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LETTER TO THE EDITOR |
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Year : 2013 | Volume
: 16
| Issue : 4 | Page : 178 |
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Bifrontal acute subdural hematoma
Pankaj Kapoor
Consultant Neurosurgeon, Neurospine Clinic, Satpathy Nagar, Mughalsarai, Uttar Pradesh, India
Date of Web Publication | 21-Jan-2014 |
Correspondence Address: Pankaj Kapoor Consultant Neurosurgeon, Neurospine Clinic, Satpathy Nagar, Mughalsarai - 230 101, Uttar Pradesh India
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/1118-8561.125584
How to cite this article: Kapoor P. Bifrontal acute subdural hematoma. Sahel Med J 2013;16:178 |
Sir,
The article "Bifrontal acute subdural hematoma" published in the Sahel Medical Journal vol 16(2) (April-June 2013) makes an interesting reading. [1] In the article, the authors report the clinical, radiological findings, and successful management of a rare case of traumatic acute bilateral bifrontal subdural hematoma. [1] While we appreciate the efforts of the authors in describing the patient, there were some inconsistencies in the manuscript. The image quality of [Figure 1], [Figure 3], and [Figure 4] was poor. Although the authors claim that the lesion was bilateral, but it was largely unilateral as evident on computed tomogram (CT) just extending to the left of the midline [Figure 1]. [1] It is supported by the obliteration of the frontal horn of the right lateral ventricle; the left frontal horn was partly visible. [2],[3],[4],[5],[6],[7],[8] If there were a large bifrontal lesion it would have led to medial compression of frontal horn of the lateral ventricles resulting in a narrow, slit-like elongated ventricles ("squeezed ventricle," "hare's ears sign," or "rabbit's ears"). [6],[7],[8],[9] There was an inconsistency between intra-operative and post-operative images. The intra-operative bone cuts on the left side was much more lateral [Figure 2]; [1] however, on the CT scan it was just away from the midline. In addition, [Figure 2] did not show the exact location of the hematoma as there was a gauze piece covering the area hiding the underlying brain and its view. For such a large lesion that was only on the right a right frontal craniotomy would have been sufficient. There was no indication for a bicoronal frontal craniotomy. On the follow-up CT scan, there was large infarct involving the whole of the right frontal lobe, part of the right basal ganglion, extending into the left medial frontal lobe through corpus callosum [Figure 4]. [1] This finding was neither described in the case report nor discussed. It would be difficult for a the patient described by the author [1] to recover without deficits in immediate post-operative period. Finally, most of the references were not related to acute subdural hematoma but chronic subdural hematoma which has different pathology and outcome.
References | | |
1. | Singh S, Mohammad A, Bedi S. Bifrontal acute subdural hematoma. Sahel Med J 2013;16:77-9. |
2. | Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: Results of a large single-center cohort study. Neurosurg Rev 2004;27:263-6. [PUBMED] |
3. | de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CA. Subdural haematoma: A potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003;74:752-5. [PUBMED] |
4. | Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural haematoma in the elderly. Postgrad Med J 2002;78:71-5. [PUBMED] |
5. | Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005;107:223-9. |
6. | Ellis GL. Subdural hematoma in the elderly. Emerg Med Clin North Am 1990;8:281-94. [PUBMED] |
7. | Karasawa H, Tomita S, Suzuki S. Chronic subdural hematomas. Time-density curve and iodine concentration in enhanced CT. Neuroradiology 1987;29:36-9. [PUBMED] |
8. | Kim KS, Hemmati M, Weinberg PE. Computed tomography in isodense subdural hematoma. Radiology 1978;128:71-4. [PUBMED] |
9. | Marcu H, Becker H. Computed-tomography of bilateral isodense chronic subdural hematomas. Neuroradiology 1977;14:81-3. [PUBMED] |
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