Treatment of a subdural empyema complicated by intracerebral abscess due to Brucella infection

A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.

Hemangioblastoma cerebeloso y trombocitopenia: reporte de caso / Cerebellar hemangioblastoma and thrombocytopenia: report of one case

The association between vascular tumors and thrombocytopenia is rare. Kasabach-Merritt Syndrome is seen in childhood and is characterized by hemangiomas and thrombocytopenia. A 42 years-old man with a cerebellar hemangioblastoma and thrombocytopenia, admitted with a subarachnoid hemorrhage is reported. The patient was operated and required a splenectomy to manage the thrombocytopenia. After the splenectomy the patient developed a subdural hematoma that was operated. Despite the surgical treatment, the patient died.

Hematoma subdural após punção inadvertida da dura-máter: relato de caso / Subdural hematoma after inadvertent dura mater puncture: case report / Hematoma subdural después de la punción inadvertida de la duramadre: relato de caso

JUSTIFICATIVA E OBJETIVOS: A cefaléia pós-punção da dura-máter é complicação bastante conhecida das anestesias subaracnóidea e peridural, e o tratamento mais difundido é o tampão sangüíneo. O tampão sangüíneo alivia totalmente a cefaléia na grande maioria dos pacientes, e nos demais não há melhora ou, apenas, melhora parcial. Nesses casos, é prudente buscar diagnósticos diferenciais, como o hematoma subdural ou pneumoencéfalo. Os métodos de imagem são extremamente úteis nessas situações. O objetivo deste relato foi apresentar o caso de um paciente que desenvolveu hematoma subdural intracraniano após punção inadvertida da dura-máter em anestesia peridural. RELATO DO CASO: Paciente do sexo masculino, 47 anos, 147 kg, 1,90 m, estado físico ASA II, foi admitido para realização de dermolipectomia abdominal, após ter-se submetido à gastroplastia redutora. Durante anestesia peridural, houve perfuração acidental da dura-máter. O paciente evoluiu com sintomas de cefaléia pós-punção da dura-máter que foram tratados com tampão sangüíneo, com melhora parcial. Houve, posteriormente, piora da cefaléia, e a ressonância nuclear magnética de encéfalo mostrou hematoma subdural intracraniano, que foi tratado clinicamente. Houve melhora progressiva, com recuperação total após 30 dias. CONCLUSÕES: A ocorrência de hematoma subdural é complicação rara, mas grave da perfuração de dura-máter. O diagnóstico é difícil e deve ser sempre cogitado quando a cefaléia pós-punção da dura-máter não se resolve com o tampão sangüíneo ou piora com sua realização. No esclarecimento diagnóstico é fundamental o auxílio de um método de imagem.

BACKGROUND AND OBJECTIVES: Post-dural puncture headache is a well-known complication of epidural and subarachnoid blockades and the blood patch is the treatment used more often. In most patients, the blood patch relieves the headache completely, but for the remaining there is no improvement or only partial relief of the symptom. In those cases, it is prudent to look for other differential diagnosis, such as subdural hematoma or pneumoencephalus. In those situations, imaging exams are extremely useful. The objective of this report was to present the case of a patient who developed subdural hematoma after accidental puncture of the dura mater during epidural block. CASE REPORT: A 47-year old male patient, 147 kg, 1.90 m, physical status ASA II, was admitted for abdominal dermolipectomy after undergoing gastroplasty. The dura mater was accidentally punctured during the epidural block. The patient developed post-dural puncture headache treated with an epidural blood patch, with partial improvement of his symptoms. However, it was followed by worsening of the headache and an MRI showed the presence of an intracranial subdural hematoma, which was treated clinically. The patient evolved with progressive improvement of the symptom and full recovery after 30 days. CONCLUSIONS: Subdural hematoma is a rare, but severe, complication of dura mater puncture. It is difficult to diagnose, but it should always be remembered when post-dural puncture headache shows no resolution or even worsens after an epidural blood patch. An imaging exam is fundamental for the diagnosis of this rare complication.

JUSTIFICATIVA Y OBJETIVOS: La cefalea pos punción de la duramadre es una complicación bastante conocida de las anestesias subaracnoidea y epidural, siendo que el tratamiento más difundido es el tapón sanguíneo. El tapón sanguíneo alivia totalmente la cefalea en la gran mayoría de los pacientes, y en los demás no hay mejorías o apenas se ve una mejoría parcial. En esos casos, es prudente buscar diagnósticos diferenciales, como el hematoma subdural o neumoencéfalo. Los métodos de imagen son extremadamente útiles en esas situaciones. El objetivo de este relato fue el de presentar el caso de un paciente que debutó con hematoma subdural intracraneal después de la punción inadvertida de la duramadre en anestesia epidural. RELATO DEL CASO: Paciente del sexo masculino, 47 años, 147 kg, 1,90 m, estado físico ASA II, fue admitido para la realización de dermolipectomía abdominal, después de haberse sometido a la gastroplastía reductora. Durante la anestesia epidural, hubo perforación accidental de la duramadre. El paciente evolucionó con síntomas de cefalea pospunción de la duramadre que fueron tratados con tapón sanguíneo, obteniéndose una mejora parcial. Hubo posteriormente, un empeoramiento de la cefalea y la resonancia nuclear magnética de encéfalo mostró un hematoma subdural intracraneal, que se trató clínicamente. Hubo una mejoría progresiva, con recuperación total después de 30 días. CONCLUSIONES: La aparición de hematoma subdural es una complicación rara, pero grave de la perforación de la duramadre. El diagnóstico es difícil y debe ser siempre pensado, cuando la cefalea pospunción de la duramadre no se resuelva con el tapón sanguíneo o tampoco se resuelva su empeoramiento. En la aclaración del diagnóstico es fundamental la ayuda de un método de imagen.

Chronic and subacute subdural hematoma in the adult population: the Puerto Rico experience

OBJECTIVE: The purpose of this investigation was to study the epidemiology of chronic and subacute subdural hematoma in an adult population and associated factors such as treatment, recurrence, seizures, complications, and outcome. METHODS: We retrospectively reviewed 267 consecutive cases operated for a suspected diagnosis of chronic or subacute subdural hematoma during a six-year period. RESULTS: An incorrect diagnosis was done in 12 of the cases (4.5 per cent) giving a total of 255 cases of chronic or subacute subdural hematoma. The mean age of the patients was 68-year old. Two-thirds of the cases were chronic and one-third were subacute. A history of head trauma was identified in 79 per cent of the patients occurring more frequently in the subacute group. The hematoma was bilateral in 16 per cent of the patients. Recurrence occurred in 7.8 per cent of the cases, but there was no significant difference between chronic and subacute cases nor the type of operation done. Postoperative seizures occurred in 6.2 per cent of the cases. Preoperative seizures are not associated to the development of postoperative seizures. A postoperative intracerebral hematoma occurred in 2.7 per cent of the patients and was associated in most of the cases with a poor outcome. The morbidity rate was 9 per cent and the mortality rate was 0.9 per cent. Outcome is good in 95 per cent of the patients. CONCLUSIONS: Chronic subdural hematoma occurs more frequently than subacute subdural hematoma. Surgical treatment modality and the use of a drain do not change the recurrence rate. Preoperative seizures are not associated to the development of postoperative seizures. The use of postoperative prophylactic antiepileptic drugs does not decrease the postoperative seizure rate even in the alcoholic patient, therefore, their prophylactic use is not indicated.

Management of chronic subdural haenatoma: a study of 31 cases

A study of chronic subdural haematomas seen in 31 patients over 5 years at Bahawal Victoria Hospital, Bahawalpur, is presented. All haematomas were drained through burr-holes. Two patients had reaccumulation of the haematoma, one had pneumocephalus and another developed seizures. The results were satisfactory in over 85% of patients. CSH most commonly occurs in elderly males. It can be treated satisfactorily by drainage through burr-holes with minimal morbidity and mortality. Early diagnosis is important as poor results are directly related to neurological condition of the patient at presentation. The clinician should advise CT scan of brain in all suspected cases

Hematoma subdural crónico: experiencia inicial / Chronic subdural hematoma: initial experience

Se analizan 35 pacientes operados por un H.S.D. crónico en el Instituto de Neurocirugía estudiando su clínica, antecedentes previos, morbilidad operatoria, mortalidad. Se evaluó el resultado final a través del índice de Karnofsky. Todos los casos fueron operados, realizándose una craniectomía, evacuación, instalando un drenaje aspiratorio tipo Jakson Pratt. La mortalidad operatoria fue de 2,8 porciento. Recidivaron el 8,6 porciento y se complicaron con un empiema el 11,4 porciento. El 77 porciento de los pacientes presentaban un índice de Karnofsky mayor que 70 al alta

Aspectos clínicos e terapêuticos do hematoma subdural crônico: revisäo de 40 casos / Clinical and therapheutical aspects of subdural hematoma: review of 40 cases

Os autores fazem uma revisäo de 40 pacientes operados de hematoma subdural crônico de 1980 a 1985 no HSPE - FMO. Säo analisados o quadro clínico, o achado tomográfico e a relaçäo do trauma cranencefálico com os fatores de prognóstico. Cerca de 72,5% dos pacientes relataram traumatismo cranencefálico e destes, 35,0% eram acompanhados em ambulatório, sendo o diagnóstico feito precocemente através da Tomografia Computadorizada do Crânio. Os pacientes acima de 65 anos apresentaram maiores índices de morbidade e recidiva, apesar da terapêutica empregada. É ressaltada a importância do acompanhamento ambulatorial dos pacientes com traumatismo craniano, assim como a realizaçäo de Tomografía Computadorizada do Crânio nesses pacientes

Coagulaçäo intravascular disseminada e hematoma subdural: relato de caso / Disseminated intravascular coagulation and subdural hematoma: a case report

Os autores apresentam caso de hematoma subdural agudo, evacuado na presença de coagulopatia, e fazem consideraçöes necessárias para a compreensäo da etiopatogenía da enfermidade

Hematoma subdural cronico: tratamiento con minitrefinacion / Chronic subdural hematoma: treatment by mini-trephination method

Se presenta el empleo del metodo de la minitrefinacion en forma aguda y sin sistema de drenaje cerrado, como tratamiento quirurgico en 44 casos de hematoma subdural cronico, 31 unilaterales y 13 bilaterales. Hubo mejoria completa en las horas o dias inmediatos al procedimiento en 38 (86%) pacientes. El hematoma se reprodujo en 3 (7%) personas. No hubo casos de infeccion ni de deterioro neurologico. Tampoco hubo muertes

Hematomas subdurales cronicos / Chronic subdural hematomas

Los autores presentan las manifestaciones clinicas, los hallazgos escanograficos y los resultados del tratamiento quirurgico en 90 pacientes con hematomas subdurales cronicos supratentoriales atendidos entre 1973 y 1980. La mayor proporcion ocurrio despues de los 50 anos en hombres quienes habian sufrido traumatismos leves o moderados entre uno y dos meses antes del comienzo de cefalea, trastornos motores, cambios mentales, principalmente. Dos pacientes tuvieron el cuadro de un accidente cerebrovascular y dos presentaron solamente cefalea con examen neurologico normal. La escanografia en 45 casos mostro 51% isodensos entre ellos 4 bilaterales, 42% hipodensos y 6.6 hiperdensos. Se presentaron diez recurrencias de ellas dos pacientes murieron en el post-operatorio.