Interhemispheric Subdural Hematoma Presenting with Falx Syndrome after Trauma

Abstract

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.

Clinical Features of Interhemispheric Subdural Hematomas

“…The most common cause of this lesion is trauma, especially over the occipital region, accounting for 80% to 90% of cases. 10 11 14) As the pathogenic mechanism of posttraumatic IHSDH, tearing of the parasagittal bridging veins were proposed by some authors, 2 5 7) however, the origin of this hematoma actually identified by surgery was veins in the IH fissure, branches of pericallosal artery or brain laceration in the IH fissure. 16) …”

Short-Term Clinical and Angiographic Outcome in Child with Traumatic Pseudoaneurysm in A2 Segment of Anterior Cerebral Artery after Endovascular Treatment: Case Report

“…These veins are stretched by the tangential forces. 10) A2 arteries are neighbored with bridging vein. In our case, the forces of falx affected A2 artery and adventitia of vessel was injured.…”

Atipik şikayetlerle prezente olan akut travmatik interhemisferik subdural hematom

“…Bununla birlikte izole interhemisferik subdural hematom (İSH) posttravmatik intrakraniyal kanamanın en nadir formunu oluşturmaktadır. İlk kez 1940'da otopside ve 1955'de de yaşayan bir kişide saptanmıştır (5).…”

“…ISH genellikle kafa travmasından sonra görülmekte olup spontan veya nontravmatik gelişimi ise çok nadirdir (5,6). İSH klinik tablosunu sıklıkla alt ekstremite monoparezisi veya bacaklarda belirgin olan hemiparezi ile karakterize olan falks sendromu oluşturmaktadır (5,7).…”

“…ISH genellikle kafa travmasından sonra görülmekte olup spontan veya nontravmatik gelişimi ise çok nadirdir (5,6). İSH klinik tablosunu sıklıkla alt ekstremite monoparezisi veya bacaklarda belirgin olan hemiparezi ile karakterize olan falks sendromu oluşturmaktadır (5,7). Diğer semptomlar arasında baş ağrısı, kusma, nöbet, demans, dil bozuklukları, okülomotor sinir parezisi veya bilinç kaybı sayılabilir (5,8)…”