• Journal of Trauma and Injury
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• v.25 no.4
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• pp.209-216
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• 2012

Purpose: The objectives of this study are to classify chronic subdural hematomas based on brain computerized tomographic scan (CT scan) findings and to determine the mechanism of evolution and treatment methods. Methods: One hundred thirty-nine patients who were diagnosed with a chronic subdural hematoma and who available for follow up assessment 6 months post-surgery were analyzed retrospectively. The presence of trauma and past medical history were reviewed and evaluation criteria based on brain CT scan findings were examined. Results: Initial brain CT scans revealed a chronic subdural hematoma in 106 patients, a subdural hygroma in 24 patients, and an acute subdural hematoma in 9 patients. In all cases where the initial acute subdural hematoma had progressed to a chronic subdural hematoma, final was a hypo-density chronic subdural hematoma. In case where the initial subdural hygroma had progressed to a chronic subdural hematoma, the most cases of hematoma were hyper-density and mixed-density chronic subdural hematoma. In total, 173 surgeries were performed, and they consisted of 97 one burr-hole drainages, 70 two burr-hole drainages and 6 craniotomies. Conclusion: This study demonstrates that rebleeding and osmotic effects are mechanisms for enlarging of a chronic subdural hematoma. In most cases, one burr-hole drainage is a sufficient for treatment. However, in cases of mixed or acute-on-chronic subdural hematomas, other appropriate treatment strategies are required.

• Journal of Korean Neurosurgical Society
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• v.41 no.4
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• pp.267-268
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• 2007

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.

• Journal of Korean Neurosurgical Society
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• v.54 no.6
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• pp.515-517
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• 2013

Coexistence of cranial and spinal subdural hematomas is rare and only a few cases have been reported in the literature. Herein, we report a case of cranial and spinal subdural hematomas after previous head trauma. As the pathogenesis of simultaneous intracranial and spinal subdural hematoma yet remains unclear, we developed an alternative theory to those proposed in the literature for their coexistence, the migration of blood through the subdural space.

• Journal of Korean Neurosurgical Society
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• v.65 no.3
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• pp.380-384
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• 2022

Subdural hematoma in infants can be caused by abuse, and is thought to be more likely if subdural hematoma is associated with retinal hemorrhage and cerebral edema. In Japan, few doctors disagree that cases of subdural hematoma with retinal hemorrhage and cerebral edema with multiple findings on the body are more likely to have been caused by abuse rather than by household accident. On the other hand, in cases where there are no other significant physical findings, only subdural hematoma and retinal hemorrhage, there is a difference of opinion as to whether the injury was caused by an accident or abuse. The reason for this is that neurosurgeons in Japan promoted the concept that infants can develop subdural hematomas and retinal hemorrages due to minor trauma at home before the concept of abusive head trauma became known. In addition, the age distribution of subdural hematomas in Japan differs from that in other countries, with peaks at around 8 months, and the reason for this remains unclear. Therefore, the etiology of infant subdural hematoma in Japan needs to be investigated in greater detail.

• Journal of Korean Neurosurgical Society
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• v.54 no.5
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• pp.431-433
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• 2013

Acute subdural hematoma is usually a neurological emergency that requires hematoma evacuation or close observation. However, spontaneous resolutions of an acute subdural hematoma without surgical interventions have been reported rarely. We report on a case who showed rapid resolution of an acute subdural hematoma with neurological improvement and review the relevant literatures.

• Journal of Korean Neurosurgical Society
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• v.60 no.6
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• pp.701-709
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• 2017

Objective : Chronic subdural hematoma is a common and relatively benign disease. However, recurrence is common after surgical treatment, and the recurrence rate varies from 5% to 33%. The aim of this study was to investigate the predictive factors for recurrence of chronic subdural hematoma. Methods : We analyzed data from 248 patients with chronic subdural hematoma who were treated by burr-hole craniostomy with a closed drainage system for hematoma evacuation in this five-year retrospective study. Results : Thirty-one (12.6%) patients underwent re-operation for recurrence of chronic subdural hematoma. Univariate analysis revealed that anticoagulation (p=0.0279), headache (p=0.0323), and preoperative midline shifting (p=0.0321) showed significant differences with respect to recurrent chronic subdural hematoma. We performed a multivariate logistic regression analysis and found that diabetes mellitus (odds ratio [OR], 2.618; 95% confidence interval [CI], 1.0899-6.2898; p=0.0314), anticoagulation (OR, 6.739; 95% CI, 1.1287-40.2369; p=0.0364), headache (OR, 2.951; 95% CI, 1.1464-7.5964; p=0.0249), and preoperative midline shifting (OR, 1.0838; 95% CI, 1.0040-1.1699; p=0.0391) were independent predictive factors for recurrence of chronic subdural hematoma. Conclusion : We showed that diabetes mellitus, anticoagulation, headache, and preoperative midline shifting were independent predictors of recurrence of chronic subdural hematoma.

• Journal of Korean Neurosurgical Society
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• v.40 no.5
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• pp.384-386
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• 2006

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.

• Journal of Trauma and Injury
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• v.19 no.1
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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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• v.55 no.3
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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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• v.45 no.1
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• pp.53-56
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• 2009

The authors present a case of subdural empyema in a macrocephalic patient. A 23-year-old male was admitted due to headache and fever. One month ago, he had mild head injury by his coworkers. Physical examination showed a macrocephaly and laboratory findings suggested purulent meningitis. Neuroimaging studies revealed a huge size of epidural space-occupying lesion. Under the impression of epidural abscess, operation was performed. Eventually, the lesion was located at subdural space and was proven to be subdural empyema. Later, histological examination of the specimen obtained by surgery demonstrated finings consistent with the capsule of the chronic subdural hematoma. Two weeks after operation, Propionibacterium acnes was isolated. The intravenous antibiotics were used for total of eight weeks under monitoring of the serum level of the C-reactive protein. Follow-up brain computed tomography (CT) scan showed the presence of significant amount of remaining subdural lesion. However, he has complained of minimal discomfort. It is suggested that the subdural empyema occurred with preexisting chronic subdural hematoma after head injury about one month prior to admission and it took a long time to treat Propionibacterium acnes subdural empyema with systemic antibiotics, at least over eight weeks.