Interhemispheric Subdural Hematoma

Abstract

Abstract:Although relatively uncommon, interhemispheric subdural hematoma (ISDH) occurs more frequently than was suspected before the advent of computerized tomographic (CT) scanning. When its mass is sufficiently large to compress the medial cerebral hemisphere, specific focal neurological abnormalities may occur. These include weakness of the contralateral leg, or contralateral hemiparesis with the leg being weaker than the arm. On the unenhanced CT scan ISDH is seen as a crescent shaped, midline hyperdensity. Treatment is dictated by the clinical course. Evacuation of the hematoma by parasagittal craniotomy is recommended if the symptoms are pronounced.

Interhemispheric Subdural Hematoma Presenting with Falx Syndrome after Trauma

“…These clinicians suggest that prompt surgery via a craniotomy is the only way to deal with this condition safely. 8,12,13,16) However, some patients with an ISH have been managed successfully with conservative measures in the acute phase. 2,5,10,14) Although there is no consensus on the ideal management of these hematomas, a flexible treatment plan should be developed.…”

Acute Interhemispheric Subdural Hematoma: Two Case Reports and Analysis of the Literature

“…ISH is usually caused by traumatic laceration of bridging veins between the parieto-occipital cortex and the superior sagittal sinus [1, 2, 5, 9 ± 11,14,17,18, 21, 24]. It has also been described in association with anticoagulant therapy [13,19,20,24,26], shunted hydrocephalus [15], or following aneurysm rupture [8]. In addition, other authors [19,20] found ISH to be a frequent complication in the abused child with whiplash injury of the head.…”

“…The most distinctive clinical manifestation of ISH is contralateral leg paresis or hemiparesis with crural predominance known as Falx syndrome [2,3,8,9,11,14,17,20,21,24,26]. Partial motor seizures [11,17,20], signs and symptoms of increased intracranial pressure [15,20], or altered consciousness [5,8,10,13,18] may be prominent features in some patients. Diagnosis is readily made by CT; the finding of a crescent-shaped, hyperdense mass along the interhemispheric fissure with a flat medial margin and a convex lateral border is highly suggestive of ISH [11,17 ± 20, 27].…”

“…Interhemispheric subdural hematoma (ISH) was considered rare before the availability of computed tomography (CT) [1,4,5,8,10,14,21,24]. In recent years, widespread use of CT and MRI has led to its better recognition [9,11,13,15,17,18,20,23,27], and has improved our understanding of this disorder; however, several aspects are still controversial. In regard to the management of ISH, little is known about the ideal time for surgery and what, if any, are the indications for a conservative approach in a given patient.…”

Adult interhemispheric subdural haematoma: A simple option for an uncommon problem

“…Generally speaking, the usual surgical manoeuvre is directed towards removal of the clot. The common surgical procedures are parasagittal craniotomy for evacuation of clot 4,5,11 and the burr hole drainage of haematoma. Glista et al.…”