Presentation
In this article, we present a rare case of intracranial meningioma presenting with acute subdural hematoma treated with surgery. [austinpublishinggroup.com]
Nineteen (4.3%) were found to have an associated aSDH and 13 (2.9%) of these presented with coma. [ncbi.nlm.nih.gov]
Hematological
- Prolonged Bleeding
Chronic SDH is more common in this age group. [ 4 ] Those with alcoholism Alcohol misuse leads to a risk of thrombocytopenia, prolonged bleeding times and blunt head trauma and is a risk factor for SDH. [ 5 ] Alcoholism also causes cerebral atrophy which [patient.info]
Alcoholics are prone to thrombocytopenia, prolonged bleeding times, and blunt head trauma. Maintain a high level of suspicion in this population. [oncare.blogspot.com]
Entire Body System
- Swelling
Yet, progressive brain swelling and evolution of right PCA infarct causing increased ICP caused expulsion of the hematoma through the fracture line underneath the scalp. [casesjournal.biomedcentral.com]
Unfortunately, we found intraoperative brain swelling, which indicated the development of a contralateral hematoma. The patient was reoperated and eventually had a poor prognosis. [ncbi.nlm.nih.gov]
- Pain
During the follow-up, the headache regressed and eventually resolved after 12 hours; however, another severe pain occurred in the lumbar region and in both legs. The pain worsened over time, progressing to sciatica in both legs. [ncbi.nlm.nih.gov]
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[…] bowel control (epidural hematoma), discoloration, nail loss, pain in the nail bed, and abdominal or flank pain (spleen, liver, or peritoneal hematoma). [medicinenet.com]
Case report A fifty-four-year-old man was admitted with lower back pain and right leg severe radiating pain with a history of previous lumbar spinal fusion(L5/S1) presented with upper adjacent level spinal stenosis. [hoajonline.com]
- Fever
A 58-year-old man, a shepherd, was admitted to Centre Hospitalier National (Nouakchott, Mauritania) on July 2, 2012, with fever and epistaxis. One week earlier, he had fever, nausea, and vomiting. [wwwnc.cdc.gov]
Case 1: A 54-year-old man presented with a 10-day history of headache, fever. At admission neurologic examination and Brain-CT were normal. Blood cultures showed Streptococcus bovis. [ncbi.nlm.nih.gov]
Signs and symptoms [ edit ] Clinical manifestations of intraparenchymal hemorrhage are determined by the size and location of hemorrhage, but may include the following: [ citation needed ] Hypertension, fever, or cardiac arrhythmias Nuchal rigidity Subhyaloid [en.wikipedia.org]
purulent discharge from any wounds), aspiration pneumonia (shortness of breath, pulmonary congestion, fever, productive cough), increased ICP Response to surgery and clot evacuation: Mental status changes, incisional healing, presence of complications [medical-dictionary.thefreedictionary.com]
- Acutely Ill Patient
Even though MRI has advantages, computed tomography remains the procedure of choice in the acute setting because of shorter examination time, which is important in acutely ill patients, reliability in identifying other parenchymal lesions, no magnetic [pmj.bmj.com]
Cardiovascular
- Hypertension
Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. [ncbi.nlm.nih.gov]
At any time during this clinical sequence, the patient may demonstrate the Cushing reflex—systemic arterial hypertension and bradycardia—which is also a secondary sign of severe intracranial hypertension. [alpfmedical.info]
- Hypotension
It may have been caused by acute intracranial hypotension secondary to rapid and massive drainage of cerebrospinal fluid. Surgeons should be aware of the possibility of intracranial hemorrhage as a rare but critical complication of extended TSS. [ncbi.nlm.nih.gov]
Some other precipitating factors have been said to be: surgical decompression, CSF fistula, aggressive anti-edema treatment, and systemic hypotension all of which can lead to intracranial hypotension [ 4 ]. [casesjournal.biomedcentral.com]
Subdural haematoma: A potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003;74:752-5. 10. Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. [smjonline.org]
Spontaneous intracranial hypotension has also been reported as a rare cause. [ 11 ] Presentation [ 12 ] Acute SDH Usually presents shortly after a moderate-to-severe head injury. Loss of consciousness may occur but not always. [patient.info]
Neurologic
- Headache
Neurosurgeons should be aware that SIH patients do not always present with orthostatic headache. [ncbi.nlm.nih.gov]
Very few other diseases can display posturodependent headache (cerebral thrombophlebitis, 6 incipient eclampsia, 7 meningitis, 8 and others), and, thus, position-related headache is almost synonymous with PDPH. [anesthesiology.pubs.asahq.org]
- Seizure
Ninety percent of patients with preoperative seizures were seizure free after operation for 3 months. Independent predictors of seizures were GCS CONCLUSION: Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH. [ncbi.nlm.nih.gov]
There will be changes in pulse and breathing rate along with possible seizures or unconsciousness. [sportsinjuryclinic.net]
- Confusion
The patient may have loss of memory and confusion. Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures. [sportsinjuryclinic.net]
METHODS (CASE PRESENTATIONS): Identical twin brothers presented 1 year and 10 days apart to an academic medical center after incurring confusion, decreased mental functioning, and a subsequent comatose state. [ncbi.nlm.nih.gov]
Deterioration in consciousness, including increasing confusion, sleepiness, and a deep coma, can quickly follow. [merckmanuals.com]
Symptoms of subdural hematomas include confusion, headache, movement difficulties, loss of sensation, visual changes, speech difficulties, seizures, lethargy, vomiting, and loss of consciousness. [healthgrades.com]
- Lethargy
Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. [ncbi.nlm.nih.gov]
Symptoms of subdural hematomas include confusion, headache, movement difficulties, loss of sensation, visual changes, speech difficulties, seizures, lethargy, vomiting, and loss of consciousness. [healthgrades.com]
Symptoms often include headache, hemiparesis or alteration of consciousness like agitation, lethargy, or coma. If the acute subdural is small, it can be managed non-surgically. Antiplatelet drugs are stopped, and coagulation is corrected. [neurosurgerybasics.com]
Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures. Causes Chronic subdural intracranial hematomas usually occur in those over the age of 60. [sportsinjuryclinic.net]
- Altered Mental Status
We report a case of plasmacytoma that presented as altered mental status after head trauma, located in the subdural area. We also describe its differential diagnosis and treatment by total removal and adjuvant radiotherapy. [ncbi.nlm.nih.gov]
Any abnormality of mental status that cannot be explained completely by alcohol intoxication or the presence of another mind-altering substance should increase suspicion of SDH in the patient with blunt head trauma. Obtain an urgent CT scan. [oncare.blogspot.com]
Gastrointestinal or Nutrition Issues Nutritional status must be closely monitored in SDH patients, especially those with altered mental status or coma. Supplemental nutrition may be required. [clinicaladvisor.com]
Workup
She was admitted for workup. The next day, she neurologically deteriorated to a GCS score of 6. CT of the head was reobtained and showed acute, left-sided subdural hematoma with shift and herniation. [ncbi.nlm.nih.gov]
Intubation and imaging Consider endotracheal intubation when Glasgow Coma Score (GCS; see the Glasgow Coma Scale calculator) score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup. [emedicine.medscape.com]
TREATMENT Emergency Department Care Consider endotracheal intubation when GCS score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup. [oncare.blogspot.com]
Treatment
Delayed traumatic intracerebral hematomas following medical or surgical treatment of increased intracranial pressure have also been reported. [ncbi.nlm.nih.gov]
Prognosis
Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. [ncbi.nlm.nih.gov]
This means that the results cannot be applied to patients with contusions or other intracranial injuries, whose treatment and prognosis are different." [news-medical.net]
Etiology
Keywords: Meningioma; Intracranial; Subdural hematoma; Surgery; Etiology Introduction Meningioma usually manifests as a gradual onset of symptoms. [austinpublishinggroup.com]
The etiological possibilities of spontaneous subdural hematoma are discussed. Patients and methods We analyzed 8 cases of acute spontaneous subdural hematoma among a total number of 321 patients with subdural hematoma is presented. [revistaneurocirugia.com]
This is one the most common etiologies because as the brain atrophies, which is more common in the elderly, the "bridging veins" that connect the cortex to the draining venous sinuses stretch, and are more easily torn from minor trauma, resulting in a [casemed.case.edu]
(Etiology) Acute Subdural Hematoma generally occurs due to a severe blow or injury to the head Research has demonstrated Acute Subdural Hematoma to be rated as one of the most serious conditions in comparison to the other head trauma associated conditions [dovemed.com]
Epidemiology
Coma/diagnosis* Coma/epidemiology Coma/surgery Female Follow-Up Studies Hematoma, Subdural, Acute/diagnosis* Hematoma, Subdural, Acute/epidemiology Hematoma, Subdural, Acute/surgery Humans Intracranial Aneurysm/diagnosis* Intracranial Aneurysm/epidemiology [ncbi.nlm.nih.gov]
Tallon JM, Ackroyd-Stolarz S, Karim SA, et al ; The epidemiology of surgically treated acute subdural and epidural hematomas in Can J Surg. 2008 Oct51(5):339-45. [patient.info]
Practical considerations for sensitivity analysis after multiple imputation applied to epidemiological studies with incomplete data. BMC Med Res Methodol 2012; 12:73. 26. D’Agostino RB. [journals.lww.com]
Pathophysiology
In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed. [ncbi.nlm.nih.gov]
"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy". Journal of Neuroinflammation. 14 (1): 108. doi : 10.1186/s12974-017-0881-y. PMC 5450087. [en.wikipedia.org]
Prevention
Decompression with a burr-hole craniotomy promptly followed by a decompressive craniectomy was performed to prevent contralateral ASDH. [ncbi.nlm.nih.gov]
Acute Subdural Hematoma can be prevented if proper safety precautions are followed. [dovemed.com]