Korean J Neurotrauma.  2017 Oct;13(2):103-107. 10.13004/kjnt.2017.13.2.103.

Clinical Features of Interhemispheric Subdural Hematomas

• Ahn JM
• Lee KS
• Shim JH
• Oh JS
• Shim JJ
• Yoon SM

• KMID: 2394542
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.103

Abstract

OBJECTIVE
Interhemispheric subdural hematoma (IHSDH) is uncommon, because of their unusual location. However, it is a distinct lesion with its unique characteristics. We investigated clinical features and outcomes of consecutive 42 patients with IHSDH, retrospectively.
METHODS
From 2006 to 2015, we treated 105 patients with IHSDH. All patients were diagnosed by computed tomography (CT) or magnetic resonance imaging. We selected 42 patients with thick (3 mm or more) IHSDH. We retrospectively reviewed the clinical and radiological findings, management and outcomes.
RESULTS
The male to female ratio was 2:1. Two thirds of the patients were over 60 years old. Slip or fall was the most common cause of trauma. The level of consciousness on admission was Glasgow Coma Scale (GCS) 13 to 15 in 25 patients. The most common symptom was headache. All IHSDH was hyperdense in CT at the time of diagnosis. IHSDH frequently accompanied convexity subdural hematoma. The outcome was favorable in 27 patients, however, six patients were expired. Twenty-two patients were managed conservatively. Surgery was performed in ten patients to remove the concurrent lesion. The outcome was poor in spontaneous one, patients with low GCS, and patients with conservative treatment.
CONCLUSION
IHSDH is rare especially the isolated one. The outcome was dependent to the severity of injury. Surgery may be helpful to remove the concurrent mass lesion, however, conservative treatment is generally preferred.

Keyword

Craniocerebral trauma; Glasgow outcome scale; Hematoma, subdural; Symptom assessment

MeSH Terms

Consciousness
Craniocerebral Trauma
Diagnosis
Female
Glasgow Coma Scale
Glasgow Outcome Scale
Headache
Hematoma, Subdural*
Humans
Magnetic Resonance Imaging
Male
Retrospective Studies
Symptom Assessment

Figure

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  FIGURE 1 Computed tomography scans of interhemispheric subdural hematoma result from leaking of the spontaneous cerebral hemorrhage in (A) 74 years old female and (B) 85 years old female patient with hypertension.

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  FIGURE 2 (A) Computed tomography scans of acute interhemispheric subdural hematoma (IHSDH) on bilateral chronic subdural hematomas (SDHs) in a 77 years old male patient. He suffered from spontaneous subarachnoid hemorrhage on October 12, 2013. (B) By bilateral subdural hygromas on October 15, 2013, (C) IHSDH was developed over bilateral chronic SDHs on November 18, 2013. (D) IHSDH was remained after bilateral burr holes on November 18, 2013. (E) IHSDH was spontaneously resolved on December 6, 2013. (F) Bilateral convexity SDHs were also resolved without an additional operation on November 21, 2014.

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