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Pontaneous Resolution Of A Large Chronic Subdural Hematoma: A Case Report And Review Of The Literature

Göksu et al., 2009Other/Unknown

Göksu, E., Akyüz, M., Uçar, T., & Kazan, S. (2009). spontaneous resolution of a large chronic subdural hematoma: a case report and review of the literature. Ulusal travma ve acil cerrahi dergisi = Turkish journal of trauma & emergency surgery : TJTES, 15(1), 95–98.

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Abstract

Purpose— The aim of this guideline is to present current and comprehensive recommendations for the diagnosis and treatment of acute spontaneous intracerebral hemorrhage. Methods— A formal literature search of MEDLINE was performed. Data were synthesized with the use of evidence tables. Writing committee members met by teleconference to discuss data-derived recommendations. The American Heart Association Stroke Council’s Levels of Evidence grading algorithm was used to grade each recommendation. Prerelease review of the draft guideline was performed by 6 expert peer reviewers and by the members of the Stroke Council Scientific Statements Oversight Committee and Stroke Council Leadership Committee. It is intended that this guideline be fully updated in 3 years’ time. Results— Evidence-based guidelines are presented for the care of patients presenting with intracerebral hemorrhage. The focus was subdivided into diagnosis, hemostasis, blood pressure management, inpatient and nursing management, preventing medical comorbidities, surgical treatment, outcome prediction, rehabilitation, prevention of recurrence, and future considerations. Conclusions— Intracerebral hemorrhage is a serious medical condition for which outcome can be impacted by early, aggressive care. The guidelines offer a framework for goal-directed treatment of the patient with intracerebral hemorrhage.

Case Details

Disease Location

Right frontoparietal

Personal Characteristics

35 -year-old male, with no chronic illness left handed soccer player that headed the ball and suffered transient headaches continued to be active before admission with squash and trekking

Clinical Characteristics

Subdural hematoma with a volume of 76.5 ml via MRI, no pathology on neurological exam, neither cerebral angiography nor eeg showed abnormalities subdural hematomas commonly caused by head injury, also coagulopathy, alcoholism, csf shunting, vasular malformations, seizure disorders, and metastatic tumors a months after the injury suffered speech disturbance with transient paresthesias in his left arm twice a months. Was asymptomatic for a months. MRI revealed right frontoparietal chronic subdural hematoma with no midline shift except for mild compression of the right ventricle no significant mass effect

Remission Characteristics

135 day follow-up showed the hematoma completely resolved

Treatment & Mechanisms

Proposed Remission Mechanisms

May be due to modified smooth-muscle cells in outer membrane producing collagen and reinforcing the membrane, reducing fragility decreased fibrinolytic activity of the hematoma capsule and the fluid corticosteroids inhibit the formation of protein-permeable membrane, decreasing the size of hematomas maturation of the neomembrane and stabilization of the neovasculature might result in spontaneous recession

Clinical Treatment

None reported

Non-Clinical Treatment

None reported