The majority of acute post-traumatic subdural hematomas (ASDH) require urgent surgical evacuation. Spontaneous resolution of ASDH has been reported in some cases. We report here on a case of a patient with a large amount of ASDH that was rapidly reduced. A 61-yr-old man was found unconscious following a high speed motor vehicle accident. On initial examination, his Glasgow Coma Score scale was 4/15. His pupils were fully dilated and non-reactive to bright light. Brain computed tomography (CT) showed a massive right-sided ASDH. The decision was made to treat him conservatively because of his poor clinical condition. Another brain CT approximately 14 hr after the initial scan demonstrated a remarkable reduction of the previous ASDH and there was the new appearance of high density in the subdural space adjacent to the falx and the tentorium. Thirty days after his admission, brain CT revealed chronic SDH and the patient underwent surgery. The patient is currently able to obey simple commands. In conclusion, spontaneous rapid resolution/reduction of ASDH may occur in some patients. The mechanisms are most likely the result of dilution by cerebrospinal fluid and the redistribution of hematoma especially in patients with brain atrophy.
Accidents, Traffic ; Atrophy ; Brain/pathology ; Glasgow Coma Scale ; *Hematoma, Subdural, Acute/pathology/physiopathology/surgery ; Humans ; Male ; Middle Aged ; Subdural Space/radiography ; Treatment Outcome

A 43-year-old female presented with persistent headache and dizziness which had first occurred two years earlier. The physical and neurological findings at admission were unremarkable, though plain radiography revealed the presence of a dense calcified mass in the left frontal area, and CT showed that a homogeneous high-density nodule was attached to the inner surface of the left frontal skull. The hard bony mass found and excised during surgery was shown at histopathologic examination to be a subdural osteoma. We describe the clinicopathologic findings of this entity and discuss the radiological features which suggest its subdural location.
Adult ; Case Report ; Female ; Frontal Bone/*pathology/*radiography/surgery ; Human ; Osteoma/*pathology/*radiography/surgery ; Skull Neoplasms/*pathology/*radiography/surgery ; Subdural Space/pathology/radiography/surgery ; Tomography, X-Ray Computed

Acute subdural hematoma (ASDH), chronic subdural hematoma (CSDH) and subdural hygroma (SDG) occur in the subdural space, usually after trauma. We tried to find a certain relationship among these three traumatic subdural lesions in 436 consecutive patients. We included all subdural lesions regardless of whether they were main or not. We evaluated the distribution, age incidence and interval from injury to diagnosis of these lesions, and the frequency of new subdural lesions in each lesion. ASDH constituted 68.6%, SDG 15.8%, and CSDH 15.6%, Age incidence of CSDH was similar to that of SDG, but differed from that of ASDH. Mean interval from injury to diagnosis was 0.4 days in ASDH, 13.4 days in SDG, and 51.6 days in CSDH. Focal brain injuries accompanied in 37.5% of ASDH, 5.8% of SDG, and no CSDH. In ASDH, 2 recurrent ASDHs, 17 SDGs and 9 CSDHs occurred. In SDG, 3 postoperative ASDHs and 8 CSDHs occurred. In CSDH, 2 postoperative ASDHs, 2 SDGs and 1 CSDH occurred. These results suggest that the origin of CSDH is not only ASDH, but also SDG in upto a half of cases. SDG is produced as an epiphenomenon by separation of the dural border cell layer when the potential subdural space is sufficient. A half of CSDHs may originate from ASDHs. ASDH may occur in CSDH by either a repeated trauma or surgery. Such transformation or development of new lesions is a function of a premorbid condition and the dynamics between the absorption capacity and expansile force of the lesion.
Adolescent ; Adult ; Age Factors ; Aged ; Brain Injuries/complications/pathology ; Child ; Female ; Glasgow Coma Scale ; Hematoma, Subdural/etiology/*pathology/therapy ; Human ; Male ; Middle Age ; Subdural Space/*pathology ; Tomography Scanners, X-Ray Computed

To investigate the epileptogenic foci in dysembryoplastic neuroepithelial tumor (DNT) in the temporal lobe, we studied extraoperative electrocorticography (ECoG) with subdural electrode arrays from nine patients with intractable epilepsy due to temporal DNT. Ictal onset zones and irritative zones were decided by the ECoG. The locations of these zones were compared to the location of the tumor. The number of ictal onset zone and irritative zone was 2.1+/-0.93 and 2.9+/-.45 in a patient with a DNT. They were detected more frequently in the adjacent tissues of the tumor (88.9%) rather than within the tumor or in mesial temporal area (66.7%). Mesial temporal involvement was found in 6 patients (66.7%) as an ictal onset zone, and in 5 (55.6%) as an irritative zone. The 7 patients (77.8%) had ictal onset zone in areas different from active irritative zone. The surgical outcome was better, when ictal onset zone was completely resected rather than partially removed. Temporal DNT can make multiple ictal onset zones and irritative zones in different regions including the mesial temporal area. Deliberate resection of epileptogenic foci, including all ictal onset zones and irritative zones, ensures excellent seizure control.
Adolescent ; Adult ; Brain/pathology ; Brain Neoplasms/*complications/surgery ; Child ; Electroencephalography/*methods ; Epilepsy, Temporal Lobe/*etiology/*pathology/surgery ; Female ; Human ; Male ; Middle Aged ; Models, Anatomic ; Neoplasms, Neuroepithelial/*complications/surgery ; Subdural Space ; Temporal Lobe/pathology ; Time Factors

BACKGROUND: It is important to control of intracranial pressure(ICP) in patients with intracranial pathology. To decrease ICP and to attenuate the adverse cardiovascular reflexes associated with anesthetic induction and tracheal intubation, we are often administered potent opiates during anesthetic induction. A side effect of these agents when used in large doses is muscle rigidity. We investigated the effects of high dose fentanyl on ICP, central venous pressure (CVP) and mean arterial pressure (MAP) during fentanyl-induced rigidity in rabbits. METHODS: Under halothane anesthesia, polyethylene catheters were surgically inserted into the femoral artery and vein for measurement of MAP and CVP in 10 rabbits. ICP was measured between epidural and subdural space through the burr hole of the frontal bone by means of fiberoptic ICP monitor. The animals were mechanically ventilated to achieve normocarbia. Following instrumentation, halothane was discontinued and fentanyl 50 microgram/kg administered intravenously at the first movement during emergence from halothane anesthesia. RESULTS: In the seven rabbits that developed rigidity, ICP and CVP were increased significantly compared to control value (delta ICP 9.2+/-1.9 mmHg, delta CVP 5.0+/-0.9 cmH2O: P<0.05). But MAP was decreased significantly from 95+/-5 to 74+/-4 mmHg (P<0.05). These variables except MAP were returned to baseline when rigidity was abolished with vecuronium. In three rabbits that did not show rigidity, ICP and CVP did not change following injection of fentanyl. But MAP in the non-rigidity group was significantly decreased like the rigidity group (P<0.05). CONCLUSIONS: These observations suggest that rigidity should be prevented when opiates like fentanyl are used as an induction drug of patients with ICP problems.
Anesthesia ; Anesthetics ; Animals ; Arterial Pressure ; Catheters ; Central Venous Pressure ; Femoral Artery ; Fentanyl ; Frontal Bone ; Halothane ; Humans ; Intracranial Pressure* ; Intubation ; Muscle Rigidity ; Pathology ; Polyethylene ; Rabbits* ; Reflex ; Subdural Space ; Vecuronium Bromide ; Veins