Chronic Subdural Hematoma, Caused by Disseminated Intravascular Coagulation and/or Anticoagulation Therapy, after COVID-19

NOMURA, Yu; Naraoka, Masato; Fujiwara, Nozomi; Kinoshita, Shouhei; Yanagiya, Keita; Sasaki, Takao; Watanabe, Ryouta; Ueno, Kayo; Shimamura, Norihito

doi:10.2176/jns-nmc.2021-0425

Cited by 2 publications

(2 citation statements)

References 18 publications

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“…Infratentorial cSDHs are a very rare and unusual entity, especially those developing without a history of trauma. [1,2,[4][5][6]8] e reported low incidence of infratentorial cSDH is probably due to a scarce number of bridging veins in the posterior fossa. [4,6,8] Patients with infratentorial cSDH usually present with cranial nerve deficits, headaches, vomiting, and cerebellar symptoms, but symptoms of obstructive hydrocephalus can also complicate its course.…”

Section: Discussionmentioning

confidence: 99%

“…[3,7] On the other hand, infratentorial cSDH is an unusual and rare neurosurgical entity that arises either due to bridging veins injury, blood extension from a cerebellar contusion into the subdural space, or spontaneously in patients under anticoagulant and/or antiplatelet therapy. [1,2,[4][5][6]8] It can also be a result of an acute subdural hematoma (aSDH) transformation, although patients with aSDH usually present with symptoms that progress rapidly, even to death. Other articles report infratentorial cSDHs occurring after an aneurysm or arteriovenous malformation rupture in the posterior fossa.…”

Section: Introductionmentioning

confidence: 99%

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Bilateral posterior fossa chronic subdural hematoma as a cause of hydrocephalus

Dlaka,

Marčinković,

Raguž

et al. 2023

Surgical Neurology International

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Background: Infratentorial chronic subdural hematoma (cSDH) is still a rather elusive neurosurgical entity, which, due to its proximity and likely compression of the cerebellum and brainstem, can lead to devastating consequences. To establish standardized treatment, more studies and reports regarding its therapy are needed. We report a case of a simultaneous unilateral supratentorial and bilateral infratentorial cSDH, with the latter causing hydrocephalus and successfully treated with a bilateral burr-hole trepanation of occipital bone and placement of subdural drains. Case Description: A 71-year-old man with gait disturbance, Glasgow Coma Scale 12, and a radiologically verified unilateral supratentorial and bilateral cSDH of the posterior fossa causing cerebellum, brainstem, and fourth ventricle compression with obstructive hydrocephalus, underwent surgical evacuation of infratentorial hematoma with a bilateral burr-hole trepanation. The postoperative course was uneventful, with a control head computed tomography scan showing the resolution of the hematoma and hydrocephalus. The patient was discharged with no newly acquired neurological deficits. Conclusion: Due to a limited number of reports and studies involving infratentorial cSDHs causing hydrocephalus, decision-making and optimal surgical treatment remain unclear. We recommend a timely surgical evacuation of the hematoma if the patient is symptomatic while avoiding placement of external ventricular drainage.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bilateral posterior fossa chronic subdural hematoma as a cause of hydrocephalus

Dlaka,

Marčinković,

Raguž

et al. 2023

Surgical Neurology International

View full text Add to dashboard Cite

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Does a negative correlation of heme oxygenase–1 with hematoma thickness in chronic subdural hematomas affect neovascularization and microvascular leakage? A retrospective study with preliminary validation

Luh

Chen

Yang

et al. 2023

Journal of Neurosurgery

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OBJECTIVE Chronic subdural hematoma (CSDH) is a common neurological disease among elderly adults. The progression of CSDH is an angiogenic process, involving inflammatory mediators that affect vascular permeability, microvascular leakage, and hematoma thickness. The authors aimed to identify biomarkers associated with angiogenesis and vascular permeability that might influence midline shift and hematoma thickness. METHODS Medical records and laboratory data of consecutive patients who underwent surgery for CSDH were analyzed. Collected data were basic demographic data, CSDH classification, CSDH thickness, midline shift, heme oxygenase–1 (HO-1) levels in hematomas, and common laboratory markers. Linear regression analysis was used to evaluate the relationship of CSDH thickness with characteristic variables. The chick chorioallantoic membrane (CAM) assay was used to test the angiogenic potency of identified variables in ex ovo culture of chick embryos. RESULTS In total, 93 patients with CSDH (71.0% male) with a mean age of 71.0 years were included. The mean CSDH thickness and midline shift were 19.7 and 9.8 mm, respectively. The mean levels of HO-1, ferritin, total bilirubin, white blood cells, segmented neutrophils, lymphocytes, platelets, international normalized ratio, and partial thromboplastin time were 36 ng/mL, 14.8 μg/mL, 10.5 mg/dL, 10.3 × 103 cells/μL, 69%, 21.7%, 221.1 × 109 cells/μL, 1.0, and 27.8 seconds, respectively. Pearson correlation analysis revealed that CSDH thickness was positively correlated with midline shift distance (r = 0.218, p < 0.05) but negatively correlated with HO-1 concentration (r = −0.364, p < 0.01) and ferritin level (r = −0.222, p < 0.05). Multivariate linear regression analysis revealed that HO-1 was an independent predictor of CSDH thickness (β = −0.084, p = 0.006). The angiogenic potency of HO-1 in hematoma fluid was tested with the chick CAM assay; topical addition of CSDH fluid with low HO-1 levels promoted neovascularization and microvascular leakage. Addition of HO-1 in a rescue experiment inhibited CSDH fluid–mediated angiogenesis and microvascular leakage. CONCLUSIONS HO-1 is an independent risk factor in CSDH hematomas and is negatively correlated with CSDH thickness. HO-1 may play a role in the pathophysiology and development of CSDH, possibly by preventing neovascularization and reducing capillary fragility and hyperpermeability.

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Chronic Subdural Hematoma, Caused by Disseminated Intravascular Coagulation and/or Anticoagulation Therapy, after COVID-19

Cited by 2 publications

References 18 publications

Bilateral posterior fossa chronic subdural hematoma as a cause of hydrocephalus

Bilateral posterior fossa chronic subdural hematoma as a cause of hydrocephalus

Does a negative correlation of heme oxygenase–1 with hematoma thickness in chronic subdural hematomas affect neovascularization and microvascular leakage? A retrospective study with preliminary validation

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