1/33. Successful treatment of traumatic acute posterior fossa subdural hematoma: report of two cases.BACKGROUND: Acute traumatic subdural hematoma of the posterior cranial fossa after a closed-head injury, excluding those in newborns, is a very rare clinical event. Generally, the outcome is poor and the overall mortality rate is high. methods: Acute posttraumatic subdural hematomas of the posterior fossa associated with acute hydrocephalus in two patients were removed by standard suboccipital approach. Preoperatively, one patient was in a coma and the Glasgow coma Score was 9 in another. CT scans showed obliterated mesencephalic cisterns in both cases. In the former there was a complex posterior fossa lesion, i.e., combined subdural and intracerebellar hematoma. The surgical decompression was completed 3 and 11 hours after injury, respectively. Intraoperative tapping of the lateral ventricle through a burr hole in the occipital area was performed in the latter case. RESULTS: Both patients survived; one made a good recovery, (i.e., glasgow outcome scale 4 in a patient who was comatose on admission), the other did not do as well (GOS 3). CONCLUSIONS: Our experience justifies the policy of mandatory early operation in cases of traumatic acute subdural hematoma of the posterior fossa associated with poor neurologic condition, even in patients of advanced age. In patients with obliterated mesencephalic cisterns and/or complex posterior fossa lesions the same approach must be followed. These clinical and CT features are not necessarily predictors of a poor outcome.- - - - - - - - - - ranking = 1keywords = coma (Clic here for more details about this article) |
2/33. Early rebleeding from intracranial dural arteriovenous fistulas: report of 20 cases and review of the literature.OBJECT: In this study the authors sought to estimate the frequency, seriousness, and delay of rebleeding in a homogeneous series of 20 patients whom they treated between May 1987 and May 1997 for arteriovenous fistulas (AVFs) that were revealed by intracranial hemorrhage (ICH). The natural history of intracranial dural AVFs remains obscure. In many studies attempts have been made to evaluate the risk of spontaneous hemorrhage, especially as a function of the pattern of venous drainage: a higher occurrence of bleeding was reported in AVFs with retrograde cortical venous drainage, with an overall estimated rate of 1.8% per year in the largest series in the literature. However, very few studies have been designed to establish the risk of rebleeding, an omission that the authors seek to remedy. methods: Presenting symptoms in the 20 patients (17 men and three women, mean age 54 years) were acute headache in 12 patients (60%), acute neurological deficit in eight (40%), loss of consciousness in five (25%), and generalized seizures in one (5%). Results of the clinical examination were normal in five patients and demonstrated a neurological deficit in 12 and coma in three. Computerized tomography scanning revealed intracranial bleeding in all cases (15 intraparenchymal hematomas, three subarachnoid hemorrhages, and two subdural hematomas). A diagnosis of AVF was made with the aid of angiographic studies in 19 patients, whereas it was a perioperative discovery in the remaining patient. There were 12 Type III and eight Type IV AVFs according to the revised classification of Djindjian and Merland, which meant that all AVFs in this study had retrograde cortical venous drainage. The mean duration between the first hemorrhage and treatment was 20 days. Seven patients (35%) presented with acute worsening during this delay due to radiologically proven early rebleeding. Treatment consisted of surgery alone in 10 patients, combined embolization and surgery in eight, embolization only in one, and stereotactic radiosurgery in one. Three patients died, one worsened, and in 16 (80%) neurological status improved, with 15 of 16 AVFs totally occluded on repeated angiographic studies (median follow up 10 months). CONCLUSIONS: The authors found that AVFs with retrograde cortical venous drainage present a high risk of early rebleeding (35% within 2 weeks after the first hemorrhage), with graver consequences than the first hemorrhage. They therefore advocate complete and early treatment in all cases of AVF with cortical venous drainage revealed by an ICH.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
3/33. Demonstration and interpretation of bridging vein ruptures in cases of infantile subdural bleedings.Report of two cases of lethal infantile subdural bleedings (SDB). Bridging vein (BV) ruptures were directly proven as the source of the (minimal) SDB by a postmortem X-ray. In the controversial discussion concerning the causes of infantile SDB, proof of the occurrence of several BV ruptures is seen as an important sign of a trauma of significant degree. Although infantile SDB undoubtedly can result from accidental as well as intentional injuries, and therefore, the SDB itself does not allow far-reaching conclusions as to the cause of injury, the presence of several BV ruptures combined with an SDB of insignificant volume, in an infant dead or in a deep coma on clinical presentation, is not compatible with the supposition of a minor fall as the cause. We have not observed such findings as the result of a minor accidental event for more than 15 years.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
4/33. Spontaneous intracranial hypotension causing confusion and coma: a headache for the neurologist and the neurosurgeon.Spontaneous intracranial hypotension presenting with confusion and coma has rarely been reported. A case is presented and the clinical features of spontaneous intracranial hypotension are discussed.- - - - - - - - - - ranking = 2.5keywords = coma (Clic here for more details about this article) |
5/33. Infectious endocarditis associated with subarachnoid hemorrhage, subdural hematoma and multiple brain abscesses.Hemorrhagic stroke is a complication of infectious endocarditis (IE), and severe hemorrhage accompanies staphylococcus aureus IE during early uncontrolled infection. However, subarachnoid hemorrhage (SAH) or subdural hematoma is rare. A case of S. aureus IE associated with SAH and subdural hematoma in the early stage is reported. A 54-year-old man with a history of mitral valve prolapse presented with fever. Two days after the onset, he fell into a confused state with convulsion and left hemiparesis. He became comatose and brain CT and MRI demonstrated SAH and subdural hematoma with severe right hemisphere swelling. Multiple brain abscesses were also observed. No septic aneurysm was detected by cerebral angiography.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
6/33. diffuse axonal injury by simple fall.diffuse axonal injury (DAI) is the second most common lethal head trauma after subdural hematoma and probably the most frequent cause of traumatic coma in the absence of an expanding intracranial mass lesion. Though it occurs most often in traffic accidents, it may occasionally result from falls from a height. Previously, it has not been associated with a simple fall or a fall of a distance not more than the victim's own height. We report herein a case of DAI from a simple fall.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
7/33. Reversible coma: a rare presentation of spontaneous intracranial hypotension.BACKGROUND: Spontaneous intracranial hypotension (SIH) is a well-recognized neurologic disorder that typically presents with orthostatic headaches, low cerebral spinal fluid pressures and distinct abnormalities on magnetic resonance imaging. methods: We present a case of a rare presentation of SIH. RESULTS: A 49-year-old man presented with a two week history of orthostatic headaches that rapidly progressed to encephalopathy and coma, requiring intubation. neuroimaging revealed abnormalities typical of SIH; diffusely enhancing pachymeninges, subdural fluid collections, and descent of the brain. Treatment with an epidural blood patch reversed his coma within minutes. Following a second blood patch, the patient became asymptomatic. No cerebral spinal leak could be identified on magnetic resonance imaging or on a nuclear medicine technetium cerebral spinal fluid flow study. At six month follow-up, he remained symptom free. CONCLUSION: The mechanism of coma in SIH is presumed to be compression of the diencephalon from downward displacement of the brain. Although it is very unusual for patients with SIH to present with coma, it is important to recognize since the coma may be reversible with epidural blood patches.- - - - - - - - - - ranking = 4.5keywords = coma (Clic here for more details about this article) |
8/33. Spontaneous intracranial hypotension resulting in coma: case report.OBJECTIVE: Spontaneous intracranial hypotension is a potentially severe condition characterized by a distinct clinical picture caused by low cerebrospinal fluid pressure. Although coma has been reported previously as a presentation of this condition, this is the first report in which misdiagnosis of this condition and unwarranted surgery led to coma. CLINICAL PRESENTATION: A 62-year-old man presented with a history of headache, and cranial magnetic resonance imaging showed bilateral chronic subdural hematomas. After evacuation of the hematoma, the patient's condition deteriorated into a state of profound depression of consciousness. Repeated cranial computed tomographic scans showed intracranial air, and intracranial pressure monitoring showed negative recording. Spinal magnetic resonance imaging demonstrated epidural cerebrospinal fluid leaks at the middle and lower thoracic levels. INTERVENTION: Epidural blood patch resulted in almost immediate improvement in the patient's condition, and he was fully awake 24 hours later. CONCLUSION: This case report expands the presently known clinical spectrum of this uncommon and generally benign illness.- - - - - - - - - - ranking = 3keywords = coma (Clic here for more details about this article) |
9/33. Ruptured distal anterior cerebral artery aneurysms presenting as acute subdural hematoma--report of three cases.The authors report three cases of distal anterior cerebral artery aneurysm presenting as acute subdural hematoma (SDH). Two patients were comatose on admission and died of massive SDH. One patient underwent aneurysmal neck clipping in the chronic stage and returned to normal daily life. A convexity SDH continuous with a wedge-shaped interhemispheric SDH was the characteristic computed tomographic appearance in all cases. There was no accompanying subarachnoid or intracerebral hemorrhage in one case (pure SDH). These cases are 9.4% of 32 ruptured distal ACA aneurysms treated in our institute in the last 14 years, a higher incidence than reported previously.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
10/33. Acute spontaneous subdural haematoma of arterial origin.Spontaneous arterial subdural haematoma is arguably a rare condition. We report on three patients who presented with progressive neurological deficit or coma and who had been initially diagnosed as strokes. Explanations for the development of this condition are reviewed and it is suggested that it is not as rare as previously thought.- - - - - - - - - - ranking = 0.5keywords = coma (Clic here for more details about this article) |
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