Spontaneous chronic subdural hematoma (SDH) is a rare condition that could develop in association with hematologic disease. A 66-year-old male developed a chronic SDH as an initial manifestation of chronic myelomonocytic leukemia (CMML). He experienced recurrent chronic subdural hemorrhage and newly developed intracerebral hemorrhage. Considering the scheduled long-term chemotherapy, bilateral middle meningeal artery (MMA) embolization was performed to prevent recurrence of subdural hemorrhage. Although pancytopenia occurred during the 7 months' follow-up period, residual chronic subdural hemorrhage was absorbed without recurrence. To our best knowledge, this is the first report of CMML with spontaneous chronic SDH. MMA embolization is potentially a useful and safe treatment option in the challenging clinical situations with underlying pathologies.
Aged ; Cerebral Hemorrhage ; Drug Therapy ; Follow-Up Studies ; Hematologic Diseases ; Hematoma, Subdural* ; Hematoma, Subdural, Chronic ; Humans ; Leukemia ; Leukemia, Myelomonocytic, Chronic ; Male ; Meningeal Arteries ; Pancytopenia ; Pathology ; Recurrence

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.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Craniocerebral Trauma/complications ; Disease Progression ; Hematoma, Subdural, Chronic/radiography* ; Hematoma, Subdural, Chronic/pathology* ; Hematoma, Subdural, Chronic/etiology ; Human ; Infant ; Longitudinal Studies ; Lymphangioma/radiography ; Lymphangioma/pathology ; Lymphangioma/etiology ; Middle Age ; Subdural Effusion/radiography* ; Subdural Effusion/pathology* ; Subdural Effusion/etiology ; Tomography, X-Ray Computed*

Shaken baby syndrome (SBS) is a form of child abuse that can cause significant head injuries, of which subdural hematoma (SDH) is the most common manifestation. We report the MRI findings of chronic SDH in three cases of SBS, involving two-, three- and eight-month-old babies. The SDH signal was mostly low on T1-weighted images and high on T2-weighted images, suggesting chronic SDH. In chronic SDH, a focal high signal on T1-weighted images was also noted, suggesting rebleeding. Contrast-enhanced MRI revealed diffuse dural enhancement.
Brain/pathology ; Case Report ; *Child Abuse ; Chronic Disease ; Female ; Hematoma, Subdural/diagnosis/*etiology ; Human ; Infant ; *Magnetic Resonance Imaging ; Male

People 65 years and older represent a rapidly growing proportion of the Korean population. During the last five years, the rate of population increasing in this age group has been 19.5%, in contrast to 4.6% among the general population. Before 1987, neurosurgery among the elderly was infrequent, but at our hospital, the percentage increased from 6.9% in 1991 to 13.5% in 1996. We analysed 119 geriatric neurosurgical cases(9.6% of all neurosur-gical cases) of our hospital over a recent three-year period. Cerebrovascular disease occurred most frequently(43 cases), while there were 22 cases of tumor, 15 of chronic subdural hematoma, 11 of head injury, seven of benign spinal lesion and six of hyperactive dysfunction syndrome. Among 119 cases, concomitant systemic disease was seen in 78%, with cardiovascular and pulmonary dysfunction usually present. In cases of benign spine lesion, chronic subdural hematoma, simple brain tumor and good grade aneurysm, the surgical outcome was good, but in patients with poor grade aneurysm, a large and complicated tumor or a large intracranial hematoma, the surgical outcome was relatively poor compared with that of the general population group. In the group in whom surgical outcome was good, concomitant systemic disease did not influence a patient's prognosis. The results of this study are as follows : 1) Old age in itself is not a contraindication for surgery. 2) Among geriatric neurosurgical patients, surgical decisions should be based on the pathology itself, type of surgery, envisioned, urgency of the surgical procedure and the presence of any coexisting disease that could influence the surgical outcome. 3) Agressive forms of surgical treatment of patients suffering from benign spinal lesion, chronic subdural hematoma, good grade aneurysm or simple brain tumor can be performed in the elderly ; they are safe and the results are effective. 4) Patients with poor grade aneurysm, a large intracranial hematoma with poor neurological status, or a brain tumor with systemic metastasis or severe intercurrent disease are not to be considered for surgery. 5) To reduce surgical mortality and morbidity in aging patients, careful patient selection and vigorous preoperative and postoperative care with regard to any coexisting disease are important.
Aged* ; Aging ; Aneurysm ; Brain Neoplasms ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Chronic ; Humans ; Mortality ; Neoplasm Metastasis ; Neurosurgery* ; Pathology ; Patient Selection ; Population Groups ; Postoperative Care ; Prognosis ; Spine

A relatively rare condition of ossified chronic subdural hematoma (SDH) mimicking cerebral stroke is presented. A 67-year-old man presented with headache, dysphasia, and left-sided hemiparesis. Routine skull x-ray showed a huge calcification extending from the frontal to the parietal regions in the right side. CT and MRI scan revealed a huge ossified SDH covering the right hemisphere. Right frontoparietal craniotomy was performed and the ossified SDH was completely removed. Severe adhesion was noticed between the pia mater and the inner surface of the ossified mass. The subdural mass had ossified hard outer and inner rims and a soft central part. The postoperative course was uneventful and 3 months after the operation, the patient was neurologically intact. The authors report the successful treatment of a patient with a huge ossified SDH covering the right hemisphere. Careful dissection and total removal are needed in such symptomatic cases to avoid cortical injury and to improve results.
Aged ; Hematoma, Subdural, Chronic/diagnosis/pathology/*surgery ; Human ; Magnetic Resonance Imaging ; Male ; Ossification, Heterotopic/diagnosis/pathology/*surgery ; Tomography, X-Ray Computed

A 26-year-old male presented with a 6-day history of paroxysmal headache which was worsen with nausea and vomiting for 1 day. Head CT on admission revealed left chronic subdural hematoma with midline shift. An emergency Burr hole drainage for hematoma was performed. Headache recurred 6 days later. MRI of the brain revealed a diffuse thickening and a gadolinium-enhancement of the falx, cranial dura mater and tentorium cerebelli on the left side with pia mater involved. Lumber puncture showed increased intracranial pressure and elevated IgG level in cerebrospinal fluid. Histological examination of the biopsy specimen showed thickened, fibrotic dura with a sterile chronic inflammation. According to pathological examination, idiopathic hypertrophic cranial pachymeningitis was considered as the final diagnosis. Symptoms were improved with steroid pulse therapy.
Adult ; Biopsy ; Brain ; pathology ; Drainage ; Dura Mater ; pathology ; Hematoma, Subdural, Chronic ; etiology ; surgery ; Humans ; Hypertrophy ; diagnosis ; Immunoglobulin G ; cerebrospinal fluid ; Intracranial Hypertension ; etiology ; Magnetic Resonance Imaging ; Male ; Meningitis ; diagnosis ; Steroids ; administration & dosage ; therapeutic use ; Tomography, X-Ray Computed

OBJECTIVETo observe the effect of Panax notoginseng (PN) on pathological features in chronic subdural hematoma (CSDH) rabbits and its mechanisms.

METHODSA stable pathological animal model similar to CSDH in humans could be established using subdural injections of small number of blood through a subdural pre-catheter in rabbits. After successful modeling, 18 rabbits were randomly divided into the model group, the low dose PN group (0.125 g/kg), and the high dose PN group (0.250 g/kg), 6 in each group. Normal saline was given to rabbits in the model group, while PN power was given to those in the PN groups by gastrogavage for 6 successive days. Pathologic features of the hematoma outer membrane were observed by HE staining. The activity of SOD and the content of MDA in the hematoma outer membrane were examined by the colorimetric method. Expressions of CD31, CD34, and VEGF in the hematoma outer membrane were observed by immunohistochemical assay. Expressions of VEGF in the peripheral blood and the subdural hematoma were detected by enzyme-linked immunosorbent assay (ELISA). Expressions of VEGFR-1 and VEGFR-2 in the hematoma outer membrane were detected by Western blot.

RESULTSCompared with the model group, the inflammatory reaction was comparatively lessen and the proliferation of the fibrous tissue was relatively mature in the low and high dose PN groups. The activity of SOD increased (P < 0.05); expressions of CD31 and CD34 were reduced (P < 0.01); VEGF expression in the residual hematoma fluid decreased (P < 0.05) in the high dose PN group. Expressions of VEGF and VEGFR-2 were all reduced in the high and low dose PN groups (P < 0. 05, P < 0.01). Compared with the low dose PN group, expressions of CD31 and CD34 were reduced (P < 0.01), and the VEGFR-2 expression was also reduced (P < 0.05) in the high dose PN group.

CONCLUSIONSPN could promote the fibrous repairing of subdural hematoma in CSDH rabbits. It also lessened inflammation and oxidative injury of the hematoma outer membrane and reduced expressions of VEGF. The pathological angiogenesis could be reduced through influencing VEGFR-2 receptor pathways, which might be an important mechanism.

Animals ; Disease Models, Animal ; Drugs, Chinese Herbal ; pharmacology ; Hematoma, Subdural, Chronic ; metabolism ; pathology ; Panax notoginseng ; chemistry ; Rabbits ; Vascular Endothelial Growth Factor A ; metabolism ; Vascular Endothelial Growth Factor Receptor-1 ; metabolism ; Vascular Endothelial Growth Factor Receptor-2 ; metabolism