Bilateral chronic subdural hematoma
Neurosurgery Department, General University Hospital Alicante, Spain
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Definition
A bilateral chronic subdural hematoma (bCSDH) is a condition where there is an accumulation of blood in the subdural space on both hemispheres of the brain. These hematomas develop over weeks to months, often due to minor head trauma, and can lead to progressive neurological deficits.
Epidemiology
The overall incidence of Bilateral Chronic Subdural Hematoma has been reported to vary from 16% to 20% 1) 2) 3)
Data on bilateral chronic subdural hematomas (CSHs) are scant 4) , including information on the frequency of symptoms, response to various treatments, and postoperative complications, compared with data on unilateral CSH. Bilateral CSHs constitute a fair portion of CSHs, especially in patients older than 75 years and in those with coagulopathy.
Classification
Bilateral hypodense chronic subdural hematoma
Bilateral isodense chronic subdural hematoma
Clinical features
Diagnosis
Differential diagnosis
If the lesion is placed more anteriorly and medially, hyperdense in intensity and enclosed in thick capsule, it may look biconvex in shape and can mimic extradural hematoma. This location of the lesion will also displace the frontal horns of the lateral ventricles laterally than medially, as in the present case. To avoid this confusion, if available, magnetic resonance imaging (MRI) would be better than CT in identifying these lesions 5) 6) 7) 8) 9).
Treatment
Outcome
Mixed high and low intensity in T2WI or low intensity in T1WI is the most predictable factor to show rapid aggravation 10).
Clinicians must be aware of the higher recurrent rate of bilateral CSDH after burr hole craniostomy 11).