RESUMO
A 74-year-old man developed involuntary rhythmic contractions of his left abdomen, after drainage of a chronic right frontoparietal subdural hematoma (Figure). These movements had electroencephalographic correlation with periodic lateralized discharges over the right posterior quadrant (Video 1, Figure) and were classified as clonic abdominal seizures. Clonic abdominal seizures are a rare clinical finding in patients with seizure disorders. The symptomatogenic zone most commonly localizes to the contralateral paracentral frontoparietal region.1 Possible etiologies include primary brain tumors, brain metastasis, CNS infections, cortical dysplasia, stroke, and postsurgical complications.1,2 Clonic abdominal seizures are infrequent, but should be suspected in patients with rhythmic and regular contractions of the hemiabdominal wall in the context of a contralateral cerebral structural lesion.
Assuntos
Neoplasias Encefálicas , Dança , Estado Epiléptico , Acidente Vascular Cerebral , Masculino , Humanos , Idoso , Hematoma Subdural/complicações , Hematoma Subdural/diagnóstico por imagemRESUMO
PURPOSE: Cerebral sinovenous thrombosis is an increasingly recognized cause of stroke in children and neonates. Its true incidence appears to be underestimated. Despite being a rare event, certain studies have found a correlation between subdural hemorrhage and cerebral sinus thrombosis. The literature suggests that spontaneous cerebral sinovenous thrombosis in the pediatric population may lead to the occurrence of a subdural hemorrhage. In this report, we present a case of cerebral venous thrombosis associated with chronic subdural hematoma and review the literature to highlight the importance of these conditions. CASE REPORT: An 11-year-old boy was admitted in the neurosurgery department with headache and a neurological examination without changes. The imaging studies identified a heterogeneous subdural collection in the fronto-temporo-parietal region. The patient underwent surgical drainage of the subdural hematoma, and the procedure was performed without complications. The magnetic resonance and angiography showed an extensive thrombosis of the superior sagittal sinus, extending downward to the occipital sinus and partially to the right transverse sinus. CONCLUSIONS: Appropriate management in the diagnosis and an early treatment of dural sinus thrombosis associated with subdural hemorrhage can reduce the risk of recurrence and improve the clinical outcome.
Assuntos
Cavidades Cranianas , Trombose dos Seios Intracranianos , Criança , Masculino , Recém-Nascido , Humanos , Hematoma Subdural/complicações , Hematoma Subdural/diagnóstico por imagem , Hematoma Subdural/cirurgia , Trombose dos Seios Intracranianos/complicações , Trombose dos Seios Intracranianos/diagnóstico por imagem , Trombose dos Seios Intracranianos/cirurgia , Imageamento por Ressonância Magnética/efeitos adversos , Seio Sagital Superior/patologiaRESUMO
OBJECTIVE: To use legal statements by perpetrators to gain new insights into the causative mechanism of classic metaphyseal lesion (CML). The CML, so called "corner fracture," is considered a highly specific marker for abuse in infants. However, the precise correlation between CMLs and abusive head trauma is still unknown. STUDY DESIGN: In this retrospective observational study, we selected 67 cases with at least 1 CML from a 15-year cohort of legally prosecuted child abuse cases. Their clinical, radiologic, and forensic records were analyzed. In 27 cases, the perpetrator confessed to abusing the child and described the events. Potential associations with subdural hematoma and with confession were evaluated using 2 separate binary logistic regression models. RESULTS: All 67 infants showed other signs of abuse. Median age was 3.4 months. Over 65% had multiple CMLs. Knees and ankles were predominantly involved (64%). Only CMLs of the shoulder were significantly associated with subdural hematoma (P = .03). Different-age fractures were more common in the nonsubdural hematoma group (P = .01). In the group with confessions, perpetrators admitted inflicting violent indirect skeletal forces (torsion, traction, compression, and forced movements). The most common circumstance was diapering (44%), reported by male perpetrators only (P = .03) followed by dressing/undressing (30%). The violence was habitual in 67% of cases. CONCLUSIONS: This unique forensic case series shows that CMLs are caused by violent acts inflicted most during physical care of infants. The frequency of habitual violence responsible for CMLs deserves greater attention.
Assuntos
Maus-Tratos Infantis/diagnóstico , Traumatismos Craniocerebrais/etiologia , Fraturas Ósseas/etiologia , Fraturas Múltiplas/etiologia , Hematoma Subdural/etiologia , Traumatismos Craniocerebrais/complicações , Feminino , Fraturas Ósseas/complicações , Fraturas Múltiplas/complicações , Hematoma Subdural/complicações , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosAssuntos
Neoplasias do Sistema Nervoso Central/diagnóstico , Febre/patologia , Hematoma Subdural/diagnóstico , Leucemia Mielomonocítica Crônica/diagnóstico , Neoplasias Meníngeas/diagnóstico , Meningioma/diagnóstico , Sarcoma Mieloide/diagnóstico , Idoso de 80 Anos ou mais , Neoplasias do Sistema Nervoso Central/complicações , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Evolução Fatal , Hematoma Subdural/complicações , Hematoma Subdural/diagnóstico por imagem , Humanos , Leucemia Mielomonocítica Crônica/complicações , Leucemia Mielomonocítica Crônica/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Neoplasias Meníngeas/complicações , Neoplasias Meníngeas/diagnóstico por imagem , Meningioma/complicações , Meningioma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Sarcoma Mieloide/complicações , Sarcoma Mieloide/diagnóstico por imagem , Distúrbios da Fala/etiologiaRESUMO
A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.
Assuntos
Abscesso Encefálico/microbiologia , Abscesso Encefálico/terapia , Brucelose/complicações , Brucelose/terapia , Empiema Subdural/microbiologia , Empiema Subdural/terapia , Antibacterianos/uso terapêutico , Abscesso Encefálico/patologia , Hemorragia Encefálica Traumática/complicações , Craniotomia/métodos , Drenagem/métodos , Hematoma Subdural/complicações , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A 55-year-old male presented with fever, stupor, aphasia, and left hemiparesis. A history of head trauma 3 months before was also reported. Cranial magnetic resonance imaging revealed slight contrast enhancement of lesions under the right frontal skull plate and right frontal lobe. Because of deterioration in nutritional status and intracranial hypertension, the patient was prepared for burr hole surgery. A subdural empyema (SDE) recurred after simple drainage. After detection of Brucella species in SDE, craniotomy combined with antibiotic treatment was undertaken. The patient received antibiotic therapy for 6 months (two doses of 2 g ceftriaxone, two doses of 100 mg doxycycline, and 700 mg rifapentine for 6 months) that resulted in complete cure of the infection. Thus, it was speculated that the preexisting subdural hematoma was formed after head trauma, which was followed by a hematogenous infection caused by Brucella species.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Abscesso Encefálico/microbiologia , Abscesso Encefálico/terapia , Brucelose/complicações , Brucelose/terapia , Empiema Subdural/microbiologia , Empiema Subdural/terapia , Antibacterianos/uso terapêutico , Abscesso Encefálico/patologia , Hemorragia Encefálica Traumática/complicações , Craniotomia/métodos , Drenagem/métodos , Hematoma Subdural/complicações , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
The association between vascular tumors and thrombocytopenia is rare. Kasabach-Merritt Syndrome is seen in childhood and is characterized by hemangiomas and thrombocytopenia. A 42 years-old man with a cerebellar hemangioblastoma and thrombocytopenia, admitted with a subarachnoid hemorrhage is reported. The patient was operated and required a splenectomy to manage the thrombocytopenia. After the splenectomy the patient developed a subdural hematoma that was operated. Despite the surgical treatment, the patient died.
Assuntos
Neoplasias Cerebelares/complicações , Hemangioblastoma/complicações , Trombocitopenia/complicações , Adulto , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/terapia , Diagnóstico Diferencial , Evolução Fatal , Hemangioblastoma/patologia , Hemangioblastoma/terapia , Hematoma Subdural/complicações , Hematoma Subdural/patologia , Humanos , Síndrome de Kasabach-Merritt/patologia , Imageamento por Ressonância Magnética , Masculino , Trombocitopenia/patologia , Trombocitopenia/terapia , Tomografia Computadorizada por Raios XRESUMO
The association between vascular tumors and thrombocytopenia is rare. Kasabach-Merritt Syndrome is seen in childhood and is characterized by hemangiomas and thrombocytopenia. A 42 years-old man with a cerebellar hemangioblastoma and thrombocytopenia, admitted with a subarachnoid hemorrhage is reported. The patient was operated and required a splenectomy to manage the thrombocytopenia. After the splenectomy the patient developed a subdural hematoma that was operated. Despite the surgical treatment, the patient died.
Assuntos
Humanos , Masculino , Adulto , Trombocitopenia/complicações , Neoplasias Cerebelares/complicações , Hemangioblastoma/complicações , Trombocitopenia/patologia , Trombocitopenia/terapia , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Neoplasias Cerebelares/patologia , Neoplasias Cerebelares/terapia , Hemangioblastoma/patologia , Hemangioblastoma/terapia , Evolução Fatal , Diagnóstico Diferencial , Síndrome de Kasabach-Merritt/patologia , Hematoma Subdural/complicações , Hematoma Subdural/patologiaRESUMO
The aim of the present study is to describe the clinical and epidemiological characteristics, complications and outcome of patients with haemophilia and acute head injury (AHI) at the emergency department (ED), and develop a protocol to prevent early and late complications. This is a retrospective cohort study including all patients with haemophilia and AHI admitted to the ED. We identified 26 patients with AHI. A computed tomography scan was carried out on all patients at admission, and again on two patients (with neurosurgical complications) 48 h later. The discharge diagnosis was as follows: 3.8% subdural haematoma, 3.8% cerebellar epidural haematoma and 92.3% uncomplicated AHI. We propose the following protocol: a computed tomography scan upon arrival and another within 48 h post-AHI, unless there is an absence of clinical symptoms. In addition, all patients must self-administer a clotting factor as soon as possible and be observed in the ED for at least 48 h.