Epidural Hematoma Publications (5566)


Epidural Hematoma Publications

A A Case Rep
A A Case Rep 2017 Jan 11. Epub 2017 Jan 11.
From the *VA Puget Sound Health Care System, Department of Pharmacy, University of Washington, Seattle, Washington; †Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; ‡VA Puget Sound Health Care System, Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, Washington; and §VA Puget Sound Health Care System, Department of Neurology, University of Washington, Seattle, Washington.

Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. Read More

This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia. Tissue plasminogen activator was emergently administered 1 hour after epidural catheter removal with a favorable recovery. The patient and his family reviewed the manuscript, and written consent to publish this case report was obtained from the patient.

A A Case Rep
A A Case Rep 2017 Jan 11. Epub 2017 Jan 11.
From the Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. Read More

An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.

Clin Nucl Med
Clin Nucl Med 2017 Jan 10. Epub 2017 Jan 10.
From the Departments of *Radiology, and †Nuclear Medicine, University of Washington, Seattle, WA.

A 54-year-old man with a 3-week history of orthostatic headache and acute on chronic subdural hematoma presented with imaging findings suggestive of spontaneous intracranial hypotension. Three myelograms were negative for leak, and nontargeted epidural blood patches did not result in symptom relief. A cerebrospinal fluid leak study using In-DTPA with SPECT/CT demonstrated a focal area of asymmetric activity at the left C2 nerve root. Read More

A left C2 root tie-off, targeted epidural blood patch, and Dura seal glue resulted in resolution of patient symptomatology highlighting the importance of fused SPECT/CT images in detection of an occult cerebral spinal fluid leak.

Brain Inj
Brain Inj 2017 Jan 5:1-6. Epub 2017 Jan 5.
a Department of Neurosurgery , Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , PR China.
Spinal Cord Ser Cases
Spinal Cord Ser Cases 2016 7;2:16007. Epub 2016 Jul 7.
Department of Physical Medicine and Rehabilitation, University District Hospital, University of Puerto Rico School of Medicine , San Juan, Puerto Rico.

Spontaneous spinal epidural hematoma (SSEH) is a rare cause of spinal cord compression. Symptoms may include sudden-onset axial pain followed by neurologic involvement including weakness, numbness and incontinence. Here we report the case of a patient followed prospectively after surgical intervention following SSEH and recovery following inpatient rehabilitation. Read More

This patient presented with right hemiplegia, neurogenic bladder and bowel with autonomic dysfunction. the patient with significant gains in Functional Independence Measure scale that improved from 15 on admission to 35 1 month following surgery. This case suggests that treating this type of patients requires hospitals specialized in spinal cord injury.

Spinal Cord Ser Cases
Spinal Cord Ser Cases 2016 7;2:15040. Epub 2016 Apr 7.
Department of Orthopedic Surgery, Yamaguchi University Graduate School of Medicine, Ube City, Japan.
Childs Nerv Syst
Childs Nerv Syst 2017 Jan 3. Epub 2017 Jan 3.
Department of Neurosurgery, Baylor College of Medicine, Division of Pediatric Neurosurgery, Texas Children's Hospital, Houston, TX, USA.

It is common to evaluate children who have sustained minor head trauma with computed tomography (CT) of the head. Scalp swelling, in particular, has been associated with intracranial injury. A subset of patients, however, present in delayed fashion, often days after the head trauma, as soft tissue edema progresses and their caregiver notices scalp swelling. Read More

We explore the value of further workup in this setting.
We conducted a retrospective review of a prospectively collected cohort of children ≤24 months of age presenting to the Texas Children's Hospital with scalp swelling more than 24 h following a head trauma. Cases were collected over a 2-year study period from June 1, 2014 to May 31, 2016.
Seventy-six patients comprising 78 patient encounters were included in our study. The mean age at presentation was 8.8 months (range 3 days-24 months). All patients had noncontrast CT of the head as part of their evaluation by emergency medicine, as well as screening for nonaccidental trauma (NAT) by the Child Protection Team. The most common finding on CT head was a linear/nondisplaced skull fracture (SF) with associated extra-axial hemorrhage (epidural or subdural hematoma), which was found in 31/78 patient encounters (40%). Of all 78 patient encounters, 43 patients (55%) were discharged from the emergency room (ER), 17 patients (22%) were admitted for neurologic monitoring, and 18 patients (23%) were admitted solely to allow further NAT evaluation. Of those patients admitted, none experienced a neurologic decline and all had nonfocal neurologic exams on discharge. No patient returned to the ER in delayed fashion for a neurologic decline. Of all the patient encounters, no patient required surgery.
Pediatric patients ≤24 months of age presenting to the ER in delayed fashion with scalp swelling after minor head trauma-who were otherwise nonfocal on examination-did not require surgical intervention and did not experience any neurologic decline. Further radiographic investigation did not alter neurosurgical management in these patients; however, it should be noted that workup for child abuse and social care may have been influenced by CT findings, suggesting the need for the future development of a clinical decision-making tool to help safely avoid CT imaging in this setting.

World Neurosurg
World Neurosurg 2016 Dec 31. Epub 2016 Dec 31.
Department of Neurosurgery, Preah Kossamak Hospital, St 265, Phnom Penh, Cambodia; Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115. Electronic address:
J Stroke
J Stroke 2016 Dec 12. Epub 2016 Dec 12.
Stanford University Hospital, Department of Radiology, Neuroimaging and Neurointervention Division, 300 Pasteur Drive, Room S047, Stanford, CA 94305, USA.

Intracranial hemorrhage is common and is caused by diverse pathology, including trauma, hypertension, cerebral amyloid angiopathy, hemorrhagic conversion of ischemic infarction, cerebral aneurysms, cerebral arteriovenous malformations, dural arteriovenous fistula, vasculitis, and venous sinus thrombosis, among other causes. Neuroimaging is essential for the treating physician to identify the cause of hemorrhage and to understand the location and severity of hemorrhage, the risk of impending cerebral injury, and to guide often emergent patient treatment. We review CT and MRI evaluation of intracranial hemorrhage with the goal of providing a broad overview of the diverse causes and varied appearances of intracranial hemorrhage. Read More


Interventional procedures directed toward sources of pain in the axial and appendicular musculoskeletal system are performed with increasing frequency. Despite the presence of evidence-based guidelines for such procedures, there are wide variations in practice. Case reports of serious complications such as spinal cord infarction or infection from spine injections lack appropriate context and create a misleading view of the risks of appropriately performed interventional pain procedures. Read More

To evaluate adverse event rate for interventional spine procedures performed at three academic interventional spine practices.
Quality assurance databases at three academic interventional pain management practices that utilize evidence-based guidelines [1] were interrogated for immediate complications from interventional pain procedures. Review of the electronic medical record verified or refuted the occurrence of a complication. Same-day emergency department transfers or visits were also identified by a records search.
Immediate complication data were available for 26,061 consecutive procedures. A radiology practice performed 19,170 epidural steroid (primarily transforaminal), facet, sacroiliac, and trigger point injections (2006-2013). A physiatry practice performed 6,190 spine interventions (2004-2009). A second physiatry practice performed 701 spine procedures (2009-2010). There were no major complications (permanent neurologic deficit or clinically significant bleeding [e.g., epidural hematoma]) with any procedure. Overall complication rate was 1.9% (493/26,061). Vasovagal reactions were the most frequent event (1.1%). Nineteen patients (<0.1%) were transferred to emergency departments for: allergic reactions, chest pain, symptomatic hypertension, and a vasovagal reaction.
This study demonstrates that interventional pain procedures are safely performed with extremely low immediate adverse event rates when evidence-based guidelines are observed.