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Multigen RF lesion generator .

22-SEPTEMBER-2010  AZIZAH ABDEL-QADER MAKKAWY  70 YEARS  SUBACUTE SUBDURAL HEMATOMA RIGHT PARITAL REGION.

Please! wait for 3-5 min till the video start to load. It depends upon the internet connection.

Anamnesis

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The patient came to the clinic 15-September-2010 complaining of headache for 7 days with epileptic attacks of weak left upper limb for 4-5 min occurring 4-5 times a day. The patient suffered RTA 25-July-2010 without loss of consciousness. She is a known diabetic for 5 months and hypertensive for 1 year.

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On examination: The patient walking normally with stable stance. She has weak grip and extensors of the left hand and hypalgesia of the right hand. Tegretol was started and sent for investigations.

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MRI of the brain showed subacute hematoma of the right parietal region compressing the brain parenchyma causing tiny cortical ecchymosis. CT-scan confirmed the nature of the hematoma, which mostly was not acute. The epi attacks stopped after starting medication.

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At the most dependent point of the supposed to be chronic subdural hematoma right parietal region, burr hole was done. No hematoma is coming out.  The skin incision was widened and craniotomy of the parietal region was done and the dura was opened. The brain is swollen and no hematoma in the field. The subdural fields were inspected down to the tentorium  and medially to the SSS. No hematoma. The MRI data were several times revised to check why there is no hematoma. The report is telling that it is intracerebral, but no convincing data at the field support the report. The craniotomy was extended interiorly to reach the senso-motor strip. There, the hematoma was rubbery in consistency and subdural in location, extracerebral with thick membrane. It was resembling a meningioma with reactionary changes to the dura around the lesion. All the solid hematoma was removed with its thick membrane and sent for biopsy.

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Routine closure of the wound and smooth postoperative recovery and the external drain was left at the site of the removed hematoma.


Comments

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In old age patients with presence of brain atrophy chronic and subacute subdural hematomas can have place after suffering even trivial trauma.

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The epi attacks were due to cortical irritation by the clot compressing the brain parenchyma.

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It is rare to have this difficult situation by 2 reasons: 1. The hematoma localization was parietal in the MRI , but in reality it was over the sensori-motor strip. 2. The hematoma was rubbery in consistency and its removal was more difficult than removing a meningioma.

Immediate postoperative control CT-scan


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Notice: Head injuries and very urgent surgeries are also escaped from the plan .

 

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