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At least 19 recordsLinked to original sources
PubMed2005

[Effects of injecting heparin into the center of hematoma on peri-hematoma edema and hematoma volume in pigs with intracerebral hemorrhage].

OBJECTIVE: To investigate the safety and effect of injecting heparin into hematoma on peri-hematoma edema and hematoma volume in pigs with intracerebral hemorrhage (ICH). METHODS: Thirteen sucking pigs were divided randomly into two groups: hemorrhage group, in which 2.5 ml arterial blood was injected into the right frontal lobe and heparin group, in which 0.2 ml of heparin was injected into the hematoma produced by the injection of 2.3 ml of blood into the similar site. The hematoma volume and peri-hematoma edema were determined by the sequences of T2* weighted image (T2*WI), fluid-attenuated inversion- recovery (FLAIR) image and diffusion weighted image (DWI) by 1.5 T magnetic resonance image (MRI) from 30-60 minutes afterwards to 24 hours. The peri-hematoma apparent diffusion coefficient (ADC) was compared with that of contralateral hemisphere, and the corresponding histologic changes were studied. RESULTS: The average volume, shown by T2*WI at 24 hours, was significantly larger than that at 30-60 minutes after hematoma formation in hemorrhagic group [(5.29+/-0.98) cm3 vs. (3.09+/-0.38) cm3, P<0.01]. But there was no significant change in hematoma volume in hemorrhagic group from 30-60 minutes on to 24 hours [(2.21+/-0.28) cm3 vs. (2.33+/-0.30) cm3, P>0.05]. Both increased and decreased ADC were found around the hematoma in some animals of the heparin group compared with that of the contralateral hemisphere. On the other hand, in hemorrhagic group, only increased ADC could be found around the lesion, and there was no decreased ADC. CONCLUSION: Injection of heparin into an intracerebral hematoma leads to enlargement of the hematoma and more marked peri-lesion edema. On ADC maps, enlargement of hematoma is attributed to the edema around the lesion leading to injury to the brain tissue.

Animals↗
PubMed1993

The osteogenic potential of fracture hematoma and its mechanism on bone formation--through fracture hematoma culture and transplantation of freeze-dried hematoma.

This study was conducted to provide further evidence of the inherent osteogenic potential of the fracture hematoma. The fracture hematoma was separated into its cellular and extracellular elements. The hematoma cells were cultured to study bone formation by the cellular elements alone. Bone formation acceleration factor was added to the cultured fracture hematoma cells. The cell responded to this stimulation by differentiation into chondrocytes. Fracture hematoma was freeze-dried to study the presence of osteoinduction by the extracellular factors in the fracture hematoma. The freeze-dried fracture hematoma was packaged in methylmethacrylate pellets and within capsules of hydroxyapatite. These pellets and capsules in response to extracellular humoral factors from the freeze-dried fracture hematoma. The results of experimental implantation of the cultured fracture hematoma cells revealed that these cells had the potential to differentiate into chondroblasts or osteoblasts when bone induction factors and bone acceleration factor was added to their media. These extracellular humoral factors are known to be present in the fracture hematoma.

Animals↗
PubMed1976

Physiopathogenesis of subdural hematomas. Part 1: Histological and biochemical comparisons of subcutaneous hematoma in rats with subdural hematoma in man.

The dorsal subcutaneous injection in rats of 12 ml or more of autologous hemolyzed whole blood clotted in situ induced the formation of sterile, hemispheric lesions, 47% of which showed an initial decrease in volume followed by a progressive enlargement. The behavior, histology, and biochemical characteristics of the liquid contents of these lesions were found to be remarkably similar to those of subdural hematomas in man. To evaluate the role of the various blood components that may have influenced the formation and growth of these lesions, more than 150 clots composed of human platelet-free plasma, autologous hemolyzed blood, or autologous whole blood were implanted subcutaneously in rats by either surgical or injection techniques. The in vitro behavior of the different clots used was also assessed. This systematic approach led to the following conclusions: 1) the composition and volumes of the clots are critical variables; 2) plasma-fibrin provides the matrix shape of the lesions; 3) the breakdown products derived from erythrocytes, hemoglobin, leukocytes, and other solid blood elements induce neomembrane formation and contribute to the lesion's subsequent growth; and 4) inflammation mechanisms appear to be essential, while cerebrospinal fluid plays no discernable role in this process.

Animals↗
PubMed1988

[Growing factors of chronic subdural hematoma--significance of CK activity in hematoma contents and neomembrane].

The growing mechanism of the chronic subdural hematoma has not fully understood yet, in spite of numerous studies about hematoma neomembranes. However, it is well known that the majority of the chronic subdural hematomas are well healed by a simple irrigation of hematoma. These facts suggested that the hematoma contents could have important growing factors of the chronic subdural hematoma. Thus, LDH and CK activities were estimated in 52 cases of hematoma contents and 15 cases of hematoma neomembranes in order to search growing factors, biochemically. Hematocrit and hemoglobin values in hematoma contents were also examined simultaneously. As a result, hematocrit and hemoglobin values in hematoma contents were gradually increased, these facts might be due to the concentration of hematoma contents. LDH and CK activities in hematoma contents were high around 60 days after the hematoma inducing head trauma, and these enzyme activities were not correlated with hematocrit value. In isozyme analysis of LDH and CK activities, LDH-1,2 and CK-MM showed high values but CK-BB, MB could not be recognized. These findings suggested that LDH activity in the hematoma contents were caused by hemolysis which had been reported to be a main cause, and CK activity might originate from muscular tissues. Therefore, author hypothesized that the CK activity in hematoma contents had originated from the neomembrane, since there was a good correlation between the mature stage of neomembrane and the high level of CK-MM, and the myofibroblast was found in neomembrane recently. CK-MM could be released from the myofibroblast in neomembrane. However, CK activity in hematoma neomembrane could not be recognized, biochemically nor immunohistochemically.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed2006

Contralateral development of chronic subdural hematoma after evacuation of chronic subdural hematoma. A case report.

Contralateral acute complications such as acute epi/subdural hematomas can be encountered after evacuation of a chronic subdural hematoma, though they are rare. We found only one case of chronic subdural hematoma following the surgery for contralateral chronic subdural hematoma, have been published in English language literature. A 73-year-old male admitted to our hospital with a right-sided subdural hematoma. The subdural hematoma was evacuated through a burr-hole. A left-sided subdural higroma appeared after operation and turned into classical subdural hematoma in the course of time. After evacuation of contralateral chronic subdural hematoma, the patient recovered completely. All stages of the development of contralateral chronic subdural hematomas were shown by serial computed tomograms. It was suggested that traumatic chronic subdural hematomas develop from mostly subdural higromas. If contralateral subdural higroma is seen after surgical evacuation of a chronic subdural hematoma, the possibility of development of contralateral chronic subdural hematoma must be kept on mind.

Aged↗
PubMed2006

Chronic subdural hematoma coexisting with ligamentum flavum hematoma in the lumbar spine: a case report.

We present a case of a chronic spinal subdural hematoma combined with a ligamentum flavum hematoma in the lumbar spine treated surgically. An 83-year-old woman receiving antiplatelet medicine due to an angina suffered from pain in her lower extremity and gait disturbance after a backward fall. Radiological findings including magnetic resonance imaging (MRI) revealed hematoma in the ligamentum flavum at the level of L2 - L3 and a chronic subdural hematoma at the level from L3 to L5. Laminectomy through L2 to L5 was performed and a hematoma existing in the ligamentum flavum and cystic mass was removed. A chronic subdural hematoma was spontaneously evacuated after splitting of the dura mater and an intact arachnoid membrane was observed with no leakage of cerebrospinal fluid. Her clinical symptoms completely disappeared after surgery. To the best of our knowledge, this is the first case of combination of chronic subdural hematoma and ligamentum flavum hematoma in the lumbar spine treated by surgery. Chronic spinal subdural hematoma and hematoma in the ligamentum flavum should be considered as a cause of progressive nerve root compression in patients with anticoagulant therapy, and an appropriate pre-operative diagnosis would be needed to achieve complete decompression of subdural and epidural hematoma.

Aged, 80 and over↗
PubMed2005

Increased mRNA expression of VEGF within the hematoma and imbalance of angiopoietin-1 and -2 mRNA within the neomembranes of chronic subdural hematoma.

The aim of the study was to determine the source of vascular endothelial growth factor (VEGF) in hematoma fluid of patients suffering from chronic subdural hematoma (CSH) and to identify the level of gene expression of the pro-angiogenic factors angiopoietin 1 (ANG-1) and ANG-2 in hematoma membranes. Samples of venous blood, hematoma fluid, and outer membrane were obtained during surgery for CSH. The numbers of mononuclear cells were determined in hematoma fluid and in venous blood samples taken from 11 patients. The concentration of VEGF was measured by ELISA technique in hematoma fluid and in plasma. RT-PCR methodology was used to study the expression of different mRNA species in 11 patients. The mRNA species analyzed include VEGF and its receptors, VEGFR-1 and VEGFR-2, and ANG-1, ANG-2 and their receptor, Tie-2. Glyceraldehyde-3-phosphate dehydrogenase (GAPDH) served as housekeeping gene and was used for semiquantitative analysis. The VEGF concentration was several hundred fold higher in the hematoma fluid than in corresponding plasma samples. A significant correlation was found between the number of neutrophils and the VEGF content in the hematoma fluid. The expression levels of VEGF, mainly VEGF165 and VEGF121 mRNA were highest in cells obtained from the hematoma fluid. In membrane samples, mRNA encoding for VEGF and its receptors was only inconsistently detected while the mRNA species encoding for ANG-1, ANG-2, and Tie-2 were found throughout all samples. The mean ratio of ANG-1/ANG-2 mRNA expression was 0.48 as opposed to 1.9 in a normal human brain tissue sample. The results suggest that the hematoma cells are the primary source of VEGF. A marked increase in the expression of ANG-2 mRNA over ANG-1 mRNA demonstrates a pro-angiogenic pattern in the hematoma membranes. Persistent activation of the ANG/Tie-2 system in addition to high levels of VEGF may keep the vasculature in a destabilized condition and may account for the continuous formation of new and immature blood vessels resulting in massive plasma extravasation and repeated bleeding episodes. Thus, the present study provides new evidence in favor of pro-angiogenic mechanisms playing an important role in the pathophysiology of CSH.

Adult↗
PubMed1988

Intraoperative development of contralateral epidural hematoma during evacuation of traumatic extraaxial hematoma.

Intraoperative development of an epidural hematoma contralateral to a craniotomy for acute traumatic extraaxial hematoma has been previously reported. This entity, however, has never been distinctly defined and differentiated from either the delayed or the bilateral acute epidural hematoma. We present 3 new cases of intraoperative contralateral acute epidural hematoma and review the 14 previously reported cases. The typical clinical presentation is a severe head injury with an acute extraaxial hematoma and severe ipsilateral brain displacement during craniotomy. If brain displacement is not noted at craniotomy, then the contralateral hematoma is manifested by immediate postoperative neurological deterioration or intractable elevated intracranial pressure. The presence of any of these signs makes an immediate postoperative CT scan or burr holes contralateral to the original craniotomy mandatory for early diagnosis. In addition to defining "intraoperative contralateral epidural hematoma," stricter definitions of the terms "delayed epidural hematoma" (no hematoma present on the initial CT scan but one present on a later scan) and "bilateral epidural hematomas" (present on the initial scan) are proposed.

Adolescent↗
PubMed1989

[Clinical aspects of traumatic intracerebral hematomas. Pathogenesis of delayed traumatic intracerebral hematomas].

Eighty three cases of traumatic intracerebral hematomas (maximum diameter of at least 3 cm) were classified into the following two groups. Group-1 consisted of 34 cases in which intracerebral hematomas were confirmed in the initial CT scans on admission. Group-2 consisted of 49 cases in which intracerebral hematomas were found not in the initial CT scans on admission, but in the second or later CT scans. This is the so-called CT-diagnosed delayed traumatic intracerebral hematomas which have been widely reported in recent years with the increasing use of CT scans. These two groups were studied clinically and the following results were obtained. 1) Traumatic intracerebral hematomas were apt to occur in middle-aged or elderly patients, and more delayed cases increased in patients of 60 or older. 2) The times when the formation of traumatic intracerebral hematomas were judged as completed showed two peaks: within 6 hours after the trauma and 12 to 24 hours after the trauma. 3) Excluding traumatic hemorrhages in the basal ganglia, there were many hematomas in the frontal lobes in the cases of coup injuries by anteroposterior force or contre-coup injuries by posteroanterior force and in the temporal lobes in the cases of contre-coup injuries by lateral force. Traumatic hemorrhages in the basal ganglia were seen in 10 cases, six of which were in Group-1. In all six of these cases, the intracerebral hematoma was confirmed within 6 hours after the trauma and the direction of the external force was unclear. Except for the findings described in 1) to 3), there were no differences in the basic pathogenesis and characteristics between the two groups. These results indicate that there is no essential difference in pathogenesis between CT-diagnosed delayed traumatic intracerebral hematomas and other intracerebral hematomas, as far as the present clinical studies are concerned.

Adolescent↗
PubMed1992

[Acute epidural hematoma following evacuation of chronic subdural hematoma with continuous closed system drainage].

The authors report a case of acute epidural hematoma occurring after evacuation of chronic subdural hematoma with continuous closed system drainage. Laboratory data of the patient including bleeding time were within normal limits. The cause of the postoperative intracranial hematoma was the rapid surgical decompression of the initial lesion, and we considered that it could be prevented if chronic subdural hematoma was treated using closed system drainage and slow decompression. But acute epidural hematoma occurred after this operative procedure and it was accelerated by evacuation of the chronic subdural hematoma through the drain. An emergent craniotomy and removal of the hematoma was performed, so the patient was discharged from hospital with satisfactory neurological recovery. A careful check of the evacuated hematoma volume is very important, and CT scanning should be immediately performed if postoperative hematoma is suspected.

Acute Disease↗
PubMed1994

Analysis of plasma and hematoma lipids related to choline glycerophospholipid in patients with chronic subdural hematoma.

The levels of platelet-activating factor (PAF) and lipid metabolites related to choline glycerophospholipid were measured in the plasma and hematoma samples obtained from patients with chronic subdural hematoma. The ratio of lyso-choline glycerophospholipids (lysoPC) to choline glycerophospholipids (PC) in hematoma correlated with the interval between the onset of symptoms and surgery. PC and lysoPC fatty acyl moieties in plasma and hematoma were essentially similar. These results suggest that the lysoPC to PC ratio in hematoma can determine the age of the chronic subdural hematoma, and that the origin of hematoma may be circulating blood. The levels of PAF in the plasma of chronic subdural hematoma patients were significantly greater than in healthy volunteers. PAF may be involved in the enlargement of chronic subdural hematoma.

Aged↗
PubMed1993

[Bilateral chronic subdural hematoma with communication between the hematoma cavities: report of an adult case].

The authors present a case of bilateral chronic subdural hematoma with communication between the hematoma cavities. This 24-year-old male had hit his forehead while playing football and visited our hospital. An initial plain CT scan revealed extracerebral low density areas in the bifrontal region, which were considered to be post-traumatic subdural hygromas. The lesion was followed up with repeat CT scans. On plain CT scan performed seven weeks after the injury, the lesion had evolved into bilateral chronic subdural hematoma and the patient was admitted to our ward. He underwent burr hole drainage on the left side, because the hematoma volume on the left side was considerably larger than that on the right side. A plain CT scan on the day following the operation revealed complete resolution of the hematomas on both sides. A favorable re-expansion of the brain was confirmed on consecutive CT scan performed two months after the operation. In general bilateral chronic subdural hematomas in adults are considered to have no communication between the hematoma cavities and therefore they should be evacuated on both sides simultaneously. In our case, on the contrary, the operation revealed a communication between the hematoma cavities. The falx cerebri is narrow in front and this narrow anterior part is frequently perforated by one or more apertures. We attributed the communication to this anatomical feature of the falx cerebri. On preoperative CT scan, in addition, the inner surface of the bifrontal hematoma cavity demonstrated a smooth concave figure indicating retrospectively that the cavity on the left side was continuous with that on the right side.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

[Acute hematoma between the dura and the external membrane of hematoma capsule of after the removal of bilateral chronic subdural hematomas by trepanation. Case report].

A case of reported of complication following surgical treatment of bilateral subdural haematomas in an elderly man. Acute haematoma developed after the operation between the dura and the external surface of the capsule of the haematoma which had been removed several hours earlier through a trepanation hole. Attention is called to the atypical localization of the complication with bleeding externally to the capsule and not into the space left after haematoma evacuation which is usually observed in case of haematoma recurrence. The problem is discussed, whether such bleeding during chronic persistence of haematoma can lead to the development of multilayer and multilocular haematomas. In the presented case quick recognition of the complication followed by reoperation with removal of haematoma and bleeding capsule through craniotomy with rehabilitation treatment after the operation has led to very good therapeutic effect.

Acute Disease↗
PubMed2003

Significance of consecutive bilateral surgeries for patients with acute subdural hematoma who develop contralateral acute epi- or subdural hematoma.

BACKGROUND: Although rare, patients with acute subdural hematoma (ASDH) because of severe head injury can develop contralateral acute epi- or subdural hematoma, requiring consecutive surgical procedures. The choice of treatment strategies for such patients is clinically important. METHODS: Among 88 patients with ASDH who were surgically treated over 13 years, we encountered and studied 5 patients who developed contralateral acute epi- or subdural hematoma (5.7%). RESULTS: All 5 patients were male, ranging in age from 17 to 40. According to the Glasgow Coma Scale on admission, 1 patient was rated 3, 1 was 4, 1 was 5, and 2 were 6. All patients underwent consecutive surgical procedures for ASDH and contralateral ASDH and/or acute epidural hematoma, and were given postoperative supportive therapy with barbiturates and mild hypothermia. Patients' outcomes according to the Glasgow Outcome Scale were as follows: 1 patient, good recovery (20.0%); 1, mild disability (20.0%); 2, severe disability (40.0%), and 1, persistent vegetative state (20.0%). No patients died. Although decompressive craniectomy and evacuation of hematoma may lead to contralateral acute epi- or subdural hematoma in patients with ASDH, this therapy is justified because hematoma irrigation with trephination therapy has a poor outcome for comatose patients. CONCLUSION: Awareness of intraoperative brain swelling is important, as it suggests the development of contralateral hematoma. Immediate computed tomography and a rapid return to the operating room are therefore critical.

Adolescent↗
PubMed2006

Subacute spinal subdural hematoma associated with intracranial subdural hematoma.

We describe a subacute spinal subdural hematoma in a patient with psot-traumatic subacute intracranial subdural hematoma. CT and MRI demonstrated hematoma within the interhemispheric subdural space and at the lumbar posterior subdural space which extended from the L1 to the S2 level. The lesion showed high signal intensity on both T1 and T2 weighted images. Surgical decompression of the spinal subdural hematoma was performed. The symptoms completely resolved after surgery. Spinal subdural hematoma may be concomitant with or may occur after intracranial subdural hematoma. If a patient with intracranial subdural hematoma complains of low back pain and weakness in both legs; lumbosacral MR examination should be performed to exclude spinal subdural hematoma.

Craniocerebral Trauma↗
PubMed2003

[Relationship of survival rate, hematoma thickness and midline shift in patients with acute subdural hematomas].

OBJECTIVE: To estimate outcomes of patients with acute subdural hematomas by analysing the hematoma thickness, midline shift and the differences between them. METHODS: Ninety-five patients with acute subdural hematoma were retrospectively studied by calculating hematoma thickness, midline shift and their difference with a statistical analysis of Kaplan-Meier, Wilcoxon-Mann-Whitney U test. RESULTS: The hematoma thickness ranged from 5.0 to 40.0 mm and midline shift was from 0 to 35.0 mm. Among these patients, 51% died and 49% survived after surgery. 18 patients (19%) showed good or satisfactory results. Kaplan-Meier analysis proved that the survival for patients with hematoma thickness approximately equal to l7 mm and a midline shift 15 mm or whose midline shift exceeded hematoma thickness by 2.2 mm, the survival rate was 50%. Glasgow outcome scale scores were correlated significantly with these parameters. CONCLUSION: The hematoma thickness, midline shift and their difference provided a database from which criteria could be derived, that is crucial for prognosis estimation.

Adolescent↗