Mimics of subacute subdural hematoma in the ED

Beer, Marlijn H. de; Gils, Ad P. van; Koppen, Hille

doi:10.1016/j.ajem.2012.10.019

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…CSDH may also cause a displacement of ventricular system and midline shift [7]. Diagnosis of a subdural fluid collection on CT is challenging, subdural haematoma, subdural empyaema, dural metastases with haemorrhagic pachymeningitis should always be considered [10]. Lymphoma, sarcoma, ischemic stroke, infectious and autoimmune issues can also mimic subdural haematoma [1,11].…”

Section: Discussionmentioning

confidence: 99%

“…Gadolinium enhanced MRI reveals enhancing and thickened dura sometimes with enhancing membranes. It is also very helpful in differential diagnosis with dural metastases, in contrast to CSDH in such cases MRI reveals intense and homogenous enhancement [10].…”

Section: Discussionmentioning

confidence: 99%

“…SE is rare, but is a serious infection with a high mortality rate, which varies from 9% -48 % [13][14]. Cranial SE occurs more often in children and young adults, with a male dominance [10,13]. Cranial SE is usually located over the convexity.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical presentation is non-specific, and has many common symptoms with CSDH. Cranial SE is usually a complication of laryngological infections (sinusitis or otitis), but it can stem from mastoiditis, infected cranial procedures, dental complications, meningitis, previous head trauma, and bacteriemic seeding of a previous subdural haematoma [3,10,[13][14]. Conditions or diseases diminishing the patient's resistance to infection may also lead to SE development [13].…”

Section: Discussionmentioning

confidence: 99%

“…There are non-specific changes in laboratory analysis: WBC -white blood cells, CRP -C-reactive protein and ESR -erythrocyte sedimentation rate may be elevated, and in the CSF. The gold standard in diagnosis is MRI with gadolinium enhancement which reveals lesions with higher sensitivity than CT. Diffusion-weighted imaging (DWI) MRI can discriminate SE from other fluid collections [10].…”

Section: Discussionmentioning

confidence: 99%

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Subdural haematoma mimicking empyema in a patient with multiple sclerosis treated with immunosuppressive monoclonal antibody

Ciesielka¹,

Jamróz-Wiśniewska²,

Bąk³

et al. 2018

J Pre Clin Clin Res.

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Subdural empyema (SE) and subdural haematoma (SH) can present similar radiological signs on magnetic resonance imaging (MRI) of the brain. Natalizumab, a monoclonal antibody used in the treatment of multiple sclerosis (MS), exerts immunosuppressive effects in the CNS and can rarely be complicated by progressive multifocal leukoencephalopathy. In a 39-year-old female treated because of MS with natalizumab, control MRI showed massive thickening of the meninges and multiple fluid reservoirs, described as most probably empyemas and meningitis. The patient denied head trauma. Laboratory tests did not show inflammation. Orthopantomogram showed dental pathologies-a possible source of infection. Despite intense treatment, the MRI lesions remained unchanged. After neurosurgical intervention, chronic SH was diagnosed. A radiological picture of SH and SE could be difficult to differentiate. The aim of the article is to show how unspecific signs in neuroimaging can be caused by chronic SH.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Subdural haematoma mimicking empyema in a patient with multiple sclerosis treated with immunosuppressive monoclonal antibody

Ciesielka¹,

Jamróz-Wiśniewska²,

Bąk³

et al. 2018

J Pre Clin Clin Res.

View full text Add to dashboard Cite

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The Neurocritical and Neurosurgical Care of Subdural Hematomas

Huang

Abd-El-Barr

et al. 2015

Neurocrit Care

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Subdural hematomas (SDHs), though frequently grouped together, can result from a variety of different etiologies, and therefore many different subtypes exist. Moreover, the high incidence of these lesions in the neurocritical care settings behooves practitioners to have a firm grasp on their diagnosis and management. We present here a review of SDHs, with an emphasis on how different subtypes of SDHs differ from one another and with discussion of their medical and surgical management in the neurocritical care setting. In this paper, we discuss considerations for acute, subacute, and chronic SDHs and how presentation and management may change in both the elderly and pediatric populations. We discuss SDHs that arise in the setting of anticoagulation, those that arise in the setting of active cerebrospinal fluid diversion, and those that are recurrent and recalcitrant to initial surgical evacuation. Management steps reviewed include detailed discussion of initial assessment, anticoagulation reversal, seizure prophylaxis, blood pressure management, and indications for intracranial pressure monitoring. Direct surgical management options are reviewed, including open craniotomy, twist-drill, and burr-hole drainage and the usage of subdural drainage systems. SDHs are a common finding in the neurocritical care setting and have a diverse set of presentations. With a better understanding of the fundamental differences between subtypes of SDHs, critical care practitioners can better tailor their management of both the patient's intracranial and multi-systemic pathologies.

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