Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

INTRODUCTION Chronic subdural hematoma (cSDH) is frequently seen by neurosurgeons. Treatment often includes evacuation of the subdural hematoma (SDH) through one or two burr holes and placement of a drain in the subdural space to further evacuate subdural fluid and prevent reaccumulation of blood during the immediate postoperative period. Complications associated with this type of drainage include fluid and blood reaccumulation, tension pneumocephalus, seizures and subdural empyema. PRESENTATION OF CASE The author presents a case in which aggressive CSF overdrainage most likely led to acute severe intracranial hypotension, causing the collapse of the contralateral bridging veins and ultimately resulting in venous insufficiency and hemorrhagic infarction. The remote intracerebral hemorrhages were suspected to be due to CSF overdrainage through the subdural drain, so the drain was immediately removed. After drain removal, the patient's neurologic status improved and his hemiplegia disappeared within 4 h. A follow-up head CT scan 1 month later revealed resolution of his subdural fluid collection and right-sided intraparenchymal hemorrhages. He returned to work 1 month later in good condition. DISCUSSION Although many authors have examined factors affecting the success of cSDH drainage procedures, there are few reports about the risks of overdrainage and little information available about drainage volume. This report links excessive cSDH drainage of with a remote contralateral intraparenchymal hemorrhage, a complication that has been noted only twice previously, and neither report suggested the mechanism for occurrence of the hemorrhage, or specified the amount of drainage. CONCLUSION Subdural drainage should be carefully monitored to avoid overdrainage.

Original languageEnglish
Pages (from-to)834-836
Number of pages3
JournalInternational Journal of Surgery Case Reports
Volume4
Issue number10
DOIs
StatePublished - 2013

Fingerprint

Hematoma, Subdural, Chronic
Drainage
Hemorrhage
Subdural Space
Subdural Empyema
Intracranial Hypotension
Pneumocephalus
Subdural Hematoma
Venous Insufficiency
Hemiplegia
Cerebral Hemorrhage
Postoperative Period
Infarction
Nervous System
Veins
Seizures
Head

Keywords

  • Cerebrospinal fluid drainage
  • Hemorrhage
  • Intracranial
  • Subarachnoid hemorrhage
  • Trauma

ASJC Scopus subject areas

  • Surgery

Cite this

@article{b1e506ba49d04ee48f3b7b9143758b52,
title = "Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma",
abstract = "INTRODUCTION Chronic subdural hematoma (cSDH) is frequently seen by neurosurgeons. Treatment often includes evacuation of the subdural hematoma (SDH) through one or two burr holes and placement of a drain in the subdural space to further evacuate subdural fluid and prevent reaccumulation of blood during the immediate postoperative period. Complications associated with this type of drainage include fluid and blood reaccumulation, tension pneumocephalus, seizures and subdural empyema. PRESENTATION OF CASE The author presents a case in which aggressive CSF overdrainage most likely led to acute severe intracranial hypotension, causing the collapse of the contralateral bridging veins and ultimately resulting in venous insufficiency and hemorrhagic infarction. The remote intracerebral hemorrhages were suspected to be due to CSF overdrainage through the subdural drain, so the drain was immediately removed. After drain removal, the patient's neurologic status improved and his hemiplegia disappeared within 4 h. A follow-up head CT scan 1 month later revealed resolution of his subdural fluid collection and right-sided intraparenchymal hemorrhages. He returned to work 1 month later in good condition. DISCUSSION Although many authors have examined factors affecting the success of cSDH drainage procedures, there are few reports about the risks of overdrainage and little information available about drainage volume. This report links excessive cSDH drainage of with a remote contralateral intraparenchymal hemorrhage, a complication that has been noted only twice previously, and neither report suggested the mechanism for occurrence of the hemorrhage, or specified the amount of drainage. CONCLUSION Subdural drainage should be carefully monitored to avoid overdrainage.",
keywords = "Cerebrospinal fluid drainage, Hemorrhage, Intracranial, Subarachnoid hemorrhage, Trauma",
author = "Aaron Cohen-Gadol",
year = "2013",
doi = "10.1016/j.ijscr.2013.06.014",
language = "English",
volume = "4",
pages = "834--836",
journal = "International Journal of Surgery Case Reports",
issn = "2210-2612",
publisher = "Elsevier BV",
number = "10",

}

TY - JOUR

T1 - Remote contralateral intraparenchymal hemorrhage after overdrainage of a chronic subdural hematoma

AU - Cohen-Gadol, Aaron

PY - 2013

Y1 - 2013

N2 - INTRODUCTION Chronic subdural hematoma (cSDH) is frequently seen by neurosurgeons. Treatment often includes evacuation of the subdural hematoma (SDH) through one or two burr holes and placement of a drain in the subdural space to further evacuate subdural fluid and prevent reaccumulation of blood during the immediate postoperative period. Complications associated with this type of drainage include fluid and blood reaccumulation, tension pneumocephalus, seizures and subdural empyema. PRESENTATION OF CASE The author presents a case in which aggressive CSF overdrainage most likely led to acute severe intracranial hypotension, causing the collapse of the contralateral bridging veins and ultimately resulting in venous insufficiency and hemorrhagic infarction. The remote intracerebral hemorrhages were suspected to be due to CSF overdrainage through the subdural drain, so the drain was immediately removed. After drain removal, the patient's neurologic status improved and his hemiplegia disappeared within 4 h. A follow-up head CT scan 1 month later revealed resolution of his subdural fluid collection and right-sided intraparenchymal hemorrhages. He returned to work 1 month later in good condition. DISCUSSION Although many authors have examined factors affecting the success of cSDH drainage procedures, there are few reports about the risks of overdrainage and little information available about drainage volume. This report links excessive cSDH drainage of with a remote contralateral intraparenchymal hemorrhage, a complication that has been noted only twice previously, and neither report suggested the mechanism for occurrence of the hemorrhage, or specified the amount of drainage. CONCLUSION Subdural drainage should be carefully monitored to avoid overdrainage.

AB - INTRODUCTION Chronic subdural hematoma (cSDH) is frequently seen by neurosurgeons. Treatment often includes evacuation of the subdural hematoma (SDH) through one or two burr holes and placement of a drain in the subdural space to further evacuate subdural fluid and prevent reaccumulation of blood during the immediate postoperative period. Complications associated with this type of drainage include fluid and blood reaccumulation, tension pneumocephalus, seizures and subdural empyema. PRESENTATION OF CASE The author presents a case in which aggressive CSF overdrainage most likely led to acute severe intracranial hypotension, causing the collapse of the contralateral bridging veins and ultimately resulting in venous insufficiency and hemorrhagic infarction. The remote intracerebral hemorrhages were suspected to be due to CSF overdrainage through the subdural drain, so the drain was immediately removed. After drain removal, the patient's neurologic status improved and his hemiplegia disappeared within 4 h. A follow-up head CT scan 1 month later revealed resolution of his subdural fluid collection and right-sided intraparenchymal hemorrhages. He returned to work 1 month later in good condition. DISCUSSION Although many authors have examined factors affecting the success of cSDH drainage procedures, there are few reports about the risks of overdrainage and little information available about drainage volume. This report links excessive cSDH drainage of with a remote contralateral intraparenchymal hemorrhage, a complication that has been noted only twice previously, and neither report suggested the mechanism for occurrence of the hemorrhage, or specified the amount of drainage. CONCLUSION Subdural drainage should be carefully monitored to avoid overdrainage.

KW - Cerebrospinal fluid drainage

KW - Hemorrhage

KW - Intracranial

KW - Subarachnoid hemorrhage

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84882766768&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84882766768&partnerID=8YFLogxK

U2 - 10.1016/j.ijscr.2013.06.014

DO - 10.1016/j.ijscr.2013.06.014

M3 - Article

VL - 4

SP - 834

EP - 836

JO - International Journal of Surgery Case Reports

JF - International Journal of Surgery Case Reports

SN - 2210-2612

IS - 10

ER -