Hematomas, cerebral

Epilepsy develops in 14-20% of patients, and putative risk factors include subdural hematoma, cerebral infarction, disability on discharge, ventricular drain insertion and surgical treatment (Olafsson et al. 2000 Claassen et al. 2003). 

Suggested Alternatives for Differential Diagnosis Meningitis, basilar artery blood clots (thrombosis), cardioembolic stroke, cavernous sinus syndromes, cerebral venous blood clots (thrombosis), confusional states and acute memory disorders, epileptic and epileptiform encephalopathies, febrile seizures, haemophilus meningitis, intracranial hemorrhage, leptomeningeal carcinomatosis, subdural pus (empyema), or bruise (hematoma). 

A 40-year-old Korean woman who had taken oxy-metholone for aplastic anemia (doses not stated) developed cerebral venous thrombosis accompanied by a tentorial subdural hematoma (30). 

Chu K, Kang DW, Kim DE, Roh JK. Cerebral venous thrombosis associated with tentorial subdural hematoma during oxymetholone therapy. J Neurol Sci 2001 185(l) 27-30. 

In the previous sections we have, by part, already reviewed delayed effects after cerebral ischemia, such as the risk of hemorrhagic complications that may occur as petechial bleedings or parenchymal hematoma. We have seen that the blood-brain barrier opens to various degrees with a substantial time... 

Brooks RA, Di Chiro G, Patronas N et al (1989) MR imaging of cerebral hematomas at different field strengths theory and applications. Comput Assist Tomogr 13 194-206 Brott T, Broderick JP, Kothari R et al (1997) Early hemorrhage growth in patients with intracerebral hemorrhage. Stroke 28 1-5... 

Offenbacher H, Fazekas F, Schmidt R, Koch M, Fazekas G, Kapeller P (1996) MR of cerebral abnormalities concomitant with primary intracerebral hematomas. Am J Neuroradiol 17 573-578... 

Misdiagnosis of stroke is not uncommon and it is well recognized that nonvascular conditions such as brain tumor, subdural hematoma and cerebral abscess may mimic cerebral ischemia (Groch et al. 1960). Misdiagnosis occurs if details regarding past history are lacking. This may be because the patient is aphasic, comatose or demented. A careful patient... 

Although intracranial mass lesions such as cerebral abscess, subdural hematoma and brain tumors do not usually present with acute stroke-like symptom onset, 6% of brain tumor patients presented with symptoms of less than 24-h duration (Snyder et al. 1993). Misdiagnosis of these cases is easily prevented by CT or MRI and should not play a major role nowadays. 

Most of the previous studies on brain temperature monitoring were performed in neurosurgical patients with head trauma, brain tumor, or large intracerebral hematoma. Busto (10) addressed the importance of brain temperature in experimental cerebral ischemic injury. He was able to show a reduction in ischemic injury depending on the level of intraischemic brain temperatures. 

O Connor AD, Rusyniak DE, Bruno A (2005). Cerebrovascular and cardiovascular complications of alcohol and sympathomimetic drug abuse. Medical Clinics of North America 89 1343-1358 O Laoire SA, Crockard A, Thomas DGT et al (1982). Brain-stem hematoma. A report of six surgically treated cases. Journal of Neurosurgery 56 222-227 Plant GT, Revesz T, Barnard RO et al (1990). Familial cerebral amyloid angiopathy with... 

A large hematoma in one cerebral hemisphere, or an infarct affecting a large proportion of the middle cerebral artery territory, causes a characteristic clinical syndrome ... 

Cognitive or visual field defects may have to be assumed in drowsy patients. Deviation of the eyes towards the affected hemisphere is common but recovers in a few days. A large hematoma may cause midUne shift, transtentorial herniation and coma within 24-hours (Fig. 9.3). By contrast, these changes take two or three days to evolve with large infarcts as cerebral edema develops. 

Spinal subarachnoid hemorrhage is very rare. It is caused by a vascular malformation, hemostatic failure, coarctation of the aorta, inflammatory vascular disease, mycotic aneurysm or a vascular tumor such as ependymoma. Accumulating hematoma may compress the spinal cord. Suspicion is aroused if the cerebral angiogram is negative and the patient develops spinal cord signs. 

Intracerebral extension of the hemorrhage occurs in at least a third of patients. Patients with a large hematoma and depressed consciousness might require immediate evacuation of the hematoma, preferably preceded by occlusion of the aneurysm (Niemann et al. 2003). Alternatively, extensive craniectomy can be employed to allow expansion of the brain, as for maUgnant middle cerebral artery infarction (Smith et al. 2002). Subdural hematomas are rare but life threatening and should be removed. 

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