Acute subdural hematoma (ASDH) constitutes one of the most critical emergencies in neurosurgery and rapid spontaneous resolution of ASDH is an infrequent phenomenon. Several mechanisms have been attributed to explain this phenomenon including redistribution of subdural blood, dilution by cerebral spinal fluid and brain atrophy. Rapid resolution of ASDH related to coagulopathy is a rare phenomenon; to our knowledge, only one case has been reported. We report on a patient who showed rapid resolution of ASDH with coagulopathy and also discuss such a rare case with speculation of the coagulopathy as a factor to promote this phenomenon.
Atrophy ; Blood Coagulation Disorders ; Brain ; Emergencies ; Hematoma, Subdural, Acute* ; Humans ; Liver Cirrhosis* ; Neurosurgery

OBJECTIVE: According to the development of endovascular technique and devices, larger aneurysms on the distal internal carotid artery (ICA) can be treated using a less invasive method. The authors report on clinical and angiographic outcomes of these aneurysms treated using an endovascular technique. MATERIALS AND METHODS: Data on 21 patients with large aneurysms at distal ICA treated by endovascular method between January 2005 and December 2012 were included in this retrospective analysis. RESULTS: Clinical outcome of patients showed strong correlation with the initial neurologic status (p < 0.05). Aneurysm morphology showed saccular, fusiform, and wide-neck in 12, six and three patients. Six patients underwent stent assisted coiling and the other 15 patients underwent simple coiling. Aneurysm occlusion was performed immediately after embolization with near-complete (Raymond class 1-2) in 20 patients (95.2%) and incomplete (Raymond class 3) in one patient (4.8%). Delayed thrombotic occlusion occurred in two patients and their clinical result was fatal. Another five patients died in the hospital, from massive brain edema and/or increased intracranial pressure due to initial subarachnoid hemorrhage. Overall mortality was 30% (seven out of 21). Fatal complication related to the endovascular procedure occurred in two patients with thrombosis at middle cerebral artery (one with stent, the other without it). CONCLUSION: Recent developed endovascular device and technique is safe enough and a less invasive method for distal large or giant aneurysms. Based on our analysis of the study, we suspect that coil embolization of large distal ICA aneurysms (with or without stenting) is effective and safe.
Aneurysm* ; Brain Edema ; Carotid Artery, Internal* ; Embolization, Therapeutic ; Endovascular Procedures ; Humans ; Intracranial Pressure ; Middle Cerebral Artery ; Mortality ; Retrospective Studies ; Stents ; Subarachnoid Hemorrhage ; Thrombosis

ST-segment elevation myocardial infarction (STEMI) is a disease decribed by typical chest pain, ST-segment elevation on eletrocardiogram, elevated cardiac enzymes, along with wall motion abnormality under echocardiographic findings, and it is caused by vulnerable plaques. However, stress induced cardiomyopathy (SICM) may show similar clinical symptoms, but specific echocardiographic findings (i.e. transient left ventricular regional wall motion abnormalities with peculiar apical ballooning appearance) and normal coronary angiography may differentiate it from STEMI. Therefore, one may mistake STEMI for SICM, and lead to serious error in diagnosis and treatment of the disease. We report a case of STEMI mimicking SICM, and suggest an idea to approach the patient with SICM.
Cardiomyopathies ; Chest Pain ; Coronary Angiography ; Humans ; Myocardial Infarction