full symptomatic recovery.
Hematomas subdurais crônicos calcificados (HSDCCs) são entidades raras, cuja incidência anual varia de 1,72 a 20,6 casos a cada 100 mil pessoas. Várias abordagens diferentes para seu manejo são relatadas na literatura, desde o tratamento conservador até a craniotomia com remoção total das neomembranas. Atualmente não há diretrizes ou consensos que estabeleçam a melhor técnica. Nós relatamos um caso de HSDCC inicialmente drenado por meio de uma craniotomia por trepanação, sem resolução dos sintomas. Posteriormente, nosso paciente foi submetido a uma craniotomia e membranectomia parcial, que resultou em plena recuperação dos sintomas.
RESUMO
Presentamos el tratamiento eficaz de una filtración espontánea de líquido cefalorraquídeo (LCR) asociada a un síndrome de hipoten-sión/hipovolumen de LCR a nivel cervical alto, caracterizado por delirio y hematomas subdurales secundarios, refractarios al drenaje quirúrgico, que se resolvió con dos parches de sangre epidurales cervicales consecutivos.
We present the case of a cerebrospinal fluid (CSF) hypotension/hypovolume syndrome due to a spontaneous CSF fistula at the upper cervical level characterized by loss of consciousness and bilateral subdural hematomas refractory to two drainage surgeries that resolved with two consecutive blood patches on the leak site.
RESUMO
Background: Chronic subdural hematoma (CSH) in the posterior fossa is extremely rare and only a few cases have been reported in the literature. We report a case of CSH in the posterior fossa successfully treated with a single burr hole surgery. Case Description: A 66-year-old woman who underwent anticoagulation therapy and was suffering, in the past 3 weeks from headache, vertigo, and gait ataxia. Screening with magnetic resonance imaging demonstrated infratentorial CSH on the right cerebellar hemisphere. Coagulation was normalized and the hematoma was evacuated through a burr hole irrigation. The symptoms resolved completely within a few days. Postoperative computed tomography showed a normal postoperative appearance and resolution of hematoma. She was discharged 1 week later without any neurological deficits. Conclusion: CSH in the posterior fossa is an extremely rare condition. Due to the limited number of reports, the optimal treatment is yet unknown. In cases with coagulation disorders, less invasive and early treatment should be considered. More studies are needed to define the best management for this pathology and cases must be individualized according to each patient's particularities.
RESUMO
Background: Chronic subdural hematoma (CSDH) commonly affects older individuals and is associated with a relatively high rate of recurrence after surgery. Many studies have created grading systems to identify patients at high risk of CSDH recurrence after the initial surgery. However, no system has been adopted widely. The authors present the first CSDH grading system created from a population-based single-center data set. Methods: A single-center Puerto Rican population-based retrospective analysis was performed on consecutive patients treated for a CSDH at a designated institution from July 1, 2017 to December 31, 2019. Univariate and multivariate analyses were used to create a CSDH recurrence grading scale. Retrospective validation was conducted on this sample population. Results: The study included 428 patients. Preoperative midline shift, postoperative midline shift, and size of postoperative subdural space differed between the recurrence and nonrecurrence groups (P = 0.03, 0.002, and 0.002, respectively). A multivariate analysis was used to create a 10-point grading scale comprising four independent variables. Recurrence rates progressively increased from the low-risk (0-3 points) to high-risk (8-10 points) groups (2.9% vs. 20.3%; P < 0.001). Conclusion: A 10-point grading scale for CSDH recurrence was developed with four components: preoperative midline shift (≤1 and >1 cm), laterality (bilateral, unilateral-right, and unilateral-left), size of postoperative subdural space (≤1.6 and >1.6 cm), and pneumocephalus (present or absent). Patients who scored higher on the scale had a higher risk of recurrence. This CSDH grading scale has implications for Puerto Rico and the general population as the elderly population increases worldwide.
RESUMO
Intracranial hematoma after spinal anesthesia is a rare complication. It generally presents with posture-dependent headache that becomes persistent. We describe the case of patient submitted to spinal anesthesia for cesarean section who presented a non-posture-dependent headache, resistant to clinical treatment, that progressively worsened and with symptoms of intracranial hypertension. The patient had a history of head trauma without symptoms. The CT-scan revealed a chronic bilateral parietal hematoma with a recent bleeding component, treated surgically. We concluded that spinal puncture led to chronic hematoma to rebleed. We have reported the case to draw attention to the importance of investigating atypical headache after spinal anesthesia.
Assuntos
Raquianestesia , Hematoma Subdural Crônico , Hematoma Subdural Intracraniano , Raquianestesia/efeitos adversos , Cesárea/efeitos adversos , Feminino , Cefaleia , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico por imagem , Hematoma Subdural Crônico/cirurgia , Hematoma Subdural Intracraniano/diagnóstico por imagem , Hematoma Subdural Intracraniano/etiologia , Humanos , GravidezRESUMO
BACKGROUND: Abusive head trauma (AHT) is the most serious injury inflicted to the nervous system of neonate an infant with a high incidence of disabilities. The authors present two cases in which the initial manifestations and neurologic status were misinterpreted and stress that clinical presentation and imaging can be variable and confuse the examiner. DISCUSSION: Subdural hemorrhage (SDH) in this age group raises high suspicion of non-accidental trauma but have been reported in other situations such as several bleeding disorders. Although rare, hematological diseases should be considered when other data of maltreatment are lacking. CONCLUSION: Differential diagnosis is important to avoid underdiagnosing AHT and to prevent morbidity if a pre-existing hematological disease is misdiagnosed.
Assuntos
Maus-Tratos Infantis , Traumatismos Craniocerebrais , Lactente , Criança , Recém-Nascido , Humanos , Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/etiologia , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/etiologia , Tomografia Computadorizada por Raios X/métodos , IncidênciaRESUMO
Abstract The occurrence of subdural hematomas following lumbar spine surgical procedures is a rare complication, but one with a high burden of morbidity and mortality, and despite an incidence rate of around 1%, it is a complication which must be considered in this group of patients. We present the case of a male patient, in the fourth decade of life, with a history of neurofibromatosis and spastic quadriparesis, who developed an altered state of consciousness following lumbar tumor resection, ending in a coma. A simple cranial CAT showed evidence of an acute right subdural hematoma which had to be drained via a craniotomy. He had an unsatisfactory postoperative course and died in the intensive care unit due to ARDS. The national literature has little information on this complication, therefore we believe that this case is an important contribution to the literature. (Acta Med Colomb 2021; 46. DOI:https://doi.org/10.36104/amc.2021.2094).
RESUMO
BACKGROUND: A subdural hematoma is defined as clot formation in the subdural space after vessel rupture or brain parenchyma damage. Several demographic and tomographic factors were associated to poor prognosis, although some debate according to their specific roles still remains. METHODS: Retrospective cohort study of comatose patients admitted to a single-institution, tertiary hospital center, between the years 2013 and 2019 with traumatic acute subdural hematoma requiring surgical evacuation were studied. Demographic and tomographic data were obtained from medical records. Univariate and multivariate statistical analysis were performed, using a value of P < 0.05 for significance. RESULTS: Seventy-seven patients were selected using the criteria and a total of 37 (48%) head CT exams were evaluated. The overall mortality was 57.1% and achieved 100% at ≥75-years-old subgroup. Univariate analysis only found young age as a good prognosis factor (P = 0.002). Gender (P = 0.784), abnormal pupillary response (P = 0.643), midline shift (P = 0.874), clot thickness (P = 0.206), compressed basal cisterns (P = 0.643), hematoma side (P = 0.879), and subarachnoid hemorrhage (P = 0.510) showed no association. Multivariate analysis showed no statistically significant association between covariates. CONCLUSION: Traumatic acute subdural hematoma is a life-threatening condition. Younger age was the only positive prognostic factor identified. More research is necessary to establish age as a rule-out criterion to surgical indication.
RESUMO
Introducción: El hematoma subdural crónico es una de las entidades clínicas más comunes en la práctica neuroquirúrgica diaria, cuya incidencia y prevalencia aumentan considerablemente con la edad. El tratamiento conservador puede ser muy útil en algunos casos. Objetivo: Mostrar que el manejo farmacológico exclusivo de este padecimiento, puede ser considerado en muchos pacientes. Casos clínicos: Se presentan dos pacientes adultos mayores, atendidos en el servicio de Neurocirugía, con diagnóstico de hematoma subdural crónico, tratados solo con fármacos. Conclusiones: Como resultado final, se logró la reabsorción de las colecciones subdurales, lo cual se comprobó mediante estudios imagenológicos(AU)
Introduction: Chronic subdural hematoma is one of the most common clinical entities in everyday neurosurgical practice, which incidence and prevalence increase considerably with age. Conservative treatment can be very useful in many patients. Objective: To show that the exclusive pharmacological management of this condition can be considered in many patients. Clinical cases: Two elderly patients attended at the neurosurgery service are presented with a diagnosis of chronic subdural hematoma. They were treated only with drugs. Conclusions: The final result was the reabsorption of the subdural collections, which was proven by imaging studies(AU)