Características Clínicas y Terapéuticas de los Pacientes que Ingresan por Trauma Craneoencefálico en el Complejo Hospitalario Dr. Arnulfo Arias Madrid. 2022 - 2023

Introducción: El trauma craneoencefálico (TCE) se define como una patología caracterizada por la alteración cerebral secundaria a una lesión traumática en la región de la cabeza, con la presencia de alteración de la consciencia y/o amnesia debido al trauma, cambios neurológicos, neurofisiológicos, con posibles fracturas de cráneo o lesiones intra craneanas atribuibles al trauma. Metodología: Es un estudio observacional, descriptivo, prospectivo en pacientes que sufrieron TCE internados en el servicio de neurocirugía en el Complejo Hospitalario Dr. Arnulfo Arias Madrid durante el periodo de marzo de 2022 a febrero de 2023. Resultados: Los resultados de este estudio mostraron que predomina el sexo masculino (78%) sobre el femenino (22%) en pacientes con TCE. Las causas de lesión más comunes fueron caídas de sus pies (27%), caídas de altura (25%) y colisión de moto/automóvil (20%). Las presentaciones clínicas más comunes fueron pérdida de consciencia (49%), amnesia/desorientación (19%) y cefalea (10%). Conclusión: El seguimiento promedio de los pacientes con TCE fue de 16 días. El género masculino fue el más frecuente, con mayor proporción en la edad media y adulta mayor. La etiología principalmente fue por caídas, manifestándose comúnmente por perdida del estado de alerta, y teniendo hallazgos múltiples en la tomografía cerebral. La mayoría de los pacientes se les dio manejo conservador. (provisto por Infomedic International)

Introduction: Cranioencephalic trauma (TBI) is defined as a pathology characterized by cerebral alteration secondary to traumatic injury in the head region, with the presence of altered consciousness and/or amnesia due to trauma, neurological, neurophysiological changes, with possible skull fractures or intracranial lesions attributable to trauma. Methodology: This is an observational, descriptive, prospective study in patients who suffered TBI hospitalized in the neurosurgery service at the Complejo Hospitalario Dr. Arnulfo Arias Madrid during the period from March 2022 to February 2023. Results: The results of this study showed a predominance of male (78%) over female (22%) patients with TBI. The most common causes of injury were falls from their feet (27%), falls from height (25%) and motorcycle/automobile collision (20%). The most common clinical presentations were loss of consciousness (49%), amnesia/disorientation (19%) and headache (10%). Conclusion: The average follow-up of patients with TBI was 16 days. The male gender was the most frequent, with a higher proportion in middle age and older adults. The etiology was mainly due to falls, commonly manifested by loss of alertness, and multiple findings in brain tomography. Most patients were managed conservatively. (provided by Infomedic International)

Síndrome de compresión medular de etiología infecciosa

El síndrome de compresión medular es una urgencia neuroquirúrgica debido a que un diagnóstico precoz y un tratamiento temprano podría revertir las incapacitantes secuelas ocasionadas por esta enfermedad. Las causas de este síndrome pueden ser traumática, metastásica, infecciosa y vascular (hematomas). La etiología infecciosa no es frecuente y el principal germen involucrado suele ser Staphylococcus aureus. A continuación presentamos el caso de una paciente de 58 años con síndrome de compresión medular de etiología infecciosa quien fue ingresada en el Servicio de Clínica Médica del Centro Médico Nacional.

Spinal cord compression syndrome is a neurosurgical emergency because early diagnosis and early treatment could reverse the disabling consequences caused by this disease. The causes of this syndrome can be traumatic, metastatic, infectious, and vascular (hematomas). Infectious etiology is not frequent and the main germ involved is usually Staphylococcus aureus. Below we present the case of a 58-year-old patient with spinal cord compression syndrome of infectious etiology who was admitted to the Medical Clinic Service of the National Medical Center.

Single versus double drainage in chronic subdural hematomas treated with burr-holes

Introduction: Chronic subdural hematoma is a frequent type of intracranial hemorrhage. Treatment for symptomatic cases is generally surgical. Burr-hole completion is the method of choice. Objective: To analyze the placement of a single versus double drain in patients with chronic subdural hematoma operated through burr-holes. Methods: An analytical correlational retrospective study was carried out in patients who underwent surgery for chronic subdural hematoma, between January 2018 and December 2020. The patients were divided into 2 groups based on the number of drains used: double or single. The variables were: age, morbidities, preoperative Glasgow Score, hematoma characteristics (laterality, internal architecture, maximum diameter, and midline shift), complications, and hospital stay. The probability value < 0.05 was considered statistically significant. Results: Of the 99 patients in the study, 39 were older than 75 years. The most frequent pattern was B with 25 cases (25,3 %). The diameter of the chronic subdural hematoma was more than 20 mm in 61 cases, and in 32 cases the displacement of the midline structures was greater than 10 mm. The average hospital stays 5,8 days. The most frequent complication was nosocomial pneumonia with eleven cases (11,11 %). The double drainage group showed fewer complications at 30 days. Conclusions: The placement of double subdural drainage in patients with chronic subdural hematoma operated through single or double burr-holes, and is related to fewer complications than those with single drainage.

Introducción: El hematoma subdural crónico es un tipo frecuente de hemorragia intracraneal. El tratamiento de los casos sintomáticos es generalmente quirúrgico. La terminación con agujeros de trépano es el método de elección. Objetivo: Analizar la colocación de drenaje simple versus doble en pacientes con hematoma subdural crónico operados mediante trepanación. Métodos: Se realizó un estudio retrospectivo correlacional analítico en pacientes operados de hematoma subdural crónico, entre enero de 2018 y diciembre de 2020. Los pacientes se dividieron en 2 grupos según el número de drenajes utilizados: doble o simple. Las variables fueron: edad, morbilidades, puntaje de Glasgow preoperatorio, características del hematoma (lateralidad, arquitectura interna, diámetro máximo y desviación de la línea media), complicaciones y estancia hospitalaria. El valor de probabilidad < 0,05 se consideró estadísticamente significativo. Resultados: De los 99 pacientes del estudio, 39 eran mayores de 75 años. El patrón más frecuente fue el B con 25 casos (25,3 %). El diámetro del hematoma subdural crónico fue mayor de 20 mm en 61 casos, y en 32 casos el desplazamiento de las estructuras de la línea media fue mayor de 10 mm. La estancia hospitalaria media fue de 5,8 días. La complicación más frecuente fue la neumonía nosocomial con once casos (11,11 %). El grupo de doble drenaje presentó menos complicaciones a los 30 días. Conclusiones: La colocación de drenaje subdural doble en pacientes con hematoma subdural crónico operados mediante trepanación simple o doble, se relaciona con menos complicaciones que aquellos con drenaje simple.

Scrub Typhus Presenting as Subdural Hemorrhage with Normal Platelet Counts: A Rare Case Presentation

Scrub typhus is a common zoonotic disease with high case fatality rate. The clinical presentation of this disease may vary from acute febrile illness, thrombocytopenia, gastrointestinal manifestations, coagulopathy to neurological manifestations. The common neurological manifestations are meningitis and meningoencephalitis, whereas subdural hemorrhage, cerebrovascular accident, i.e., intracerebral hemorrhage, infarct, subarachnoid hemorrhage, etc. are among rare neurological presentations. Scrub typhus-induced neurological disease should be investigated to provide a timely and appropriate diagnosis and to reduce the mortality in complicated scrub typhus infection. Here we report a case of scrub typhus complicated with subdural hemorrhage admitted in our hospital.

Acute subdural hematoma secondary to sacral arachnoid cyst surgery: a case report / 中华神经科杂志

Sacral cyst usually occurs around the nerve root, which is the accumulation of cerebrospinal fluid between the intima and the perineurium at the junction of the posterior spinal nerve root and the dorsal root ganglion. Its typical clinical manifestations include low back pain, lower limb radiation pain, rectal/bladder dysfunction and so on. Complications of acute subdural hematoma with cerebral hernia after posterior midline cystectomy of sacral cyst are rare. A middle-aged female patient with sacral cyst was admitted to Gansu Provincial Hospital. After the operation, acute subdural hematoma occurred in the right frontoparietal temporal occipital region, and cerebral herniation was formed. After the operation, the patient was given rehabilitation exercise and discharged well. No neurological deficits were observed during follow-up.

Research progress in portable diagnosis devices for traumatic intracranial hematoma / 中华创伤杂志

Traumatic intracranial hematoma progresses rapidly and may cause quick increase of intracranial pressure and even brain hernia, ultimately leading to coma or death. Therefore, traumatic intracranial hematoma needs prompt treatment, but the prerequisite of treatment is early examination and diagnosis. Due to the limited transportation and other reasons, the existing large-scale detection devices such as CT and MRI cannot be deployed on the rescue site or during patient transportation. Instead, the portable diagnosis devices have the characteristics of miniaturization and high flexibility, which is conducive to promoting early detection, assisting diagnosis and further guiding the formulation of treatment plans. At present, more and more attention has been paid to the portable diagnosis devices in the diagnosis of intracranial hematoma. The authors summarized the conventional diagnosis methods and application of portable diagnosis devices for traumatic intracranial hematoma, aiming to provide a reference for the diagnosis of traumatic intracranial hematoma.

Effects of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma / 中国基层医药

Objective:To investigate the clinical efficacy of neuroendoscopic hematoma removal versus soft channel drainage in the treatment of chronic subdural hematoma. Methods:The clinical data of 102 patients with chronic subdural hematoma who received treatment in Jincheng People's Hospital from May 2018 to May 2020 were retrospectively analyzed. They were divided into the neuroendoscopy group ( n = 50) and the soft channel group ( n = 52) according to different surgical methods. Perioperative indexes, hematoma clearance rate, China Stroke Scale score, the activity of daily living score, and oxidative stress indexes were compared between the two groups. All patients were followed up for 3 months. The incidence of complications during the follow-up period was calculated. Results:The retention time of the drainage tube in the neuroendoscopy group was shorter than that in the soft channel group [(2.45 ± 0.63) days vs. (3.30 ± 0.78) days, t = 6.06, P < 0.001]. The length of hospital stay in the neuroendoscopy group was shorter than that in the soft channel group [(7.14 ± 1.65) days vs. (9.07 ± 2.11) days, t = 5.15, P < 0.001]. The hematoma clearance rate at postoperative 7 days in the neuroendoscopy group was higher than that in the soft channel group [(93.45 ± 5.50)% vs. (81.86 ± 7.24)%, χ2 = 9.12, P < 0.001]. There were no significant differences in operation time and intraoperative blood loss between the two groups (both P > 0.05). At postoperative 30 days, the China Stroke Scale score in the neuroendoscopy group was lower than that in the soft channel group [(12.74 ± 2.23) points vs. (18.67 ± 2.45) points, t = 12.79, P < 0.001]. The activity of daily life score in the neuroendoscopy group was significantly higher than that in the soft channel group [(77.69 ± 7.11) points vs. (91.35 ± 7.25) points, t = 9.60, P < 0.001]. At postoperative 7 days, glutathione peroxidase level in the neuroendoscopy group was significantly lower than that in the soft channel group [(130.75 ± 13.66) U/L vs. (148.60 ± 14.64) U/L, t = 6.37, P < 0.001]. Malondialdehyde level in the neuroendoscopy group was significantly lower than that in the soft channel group [(5.11 ± 0.65) nmol/L vs. (6.19 ± 0.74) nmol/L, t = 7.83, P < 0.001]. Superoxide dismutase level in the neuroendoscopy group was significantly higher than that in the soft channel group [(275.60 ± 22.33) U/L vs. (254.60 ± 18.55) U/L, t = 5.15, P < 0.001]. There was no significant difference in the incidence of complications between the two groups ( P > 0.05). Conclusion:Compared with soft channel drainage, neuroendoscopic hematoma removal can obtain better short-term curative effects and less oxidative stress response in the treatment of chronic subdural hematoma. Neuroendoscopic hematoma removal does not increase the incidence of postoperative complications and is highly safe.

Caracterización epidemiológica: descripción de mortalidad para hemorragia subdural aguda no traumática en el período 2017-2021, en Chile / Epidemiological characterization: description of mortality for non-traumatic acute subdural hemorrhage in the 2017-2021 period, in Chile

Introducción: La hemorragia subdural aguda no traumática (HSDNT) es una patología relacionada a factores de riesgo cardiovascular (RCV). Por falta de estudios epidemiológicos nacionales, se plantea estudiar la tasa de mortalidad (TM) y defunciones por HSDNT entre los años 2017-2021 en Chile. Metodología: Estudio descriptivo, transversal, sobre defunciones por HSDNT entre los años 2017-2021 en Chile (N=878), según grupo etario, sexo y lugar de defunción, usando datos obtenidos del departamento de estadística e información en salud. Se utilizó estadística descriptiva y cálculo de TM. No requirió aprobación por comité de ética. Resultados: Se calculó una TM de 0,99/100.000 habitantes entre los años 2017-2021, siendo la mayor los años 2017-2019 y 2020 con TM de 1/100.000. El sexo masculino presentó TM de 1,27/100.000, el grupo etario mayor a 80 años presentó una TM de 19,28/100.000 habitantes. Según lugar de defunción, el año 2020 un 83% (148) de las defunciones fue en hospital o clínica. Discusión: La prevalencia del RCV hace relevante el estudio de mortalidad por HSDNT, donde la principal hipótesis de su mortalidad en Chile estaría basada en estos factores riesgo latentes. Según lugar de defunción, se podría suponer dadas mayores complicaciones en aquellos pacientes hospitalizados por HSDNT. Conclusión: Dada la nula existencia de datos sobre esta patología en Chile, se realizó una caracterización epidemiológica en conjunto a un análisis de defunciones según el lugar, aportando una perspectiva nacional de mortalidad sobre este cuadro en particular.

Introduction: Non-traumatic acute subdural hemorrhage (NTSDH) is related to cardiovascular risk factors (CVR). Due to lack of national epidemiological studies, it is proposed to study mortality rate (MR) and deaths from HSD between the years 2017-2021 in Chile. Methodology: Descriptive, observational, cross-sectional study on deaths due to SDH between the years 2017-2021 in Chile (N=878), in a population older than 15 years, according to age group, sex and place of death, using data obtained from Departamento de estadísticas e información en salud. Descriptive statistics and MR calculation were used. It did not require approval by an ethics committee. Results: A MR of 0.99/100,000 inhabitants was calculated between the years 2017-2021, the year being the highest in the years 2017-2019 and 2020 with MR of 1/100,000. Male sex presented a MR of 1.27/100,000, the age group over 80 years presented a MR of 19.28/100,000 inhabitants. By place of death, in 2020 there were 148 deaths in hospitals or clinics. Discussion: The prevalence of CVR makes the study of mortality from NTSDH relevant, where the hypothesis of its mortality in Chile would be based on these risk factors. Depending on the place of death, it could be assumed that there are greater complications in those patients hospitalized for NTSDH. Conclusion: Given the null existence of data on this pathology in Chile, an epidemiological characterization was carried out together with an analysis of deaths according to the place, providing a national perspective of mortality about this disease.

Hematoma subdural secundario a punción lumbar / Subdural hematoma secondary to lumbar puncture

Introducción: la punción lumbar es una de las herramientas diagnósticas más importantes para diferentes patologías neurológicas. Caso clínico: hombre de 32 años, con epilepsia, toxoplasmosis cerebral y VIH que presentó un hematoma subdural posterior a una punción lumbar diagnóstica, sin sintomatología, siendo un hallazgo imagenológico incidental. Discusión y conclusiones: el mecanismo por el que se produce el hematoma subdural, se basa en una presión baja del LCR que da lugar a un deslizamiento de la aracnoides sobre la duramadre y como consecuencia se desgarran los vasos del espacio subdural, produciendo una extravasación de sangre en dicho espacio.

Introduction: lumbar puncture is one of the most important diagnostic tools for a variety of neurological disorders. Case presentation: a 32-year-old man with epilepsy, cerebral toxoplasmosis, and HIV, who presented an asymptomatic subdural hematoma following a diagnostic lumbar puncture, which was an incidental finding on imaging. Discussion and conclusions: the mechanism for post lumbar puncture subdural hematoma development is based on a low CSF pressure which allows the arachnoid matter to slide over the dura mater leading to subdural vessels tear, causing blood extravasation into the subdural space.

Evaluación multimodal del hematoma subdural crónico

Introducción: El hematoma subdural crónico es la complicación tardía más frecuente del trauma craneoencefálico. Su diagnóstico precoz y el tratamiento oportuno permiten la evolución favorable y curación de los pacientes. Objetivo: Sistematizar los diferentes ejes de clasificación del hematoma subdural crónico, que permitan la evaluación multimodal con una orientación más precisa de la técnica quirúrgica. Métodos: Se realizó una revisión bibliográfica en las principales bases de datos disponibles, centrada en las diferentes clasificaciones clínicas y radiológicas del hematoma subdural crónico y se seleccionaron 26 artículos. Se escogieron las principales clasificaciones y escalas y se aplicaron en 22 pacientes, obteniéndose resultados preliminares. Resultados: Las escalas de evaluación clínica de Bender, Marckwalder y la clasificación de Gordon Firing son las más conocidas, sin embargo, existen clasificaciones tomográficas que tienen en cuenta la densidad, la homogeneidad del hematoma que son de gran importancia en la selección de la técnica quirúrgica. La presencia de membranas y tabiques aparecen solo incluidas dentro de la valoración de la densidad del hematoma. Existen otras con valor predictivo que identifican aquellos factores relacionados con las recurrencias, desde antes de la cirugía, las mismas se consideran un factor de mal pronóstico para la evolución final de los pacientes con este tipo de hematomas. Conclusiones: La evaluación preoperatoria exige de la aplicación de múltiples escalas, la identificación y caracterización de las membranas es importante para personalizar la técnica quirúrgica, en busca de disminuir la morbilidad y mortalidad posoperatoria.

Introduction: Chronic subdural hematoma is the most frequent late complication of cranioencephalic trauma. The early diagnosis and correct treatment allow the recovery of patients. Objective: To systematize the different criteria of classification of chronic subdural hematoma that leads the multimodal evaluation for more effective selection of surgical technique. Methods: A review of literature about chronic subdural hematoma was done in the main database focused on different clinical and radiological classifications and 26 articles were selected. The main classifications and scales were chosen and applied to 22 patients, obtaining preliminary results. Results : Benders, Marckwalder and Gordon Firing scales are the most common, nevertheless there are tomographic classifications that include density, homogeneity of hematoma that are of great importance in the selection of the surgical technique. The presence of membranes and septum are only included in the evaluation of hematoma density. There are some others with predictive value that identify those factors related to recurrences before surgery that are considered a bad prognosis to the final evolution of these patients with this type of hematoma. Conclusions: The previous evaluation to surgery requires the use of different scales, the identification and characterization of membranes are important to select the optimum surgical technique to decrease morbidity and mortality after surgery.

Fatal case of subdural empyema caused by Campylobacter rectus and Slackia exigua

ABSTRACT We report a fatal subdural empyema caused by Campylobacter rectus in a 66-year-old female who developed acute onset of confusion, dysarthria, and paresis in her left extremities. A CT scan showed hypodensity in a crescentic formation with a mild mid-line shift. She had a bruise on her forehead caused by a fall several days before admission, which initially raised subdural hematoma (SDH) diagnosis, and a burr hole procedure was planned. However, her condition deteriorated on the admission night, and she died before dawn. An autopsy revealed that she had subdural empyema (SDE) caused by Campylobacter rectus and Slackia exigua. Both microorganisms are oral microorganisms that rarely cause extra-oral infection. In our case, head trauma caused a skull bone fracture, and sinus infection might have expanded to the subdural space causing SDE. CT/MRI findings were not typical for either SDH or SDE. Early recognition of subdural empyema and prompt initiation of treatment with antibiotics and surgical drainage is essential for cases of SDE. We present our case and a review of four reported cases.

Parche de sangre cervical para tratamiento de síndrome de hipotensión/ hipovolumen de líquido cefalorraquídeo espontáneo. Reporte de un caso / Cervical blood patch for the treatment of spontaneous cerebrospinal fluid hypotension/hypovolume syndrome. A case report

Presentamos el tratamiento eficaz de una filtración espontánea de líquido cefalorraquídeo (LCR) asociada a un síndrome de hipoten-sión/hipovolumen de LCR a nivel cervical alto, caracterizado por delirio y hematomas subdurales secundarios, refractarios al drenaje quirúrgico, que se resolvió con dos parches de sangre epidurales cervicales consecutivos.

We present the case of a cerebrospinal fluid (CSF) hypotension/hypovolume syndrome due to a spontaneous CSF fistula at the upper cervical level characterized by loss of consciousness and bilateral subdural hematomas refractory to two drainage surgeries that resolved with two consecutive blood patches on the leak site.

Empiema subdural y su relación con hematomas subdurales: experiencia local y revisión de la literatura / Subdural empyema and its relationship to subdural hematomas: local experience and literature review

RESUMEN: Los empiemas subdurales, tanto los de aparición espontánea o como complicación en la evolución de un hematoma subdural (HSD), son infrecuentes y de los cuales existen pocas publicaciones en la literatura(1). En este trabajo se revisa una serie de 15 casos operados en el Hospital de Urgencia Asistencia Pública (HUAP) en un período de 15 años. Se observó que en general tienen buena evolución con el tratamiento instaurado en forma oportuna y que son larvados en su presentación, pudiendo llegar a ser diagnosticados incluso en el intraoperatorio. No se observó diferencia en su evolución cuando se operaron a través de una craniectomía o de una craneotomía (plaqueta)(2). No se encontró tampoco diferencia cuando se trataron con o sin drenaje. Como consenso general, deben ser tratados con antibioticoterapia prolongada de al menos 3-4 semanas para controlar el foco infeccioso(2). Ninguno de los casos revisados requirió de reintervención.

ABSTRACT Subdural empyemas, both spontaneous or as a complication in the evolution of subdural hematomas, are an uncommon fact of which there are few publications in literature. In this review we analyze a retrospective serie of 15 cases operated in HUAP in a period of 15 years. In general we don't observed differences in the outcome using different surgical techniques, both in those treated by craniectomy as those treated by craniotomy. Also we don't observed differences in those treated with or without drainage. In the same way is clear that the optimal period of antibiotic treatment must be 3-4 weeks to fully cover them. None of the cases treated, needed reintervention.

Silent killer presenting as isolated oculomotor nerve palsy

Head trauma can result trivial to life threatening manifestations to a person. Subdural hemotomais characterised by accumulation of blood in subdural space, in most cases it is a serious condition and requires prompt diagnosis and treatment for the same to provide good outcome. Large collection, mid line shift, brain herniation associated with subdural hematoma is associated with increased morbidity and mortality. However, if the collection is minimal or is places like tentorium cerebelli may not have the typical presentation and if it抯 picked up using the subtle signs the devastating sequelae can be prevented. We report a 19 years old male with head trauma presenting with features of right-side isolated oculomotor nerve palsy who eventually found to have tentorial subdural hemotoma in imaging which has been intervened and complications were avoided.

Procedimiento anestésico - quirúrgico en un lactante con higrohematoma subdural / Anesthetic - surgical procedure in an infant with subdural hygrohematoma

Se describe el caso clínico de un lactante de 47 días de nacido, quien fue atendido en el Cuerpo de Guardia de Pediatría del Hospital Provincial General Docente Antonio Luaces Iraola de Ciego de Ávila, por presentar aumento de la circunferencia cefálica, irritabilidad y agitación. Los exámenes realizados mostraron signos de hipertensión endocraneana descompensada, secundaria a colección del espacio subdural izquierdo. Se eliminó el higroma subdural y la recuperación fue favorable en las primeras 36 horas; luego comenzó a convulsionar y apareció nuevamente el deterioro neurológico, por lo cual se decidió reintervenir. Se realizó inducción anestésica con tiopental sódico fentanilo y rocuronio. El paciente evolucionó sin complicaciones.

The case report of a 47 days infant is described. He was assisted in the children emergency room of Antonio Luaces Iraola Teaching General Provincial Hospital in Ciego de Ávila, due to an increase of the cephalic circumference, irritability and agitation. The exams showed signs of upset endocranial hypertension, secondary to collection of the left subdural space. The subdural hygroma was eliminated and the recovery was favorable in the first 36 hours; then a covulsion began and the neurological deterioration appeared again, reason why it was decided to operate once more. Anesthetic induction was carried out with fentanyl sodium thiopental and rocuronium. The patient had a favorable clinical course without complications.

Caracterización tomográfica de las membranas en pacientes con hematoma subdural crónico

Introducción: El hematoma subdural crónico es un hematoma encapsulado por dos membranas interna y externa. Existen diferentes clasificaciones imagenológicas que incluyen las características de estas lesiones, pero la presencia de las membranas y sus características es un aspecto poco descrito. Objetivo: Describir las características tomográficas de las membranas de los hematomas subdurales crónicos. Métodos: Se realizó un estudio descriptivo en el Servicio de Neurocirugía en conjunto con el Servicio de Imagenología, del Hospital Universitario Manuel Ascunce Domenech durante el año 2021. Se incluyeron 20 pacientes adultos que fueron operados con el diagnóstico de hematoma subdural crónico. Las membranas se caracterizaron de acuerdo con su densidad, grosor, número de capas, morfología y extensión. Resultados: Predominaron los pacientes de más de 65 años del sexo masculino, con hematomas unilaterales más frecuentes del lado izquierdo. El volumen promedio fue de 150 ml y el diámetro fue de 3 cm. Fueron más frecuentes las membranas finas, hiperdensas, incompletas, de una sola capa y la morfología fue variable. Conclusiones: Las membranas que conforman el hematoma subdural crónico pueden observarse en la tomografía axial computarizada. Se han encontrado diferentes tipos de membranas de acuerdo con su densidad, grosor, morfología, extensión y presencia de tabiques. La presencia de una membrana gruesa o fina con tabiques, puede tener indicación de una craneotomía que permita la resección cuidadosa de la membrana parietal y la apertura suficiente de la visceral para facilitar la re expansión cerebral y disminuir la incidencia de recolecciones.

Introduction: Chronic subdural hematoma is a hematoma encapsulated by two internal and external membranes. There are different imaging classifications that include the characteristics of these lesions, but the presence of the membranes and their characteristics is a little described aspect. Objective: To describe the tomographic characteristics of the membranes of chronic subdural hematomas. Methods: A descriptive study was carried out in the Neurosurgery service in conjunction with the Imaging service of the Manuel Ascunce Domenech University Hospital during the year 2021. 20 adult patients who underwent surgery with the diagnosis of chronic subdural hematoma were included. The membranes were characterized according to their density, thickness, number of layers, morphology and extension. Results: Male patients over 65 years of age predominated, with more frequent unilateral hematomas on the left side. The average volume was 150 ml and the diameter was 3 cm. Thin, hyperdense, incomplete, single-layer membranes were more frequent, and the morphology was variable. Conclusions: The membranes that make up the chronic subdural hematoma can be seen on computerized axial tomography. Different types of membranes have been found according to their density, thickness, morphology, extension and presence of septa. The presence of a thick or thin membrane with septa may indicate a craniotomy that allows careful resection of the parietal membrane and sufficient opening of the visceral membrane to facilitate brain re-expansion and reduce the incidence of recollections.

Empiema subdural secundario a una sinusitis polipoidea / Subdural empyema secondary to polypoid sinusitis

RESUMEN Introducción: El empiema subdural es una afección infrecuente, caracterizada por la presencia de material purulento entre la duramadre y la aracnoides. Representa entre el 15-20 % de las infecciones intracraneales, con una mortalidad de un 10 %. Objetivo: Presentar un paciente con diagnóstico de empiema subdural. Caso clínico: Paciente masculino de 22 años, con síntomas de infección respiratoria alta, fiebre de 39 °C, cefalea, toma del estado general y dificultad para movilizar el miembro inferior derecho; que la evaluación inicial sugiere diagnóstico de meningoencefalitis bacteriana y tuvo evolución desfavorable, se identifica con los estudios imagenológicos, la presencia de un empiema subdural secundario a una sinusitis polipoidea. Conclusiones: El empiema subdural es una entidad poco frecuente, con elevada mortalidad si no se realiza un diagnóstico y tratamiento precoz. Dentro de las infecciones del sistema nervioso central siempre se debe tener en cuenta, pues requiere un alto índice de sospecha clínica y el uso adecuado de las imágenes para su diagnóstico.

ABSTRACT Introduction: Subdural empyema is a rare condition, characterized by the presence of purulent material between the dura mater and the arachnoid mater. It represents between 15-20 % of intracranial infections, with a mortality of 10 %. Objective: To present a patient with a diagnosis of subdural empyema. Clinical case: A 22-year-old male patient, with symptoms of upper respiratory infection, fever of 39 °C, headache, poor general condition and difficulty in mobilizing the right lower limb; whose initial evaluation suggests a diagnosis of bacterial meningoencephalitis and had an unfavorable evolution, being identified after imaging studies the presence of a subdural empyema secondary to polypoid sinusitis. Conclusions: Subdural empyema is a rare entity, with high mortality if early diagnosis and treatment are not performed. Within infections of the central nervous system, it should always be taken into account, since it requires a high index of clinical suspicion and the adequate use of images for its diagnosis.

Coma in spontaneous intracranial hypotension complicated with subdural hematoma: a case report / 中华神经科杂志

Spontaneous intracranial hypotension can frequently result in several complications including subdural hygroma, subdural hematoma and cerebral venous thrombosis, but coma rarely. A case of spontaneous intracranial hypotension presented with orthostatic headaches was described. He experienced somnolence, disorientation, incontinence, and then coma, though received conservative treatment. Brain imaging demonstrated acute-on-chronic subdural hematoma, magnetic resonance myelography using heavily T 2-weighted fast spin-echo pulse sequences showed spinal longitudinal extradural collection, and magnetic resonance myelography with intrathecal gadolinium revealed cerebrospinal fluid leak at the level of T 6, T 7. The patient recovered consciousness after surgical evacuation of the hematoma, and the headache disappeared after a targeted epidural blood patch. The hematoma resolved 2 months later and the patient kept free from headache during follow-up.

Comparison of the efficacy of middle meningeal artery embolization and conventional therapy for chronic subdural hematomas: a propensity score matching study / 中华放射学杂志

Objective:To compare the effect of middle meningeal artery embolization (MMAE) versus conventional therapy for chronic subdural hematoma (CSDH).Methods:Retrospective analysis of 38 patients with 48 CSDHs treated with MMAE from May 2019 to May 2021 was performed. Comparisons were made with a conventional treatment for 126 patients with 126 CSDHs from January 2016 to May 2021. The MMAE and conventional treatment patients were matched by the propensity score matching method, and a total of 25 pairs of patients (31 pairs of CSDHs) were successfully matched. The CSDH recurrence, rescue treatment, radiographic follow-up outcome, clinical improvement and complication between the two groups were compared by t test, χ 2 test or Fisher exact probability methods. Results:The rescue treatment rate in MMAE group was significantly lower than that in conventional treatment group [0 (0/31) vs 19.4% (6/31), P=0.024] and the complete resolution rate at 6 months follow-up in MMAE group was significantly higher than that in conventional treatment group [96.8 (30/31) vs 74.2% (23/31), P=0.026]. In terms of CSDH recurrence, there was a trend of lower recurrence in the MMAE group [3.2%(1/31) vs 22.6% (7/31), P=0.053]. The complete resolution rate at 3 months follow-up was 61.3% (19/31) in MMAE group and 45.2% (14/31) in conventional treatment, clinical improvement rate was 92.0% (23/25) in MMAE group and 88.0% (22/23) in conventional treatment, good outcome rate (mRS≤2) was 92.0% (23/25) in MMAE group and 84.0% (21/25) in conventional treatment, complication rate was 0(0/25) in MMAE group and 4.0% (1/25) in conventional treatment, and there were no significant differences in all above-mentioned parameters ( P>0.05). Conclusions:The MMAE may be considered as a safe and effective treatment for CSDH, and MMAE for CSDH is associated with lower trend of recurrence, lower rescue treatment rate and better radiographic follow-up outcome than conventional therapy.

Epidural analgesia failure followed by intracranial subdural hematoma: a case report / 中华围产医学杂志

We report the diagnosis and treatment of a rare case of epidural analgesia failure followed by postpartum subdural hematoma. The patient underwent vaginal delivery under epidural analgesia at 32 +6 gestational weeks due to threatened premature labor, during which an unexpected dural rupture occurred. She gave no history of headache and there was no obvious abnormality during the pregnancy. However, on postpartum day 4, the patient complained of headache that could not be relieved when supine, but without any other neurological symptoms. A prompt cranial CT examination showed a left frontotemporal subdural hematoma. After conservative management with intravenous drip of mannitol, re-examination of cranial CT showed that the left frontotemporal subdural hematoma was mostly absorbed and the patient was discharged on postpartum day 18. The patient was healthy during follow up. Intracranial subdural hematoma after dural puncture is a rare and serious complication that requires early recognition and treatment.