A variant of the course of chronic subdural hematoma (clinical case)

Abstract

Introduction. Doctors of various specialties face difficulties in diagnosing chronic subdural hematomas (CSDH) at different stages, usually due to the lack of an evident causal relationship between neurological manifestations of subdural hematoma and the head injury sustained several weeks or even months prior to the patient's examination. Clinically, CSDH can mimic multiple neurological disorders, and before the patient is referred to a neurosurgeon, they might be inspected by various specialists such as neurologists, physicians, traumatologists and even psychiatrists. As a results, the patient initially does not receive specialized treatment, which directly affects postoperative mortality and disabi lity in patients with this pathology.Aim. In this paper we aim to describe a rare clinical case of atypical course of CSDH. A clinical case. A 54‑year‑old woman, after falling from a ladder about 2 m high, 1.5 months after the injury, developed depression of consciousness and tetraparesis up to 2–3 points according to the Medical research counsil Weakness scale. After examination, the patient was verified to have a chronic hemispheric subdural hematoma of large volume, transverse dislocation of the median structures of the brain by 16 mm. An injury to the cervical spine was ruled out. The patient was operated on, HSDG was removed from 2 milling holes, achieving complete washing of the hematoma and, subsequently, complete restoration of motor functions in the patient – 5 point by Glasgow outcome scale (5‑point Glasgow scale).Discussion. This paper presents the results of treatment and observation of patients with atypical course of CSDH of traumatic origin. The main method of treatment is the surgical removal of chronic subdural hematoma by a minimally invasive method: the imposition of 2 trefination holes with removal by evacuation of CSDH.Conclusion. The problem of early detection of chronic subdural hematomas is extremely relevant. Careful collection of anamnesis, the alertness of doctors of related specialties on this problem, the mandatory use of neuroimaging methods (computer and magnetic resonance imaging) will often help to correctly and timely diagnose, start treatment on time and increase the patient’s chance of recovery, even in cases of atypical course.