Spontaneous Spinal Epidural Hematoma Following Transcatheter Aortic Valve Replacement
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Spinal epidural hematoma
Valve replacement
Objective To explore the distant parts of the brain of postoperative epidural hematoma of the mechanism and its clinical significance.Methods We collected 20 cases of postoperative distant parts of the brain in patients with epidural hematoma,have been checked at diagnosis.After the tumor size,location location,distant parts of the epidural hematoma size and location of the site,time of occurrence of the statistics.Results distant hematoma occurred in 5 cases the average size of 30 mm×50 mm,the amount of the top left,recovered;including four cases of distant hematoma occurred an average size of 40 mm×80 mm,right parietal occipital,death;5 cases occurrence of distant hematoma occurs the average size of 40 mm×50 mm,automatic discharge;6 patients had distant hematoma occurred,the average size of 20 mm×60 mm,left parietal occipital,left frontal recovery.Combination of literature review,to explore its mechanism and clinical significance of its possible causes and surgical considerations.Conclusion Brain surgery to fill the cavity should be timely,good drainage work,and timely processing of early complications.
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Since 1986, we have treated five cases of spinal epidural hematoma, all of which were examined with magnetic resonance imaging (MRI). Up till 4 days from onset, the hematoma was visualized as iso-intense on the T1-weighted view, although on the T2-weighted view various patterns were seen. Thirteen days after onset the lesion was iso-intense on the T1-weighted view, and of high intensity on the T2-weighted view. Eighty days after onset, the lesion was visualized as highintensity on T1 and T2-weighted views. The signal intensity of spinal epidural hematoma on MRI changes with time according to the metabolism of hemoglobin. We confirm that MRI is a useful examination for spinal epidural hematoma.
Spinal epidural hematoma
Intensity
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Objective To analyze the MR manifestations and differential diagnosis of nontraumatic spinal epidural hematoma. Methods 10 patients with nontraumatic spinal epidural hematoma were performed MR plan scan, 7 of which enhanced. 9 cases were proved by surgery and pathology and 1 case were proved by follow up. Results Hematoma occurred in cervical level in 4 cases, cervical-thoracic level in 3 cases and thoracic level in 3 cases. Hematoma were located in the dorsal of spinal cord in 7cases, located in the ventral of the spinal cord in 1 case and both in 1 case. The hematomas in 7 cases were spindle-shaped, 2 were strip-shaped and 1 was oval. Vessel bleeding were found in 2 case, angioma in 2 case and AVM in 1 case by surgery. Hematoma were demonstrated slight hyper intensity on T1 WI and slight hypo intensity on T2 WI in acute phase. In subacute phase, hematoma showed iso- or hyper signal intensity on T1 WI, hypo- or hyper intensity on T2 WI, and isointensity on both sequences in chronic phase. The enhanced pattern was different towards period and different reason. Conclusions MR is valuable in diagnosing the nontraumatic spinal epidural hematoma with presenting the extend of lesions precisely, judging the phase of hematoma correctly and help in analyzing the reason some degree.
Spinal epidural hematoma
Intensity
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Subarachnoid space
Skull fracture
Acute subdural hematoma
Epidural space
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Objective To explore the clinical characteristics of epidural hematoma in children. Methods A total of 120 children with epidural hematomas within recent three years were reviewed. Results The main cause of injury in infants and preschool children was falling or sliping, but traffic accident was the predominant cause in children over seven years old. About 65.8% children were complicated by skull fractures, with average Glasgow Coma Scale (GCS) score of 13.6. Except for acute hematoma treated with emergency surgical operation, the other hematoma was rechecked with CT scan at days 1 and 3 or so after it was found for the first time. Patients receiving operation accounted for 57.5% and those with hematoma due to diploe bleeding for 43.9%. Conclusions The primary cerebral injury is not severe relatively in children with epidural hematoma, in which the incidence of skull fracture is lower than that in adults. The main cause for hematoma formation is diploe bleeding. Sound prognosis can be obtained through recheck of CT scan and suitable therapy.
Skull fracture
Coma (optics)
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A 16-year-old boy collided with a passenger car while riding a motorcycle. He was thrown to a distance and experienced a head injury on impact. When brought to our medical facility, he was alert, had no neurological abnormalities, and did not complain of headache. A head computed tomography(CT)scan indicated a left cranial fracture and an acute epidural hematoma(15mm thick)directly under the fracture. Follow-up head CT performed 3 hours after the injury indicated no change in the size of the hematoma. The head CT performed on the following day indicated that most of the hematoma had disappeared. As the patient had neither headache nor neurological symptoms, he was placed under observation. However, a head CT performed 7 days after the injury indicated the formation of an epidural hematoma approximately the same size as the initial hematoma and located at the same site. We performed craniotomy to evacuate the hematoma, identify the source of the bleeding, and restore hemostasis. Although cases in which an acute epidural hematoma rapidly and spontaneously resolves have been reported, these are extremely rare. Recurrence of an epidural hematoma despite normal blood coagulation function after its initial rapid resolution has not been reported yet. We report on this rare case of acute epidural hematoma with reference to relevant literatures.
Acute subdural hematoma
Head trauma
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Objective To investigate 16 cases of delayedintracerebral hematoma after surgical removal of epidural Hematoma,deserve the clinic value.Methods Analysing the images of the 16 cases delayedintracerebral hematoma after surgical removal of epidural hematoma,intraoperative atate and postoperative clinical symptom.Results The 16 cases delayedintracerebral hematoma were diagnosised by CT scanning after surgical removal of epidural hematoma.Conclusion We should think highly of delayed intracerebral hematoma after surgical removal of acute epidural hematoma.The curative effect may be improved if delayed intracerebral hematoma were diagnosised by CT scanning and treatment in time.
Intracerebral hematoma
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Intracranial hematoma rarely presents between two dural layers of pachimeninges.Here, we present a case of an interdural hematoma with similar appearance to an epidural hematoma.A 51-year-old man presented with a left temporal contusion following a motor vehicle accident.After craniotomy and contusion removal, the post-operative CT scan showed a parietal intracranial hematoma located posterior and superior to the bone flap.The CT scan appearance of the new hematoma was similar to the CT scan appearance of an epidural hematoma.Upon operation, we determined that the hematoma was located between two layers of dura mater, i.e., an interdural hematoma.We removed the hematoma and sutured the two layers of dura to each other at multiple sites.Interdural hematoma is a rare entity.Its appearance in a CT scan can be mistaken for an extradural hematoma. KeywoRds:
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Background: Spinal epidural hematoma is rare condition that can rapidly develop into severe neurologic deficits. The pathophysiology of this development remains unclear. There are several case reports of emergency hematoma evacuations after epidural steroid injection. Case: We report on two patients who developed acute, large amounts of epidural hematoma without neurological deficits after transforaminal epidural steroid injection. After fluoroscopy guided aspiration for epidural hematoma was performed, neurological defects did not progress and the hematoma was shown to be absorbed on magnetic resonance imaging. Conclusions: These reports are believed to be the first of treating epidural hematoma occurring after transforaminal epidural steroid injection through non-surgical hematoma aspiration. If large amounts of epidural hematoma are not causing neurological issues, it can be aspirated until it is absorbed.
Epidural steroid injection
Spinal epidural hematoma
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Objective To study the risk factors,treatment and prevention of acute epidural hematoma after spinal surgery. Methods From June 2003 to June 2008,10 acute epidural hematoma in operative site after spinal operation were confirmed surgically.Of whom,nine cases were after through posterior approach surgery of thoracic vertebrae,and one after posterior approach cervical vertebrae.A retrospective analysis was done for the above patients. Results Before and after hematoma removal,the neurofunctional scores were 1.50±0.85 and 2.90±1.37,respectively,the difference being significant(t=5.25,P0.01).The compression time of hematoma was 6.95±5.20 hours on average,the neurofunctional score after removal of hematoma was negatively correlated with the compression time of hematoma(r=-0.846,P0.01). Conclusion Postoperative acute epidural hematoma should be decompressed as soon as possible,the earlier the hematoma to be removed,the better the nerve function recovers after surgery.
Spinal epidural hematoma
Postoperative hematoma
Spinal Surgery
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