Artikel
Chronic subdural hematoma of the young – A sequel of spinal dural tear?
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Autoren
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Christian Fung
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
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Jürgen Beck
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
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Philippe Schucht
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
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Werner Z’Graggen
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
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Jan Gralla
- Institut für Neuroradiologie, Inselspital, Bern, Schweiz
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Andreas Raabe
- Universitätsklinik für Neurochirurgie, Inselspital, Bern, Schweiz
| Veröffentlicht: | 16. September 2010 |
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Gliederung
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Objective: Chronic subdural hematoma (cSDH) is a common disease especially in the elderly. Minor trauma to the head and subsequent bleedings or chronic inflammation may be the main pathophysiological components for cSDH. A small number of young patients (<60 years) without anticoagulant therapy or apparent trauma develop cSDH. In this subset of young patients with cSDH, we hypothesize that cerebrospinal fluid (CSF) loss via spontaneous or traumatic spinal dural tears may be the underlying cause for cSDH.
Methods: We report on three cases of cSDH in young patients in whom we found spinal dural tears in two cases and meningo-epithelial cyst (root cyst) in one case as the presumed aetiology for cSDH.
Results: Three patients, a 38 year old woman and two males age 42 and 54, were referred to our department for evacuation of newly diagnosed cSDH. Initially all patients presented with headaches. They had their cSDH evacuated. Yet the two, in whom spinal dural tears were diagnosed eventually, did not show improvement. After thorough work up we found spinal epidural effusions in two patients (MRI) and meningo-epithelial cysts (MRI) in one as hints for spinal CSF loss as the pathophysiological basis for cSDH. A precise localisation of the spinal dural tear could be found in the two patients using myelography. Closure of the dural tear by means of an epidural blood patch was ineffective. Therefore spinal operation was performed with identification and subsequent microsurgical closure of spinal dural tears. After identification and closure of the spinal dural tears – the underlying cause – patients improved immediately. The patient with cSDH and root cysts was treated with craniotomy and hematoma evacuation.
Conclusions: These three cases illustrate that spinal dural tears with CSF leakage may be the basis for subdural hematoma. Without treatment of the underlying cause – the spinal dural tear – these patients have a high likelihood for recurrence and a complicated course. We hypothesize that dural tears and loss of CSF may even be a common cause for cSDH in the young. We believe that spinal dural tears with loss of CSF would be more often diagnosed if considered.
