Intracranial subdural hematoma after lumbar myelography

Two cases of intracranial subdural hematoma after lumbar myelography are reported. This complication should be considered in patients who complain of prolonged headache or who develop neurological signs after lumbar puncture.     

Spinal subdural haematoma: an unusual complication of lumbar puncture

A case in which a spinal subdural haematoma obscured the diagnosis of spinal stenosis is described. The haematoma resulted as a complication of the lumbar puncture necessary for the myelogram. No other aetiological factors were found, but it is suggested that this condition may become more frequent as the result of iatrogenic haemostatic defects.     

Interhemispheric subdural hematoma

The interhemispheric subdural hematoma (ISH) is a special subdural hematoma with regard to both location and symptomatology. The most widely described clinical signs and symptoms associated with an ISH are a lucid interval and the falx syndrome. The latter is featured by a contralateral hemiparesis that is accentuated in the lower extremity but spares the face. Minor head trauma or a preexisting coagulation disorder are also often found. Nonsurgical treatment should be chosen in patients with little neurologic dysfunction and a stable clinical course. Patients with progressive neurologic deterioration and focal neurologic deficits should be operated on without delay. This article provides a review of 99 published cases of ISH and adds 3 cases to the existing literature.     

Mozart's chronic subdural hematoma

No commemoration of the bicentennial of Mozart's death would be complete without some consideration of that premature yet predictable demise. Mozart's premonitions of death are well known and apparently played a role in the composition of the K.626 Requiem and perhaps other works. His death has traditionally been ascribed to infectious causes, chiefly rheumatic fever or post-streptococcal glomerulonephritis, exacerbated by intemperance and chronic penury. Pathology has been difficult because of his supposed burial in a pauper's grave, the location and contents of which were later supposedly lost. Mozart's burial place in St. Mark's Cemetery in Vienna was known and, in the parlance of the day, "reorganized" a decade later, as the occupants of plots were disinterred to make room for the more recently decreased. A skull believed to the Mozart's was saved by the successor of the gravedigger who had supervised Mozart's burial, and then passed into the collections of the anatomist Josef Hyrtl, the municipality of Salzburg, and the Mozarteum museum (Salzburg). Forensic reconstruction of soft tissues related to this skull reveals substantial concordance with Mozart's portraits. The skull suggests premature closure of the metopic suture, which has been suggested on the basis of his physiognomy. A left temporal fracture and concomitant erosions raise the question of chronic subdural hematoma, which would be consistent with several falls in 1789 and 1790 and could have caused the weakness, headaches, and fainting he experienced in 1790 and 1791. Aggressive bloodletting to treat suspected rheumatic fever could have decompensated such a lesion to produce his death on December 5, 1791.     

Masked subdural hematoma in alcoholics

Nineteen cases of subdural hematomata in alcoholics are discussed to show the special diagnostic problems that the psychiatrist is faced with when dealing with such a disease picture. Although it is relatively easy to show that subdural hematomata in alcoholics are usually of traumatic origin, yet there is the difficulty of the psychiatrist being confronted with the task of giving medical attention to patients where, anamnestically, the trauma is of secondary importance only, and where psychopathological phenomena are a prime consideration. This syndrome, which is characterized by a fluctuation in consciousness and impulsion, psychomotor retardation, and baseless exaltation, may be regarded as suggesting the presence of a subdural hematoma in a person addicted to the use of alcoholic beverages in excess, even if the medical history of the patient is free from any traumata.     

Fatal spontaneous spinal epidural hematoma following thrombolysis for myocardial infarction

BACKGROUND: This is the first communication of a fatal spontaneous spinal epidural hematoma following thrombolysis. CLINICAL PRESENTATION: Spine pain may precede neurologic deterioration by many hours. The diagnosis can be accurately made with axial computed tomography (CT) of the involved spinal segment. TREATMENT: Emergency surgery is the treatment for this condition, but conditions such as the acute stage of a myocardial infarction or intraoperative bleeding difficulties due to iatrogenic coagulopathy, the degree of preoperative neurologic deficit, and the timing of surgery must be cautiously considered. CONCLUSIONS: Neurosurgeons will be faced with another devastating complication of thrombolytic therapy, as long as the available drugs are being used. Early clinical suspicion and availability of CT or magnetic resonance imaging for prompt diagnosis are essential to initiate appropriate medical therapy and timely surgery. New strategies must include the development of completely fibrin-specific thrombolytics and drugs that may rapidly reverse the systemic and local clotting disorder.     

Chordoid meningioma associated with chronic subdural hematoma

A 50-year-old man with 'presyncope' is presented. He was found to have an aneurysm of the right coronary sinus of Valsalva and an aneurysm of the noncoronary sinus. Neither aneurysm had ruptured. It is postulated that the patient's symptoms were related to partial obstruction of the right ventricle. Other potential complications of an unruptured aneurysm of the sinus of Valsalva are discussed.     

Deafness secondary to lumbar puncture

INTRODUCTION AND OBJECTIVE: Disorders of hearing have been described in patients who have undergone lumbar puncture. The lower frequencies are most affected, temporarily and with spontaneous recovery in most cases. It would seem that the cochlea aqueduct (AC) (an anatomical structure found in the internal ear) is the part involved in the pathogenesis of this infrequent complication. The object of this paper is to review the different hypothesis put forward by various authors on the subject, emphasizing the one which seems most probable. At the same time, we offer a new vision of this little known and often forgotten anatomical structure of the internal ear. The anatomy and physiology of the AC is considered, studying the part played by the labyrinth fluid when the patient undergoes an operation involving the cerebro-spinal fluid (CSF) or the subarachnoid space. CONCLUSIONS: Whenever this technique is to be used, it is essential to obtain a clinical history to find out whether the patient has, or has had, any problems of hearing, and if so of what type. All patients should be warned of the possibility of deafness, in most cases temporary, and if the patient has hydrops endolymphaticus (syndrome of Ménière) of the high risk of worsening his hearing threshold. We therefore recommend precise evaluation of the use of this technique.     

Modifications of the pupil in acute subdural hematoma

This study is based on the observation of 81 operated acute subdural haematoma. The various coordinates concerning the clinical aspects and the evolution are analysed in function of the presence or absence of pre-operatory anisoria. The discussion abords the gravity of this sign and its value in localizing the lesion, as well as the clinical distinction between ipsi-lateral and contra-lateral mydriasis. Possible subdivisions in cases of contra-lateral relative mydriasis, as well as their probable pathophysiological mechanisms and respective clinical and prognostic implications are also examined.     

Spontaneous resolution of subdural hematoma. MRI findings

In the present study, to clarify the role of the N-methyl-D-aspartate (NMDA) receptor in the appearance of diazepam withdrawal signs, the changes in [3H]dizocilpine binding in several brain regions from diazepam-withdrawn rats were investigated. Brain membranes were prepared 42-45 h after termination of diazepam treatment when maximal withdrawal signs were shown. The Bmax value for [3H]dizocilpine binding was significantly increased in cerebrocortical, but not hippocampal and cerebellar, tissues from diazepam-withdrawn rats, while the Kd value did not change in any group. Together with our previous finding that NMDA receptor antagonists potently suppress diazepam withdrawal signs, these results suggest that the upregulation of the NMDA receptor in the cerebral cortex may play an important role in the appearance of spontaneous withdrawal signs caused by discontinuation of chronic diazepam treatment.     

Hearing loss secondary to lumbar puncture

Hearing complaints have been described in patients after lumbar puncture, although other symptoms like headache, nausea, and dizziness can easily obscure hearing disorders. Reduced cerebrospinal fluid pressure after lumbar puncture may explain the origin of this vestibulocochlear dysfunction. Two cases of hearing loss and tinnitus that appeared hours after otherwise uncomplicated diagnostic spinal puncture are reported. The pure tone audiogram showed a 40-50 dB bilateral sensorial hearing loss in the lower frequencies. Hearing recovered and tinnitus disappeared entirely within 7-10 days. Since permanent hearing loss has been reported after diagnostic or therapeutic lumbar puncture, we should be aware of the possibility of this adverse effect.     

Ethanol level differential between postmortem blood and subdural hematoma

Alcohol use is a major risk factor for accidental injury and death. However, when death occurs several hours after injury, ethanol in the blood may be absent or low. Ethanol in sequestered hematomas has been used to retrospectively implicate alcohol as a contributing factor at the time of injury. A 69-year-old man died from a large acute subdural hematoma. He had been seen in a hospital emergency department 8 to 12 hours before his death for treatment of two lacerations (one on the head) that occurred during a fall. Postmortem blood ethanol was 0.07%, and subdural hematoma ethanol was 0.04%. This ethanol level differential between the postmortem blood and the subdural hematoma indicates that this man had consumed alcohol after being released from the hospital.     

Isodense subdural hematoma presenting with paraparesis: case report

Computerized tomography (CT) has replaced cerebral angiography in many institutions as the diagnostic test of choice in cranial trauma. However, isodense subdural hematomas can be a source of false-negative results on CT scans, resulting in omissions in therapy. The authors report a patient with bilateral isodense subdural hematomas who presented with paraparesis but was otherwise alert and fully oriented. The CT findings caused an initial diagnostic dilemma before being resolved.     

Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man

The dorsal subcutaneous injection in rats of 12 ml or more of autologous hemolyzed whole blood clotted in situ induced the formation of sterile, hemispheric lesions, 47% of which showed an initial decrease in volume followed by a progressive enlargement. The behavior, histology, and biochemical characteristics of the liquid contents of these lesions were found to be remarkably similar to those of subdural hematomas in man. To evaluate the role of the various blood components that may have influenced the formation and growth of these lesions, more than 150 clots composed of human platelet-free plasma, autologous hemolyzed blood, or autologous whole blood were implanted subcutaneously in rats by either surgical or injection techniques. The in vitro behavior of the different clots used was also assessed. This systematic approach led to the following conclusions: 1) the composition and volumes of the clots are critical variables; 2) plasma-fibrin provides the matrix shape of the lesions; 3) the breakdown products derived from erythrocytes, hemoglobin, leukocytes, and other solid blood elements induce neomembrane formation and contribute to the lesion's subsequent growth; and 4) inflammation mechanisms appear to be essential, while cerebrospinal fluid plays no discernable role in this process.     

Supratentorial arachnoid cyst and associated subdural hematoma: neuroradiologic studies

CT and MR images of 8 patients with supratentorial arachnoid cyst complicated by subdural hematoma were studied and compared with those of 8 patients who developed nontraumatic subdural hematoma without arachnoid cyst. Of the 8 patients with supratentorial arachnoid cyst, CT and MR disclosed temporal bulging and/or thinning of the temporal squama in all 6 patients with middle fossa arachnoid cysts, and the thinning of the calvaria was evident in another patient with a convexity cyst. Calvarial thinning at the site corresponding to interhemispheric arachnoid cyst was clearly depicted on coronal MR images. In contrast, none of the 8 young patients with nontraumatic subdural hematoma without arachnoid cyst had abnormal calvaria. Temporal bulging and thinning of the overlying calvaria were identified as diagnostic CT and MR features of arachnoid cyst with complicating intracystic and subdural hemorrhage. Radiologists should be aware of this association and should evaluate the bony structure carefully.