DOCSLIB.ORG

Outcomes of Chronic Subdural Hematoma in Patients with Liver Cirrhosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Outcomes of Chronic Subdural Hematoma in Patients with Liver Cirrhosis CLINICAL ARTICLE J Neurosurg 130:302–311, 2019 Outcomes of chronic subdural hematoma in patients with liver cirrhosis *Ching-Chang Chen, MD,1 Shao-Wei Chen, MD,2 Po-Hsun Tu, MD,1 Yin-Cheng Huang, MD, PhD,1 Zhuo-Hao Liu, MD,1 Alvin Yi-Chou Wang, MD,1 Shih-Tseng Lee, MD,1 Tien-Hsing Chen, MD,3 Chi-Tung Cheng, MD,4 Shang-Yu Wang, MD,4 and An-Hsun Chou, MD5 Departments of 1Neurosurgery and 5Anesthesiology and Divisions of 2Thoracic and Cardiovascular Surgery and 4Trauma and Emergency Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University; and 3Department of Cardiology, Chang Gung Memorial Hospital, Keelung Branch and Linkou Medical Center, Taoyuan City, Taiwan OBJECTIVE Burr hole craniostomy is an effective and simple procedure for treating chronic subdural hematoma (CSDH). However, the surgical outcomes and recurrence of CSDH in patients with liver cirrhosis (LC) remain unknown. METHODS A nationwide population-based cohort study was retrospectively conducted using data from the Taiwan Na- tional Health Insurance Research Database. The study included 29,163 patients who underwent first-time craniostomy for CSDH removal between January 1, 2001, and December 31, 2013. In total, 1223 patients with LC and 2446 matched non-LC control patients were eligible for analysis. All-cause mortality, surgical complications, repeat craniostomy, ex- tended craniotomy, and long-term medical costs were analyzed. RESULTS The in-hospital mortality rate (8.7% vs 3.1% for patients with LC and non-LC patients, respectively), frequen- cy of hospital admission, length of ICU stay, number of blood transfusions, and medical expenditures of patients with LC who underwent craniostomy for CSDH were considerably higher than those of non-LC control patients. Patients with LC tended to require an extended craniotomy to remove subdural hematomas in the hospital or during long-term follow-up. The surgical outcome worsened with an increase in the severity of LC. CONCLUSIONS Even for simple procedures following minor head trauma, LC remains a serious comorbidity with a poor prognosis. https://thejns.org/doi/abs/10.3171/2017.8.JNS171103 KEY WORDS chronic subdural hematoma; liver cirrhosis; burr hole; craniostomy; vascular disorders HRONIC subdural hematoma (CSDH) is a common patients present with LC because the incidence of chronic condition and tends to occur in elderly patients af- hepatitis and LC is higher in Taiwan and East Asia than in ter minor head trauma.6 Burr hole craniostomy is other regions.9,24 LC and its associated complications have Cthe simplest and most common treatment for the initial been identified as significant risk factors for increased stages of CSDH. Despite recurrence, CSDH has a favor- morbidity and mortality in trauma patients,7,12,13,17 and they able outcome and prognosis.6,32,33,38 However, in our pre- have a considerable effect on poor outcomes of major sur- viously published data, the mortality and complication gery. 8,9,13,16,23,35 To our knowledge, there is no published rates associated with CSDH in patients with liver cirrhosis report on the surgical risk of CSDH in patients with LC. (LC) were as high as 33.3% (5 of 15 patients).7 Because Conclusions regarding the effects of LC on minor head the number of cases in our previous study was small, our trauma and the outcomes of a simple surgical procedure, results were inconclusive. In our clinical practice, many such as CSDH, are tentative. Therefore, to understand the ABBREVIATIONS CCI = Charlson Comorbidity Index; CIC = catastrophic illness certificate; CSDH = chronic SDH; CTP = Child-Turcotte-Pugh; ICD-9-CM = International Classification of Diseases, 9th Revision, Clinical Modification; LC = liver cirrhosis; NHI = National Health Insurance; NHIRD = NHI Research Database; SDH = subdural hematoma; TBI = traumatic brain injury. SUBMITTED May 3, 2017. ACCEPTED August 1, 2017. INCLUDE WHEN CITING Published online February 2, 2018; DOI: 10.3171/2017.8.JNS171103. * C.C.C. and S.W.C. contributed equally to this work. 302 J Neurosurg Volume 130 • January 2019 ©AANS 2019, except where prohibited by US copyright law Unauthenticated | Downloaded 10/07/21 03:13 AM UTC C. C. Chen et al. FIG. 1. Enrollment of the study population. actual risks and outcomes of CSDH in patients with LC, national Classification of Diseases, 9th Revision, Clinical we used patient data from a large national database, the Modification (ICD-9-CM). This study was completely ex- Taiwan National Health Insurance Research Database empt from ethics review by the ethics institutional review (NHIRD). In this longitudinal cohort study, NHIRD was board of Chang Gung Memorial Hospital. used to analyze the outcomes of using craniostomy to treat CSDH in patients with LC. Study Population In this study, we included all hospitalization records of Methods patients who were admitted for CSDH and had undergone a craniostomy for CSDH treatment. Index hospitalization Data Source was defined as the date when the patient was admitted for We conducted this nationwide cohort study using data first-time craniostomy to remove CSDH between January from NHIRD. NHIRD is an administrative database of 1, 2001, and December 31, 2013. Patients were identified Taiwan’s National Health Insurance (NHI) program, using the diagnostic ICD-9-CM codes for subdural hem- which is a compulsory, universal health insurance pro- orrhage (432.1, 852.2, and 852.3) and the presence of NHI gram that covers nearly 100% of the 23.7 million resi- reimbursement procedure code 83038C, which is unique dents of Taiwan.19 The database contains comprehensive for craniostomy to “remove chronic subdural hematoma” health-related information, such as diagnostic codes, performed by neurosurgeons. Because acute subdural medical procedures, and prescription details. As of 2015, hematoma (SDH) should typically be treated with crani- more than 3000 research articles based on NHIRD data otomy (NHI code 83037C), our study population included had been published. NHIRD uses information protection only nonacute patients. Otherwise, patients younger than measures, including an extremely strict data access pro- 20 years were excluded from our study, as shown in Fig. cedure and encryption of all personal information with 1. The study population was divided into LC and non-LC anonymous 32-digit identification numbers. In NHIRD groups according to the diagnosis of cirrhosis (ICD-9-CM data, disease diagnoses are coded according to the Inter- codes 571.2, 571.5, and 571.6). J Neurosurg Volume 130 • January 2019 303 Unauthenticated | Downloaded 10/07/21 03:13 AM UTC C. C. Chen et al. TABLE 1. Baseline characteristics of the study population Before Matching After Matching Variable LC Patients Non-LC Patients p Value LC Patients Non-LC Patients p Value No. of patients 1225 27,938 1223 2446 Age, mean ± SD, yrs 63.7 ± 15.3 70.5 ± 13.9 <0.001 63.7 ± 15.3 63.6 ± 15.9 0.949 Age in yrs 20–39 85 (6.9) 1092 (3.9) <0.001 85 (7.0) 177 (7.2) 0.946 40–59 412 (33.6) 4412 (15.8) 410 (33.5) 809 (33.1) 60–79 535 (43.7) 15,154 (54.2) 535 (43.7) 1059 (43.3) ≥80 193 (15.8) 7280 (26.1) 193 (15.8) 401 (16.4) Sex 0.009 0.840 Male 968 (79.1) 21,181 (75.8) 967 (79.1) 1941 (79.4) Female 256 (20.9) 6750 (24.2) 256 (20.9) 505 (20.6) Comorbid conditions Diabetes mellitus 470 (38.4) 6982 (25.0) <0.001 469 (38.3) 922 (37.7) 0.700 Hypertension 566 (46.2) 14,039 (50.3) 0.006 566 (46.3) 1150 (47.0) 0.674 Hyperlipidemia 126 (10.3) 2231 (8.0) 0.004 125 (10.2) 255 (10.4) 0.848 Heart failure 119 (9.7) 1632 (5.8) <0.001 119 (9.7) 249 (10.2) 0.669 Coronary artery disease 226 (18.4) 4344 (15.5) 0.006 226 (18.5) 439 (17.9) 0.694 History of myocardial infarction 29 (2.4) 749 (2.7) 0.505 29 (2.4) 52 (2.1) 0.634 Peripheral arterial disease 24 (2.0) 424 (1.5) 0.219 24 (2.0) 59 (2.4) 0.388 Prior ischemic stroke 202 (16.5) 4240 (15.2) 0.211 202 (16.5) 394 (16.1) 0.752 Prior hemorrhagic stroke 113 (9.2) 1822 (6.5) <0.001 113 (9.2) 220 (9.0) 0.807 Prior seizure 126 (10.3) 876 (3.1) <0.001 126 (10.3) 230 (9.4) 0.386 Dialysis 51 (4.2) 543 (1.9) <0.001 51 (4.2) 96 (3.9) 0.721 Chronic obstructive pulmonary disease 180 (14.7) 2596 (9.3) <0.001 179 (14.6) 360 (14.7) 0.947 Malignancy 186 (15.2) 1944 (7.0) <0.001 185 (15.1) 391 (16.0) 0.500 CCI, mean ± SD 5.1 ± 2.8 1.9 ± 2.2 <0.001 5.1 ± 2.8 2.6 ± 2.8 <0.001 CCI score 1 99 (8.1) 15,546 (55.6) <0.001 98 (8.0) 1121 (45.8) <0.001 2–3 295 (24.1) 7472 (26.7) 295 (24.1) 650 (26.6) 4–5 329 (26.9) 2897 (10.4) 329 (26.9) 322 (13.2) ≥6 502 (41.0) 2023 (7.2) 501 (41.0) 353 (14.4) Hospital level <0.001 0.793 Regional/district hospital 736 (60.1) 14,121 (50.5) 735 (60.1) 1481 (60.5) Tertiary teaching hospital 489 (39.9) 13,817 (49.5) 488 (39.9) 965 (39.5) Length of follow-up, yrs 2.8 ± 3.0 4.5 ± 3.7 <0.001 2.8 ± 3.0 4.2 ± 3.6 <0.001 Data are shown as the number of patients (%) unless indicated otherwise.
Load more

Recommended publications
  • Blood Pressure Control in Neurological ICU Patients: What Is Too High and What Is Too Low? Gulrukh Zaidi*,1, Astha Chichra1, Michael Weitzen2 and Mangala Narasimhan1
    Send Orders for Reprints to [email protected] 46 The Open Critical Care Medicine Journal, 2013, 6, (Suppl 1: M3) 46-55 Open Access Blood Pressure Control in Neurological ICU Patients: What is Too High and What is Too Low? Gulrukh Zaidi*,1, Astha Chichra1, Michael Weitzen2 and Mangala Narasimhan1 1The Division of Pulmonary, Critical Care and Sleep Medicine, The North Shore, Long-Island Jewish Health System, The Hofstra-North Shore LIJ School of Medicine, USA 2Department of Surgery, Phelps Memorial Hospital, USA Abstract: The optimal blood pressure (BP) management in critically ill patients with neurological emergencies in the intensive care unit poses several challenges. Both over and under correction of the blood pressure are associated with increased morbidity and mortality in this population. Target blood pressures and therapeutic management are based on guidelines including those from the American Stroke Association and the Joint National Committee guidelines. We review these recommendations and the current concepts of blood pressure management in neurological emergencies. A variety of therapeutic agents including nicardipine, labetalol, nitroprusside are used for blood pressure management in patients with ischemic and hemorrhagic strokes. Currently, the role of inducing hypertension remains unclear. Hypertensive crises include hypertensive urgencies where elevated blood pressures are seen without end organ damage and can usually be managed by oral agents, and hypertensive emergencies where end organ damage is present and requires immediate treatment with intravenous drugs. Keywords: Ischemic stroke, hemorrhagic stroke, hypertension, hypotension, thrombolytic therapy, hypertensive urgency and emergency, posterior reversible encephalopathy syndrome. INTRODUCTION However, an understanding of cerebral autoregulation is essential prior to discussing the management of either hyper The optimization of blood pressure in patients admitted or hypotension in these patients.
    [Show full text]
  • Anesthetic Management of a Patient with Obstructive Prosthetic Aortic Valve Dysfunction -A Case Report
    Korean J Anesthesiol 2014 February 66(2): 160-163 Case Report http://dx.doi.org/10.4097/kjae.2014.66.2.160 Anesthetic management of a patient with obstructive prosthetic aortic valve dysfunction -a case report- Bo Ra Lee, Jeong-Rim Lee, and Min Soo Kim Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea We present a 55-year-old female patient who underwent burr-hole drainage due to chronic subdural hematoma, with obstructive prosthetic aortic valve dysfunction. Anesthetic management of a patient with severe obstructive prosthetic aortic valve dysfunction can be challenging. Similar considerations should be given to patients with aortic stenosis with an additional emphasis on thrombotic complication due to discontinuation of anticoagulation, which may further jeop- ardize the valve dysfunction. This case emphasizes the importance of a comprehensive understanding of the etiology and hemodynamic consequences of obstructive prosthetic valve dysfunction and the adequacy of anticoagulation for patients undergoing noncardiac surgery even after a successful valve replacement. (Korean J Anesthesiol 2014; 66: 160-163) Key Words: Aortic valve stenosis, Echocardiography, Heart valve prosthesis, Thrombosis. Even after a successful heart valve replacement without pros- valves, discontinuation of anticoagulation for other medico- thetic valve malfunction, obstructive prosthetic valvular dys- surgical conditions may further aggravate the pressure imposed function (PVD) may occur due to prosthesis-patient mismatch on the LV due to thrombus formation [4]. We herein report a (PPM), pannus formation, and thrombus formation [1]. Consid- case of a patient with obstructive PVD after mechanical aortic ering the relatively narrow anatomic feature of the left ventricu- valve replacement for severe aortic stenosis, requiring burr-hole lar (LV) outflow tract, the aortic valve is more prone to develop drainage for a subdural hematoma.
    [Show full text]
  • Anticoagulant-Related Subdural Hematoma in Patients with Mechanical Heart Valves
    Neurology Asia 2005; 10 : 13 – 19 ORIGINAL ARTICLES Anticoagulant-related subdural hematoma in patients with mechanical heart valves GVS Chowdary MD DM, T Jaishree Naryanan MD PhD, *P Syed Ameer Basha MBBS MCh, *TVRK Murthy MBBS MCh, JMK Murthy MD DM Department of Neurology and *Neurosurgery, The Institute of Neurological Sciences, CARE Hospital, Nampally, Hyderabad, India Abstract Introduction: There is uncertainty on the timing of surgery in patients with anticoagulant-related subdural hematoma (SDH) and also on the timing of reintroduction of anticoagulants. Methods: We retrospectively analyzed records of 7 patients with mechanical heart valves and anticoagulant-related SDH. Results: Of the 7 patients, 6 (83%) survived to discharge with good functional outcome, modified Rankin Scale 0-1. Reversal of anticoagulation (INR < 1.4) could be achieved in 5 patients. Three patients with minimal deficit and no CT evidence of midline shifts were managed non-surgically. Three patients had surgical evacuation, 2 with acute SDH and midline shift and one patient with bilateral subacute SDH and no midline shift. The mean duration of anticoagulation withholding was 20.3 days (range 8-28). None had thrombolic events while off anticoagulation. Five patients were restarted on acenocumarol/warfarin when follow-up cranial CT showed decrease or resolution of SDH. High risk for thromboembolism was the indication for early anticoagulation in the patient with mitral position of the prosthesis and atrial fibrillation. One of the patient with subacute SDH who had post surgical residual SDH and echocardiographic evidence of valve dysfunction was initially started on unfractionated heparin followed by nadroparin calcium and subsequently on acenocumarol.
    [Show full text]
  • Acute Subdural Hematoma in Patients on Oral Anticoagulant Therapy: Management and Outcome
    NEUROSURGICAL FOCUS Neurosurg Focus 43 (5):E12, 2017 Acute subdural hematoma in patients on oral anticoagulant therapy: management and outcome Sae-Yeon Won, MD, Daniel Dubinski, MD, MSc, Markus Bruder, MD, Adriano Cattani, MD, PhD, Volker Seifert, MD, PhD, and Juergen Konczalla, MD Department of Neurosurgery, University Hospital, Goethe-University, Frankfurt am Main, Germany OBJECTIVE Isolated acute subdural hematoma (aSDH) is increasing in older populations and so is the use of oral anticoagulant therapy (OAT). The dramatic increase of OAT—with direct oral anticoagulants (DOACs) as well as with conventional anticoagulants—is leading to changes in the care of patients who present with aSDH while receiving OAT. The purpose of this study was to determine the management and outcome of patients being treated with OAT at the time of aSDH presentation. METHODS In this single-center, retrospective study, the authors analyzed 116 consecutive cases involving patients with aSDH treated from January 2007 to June 2016. The following parameters were assessed: patient characteristics, admission status, anticoagulation status, perioperative management, comorbidities, clinical course, and outcome as determined at discharge and through 6 months of follow-up. Oral anticoagulants were classified as thrombocyte inhibi- tors, vitamin K antagonists, and DOACs. Patients were stratified based on which type of medication they were taking, and subgroup analyses were performed. Predictors of unfavorable outcome at discharge and follow-up were identified. RESULTS Of 116 patients, 74 (64%) had been following an OAT regimen at presentation with aSDH. The patients who were taking oral anticoagulants (OAT group) were significantly older (OR 12.5), more often comatose 24 hours postop- eratively (OR 2.4), and more often had ≥ 4 comorbidities (OR 3.2) than patients who were not taking oral anticoagulants (no-OAT group).
    [Show full text]
  • 2015 Year End Statistics
    Palm Beach County Medical Examiner Office 3126 Gun Club Road West Palm Beach, Florida 33406-3005 (561) 688-4575 2015 END OF AND YEAR STATISTRICS ACCIDENT: YTD TRANSPORTATION RELATED……………………………………………………………....................…207 Driver/Operator………………………………………………………………………..…...106 Occupant………………………………………………………................................................7 Passenger………………………………………………………………………………..…...28 Pedalcyclist……………………………………………………………………………..…....21 Pedestrian………………………………………………………………………………..…...45 NON TRANSPORTATION RELATED………………………………………………....................................704 Drug Intoxication…………………………………………………………………….…......331 Fall……………………………………………………………………………………...…..270 Other………………………………………………………………………….................….103 TOTAL ACCIDENTS……………..….…………………….…..................…...………......911 HOMICIDE………………………………………………………………………………………….……….…………111 NATURAL………………………………………………………………………………………………….………...…412 NONCLASSIFIED…………………………………………………………………………………….……..………..…..9 SUICIDE………………………………………………………………………………………………….......................238 UNDETERMINED…………………………………………………………………………….……….………….……..40 CREMATION APPROVALS…………………………………………………………………….…….…..................7,312 NON MEDICAL EXAMINER CASES INVESTIGATED………………………...………….….…….……...…..... 806 TOTAL CASES REFERRED TO THE MEDICAL EXAMINER OFFICE…………...........................9,839 AUTOPSIES…………………………………………………………………………………….………………....….1,057 INSPECTIONS (VISUAL EXAMINATIONS)…………………………………………………….…………….…….415 NO BODY CASES………………………………………………………………………………………………….... 249 TOTAL CASES INVESTIGATED……………………………………………………………….…..………..……..1,721
    [Show full text]
  • Acute Spinal Subdural Hematoma in a Patient with Active Systemic Lupus Erythematosus: a Case Report and Literature Review
    □ CASE REPORT □ Acute Spinal Subdural Hematoma in a Patient with Active Systemic Lupus Erythematosus: A Case Report and Literature Review Koji Akita 1, Taishi Wada 1, Shunpei Horii 1, Mitsuyo Matsumoto 2, Takeshi Adachi 1, Fumihiko Kimura 2 and Kenji Itoh 2 Abstract We herein describe a case of acute spinal subdural hematoma (SSDH) during the administration of high- dose corticosteroids and intravenous heparin for the treatment of active lupus nephritis. After SSDH was promptly diagnosed using magnetic resonance imaging (MRI), the patient recovered well with conservative treatment involving the discontinuation of heparin sodium. Although SSDH is a rare complication, it should be considered as a cause of neurological manifestations in patients with active systemic lupus erythematosus. Key words: MRI, spinal subdural hematoma, systemic lupus erythematosus (Intern Med 53: 887-890, 2014) (DOI: 10.2169/internalmedicine.53.1624) In addition, we provide a review of the literature. Introduction Case Report Complications involving the spinal cord are rare in pa- tients with systemic lupus erythematosus (SLE) (1). Trans- A 30-year-old woman presented to our hospital with gen- verse myelitis, a demyelinating syndrome resulting from the eral fatigue, digital swelling and dyspnea on exertion lasting high disease activity of SLE, is the most frequent spinal for three months. A hematological examination revealed complication and has been suggested to have a strong asso- pancytopenia (red blood cell count, 314×104/mm3; hemoglo- ciation with the presence of anti-phospholipid antibodies (1). bin level, 8.5 g/dL; hematocrit, 26.3%; white blood cell However, symptoms that are similar to transverse myelitis count, 2,900/mm3; platelet count, 11.8×104/mm3).
    [Show full text]
  • Perioperative Takotsubo Cardiomyopathy (Broken Heart Syndrome)—A Diagnostic Dilemma
    Published online: 2020-02-20 THIEME Letter to the Editor 355 Perioperative Takotsubo Cardiomyopathy (Broken Heart Syndrome)—A Diagnostic Dilemma S. Kiran1 Shalendra Singh1 Nipun Gupta1 Deepak Dwivedi1 Kaminder Bir Kaur1 1Department of Anaesthesia and Critical Care, Armed Forces Address for correspondence Shalendra Singh, DM, Department of Medical College, Pune, India Anaesthesiology and Critical Care, Armed Forces Medical College, Pune 411040, India (e-mail: [email protected]). J Neurosci Rural Pract 2020;11:355–356 Takotsubo cardiomyopathy (TCM) is a stress-induced car- in the postoperative period, patient had persistent hypo- diomyopathy (apical ballooning syndrome/broken heart tension and developed tachycardia in spite of infusion nor- syndrome) triggered by an acute medical illness or intense adrenaline at 0.6 μg/kg/min. In view of the above, vasopressin physical or emotional stress.1 It is characterized by acute-on- was added at 0.04 U/min. On first postoperative day, patient set symptoms associated with electrocardiographic (ECG) remained tachycardic and hypotensive with continued vaso- abnormalities suggesting an acute coronary syndrome in the pressor support, in spite of adequate fluid resuscitation. setting of absence of obstructive coronary artery disease. 1 Arterial blood gas picture revealed severe metabolic acidosis TCM has been classified based on the etiology into primary with lactates of 4.1 mmol/L. Simultaneously, patient devel- and secondary subtypes, with structural brain damage oped increased ventilatory requirement with a positive end and anesthetic stress being common triggering factors for expiratory pressure of 14 cm H2O and FiO2 of 0.8. ECG done secondary TCM.2 We describe a patient who developed sec- on first postoperative day showed sinus tachycardia with no ondary TCM postoperatively after evacuation of chronic sub- ST-T changes and chest roentgenogram showed increased dural hematoma under general anesthesia (GA).
    [Show full text]
  • Craniotomy and Membranectomy for Treatment of Organized Chronic Subdural Hematoma
    pISSN 2234-8999 / eISSN 2288-2243 CASE REPORT Korean J Neurotrauma 2018;14(2):134-137 https://doi.org/10.13004/kjnt.2018.14.2.134 Craniotomy and Membranectomy for Treatment of Organized Chronic Subdural Hematoma Hong-Gyu Baek and Seong-Hyun Park Department of Neurosurgery, Kyungpook National University Hospital, Kyungpook National University School of Medicine, Daegu, Korea We report the case of a patient with organized chronic subdural hematoma (OCSH) that was treated with craniotomy. A 72-year-old man was admitted with a complaint of a drowsy mental status after a generalized tonic-clonic seizure. A brain computed tomography scan acquired at a local hospital revealed a large chronic subdural hematoma (CSDH) in the left frontoparietal lobe. The patient had not experienced head trauma and had been taking clopidogrel due to angina. A neuro- surgeon at the local hospital performed single burr hole trephination in the left frontal bone and drained some of the he- matoma. Brain magnetic resonance imaging performed upon transfer to our hospital showed a large OCSH with a midline shift to the right side, revealing a low, heterogeneous signal on T2-weighted images (WI) and an isodense signal on T1- WI. We performed craniotomy and membranectomy to achieve adequate decompression and expansion of the brain. Fol- lowing this, the patient recovered completely. Our findings support that neurosurgeons should consider the possibility of organization of a CSDH when selecting a diagnosis and treatment plan. (Korean J Neurotrauma 2018;14(2):134-137) KEY WORDS: Chronic subdural hematoma ㆍCraniotomy ㆍOrganized. Introduction discuss the clinical course. Among chronic subdural hematomas (CSDHs), orga- Case Report nized CSDH (OCSH) is rare.1,4,9,10) A common CSDH can be treated by burr hole trephination and drainage of the A 72-year-old man was referred from a local hospital due hematoma; however, OCSH is not usually treated by burr to impaired consciousness after a generalized tonic-clonic hole drainage and it is treated by craniotomy and membra- seizure.
    [Show full text]
  • Acute Subdural Hematoma After Intra-Arterial Thrombolysis for Acute Ischemic Stroke —Case Report—
    Neurol Med Chir (Tokyo) 45, 627¿630, 2005 Acute Subdural Hematoma After Intra-arterial Thrombolysis for Acute Ischemic Stroke —Case Report— Toshinari MEGURO,HisatoHIGASHI,andKenNISHIMOTO Department of Neurological Surgery, Sumitomo Besshi Hospital, Niihama, Ehime Abstract A 79-year-old man with a cardiac pacemaker for bradycardia fell down and presented with sudden onset of right hemiplegia and aphasia. Initial computed tomography (CT) showed no cerebral infarction but angiography revealed occlusion of the left middle cerebral artery (MCA). Local intra-arterial thromboly- sis with tissue plasminogen activator (tPA; tisokinase, 1,600,000 units) was performed 3 hours after the onset, and the MCA was partially recanalized. Further administration of tPA was suspended because of nosebleed. However, the patient's neurological findings did not improve. His consciousness gradually deteriorated to coma and quadriplegia with dilation of the left pupil 2.5 hours after thrombolysis. CT disclosed marked mass effect with a left acute subdural hematoma and a small intracerebral hematoma in the left frontal lobe. He underwent urgent craniotomy and removal of the subdural hematoma. The subdural hematoma originated in a frontal cerebral contusion. He died of severe brain edema 2 days after surgery. Acute subdural hematoma is a very rare complication of intra-arterial thrombolysis. Presumably he had suffered head trauma at the first onset. Evidence of head trauma should be considered a contraindication for the use of thrombolytic agents in a patient with acute stroke. Key words: acute subdural hematoma, thrombolysis, tissue plasminogen activator, stroke, trauma Introduction 4, V: 1, M: 5) on the Glasgow Coma Scale. He presented with right hemiplegia and aphasia.
    [Show full text]
  • Stroke, Atrial Fibrillation, and Anticoagulation
    Stroke, Atrial Fibrillation, and Anticoagulation Steven Messé, MD FAHA FAAN Associate professor of Neurology Hospital of the University of Pennsylvania 1 Disclosures Consulting: • Glaxo Smith Kline, protocol development Research: • Glaxo Smith Kline: Co-National PI GSK DEPHINES – TAA trial • WL Gore: Local PI Gore REDUCE PFO Closure Trial • NIH: – U01-DK060990 (Prospective renal insufficiency cohort, stroke endpoint adjudication committee) – 1R01HL084375-01A2 (Determining neurologic outcomes from aortic valve surgery, co-investigator neurologic assessments) – 5U01HL088957-04 (local sub-investigator, NIH/NHLBI CT Surgery Network) 2 Overview Types of intracranial hemorrhage (ICH) The intersection of ICH and atrial fibrillation Stroke type and use/timing of anticoagulation 3 Stroke Brain injury due to a vascular blockage or rupture Two kinds of stroke: Ischemia (lack of blood flow) = 75-80% Hemorrhage (ruptured blood vessel) = 20-25% 4 Ischemic and Hemorrhagic Strokes Venous Thrombosis Hemorrhagic Ischemic Stroke Stroke Hemorrhagic Conversion of Ischemia 5 Outcome of ICH Compared to Ischemic Stroke • Mortality 100% • 6-month, 30-50% 90% • 1-year, 50% 80% 70% • Only 20% of ICH patients are 60% independent at 6 months vs 50% 60% of ischemic stroke patients 40% 30% (%) patients of Proportion 20% 10% 0% ICH Ischemic Dead Dependent Independent Manno EM, et al. Mayo Clin Proc. 2005;80:420-433; Mayer SA, Rincon F. Lancet Neurol. 2005;4:662- 672; Qureshi AI, et al. N Engl J Med. 2001;344:1450-1460; Taylor TN, et al. Stroke. 1996;27:1459- 1466;
    [Show full text]
  • Polycystic Subdural Hygroma Associated with Immunoglobulin G4
    Ota et al. BMC Neurology (2020) 20:228 https://doi.org/10.1186/s12883-020-01815-z CASE REPORT Open Access Polycystic subdural hygroma associated with immunoglobulin G4-related intracranial hypertrophic pachymeningitis: a case report Kazumichi Ota* , Yoshihiko Nakazato, Risa Okuda, Ryu Yokoyama, Hitoshi Kawasaki, Naotoshi Tamura and Toshimasa Yamamoto Abstract Background: Recent studies have examined hypertrophic pachymeningitis as an IgG4-RD. However, there are no reports of immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis with polycystic subdural hygroma. Case presentation: A 56-year-old man presented to the hospital with complaints of a persistent, pulsatile, occipital headache and general malaise. Magnetic resonance imaging of the brain revealed hypertrophic pachymeningitis with polycystic subdural hygroma and hematoma. Based on the dural biopsy findings and exclusion of other diseases, the patient was diagnosed with immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis. IgG4- related diseases may cause subdural hygroma more commonly than other diseases that cause hypertrophic pachymeningitis. Conclusions: This is the first case report discussing polycystic subdural hygroma and hematoma with IgG4-related hypertrophic pachymeningitis. Keywords: Hypertrophic pachymeningitis, IgG4-related disease, Polycystic hygroma, Hematoma Background Case report Immunoglobulin G4-related disease (IgG4-RD) was first A 56-year-old man with a history of asthma, sinusitis, reported as hyper-IgG4emia in autoimmune pancreatitis serous otitis media, idiopathic eosinophilia, recurrent [1]. In recent studies, the hypertrophic pachymeningitis idiopathic myocarditis, and idiopathic interstitial pneu- spectrum has also been included in IgG4-RDs [2–4]. monia was treated with prednisolone (PSL) at a dose of Several studies have been conducted to examine the 27.5 mg/day.
    [Show full text]
  • Safety of Discontinuation of Anticoagulation in Patients with Intracranial Hemorrhage at High Thromboembolic Risk
    ORIGINAL CONTRIBUTION Safety of Discontinuation of Anticoagulation in Patients With Intracranial Hemorrhage at High Thromboembolic Risk Thanh G. Phan, FRACP; Merian Koh, MB,BS; Eelco F. M. Wijdicks, MD Background: Limited data are available to guide the patients. The median time not taking warfarin in this co- management of anticoagulation in patients with intra- hort was 10 days. Three patients had an ischemic stroke cranial hemorrhage (ICH) at high thromboembolic risk. within 30 days of warfarin therapy discontinuation. Us- ing Kaplan-Meier survival estimates, the probability of Objective: To review the management of anticoagula- having an ischemic stroke at 30 days following warfarin tion in patients with ICH at high thromboembolic risk. therapy cessation in groups 1, 2, and 3 was 2.9% (95% confidence interval, 0%-8.0%), 2.6% (95% confidence in- Patients and Methods: We reviewed the manage- terval, 0%-7.6%), and 4.8% (95% confidence interval, 0%- ment of anticoagulation in 141 patients who have a high 13.6%), respectively. In the 35 patients who had warfa- risk of ischemic stroke and have ICH while taking war- rin therapy restarted, none had recurrence of ICH during farin. The 30-day risk of ischemic stroke while not tak- the same hospitalization. ing anticoagulation treatment was determined using Kaplan-Meier survival estimates. Conclusions: Discontinuation of warfarin therapy for 1 to 2 weeks has a comparatively low probability of em- Results: The indications for anticoagulation were a pros- bolic events in patients at high embolic risk. This should thetic heart valve (52 patients [group 1]), atrial fibrilla- be taken into consideration when deciding whether to tion and cardioembolic stroke (53 patients [group 2]), continue or discontinue anticoagulation in these pa- and a recurrent transient ischemic attack or an ischemic tients at high embolic risk.
    [Show full text]