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Lacunar Infarction Caused by Chronic Subdural Hematoma

In chronic subdural hematoma (CSDH) patients, motor functions usually recover quickly after burr-hole surgery; however, in a rare case, the hemiparesis showed poor improvement after surgery. In that case, investigation of cerebral infarctions is important. Among the 284 CSDH patients with motor weak...

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Autores principales: YAMADA, Shoko Merrit, TOMITA, Yusuke, TAKAYA, Yoshinori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The Japan Neurosurgical Society 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431875/
https://www.ncbi.nlm.nih.gov/pubmed/32727979
http://dx.doi.org/10.2176/nmc.oa.2019-0183
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author YAMADA, Shoko Merrit
TOMITA, Yusuke
TAKAYA, Yoshinori
author_facet YAMADA, Shoko Merrit
TOMITA, Yusuke
TAKAYA, Yoshinori
author_sort YAMADA, Shoko Merrit
collection PubMed
description In chronic subdural hematoma (CSDH) patients, motor functions usually recover quickly after burr-hole surgery; however, in a rare case, the hemiparesis showed poor improvement after surgery. In that case, investigation of cerebral infarctions is important. Among the 284 CSDH patients with motor weakness, magnetic resonance image (MRI) and MR angiography (MRA) were acquired in 82 patients before surgery when the hemiparesis progressed rapidly. Small lacunar infarction was identified on the hematoma side in five cases; all were older than 80 years with hypertension, and diabetes mellitus had been diagnosed in two. In all the five patients (100%), MRA demonstrated a downward or upward shift of the M1 portion of the middle cerebral artery on the hematoma side, where the perforating arteries originate. Conversely, only 4 CSDH patients (5.2%) without lacunar infarction demonstrated M1 downward shift. The risk factors of lacunar infarction were high in the five detected cases; however, distortion, twisting, or elongation of the lenticulostriate arteries might be a cause of the lacunar infarctions, rather than the formation of lipohyalinosis or microatheroma in the arteries. Therefore, anti-platelet treatment might not be necessary for CSDH-inducing lacunar infarction. The lacunar infarctions caused by CSDH were small, the patients’ hemiparesis was mild, a prognosis of all the patients was good, and they recovered well from the motor weakness after physical rehabilitation. MR examinations before surgery are recommended for CSDH patients especially when a patient complains of sudden onset or rapid deterioration of motor weakness.
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spelling pubmed-74318752020-08-20 Lacunar Infarction Caused by Chronic Subdural Hematoma YAMADA, Shoko Merrit TOMITA, Yusuke TAKAYA, Yoshinori Neurol Med Chir (Tokyo) Original Article In chronic subdural hematoma (CSDH) patients, motor functions usually recover quickly after burr-hole surgery; however, in a rare case, the hemiparesis showed poor improvement after surgery. In that case, investigation of cerebral infarctions is important. Among the 284 CSDH patients with motor weakness, magnetic resonance image (MRI) and MR angiography (MRA) were acquired in 82 patients before surgery when the hemiparesis progressed rapidly. Small lacunar infarction was identified on the hematoma side in five cases; all were older than 80 years with hypertension, and diabetes mellitus had been diagnosed in two. In all the five patients (100%), MRA demonstrated a downward or upward shift of the M1 portion of the middle cerebral artery on the hematoma side, where the perforating arteries originate. Conversely, only 4 CSDH patients (5.2%) without lacunar infarction demonstrated M1 downward shift. The risk factors of lacunar infarction were high in the five detected cases; however, distortion, twisting, or elongation of the lenticulostriate arteries might be a cause of the lacunar infarctions, rather than the formation of lipohyalinosis or microatheroma in the arteries. Therefore, anti-platelet treatment might not be necessary for CSDH-inducing lacunar infarction. The lacunar infarctions caused by CSDH were small, the patients’ hemiparesis was mild, a prognosis of all the patients was good, and they recovered well from the motor weakness after physical rehabilitation. MR examinations before surgery are recommended for CSDH patients especially when a patient complains of sudden onset or rapid deterioration of motor weakness. The Japan Neurosurgical Society 2020-08 2020-07-30 /pmc/articles/PMC7431875/ /pubmed/32727979 http://dx.doi.org/10.2176/nmc.oa.2019-0183 Text en © 2020 The Japan Neurosurgical Society This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/4.0/
spellingShingle Original Article
YAMADA, Shoko Merrit
TOMITA, Yusuke
TAKAYA, Yoshinori
Lacunar Infarction Caused by Chronic Subdural Hematoma
title Lacunar Infarction Caused by Chronic Subdural Hematoma
title_full Lacunar Infarction Caused by Chronic Subdural Hematoma
title_fullStr Lacunar Infarction Caused by Chronic Subdural Hematoma
title_full_unstemmed Lacunar Infarction Caused by Chronic Subdural Hematoma
title_short Lacunar Infarction Caused by Chronic Subdural Hematoma
title_sort lacunar infarction caused by chronic subdural hematoma
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7431875/
https://www.ncbi.nlm.nih.gov/pubmed/32727979
http://dx.doi.org/10.2176/nmc.oa.2019-0183
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