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

Acute subdural hematoma is an exceptionally rare, but life-threatening complication of spinal anesthesia. The authors report here on a case of acute subdural hematoma in a 52-year-old male who underwent an arthroscopic knee joint operation under spinal epidural anesthesia due to tearing of the medial meniscus. He complained of headache after surgery. Computed tomography(CT) revealed acute subdural hematoma in the right fronto-tempo-parietal area. The headache progressed in spite of analgesics and bed rest; two weeks later, the CT showed subacute subdural hematoma with a mass effect. The patient improved after surgical decompression. The pathogenesis of subdural hematoma formation after dural puncture is discussed and we briefly review the relevant literature. Prolonged and severe postdural puncture headache(PDPH) should be viewed with suspicion and investigated promptly to rule out any intracranial complications. Immediate treatment of the PDPH with an epidural blood patch to prevent further CSF leakage should be considered.
Analgesics ; Anesthesia, Epidural* ; Anesthesia, Spinal ; Bed Rest ; Blood Patch, Epidural ; Decompression, Surgical ; Headache ; Hematoma, Subdural ; Hematoma, Subdural, Acute* ; Humans ; Knee Joint ; Male ; Menisci, Tibial ; Middle Aged ; Punctures*

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.
Adult ; Anesthesia, Spinal ; Blood Patch, Epidural* ; Epidural Space ; Headache ; Hematoma, Subdural ; Humans ; Intracranial Hypotension* ; Male ; Spine

Spontaneous intracranial hypotension is a syndrome characterized by postural headache without trauma, spinal anesthesia or other medical history. The headache is usually resolved in a few days or weeks if the patient remains in bed with good hydration. Relief can usually be obtained by the application of a blood patch, by injecting 10-20 ml of the patient's own blood into the epidural space close to the leakage site. In the overwhelming majority of patients, the leak is at the level of the spine, particularly the thoracic spine and cervicothoracic junction. Spontaneous intracranial hypotension presenting with mental change has rarely been reported. We report a 39 years old male patient who was diagnosed with spontaneous intracranial hypotension. The patient experienced continuous headache followed by slight mental change. The patient was successfully managed by 3 episodes of epidural blood patch.
Adult ; Anesthesia, Spinal ; Blood Patch, Epidural* ; Epidural Space ; Headache ; Hematoma, Subdural ; Humans ; Intracranial Hypotension* ; Male ; Spine

Spinal epidural and subdural hematomas are uncommonly recognized conditions. These conditions can result in severe irreversible neurologic deficits, if left untreated. Like intracranial lesions, these hematomas can expand rapidly and cause sudden spinal cord and/or cauda equina compression. This case is very rare in which is a concurrence of cervical spinal epidural and subdural hematoma after motor vehicle accident without spine fracture. The pathophysiology of these entities are discussed and the radiologic diagnosis focused on MR findings are reviewed. The importance of prompt surgical treatment is emphasized to facilitate good postoperative outcome.
Cauda Equina ; Diagnosis ; Hematoma ; Hematoma, Epidural, Spinal ; Hematoma, Subdural* ; Hematoma, Subdural, Spinal ; Motor Vehicles ; Neurologic Manifestations ; Spinal Cord ; Spine*

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

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*

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