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Simple bedside technique for evacuating chronic subdural hematomas

Technical note

Roberto A. Negrón, Gilberto Tirado, and César Zapater

F or years we have drained chronic subdural hematomas by a single skull trephination. Thorough evacuation of all hematoma fluid is not possible this way, but almost all our patients have done well, without recurrences. We have concluded that whatever fluid was left has been absorbed. The spontaneous resolution of subdural hematomas has been described by several authors. 1–3, 5, 8 Dr. Calvin Early, then of the National Institute of Health, Bethesda, Maryland, 4 taught us a simple method of penetrating the intracranial cavity with an 18-gauge spinal needle

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Relationship between supratentorial arachnoid cyst and chronic subdural hematoma: neuroradiological evidence and surgical treatment

Clinical article

Maurizio Domenicucci, Natale Russo, Elisabetta Giugni, and Alberto Pierallini

, McEvoy AW , Kitchen ND : Subdural haematoma associated with an arachnoid cyst after repetitive minor heading injury in ball games . Br J Sports Med 38 : E8 , 2004 10.1136/bjsm.2003.005710 5 Domenicucci M , Strzelecki JW , Delfini R : Acute posttraumatic subdural hematoma: “intradural” computed tomographic appearance as a favourable prognostic factor . Neurosurgery 42 : 51 – 55 , 1998 10.1097/00006123-199801000-00010 6 Foelholm R , Waltimo O : Epidemiology of chronic subdural haematoma . Acta Neurochir (Wien) 32 : 247 – 250 , 1975 10

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Seizures after evacuation of subdural hematomas: incidence, risk factors, and functional impact

Clinical article

Alejandro A. Rabinstein, Seung Young Chung, Leslie A. Rudzinski, and Giuseppe Lanzino

, Lin HJ , Yeh CH , Wong BS , Kao CH , : Early post-operative seizures after burr-hole drainage for chronic subdural hematoma: correlation with brain CT findings . J Clin Neurosci 11 : 706 – 709 , 2004 4 Chu NS : Acute subdural hematoma and the periodic lateralized epileptiform discharges . Clin Electroencephalogr 10 : 145 – 150 , 1979 5 D'Amato L , Piazza O , Alliata L , Sabia G , Zito G , Frassanito L , : Prognosis of isolated acute post-traumatic subdural haematoma . J Neurosurg Sci 51 : 107 – 111 , 2007 6 Gebel

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Plasmin-α 2-plasmin inhibitor complex and α 2-plasmin inhibitor in chronic subdural hematoma

Kenichi Saito, Haruhide Ito, Takeshi Hasegawa, and Shinjiro Yamamoto

T he high concentrations of fibrin and fibrinogen degradation products in the hematoma fluid of chronic subdural hematomas (SDH's) suggest local hyperfibrinolytic activity in the hematomas. 6, 7 The purpose of this study was to examine the fibrinolytic activity in the hematoma fluid. The intermittent cycles of fibrinolysis, bleeding, coagulation, and hemostasis in the SDH cause a gradual expansion of the hematoma. Weir and Gordon 11 measured α 2 -plasmin inhibitor (A2PI) and plasminogen in chronic SDH's; however, in contrast to our technique, their method

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Two fluid-blood density levels in chronic subdural hematoma

Case report

Naoya Hashimoto, Takehiko Sakakibara, Kazuaki Yamamoto, Masahito Fujimoto, and Tarumi Yamaki

I t is well known that computerized tomography (CT) can clearly reveal the fluid-blood density level in a chronic subdural hematoma. 5 This is encountered in 5% of such cases. 4 Recently, we managed a patient with chronic subdural hematoma in which the CT scan showed two parallel fluid-blood density levels. The significance of this rare CT finding is discussed. Case Report This 88-year-old man had fallen out of bed and hit his head about 2 months previous to his admission to our hospital because of disturbed consciousness. Examination On

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Negative intracranial pressure hydrocephalus in adults with shunts and its relationship to the production of subdural hematoma

David C. McCullough and John L. Fox

R ecognition of the syndrome of normal-pressure hydrocephalus in adults has resulted in frequent shunt operations in the past 8 years. While numerous patients have improved significantly and some have gained full functional status, an alarmingly high proportion of complicating subdural hematomas (20.8%) has been reported in one recent series. 12 We have had a similar incidence of subdural collections (23%) in a series of 39 shunt-treated adults from 1968–1973. 8 Although these patients were carefully selected on the basis of neurological history and

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Subduroperitoneal drainage for subdural hematomas in infants: results in 244 cases

Matthieu Vinchon, Nathalie Noulé, Gustavo Soto-Ares, and Patrick Dhellemmes

distribution of patients at the time of surgery. Subdural hematomas are almost specific to infants younger than 1 year of age. The sharp decline in incidence as patients age coincides with the acquisition of sitting and standing postures, suggesting an earlier period of increased vulnerability. Presenting symptoms included intracranial hypertension (118 cases [48.4%]), epilepsy (112 cases [45.9%]), enlarged head (63 cases [25.8%]), hypotonia (20 cases [8.2%]), localized deficit (nine cases [3.7%]), and delayed milestones (six cases [2.5%]). Clinical presentation was

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Glutaric aciduria type 1 presenting as bilateral subdural hematomas mimicking nonaccidental trauma

Case report and review of the literature

Frank S. Bishop, James K. Liu, Todd D. McCall, and Douglas L. Brockmeyer

Morris AA , Hoffmann GF , Naughten ER , Monavari AA , Collins JE , Leonard JV : Glutaric aciduria and suspected child abuse . Arch Dis Child 80 : 404 – 405 , 1999 10.1136/adc.80.5.404 13 Osaka H , Kimura S , Nezu A , Yamazaki S , Saitoh K , Yamaguchi S : Chronic subdural hematoma, as an initial manifestation of glutaric aciduria type-1 . Brain Dev 15 : 125 – 127 , 1993 10.1016/0387-7604(93)90049-E 14 Piatt JH Jr , Frim D : Glutaric aciduria type 1 and nonaccidental head injury . Pediatrics 109 : 554 , 2002 10

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Thoracolumbar spine subdural hematoma as a result of nonaccidental trauma in a 4-month-old infant

Case report

Thomas J. Gruber and Curtis J. Rozzelle

S pinal subdural hematoma is a rare condition usually associated with lumbar puncture, spinal anesthesia, antiplatelet or anticoagulant therapy, or hematological disease. 13 , 15 Traumatic injury is also an uncommon, but documented, cause of spinal SDH. 6 , 8 Spinal trauma accounts for only 1–10% of injuries resulting from nonaccidental trauma. 1 , 3–5 , 7 Spinal SDH as a result of nonaccidental trauma has been reported in the cervical spine, but thoracolumbar SDH has not been reported in this setting. 4 , 7 , 16 Nonaccidental trauma in infants is a

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Correlation of the extracellular glutamate concentration with extent of blood flow reduction after subdural hematoma in the rat

Ross Bullock, Steve P. Butcher, Min-Hsiung Chen, L. Kendall, and James McCulloch

W hen a head-injured patient develops a mass lesion due to bleeding into the subdural space, the prognosis becomes very much worse; the majority of such patients die or are left severely disabled. 11, 24, 25 Yet the mechanisms by which an acute subdural hematoma worsens the prognosis in this way remain unclear. Neuropathological studies have demonstrated that ischemic damage is present in almost all patients who die after acute subdural hematoma. 1, 7, 12 Clinical and pathological investigations have also shown that more than half of these patients have had