Morphological characteristics of infected subdural hematoma: Comparison with images of chronic subdural hematoma

Tamai, Sho; Watanabe, Takuya; Ichinose, Toshiya; Murakami, Kenichi; Ueno, Mariko; Munemoto, S; Nakada, Mitsutoshi; Hayashi, Yutaka

doi:10.1016/j.clineuro.2020.105831

Cited by 3 publications

(4 citation statements)

References 14 publications

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“…[4] ickened and hardened encapsulation of the hematoma due to inflammatory changes reportedly prevented the infection from spreading into the arachnoid membrane and brain parenchyma, resulting in focal infection and mild symptoms. [6,19] Compared to the previous reports, [3,4,9,19] our case followed a chronic course with the longest duration with no neurological deficits. Consequently, it was difficult to differentiate an infectious hematoma from a spontaneous hematoma expansion preoperatively.…”

Section: Discussionmentioning

confidence: 49%

“…[4] Although ISH shows heterogeneous patterns on CT and MRI, the hyperintensity within the hematoma on DWI and biconvex shape of the hematoma on CT can help diagnose an infected hematoma. [4,13,19] In our case, we presumed that the infection spreads from the bacteremia to the subdural hematoma capsule. However, there was no distinct bacteremia source or specific changes in the hematoma shape on CT or the intracapsular hyperintensity on DWI during the first admission, suggesting that the patient had not developed ISH at this time.…”

Section: Discussionmentioning

confidence: 76%

“…CSDH is a common disease in neurosurgical practice, while ISH in adults is clinicopathological rare, with only 41 reports available in the literature. [3,4,9,19] ISH acquires an infection hematogenously through the hematoma capsule of a preexisting CSDH as opposed to a typical intracranial subdural empyema, which develops through the direct extension of neurosurgical procedures, sinusitis, otitis media, mastoiditis, and skull trauma. [4] Although ISH shows heterogeneous patterns on CT and MRI, the hyperintensity within the hematoma on DWI and biconvex shape of the hematoma on CT can help diagnose an infected hematoma.…”

Section: Discussionmentioning

confidence: 99%

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Helicobacter cinaedi-infected chronic subdural hematoma mimicking an expanding hematoma: A case report

Akiyama¹,

Imamura²,

Fukui³

et al. 2021

Surgical Neurology International

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Background: We present the rare case of a spontaneous intracranial subdural empyema caused by Helicobacter cinaedi in a preexisting chronic subdural hematoma (CSDH). Case Description: A 72-year-old man with a history of the right CSDH that remained radiologically unchanged for the past 2 years with conservative management was transferred to our hospital because of fever and convulsive seizure. Systemic sources of infection were not identified. Fever and extremely high levels of serum C-reactive protein (CRP) spontaneously improved without antibacterial therapy. One month after the fever disappeared, brain computed tomography (CT) showed an increase in CSDH size. Mildly elevated CRP levels persisted without fever. Interval changes in shape on CT and hyperintense signals on diffusion-weighted magnetic resonance imaging (DWI) within the CSDH were observed with no neurological deficits. Five months later, the patient underwent craniotomy for a progressively enlarged CSDH. An infected organized hematoma was found, and copious pus was evacuated. Subsequently, an infected subdural hematoma (ISH) was diagnosed. Although bacterial cultures of the purulent specimen were negative, H. cinaedi was identified by gene sequencing analysis. Six months post antibiotic therapy, the ISH was under control, and abnormal DWI signals disappeared. Conclusion: To the best of our knowledge, this is the first report of ISH caused by H. cinaedi. This case suggests that ISH can follow a chronic course, mimicking the progressive expansion of subdural hematoma, and that H. cinaedi should be considered as a causative organism of ISH especially when conventional cultures are negative.

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Section: Discussionmentioning

confidence: 49%

Section: Discussionmentioning

confidence: 76%

Section: Discussionmentioning

confidence: 99%

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Helicobacter cinaedi-infected chronic subdural hematoma mimicking an expanding hematoma: A case report

Akiyama¹,

Imamura²,

Fukui³

et al. 2021

Surgical Neurology International

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“…Not only history, neurological examination, and blood tests but also radiological features, especially CT imaging, have been reported to show biconvex lenticular hematomas. [ 16 ]…”

Section: Discussionmentioning

confidence: 99%

Middle meningeal artery embolization before craniotomy for infected organizing chronic subdural hematoma: A case report and review of the literature

Sato¹,

Mochizuki²,

Fukuchi³

et al. 2022

Surgical Neurology International

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Background: Organizing chronic subdural hematoma (OSDH) is intractable and its radical treatment remains controversial. Middle meningeal artery embolization has emerged as an adjunctive treatment to craniotomy for OSDH. Case Description: The patient is an 86-year-old man. He had been taking warfarin for atrial fibrillation and was referred to the department for the treatment of bilateral chronic subdural hematoma (CSDH), which was found on head computed tomography after a fall. Bilateral burr hole drainages were performed, but his hematomas were organized, so the hematomas could not be drained sufficiently. The patient was discharged from the hospital without any neurological symptoms. Two months later, the patient presented with persistent fever and headache and had recurrent bilateral CSDHs. The hematoma on the right side was larger. Based on the initial intraoperative findings, OSDH was suspected, and craniotomy was performed on the right hematoma. Propionibacterium acnes were detected in the hematoma culture, and antimicrobial therapy was started postoperatively. Since the right hematoma recurred on the 7th postoperative day, bilateral middle meningeal artery (MMA) embolization with 20% n-butyl-2-cyanoacrylate was performed, followed by craniotomy for the left hematoma and drainage for the right recurrent hematoma. Antimicrobials were administered for 2 weeks after the last operations. Six months after the operations, both bilateral hematomas had almost disappeared. Conclusion: Craniotomy is effective for the treatment of infected OSDH, and MMA embolization is useful to reduce the risk of bleeding complications in the perioperative period, and may also reduce the recurrence of CSDH.

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Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

Quiñones-Ossa,

Maurya,

Deivasigamani

et al. 2023

J Neurointensive Care

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Chronic subdural hematoma (CSDH) is a common neurosurgical disease encountered by neurologists, neurosurgeons, intensive care specialists, and emergency physicians in the emergency department. Although much has been published on CSDH, it remains a topic of active research, also a significant challenge in specific scenarios. The spectrum of clinical presentation varies from asymptomatic radiological entity to significant sensory-motor deterioration resulting in a comatose state. The majority of these cases have an underlying history of trivial trauma in one or the other form. More often, elderly individuals present with CSDH. Management of CSDH in elderly individuals presents specific challenges due to pre-existing comorbidities and medications which alter the pathophysiology. There exists a significant diversity in the treatment modality of CSDH amongst neurosurgeons. The treatment modality includes medical management as well as various forms of surgical manoeuvres intended to evacuate the hematoma and hence alleviate the mass effect over the surrounding brain matter. The treatment modality needs to be individualized for every case. The rationale selection of cases for medical and surgical intervention with robust follow-up results in a better prognostication of these cases.

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Morphological characteristics of infected subdural hematoma: Comparison with images of chronic subdural hematoma

Cited by 3 publications

References 14 publications

Helicobacter cinaedi-infected chronic subdural hematoma mimicking an expanding hematoma: A case report

Helicobacter cinaedi-infected chronic subdural hematoma mimicking an expanding hematoma: A case report

Middle meningeal artery embolization before craniotomy for infected organizing chronic subdural hematoma: A case report and review of the literature

Management of Chronic Subdural Hematoma a Challenge in Neurosurgical Practice

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