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

Most cases of spinal subdural hematoma are very rare and result from iatrogenic causes, such as coagulopathy or a spinal puncture. Cases of non-traumatic spinal subdural hematoma accompanied by intracranial hemorrhage are even more rare. There are a few reports of spontaneous spinal subdural hematoma with concomitant intracranial subdural or subarachnoid hemorrhage, but not with intracerebral hemorrhage. Especially in our case, the evaluation and diagnosis were delayed because the spontaneous intracerebral hemorrhage accompanying the unilateral spinal subdural and subarachnoid hemorrhages caused hemiplegia. We report a case of spinal subdural and subarachnoid hemorrhage with concomitant intracerebral hemorrhage, for the first time, with a relevant literature review.
Cerebral Hemorrhage ; Diagnosis ; Hematoma ; Hematoma, Subdural, Spinal ; Hemiplegia ; Intracranial Hemorrhages ; Spinal Puncture ; Subarachnoid Hemorrhage

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

Cerebral hyperperfusion syndrome is a major cause of morbidity and mortality following carotid artery stenting (CAS). We present a case of acute subdural hematoma (SDH) 2 hours after CAS. In this case, arterial origin of bleeding was verified during operation. To our knowledge, there is no prior case report of SDH without intraparenchymal nor subarachnoid hemorrhage subsequent to CAS. We postulate that SDH was caused by sudden rise in intracranial pressure due to the hyperperfusion which disrupted a corticodural bridging artery.
Arteries ; Carotid Arteries* ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Hemorrhage ; Intracranial Pressure ; Mortality ; Stents* ; Subarachnoid Hemorrhage

We had experienced 2 cases of acute subdural hematoma due to vitaimin K(vit. K) deficiency. They were 44-and 42-day-old. After the adminstration of vit.K1, prolonged prothrombin time(PT) and activated partial thromboplastin time(APTT) were corrected, so the surgical treatment ws performed. We supposed the predisposing factors were breast feeding and unknown hepatic pathology. No complication remained to one infant but the other multiple cerebral infarctions. The etiology, pathogenesis, diagnosis, prevention are discussed. We insist on neonatal administration of vit. K1 for the prevention of bleeding tendency. If intracranial hemorrhage develops, we must keep in mind that the early neurosurgical intervention may be needed.
Breast Feeding ; Causality ; Cerebral Infarction ; Diagnosis ; Hematoma, Subdural, Acute* ; Hemorrhage ; Humans ; Infant* ; Intracranial Hemorrhages ; Partial Thromboplastin Time ; Pathology ; Prothrombin ; Prothrombin Time ; Thromboplastin ; Vitamin K Deficiency ; Vitamins*

OBJECTIVE: Spontaneous intracranial hemorrhage is still common cause of death in the hematologic disorder including leukemia. The authors examine laboratory & radiological findings in patients with intracranial hemorrhage caused by hematologic disorder. METHODS: From March 1998 to May 2002, 42 patients with hematologic disease complicated by intracranial hemorrhage were transferred from hematology department. The patients were normotensive and had not trauma history. In all patients, intracranial hemorrhages were diagnosed with the brain computerized tomography. Surgical treatment was performed in one case. RESULTS: Underlying hematologic disorders included aplastic anemia (4), acute myeloblastic leukemia (20), acute lymphoblastic leukemia (6), chronic myeloblastic leukemia (8), myelodysplastic syndrome (2), multiple myeloma (1), and polycythemia vera (1). Intracranial hemorrhage subtypes consisted of intracerebral hemorrhage (39) including mainly subcortical lobar hemorrhage (28), and subarachnoid hemorrhage (3). Twenty (48%) of the 42 patients had multifocal hematomas. Thirty six patients (86%) had moderate and severe thrombocytopenia (less than 100x10(9)/L). Twenty four patients (57%) had moderate and severe leukocytosis (greater than 20x109/L). CONCLUSION: It showed that (1) the risk factors of intracranial hemorrhage in hematologic disorders are thrombocytopenia, leukocytosis and disseminated intravascular coagulopathy ; (2) intracerebral hemorrhage in hematologic disorders occur preferentially in the subcortical portion ; (3) intracranial hemorrhage in hematologic disorders consist of various combinations of subcortical lobar hemorrhage, subarachnoid hemorrhage, subdural hemorrhage and intraventricular hemorrhage ; (4) intracerebral hemorrhage in hematologic disorders tend to be multiple.
Anemia, Aplastic ; Brain ; Cause of Death ; Cerebral Hemorrhage ; Granulocyte Precursor Cells ; Hematologic Diseases ; Hematology ; Hematoma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Intracranial Hemorrhages* ; Leukemia ; Leukemia, Myeloid, Acute ; Leukocytosis ; Multiple Myeloma ; Myelodysplastic Syndromes ; Polycythemia Vera ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; Risk Factors ; Subarachnoid Hemorrhage ; Thrombocytopenia

PURPOSE: This study is to evaluate the Brain CT manifestations of late hemorrhagic disease of the newborn. METHODS: We evaluated 13 cases with late hemorrhagic disease of the newborn, for whom brain CT scans were performed. Clinical indications for brain CT scan were mental changes(n=5), vomiting(n=2), irritability(n=2), seizure(n=3), and lethargy(n=1). We analyzed the result of the brain CT findings with attention to anatomic locations of hemorrhage and characteristics of hemorrhagic manifestations. RESULTS: Only one patient in 13 patients was normal on brain CT scan, and 12 patients showed hemorrhagic lesions. Among 12 patients, 5 cases had single hemorrhagic lesion(3 subdural hemorrhages and 2 intracerebral hemorrhages, and 7 cases had multiple lesions, in which subdural hemorrhage and subarachnoid hemorrhage were common respectively. The other common brain CT findings except hemorrhagic lesion were the mass effects with ventricle compression(n=11), midline shifting(n=6), ventricular dilatation(n=7), and fluid-fluid levels in hemorrhagic lesion(n=9). CONCLUSION: The common intracranial hemorrhages of late hemorrhagic disease of the newborn were subdural and subarachnoid hemorrhages. The associated CT findings were mass effect and fluid-fluid levels. Intracranial hemorrhage in late hemorrhagic disease of newborn could massively occurr. Thus brain CT scan should be done if any symptom for neurologic abnormality was present.
Brain* ; Cerebral Hemorrhage ; Hematoma, Subdural ; Hemorrhage ; Humans ; Infant, Newborn* ; Intracranial Hemorrhages* ; Subarachnoid Hemorrhage ; Tomography, X-Ray Computed ; Vitamin K Deficiency Bleeding

Although there are differences in the mode of onset, symptomatology and clinical course in the various types of cerebrovascular lesions, the general picture may be quite similar and it is often difficult to determine the nature of the lesion in any individual case from the clinical data. In the vast majority of cases the symptoms of a cerebrovascular accident are of sudden onset and reach maximum intensity within few minutes or a few hours at the most. Locksley, et al. have reported autopsies on people who died from spontaneous intracerebral or subarachnoid hemorrhage, and they found that a primary or metastatic brain tumor was the cause of hemorrhage in only 2%~3% of their necropsy. We presented our experience with two such patient whose clinical pictures before the surgery were quite similar with those of cerebrovascular accident. Cases with a large chronic subdural hematoma and cerebral glioblastoma multiforme demonstrated a sudden and dramatic onset of coma and focal neurological symptoms immediately before admission to the hospital. The responsible mechanism or etiology for the mode of such sudden dramatic onset of symptoms may be derangement of intracranial pressure mechanism and sudden hemorrhage in the tumor.
Autopsy ; Brain Neoplasms ; Coma ; Glioblastoma ; Hematoma, Subdural, Chronic ; Hemorrhage ; Humans ; Intracranial Pressure ; Stroke* ; Subarachnoid Hemorrhage

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage.
Arteriovenous Malformations ; Central Nervous System Vascular Malformations ; Cerebral Amyloid Angiopathy ; Cerebral Infarction ; Craniocerebral Trauma ; Hematoma, Subdural ; Hemorrhage ; Humans ; Hypertension ; Intracranial Aneurysm ; Intracranial Hemorrhages* ; Magnetic Resonance Imaging ; Neuroimaging ; Pathology ; Sinus Thrombosis, Intracranial ; Subarachnoid Hemorrhage ; Vasculitis

Chronic subdural hematoma (CSDH) and symptomatic subdural hygroma are common diseases that require neurosurgical management. Burr hole trephination is the most popular surgical treatment for CSDH and subdural hygroma because of a low recurrence rate and low morbidity compared with craniotomy with membranectomy, and twist-drill craniotomy. Many reports suggest that placing a catheter in the subdural space for drainage can further reduce the rate of recurrence; however, complications associated with this type of drainage include acute subdural hematoma, cortical injury, and infection. Remote hemorrhage due to overdrainage of cerebrospinal fluid (CSF) is another possible complication of burr hole trephination with catheter drainage that has rarely been reported. Here, we present 2 cases of remote hemorrhages following burr hole trephination with catheter drainage for the treatment of CSDH and symptomatic subdural hygroma. One patient developed intracerebral hemorrhage and subarachnoid hemorrhage in the contralateral hemisphere, while another patient developed remote hemorrhage 3 days after the procedure due to the sudden drainage of a large amount of subdural fluid over a 24-hour period. These findings suggest that catheter drainage should be carefully monitored to avoid overdrainage of CSF after burr hole trephination.
Catheters ; Cerebral Hemorrhage ; Cerebrospinal Fluid ; Craniotomy ; Drainage* ; Hematoma, Subdural, Acute ; Hematoma, Subdural, Chronic* ; Hemorrhage* ; Humans ; Recurrence ; Subarachnoid Hemorrhage ; Subdural Effusion ; Subdural Space ; Trephining