Chronic subdural hematomas (CSHs) are generally regarded to be a traumatic lesion. It was regarded as a stroke in 17th century, an inflammatory disease in 19th century. From 20th century, it became a traumatic lesion. CSH frequently occur after a trauma, however, it cannot occur when there is no enough subdural space even after a severe head injury. CSH may occur without trauma, when there is sufficient subdural space. The author tried to investigate trends in the causation of CSH. By a review of literature, the author suggested a different view on the causation of CSH. CSH usually originated from either a subdural hygroma or an acute subdural hematoma. Development of CSH starts from the separation of the dural border cell (DBC) layer, which induces proliferation of DBCs with production of neomembrane. Capillaries will follow along the neomembrane. Hemorrhage would occur into the subdural fluid either by tearing of bridge veins or repeated microhemorrhage from the neomembrane. That is the mechanism of hematoma enlargement. Trauma or bleeding tendency may precipitate development of CSH, however, it cannot lead CSH, if there is no sufficient subdural space. The key determinant for development of CSH is a sufficient subdural space, in other words, brain atrophy. The most common and universal cause of brain atrophy is the aging. Modifying Virchow's description, CSH is sometimes traumatic, but most often caused by degeneration of the brain. Now, it is reasonable that degeneration of brain might play pivotal role in development of CSH in the aged persons.
Aging ; Atrophy ; Brain ; Capillaries ; Classification ; Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural, Acute ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Intracranial Pressure ; Stroke ; Subdural Effusion ; Subdural Space ; Tears ; Veins

A case of chronic subdural hematoma aggravated after cervical myelography is reported. The patient was recovered after simple drainage of the hematoma. Various complications of lumbar puncture and myelography are reviewed.
Drainage ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Myelography* ; Spinal Puncture

Chronic subdural hematomas mainly occur amongst elderly people and usually develop after minor head injuries. In younger patients, subdural collections may be related to hypertension, coagulopathies, vascular abnormalities, and substance abuse. Different techniques can be used for the surgical treatment of symptomatic chronic subdural hematomas : single or double burr-hole evacuation, with or without subdural drainage, twist-drill craniostomies and classical craniotomies. Failure of the brain to re-expand, pneumocephalus, incomplete evacuation, and recurrence of the fluid collection are common complications following these procedures. Acute subdural hematomas may also occur. Rarely reported hemorrhagic complications include subarachnoid, intracerebral, intraventricular, and remote cerebellar hemorrhages. The causes of such uncommon complications are difficult to explain and remain poorly understood. Overdrainage and intracranial hypotension, rapid brain decompression and shift of the intracranial contents, cerebrospinal fluid loss, vascular dysregulation and impairment of venous outflow are the main mechanisms discussed in the literature. In this article we report three cases of different post-operative intracranial bleeding and review the related literature.
Aged ; Brain ; Cerebrospinal Fluid ; Craniocerebral Trauma ; Craniotomy ; Decompression ; Drainage* ; Hematoma, Subdural, Acute ; Hematoma, Subdural, Chronic* ; Hemorrhage ; Humans ; Hypertension ; Intracranial Hypotension ; Pneumocephalus ; Recurrence ; Subarachnoid Hemorrhage ; Substance-Related Disorders

Complications after surgery for chronic subdural hematoma (SDH) include recurrence of the hematoma, tension pneumoencephalus and intracerebral hematoma. We report an unusual case of development bilateral of acute subdural hematoma after drainage of chronic subdural hematoma in a 48-year-old woman. Pathophysiological mechanisms of this uncommon entity are discussed and relevant literature is reviewed.
Drainage ; Female ; Hematoma ; Hematoma, Subdural, Acute* ; Hematoma, Subdural, Chronic* ; Humans ; Middle Aged ; Recurrence

A case of traumatic acute bilateral subdural hematoma with different times is expierenced. The contralateral shbural hematoma was developed during the evacuation of an acute subdural hematoma. The reduction of intracranial pressure after removal of subdural hematoma was postulated to be contributing factor to formation of the contralateral subdural hematoma.
Craniocerebral Trauma ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Acute* ; Intracranial Pressure

We experienced 2 cases of caute subdural hematoma with tentorial herniation due to ruptured posterior communicating artery aneurysm. Based on a review of the literature and the clinical course in the present cases, recommend therapy consist of early evacuation of hematoma and clipping of aneurysm because of the not infrequent development of rapid deterioration.
Aneurysm ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Acute ; Intracranial Aneurysm*

A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.
Brain ; Emergencies ; Glasgow Coma Scale ; Headache ; Hematoma ; Hematoma, Subdural* ; Hematoma, Subdural, Acute ; Hemorrhage ; Heparin ; Humans ; Intensive Care Units ; Intracranial Pressure ; Kidney Failure, Chronic ; Mannitol ; Middle Aged ; Neurologic Examination ; Renal Dialysis* ; Renal Replacement Therapy ; Seizures ; Tomography, X-Ray Computed ; Trephining ; Vomiting

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.
Adult ; Anesthesia, Spinal ; Brain ; Cerebrospinal Fluid ; Diagnosis ; Drainage ; Emergencies ; Female ; Headache ; Headache Disorders* ; Hematoma ; Hematoma, Subdural, Chronic* ; Humans ; Intracranial Hypotension ; Magnetic Resonance Imaging

OBJECTIVE: The conscious patients with a small amount of acute subdural hematoma had no neurological deterioration are managed conservatively. Most of them are resolved spontaneously in several weeks without surgery. In our experience, however, some progressed to chronic stage requiring surgical treatment in a few days, unlike chronic subdural hematoma derived from acute hematoma following several weeks or months after head trauma. We aimed to analyse this phenomenon and associated the risk factor comparing with the chronic subdural hematomas. METHODS: Retrospective analysis of 175 alert patients with unilateral acute subdural hematoma identified among 661 patients diagnosed the acute subdural hematoma from October 2009 to September 2012 was performed. Univariate and multivariate analyses were performed to describe the relationships between progression to chronic stage requiring surgery from small amount of acute subdural hematoma and clinical characteristics and radiologic features. RESULTS: Eighteen patients (10.3%) showed neurological deterioration due to progression to chronic stage of acute subdural hematoma and underwent a surgical treatment. The mean time interval between the head trauma and development of neurological symptoms was 12.7 days. Univariate and multivariate analyses found that depth of hematoma and degree of brain swelling were a risk factor for progression to chronic stage requiring surgery from the acute subdural hematoma. CONCLUSION: In spite of the conscious patients with acute subdural hematoma not requiring surgical decompression, the more amount of hematoma and the severer brain swelling, there is higher probability of neurological deterioration caused by the progression to chronic stage in a few days.
Brain Edema ; Craniocerebral Trauma ; Decompression, Surgical ; Hematoma ; Hematoma, Subdural, Acute* ; Hematoma, Subdural, Chronic ; Humans ; Multivariate Analysis ; Retrospective Studies ; Risk Factors

Subdural hematoma is a serious but rare complication of spinal anesthesia. A 70-year-old woman patient underwent elective total knee replacement under spinal anesthesia. At 4 days postoperatively, the patient complained of headache and vomiting. Brain computed tomography revealed an acute-on-chronic subdural hematoma with midline shift. The patient recovered completely after surgical decompression. We report a patient with an undiagnosed chronic subdural hematoma, who developed acute-on-chronic subdural hematoma after spinal anesthesia.
Aged ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee ; Brain ; Decompression, Surgical ; Female ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Chronic ; Humans ; Vomiting