• Title/Summary/Keyword: EDH

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Epidural Hematomas due to Occipital Artery Injury Following Ventriculoperitoneal Shunt and Extraventricular Drainage

  • Choi, Jeong-Hoon;Moon, Jae-Gon;Hwang, Do-Yun;Choi, Jong-Hun
    • Journal of Korean Neurosurgical Society
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    • v.41 no.5
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    • pp.314-317
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    • 2007
  • Ventriculoperitoneal [VP] shunt is a common treatment for hydrocephalic patients. However, complications, such as shunt tube occlusion, infection, intracranial hemorrhage, seizure can occur. Of these, intracranial hemorrhage may occur due to intracranial vascular injury or a rapid decrease of intracranial pressure [ICP]. Most of these hemorrhages are subdural hematomas [SDH] while a few are epidural hematomas [EDH]. It is extremely rare for an intracranial hemorrhage to occur due to an extension of the bleeding from an injured extracranial vessel. We report two cases of EDH due to occipital artery injury following VP shunt and extraventricular drainage [EVD].

Immediate Postoperative Epidural Hematomas Adjacent to the Craniotomy Site

  • Jeon, Jin-Soo;Chang, In-Bok;Cho, Byung-Moon;Lee, Ho-Kook;Hong, Seung-Koan;Oh, Sae-Moon
    • Journal of Korean Neurosurgical Society
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    • v.39 no.5
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    • pp.335-339
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    • 2006
  • Objective : The authors present eight cases of immediate post-operative epidural hematomas[EDHs] adjacent to the craniotomy site, describe clinical details of them, and discuss their pathogenesis. Methods : Medical records of eight cases were retrospectively reviewed and their clinical data, operation records, and radiological findings analyzed. Any risk factors of the EDHs were searched. Results : In 5 of 8 cases, adjacent EDHs developed after craniotomies for the surgical removal of brain tumors. Three cases of adjacent EDHs developed after a pterional approach and neck clipping of a ruptured anterior communicating artery aneurysm, a ventriculoperitoneal shunt, and a craniotomy for a post-traumatic EDH, respectively. In all eight cases, brain computed tomography[CT] scans checked immediately or a few hours after the surgery, revealed large EDHs adjacent to the previous craniotomy site, but there was no EDH beneath the previous craniotomy flap. After emergent surgical removal of the EDHs, 7 cases demonstrated good clinical outcomes, with one case yielding a poor result. Conclusion : Rapid drainage of a large volume of cerebrospinal fluid or intra-operative severe brain collapse may separate the dura from the calvarium and cause postoperative EDH adjacent to the previous craniotomy site. A high-pressure suction drain left in the epidural space may contribute to the pathogenesis. After the craniotomy for brain tumors or intracranial aneurysms, when remarkable brain collapse occurs, an immediate postoperative brain CT is mandatory to detect and adequately manage such unexpected events as adjacent EDHs.

3D Modeling of Cerebral Hemorrhage using Gradient Vector Flow (기울기 벡터 플로우를 이용한 뇌출혈의 3차원 모델링)

  • Seok-Yoon Choi
    • Journal of the Korean Society of Radiology
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    • v.18 no.3
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    • pp.231-237
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    • 2024
  • Brain injury causes persistent disability in survivors, and epidural hematoma(EDH) and subdural hematoma (SDH) resulting from cerebral hemorrhage can be considered one of the major clinical diseases. In this study, we attempted to automatically segment and hematomas due to cerebral hemorrhage in three dimensions based on computed tomography(CT) images. An improved GVF(gradient vector flow) algorithm was implemented for automatic segmentation of hematoma. After calculating and repeating the gradient vector from the image, automatic segmentation was performed and a 3D model was created using the segmentation coordinates. As a result of the experiment, accurate segmentation of the boundaries of the hematoma was successful. The results were found to be good even in border areas and thin hematoma areas, and the intensity, direction of spread, and area of the hematoma could be known in various directions through the 3D model. It is believed that the planar information and 3D model of the cerebral hemorrhage area developed in this study can be used as auxiliary diagnostic data for medical staff.

Our Experience with Surgically Treated Epidural Hematomas in Children

  • Jung, Sang-Won;Kim, Dong-Won
    • Journal of Korean Neurosurgical Society
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    • v.51 no.4
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    • pp.215-218
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    • 2012
  • Objective: Traumatic epidural hematomas (EDHs) in children are a relatively unusual occurrence. The cause and outcome vary depending on period and reg ion of study. The aims of this analysis were to review the cause and outcome of pediatric EDHs nowadays and to discuss outcome-related variables in a large consecutive series of surgically treated EDH in children. Methods: This is a retrospective review of 29 patients with surgically treated EDHs between Jan 2000 and February 2010. Patients' medical records, computed tomographic (Cl) scans, and, if performed, magnetic resonance imaging (MRI) were reviewed to define variables associated with outcome. Variables included in the analysis were age, associated severe intracranial injury, abnormal pupillary response, hematoma thickness, severity of head injury (Glasgow Coma Scale score), parenchymal brain injury, and diffuse axonal injury. Results: The mean (SO) age of the patients was 109 months (0-185 months). Most of the injuries with EDHs occurred in traffic accident (14 cases, 48.2%) and followed by slip down in 6 cases and falls in 6 cases. There were one birth injury and one unknown cause. EDHs in traffic accidents occurred in pedestrians hit by a motor vehicle, 9 cases; motorbike and car accidents, 5 cases and bicycle accidents, 1 case. The locations of hematoma were almost same in both sides (left side in 15 cases). Temporal lobe is the most common site of hematomas (13 cases, 44%). The mean size of the EDHs was 18 mm (range, 5-40 mm). Heterogeneous hematomas in CT scans were 20 cases (67%). Two patients were referred with unilateral or bilateral dilated pupil(s). There was enlargement of EDH in 5 patients (17%). All of them were heterogeneous hematomas in CT scans. Except for 4 patients, all EDHs were associated with skull fracture(s) (87%). There was no case of patient with major organ injury. CT or MRI revealed brain contusion in 5 patients, and diffuse axonal injury in one patient The mortality was zero, and the outcomes were excellent in 26 and good in 2 patients. None of the tested variables were found to have a prognostic relevance. Conclusion: Regardless of the EDH size, the clinical status of the patients, the abnormal pupillary findings, or the cause of injury, the outcome and prognosis of the patients with EDH were excellent.

Rapidly Calcified Epidural Hematoma in a Neonate

  • Yu, Dong-Kun;Heo, Dong-Hwa;Cho, Sung-Min;Cho, Yong-Jun
    • Journal of Korean Neurosurgical Society
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    • v.44 no.2
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    • pp.98-100
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    • 2008
  • We report a very rare case of a rapidly calcified chronic epidural hematoma (EDH) in a neonate. A 26-day-old female infant was referred to us from a regional hospital because of drowsy mentality and a seizure attack. She was delivered through caesarian section because normal spontaneous vaginal delivery was prolonged and failed. At birth, mild scalp swelling was found on the right frontal area. Scalp swelling was spontaneously resolved and she was discharged without any problems. On the 25th day after her birth, the baby presented with drowsiness and hypotonia following a generalized tonic-clonic seizure. Magnetic resonance imaging (MRI) and a computed tomography (CT) scan revealed a chronic EDH that had a thick layer of calcification. A small burr-hole trephination was performed and a single silastic drainage catheter was inserted. After the operation, a total of 12 ml of liquefied hematoma was drained, and the patient's mentality improved from drowsiness to alertness. The patient was asymptomatic when discharged.

Extravascular Migration of a Fractured Inferior Vena Cava Filter Strut

  • Lim, Jung Hyeon;Lee, Weon Yong;Ra, Yong Joon;Jeong, Jae Han;Park, Bong Suk;Ko, Ho Hyun
    • Journal of Chest Surgery
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    • v.50 no.3
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    • pp.224-227
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    • 2017
  • A 20-year-old man presented with a femur fracture and epidural hemorrhage (EDH) following a fall. One month after fracture surgery, swelling developed in both legs, and he was diagnosed as having a deep-vein thrombosis and pulmonary embolism. A retrievable inferior vena cava filter (IVCF) was inserted, because EDH is a contraindication to anticoagulants. Four months later, he complained of abdominal pain, and a computed tomography scan showed a fractured IVCF strut. After percutaneous removal failed 3 times, the IVCF was surgically removed by orthopedists using a portable image intensifier without cardiopulmonary bypass.

A case of Kawasaki disease preceding a retropharyngeal abscess (인두 후부 농양이 선행된 가와사끼병 1례)

  • Park, Hee Ok;Lim, Jae Woo;Cheon, Eun Jung;Ko, Kyung Ok
    • Clinical and Experimental Pediatrics
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    • v.51 no.5
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    • pp.542-545
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    • 2008
  • Epidural hematoma (EDH) is relatively rare in newborn infants and frequently associated with instrumental deliveries or other complications during labor and delivery. Although surgical evacuation has been the most common therapy, many other procedures have been suggested. Although many epidural hematomas require surgical evacuation rather than non-surgical management, the conservatiob or aspiration of hematoma have been attempted. In the case of EDH associated with cephalhematoma, aspiration of cephalhematoma could be attempted because frequent features of these combination were communication between these hematoma. We report a case of successful nonsurgical management for epidural hematoma through the aspiration of accompanying cephalhematoma in a five-day-old newborn infant.

Remote Epidural Hematoma Following the Removal of Brain Tumors : Report of Three Cases (뇌종양 제거 후 원격부위에 발생한 뇌경막외혈종 - 증례보고 -)

  • Bae, Kwang-Ju;Kim, Ill-Man;Yim, Man-Bin
    • Journal of Korean Neurosurgical Society
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    • v.30 no.3
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    • pp.366-370
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    • 2001
  • Objective : The authors present three cases of brain tumors in which epidural hematomas(EDHs) were developed postoperatively in the remote areas from craniotomy sites. The preventive tactics as well as possible mechanisms of development of remote EDH are discussed. Material and Methods : The magnetic resonance imagings of three patients revealed a left lateral ventricular mass located just aside of foramen Monro in a 27-year-old male, a large cystic mass in the temporal lobe in a 35-year-old male, and a partially calcified pineal mass in a 27-year-old male patient. The surgical removals of these tumors were performed without any noticeable events during surgery via left frontal transcortical transventricular approach for lateral ventricular tumor, left temporal craniotomy for cystic temporal tumor, and right occipital transtentorial approach for pineal tumor. Results : Postoperative EDHs remote from the sites of craniotomy were detected by the immediate postoperative computerized tomographic scans. We obtained good outcomes without any morbidity in all three patients with emergent evacuation of the hematoma. The pathologic diagnoses were lateral ventricular ependymoastrocytoma, temporal craniopharyngioma and mixed germinoma of the pineal region. Conclusion : It is postulated that a sudden reduction of intracranial pressure(ICP) at the time of tumor removal may strip the dura from the inner table of the skull to cause EDH from the remote site of craniotomy. Gradual reduction of ICP with slow drainage of cerebrospinal fluid before tumor removal as well as lowering the head position of patient during surgery might be helpful for preventing this unusual complication.

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Is Routine Repeated Head CT Necessary for All Pediatric Traumatic Brain Injury?

  • Kim, Won-Hyung;Lim, Dong-Jun;Kim, Se-Hoon;Ha, Sung-Kon;Choi, Jong-Il;Kim, Sang-Dae
    • Journal of Korean Neurosurgical Society
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    • v.58 no.2
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    • pp.125-130
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    • 2015
  • Objective : Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT. Methods : Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores. Results : Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status. Conclusion : We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.

Endothelial Ca2+ signaling-dependent vasodilation through transient receptor potential channels

  • Hong, Kwang-Seok;Lee, Man-Gyoon
    • The Korean Journal of Physiology and Pharmacology
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    • v.24 no.4
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    • pp.287-298
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    • 2020
  • Ca2+ signaling of endothelial cells plays a critical role in controlling blood flow and pressure in small arteries and arterioles. As the impairment of endothelial function is closely associated with cardiovascular diseases (e.g., atherosclerosis, stroke, and hypertension), endothelial Ca2+ signaling mechanisms have received substantial attention. Increases in endothelial intracellular Ca2+ concentrations promote the synthesis and release of endothelial-derived hyperpolarizing factors (EDHFs, e.g., nitric oxide, prostacyclin, or K+ efflux) or directly result in endothelial-dependent hyperpolarization (EDH). These physiological alterations modulate vascular contractility and cause marked vasodilation in resistance arteries. Transient receptor potential (TRP) channels are nonselective cation channels that are present in the endothelium, vascular smooth muscle cells, or perivascular/sensory nerves. TRP channels are activated by diverse stimuli and are considered key biological apparatuses for the Ca2+ influx-dependent regulation of vasomotor reactivity in resistance arteries. Ca2+-permeable TRP channels, which are primarily found at spatially restricted microdomains in endothelial cells (e.g., myoendothelial projections), have a large unitary or binary conductance and contribute to EDHFs or EDH-induced vasodilation in concert with the activation of intermediate/small conductance Ca2+-sensitive K+ channels. It is likely that endothelial TRP channel dysfunction is related to the dysregulation of endothelial Ca2+ signaling and in turn gives rise to vascular-related diseases such as hypertension. Thus, investigations on the role of Ca2+ dynamics via TRP channels in endothelial cells are required to further comprehend how vascular tone or perfusion pressure are regulated in normal and pathophysiological conditions.