Acute Spontaneous Posterior Fossa Subdural Hematoma

Year 2014, Volume: 39 Issue: 1, 125 - 130, 22.07.2014

Osama Shukir Muhammed Amin

https://doi.org/10.17826/cutf.61744

Cited By: 1

Abstract

Acute posterior fossa subdural hematomas are rare and most of them are trauma-related. Non-traumatic ones have been reported in patients who had idiopathic thrombocytopenic purpura or those who had been receiving anticoagulant therapy. We report on the case of 57-year-old Iranian man who developed sudden severe occipital headache, drowsiness, repeated vomiting, and instability of stance and gait. He was neither hypertensive nor diabetic. No history of head trauma was obtained and he denied illicit drug or alcohol ingestion. A preliminary diagnosis of acute intra-cerebellar hemorrhage was made. His CT brain scan revealed an acute right-sided, extra-axial, crescent-shaped hyperdense area at the posterior fossa. His routine blood tests, platelets count, bleeding time, and coagulation profile were unremarkable. The patient had spontaneous acute infratentorial subdural hematoma. He was treated conservatively and discharged home well after 5 days. Since then, we could not follow-up him, clinically and radiologically because he went back to Iran. Our patient"s presentation, clinical course, and imaging study have called for conservative management, as the overall presentation was relatively benign. Unless the diagnosis is entertained and the CT brain scan is well-interpreted, the diagnosis may easily escape detection.

Keywords

acute subdural hematoma; posterior fossa; cerebellar compression; ataxia; spontaneous

Akut Posterior Fossa Subdural Hematom

Abstract

Akut posterior fossa subdural hematom nadir olarak gözlenir ve çoğu travmaya bağlıdır. Travmatik olmayanlar ise anti-koagulan tedavi görmüş yada idiopatik trombositopenik purpura hastalarında rapor edilmiştir. Çalışmamızda ani ve ciddi oksipital baş ağrısı ile birlikte halsizlik, tekrarlayan kusmalar, dengesiz duruş ve yürüyüşü olan iranlı 57 yaşındaki bir erkek rapor edilmiştir. Bu kişi hipertansiyon veya diabet hastası değildir. Başında travma geçmişi bulunmamaktadır ve kişi uyuşturucu yada alkol kullanmadığını söylemektedir. Akut intra serebral hemoraji için ön bir tanı yapıldı. CT beyin taraması, posterior fossa bölgesinde sağ taraflı, ekstra aksiyal hilal şeklinde yoğunlaşmış bir alan olduğunu gösterdi. Rutin kan testleri, kanama zamanı, koagülasyon durumu ve trombosit sayımı normaldi. Hastada spontan gelişen akut infratentoryal subdural hematom vardı. Hasta tedavi edildi ve 5 gün sonra iyi bir şekilde taburcu edildi. O zamandan beri hasta klinik olarak veya radyolojik olarak takip edilemedi, çünkü hasta irana geri döndü. Hastanın durumu, klinik seyiri ve görüntüleri konservatif bir yönetim gerektirmiştir. Dolayısıyla genel anlamda hastanın durumu nispeten iyi olsada, CT beyin taramasını iyi yorumlanmadıkça ve olası teşhis konusunda önceden fikir sahibi olunmadıkca hastalık kolayca gözden kaçabilir.

Keywords

Akut subdural hematom, posterior fossa, serebral basınç, spontan, ataksi

References

• Isla A, Alvarez F, Manrique M, Castro A, Amaya C, Blázquez MG. Posterior fossa subdural hematoma. J Neurosurg Sci. 1987;31:67-9.
• Miranda P, Alday R, Lagares A, Pérez A, Lobato RD. Posterior fossa subdural hematoma mimicking intracerebellar hemorrhage. Neurocirugia (Astur). 2003;14:526-8.
• Takeuchi S, Takasato Y, Wada K, Nawashiro H, Otani N, Masaoka H, et al. Traumatic posterior fossa subdural hematomas. J Trauma Acute Care Surg 2012;72:480-6.
• Saito K, Sakurai Y, Uenohara H, Seki K, Imaizumi S, Katakura R, et al. [A case of acute subdural hematoma in the posterior fossa with idiopathic thrombocytopenic purpura]. No To Shinkei 1992;44:377-81.
• Chatterjee S, Karmakar PS, Ghosh P, Ghosh A. Subdural hematoma associated with immune thrombocytopenic purpura in two different clinical settings. J Assoc Physicians India 2010;58:504-6.
• Sreedharan PS, Rakesh S, Sajeev S, Pavithran K, Thomas M. Subdural haematoma with spontaneous resolution--rare manifestation of idiopathic thrombocytopenic purpura. J Assoc Physicians India 2000;48:432-4.
• Meena AK, Murthy JM. Subdural haematoma in a patient with immune thrombocytopenic purpura. Neurol India. 1999;47:335-7.
• Takeuchi S, Wada K, Takasato Y, Masaoka H, Hayakawa T, Yatsushige H, et al. Traumatic hematoma of the posterior fossa. Acta Neurochir Suppl 2013;118:135-8.
• Komatsu Y, Uemura K, Yasuda S, et al. [Acute subdural hemorrhage of arterial origin: report of three cases]. No Shinkei Geka 1997;25:841-5.
• Ishii T, Sawauchi S, Taya K, et al. [Acute spontaneous subdural hematoma of arterial origin]. No Shinkei Geka 2004;32:1239.
• Sung SK, Kim SH, Son DW, Lee SW. Acute spontaneous subdural hematoma of arterial origin. J Korean Neurosurg Soc. 2012;51:91-3.
• Kim MS, Jung JR, Yoon SW, Lee CH. Subdural hematoma of the posterior fossa due to posterior communicating artery aneurysm rupture. Surg Neurol Int. 2012;3:39.
• Mrfka M, Pistracher K, Augustin M, KurschelLackner S, Mokry M. Acute subdural hematoma without subarachnoid hemorrhage or intraparenchymal hematoma caused by rupture of a posterior communicating artery aneurysm: case report and review of the literature. J Emerg Med 2013;44:369-73.
• Datta NN, Chan KY, Kwok JC, Poon CY. Posterior fossa subdural hematoma due to ruptured arteriovenous malformation. Case report. Neurosurg Focus. 2000;8:ecp1.
• Yoneoka Y, Takeda N, Inoue A, Ibuchi Y, Kumagai T, Sugai T, et al. Human Kluver-Bucy syndrome following acute subdural haematoma. Acta Neurochir (Wien). 2004;146:1267-70.
• Steinbok P, Haw CS, Cochrane DD, Kestle JR. Acute subdural hematoma associated with cerebral infarction in the full-term neonate. Pediatr Neurosurg. 1995;23:206-15.
• Amin OSM. Two different intracranial haemorrhages and one cerebral infarction: what are the odds? BMJ Case Rep 2012;10.1136/bcr-2012-007158, published 6 October 2012.
• Agunloye AM, Adeyinka AO, Obajimi MO, Malomo A, Shokunbi MT. Computerised tomography of intracranial subdural haematoma in Ibadan. Afr J Med Med Sci. 2003;32:235-8.
• Gentry LR, Godersky JC, Thompson B, Dunn VD. Prospective comparative study of intermediate-field MR and CT in the evaluation of closed head trauma. AJR Am J Roentgenol. 1988;150:673-82.
• Patel MR, Edelman RR, Warach S. Detection of hyperacute primary intraparenchymal hemorrhage by magnetic resonance imaging. Stroke. 1996;27:2321
• Smith EE, Rosand J, Greenberg SM. Hemorrhagic stroke. Neuroimaging Clin N Am 2005;15:259-72.
• Servadei F, Nasi MT, Cremonini AM, Cremonini AM, Giuliani G, Cenni P, et al. Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma. 1998;44:868-73.
• Mathew P, Oluoch-Olunya DL, Condon BR, Bullock R. Acute subdural haematoma in the conscious patient: outcome with initial non-operative management. Acta Neurochir (Wien). 1993;121:100
• Wong CW. Criteria for conservative treatment of supratentorial acute subdural haematomas. Acta Neurochir (Wien) 1995;135:38-43.
• Bullock MR, Chesnut R, Ghajar J, Gordon D, Hartl R, Newell DW, et al. Surgical management of acute subdural hematomas. Neurosurgery 2006;58:16-24; discussion Si-iv.
• Yazışma Adresi / Address for Correspondence: Osama Shukir Muhammed Amin Sulaimaniya City Post-Office, PO BOX 196, Sulaimaniya City, IRAQ e-mail: [e-mail] geliş tarihi/received :28.08.2012 kabul tarihi/accepted:25.09.2012 .