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Neurosurgical Review Oct 2022Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs)....
Postoperative seizures are a frequently occurring yet not well-understood complication in patients undergoing surgical treatment of chronic subdural haematomas (cSDHs). Therefore, we investigated surgical and non-surgical risk factors that are commonly considered causal in provoking epileptic seizures, paying special attention to the intracranial course of the subdural drain (SDD) and the configuration of the haematoma. Data of patients with a cSDH, that were treated at our neurosurgical department between 2008 and 2014 were analysed. Patients suffering from severe pre-existing conditions and those who have been treated conservatively were excluded. Epidemiologic data as well as relevant clinical data were collected. Pre- and postoperative CT scans were analysed regarding morpho- and volumetric parameters. In order to objectify the influence of the SDD, its intracranial course and localisation (entering angle as well as the angle between drain and brain surface) were measured. For statistical analysis, univariate and multiple logistic regression models as well as Fisher's exact test were used. Two hundred eleven consecutive patients have been included. Mean age was 75.6 years, and 69% were male. Nineteen (9%) patients suffered from postsurgical seizures. Membranes within the haematoma were present in 81.5%. Pre- to postoperative haematoma reduction was significant (mean of difference - 12.76 mm/ - 9.47 mm in coronal/axial CT planes, p = 0.001/ < 0.001). In 77.9%, SDD showed cortical contact with eloquent regions and had an unfavourable course in 30 cases (14.2%). Surgical complications consisted of cortical bleeding in 2.5%, fresh subdural haematoma in 33.5% and wound infections in 1.4% of patients. Neither in univariate nor in multiple regression analyses any of the following independent variates was significantly correlated with postsurgical seizures: pre-existing epilepsy, alcohol abuse, right-sided haematomas, localization and thickness of haematoma, presence of septations, SDD-localization and to-brain angle, subdural air, and electrolyte levels. Instead, in multiple regression analyses, we found the risk of postsurgical seizures to be significantly correlated and increased with left-sided cSDH treated via craniotomy (p = 0.03) and an unfavourable course of the SDD in left-sided cSDH (p = 0.033). Burr hole trepanation should be preferred over craniotomy and care must be taken when placing a SDD to avoid irritating cortical tissue. The configuration of the haematoma does not appear to affect the postoperative seizure rate.
Topics: Aged; Drainage; Electrolytes; Female; Hematoma; Hematoma, Subdural, Chronic; Humans; Male; Postoperative Complications; Risk Factors; Seizures
PubMed: 36097085
DOI: 10.1007/s10143-022-01858-5 -
Journal of Neurointerventional Surgery May 2022Evidence is growing to support minimally invasive surgical evacuation of intraparenchymal hematomas, particularly those with minimal residual hematoma volumes following... (Review)
Review
Evidence is growing to support minimally invasive surgical evacuation of intraparenchymal hematomas, particularly those with minimal residual hematoma volumes following evacuation. To maximize the potential for neurologic recovery, it is imperative that the trajectory for access to the hematoma minimizes disruption of normal parenchyma. Flat panel detector CT-based navigation and needle guidance software provides a platform that uses flat panel detector CT imaging obtained on the angiography table to aid reliable and safe access to the hematoma. In addition to providing a high degree of accuracy, this method also allows convenient and rapid re-imaging to assess navigation accuracy and the degree of hematoma evacuation prior to procedural completion. We provide a practical review of the iGuide needle guidance software and the methodology for incorporating its use, and the software of other vendors, in a variety of minimally invasive methods for evacuation of intraparenchymal hematomas.
Topics: Cerebral Hemorrhage; Hematoma; Humans; Minimally Invasive Surgical Procedures; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 34635580
DOI: 10.1136/neurintsurg-2021-017903 -
BioMed Research International 2017Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage and leads to high rates of mortality and morbidity. Currently,... (Review)
Review
Hematoma expansion (HE) occurs in approximately one-third of patients with intracerebral hemorrhage and leads to high rates of mortality and morbidity. Currently, contrast extravasation within hematoma, termed the spot sign on computed tomography angiography (CTA), has been identified as a strong independent predictor of early hematoma expansion. Past studies indicate that the spot sign is a dynamic entity and is indicative of active hemorrhage. Furthermore, to enhance the spot sign's accuracy of predicting HE, spot parameters observed on CTA or dynamic CTA were used for its quantification. In addition, spot signs detected on multiphase CTA and dynamic CTA are shown to have higher sensitivity and specificity when compared with simple standardized spot sign detection in recent studies. Based on the spot sign, novel methods such as leakage sign and rate of contrast extravasation were explored to redefine HE prediction in combination with clinical characteristics and spot sign on CTA to assist clinical judgment. The spot sign is an accepted independent predictor of active hemorrhage and is used in both secondary intracerebral hemorrhage and the process of surgical assessment for hemorrhagic risk in patients with ischemic stroke. Spot sign predicts patients at high risk for hematoma expansion.
Topics: Brain; Cerebral Hemorrhage; Computed Tomography Angiography; Hematoma; Humans; Predictive Value of Tests
PubMed: 28852647
DOI: 10.1155/2017/4137210 -
The Journal of International Medical... Jun 2016To measure the differential expression of microRNAs (miRNAs) in peripheral blood samples from patients with intracerebral haemorrhage (ICH) and to measure the levels of...
OBJECTIVE
To measure the differential expression of microRNAs (miRNAs) in peripheral blood samples from patients with intracerebral haemorrhage (ICH) and to measure the levels of hsa-miR-21-5p in peripheral blood and haematoma samples from patients with ICH.
METHODS
This case-control study enrolled individuals with ICH in the putamen treated by craniotomy and age- and sex-matched healthy control subjects. Serum miRNA expression profiles were determined in the patient and control groups using miRNA polymerase chain reaction (PCR) arrays. The ICH-related miRNA hsa-miR-21-5p was selected and its differential expression was assessed in peripheral blood and haematoma specimens from patients with ICH compared with peripheral blood samples controls using real-time PCR.
RESULTS
Seven patients and five control subjects were included in the miRNA expression profile analysis; and 31 patients and 22 control subjects provided samples for the real-time PCR of hsa-miR-21-5p expression. A total of 59 miRNAs were significantly downregulated in patients with ICH. Relative hsa-miR-21-5p levels of 0.43 and 0.31 for peripheral blood and haematoma samples, respectively, were obtained in the patient group compared with the control subjects.
CONCLUSION
Hsa-miR-21-5p levels were significantly reduced in both peripheral blood and haematoma samples in patients with ICH.
Topics: Case-Control Studies; Cerebral Hemorrhage; Demography; Female; Gene Expression Profiling; Gene Expression Regulation; Hematoma; Humans; Male; MicroRNAs; Middle Aged; Real-Time Polymerase Chain Reaction
PubMed: 27020596
DOI: 10.1177/0300060516630852 -
BMJ Case Reports Dec 2023Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without...
Epidural anaesthesia is widely used in major thoracic and abdominal surgery for postoperative analgesia. Spinal haematoma after epidural anaesthesia in patients without risk factors is very rare. Most of the reported spinal haematomas arose in the epidural space, whereas the subdural localization seen in this case is very uncommon.We report a case of spinal subdural haematoma after difficult and repeated placement of an epidural catheter for postoperative analgesia. As no sensorimotor deficit of the lower limb arose, we refrained from immediate neurosurgical decompression and the patient recovered fully in the course. Nevertheless, any kind of spinal haematoma is a serious complication we should always be aware of. Prompt detection of clinical symptoms such as sensory or motor deficit is most important. Further diagnostic steps and treatment should not be delayed to avoid permanent neurological deficits.
Topics: Humans; Hematoma; Hematoma, Subdural; Anesthesia, Epidural; Risk Factors
PubMed: 38160037
DOI: 10.1136/bcr-2023-255104 -
Pediatrics and Neonatology Jan 2023
Topics: Humans; Duodenal Diseases; Gastrointestinal Hemorrhage; Hematoma
PubMed: 36002379
DOI: 10.1016/j.pedneo.2022.07.003 -
Scientific Reports Feb 2022MR imaging provides awareness for rectoprostatic hematomas as a complication in prostate biopsy. We evaluated the frequency and size of clinically silent bleeding after... (Observational Study)
Observational Study
MR imaging provides awareness for rectoprostatic hematomas as a complication in prostate biopsy. We evaluated the frequency and size of clinically silent bleeding after in-bore MRI-guided prostate biopsy according to documentation in MRI. From 2007 until 2020 in-bore MRI-guided prostate biopsy was performed in 283 consecutive patients with suspected prostate cancer. Interventional image documentation was reviewed for rectoprostatic hematomas and rectal blood collections in this retrospective observational single-center study. Correlation to patient characteristics was analyzed using a multivariable logistic regression model. 283 consecutive patients with a mean age of 66 ± 8 years were included. We diagnosed bleeding complications in 41 (14.5%) of the patients. Significant rectoprostatic hematomas were found in 24 patients. Intra-rectal blood collections were observed in 16 patients and one patient showed bleeding in the urinary bladder. The volume of rectoprostatic hematomas was determined with a median of 7.5 ml (range 2-40 ml, IQR 11.25). We found no correlation between the presence of a rectoprostatic hematoma and malignant findings, patient position in biopsy, number of cores, age, prostate volume nor PSA density (p > 0.05). Rectoprostatic hematomas and rectal blood collections are rare complications after in-bore MR-guided prostate biopsy. MR imaging provides benefits not only for lesion detection in prostate biopsy but also for the control of bleeding complications, which can be overlooked in standard TRUS biopsy. Their significance in pain, erectile dysfunction, and urinary retention remains to be investigated.
Topics: Adult; Aged; Aged, 80 and over; Hematoma; Hemorrhage; Humans; Image-Guided Biopsy; Magnetic Resonance Imaging, Interventional; Male; Middle Aged; Predictive Value of Tests; Prostate; Retrospective Studies; Risk Assessment; Risk Factors
PubMed: 35115642
DOI: 10.1038/s41598-022-05909-1 -
BMJ Case Reports Feb 2020Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes...
Spontaneous rupture of an intercostal artery is exceptionally rare. It can be complicated by haemothorax, haematoma and/or retroperitoneal haemorrhage, which contributes to its morbidity and mortality. The authors report a case of a 76-year-old patient who was referred to the emergency department for pain associated with the appearance of a mass with progressive growth for 2 days in the right subscapular region. The patient had no previous history of trauma, ecchymosis or noticeable skin changes. History included the use of acetylsalicylic acid and a history of heart failure, as well as haemodialysis due to stage 5 chronic renal disease. CT scan showed an active haemorrhage from an artery in the fifth intercostal space. Embolisation was performed with microspheres and microcoils. No complications or recurrent bleeding was observed. Spontaneous rupture of an intercostal artery is rare, but it is an emergency requiring immediate diagnosis and intervention.
Topics: Aged; Computed Tomography Angiography; Embolization, Therapeutic; Hematoma; Hemorrhage; Hemothorax; Humans; Male; Microspheres; Rupture, Spontaneous; Thoracic Arteries; Treatment Outcome; Vascular Diseases
PubMed: 32060114
DOI: 10.1136/bcr-2019-233242 -
Annals of the Royal College of Surgeons... Sep 2021Spontaneous intestinal intramural haematomas are uncommon in the absence of trauma and may occur in those on anticoagulation. A young girl presented with generalised...
Spontaneous intestinal intramural haematomas are uncommon in the absence of trauma and may occur in those on anticoagulation. A young girl presented with generalised abdominal pain and was found to have pneumoperitoneum. She underwent an exploratory laparotomy and was found to have multiple ileal intramural haematomata with an area of possible perforation with a collection of pus. We believe that this is the first reported case of a rupture of spontaneous intestinal intramural haematoma in a young girl with no history of anticoagulation use or coagulation disorders.
Topics: Abdominal Pain; Adolescent; Female; Hematoma; Humans; Ileal Diseases; Pneumoperitoneum; Rupture, Spontaneous; Tomography, X-Ray Computed; Vomiting
PubMed: 34464559
DOI: 10.1308/rcsann.2020.7039 -
Role of mass effect and trehalose on early erythrolysis after experimental intracerebral hemorrhage.Journal of Neurochemistry Jan 2022The mechanisms of brain injury after intracerebral hemorrhage (ICH) involve mass effect-induced primary injury and secondary injury caused by a pathologic response to...
The mechanisms of brain injury after intracerebral hemorrhage (ICH) involve mass effect-induced primary injury and secondary injury caused by a pathologic response to the hematoma. Considerable attentions have recently been paid to the mechanisms and therapeutic strategy for secondary brain injury due to no overall benefit from early surgery compared with initial conservative treatment. However, it is unclear whether there is a causal relationship between mass effect and secondary brain injury. Here, the role of mass effect on early erythrolysis after experimental ICH was investigated based on the poly(N-isopropylacrylamide) (PNIPAM) ICH model. Autologous blood and PNIPAM hydrogel were co-injected into the right basal ganglia of rats to induce different degrees of mass effect, but with a constant hematoma. The influences of different mass effect and time courses on erythrolysis and brain damages after ICH were investigated. Furthermore, the protective effect of trehalose against erythrolysis after ICH was evaluated. The results showed that mass effect caused erythrocyte morphological change at 24 hr after ICH. The released hemoglobin was quantitatively evaluated by a polynomial concerning with the mass effect, the volume of hematoma, and the time of ICH. An obvious increase in heme oxygenase-1 (HO-1) and ionized calcium binding adaptor molecule-1 (Iba-1) expression, iron deposition, cell death, and neurological deficits was observed with increasing mass effect. Moreover, trehalose alleviated brain injury by inhibiting erythrolysis after ICH. These data demonstrated that mass effect accelerated the erythrolysis and brain damages after ICH, which could be relieved through trehalose therapy.
Topics: Animals; Cerebral Hemorrhage; Disease Models, Animal; Erythrocytes; Hematoma; Male; Rats; Rats, Sprague-Dawley; Trehalose
PubMed: 33797772
DOI: 10.1111/jnc.15361