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subdural hematoma guidelines

Brian J Yun, Benjamin A White, H Benjamin Harvey, Anand M Prabhakar, Jonathan D Sonis, McKinley Glover, Emily Vallillo, Sun Choi, Pierre Borczuk, Ali S Raja
OBJECTIVE: Current guidelines do not address the disposition of patients with mild traumatic brain injury (TBI) and resultant intracranial hemorrhage (ICH). Emergency medicine clinicians working in hospitals without neurosurgery coverage typically transfer patients with both to a trauma center with neurosurgery capability. Evidence is accruing which demonstrates that the risk of neurologic decompensation depends on the type of ICH and as a result, not every patient may need to be transferred...
March 30, 2017: American Journal of Emergency Medicine
Mauricio A Escobar, Marc Auerbach, Katherine Flynn-O'Brien, Gunjan Tiyyagura, Matthew A Borgman, Susan J Duffy, Kelly Falcone, Rita Burke, John M Cox, Sabine Maguire
Early identification of non-accidental trauma (NAT) is a critical component of pediatric trauma care. Literature searches were conducted related to the association of NAT with seven key areas: history, exam findings (burns, oral trauma, bruising) and imaging (fractures, abdominal and brain injuries). When available, odds ratios (OR) with 95% confidence intervals (CI) for associations with NAT are presented. Systematic reviews have been published in six of the seven key areas and are described. The operational definition of NAT was widely variable across studies, prohibiting meta-analysis...
March 23, 2017: Journal of Trauma and Acute Care Surgery
Rafael A Vega, Alex B Valadka
Because published guidelines for surgical decision-making in patients with acute subdural hematomas (ASDHs) are based largely on case series and other weak evidence, management often must be individualized. Nonoperative management is a viable option in many cases. The literature is divided about the effects of anticoagulant and antiplatelet medications on rapid growth of ASDHs and on their likelihood of progression to large chronic subdural hematomas. Close clinical and radiologic follow-up is needed, both acutely to detect rapid expansion of an ASDH, and subacutely to detect formation of a large subacute or chronic subdural hematoma...
April 2017: Neurosurgery Clinics of North America
Sae-Yeon Won, Daniel Dubinski, Eva Herrmann, Colleen Cuca, Adam Strzelczyk, Volker Seifert, Juergen Konczalla, Thomas M Freiman
OBJECT: Clinically evident or subclinical seizures are common manifestation in acute subdural hematoma (aSDH); however, there is a paucity of research investigating the relationship between seizures and aSDH. The purpose of this study is, firstly to determine incidence, predictors of seizures and secondly establish a guideline in patients with aSDH to standardize the decision for prophylactic antiepileptic treatment. METHOD: The author analyzed 139 patients with aSDH treated from 2007 until 2015...
February 14, 2017: World Neurosurgery
Maria Kamenova, Edin Nevzati, Katharina Lutz, Armando Dolp, Javier Fandino, Luigi Mariani, Jehuda Soleman
BACKGROUND: Chronic subdural hematoma (cSDH) is one of the most common neurosurgical diseases typically affecting older people. Many of these patients have coronary artery disease and receive antiplatelet therapy, usually acetylsalicylic acid (ASA). Despite growing clinical relevance, there is still a lack of data focusing on the perioperative management of such patients. OBJECTIVE: The aim of this study is to compare the perioperative and postoperative bleeding and cardiovascular complication rates of patients undergoing burr-hole drainage for cSDH with and without discontinuation of low-dose ASA...
April 2017: World Neurosurgery
Christopher Munoz-Bendix, Robert Pannewitz, Daniel Remmel, Hans-Jakob Steiger, Bernd Turowski, Phillip Jorg Slotty, Marcel Alexander Kamp
As a result of the demographic shift in western societies, the mean age at presentation of patients suffering from chronic subdural hematomas (cSDH) is increasing. Therapeutic strategies, surgical and non-surgical, need to be reevaluated and adapted accordingly. Age is considered to be a positive risk factor for a higher perioperative morbidity and mortality. The purpose of this study is to determine if old age (≥85 years) should be seen as a contraindication for surgical treatment. Two groups (56 patients each) with cSDH over and below 85 years of age from a single neurosurgical department with well-defined surgical treatment guidelines were retrospectively analyzed...
December 28, 2016: Neurosurgical Review
Jacob R Joseph, Brandon W Smith, Hugh J L Garton
Blunt prenatal trauma is known to have consequences to the developing brain, and can result in subdural hematoma (SDH) or epidural hematoma (EDH). The authors present a case of blunt prenatal trauma resulting in a fetal SDH, intraparenchymal hematoma, and intraventricular hemorrhage, and perform a systematic review of the literature. This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Relevant studies (up to April 2016) that reported on cases of fetal SDH or EDH after blunt prenatal trauma were identified from the PubMed database...
January 2017: Journal of Neurosurgery. Pediatrics
Raghunath Avanali, Biju Bhadran, Krishna Kumar P, Abhishek Vijayan, Arun S, Aneeze M Musthafa, Sunil Panchal, Vinu V Gopal
OBJECTIVE: To identify the current management modalities practiced by neurosurgeons in India for chronic subdural hematoma. METHODS: A questionnaire was prepared for the survey and sent via e mail to neurosurgeons. It covered the following aspects of managing the CSDH. 1) Demographic and institutional details. 2) Choice of surgical procedure. 3) Surgical adjutants such as placing a subdural drain 4) Pre and Post operative care 4) Recurrences and management. Responses obtained were entered in SPSS data sheet and analyzed...
September 16, 2016: World Neurosurgery
Maria Kamenova, Katharina Lutz, Sabine Schaedelin, Javier Fandino, Luigi Mariani, Jehuda Soleman
BACKGROUND: Antiplatelet therapy in patients with chronic subdural hematoma (cSDH) presents significant neurosurgical challenges. Given the lack of guidelines regarding perioperative management with antiplatelet therapy, it is difficult to balance the patient's increased cardiovascular risk and prevalence of cSDH. OBJECTIVE: To better understand the risk and recurrence rates related to resuming low-dose acetylsalicylic acid (ASA) by evaluating our patients' resumption of low-dose ASA at various times after burr-hole drainage of the hematoma...
November 2016: Neurosurgery
Jarin Vaewpanich, Karin Reuter-Rice
BACKGROUND: Traumatic brain injury (TBI) is a major cause of pediatric morbidity and mortality. Secondary injury that occurs as a result of a direct impact plays a crucial role in patient prognosis. The guidelines for the management of severe TBI target treatment of secondary injury. Posttraumatic seizure, one of the secondary injury sequelae, contributes to further damage to the injured brain. Continuous electroencephalography (cEEG) helps detect both clinical and subclinical seizure, which aids early detection and prompt treatment...
September 2016: Epilepsy & Behavior: E&B
Ha Son Nguyen, Karl Janich, Ashish Sharma, Mohit Patel, Wade Mueller
BACKGROUND: The fate of the bone flap is a significant decision during surgical treatment of acute subdural hematoma (SDH). A general guideline revolves around the surgeon's concern for brain edema. Limited studies, however, have focused on the factors that contribute to perioperative brain edema. METHODS: From 2012 to 2015, 38 patients who underwent decompressive craniectomy for acute SDH were reviewed. Clinical data were extracted (age, sex, initial Glasgow Coma Scale (GCS) score, sodium level, hematocrit, and intraoperative blood loss)...
November 2016: World Neurosurgery
Jian Yu
INTRODUCTION: Traumatic brain injury (TBI) is a common disease for adults, particularly for young people. Most TBI patients have intracerebral hemorrhage, which often to brain edema and toxicity to the neural tissue. Deferoxamine (also known as Deferrioxamine B, Deferoxamine B, DFO-B, DFOA, DFB or desferal, DFX) is a bacterial siderophore produced by the Actinobacteria Streptomyces pilosus. It has medical applications as a chelating agent used to remove excess iron from the body. Animal models indicate that Deferoxamine accelerates intracranial hemorrhage absorption, although its effects on human patients remain unclear...
August 2016: Neurosurgery
Ha Son Nguyen, Luyuan Li, Mohit Patel, Wade Mueller
BACKGROUND: Extra-axial hematoma can cause significant brain compression. Guidelines for surgical evacuation include imaging findings (midline shift and hematoma thickness/volume) in conjunction with Glasgow Coma Scale (GCS) scores and/or intracranial pressure (ICP) monitoring. Physiologically, overall brain density should also change with compression. In our observational study, we explored whether overall brain density, defined using computed tomography Hounsfield Units (CT HU), changes after surgical evacuation of extra-axial hematoma...
October 2016: Neuroradiology Journal
Paige J Ostahowski, Nithya Kannan, Mark S Wainwright, Qian Qiu, Richard B Mink, Jonathan I Groner, Michael J Bell, Christopher C Giza, Douglas F Zatzick, Richard G Ellenbogen, Linda Ng Boyle, Pamela H Mitchell, Monica S Vavilala
OBJECTIVE Posttraumatic seizure is a major complication following traumatic brain injury (TBI). The aim of this study was to determine the variation in seizure prophylaxis in select pediatric trauma centers. The authors hypothesized that there would be wide variation in seizure prophylaxis selection and use, within and between pediatric trauma centers. METHODS In this retrospective multicenter cohort study including 5 regional pediatric trauma centers affiliated with academic medical centers, the authors examined data from 236 children (age < 18 years) with severe TBI (admission Glasgow Coma Scale score ≤ 8, ICD-9 diagnosis codes of 800...
October 2016: Journal of Neurosurgery. Pediatrics
Tushit Mewada, Tomotaka Ohshima, Taiki Yamamoto, Shunsaku Goto, Yoko Kato
BACKGROUND: Refractory chronic subdural hematomas due to iatrogenic dural arteriovenous fistulas (dAVFs) are difficult to treat. We report our experience and propose a guideline on basis of a literature review for the usefulness of embolization of middle meningeal artery (MMA) for the treatment of the same. CASE DESCRIPTION: We report a case with right hemiparesis and aphasia 1 month after a fall from a bicycle. Computed tomography scan of the head showed left chronic subdural hematoma, which was evacuated by burr-hole drainage...
August 2016: World Neurosurgery
Kwang Jin Lee, Ki Seong Eom, Jong Tae Park, Tae Young Kim
Incidence of post-operative seizure after burr-hole trephination (BHT) for chronic subdural hematoma (CSDH) is known to be very low. The effect of the prophylactic antiepileptic drug in reducing the development of new seizure after surgery is still unclear. Here, we present a case of fatal status epilepticus with progressive respiratory complication following early discontinuation of prophylactic antiepileptic drug in an 84-year-old man who had undergone bilateral BHT and closed-system drainage for bilateral CSDH...
October 2015: Korean Journal of Neurotrauma
Jong Joo Lee, Yusam Won, Taeyoung Yang, Sion Kim, Chun-Sik Choi, Jaeyoung Yang
OBJECTIVE: Acute subdural hematoma (ASDH) patients are treated conservatively or surgically according to the guidelines for surgical treatment. Many patients with thin ASDH and mild neurologic deficit are managed conservatively, but sometimes aggravation of thin ASDH to chronic subdural hematoma (CSDH) results in exacerbated clinical symtoms and consequently requires surgery. The aim of this study is to evaluate risk factors that indicate progression of initially non-operated ASDH to CSDH...
October 2015: Korean Journal of Neurotrauma
Jehuda Soleman, Katharina Lutz, Sabine Schaedelin, Luigi Mariani, Javier Fandino
BACKGROUND: Chronic subdural hematoma (cSDH) is one of the most frequent neurosurgical conditions affecting elderly people and is associated with substantial morbidity and mortality. The use of a subdural drain (SDD) after burr-hole trepanation for cSDH was proven to reduce recurrence and mortality at 6 months. To date in neurosurgery practice, evidence-based guidelines on whether an SDD or subperiosteal drain (SPD) should be used do not exist. Currently both methods are being practiced depending on the institute and/or the practicing neurosurgeon...
April 8, 2016: JMIR Research Protocols
Jared Cooper, John L Gillick, Michael LaBagnara, Kaushik Das, Virany H Hillard
BACKGROUND: Traumatic spinal subdural hematoma is an exceedingly rare condition, with those occurring in the absence of intracranial disease being particularly uncommon. Only 13 such cases have been reported. Although theories exist to describe the pathophysiology of traumatic spinal subdural hematoma, the precise mechanism and guidelines for management remain unclear. CASE DESCRIPTION: This report describes a 37-year-old woman who suffered a traumatic assault who developed progressive low back pain with radicular symptoms 2 days after presentation...
June 2016: World Neurosurgery
Ha Son Nguyen, Peter A Pahapill
Subdural hematomas (SDH) in patients with implanted deep brain stimulating (DBS) electrodes are rare. Only a handful of cases have been reported in the literature. No clear management guidelines exist regarding the management of the hematoma and the existing electrodes. We describe a 68-year-old female with bilateral DBS electrodes, who presented with acute, severe hemiparesis due to a large subacute SDH with associated electrode displacement. Urgent hematoma evacuation reversed the hemiparesis; the electrodes were left undisturbed...
2015: Case Reports in Neurological Medicine
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