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(A) Non-contrast computed tomography demonstrated a SDH over the left convexity. (B) Gradient-echo and (C) T2-weighted images revealing a SDH in the left convexity. (D) Post-operative computed tomography following drainage of the left hematoma, demonstrating a newly developed subdural hemorrhage along the right convexity. SDH, subdural hemorrhage.
Source publication
Background Since the first report of a rapidly resolved subdural hemorrhage (SDH) in 1986, few additional case reports have been presented in the literature. Case Report An 82-year-old female patient presented with a SDH over the left convexity. The SDH was removed via catheter drainage through a burr hole trephination. Post-operative computed tomo...
Contexts in source publication
Context 1
... The patient denied any recent or remote head trauma history. Her past medical history included hypertension. The patient did not take any antiplatelet agents or anticoagulants. Laboratory results did not show coagulopathy. A non-contrast computed tomography (CT) performed during the initial evaluation demonstrated an SDH over the left convexity (Fig. 1A). Magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities, other than a chronic SDH with a thickness of 28.6 mm in the left convexity (Fig. 1B, ...
Context 2
... Laboratory results did not show coagulopathy. A non-contrast computed tomography (CT) performed during the initial evaluation demonstrated an SDH over the left convexity (Fig. 1A). Magnetic resonance imaging and magnetic resonance angiography revealed no abnormalities, other than a chronic SDH with a thickness of 28.6 mm in the left convexity (Fig. 1B, ...
Context 3
... was performed under general anesthesia. The SDH was removed through catheter drainage without saline irrigation. Chronic SDH is usually drained to 150 mL per day after surgery. However, postoperative CT following 300 mL of sudden drainage from the chronic SDH presented a newly developed SDH along the right convexity with a 7 mm midline shift (Fig. 1D). The right SDH showed high and mixed density, which may be seen as an expansion of a small amount of hemorrhage by decompression due to overdrainage of the left ...
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Background: Chronic Subdural Hematoma (CSDH) is a common condition in the elderly population. Recurrence rates after surgical evacuation range from 5 to 30%. Factors predicting recurrence remain debated and unclear.
Objective: To identify factors associated with increased risk of recurrence.
Methods: Cases of CSDHs that underwent surgical treatment...
Objective
Chronic subdural hematoma (CSDH) is a common disease which is increasing due to aging population and the use of anticoagulation and antiplatelet medication. Aim of this study is to analyze the internal structure of CSDH and investigate potential risk factors for recurrence.
Methods
This retrospective study evaluated data of 189 patients...
Several theories have tried to elucidate the mechanisms behind the pathophysiology of chronic subdural hematoma (CSDH). However, this process is complex and remains mostly unknown. In this study we performed a retrospective randomised analysis comparing the cortical atrophy of 190 patients with unilateral CSDH, with 190 healthy controls. To evaluat...
Chronic subdural hematoma (CSDH) is one of the most common neurological diseases, which mainly occurs among elderly people and usually develop after minor head injuries. Over the years, a simple burr hole evacuation of the hematoma has been accepted as the widespread method for most cases of CSDH, but acute parenchymal hemorrhage is a rare and dead...
Citations
... Second, during the BTS procedure, rapid changes in intracranial pressure and over-drainage should be avoided. These conditions can result in intracranial bleeding remote from the surgical site [1,8,23]. Considering these complications, the BTS technique is performed slowly at a speed of 5 ml/min during aspiration to prevent a rapid decrease in intracranial pressure and overdrainage. ...
Background
In this study, we propose a butterfly needle tap and suction (BTS) technique for recurrent chronic subdural hematoma (CSDH) as an alternative to reoperation with burr hole craniostomy (BHC) and investigate its efficacy and safety. The procedure involves percutaneous puncture through the burr hole created during the previous surgery and subsequent hematoma evacuation using a butterfly needle.
Methods
This retrospective study included patients who underwent BTS for CSDH at Ogaki Municipal Hospital between January 2017 and December 2020. The follow-up CT scans were reviewed after several weeks. We evaluated the number of percutaneous punctures required to resolve CSDH during the BTS technique, the volume of the evacuated hematoma, and procedure-related complications.
Results
Twenty-six patients were enrolled in the study, 21 of whom achieved resolution of the hematoma using punctures with the BTS technique alone (mean, 2.2 ± 1.5). Five patients had a recurrence of hematoma after one or more punctures during the BTS technique, and they underwent reoperation with BHC according to the surgeon’s decision or patient requests. Among the 55 punctures, 43.0 ± 16.0 ml of hematoma was evacuated per puncture. The evacuated hematoma volume was 41.9 ± 16.4 ml in the BTS-alone group and 49.4 ± 12.9 ml in the reoperation group, with no significant difference (p = 0.25). Three patients complained of a headache during the puncture procedure, and no other complications, including intracranial hemorrhage or infection, were reported therein.
Conclusions
The BTS technique is an effective alternative to reoperation with BHC.
... 11,14) Although rare, ASDH may disappear spontaneously within a short time without surgery. 7,12,17,19) Herein, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy and review relevant literature. ...
... We found a total of 9 cases of contralateral ASDH after BHT for CSDH or SH through literature search in PUBMED and Google Scholar. They are summarized in TABLE 1. 2,4,5,6,8,15,16,18,19) After BHT and opening the dura and outer membrane of CSDH, as CSDH flows out through the burr hole, intracranial pressure (ICP) decreases, the brain compressed by CSDH is decompressed or expanded, and the brain that has shifted to the contralateral side returns to the midline. When brain shift to the midline occurs too rapidly, contralateral bridging veins (BVs) that run between the dura and brain surface can be stretched and torn, resulting in ASDH. ...
... In our literature review, irrigation was performed in 4 out of 5 cases that mentioned whether or not irrigation was performed (TABLE 1). 2,5,15,16,19) In addition, contralateral ASDH developed after BHT when there was an episode of intraoperative transient rise in arterial pressure, intraoperative drainage of bloody fluid or hematoma fluid, or postoperative sudden drainage of a large amount of CSDH (TABLE 1). 2,15,18,19) In the present case, there were no aforementioned events during or immediately after the surgery. ...
Although rare, acute subdural hematoma (ASDH) may occur after burr hole trephination (BHT) for chronic subdural hematoma (CSDH). It usually occurs in the hemisphere ipsilateral to the burr hole site and rarely in the hemisphere contralateral to the burr hole site. On computed tomography (CT), SDH is usually crescent-shaped and occasionally lentiform or biconvex, which can be misdiagnosed as epidural hematoma (EDH). In rare cases, ASDH may resolve spontaneously and rapidly. Here, we report a case of rapid spontaneous resolution of contralateral lentiform ASDH after BHT for CSDH in a patient with brain atrophy. A 55-year-old man developed left CSDH 2 months after traumatic brain injury. Left BHT was performed, and a lentiform hematoma, presumed to be EDH, was found in the right frontal region on the CT scan acquired immediately after BHT. On the CT scan acquired 12 hours later, the lentiform hematoma disappeared and spread along the hemisphere. It was presumed to be ASDH. To prevent contralateral ASDH after BHT, slow decompression and minimal gentle or no irrigation should be performed during BHT, particularly in patients with brain atrophy.
