Chronic subdural hematoma simulating transient cerebral ischemic attacks

Melamed, Eldad; Lavy, S; Reches, Avinoam; Sahar, Abraham

doi:10.3171/jns.1975.42.1.0101

Cited by 25 publications

(19 citation statements)

References 7 publications

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“…Aphasia was the most common symptom in our patients and occurred in 9 of 13 patients with CSH on the left side. Of previously reported patients, 1 1 of 13 with TNDs had aphasia {3, 4,11,13,14,17,IS]. Aphasia is therefore the most common symptom of TNDs associated with CSH.…”

Section: Discussionmentioning

confidence: 97%

Chronic subdural hematoma with transient neurological deficits: A review of 15 cases

Moster

Johnston

Reinmuth

1983

Annals of Neurology

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Section: Discussionmentioning

confidence: 97%

Chronic subdural hematoma with transient neurological deficits: A review of 15 cases

Moster

Johnston

Reinmuth

1983

Annals of Neurology

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“…Transient focal neurological dysfunction has been reported with extracerebral masses with possible mechanisms including compression of vessels subjacent to the mass, postictal suppression, and spreading cortical depression after mechanical stimulation of cortex. 3 A transient increase in regional swelling might also cause a critical degree of vascular Fig. 1 e Right frontoparietal convexity meningioma lying over the parietal area and producing mass effect on underlying parietal cortex.…”

Section: Discussionmentioning

confidence: 99%

Recurrent transient focal neurological deficits in convexity meningioma: TIA or negative motor seizures?

Garg

Muniem

Bhuyan

et al. 2014

International Journal of Epilepsy

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Transient ischemic attack (TIA) is defined as a temporary focal neurological deficit of presumed vascular origin, lasting for less than 1 h, with no evidence of infarct on neuroimaging. If a patient is suffering from multiple cardiovascular risk factors and presents with transient and recurrent focal neurological deficits, the most likely diagnosis considered is TIA. As the possibility of stroke within first 24 h is high, such patients need aggressive investigation and management, and ideally should be hospitalized. TIA usually occurs due to major intracranial or extra cranial artery stenosis. However, if vascular imaging and cardiac workup is normal, possibility of small vessel disease is considered. Space occupying lesions usually presents with seizure, symptoms of raised intracranial pressure or progressive neurological deficits rather than TIA. There are a few case reports where meningioma presented as TIA, due to vascular compromise by encasing internal carotid artery. 1,2 transient focal neurological deficits can have other differentials like post ictal palsy and negative motor seizures. In a given patient with space occupying lesion like meningioma presenting with recurrent transient focal neurological deficits we need to consider all these differentials. We are hereby reporting a case of convexity meningioma, which presented as recurrent focal neurological deficit due to negative motor seizures, mimicking transient ischemic attack.

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“…Ross thought that a focal seizure discharge would be a reasonable explanation for such attacks,6 but Melamed et al suggested that other mechanisms were more likely, including intermittent compression of surrounding vessels, spreading cortical depression of the type associated with migraine after mechanical stimulation of the cortex, and even coexistent thromboembolic transient ischaemic attack. 7 Moster et al noted that aphasia was the most frequent presenting symptom of these transient neurological deficits, though suggested that repeated small haemorrhages into the haematoma might be responsible. 8 The subsequent clinical course in our patient suggests that the episodes of loss of speech were the first manifestation of epilepsy.…”

Section: Discussionmentioning

confidence: 99%

Multiple forms of epileptic attack secondary to a small chronic subdural haematoma.

Jones¹,

Bamford²,

Heath³

et al. 1989

BMJ

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Hearing loss is not a diagnosis; rather it is a symptom, and patients require careful assessment. The Royal National Institute for the Deaf proposes that hearing aid dispensers should perform this function. Failure ?r.Atedj 1989;299:439-41 Since the introduction of computed tomography (CT) small or asymptomatic chronic subdural haematomas have been recognised with increasing frequency, though their detection may depend on the use of contrast enhancing agents.' Patients with chronic subdural haematoma commonly present with headache, disturbances of higher cerebral function such as personality change and confusion, or features of raised intracranial pressure. Hemiparesis, with dysphasia if the lesion is over the dominant hemisphere, is the most frequent focal neurological deficit. Epilepsy is traditionally thought of as a rare presenting feature.) We describe a patient in whom several different forms of epilepsy were the only clinical manifestations of a very small chronic subdural haematoma. Case historyA 75 year old man was admitted after a witnessed tonic-clonic convulsion. Over the previous two weeks he had suffered three episodes of sudden, complete inability to speak, during which he remained fully conscious without any abnormal movements being noted. Each episode lasted about five minutes. He was seen by his general practitioner, who diagnosed transient ischaemic attacks but did not prescribe aspirin. The patient denied headache, and neither he nor his family could recall any recent head injury. He was taking chlorpropamide for maturity onset diabetes but there was no previous history of epilepsy or cerebrovascular disease. He had never had an excessive alcohol intake. Full neurological examination on admission showed nothing abnormal, and in particular there was no disturbance of higher cerebral function. Blood glucose, electrolyte, and calcium concentrations remained normal throughout.Over the next 24 hours attacks were witnessed during which the patient would become vacant and his head and eyes would deviate to the right. His right arm would then become elevated with external rotation of the shoulder followed by alternating flexion and extension at the elbow while the wrist remained flexed and the fingers extended and abducted. These attacks would last between five and 60 seconds and were followed by a variable period of confusion. They could occur several times an hour, often without complete recovery of consciousness in between. During periods of full consciousness, however, no neurological deficit could be detected. An attack could be terminated with intravenous diazepam, which would continue to act for about 30 minutes. He was given a loading dose of intravenous phenytoin followed by conventional oral doses.About 48 hours after admission a further change was noted, in that he was continuously confused with a fluctuating level of consciousness. On occasions he BMJ VOLUME 299 12 AUGUST 1989 439

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Chronic subdural hematoma simulating transient cerebral ischemic attacks

Cited by 25 publications

References 7 publications

Chronic subdural hematoma with transient neurological deficits: A review of 15 cases

Chronic subdural hematoma with transient neurological deficits: A review of 15 cases

Recurrent transient focal neurological deficits in convexity meningioma: TIA or negative motor seizures?

Multiple forms of epileptic attack secondary to a small chronic subdural haematoma.

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