Chronic subdural hematoma presenting as diplegia-A rare presentation

Kumar, Ambati Sumanth; Alugolu, Rajesh

doi:10.4103/0976-3147.140024

Cited by 4 publications

(1 citation statement)

References 3 publications

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“…The article by Kumar and Alugolu 1 described atypical neurologic presentation of the chronic subdural hematoma (SDH) in 2014, which confirms the statement that the medicine is not like mathematics. Sometimes radiologic findings do not correlate with neurologic symptom; therefore, every patient is to be considered individually for correct management.…”

Section: Introductionmentioning

confidence: 77%

Unusual Clinical and Imaging Presentation of Chronic Subdural Hematoma

Ghosh

Roy

Saha

2017

Indian Journal of Neurotrauma

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Various clinical and radiologic presentations of chronic subdural hematoma (SDH) are reported in the literature. Therefore, sometimes the presentation of a patient with chronic SDH often creates confusion regarding decision making. Here, the authors present three cases of chronic SDH, in which the clinical presentation, radiology, and operative findings were unusual. In the first case, the patient presented with acute extradural hematoma like clinical as well as radiologic presentation but intraoperatively found to have chronic calcified SDH, whereas another case with history of bilateral ventriculoperitoneal (VP) shunting at childhood presented with large head with discharging sinus at the forehead. Radiologic and operative findings were very much unusual. Intraoperatively, the bilateral subdural collection was found to have fungus-like projections with subdural space communicating with the forehead sinus. In another case, a 10-year-old girl with history of VP shunting at age of 6 months presented with left hemiparesis of subacute onset. Computed tomographic (CT) scan revealed biconvex lesion at the right parietal region intraoperatively. The authors found the shell-like lesion with inner and outer membrane calcified, within which the subdural collection was present. In these three cases, they observed the very unusual mode of presentation of chronic SDH, and in the literature such mode of presentation and operative findings of such type are very rare.

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Section: Introductionmentioning

confidence: 77%

Unusual Clinical and Imaging Presentation of Chronic Subdural Hematoma

Ghosh

Roy

Saha

2017

Indian Journal of Neurotrauma

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Main Clinical Presentations of Chronic Subdural Hematomas

Witt

Hall

2021

Subdural Hematoma

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Subdural Lesions Linking Additional Intracranial Spaces and Chronic Subdural Hematomas: A Narrative Review with Mutual Correlation and Possible Mechanisms behind High Recurrence

Lin

2023

Diagnostics

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The purpose of this study was two-fold. The first was to investigate the pathologic mechanisms underlying the formation of subdural fluid collection, an umbrella term referring to a condition commonly seen in the clinical setting. Accumulation of the cerebrospinal fluid (CSF) in the subdural space can be referred to in this disease category, disregarding the underlying source of the subdural fluid. However, in these two clinical situations, especially after trauma or brain surgery, fluid collection from the subarachnoid space (subdural hygroma) or from the ventricle to the subarachnoid space and infusion into the subdural space (external hydrocephalus), surgical management of critical patients may adopt the strategies of burr-hole, subduroperitoneal shunt, or ventriculoperitoneal shunt, which present distinctly different thoughts. Crucially, the former can be further transformed into chronic subdural hematoma (CSDH). The second significant theme was the pathogenesis of CSDH. Once the potential dural border cell (DBC) layer is separated such as if a wound is formed, the physiological mechanisms that seem to promote wound healing will resume in the subdural space as follows: coagulation, inflammation, fibroblast proliferation, neovascularization, and fibrinolysis. These aptly correspond to several key characteristics of CSDH formation such as the presence of both coagulation and fibrinolysis signals within the clot, neomembrane formation, angiogenesis, and recurrent bleeding, which contribute to CSDH failing to coagulate and absorb easily. Such a complexity of genesis and the possibility of arising from multiple pathological patterns provide a reasonable explanation for the high recurrence rate, even after surgery. Among the various complex and clinically challenging subdural lesions, namely, CSDH (confined to the subdural space alone), subdural hygroma (linked in two spaces), and external hydrocephalus (linked in three spaces), the ability to fully understand the different pathological mechanisms of each, differentiate them clinically, and devote more interventional strategies (including anti-inflammatory, anti-angiogenic, and anti-fibrinolysis) will be important themes in the future.

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Chronic subdural hematoma presenting as diplegia-A rare presentation

Cited by 4 publications

References 3 publications

Unusual Clinical and Imaging Presentation of Chronic Subdural Hematoma

Unusual Clinical and Imaging Presentation of Chronic Subdural Hematoma

Main Clinical Presentations of Chronic Subdural Hematomas

Subdural Lesions Linking Additional Intracranial Spaces and Chronic Subdural Hematomas: A Narrative Review with Mutual Correlation and Possible Mechanisms behind High Recurrence

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