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Chronic subdural hematoma

Surgery or mannitol treatment

Flemming Gjerris and Kaare Schmidt

T he mode of development of chronic subdural hematoma has been the subject of discussion for many years. There seems to be general agreement that it is often preceded by trivial head injury, and is most commonly due to tearing of one of the bridging veins. 11, 15 Proliferation of the inner surface of the dura leads to encapsulation of the collection of blood. 3 It is a common observation that the increase in the volume of a chronic subdural hematoma is associated with increasing osmolarity of the contents, with subsequent drawing in of water from or through

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Chronic subdural hematoma in adults

Influence of patient's age on symptoms, signs, and thickness of hematoma

Rainer Fogelholm, Olli Heiskanen and Olli Waltimo

C hronic subdural hematoma is relatively common and its outcome without operative treatment is almost invariably fatal. Early diagnosis and proper operative treatment, on the other hand, result in complete recovery in most cases. Unfortunately, one encounters certain difficulties in diagnosis, especially in elderly patients, 2, 9, 11 due to the characteristically nonspecific symptoms and signs. Influence of the patient's age on the clinical picture of chronic subdural hematoma has received little attention. We have found only one report dealing primarily

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Kohkichi Hosoda, Norihiko Tamaki, Michio Masumura, Satoshi Matsumoto and Fumio Maeda

R ecent reports have described the appearance of chronic subdural hematomas on magnetic resonance imaging (MRI). 7, 11, 12, 15 The superiority of MRI over computerized tomography (CT) has already been shown. Here we summarize our experience using MRI on 20 chronic subdural hematomas and discuss the mechanism of changes in relaxation times. Materials and Methods The study was conducted on 20 chronic subdural hematomas from 18 patients (five females and 13 males, aged 4 months to 81 years). The MRI studies were carried out at Shinsuma Hospital with a

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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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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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Thomas-Marc Markwalder

S ince the detailed description of pachymeningitis hemorrhagica interna by Virchow in 1857, 136 the pathophysiological, ultrastructural, diagnostic, and management aspects of chronic subdural hematomas (SDH's) have remained controversial. The aim of this article is to elaborate the present state of knowledge of chronic SDH in order to remind the practicing neurosurgeon of the principles that are generally accepted today. Physiopathogenesis of Chronic SDH Origin of SDH Chronic SDH's are clearly delineated fluid collections located between the dura

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Neurosurgical Forum: Letters to the Editor To The Editor Nobusuke Tsuzuki , M.D. National Defense Medical College Saitama, Japan 1251 1253 Abstract Object. Thrombomodulin is a thrombin receptor on vascular endothelial cells that is highly expressed when these cells are injured, and it has anticoagulating activity. The authors investigated thrombomodulin expression to clarify why chronic subdural hematomas (CSDHs) continue to grow slowly, like a tumor, and are liquefied. Methods. Burr hole craniotomy and

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Eldad Melamed, Slvan Law, Avinoam Reches and Abraham Sahar

A s a slowly expanding intracranial mass, chronic subdural hematoma usually has the typical symptomatology of a progressive neurological deficit. In the following report we present an unusual case in which chronic subdural hematoma gave rise to recurrent transient, focal neurological phenomena. Case Report A 59-year-old male was transferred as an emergency to the Department of Neurology of the Hadassah University Hospital in Jerusalem. Until September, 1973, the patient had enjoyed good general health, with no history of hypertension, coronary or

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Haruhide Ito, Toshio Komai and Shinjiro Yamamoto

V irchow regarded inflammation of the dura mater as the cause of chronic subdural hematoma, 11 while Gardner proposed an osmotic gradient theory. 5 However, the pathogenesis of chronic subdural hematoma is still under debate. The contents of most chronic subdural hematomas are liquid. Raised levels of fibrin and fibrinogen degradation products (FDP) in the hematoma contents 6, 7, 9 and continuous hemorrhage into the hematoma 7, 10, 13 have been demonstrated, and the presence of tissue activator in the outer membrane of the hematoma has been shown

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Tetsumori Yamashima, Toshihiko Kubota and Shinjiro Yamamoto

E osinophilic leukocytes (eosinophils) often infiltrate the outer membranes of chronic subdural hematomas. However, it is not established whether the eosinophils operate to the advantage or to the detriment of the hematoma. Despite a number of morphological studies on hematoma capsules, 3, 5, 8, 11, 12 the function of these cells has not been clearly defined in chronic subdural hematomas. A requirement for the eosinophils to function may be the secretion of granule components, 2 but evidence of this is usually difficult to obtain microscopically in the outer