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Headache 2021 Jun 21. Epub 2021 Jun 21.

University of South Carolina School of Medicine, Greenville, SC, USA.

Objectives/background: Expand the differential diagnosis of sentinel headache to include spontaneous spinal epidural hematoma (SSEH) and reinforce the need for lumbar puncture in the evaluation of thunderclap headache. SSEH is a rare clinical presentation especially in the absence of bleeding tendencies. Clinicians recognize SSEH with typical presenting signs and symptoms including regional paraspinal muscular contraction and pain along with myelopathy. Read More

CNS Spectr 2021 Apr;26(2):178-179

Western University of Health Sciences, Pomona, CA, USA.

Traumatic brain injury (TBI) is a complex phenomenon affecting multiple areas of the brain in multiple ways. Both right and left hemispheres are affected as well as supratentorial and infratentorial compartments. These multifocal injuries are caused by many factors including acute mechanical injury, focal intracranial hemorrhage, blunt and rotational forces, epidural and subdural hematoma, hypoxemia, hypotension, edema, axonal damage, neuronal death, gliosis and blood brain barrier disruption. Read More

Int J Surg Case Rep 2021 May 26;83:106039. Epub 2021 May 26.

Department of Surgery, Imam Khomeini Hospital Complex, Iran. Electronic address:

Introduction: Utilising epidural analgesia (EA) during major abdominal surgery in combination with general anaesthetic, is a proven approach to decrease anaesthetic requirement in patients with severe comorbidities, enhance recovery and improve pain management.

Case Presentation: Herein we report a case of an 81-years-old female with bilateral lower limb sensory loss, saddle paraesthesia, paraplegia, and incontinence following a thoracic epidural catheterisation required for low anterior resection of rectal adenocarcinoma. The complication was reported by the patient on the third day of post-op. Read More

J Clin Neurosci 2021 Jul 2;89:365-374. Epub 2021 Jun 2.

Department of Radiology, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, South Korea.

An understanding of the common MRI findings observed after decompression surgery is important. However, to date, no study addressing this has been published. The aim of this study was to analyze and describe the immediate postoperative MRI findings after lumbar decompression surgery. Read More

Surg Neurol Int 2021 26;12:181. Epub 2021 Apr 26.

Department of Neurosurgery, Highly Specialized Hospital and of National Importance "Garibaldi", Catania, Italy.

Background: The treatment of spontaneous spinal epidural hematomas (SSEHs), depending on the lesion size and myeloradicular involvement, can be surgical or conservative. Here, we present a 55-year-old patient who sustained a SSEH several months following a systemic SARS-CoV-2 infection.

Case Description: A 55-year-old immunocompromised female (i. Read More

Quant Imaging Med Surg 2021 Jun;11(6):2499-2508

Department of Radiology, Peking University Third Hospital, Beijing, China.

Background: Our study aimed to characterize the imaging appearance of spinal fractures in ankylosing spondylitis (AS) and identify situations in which the use of magnetic resonance imaging (MRI) is necessary.

Methods: A total of 70 cases of spinal fractures associated with AS were retrospectively enrolled. Two radiologists independently reviewed the preoperative images. Read More

Cureus 2021 Apr 26;13(4):e14694. Epub 2021 Apr 26.

Radiodiagnosis, Sikkim Manipal Institute of Medical Science, Gangtok, IND.

Background Multiecho fast field echo (mFFE) MRI sequence provides added value to the conventional MR imaging in evaluation of acute spinal trauma, especially for detecting spinal cord hemorrhage which is a best predictor for patient prognosis. Objective This study aims to evaluate the diagnostic efficacies of three-plane mFFE MRI sequence along with the conventional MRI sequences in acute spinal trauma patients using sensitivity.  Materials and methods This prospective study comprised of 48 patients of acute spinal trauma. Read More

Int J Surg Case Rep 2021 May 21;83:105993. Epub 2021 May 21.

Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam.

Introduction And Importance: Spontaneous bone formation following craniectomy is an extremely rare in adult. As in the medical literature, this is the first case report on total spontaneous ossification following craniectomy in a pregnant woman.

Case Presentation: In this paper, we reported a 20-year-old female currently in the 30th week of her pregnancy suffered from head trauma following motorcycle accident. Read More

Eur Neurol 2021 May 21:1-7. Epub 2021 May 21.

Interventional Drug Delivery Systems & Strategies (ID2S2), Jupiter, Florida, USA.

Introduction: Epidural blood patches (EBPs) are rarely performed at the high-level cervical levels. The aim of the study was to investigate the imaging features, safety, and effectiveness of CT-guided percutaneous EBPs for high-level cervical cerebrospinal fluid (CSF) leakage.

Methods: Twenty-five patients with spontaneous high-level (C1-C3) CSF leakage on MRI and CT imaging, including 2 patients with intracranial epidural hematoma caused by CSF, were treated with EBP. Read More

Spinal Cord Ser Cases 2021 May 21;7(1):39. Epub 2021 May 21.

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, USA.

Introduction: Cervical spontaneous epidural hematoma is a serious neurosurgical pathology that often requires prompt surgical intervention. While a variety of causes may contribute, the authors present the first case in the literature of cervical disc extrusion provoking epidural hemorrhage and acute neurological deterioration.

Case Presentation: A 65 year old male presented with six months of worsening signs and symptoms of cervical myelopathy. Read More

World J Clin Cases 2021 May;9(14):3411-3417

Division of Neurosurgery, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.

Background: Spontaneous spinal epidural hematoma is a rare neurosurgical emergency.

Case Summary: A 53-year-old healthy woman suffered from complete paraplegia in both legs and loss of all sensation below the xiphoid process. She was diagnosed as acute spontaneous thoracic epidural hematoma caused by an intraspinal lymphangioma. Read More

Clin Spine Surg 2021 May 12. Epub 2021 May 12.

Department of Orthopedic Surgery, Osaka Medical College, Takatsuki-shi, Osaka Prefecture, Japan.

Study Design: This was a retrospective study.

Objective: The objective of this study was to investigate the diagnostic utility of percutaneous ultrasonography (PUS) for postoperative epidural hematoma (EH) as a postoperative complication.

Summary Of Background Data: We investigated the usefulness of PUS for determining the need of surgical evacuation of postoperative EH by comparing the postoperative magnetic resonance imaging (MRI) and PUS of the spinal cord. Read More

World Neurosurg 2021 May 1. Epub 2021 May 1.

Department of Neurosurgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania; Neurosciences Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Background: Epidural hematoma causing brain herniation is a major cause of mortality and morbidity after severe traumatic brain injury, even if surgical treatment is performed quickly. Decompression may be effective in decreasing intracranial pressure, but its effect on outcomes remains unclear.

Methods: A retrospective analysis of deeply comatose patients (Glasgow Coma Scale score 3-5) who underwent surgical treatment during a 12-year period, either via osteoplastic craniotomy (OC) or decompressive craniectomy, was carried out. Read More

World Neurosurg 2021 Apr 30. Epub 2021 Apr 30.

Department of Neuroradiology, University of Florida College of Medicine, Jacksonville, Florida, USA.

Background: The posterior atlantooccipital membrane complex consists of the posterior atlantooccipital membrane and posterior atlantoaxial membrane. Posttraumatic, posterior atlantooccipital membrane complex injuries may have varied appearances on cervical magnetic resonance imaging. The purpose of this study was to identify the different types of posterior atlantooccipital membrane complex injuries that occur in trauma patients. Read More

Neurosurg Focus 2021 May;50(5):E13

Departments of1Neurologic Surgery and.

Objective: The authors aimed to demonstrate the feasibility and advantages of carbon fiber-reinforced PEEK (CFRP) composite implants in patients with both primary and secondary osseous spinal tumors.

Methods: Twenty-eight spinal tumor patients who underwent fixation with CFRP hardware were retrospectively identified in a Spine Tumor Quality Database at a single institution. Demographic, procedural, and follow-up data were retrospectively collected. Read More

Radiol Technol 2021 May;92(5):459-466

Lecturer for the department of Medical Imaging and Therapeutic Sciences and is a faculty member of Health and Wellness Sciences for the Cape Peninsula University of Technology, South Africa.

Purpose: To assess the type and degree of neurological complications in patients with traumatic brain injury (TBI) who presented with an initial typical baseline computed tomography (CT) brain scan and to assess the time in which neurological complications developed.

Methods: A retrospective cross-sectional quantitative research design was conducted in whichCT radiology reports of 85 adult patients with TBI and typical baseline CT scans were analyzed during a 2-year period. The evolution of different types of neurological pathology diagnosed on follow-up CT brain imaging in these patients was recorded and analyzed. Read More

BMC Anesthesiol 2021 Apr 26;21(1):130. Epub 2021 Apr 26.

Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Sichuan Province, Chengdu, China.

Background: Subdural anesthesia and spinal subdural hematoma are rare complications of combined spinal-epidural anesthesia. We present a patient who developed both after multiple attempts to achieve combined spinal-epidural anesthesia.

Case Presentation: A 21-year-old parturient, gravida 1, para 1, with twin pregnancy at gestational age 34 weeks underwent cesarean delivery. Read More

J Neurol Sci 2021 06 19;425:117467. Epub 2021 Apr 19.

Anesthesiology and Intensive Care Department, AOR San Carlo, Potenza (IT), Italy.

Background: The occurrence of cerebral venous thrombosis (CVT) in patients with spontaneous intracranial hypotension (SIH) raises difficult practical questions regarding the management of the two conditions. The first-line therapy for CVT is anticoagulation (AC); however, its potential benefit in SIH/CVT patients, especially if complicated by subdural haematoma, must be carefully evaluated taking account of the intracranial haemorrhage risk. Venous system recanalization and good prognosis in SIH/CVT patients treated with epidural blood patch (EBP), the main treatment option for SIH, have been already described. Read More

Blood Coagul Fibrinolysis 2021 Apr 14. Epub 2021 Apr 14.

Hematology Service Pediatric Department, Hospital Universitario 'Dr José Eleuterio González', Universidad Autónoma de Nuevo León, Monterrey, México.

Hemorrhage in the central nervous system is the most severe and debilitating manifestation affecting patients with hemophilia A. The spinal epidural space is the most unusual and clinically challenging site of central nervous system hemorrhage in hemophilia A. These patients often show insidious neurological signs and symptoms that delay diagnosis and treatment. Read More

Anesth Pain Med (Seoul) 2021 Apr 9;16(2):184-190. Epub 2021 Apr 9.

Department of Anesthesiology and Pain Medicine, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, Korea.

Background: Spinal epidural hematoma is rare condition that can rapidly develop into severe neurologic deficits. The pathophysiology of this development remains unclear. There are several case reports of emergency hematoma evacuations after epidural steroid injection. Read More

J Med Case Rep 2021 Apr 9;15(1):154. Epub 2021 Apr 9.

Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba-shi, Chiba, 260-8677, Japan.

Background: Mayfield skull clamps are widely used and indispensable in current neurosurgery. Complications such as skull fractures or intracranial hematoma from using a Mayfield skull clamp have largely been reported in the pediatric population, are likely related to the relative thinness of the skull, such as in patients with hydrocephalus, and are extremely rare in adults. Here, we report a case of skull fracture and epidural hematoma caused by a Mayfield skull clamp used for posterior decompression surgery in an adult patient with chronic hemodialysis. Read More

AJR Am J Roentgenol 2021 06 7;216(6):1641-1648. Epub 2021 Apr 7.

Department of Neuroradiology, University of Florida Health-Jacksonville, 655 W 8th St, Jacksonville, FL 32209.

A traumatic retroclival epidural hematoma is a rare imaging finding of severe cervical flexion-extension injury in the pediatric population. The purpose of our study was to identify pediatric patients with a retroclival epidural hematoma, record the hematoma size and extent, and examine the major craniocervical ligaments for injury. Pediatric patients who suffered a retroclival epidural hematoma were identified retrospectively using the keywords "clivus," "epidural hematoma," and "retroclival" included in head CT reports between 2012 and 2019. Read More

Rev Esp Anestesiol Reanim (Engl Ed) 2021 Apr 1. Epub 2021 Apr 1.

Hospital do Divino Espírito Santo de Ponta Delgada, Ponta Delgada, Portugal.

Cauda equina syndrome (CES) is a rare but possible complication of neuroaxial anesthesia. Damage to the nerve roots may occur due to compression, inflammation, stretching, direct trauma, spinal ischemia or neurotoxicity, usually with lidocaine or bupivacaine. We describe a case of a 33-year-old patient that underwent an uneventful cesarean section with a combined spinal-epidural technique anesthesia, with levobupivacaine. Read More

Spine J 2021 Mar 26. Epub 2021 Mar 26.

Department of Orthopaedic Surgery, National University Hospital, National University Health System Tower Block, Level 11, 1E Kent Ridge Road, 119228, Singapore.

Background Context: Ossification of the posterior longitudinal ligament (OPLL) is a progressive, debilitating disease most commonly affecting the cervical spine. When compared to other degenerative pathologies, OPLL procedures carry a significantly higher risk of complications owing to increased case complexity and technical difficulties. Most previous studies have focused on functional outcomes and few have reported on risk factors for postoperative complications in OPLL patients. Read More

Surg Neurol Int 2021 2;12:79. Epub 2021 Mar 2.

School of Medicine, University of New Mexico, Albuquerque, New Mexico, United States.

Background: First characterized in the 19 century, spontaneous spinal epidural hematoma (SSEH) is known as the idiopathic accumulation of blood within the spinal canal's epidural space, causing symptoms varying from general back pain to complete paraplegia. With varying etiologies, a broad spectrum of severity and symptoms, a time-dependent resolution period, and no documented diagnosis or treatment algorithm, SSEH is a commonly misunderstood condition associated with increasing morbidity. While SSEH can occur at any vertebrae level, 16% of all SSEH cases occur in the cervical spine, making it a region of interest to clinicians. Read More

No Shinkei Geka 2021 Mar;49(2):356-361

Department of Diagnostic Radiology, Sapporo City General Hospital.

A woman in her 60s was admitted to our hospital because of sudden-onset right hemiparesis, paresthesia, and neck pain. At first, a head CT scan was performed to rule out stroke, which did not detect any abnormalities. Subsequently, a neck CT scan was performed, which revealed a mild high-density structure compressing the dural sac within the cervical spinal canal. Read More

Can J Anaesth 2021 06 16;68(6):918-920. Epub 2021 Mar 16.

Department of Anesthesiology, University of California San Diego, San Diego, CA, USA.

Neurochirurgie 2021 Mar 2. Epub 2021 Mar 2.

Department of Neurological Surgery, Fukuyama City Hospital, Fukuyama, Japan.

Background: Chronic subdural hematoma (CSDH) with cerebrospinal fluid hypovolemia syndrome (CHS) remains refractory to standard treatment with hematoma drainage by burr hole and irrigation and/or epidural blood patch. Previously, we reported the utility of middle meningeal artery (MMA) embolization for intractable CSDH. In this study, we present the usefulness of MMA embolization as a treatment for CSDHs with CHSs. Read More

Cureus 2021 Jan 29;13(1):e12997. Epub 2021 Jan 29.

Radiology, USA Health University Hospital, Mobile, USA.

The spectrum of presentation for patients who have neurofibromatosis type 1 (NF1), or von Recklinghausen disease, is very diverse due to a phenomenon known as variable expressivity. Patients may or may not present with cutaneous lesions or central nervous system (CNS) manifestations. However, multiple neurofibromas are the pathognomonic hallmark of NF1. Read More

Curr Opin Obstet Gynecol 2021 Apr;33(2):94-99

Department of Anesthesia, Division of Obstetric Anesthesia, Stanford University, Stanford, California, USA.

Purpose Of Review: Postpartum headache is a common occurrence with various obstetric, neurologic, and anesthetic etiologies. Post dural puncture headache (PDPH) after neuraxial anesthesia is a culprit that may be less familiar to obstetricians. In this review, authors will discuss the differential diagnosis and management of postpartum headache, review PDPH, and explore evidence suggesting that PDPH may have greater implications than previously considered. Read More