• Journal of Korean Neurosurgical Society
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• 제58권2호
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• pp.144-146
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• 2015

Postdural punctural headache (PDPH) following spinal anesthesia is due to intracranial hypotension caused by cerebrospinal fluid (CSF) leakage, and it is occasionally accompanied by an intracranial hematoma. To the best of our knowledge, an intracranial chronic subdural hematoma (CSDH) presenting with an intractable headache after a cervical epidural steroid injection (ESI) has not been reported. A 39-year-old woman without any history of trauma underwent a cervical ESI for a herniated nucleus pulposus at the C5-6 level. One month later, she presented with a severe headache that was not relieved by analgesic medication, which changed in character from being positional to non-positional during the preceding month. Brain magnetic resonance imaging revealed a CSDH along the left convexity. Emergency burr-hole drainage was performed and the headache abated. This report indicates that an intracranial CSDH should be considered a possible complication after ESI. In addition, the event of an intractable and changing PDPH after ESI suggests further evaluation for diagnosis of an intracranial hematoma.

• Journal of Korean Neurosurgical Society
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• 제55권3호
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• pp.170-172
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• 2014

Percutaneous epidural neuroplasty (PEN) is a known interventional technique for the management of spinal pain. As with any procedures, PEN is associated with complications ranging from mild to more serious ones. We present a case of intracranial subdural hematoma after PEN requiring surgical evacuation. We review the relevant literature and discuss possible complications of PEN and patholophysiology of intracranial subdural hematoma after PEN.

• Journal of Korean Neurosurgical Society
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• 제41권1호
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• pp.11-15
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• 2007

Objective : The authors attempted to confirm the risk factors for recurrent chronic subdural hematoma[CSDH] after simple burr-hole drainage. Methods : A total of 302 patients with CSDH who were treated at our hospital between January 1998 and May 2005 were studied. Various parameters considered for analysis of factors associated with CSDH recurrence; demographic and clinical findings [age, sex, history of seizures, diabetes, vascular diseases], initial and perioperative CT findings [hematoma density, location of catheter tip, post operative intracranial air, intracranial hematoma extension, hematoma width, hematoma site]. Results : Twenty-four patients [7.9%] experienced recurrence, whereas 278 patients [92.1%] did not. Five major risk factors should be considered : 1) layered type by hematoma density, 2) type I, II by location of catheter tip, 3) presence of postoperative intracranial air, 4) cranial base type of intracranial hematoma extension, 5) greater hematoma width. Conclusion : In this study, we report that the incidence of postoperative CSDH recurrence can be reduced by the examination of the hematoma characteristics on initial and perioperative CT findings and by preventing subdural air accumulation during operation. In addition, the location of the catheter tip can be used as a helpful factor in reducing the recurrence.

• Journal of Trauma and Injury
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• 제19권1호
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• pp.93-96
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• 2006

A traumatic spinal subdural hematoma is a rare condition, and only nine cases have been reported until now. We report a rare case of concomitant intracranial hemorrhage and spinal subdural hematoma with a review of the literature. A 45-year-old man was referred to our institute after being stroke by a car. He complained of nausea, headache, back pain, and bilateral sciatica. Brain computed tomography and lumbar spine magnetic resonance images revealed both an intracerbral hemorrhage and a subdural hematoma in the L4 to S1 level. After performing a lumbar spinal puncture and draining the hemorrhagic cerebrospinal fluid (CSF), the intracranial and spinal hematomas were resolved completely without any neruologic deficits.

• Journal of Korean Neurosurgical Society
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• 제55권6호
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• pp.348-352
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• 2014

Objective : Management guidelines for single intracranial hematomas have been established, but the optimal management of multiple hematomas has little known. We present bilateral traumatic supratentorial hematomas that each has enough volume to be evacuated and discuss how to operate effectively it in a single anesthesia. Methods : In total, 203 patients underwent evacuation and/or decompressive craniectomies for acute intracranial hematomas over 5 years. Among them, only eight cases (3.9%) underwent operations for bilateral intracranial hematomas in a single session. Injury mechanism, initial Glasgow Coma Scale score, types of intracranial lesions, surgical methods, and Glasgow outcome scale were evaluated. Results : The most common injury mechanism was a fall (four cases). The types of intracranial lesions were epidural hematoma (EDH)/intracerebral hematoma (ICH) in five, EDH/EDH in one, EDH/subdural hematoma (SDH) in one, and ICH/SDH in one. All cases except one had an EDH. The EDH was addressed first in all cases. Then, the evacuation of the ICH was performed through a small craniotomy or burr hole. All patients except one survived. Conclusion : Bilateral intracranial hematomas that should be removed in a single-session operation are rare. Epidural hematomas almost always occur in these cases and should be removed first to prevent the hematoma from growing during the surgery. Then, the other hematoma, contralateral to the EDH, can be evacuated with a small craniotomy.

• Journal of Korean Neurosurgical Society
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• 제40권3호
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• pp.199-201
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• 2006

An organizing hematoma with tumor-like presentation in association with a chronic subdural hematoma[CSDH] has not been reported. Most reported cases of an intracranial mass in association with a CSDH have been associated with primary or metastatic neoplasm. A 72-year-old man presenting with an intracranial contrast-enhancing mass in association with a CSDH in magnetic resonance images is reported. Operative exploration revealed the mass to be an organized hematoma adjoining cortical draining veins between the outer and inner membranes of a chronic subdural hematoma. This report adds another important differential diagnosis to various primary and metastatic neoplasms that have been reported in the literature when encountering an intracranial mass in association with a CSDH. Neurosurgeons should be aware of the possibility and, It necessary, should apply more diagnostic modalities than magnetic resonance images before deciding management plans.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.467-469
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• 2010

We report an extremely rare case of traumatic cervical spinal subdural hematoma not related to intracranial injury. There has been no report on traumatic cervical spinal subdrual hematoma not related to intracranial injury. A 27-year-old female patient was admitted to our emergency room due to severe neck pain and right arm motor weakness after car collision. On admission, she presented with complete monoplegia and hypoesthesia of right arm. Magnetic resonance imaging (MRI) revealed subdural hematoma compressing spinal cord. Lumbar cerebrospinal fluid (CSF) analysis revealed 210,000 red blood cells/$mm^3$. She was managed conservatively by administrations of steroid pulse therapy and CSF drainage. Her muscle power of right arm improved to a Grade III 16 days after admission. Follow-up MRI taken 16th days after admission revealed almost complete resolution of the hematoma. Here, the authors report a traumatic cervical spinal SDH not associated with intracranial injury.

• Journal of Trauma and Injury
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• 제25권4호
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• pp.275-277
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• 2012

An eipdural hematoma in an infant is a very rare entity. We report a case of an acute traumatic intracranial epidural hematoma that developed with a lucid interval in a 4-month-old infant after a fall down from a bed. The infant was admitted at the emergency room. The child had initially cried and may have had a decreased level of consciouseness due to brain injury, but then returned to normal level of consciousness for several hours prior to admission. However, the infant had vomited twice after taking milk and then was lethargic. The brain CT revealed a lentiform-shaped huge hematoma on the right parietal area with a midline shift of 8 mm. An osteoplastic craniotomy was performed, and the intracranial epidural hematoma was totally removed. Postoperatively, the infant recovered well and was dischaged.

• Journal of Korean Neurosurgical Society
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• 제40권1호
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• pp.51-53
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• 2006

Decompressive craniectomy is usually performed to relieve raised intracranial pressure[ICP] caused by various intracranial lesions. A 67-year-old man presented with acute subdural hematoma and traumatic intracerebral hematoma. The patient underwent a decompressive craniectomy. Four weeks later, the patient presented with acute neurological deterioration. Brain computed tomographic[CT] scans revealed the marked concavity of the brain at the site of the craniectomy and associated with midline shift which was reversed by cranioplasty. We report an unusual case of cerebral herniation from intracranial hypotension after decompressive craniectomy for a traumatic subdural hematoma. The cranioplasty may be helpful to prevent paradoxial cerebral herniation.

• Journal of Korean Neurosurgical Society
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• 제56권6호
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• pp.527-530
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• 2014

Spinal subarachnoid hemorrhages (SAH) can extend into the intracranial subarachnoid space, but, severe cerebral vasospasm is rare complication of the extension of intracranial SAH from a spinal subarachnoid hematoma. A 67-year-old woman started anticoagulant therapy for unstable angina. The next day, she developed severe back pain and paraplegia. MRI showed intradural and extramedullar low signal intensity at the T2-3, consistent with intradural hematoma. High signal intensity was also noted in the spinal cord from C5 to T4. We removed subarachnoid hematoma compressing the spinal cord. The following day, the patient complained of severe headache. Brain CT revealed SAH around both parietal lobes. Three days later, her consciousness decreased and left hemiplegia also developed. Brain MRI demonstrated multiple cerebral infarctions, mainly in the right posterior cerebral artery territory, left parietal lobe and right watershed area. Conventional cerebral angiography confirmed diffuse severe vasospasm of the cerebral arteries. After intensive care for a month, the patient was transferred to the rehabilitation department. After 6 months, neurologic deterioration improved partially. We speculate that surgeons should anticipate possible delayed neurological complications due to cerebral vasospasm if intracranial SAH is detected after spinal subarachnoid hematoma.