Bilateral interhemispheric subdural hematomas

Kasdon, David L.; Magruder, Michael R.; Stevens, Edwin A.; Paullus, Wayne S.

doi:10.1097/00006123-197907010-00010

Cited by 20 publications

(11 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Interhemispheric Subdural Hematoma Presenting with Falx Syndrome after Trauma

Lee

Kim

Yoon

2010

J Korean Neurotraumatol Soc

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Interhemispheric subdural hematoma (ISH) presenting with falx syndrome is a rare occurrence. We present a case of ISH presenting with falx syndrome with visual disturbances. A 66-year-old woman reported headache as a result of a fall. Initial nonenhanced computed tomography (CT) showed a left frontal ISH. Two days later, she was noted to have right homonymous hemianopsia and marked right hemiparesis, especially in the right lower extremity. Follow up CT demonstrated an increase in the size of the frontal ISH and a newly developed occipital ISH. On thirteen day after the trauma, she was treated with mannitol and dexamethasone. Twelve hours after the start of the mannitol and dexamethasone therapy, the patient showed marked improvement of the neurologic deficit. Five months after the trauma, she showed no neurological deficits. (J Kor Neurotraumatol Soc 2010;6:158-161) KEY WORDS: Hematoma ㆍSubdural ㆍInterhemispheric ㆍFalx.

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Section: Discussionmentioning

confidence: 99%

Interhemispheric Subdural Hematoma Presenting with Falx Syndrome after Trauma

Lee

Kim

Yoon

2010

J Korean Neurotraumatol Soc

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…In most cases, ISH is confined to one side of the falx because firm adherence of subarachnoidal trabeculations between the brain and the parasagittal dura precludes further dissemination of the bleeding [11]. Some patients with ISH have bilateral hematomas [15], or associated convexity subdural hematomas; these lesions are often related to severe head trauma causing bleeding from separate sources [10,18,23].…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Llamas

Ramos-Zúñiga²,

Sandoval

2002

Minim Invasive Neurosurg

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Interhemispheric subdural hematoma (ISH) had been considered extremely rare until identification with imaging studies. Its natural history is still quite unknown in terms of potential origin and course. As a consequence of various controversies, there is still no clearly established treatment, particularly in regard to medical or surgical management. The best decision requires tailoring treatment to the individual patient according to his or her clinical condition. Two patients with acute interhemispheric subdural hematomas are reported, the controversial management of this rare entity is analysed. In reviewing current published cases of interhemispheric subdural hematoma, it seems that the outcome of an individual patient is not related to the therapeutic approach, but to the level of consciousness and the neurological condition on admission. Surgical and medical treatment indications are taken into account for management. A patient with ISH developed an extension of the hematoma to the convexity at 2 weeks of his clinical course, with a decline of his neurological condition. The hematoma was then evacuated through a parietal craniotomy with an uneventful postoperative course. Another case of ISH presented as headache and TIA, with spontaneous clinical improvement at 12 hours and with no decline in the patient's neurological condition. Management was conservative. In both cases the neurological examination was normal after 6 months. As in previously reported cases, the clinical and neurological condition of the patient on admission is crucial for the course of an ISH. Treatment strategies are based on the individual neurological response of each case and the risk-benefit ratio to decide on a medical or surgical approach.

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