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Chronic subdural hematoma associated with type II and type III Galassi arachnoid cysts: illustrative cases

Bac Thanh Nguyen, Van Dinh Tran, Jehan Bista, and Trung Van Trinh

, hydrocephalus, and epileptic seizures. 2 The diagnosis of asymptomatic ACs has increased in recent years due to the extensive utilization of computed tomography (CT) and magnetic resonance imaging (MRI) techniques. 3 Head trauma is one of the most significant risk factors for the development of intracystic hemorrhage in ACs and subsequent subdural hematoma (SDH). However, fewer than 182 cases of spontaneous intracystic hemorrhage have been reported in the literature. 3 , 4 In this report, we present illustrative cases of three young patients who experienced spontaneous AC

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Middle meningeal artery embolization for refractory chronic subdural hematoma in a pediatric victim of nonaccidental trauma: illustrative case

Zsombor T Gal and Alfred P See

meningeal artery embolization for chronic subdural hematoma: a systematic review and meta-analysis . J Neurointerv Surg . 2021 ; 13 ( 10 ): 951 – 957 . 11 Catapano JS , Nguyen CL , Wakim AA , Albuquerque FC , Ducruet AF . Middle meningeal artery embolization for chronic subdural hematoma . Front Neurol . 2020 ; 11 : 557233 . 12 Deora H , Mishra A , Gupta R , Paediatric chronic subdural haematoma: what are the predisposing factors and outcomes in management of these cases? Childs Nerv Syst . 2022 ; 38 ( 1 ): 123 – 132

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Intracranial subdural hemorrhage following closed neural tube defect repair: illustrative case

Stacey Podkovik, Jonathon Cavaleri, Carli Bullis, and Susan Durham

Intradural spine surgeries are extremely common procedures within the fields of both adult and pediatric neurosurgery. Distant intracranial extraaxial hemorrhages are a known, but uncommon, complication after intradural spinal procedures. Most of these occurrences are typically due to an iatrogenic cerebrospinal fluid (CSF) leak leading to intracranial hypotension. 1 The incidence of subdural hematoma (SDH) in the setting of intracranial hypotension is approximately 10%. 1 However, the incidence of SDH after intradural spine surgeries is reported to be as

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Tangential cranial gunshot wound in an infant in historical context: illustrative case

Jeffrey Campbell and Joseph Piatt

shooting. A 9-month-old male child had suffered a gunshot wound to the head. In the emergency department there was no eye opening or vocalization and the left pupil was dilated. There was a sagittally oriented 8 cm laceration just to the right of the midline with a bridge of intact scalp at the midpoint, associated with grooving of the underlying calvaria but no penetration ( Fig. 1 ). After immediate intubation, an expedited computed tomography (CT) scan revealed a large, hyperacute, left convexity subdural hematoma with midline shift ( Fig. 2A and B ). There was no

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Pediatric skull fracture with injury and thrombosis of the superior sagittal sinus: illustrative case

Douglas M. Zoerner, Taylor Reardon, and Brandon A. Miller


Cerebral venous sinus thrombosis (VST) is a complication of head injury and can be secondary to sinus compression by depressed skull fractures. Fracture elevation is a treatment option for VST secondary to extrinsic compression, but conservative management may also be effective. Venous sinuses can also be lacerated from skull fractures, resulting in epidural or subdural hematomas. The authors presented a case of sagittal sinus injury and thrombosis from a depressed skull fracture that caused a subgaleal hematoma. The injury was successfully managed conservatively.


A 14-year-old boy presented after a head injury with a diastatic, depressed parietal bone fracture. Computed tomography venogram showed disruption and occlusion of the superior sagittal sinus with a subgaleal hematoma in continuity with the injured sagittal sinus. Because of concern for hemorrhage if tamponade on the sinus was removed, the patient was treated nonsurgically. At follow-up, the sinus had recanalized and the fracture had healed.


Skull fractures with underlying sinus thrombosis can be managed conservatively with good outcome. Careful assessment for venous sinus injury should be made before undertaking fracture elevation to relieve sinus compression.

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Spontaneous rupture of an arachnoid cyst in an adult: illustrative case

Lydia A. Leavitt, Pranav Nanda, Anat Stemmer-Rachamimov, Gavin P. Dunn, and Pamela S. Jones

presentation for symptomatic patients, although arachnoid cysts may also cause hydrocephalus, neuropathies, seizures, cognitive complaints, and other focal neurological deficits. 1 , 2 Rarely, arachnoid cysts can present as a neurosurgical emergency due to cyst rupture with subsequent intracystic hemorrhage or subdural hematoma causing mass effect or a rapid rise in intracranial pressure. 1 , 3 Few documented reports of spontaneous arachnoid cyst hemorrhages exist as this predominantly occurs following head trauma. 1 , 4 In this report, we describe a patient who presented

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Adolescent subdural empyema in setting of COVID-19 infection: illustrative case

Vladimir A. Ljubimov, Robin Babadjouni, Joseph Ha, Viktoria O. Krutikova, Jeffrey A. Koempel, Jason Chu, and Peter A. Chiarelli

approximately 80% over normal, likely facilitating the development of sinusitis. Our novel finding was a negative SARS-CoV-2 RT-PCR result from the intracranial purulent material. This suggests that SARS-CoV-2 viral particles were not transmitted into the subdural space despite documented COVID-19 infection within the nares. Al-Olama et al. recently published a report on a patient with COVID-19 meningoencephalitis with resultant intraparenchymal hemorrhage and subdural hematoma. 7 The subdural hematoma required burr hole evacuation in a delayed fashion, and the authors

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Wound vacuum-assisted closure as a bridge therapy in the treatment of infected cranial gunshot wound in a pediatric patient: illustrative case

Harjus Birk, Audrey Demand, Sandeep Kandregula, Christina Notarianni, Andrew Meram, and Jennifer Kosty

/F Traumatic SDH complicated by empyema Infection 15 Thigh free flap Good wound healing Makler et al., 2018 11 56/F Invasive scalp squamous cell carcinoma Infection 30 None; death due to carcinoma Death due to carcinoma SDH = subdural hematoma; STSG = split-thickness skin graft. There is only one other case in which a wound VAC was used in the setting of a CGI. This case was presented by Powers et al. and involved a 24-year-old man who sustained a gunshot wound to the face that extended into the anterior fossa. 5 He received

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Spontaneous intracranial hemorrhage presenting in a patient with vitamin K deficiency and COVID-19: illustrative case

Nathaniel R. Ellens and Howard J. Silberstein

lethargic with a bulging but compressible fontanelle and a fixed right gaze deviation with reports of seizure activity en route to the hospital. Intravenous Keppra was administered at a dose of 60 mg/kg. Noncontrast computed tomography (CT) scans of the head demonstrated extensive subdural hematomas, most prominently over the tentorium bilaterally, along the falx, and extending inferiorly toward the foramen magnum. There was also moderate intraventricular hemorrhage within the bilateral lateral ventricles and the 3rd and 4th ventricles, with prominent hydrocephalus ( Fig

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Acetazolamide to treat symptomatic ruptured arachnoid cysts: illustrative cases

Isabella Watson, Patrick J. McDonald, Paul Steinbok, Brendon Graeber, and Ashutosh Singhal

ruptured ACs, intervention may be needed. 5 Particularly in the case of an AC rupture, there is a risk of intracystic hemorrhage, subdural hematoma, or subdural hygroma, which can cause raised intracranial pressure (ICP) and lead to adverse neurological symptoms. 5 The optimal treatment for a ruptured AC remains controversial, and a consensus has yet to be reached on whether a conservative, nonoperative, or surgical approach is most effective. Because ruptured ACs are relatively uncommon, there is limited literature on treatment options and treatment effectiveness