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.

Meningioma parasagital y hematoma subdural crónico, una asociación inusual / Parasagittal meningioma and chronic subdural hematoma, unusual association

RESUMEN En muchas ocasiones, los pacientes con tumores cerebrales tienen una variedad de síntomas psiquiátricos inespecíficos. Algunos de estos pueden constituir la primera o única manifestación del tumor, sin la presencia de ningún síntoma o signo neurológico. El diagnóstico ha de basarse en la anamnesis completa y en la exploración neurológica; la neuroimagen confirmará el diagnóstico clínico. Con el presente trabajo se describió la asociación inusual de hematoma subdural crónico y meningioma parasagital en un caso presentado. Se trató de un paciente de 68 años con antecedentes de esquizofrenia. Acudió a consulta con una hemiparesia izquierda. Se le realizó una tomografía axial computarizada de cráneo y arrojó un hematoma subdural crónico y un meningioma parasagital derecho. Se le aplicó tratamiento quirúrgico en dos tiempos operatorios. Su evolución posquirúrgica transcurrió sin complicaciones (AU).

ABSTRACT In many cases, patients with brain tumors have a variety of nonspecific psychiatric symptoms. Some of them can be the first or the only manifestation of the tumor, without presenting any neurological signs or symptoms. The diagnosis must be based on the complete anamnesis and on the neurological examination. The neuroimaging will confirm the clinical diagnosis. The unusual association of a chronic subdural hematoma and a parasagittal meningioma was described in a case presented in the current work. It dealt with a patient, aged 68 years with antecedents of schizophrenia. He assisted the consultation with left hemiparesis. A skull computed tomography showed a chronic subdural hematoma and a right parasagittal meningioma. He underwent a two-steps surgery. His post-surgery evolution ran without complications (AU).

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.

Epidemiology and Estimated Cost of Surgery for Chronic Subdural Hematoma Conducted by the Unified Health System in Brazil (2008­2016)

Introduction Chronic subdural hematoma (CSH) is one of the most frequent forms of intracranial hemorrhage. It is a collection of encapsulated, well-delimited fluid and/or coagulated blood in several clotting stages located between the dura mater and the arachnoid mater. Objective To describe the epidemiological aspects of CSH described in the database of the Brazilian Unified Health System (SUS, in the Portuguese acronym) regarding admission numbers, hospitalization expenses, health care professional expenses, mortality rate, and death numbers by region from 2008 to the first half of 2016. Methods The present work was performed between August and September 2016 with a review about the epidemiological aspects of CSH in Brazil according to the Informatics Department of the Unified Health System (DATASUS) database, encompassing the period from January 2008 to June 2016, and to scientific papers from the past 10 years which were electronically published at the PubMed, Scielo, and LILACS databases. Results From 2008 to the first half of 2016, the total values were the following: hospital admission authorizations (HAAs). 33,878; hospital expenses, BRL 65,909,429.22; health care professional expenses, BRL 25,158,683.21; deaths, 2,758; and mortality rates ranging from 6.47 to 12.63%. Conclusion In spite of the high clinical relevance of CSH, epidemiological studies about this condition are limited. As such, the present paper is an updated approach on CSH, focusing on its epidemiological aspects according to the DATASUS database.

Analysis of predisposing factors for chronic subdural hematoma recurrence

SUMMARY OBJECTIVES: To identify recurrence and its potential predisposing factors in a series of 595 patients with an initial diagnosis of Chronic Subdural Hematoma (CSDH) who underwent surgical treatment at a Reference Hospital of São Paulo. METHODS: A retrospective descriptive study, in which the medical records of all patients with a CSDH diagnosis submitted to surgical treatment from 2000 to 2014 were analyzed. RESULTS: The final study population consisted of 500 patients with a diagnosis of CSDH (95 patients with a diagnosis of Cystic Hygroma were excluded), of which 27 patients presented recurrence of the disease (5.4%). There were no statistically significant differences in relapses when cases were stratified by gender, laterality of the first episode or surgical procedure performed in the first episode (trepanning vs. craniotomy). It was possible to demonstrate an age-related protective factor, analyzed as a continuous variable, regarding the recurrence of the CSDH, with a lower rate of recurrence the higher the age. CONCLUSIONS: The results indicate that, among possible factors associated with recurrence, only age presented a protective factor with statistical significance. The fact that no significant difference between the patients submitted to trepanning or craniotomy was found favors the preferential use of burr-hole surgery as a procedure of choice due to its fast and less complex execution.

RESUMO OBJETIVOS: Identificar a taxa de recidiva e seus potenciais fatores predisponentes em série de 595 pacientes consecutivos com diagnóstico inicial de hematoma subdural crônico (HSDCr) submetidos a tratamento cirúrgico em hospital terciário de São Paulo nos últimos 14 anos. MÉTODOS: Estudo retrospectivo descritivo, no qual foram analisados os prontuários de todos os pacientes com diagnóstico de HSDCr submetidos a tratamento cirúrgico, no período de 2000 a 2014. RESULTADOS: A amostra final consistiu em 500 pacientes com diagnóstico de HSDCr — foram excluídos 95 pacientes com diagnóstico de higroma cístico —, dos quais 27 sujeitos apresentaram recidiva do quadro (5,4%). Não foram observadas diferenças estatisticamente significativas nas recidivas quando os casos foram estratificados por gênero, lateralidade do primeiro episódio ou procedimento cirúrgico executado no primeiro episódio (trepanação vs. craniotomia). Foi possível demonstrar um fator protetor relacionado à idade, analisado como variável contínua, no que diz respeito à recidiva do HSDCr, com menor taxa de recidiva com o avançar desta CONCLUSÕES: Os resultados indicam que, dentre os fatores possivelmente associados à recidiva, apenas a idade se apresentou como fator protetor com significância estatística. O fato de não ser demonstrada diferença significativa entre os pacientes submetidos a tratamentos cirúrgicos por trepanação ou por craniotomia favorece o uso preferencial da trepanação como procedimento de escolha, em virtude de apresentar execução rápida e menos complexa.

Evacuación de hematoma subdural crónico: hemorragia de Duret postoperatoria y restitución ad-integrum. A propósito de un caso / Evacuation of chronic subdural hematoma: postoperative Duret hemorrhage and ad-integrum replacement. About a case

El tratamiento de elección para la evacuación de hematoma subdural crónico es la evacuación mediante orificio de trépano. Las complicaciones más frecuentes son recurrencia, neumoencefalo, convulsiones, hemorragia intracraneal y en otros sitios. La hemorragia del tronco cerebral secundaria a la cirugía es extremadamente rara. Aquí presentamos un paciente masculino de 72 años, que ingresa con GSC 9/15, hemiparesia izquierda 2/5. Con HSD crónico bilateral con desplazamiento de línea media de 1.5 cm. hacia izq. Al cual se realiza evacuación de HSD derecho. Y en el POP se detecta GSC 12/15, lado izquierdo fuerza 5/5, con hemiparesia derecha a predominio braquial. TC control POP: adecuada evacuación de HSD y lesión hiperdensa protuberancial. Es externado al 6to día POP con GSC 14/15 sin déficit motor. Este reporte, además de abordar la bibliografía actual y fisiopatología; agrega otro caso para reafirmar la posibilidad de pronóstico favorable en ésta patología

ABSTRACT The treatment of choice for the evacuation of chronic subdural hematoma is evacuation through a trepan orifice. The most frequent complications are recurrence, re-accumulation of the hematoma, pneumoencephalus, seizures, intracranial hemorrhage and elsewhere. Brainstem hemorrhage secondary to surgery is extremely rare. Here we present a 72-year-old male patient, admitted with GSC 9/15, left hemiparesis 2/5. Without obeying orders. With bilateral chronic HSD with midline displacement of 1.5 cm. to left; to which evacuation of right HSD is performed. And in the POP GSC 12/15 is detected, left side force 5/5, with right hemiparesis to brachial predominance. POP control CT: adequate evacuation of HSD and hyperdense pontine lesion. It is extership to the 6th day POP with GSC 14/15 without motor deficit. This report, besides addressing the current bibliography and physiopathology; adds another case to reaffirm the possibility of favorable prognosis in this pathology

The number of burr holes and use of a drain do not interfere with surgical results of chronic subdural hematomas / Tratamento cirúrgico do hematoma subdural crônico: o número de trepanações e o uso de dreno subdural não interferem no resultado cirúrgico

ABSTRACT Burr hole evacuation has been the most frequently-used procedure for the treatment of chronic subdural hematomas (CSDH). Objective: To evaluate whether the use of a drain and/or the number of burr holes for treatment of CSDH modifies the rates of recurrence and complications. Methods: A retrospective review of 142 patients operated on because of CSDH, between 2006 and 2015, analyzing recurrence and complications of the use of one or two burr holes with or without the use of a drain. Results: Thirty-seven patients had bilateral CSDH (26%) and 105 (73.9%) patients had unilateral CSDH. Twenty-two (59.4%) patients were given a drain and 15 (40.6%) were not. A total number of recurrences occurred in 22 (15.5%) patients and the total number of complications was in six (4.2%) patients. Mean follow-up time was 7.67 months. Conclusions: The number of burr holes and the use of the drain did not alter the rates of recurrence and complications in the treatment of CSDH.

RESUMO A trepanação é o procedimento mais utilizado para o tratamento de hematomas subdurais crônicos (HSDC). Objetivo: Avaliar o uso de dreno subdural e / ou o número de trepanações para tratamento de HSDC modifica as taxas de recidiva e complicações. Métodos: Uma revisão retrospectiva de 142 pacientes operados por HSDC entre 2006 e 2015 analisando recidiva e complicações usando um ou dois orifícios com ou sem uso de dreno. Resultados: Trinta e sete casos apresentaram HSDC bilaterais (26%) e 105 (73,9%) unilaterais. Em vinte e dois (59,4%) casos houve uso de dreno e em 15 (40,6%) não houve. O número total de recidivas foi de 22 casos (15,5%) e o número total de complicações foi de 6 casos (4,2%). O tempo médio de seguimento foi de 7,67 meses. Conclusões: O número de trepanações e o uso do dreno não alteraram as taxas de recidiva e complicações no tratamento de HSDC.

Surgical Treatment of Chronic Subdural Hematoma: Systematic Review and Meta-Analysis of the Literature / Tratamento cirúrgico do hematoma subdural crônico: revisão sistemática e metanálise da literatura

Background There are many controversies in the literature on the treatment of chronic subdural hematoma (CSDH). Objective To assess the effects of different surgical techniques and postoperative care on recurrence of CSDH. Methods Systematic review through Medline search of articles published between January 1990 and July 2011. Controlled observational and randomized clinical trials (RCT) regarding surgical approach, irrigation, drainage, and postoperative patient position in patients with CSDH were included. The outcome was recurrence requiring reoperation. Independent extraction of articles was conducted by 2 authors using predefined data fields, including study risk of bias indicators. Results 35 publications met inclusion criteria. Pooled analyses did not demonstrate difference in recurrence rates when compared burr-hole craniostomy (BHC) x twist-drill craniostomy (TDC) (OR: 0.99; CI95%: 0.53­1.84; p » 0.97), BHC x craniotomy (OR: 1.23; CI95%: 0.78­1.95; p » 0.36), nor TDC x craniotomy (OR: 16.11; CI95%: 0.85­306.88; p » 0.06). In patients receiving BHC, pooled analysis showed a lower recurrence rate in patients receiving 2BHC compared with 1BHC (OR: 0.58; CI95%: 0.37­0.88; p » 0.01). The use of drainage system after evacuation of CSDH by BHC reduces the recurrence (OR: 0.41; CI95%: 0.23­0.74; p » 0.003).There is not enough evidence to support either a specific location of the tip of drain, nor the postoperative patient position as factors influencing on recurrence. Conclusion Well-designed studies are urgently needed to verify the effectiveness of most neurosurgical procedures routinely performed for CSDH.

Introdução Existem inúmeras controvérsias na literatura sobre o tratamento do hematoma subdural crônico (HSDC). Objetivo Avaliar os resultados das diferentes técnicas cirúrgicas e cuidados pós operatórios na recidiva do HSDC. Métodos Revisão sistemática de artigos publicados no Medline entre Janeiro de 1990 a Julho de 2011. Foram incluídos estudos observacionais controlados e ensaios clínicos randomizados (ECR) relacionados à abordagem cirúrgica, irrigação, uso de dreno e posicionamento no pós-operatório de pacientes com HSDC. O desfecho estudado foi recidivo necessitando reoperação. A extração dos dados foi conduzida de maneira independente por dois autores utilizando campos pré-definidos, incluindo indicadores de viés dos estudos. Resultados Trinta e cinco artigos foram incluídos na análise. A metanálise não demonstrou diferença nas taxas de recorrência quando comparadas às técnicas de trepanação burr-hole (BHC) X twist-drill (TDC) (OR: 0,99; IC95%: 0,53­1,84; p » 0,97), BHC X craniotomia (OR: 1,23; IC95%: 0,78­1,95; p » 0,36), nem TDC X craniotomia (OR: 16,11; IC95%: 0,85­306,88; p » 0.06). Em pacientes operados por BHC, a metanálise demonstrou menor taxa de recidiva em pacientes operados com 2BHC em comparação a 1BHC (OR: 0,58; IC95%: 0,37­0,88; p » 0,01). O uso de dreno no pós-operatório por BHC reduziu a recidiva (OR: 0,41; IC95%: 0,23­0,74; p » 0,003). Não há evidência suficiente que aponta do dreno ou a posição do paciente no pós operatório tenham influência na chance de recidiva. Conclusão Estudos bem delineados são necessários para comparar a efetividade da maioria dos procedimentos neurocirúrgicos realizados rotineiramente para HSDC.

Comparison of Drainage Volume of Chronic Subdural Hematoma According to Drainage Catheter Type

PURPOSE: To assess the therapeutic value of two different drainage catheters in treating chronic subdural hematoma (CSDH). MATERIALS AND METHODS: Two types of drainage catheters can be used to treat CSDH according to the position of holes in the catheter: open-type or closed-type catheter. In this retrospective study, 199 total patients with CSDH were reviewed according to catheter type. Among them, 84 patients were and 113 in the closed-type group (holes positioned within the distal-most 1 cm of the catheter). The surgeon selected the catheter type. Total drainage volume, initial drainage volume within 2 days, percentage of initial drainage volume per total drainage volume, duration of catheter insertion, and reoperation rate were compared. RESULTS: Total drainage volume was not different between the two groups (p=0.333). The initial drainage volume within 2 days was larger in the open-type group than closed-type group (p=0.024), but the percentage of initial drainage volume per total drainage volume was not different (p=0.354). The duration of catheter insertion was shorter in the open-type group than closed-type group (p=0.015). The reoperation rate of CSDH was also higher in the open-type group than closed-type group (p=0.004). CONCLUSION: CSDH drainage with an open-type catheter is faster compared with a closed-type catheter, but total drainage volume is similar and reoperation rate is higher. Therefore, the open-type catheter for CSDH drainage has limited clinical value.

Hematoma subdural crónico: análisis retrospectivo de una serie de 100 casos / Chronic subdural hematoma: surgical management in 100 patients

Chronic subdural hematoma (CSH) represents one of the most frequent types of intracranial hemorrhage. A standard surgical procedure is not available for each individual condition, and treatment options are often different at each institution. Therefore, management of CSH may represent a real challenge in the decision-making process of choosing a burr hole drainage instead of a large craniotomy in certain cases with borderline features. Prognosis depends directly on the appropriate selection of the surgical procedure. In this study we included 100 patients with CSH in order to analyze surgical results. The majority of the hematomas had a frontoparietal location in both cerebral hemispheres. The procedure of choice was usually a burr hole drainage in most cases. We found incomplete drainage in 18% of cases, each of which underwent a new surgical procedure and pneumoencephalus in 11% of cases. Mortality was 2%, which was less than reported in previous studies.

Chronic subdural hematoma with sudden clinical uncal herniation and coma: case report

Context: Chronic subdural hematomas are frequent diseases in neurosurgery units. Decreased level of consciousness is observed in 28 to 100 percent of cases, nevertheless in rare cases are seen comatous patients. We describe a case of a patient with clinical uncal herniation elapsed by a chronic subdural hematoma. Case report: Patient with previous diagnosis of breast cancer, presented sudden occurrence of a headache followed by decreasing level of consiousness the day before reaching our service. The patient was taken than to another Hospital at 1:00 AM in Glasgow Coma Scale (GCS) 13, with isochonic pupils. At 7:00 AM the GCS went to 7 and the pupils became anisochonic L > R and than transferred to our Unit and immediatly submitted to a computed tomohraphy scanning of the head that showed a chronic subdural hematoma with midline shift. The patient promptly was taken to surgical room and treated with a single burr hole with drainage of hypertensive chronic subdural hematoma. The level of consiousness increased few hours after surgery, being in GCS 15 just 6 hours after, without motor deficits. Conclusion: In spite of commonly progressive evolution chronic subdural hematomas can present with herniation, becoming itself a neurosurgical emergency.

Manejo del hematoma subdural crónico mediante minitrépano y sistema de drenaje sin succión, experiencia en 213 pacientes / Management of chronic subdural hematoma with twist-drill craniostomy: report of 213 patients

Objetivos: Aún existen controversias respecto a la técnica en el manejo quirúrgico del hematoma subdural crónico. Este estudio tiene como objetivo describir nuestra experiencia en la craneostomía mediante el uso de minitrépano (twist drill). Pacientes y métodos: Fueron tratados 213 pacientes en los hospitales “Teodoro Maldonado Carbo” y “Alcívar” de Guayaquil, entre los meses de enero del 1992 y febrero del 2005. La técnica quirúrgica consistió en la evacuación del hematoma mediante minitrépano que se realizó en la cama del paciente y bajo anestesia local. Para evaluar los resultados utilizamos las escalas de Markwalder y la escala de evolución de Glasgow. Valoramos la evolución, las complicaciones y la recidiva. Resultados: Existió antecedente traumático en 65 % de los casos. Setenta y nueve por ciento ingresaron en grado 2 de la escala de Markwalder. Nueve por ciento presentó alguna complicación. Ocho por ciento recidivó, pero mostró curación después de un nuevo procedimiento. A los 6 meses, el 97 % evolucionó en grado 5 según la escala de evolución Glasgow. Conclusiones: La craneostomía por minitrépano es un método rápido, seguro, efectivo y menos costoso.

OBJECTIVES: Controversies regarding the surgical management of chronic subdural hematoma still remain. The objective of the present study was to describe our experience with twist-drill craniostomy. PATIENTS AND METHODS: Two hundred and thirteen patients were treated at the "Teodoro Maldonado Carbo" and "Alcívar" facilities between January 1992- February 2005. The surgical technique consisted of a twist-drill made under local anesthesia at the patient's bedside. We administered the Markwalder grading scale and the Glasgow outcome scale to assess treatment results. Clinical outcome, complications and relapse were measured. RESULTS: The etiology was traumatic in 65% of cases. At admission, 79% scored 2 of the Markwalder grading scale. Nine percent of the patients displayed complications. The chronic subdural hematoma persisted in 8%; they were treated again with another twist-drill craniostomy with favorable results. At six months, 97.6% reached 5 in the Glasgow outcome scale. CONCLUSIONS: Twist-drill craniostomy is a less time consuming, safe, effective, and cost-efficient method for the treatment of chronic subdural hematoma.

Análise da cirurgia do hematoma subdural crônico em cem pacientes idosos / Analysis of the surgical tratment of chronic subdural hematoma in 100 elderly patients

Objetivo: avaliar o tratamento cirúrgico do hematoma subdoral crônico em pacientes idosos, com idade a partir de 75 anos. Método: estudo retrospectivo de série consecutiva de 100 pacientes dessa faixa etária, com hematoma subdural, operados em um período de oito anos, no Service de Neurochirurgie-Professeur Bernard Alliez do Hôpital Nord, AP-HM, Centre Hospitalier Universitaire de Marseille, França. Resultados: os sintomas de alrme e o quadro clínico foram variados e enganadores, diferente do observado em pacientes mais jovens. Houve predominância masculina, a média etária foi de 82 anos; traumatismo craniano foi realtado em 42 casos; 96 pacientes foram operados, obtendo-se cura completa em 59 (61,4 por cento); 22(23 por cento) ficaram com sequelas neurológicas, e 15(15,6 por cento) faleceram. Conclusão: apesar da idade avançada dos pacientes, a resposta ao tratamento cirúrgico foi boa com mais de 60 por cento de cura completa. A idade avançada dos pacientes não deve ser considerada contra-indicação à cirurgia.

Hematoma subdural subagudo y cronico: tratamiento quirurgico en 176 pacientes. Nuestra experiencia / Subacute and chronic subdural hematomas: surgical treatment in 176 patients. Our experience

Objective: to describe our surgical experience in suvacute and chronic subdural hematomas. Method: 176 patients with subacute or chronic subdural hematomas were operated between June 1998 and May 2003. Hospital records were used to ascertain data. We did a comparative analysis of the different types of surgical procedures performed. Results: the surgical procedure commonly performed was a burrhole craniostomy with subdural closed - system drainage (66 por ciento). This procedure was associated with a low rate of complications and reoperations, in comparison with the burr hole craniostomy or the craniostomy without subdural closed-system drainge. Global recurrence rate was 13 por ciento and 20,4 por ciento of the cases required reoperation. Clinical improvement rate was 72,3 por ciento. Conclusion: In our cases, burr hole craniostomy with closed-system drainge was the method of choice for the initial treatment in subacute and chronic subdural hematomas. Craniotomy should be reserved for those cases of recurrence or residual hematoma

Hematoma subdural crônico: estudo de 161 pacientes operados e a relação com alterações no coagulograma / Chronic subdural hematoma: study of 161 patients and the relationship with coagulation abnormalities

O objetivo deste estudo é analisar a evolução de pacientes com hematoma subdural crônico em relação aos achados do coagulograma. Foram analisados 161 pacientes operados no Hospital das Clínicas-UNICAMP entre abril de 1994 e 2000. Foi detectado um predomínio do sexo masculino (86,3 por cento), da cor branca (85,1 por cento) e da faixa etária na quinta década (mediana 57 anos). O estudo mostrou mortalidade maior no período pós-operatório entre os pacientes com valores de RNI (international normalized ratio) superiores a 1,25 e/ou trombocitopenia (p<0,001 e p=0,004, respectivamente) e mortalidade menor para os pacientes com antecedente de traumatismo cranioencefálico (76 por cento) (p=0,044). Os resultados ressaltam a importância da avaliação pré-operatória com o coagulograma a fim de se corrigir possíveis alterações

Hematoma subdural crônico. Apresentação de 31 casos operados entre janeiro de 1995 e outubro de 1999, mediante técnica própria / Chronic subdural hematoma. Presentation of thirty-one cases submitted to surgical treatment through a personal technique

Os autores apresentam 31 casos de hematoma subdural crônico, operados no período de janeiro de 1995 a outubro de 1999, nos quais a mortalidade e a morbidade cirúrgica foram nulas e atribuídas à técnica operatória utilizada, que se baseia em: 1) uso exclusivo de anestesia local; 2) orifício único de trepanação; 3) lavagem ostensiva da cavidade do hematoma; 4) drenagem aspirativa por 48 horas; e 5) decúbito lateral da cabeça para o lado da trepanação. Em dois casos o procedimento foi realizado bilateralmente devido à bilateralidade do processo, sendo, conseqüentemente, adotada alternância do decúbito.

Hematoma subdural crónico: una enfermedad del adulto mayor / Chronic subdural hematoma: a disease of elderly people

The lack of specificity and heterogeneity of the clinical picture of chronic subdural hematoma, hampers its diagnosis. Aim: To report the experience of a Neurosurgical Service in chronic subdural hematoma. Patients and methods: One hundred patients (77 male, mean age 77ñ13 years) with chronic subdural hematoma were analyzed. Results: The main clinical presentations were mental status changes (50 percent) and progressive focal neurological deficit (46 percent). Five cases presented as a transient neurological deficit. All patients were treated with burr hole drainage. Thirteen had recurrence of the hematoma and they were reoperated. The surgical mortality was 3 percent. Eighty seven patients were followed for a mean of 66 months. Eighty one of these had a complete recovery, 6 had permanent neurological deficit and 2 of these were unable to care for themselves. Bad prognosis was associated with the absence of a previous trauma to explain the hematoma and symptoms of dementia as the clinical presentation. Conclusions: Most patients with chronic subdural hematoma treated with burr hole drainage have a good outcome

Development of chronic subdural haematoma: a reminder to its pathogenesiss

A patient of road traffic accident was noted to have contusions, which in due course of time resolved and he improved, but never became fully all right. He was treated conservatively. Two months later, he presented with a short history of progressive hemiparesis and difficulty in walking. He was detected to have a large chronic subdural haematoma. He was treated with burr hole evacuation with which he improved. The case is discussed and hypothesis about its evolution and progression are discussed highlighting the unpredictabillty in its development. A high index of suspicion is the only key to anticipate and diagnose this neurological chameleon