Hematoma subdural crónico / Chronic subdural hematoma

El hematoma subdural crónico (HSC) es una patología neuroquirúrgica frecuente, que se reconoce como consecuencia de traumatismos craneoencefálicos de poca magnitud que habitualmente se diagnostican en pacientes seniles, aunque puede presentarse en pacientes jóvenes y sin antecedentes de traumas.El objetivo que persigue este trabajo es la presentación de una paciente con un HSC bilateral, con características poco usuales.Caso clínico: se presenta una paciente del sexo femenino, de 46 años de edad, sin antecedente de traumatismo craneal ni de otra patología concomitante, que consulta por una cefalea de 15 días de evolución. El examen físico constató midriasis, pupila de Hutchinson, papiledema bilateral y exoforia del ojo derecho, parálisis del tercer par craneal y ataxia de tronco, fue catalogada con Glasgow 13. Se realizó tratamiento anti edema cerebral temprano y las manifestaciones desaparecieron en gran medida. En la Tomografía axial computarizada se diagnosticó un hematoma subdural frontotemporal bilateral con desplazamiento de las estructuras de la línea media a la izquierda. Fue operada de urgencia y dada de alta completamente recuperada tres días después.Conclusión: el HSC puede presentarse con distintas formas clínicas, simulando procesos expansivos tumorales, ataques cerebrovasculares, demencias o entidades neurológicas de otra índole. El manejo del caso por clínicos y neurocirujanos fue rápido y efectivo, lo que explica que la paciente tuvo una recuperación temprana y total. En estos casos la actuación médica es decisiva en el éxito del tratamiento.

Chronic subdural hematoma (CSH) is a common neurosurgical pathology that is recognized as a consequence of minor head injuries that are usually diagnosed in senile patients, although it can occur in young patients without a history of trauma.The objective of this work is the presentation of a patient with a bilateral CSH, with unusual characteristics.Clinical case: a 46-year-old female patient with no history of head trauma or other concomitant pathology is presented, who consulted for a 15-day-old headache. Physical examination confirmed mydriasis, Hutchinson's pupil, bilateral papilledema and exophoria of the right eye, third cranial nerve palsy, and trunk ataxia. She was cataloged with Glasgow 13. Early anti-cerebral edema treatment was performed and the manifestations largely disappeared. A computed tomography scan diagnosed a bilateral fronto temporal subdural hematoma with displacement of the midline structures to the left. She underwent emergency surgery and was discharged completely recovered three days later. Conclusion: HSC can present with different clinical forms, simulating expansive tumor processes, cerebrovascular attacks, dementias or neurological entities of another nature. The case management by clinicians and neurosurgeons was quick and effective, which explains that the patient had an early and complete recovery. In these cases, medical action is decisive in the success of the treatment.

Abducens Nerve Palsy as Initial Manifestation of Chronic Subdural Hematoma: Case Report

Chronic subdural hematoma (CSDH) is a form of progressive intracranial hemorrhage, typically associated with cases of trauma. The manifestation of this comorbidity with abducens palsy is a rare finding. The present work aims to describe the case of an adult patient with abducens nerve palsy as a manifestation of CSDH. Chronic subdural hematoma is most commonly found in elderly patients, with systemic hypertension as amanifestation. The relation with the sixth cranial nerve is unusual and draws attention to the case reported. In addition, the prognosis is positive, since trepanation and drainage surgery was performed, as it is recommended in the literature.

Kernohan-Woltman Notch Phenomenon ­ Case Report

The Kernohan-Woltman notch phenomenon is a paradoxical neurological manifestation consisting of a motor deficit ipsilateral to a primary brain injury. It has been observed in patients with brain tumors and with supratentorial hematomas. It is considered a false localizing neurological sign. Magnetic resonance imaging (MRI) scan has been the test of choice. The recognition of this phenomenon is important to prevent a surgical procedure on the opposite side of the lesion. The present case report describes a case of chronic subdural hematoma with a probable finding of the Kernohan-Woltman phenomenon, and it discusses its pathophysiology, imaging findings, treatment, and prognosis.

Delayed-onset bilateral abducens paresis after head trauma.

Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

The use of reservoir shunt in chronic subdural hematoma.

Recurrent chronic subdural hematomas (CSDH) can be a therapeutic challenge. We report the use of reservoir shunts for continuous irrigation and drainage of the subdural space for a prolonged period. This system appears to be more useful than an external drainage system.

The fate of traumatic subdural hygroma in serial computed tomographic scans

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.