MyMedR

Chandrasekaran S, Zainal J

Aust N Z J Surg, 1993 Oct;63(10):780-3.

A total of 76 patients with traumatic extradural haematoma were treated within a period of 3 years. Four patients developed delayed extradural haematomas. These cases are reported in view of the unusual sequence and the importance of early diagnosis.

Matched MeSH terms: Hematoma, Epidural, Cranial/etiology*

Dengue shock syndrome with retroperitoneal haematoma requiring repeated artery angioembolization

Teh YH, Tan YP, Zain MM

Med J Malaysia, 2017 08;72(4):254-256.

PMID: 28889142 MyJurnal

Eyelid reconstruction is complex and challenging since it is not only for structural and functional restoration, but also for an acceptable aesthetic result. In full thickness eyelid injuries, it will involve both anterior and posterior lamella. Therefore, when reconstructing the defect, it requires at least two layers; one will be a flap with blood supply, and the other can be a free graft. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid.

Matched MeSH terms: Hematoma/etiology*; Hematoma/therapy

Fulltext Recurrent Nasal Septal Hematoma and Abscess: A Rare Manifestation of Leukemia

Hong CX, Husain S, Wan Hamizan AK, Zahedi FD

Clin Med Res, 2021 Mar;19(1):35-38.

PMID: 33582646 DOI: 10.3121/cmr.2020.1552

Nasal septal abscess and hematoma are rare clinical entities. To the best of our knowledge, there have only been 2 cases of nasal septal abscess associated with haematological malignancy reported in the literature. Herein, we present a unique case of recurrent spontaneous nasal septal hematoma and abscess in a patient prior to and after the diagnosis of acute myelogenous leukemia. Its rarity in immunocompromised population, clinical presentation, treatment and complications are further discussed.

Matched MeSH terms: Hematoma/etiology

Fulltext Cervical spine fracture in a patient with ankylosing spondylitis causing a C2-T9 spinal epidural hematoma- Treatment resulted in a rapid and complete recovery from tetraplegia: Case report and literature review

Wong AS, Yu DH

Asian J Neurosurg, 2015 3 15;10(1):53.

PMID: 25767586 DOI: 10.4103/1793-5482.151519

Full recovery from tetraplegia is uncommon in cervical spine injury. This has not being reported for cervical spine fracture in a patient with ankylosing spondylitis causing spinal epidural hematoma. We report on a case of cervical spine fracture in a patient with ankylosing spondylitis who came with tetraplegia. He underwent a two stage fixation and fusion. He had a complete recovery. Two hours after the operation he regained full strength in all the limbs while in the Intensive Care Unit. He went back to full employment. There are only two other reports in the literature where patients with ankylosing spondylitis and extradural hematoma who underwent treatment within 12 h and recovered completely from tetraparesis and paraplegia respectively. Patient with ankylosing spondylitis has a higher incidence of spinal fracture and extradural hematoma. Good outcome can be achieved by early diagnosis and treatment. This can ensure not only a stable spine, but also a rapid and complete recovery in a tetraplegic patient.

Matched MeSH terms: Hematoma, Epidural, Cranial; Hematoma, Epidural, Spinal

Post-traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage

Suhara S, Wong AS, Wong JO

Br J Neurosurg, 2008 Apr;22(2):295-7.

PMID: 18348031 DOI: 10.1080/02688690701687678

A 27-year-old patient presented with severe headache and seizures about a month after the initial head trauma. Computed tomography (CT) brain scan revealed acute subdural bleed continuous into the interhemispheric region, with no subarachnoid haemorrhage. This was due to rupture of a traumatic pericallosal artery aneurysm. This represents a rare case of traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage.

Matched MeSH terms: Hematoma, Subdural/etiology*

Use of the Gynecare Prolift system in surgery for pelvic organ prolapse: 1-year outcome

Vaiyapuri GR, Han HC, Lee LC, Tseng LA, Wong HF

Int Urogynecol J, 2011 Jul;22(7):869-77.

PMID: 21479713 DOI: 10.1007/s00192-011-1400-9

INTRODUCTION AND HYPOTHESIS: This retrospective study reports the 1-year outcome in women who underwent mesh-augmented Prolift surgery performed from 2006 to 2008. There were a total of 254 patients, with 128, 106 and 20 patients receiving total, anterior and posterior Prolift, respectively.

METHODS: Incidence of thigh pain was lower in 2008 compared to 2006 and 2007 (p < 0.0001). The percentage of patients requiring blood transfusions (p = 0.09), duration of IDC ≥ 7 days (p = 0.27), wound dehiscence and re-operation rate were lower in 2008 in contrast to 2006 and 2007 (p = 0.43). Only 209 patients (82.3%) were available for review at 1 year. There were two (1.0%) cases of recurrent vault prolapse.

RESULTS: The subjective and objective cure rates at 1 year after this mesh implant surgery in 2006, 2007 and 2008 were 92.1% and 92.1%; 97.0% and 92.4% and 100% and 97%, respectively. The mesh erosion rate was remarkably lower in 2008 as compared to 2007 and 2006 (p < 0.001).

CONCLUSIONS: This synthetic mesh-augmented implant surgery is effective and safe, and surgical outcome appears related to the learning curve of the surgeon.

Matched MeSH terms: Hematoma/etiology

Chronic Subdural Hematoma Drainage Under Local Anesthesia with Sedation versus General Anesthesia and Its Outcome

Wong HM, Woo XL, Goh CH, Chee PHC, Adenan AH, Tan PCS, et al.

World Neurosurg, 2022 01;157:e276-e285.

PMID: 34648987 DOI: 10.1016/j.wneu.2021.10.074

BACKGROUND: Burr hole drainage is the criterion standard treatment for chronic subdural hematoma (CSDH), a common neurosurgical condition. However, apart from the surgical technique, the method of anesthesia also has a significant impact on postoperative patient outcome. Currently, there are limited studies comparing the use of local anesthesia with sedation (LA sedation) versus general anesthesia (GA) in the drainage of CSDH. The objective of this study was to compare the morbidity and mortality outcomes of using LA sedation versus GA in CSDH burr hole drainage.

METHODS: This retrospective study presents a total of 257 operations in 243 patients from 2 hospitals. A total of 130 cases were operated under LA sedation in hospital 1 and 127 cases under GA in hospital 2. Patient demographics and presenting features were similar at baseline.

RESULTS: Values are shown as LA sedation versus GA. Postoperatively, most patients recovered well in both groups with Glasgow Outcome Scale scores of 4-5 (96.2% vs. 88.2%, respectively). The postoperative morbidity was significantly increased by an odds ratio of 5.44 in the GA group compared with the LA sedation group (P = 0.005). The mortality was also significantly higher in the GA group (n = 5, 3.9%) than the LA sedation group (n = 0, 0.0%; P = 0.028). The CSDH recurrence rate was 4.6% in the LA sedation group versus 6.3% in the GA group. No intraoperative conversion from LA sedation to GA was reported.

CONCLUSIONS: This study demonstrates that CSDH drainage under LA sedation is safe and efficacious, with a significantly lower risk of postoperative mortality and morbidity when compared with GA.

Matched MeSH terms: Hematoma, Subdural, Chronic/epidemiology; Hematoma, Subdural, Chronic/surgery*

Spontaneous lateral pontine hemorrhage with associated trigeminal nerve root hematoma

Veerapen R

Neurosurgery, 1989 Sep;25(3):451-3; discussion 453-4.

PMID: 2771016

Spontaneous hemorrhage into the lateral part of the pons with sequelae compatible with survival has been documented previously. The author describes an unusual case with spontaneous hemorrhage into the lateral pons, with intraneural extension into the right trigeminal nerve root. Radiological features were of an expanding mass of the cerebellopontine angle. The patient was treated surgically with success.

Matched MeSH terms: Hematoma/surgery*

Fulltext Chronic subdural hematoma: a review at General Hospital, Kuala Lumpur

Cheah FKC, Ujang MA

Med J Malaysia, 1987 Sep;42(3):177-81.

PMID: 3506640

Forty-eight patients treated surgically for chronic subdural hematoma in General Hospital Kuala Lumpur were studied retrospectively. The clinical presentations were insidious and nonspecific. A high clinical index of suspicion for this disease is required. Diagnosis is confirmed by CAT Scan of the brain with or without cerebralangiography. Treatment consists or burr-holes and drainage

Matched MeSH terms: Hematoma, Subdural/epidemiology*; Hematoma, Subdural/surgery

Fulltext Intracranial Subdural Hematoma after Lumbar Spine Surgery: A Case Report

Zakaria AF, Tsuji M

Malays Orthop J, 2019 Nov;13(3):85-87.

PMID: 31890118 DOI: 10.5704/MOJ.1911.016

Intracranial subdural hematoma following lumbar surgery is a devastating but rare complication. It has been implicated due to intracranial hypotension secondary to persistent cerebrospinal fluid leakage. The resultant drop in intracranial pressure presumably causes traction and tearing of venous structures. Patients typically present with postural headaches. However, other symptoms of subdural hematoma, intracranial hypotension and cerebrospinal fluid leak must also be cautioned.

Matched MeSH terms: Hematoma, Subdural; Hematoma, Subdural, Intracranial

Spontaneous neonatal scrotal haematoma: an early manifestation of severe haemophilia

Lee JS, Chieng CH, Martin M, Toh TH

BMJ Case Rep, 2021 Apr 28;14(4).

PMID: 33910804 DOI: 10.1136/bcr-2020-241482

We report a term newborn who presented on day 3 of life with unilateral, tender scrotal swelling with skin discolouration, which was subsequently diagnosed as haemophilia A at about 6 months of age. He received intramuscular vitamin K and hepatitis B vaccine at birth uneventfully. The scrotal swelling was treated as an infected hydrocoele, considering the absence of a family history of bleeding disorder and other risks of bleeding tendency, as well as the ultrasonographic features. He also had congenital pneumonia requiring venepuncture, non-invasive oxygen supplementation and intravenous antibiotics, without any complication. The swelling slowly improved over 2 months. He later developed post-trial vaccine injection haematoma at 4 months of age, and multiple non-traumatic bruises when he was 6 months old, leading to the diagnosis. This case demonstrates an uncommon, but a possible, early manifestation of haemophilia A at birth with a unilateral scrotal haematoma.

Matched MeSH terms: Hematoma/etiology

Fulltext Neuropsychiatric manifestations of acute-on-chronic subdural hematoma in a lady with learning disability: a case report

Chua, S.Y., Seed, H.F., Yeoh, C.M., Thong, K.S.

Malaysian Journal of Psychiatry, 2016;25(1):0-0.

MyJurnal

Chronic subdural hematoma manifests differently and may mimic the
presentation of psychiatric illnesses. Many a time, physicians are quick to
judge that new onset of psychiatric symptoms is due to the worsening of the
existing psychiatric illness. We reported a case of a lady with learning
disability presenting with neuropsychiatric symptoms who was found to have
an acute-on-chronic subdural hematoma. We discussed regarding the new
onset of neuropsychiatric features seen in patients with chronic subdural
hematoma and its management.

Matched MeSH terms: Hematoma; Hematoma, Subdural, Chronic

Posttransplant lymphoproliferative disease masquerading as postbiopsy hematoma

Gan WH, Thye YL, Chang SH, Chua CB, Looi LM, Tan SY

Transplant Proc, 2004 Sep;36(7):2148-9.

PMID: 15518779

Matched MeSH terms: Hematoma/diagnosis*

Fulltext A lesion mistaken for malignant melanoma of the posterior uvea: a case report

Sukumaran K, Chandran S, Visvaraja S, Couper NT, Tan PE

Med J Malaysia, 1984 Dec;39(4):317-9.

PMID: 6544942

A case is presented to illustrate the difficulties
encountered in the clinical diagnosis of an intraocular mass. The fundus was not visible ophthalmoscopically because of opaque media. The anterior surface of the iris showed three discrete hyperpigmented nodular patches. Ultrasound showed an intraocular mass occupying half the posterior segment. The eye did not have useful vision and was enucleated after a clinical diagnosis of malignant melanoma of the choroid was made. The eye did not contain a melanoma but an organised blood clot after an extensive vitreous haemorrhage because of systemic hypertension.

Matched MeSH terms: Hematoma/diagnosis

Successful Transcatheter Arterial Embolisation for a Traumatic Iliacus Hematoma: A Case Report

Kato T, Chinzei N, Katayama N, Hirota S, Takahashi M

Malays Orthop J, 2020 Mar;14(1):92-95.

PMID: 32296490 DOI: 10.5704/MOJ.2003.016

A traumatic iliacus hematoma is rare and usually occurs in patients after a fall involving a lower back injury. Although the hematoma may compress the femoral nerve causing femoral nerve palsy, the gold standard treatment for this condition has not been established. Here we report transcatheter arterial embolisation as a useful treatment strategy for a traumatic iliacus hematoma.

Matched MeSH terms: Hematoma

Fulltext Predictors and Outcomes of Neurological Deterioration in Intracerebral Hemorrhage: Results from the TICH-2 Randomized Controlled Trial

Law ZK, Dineen R, England TJ, Cala L, Mistri AK, Appleton JP, et al.

Transl Stroke Res, 2021 Apr;12(2):275-283.

PMID: 32902808 DOI: 10.1007/s12975-020-00845-6

Neurological deterioration is common after intracerebral hemorrhage (ICH). We aimed to identify the predictors and effects of neurological deterioration and whether tranexamic acid reduced the risk of neurological deterioration. Data from the Tranexamic acid in IntraCerebral Hemorrhage-2 (TICH-2) randomized controlled trial were analyzed. Neurological deterioration was defined as an increase in National Institutes of Health Stroke Scale (NIHSS) of ≥ 4 or a decline in Glasgow Coma Scale of ≥ 2. Neurological deterioration was considered to be early if it started ≤ 48 h and late if commenced between 48 h and 7 days after onset. Logistic regression was used to identify predictors and effects of neurological deterioration and the effect of tranexamic acid on neurological deterioration. Of 2325 patients, 735 (31.7%) had neurological deterioration: 590 (80.3%) occurred early and 145 (19.7%) late. Predictors of early neurological deterioration included recruitment from the UK, previous ICH, higher admission systolic blood pressure, higher NIHSS, shorter onset-to-CT time, larger baseline hematoma, intraventricular hemorrhage, subarachnoid extension and antiplatelet therapy. Older age, male sex, higher NIHSS, previous ICH and larger baseline hematoma predicted late neurological deterioration. Neurological deterioration was independently associated with a modified Rankin Scale of > 3 (aOR 4.98, 3.70-6.70; p hematoma size, intraventricular and subarachnoid extension increased the risk of neurological deterioration. Neurological deterioration increased the risk of death and dependency at day 90. Tranexamic acid reduced the risk of early neurological deterioration and warrants further investigation in ICH. URL: https://www.isrctn.com Unique identifier: ISRCTN93732214.

Matched MeSH terms: Hematoma/etiology

Fulltext Noncontrast Computed Tomography Signs as Predictors of Hematoma Expansion, Clinical Outcome, and Response to Tranexamic Acid in Acute Intracerebral Hemorrhage

Law ZK, Ali A, Krishnan K, Bischoff A, Appleton JP, Scutt P, et al.

Stroke, 2020 01;51(1):121-128.

PMID: 31735141 DOI: 10.1161/STROKEAHA.119.026128

Background and Purpose- Blend, black hole, island signs, and hypodensities are reported to predict hematoma expansion in acute intracerebral hemorrhage. We explored the value of these noncontrast computed tomography signs in predicting hematoma expansion and functional outcome in our cohort of intracerebral hemorrhage. Methods- The TICH-2 (Tranexamic acid for IntraCerebral Hemorrhage-2) was a prospective randomized controlled trial exploring the efficacy and safety of tranexamic acid in acute intracerebral hemorrhage. Baseline and 24-hour computed tomography scans of trial participants were analyzed. Hematoma expansion was defined as an increase in hematoma volume of >33% or >6 mL on 24-hour computed tomography. Poor functional outcome was defined as modified Rankin Scale of 4 to 6 at day 90. Multivariable logistic regression was performed to identify predictors of hematoma expansion and poor functional outcome. Results- Of 2325 patients recruited, 2077 (89.3%) had valid baseline and 24-hour scans. Five hundred seventy patients (27.4%) had hematoma expansion while 1259 patients (54.6%) had poor functional outcome. The prevalence of noncontrast computed tomography signs was blend sign, 366 (16.1%); black hole sign, 414 (18.2%); island sign, 200 (8.8%); and hypodensities, 701 (30.2%). Blend sign (adjusted odds ratio [aOR] 1.53 [95% CI, 1.16-2.03]; P=0.003), black hole (aOR, 2.03 [1.34-3.08]; P=0.001), and hypodensities (aOR, 2.06 [1.48-2.89]; P<0.001) were independent predictors of hematoma expansion on multivariable analysis with adjustment for covariates. Black hole sign (aOR, 1.52 [1.10-2.11]; P=0.012), hypodensities (aOR, 1.37 [1.05-1.78]; P=0.019), and island sign (aOR, 2.59 [1.21-5.55]; P=0.014) were significant predictors of poor functional outcome. Tranexamic acid reduced the risk of hematoma expansion (aOR, 0.77 [0.63-0.94]; P=0.010), but there was no significant interaction between the presence of noncontrast computed tomography signs and benefit of tranexamic acid on hematoma expansion and functional outcome (P interaction all >0.05). Conclusions- Blend sign, black hole sign, and hypodensities predict hematoma expansion while black hole sign, hypodensities, and island signs predict poor functional outcome. Noncontrast computed tomography signs did not predict a better response to tranexamic acid. Clinical Trial Registration- URL: https://www.isrctn.com. Unique identifier: ISRCTN93732214.

Matched MeSH terms: Hematoma/drug therapy*

Fulltext Cerebral Amyloid Angiopathy and the Risk of Hematoma Expansion

Seiffge DJ, Polymeris AA, Law ZK, Krishnan K, Zietz A, Thilemann S, et al.

Ann Neurol, 2022 Dec;92(6):921-930.

PMID: 36054211 DOI: 10.1002/ana.26481

OBJECTIVE: We assessed whether hematoma expansion (HE) and favorable outcome differ according to type of intracerebral hemorrhage (ICH).

METHODS: Among participants with ICH enrolled in the TICH-2 (Tranexamic Acid for Hyperacute Primary Intracerebral Haemorrhage) trial, we assessed baseline scans for hematoma location and presence of cerebral amyloid angiopathy (CAA) using computed tomography (CT, simplified Edinburgh criteria) and magnetic resonance imaging (MRI; Boston criteria) and categorized ICH as lobar CAA, lobar non-CAA, and nonlobar. The main outcomes were HE and favorable functional outcome. We constructed multivariate regression models and assessed treatment effects using interaction terms.

RESULTS: A total of 2,298 out of 2,325 participants were included with available CT (98.8%; median age = 71 years, interquartile range = 60-80 years; 1,014 female). Additional MRI was available in 219 patients (9.5%). Overall, 1,637 participants (71.2%) had nonlobar ICH; the remaining 661 participants (28.8%) had lobar ICH, of whom 202 patients had lobar CAA-ICH (8.8%, 173 participants according to Edinburgh and 29 participants according to Boston criteria) and 459 did not (lobar non-CAA, 20.0%). For HE, we found a significant interaction of lobar CAA ICH with time from onset to randomization (increasing risk with time, pinteraction

Matched MeSH terms: Hematoma/complications; Hematoma/epidemiology

Spontaneous, extra-dural haematoma causing spinal cord compression

Mustafa M, Subramanian N

Int Orthop, 1996;20(6):383-4.

PMID: 9049770

We describe a patient with acute compression of the spinal cord by a spontaneous extra-dural haematoma. This rare condition is often misdiagnosed. We believe that an urgent MRI scan is indicated in patients presenting with progressive neurological deficit following spinal trauma. This allows the diagnosis of extra-dural haematoma to be made rapidly and for prompt decompression of the cord.

Matched MeSH terms: Hematoma/complications*; Hematoma/diagnosis

Fulltext Treatment of intracerebral haemorrhage with tranexamic acid - A review of current evidence and ongoing trials

Law ZK, Meretoja A, Engelter ST, Christensen H, Muresan EM, Glad SB, et al.

Eur Stroke J, 2017 Mar;2(1):13-22.

PMID: 31008298 DOI: 10.1177/2396987316676610

Purpose: Haematoma expansion is a devastating complication of intracerebral haemorrhage (ICH) with no established treatment. Tranexamic acid had been an effective haemostatic agent in reducing post-operative and traumatic bleeding. We review current evidence examining the efficacy of tranexamic acid in improving clinical outcome after ICH.

Method: We searched MEDLINE, EMBASE, CENTRAL and clinical trial registers for studies using search strategies incorporating the terms 'intracerebral haemorrhage', 'tranexamic acid' and 'antifibrinolytic'. Authors of ongoing clinical trials were contacted for further details.

Findings: We screened 268 publications and retrieved 17 articles after screening. Unpublished information from three ongoing clinical trials was obtained. We found five completed studies. Of these, two randomised controlled trials (RCTs) comparing intravenous tranexamic acid to placebo (n = 54) reported no significant difference in death or dependency. Three observational studies (n = 281) suggested less haematoma growth with rapid tranexamic acid infusion. There are six ongoing RCTs (n = 3089) with different clinical exclusions, imaging selection criteria (spot sign and haematoma volume), time window for recruitment and dosing of tranexamic acid.

Discussion: Despite their heterogeneity, the ongoing trials will provide key evidence on the effects of tranexamic acid on ICH. There are uncertainties of whether patients with negative spot sign, large haematoma, intraventricular haemorrhage, or poor Glasgow Coma Scale should be recruited. The time window for optimal effect of haemostatic therapy in ICH is yet to be established.

Conclusion: Tranexamic acid is a promising haemostatic agent for ICH. We await the results of the trials before definite conclusions can be drawn.

Matched MeSH terms: Hematoma

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