Akut Intrahemisferik Subdural Hematomlar: Üç Vakanın Sunumu ve Literatürün Gözden Geçirilmesi

Akut supratentoriyal intrahemisferik subdural hematomların gelişimi yaygın olmamalarına rağmen sıradışı lokasyonları, bilinmeyen hikayeleri ve tartışmalı yönetimi nedeniyle oldukça ayırtedicidir. Majör nedenleri kafa travmaları, kanama yatkınlığı veya koagülopatidir. Burada akut supratentoriyal intrahemisferik subdural hematom geçiren 3 hastayı rapor ettik. Hastalar sırasıyla 72, 66 ve 65 yaşlarındadır. İlk 2 hasta erkek, 3. hasta ise kadındır. Bu hastalarda kafa travması, kanama eğilimi veya koagülopati yoktu. İkinsi hipertansif ama diyabetik, epileptik veya alkolik değiller. İki hasta sırayla 1. ve 2. günlerde öldüler, üçüncü hasta akrabası tarafından akut ve acil bölümüne kabülünden 3 saat sonra taburcu edildi. Hiçbir hastaya nörocerrahi girişimi yapılmadı ve tüm hastalara konservatif tedavi protokolü uygulandı. İki hastada sol frontooksipital hematom tespit edilirken 3. hastada sağ parietooksipital hematom tespit edildi. Tüm hastalarımızda hematomun etiyolojisi ve gelişimi tartışmalı olmasına ve iyi araştırılamamasına rağmen ilk iki hastanın erken ölmesi ve 3. hastanın erken taburcu olması bu çalışma grubunun bütünlüğünü bozmuştur. Ayrıca bu iki hasta eğer daha erken takibe alınabilseydi belki de ölmeleri önlenebilirdir.

Anahtar Kelimeler:

interhemisferik; subdural hematom; spontan; supratentoriyal

Acute Interhemispheric Subdural Hematomas: A Report of 3 Cases and Review of the Literature

The development of acute supratentorial interhemispheric subdural hematomas is an uncommon yet a highly distinct event because of their unusual location, unknown natural history, and debated management. The majority develop in patients with head trauma, generalized bleeding tendency, or coagulopathy. We report on 3 patients who developed spontaneous acute inter-hemispheric subdural hematomas. They were 72, 66, and 65 years old, respectively. Two were males and the 3rd was a female. There was no head trauma, bleeding tendency, or coagulopathy. Two of them were hypertensive but none of them was diabetic, epileptic, or alcoholic. Two patients died, on day 1 and 2 respectively, and the 3rd patient was discharged by his next of kin after 3 hours of admission to our Acute and Emergency department. No neurosurgical intervention was carries out and all patients were treated conservatively. The hematoma was fronto-occipital and was located on the left side in 2 patients while in the 3rd patient it was a right-sided parieto-occipital one. Although the initial investigations had pointed out to the spontaneous development of those hematomas in our patients, a further search for an underlying etiology was supposed to be done, but the early death of 2 patients and the premature discharge of the 3rd patient had intersected with this work-up. The rapid deterioration and death of 2 patients might have been prevented if an early evacuation was done.

Keywords:

interhemispheric; subdural hematoma; spontaneous; supratentorial,

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Yazışma Adresi / Address for Correspondence: Osama Shukir Muhammed Amin Sulaimaniya City Post-Office, PO BOX 196, Sulaimaniya City, IRAQ e-mail: dr.osama.amin@gmail.com geliş tarihi/received :28.08.2012 kabul tarihi/accepted:25.09.2012