Spinal Epidural Hematoma Related to Intracranial Hypotension

A 45-year-old female patient visited the hospital complaining of severe sudden headache and posterior neck pain. The patient did not have any traumatic history or abnormal neurologic finding. The patient had sudden quadriplegia and sensory loss. Cervical spine MRI scan was taken, and the compatible findings to acute epidural hematoma were shown. The emergency operation was performed. After the operation, the patient recovered all motor and senses. As there was CSF leakage in the postoperative wound, this was confirmed by cervical spinal computed tomography (CT). Then lumbar drainage was thus performed. The opening pressure upon lumbar puncture was not measured as it was very low. As a result of continous CSF leakage, dural repair was performed. After the operation, the patient had been discharged without neurologic deficits. In this case, it is sensible to suspect intracranial hypotension as a possible cause of spinal EDH.

The Clinical Course of Subdural Hygroma with Head Injury / 대한신경손상학회지

OBJECTIVE: Traumatic subdural hygroma (T-SDG) has been generally treated using conservative management rather than surgical methods. This study was performed to evaluate the clinical course of T-SDG with radiologic studies. METHODS: A retrospective study was conducted among patients diagnosed with T-SDG from January 2011 to December 2011. The patients were categorized into two groups. Group A has the widest width of T-SDG below 8 mm, Group B more than 8 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) were carried out in both groups. RESULTS: Seventy-four patients were confirmed with T-SDG and were grouped as follows: 44 patients in Group A and 30 patients in Group B. There was no significant difference in age and sex ratio between group A and B. It took more time to resolve T-SDG in Group B (95.2+/-86.4 days) than Group A (14.4+/-6.7)(p<0.001). However, no significant difference was observed in the Glasgow Coma Scale (GCS) between the groups. In 10 patients of Group B, T-SDG developed into chronic subdural hematoma and one of these patients underwent surgery. CONCLUSION: Most T-SDGs were resolved after some period in this study. Surgery does not seem to be necessary in resolving T-SDG.

The Clinical Course of Subdural Hygroma with Head Injury / 대한신경손상학회지

OBJECTIVE: Traumatic subdural hygroma (T-SDG) has been generally treated using conservative management rather than surgical methods. This study was performed to evaluate the clinical course of T-SDG with radiologic studies. METHODS: A retrospective study was conducted among patients diagnosed with T-SDG from January 2011 to December 2011. The patients were categorized into two groups. Group A has the widest width of T-SDG below 8 mm, Group B more than 8 mm. Computed tomography (CT) and magnetic resonance imaging (MRI) were carried out in both groups. RESULTS: Seventy-four patients were confirmed with T-SDG and were grouped as follows: 44 patients in Group A and 30 patients in Group B. There was no significant difference in age and sex ratio between group A and B. It took more time to resolve T-SDG in Group B (95.2+/-86.4 days) than Group A (14.4+/-6.7)(p<0.001). However, no significant difference was observed in the Glasgow Coma Scale (GCS) between the groups. In 10 patients of Group B, T-SDG developed into chronic subdural hematoma and one of these patients underwent surgery. CONCLUSION: Most T-SDGs were resolved after some period in this study. Surgery does not seem to be necessary in resolving T-SDG.

Comparative Study on the Period of Absolute Bed Rest of Vertebral Compression Fracture

OBJECTIVE: As a conservative treatment of compression fractures, absolute bed rest (ABR) for a certain period has been recommended, but no guideline on the period has yet been established. Considering that a long ABR period may adversely affect patients, the difference in prognosis according to the ABR period was investigated in this study. METHODS: A prospective study was conducted who were diagnosed with compression fracture. Groups A and B were put on ABR (one week for group A and two weeks for group B). X-ray images at baseline, 1, 2, 4, and 8 weeks were obtained from both groups, for assessment purposes. RESULTS: The compression rates of both groups were no significant difference at baseline, 1, 2, 4, and 8 weeks. The conditions of 25.9% and 21.2% of the subjects deteriorated in groups A and B, showing no significant difference. Between the groups of age and bone mineral densities (BMD), no significant difference was observed in the incidence of deterioration. In terms of complications development including constipation and other Gastrointestinal problems, voiding difficulty, etc., group A reported 57.4%, and group B, 84.8%, showing a significant difference (p-value=0.001). CONCLUSION: No significant difference in the conservative period was observed between the groups. Group B, however, reported a higher complications development rate than group A. Therefore, a short ABR period may be helpful in the early stage of conservative treatment.