Brain Neurorehabil.  2019 Sep;12(2):e15. 10.12786/bn.2019.12.e15.

Delayed Extensive White Matter Injury Caused by a Subdural Hemorrhage and Role of Corticospinal Tract Integrity

• Lee KB
• Yoon SC
• Kim JS
• Hong BY
• Park JG
• Sung WJ
• Park HJ
• Lim SH

• KMID: 2458558
• DOI: http://doi.org/10.12786/bn.2019.12.e15

Abstract

A subdural hemorrhage (SDH) is a common disorder with usually good prognosis. Most SDHs resolve with or without with minimal sequelae. We present a case report of a patient with SDH, who had delayed extensive white matter injury with disruptions of corticospinal tracts (CSTs) by diffusion tensor imaging (DTI) and showed abysmal prognosis, despite long-term rehabilitation. A 62-year-old man with an SDH underwent burr hole trephination for hematoma removal. Within 7 days, the hemorrhage diminished. At 12 weeks after the onset, the patient's weakness did not improve, and a follow-up magnetic resonance imaging revealed extensive leukomalacia, especially in the white matter. The DTI for CST revealed severe injury of CST integrity. He did not re-gain muscle strength and functional independence, despite 3 months of inpatient rehabilitation. This case describes SDH with delayed extensive white matter injury and exceptional poor prognosis and urges caution in that the SDH may induce very variable functional recovery. Besides, DTI for CST would be useful in predicting the long-term functional prognosis in extensive white matter injury.

Keyword

Subdural hemorrhage; Corticospinal tracts; Diffusion tensor imaging; Leukomalacia; White matter injury

MeSH Terms

Diffusion Tensor Imaging
Follow-Up Studies
Hematoma
Hematoma, Subdural*
Hemorrhage
Humans
Inpatients
Magnetic Resonance Imaging
Middle Aged
Muscle Strength
Prognosis
Pyramidal Tracts*
Rehabilitation
Trephining
White Matter*