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Chronic subdural hematoma clinical features

Chronic subdural hematoma has been referred to as the “great neurologic imitator” as it can mimic many neurological conditions.

They typically present with symptoms of increased intracranial pressure including headache, nausea/vomiting, and somnolence or with contralateral weakness. Compression of the convexity cerebral cortex usually causes motor deficit that is more readily appreciated in the upper extremity rather than in the leg, and very subtle deficit may be only detected by looking for pronator drift. The precise pattern of signs and symptoms in a given patient with chronic subdural may vary from case to case depending upon the specific anatomy of compression, but isolated lower extremity weakness is rare 1).

They can present in many different unusual ways including bilateral complete paraplegia and acute urinary retention mimicking acute spinal cord pathology. The exact mechanism of this clinical presentation is not clear and may be due to direct compression of the motor cortex to the falx or due to compression of the anterior cerebral artery due to subfalcine herniation 2).

Chronic subdural hematoma may have a presentation similar to that of Parkinson disease 3) 4).

Patients with unilateral chronic subdural hematoma had more frequent occurrence of hemiparesis than the patients with bilateral chronic subdural hematoma. It took the left-sided chronic subdural hematomas less time (about 200 hours earlier) than the right-sided ones to present its symptoms although the average hematoma diameter value was almost the same.

The site and the form of intracranial lesion-chronic subdural hematoma could have a great influence on neurological and functional condition in a patient. Although the length of time required for making diagnosis as well as clinical symptoms greatly differ and the latter are not always so clear, physicians should maintain a high level of suspicion for this disease and thus contribute to prompt diagnosis and better clinical outcome of patients 5).

Weisberg SD, Houten JK. An Unusual Presentation of Chronic Subdural Hematoma with Isolated Footdrop. World Neurosurg. 2018 Oct 13. pii: S1878-8750(18)32338-6. doi: 10.1016/j.wneu.2018.10.042. [Epub ahead of print] PubMed PMID: 30326314.
Herath HMMTB, Matthias AT, Kulatunga A. Acute on chronic bilateral subdural hematoma presenting with acute complete flaccid paraplegia and urinary retention mimicking an acute spinal cord injury: a case report. BMC Res Notes. 2017 Nov 28;10(1):627. doi: 10.1186/s13104-017-2969-y. PubMed PMID: 29183359.
Suman S, Meenakshisundaram S, Woodhouse P. Bilateral chronic subdural haematoma: a reversible cause of parkinsonism. J R Soc Med. 2006 Feb. 99(2):91-2.
Giray S, Sarica FB, Sen O, Kizilkilic O. Parkinsonian syndrome associated with subacute subdural haematoma and its effective surgical treatment: a case report. Neurol Neurochir Pol. 2009 May-Jun. 43(3):289-92.
Juković M, Petrović K, Till V. The question is whether hemiparesis is more common in unilateral than bilateral chronic subdural hematoma. Med Pregl. 2014 Sep-Oct;67(9-10):277-81. PubMed PMID: 25546973.
chronic_subdural_hematoma_clinical_features.txt · Last modified: 2018/10/17 21:38 by administrador