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Related Concept Videos

Hemorrhagic Stroke l: Introduction01:17

Hemorrhagic Stroke l: Introduction

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A hemorrhagic stroke is an acute neurological event that occurs when a weakened cerebral blood vessel ruptures, allowing blood to accumulate within or around the brain. The sudden release of blood forms a focal hematoma that increases intracranial pressure, displaces neural tissue, and can obstruct cerebrospinal fluid pathways. These effects may be compounded by intraventricular extension of the hemorrhage, cerebral edema, or compression of adjacent structures, all of which contribute to...
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Hemorrhagic Stroke ll: Pathophysiology01:29

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A hemorrhagic stroke develops when a cerebral blood vessel ruptures, allowing blood to escape into the surrounding brain tissue, as in intracerebral hemorrhage (ICH), or into the subarachnoid space, as in subarachnoid hemorrhage (SAH). Because the skull is a rigid compartment, the sudden presence of extravascular blood rapidly increases intracranial pressure and compresses adjacent neural structures, leading to immediate tissue injury and impaired cerebral perfusion.Mass Effect and Primary...
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Brain Abscess l: Introduction01:26

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A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial...
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Cerebral Edema ll: Pathophysiology01:22

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Vasogenic edema is a major form of cerebral edema characterized by abnormal accumulation of fluid in the brain’s extracellular space due to disruption of the blood–brain barrier (BBB). The BBB is a specialized structure composed of endothelial cells connected by tight junctions, supported by astrocytic endfeet and a basement membrane. Under normal conditions, it tightly regulates the movement of ions, proteins, and solutes between the bloodstream and brain parenchyma. When this...
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Related Experiment Video

Updated: May 5, 2026

Double Direct Injection of Blood into the Cisterna Magna as a Model of Subarachnoid Hemorrhage
10:34

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Bilateral Subdural Hematomas Without Midline Shift: A Case Report.

Juhi Patel1, Nicholas D Luke1, Mehrdad Alaie1

  • 1Emergency Medicine, St. Barnabas Hospital Health System, New York City, USA.

Cureus
|November 25, 2024
PubMed
Summary

This case study highlights the successful surgical management of acute-on-chronic bilateral subdural hematomas in an elderly patient. The treatment involved bilateral burr hole evacuation, demonstrating a viable option for select patients without midline shift or neurological deficits.

Keywords:
glasgow coma scaleglasgow coma scale scoremidline shiftneurological outcomesneurosurgerysubdural hematoma

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Area of Science:

  • Neurosurgery
  • Neurology

Background:

  • Subdural hematomas (SDH) are collections of blood between the dura mater and arachnoid mater, posing a significant risk for neurological compromise.
  • Commonly associated with elderly individuals and alcohol abuse, SDH can lead to midline shift and brain herniation, often requiring surgical intervention.
  • Treatment modalities for SDH include craniotomy or burr hole trephination, with outcomes influenced by factors like the Glasgow Coma Scale (GCS) score and radiological findings.

Observation:

  • A 93-year-old male presented with acute-on-chronic bilateral subdural hematomas following a home fall.
  • The patient was neurologically intact, hemodynamically stable, and notably lacked a midline shift on imaging.
  • Despite the bilateral nature of the hematomas, conservative management was not pursued due to the acute-on-chronic presentation.

Findings:

  • Bilateral burr hole trephination was performed to evacuate the subdural hematomas.
  • The patient experienced an uncomplicated postoperative recovery.
  • Discharge was uneventful, with no immediate complications noted.

Implications:

  • This case demonstrates the successful surgical management of bilateral subdural hematomas in an elderly patient with preserved neurological status and no midline shift.
  • It suggests that bilateral burr hole evacuation can be a safe and effective treatment option in carefully selected cases of SDH, even in the absence of significant mass effect.
  • Further research may explore criteria for surgical intervention in neurologically intact patients with bilateral SDH.