J Korean Neurosurg Soc.  2014 Apr;55(4):218-221. 10.3340/jkns.2014.55.4.218.

The Surgical Treatment of Three Young Chronic Subdural Hematoma Patients with Different Causes

• Hou K
• Li CG
• Zhang Y
• Zhu BX

• KMID: 2191097
• DOI: http://doi.org/10.3340/jkns.2014.55.4.218

Abstract

Chronic subdural hematoma (CSDH), which rarely happens in the young, is thought to be a disease of the elderly. Whereas unspecific symptoms and insidious onset in juveniles and young adults, as a result of its relative low morbidity, CSDH is usually neglected even undertreated in the young. Through the three cases and review of the current literature on this subject, we tried to illustrate the clinical and etiopathological characteristics of this entity and find out the most appropriate treatment strategy. We report three young CSDH patients with different but similar symptoms. The present histories, tests and examinations revealed different predisposing factors accounting for the genesis of CSDH. Their preoperative symptoms were all resolved with burr hole and drainage operation. Juveniles and young adults suffering from CSDH differ from that of their elderly counterparts in their clinical and etiopathological characteristics. Although trauma is the most important risk factor in young and old CSDH patients, some other predisposing factors may exist. Burr hole and drainage surgery could resolve the problem most of the time. But further tests and examinations even specific management should be made in some cases.

Keyword

Chronic subdural hematoma; Young adult; Cerebrospinal fluid leakage; Intracranial hypotension; Arachnoid cyst

MeSH Terms

Aged
Causality
Drainage
Hematoma, Subdural, Chronic*
Humans
Intracranial Hypotension
Risk Factors
Young Adult

Figure

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  Fig. 1 A : Preoperative CT shows an isodense subdural hematoma in the left frontal and parietal region with an obvious compression of the left lateral ventricle and evident midline shift to the right. B : Preoperative CT reveals an arachnoid cyst on the right sylvian region. Arrow shows the bony indentation and thinning of the peak of the left middle fossa.

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  Fig. 2 A : MRI shows a half-mooned high intensity effusion on T1 and T2 weighted imaging in the right hemisphere with compressed ipsilateral ventricle and midline shift. B : Postoperative CT illustrates a complete evacuation of the hematoma and restoration of the compressed brain tissue.

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  Fig. 3 A : CT shows an isodense subdural hematoma in the left frontal and parietal region with compressed ipsilateral ventricle and midline shift. B : Postoperative CT illustrates a subtotal evacuation of the subdural hematoma and restoration of the midline structures with the residual hematoma cavity replaced by low density fluid and air.

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