Article
Chronic subdural hematoma secondary to head-banging
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Published: | May 13, 2014 |
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Objective: “Head-banging” (HB) describes a dance form including the violent movement of the head to the rhythm of rock music, most commonly seen in the heavy metal genre. A thorough review of the literature yielded three cases of subdural hematomas described in association with intensive HB. We report of a patient with an arachnoidal cyst (AC) and chronic subdural hematoma (cSDH) following excessive HB.
Results: A 50-year-old male hard rock enthusiast presented with a 2-week history of increasing headache. There was no history of head trauma, but the patient reported that he had performed HB during a rock show 4 weeks earlier. Results of the neurological examination and laboratory studies, including coagulation screening, were unremarkable. Cranial computed tomography (CCT) demonstrated an extensive right hemispheric cSDH with a midline shift of approximately 15 mm. The patient underwent burr hole evacuation of the cSDH and closed system subdural drainage that was continued for 6 days after surgery. During the postoperative course his headache subsided and he was discharged on the 9th postoperative day with no neurological deficits. At 2-month clinical follow-up the patient was free of neurological symptoms. The complementary CCT showed in addition to a complete resolution of the subdural collection an AC of the ipsilateral middle cranial fossa (grade I according to Galassi et al., 1982) that was initially interpreted as a bleeding at the tip of the temporal lobe in extension of the right hemispheric cSDH.
Conclusions: Our case illustrates the impact of HB on the development of subdural hematoma. It further highlights the importance of a subdural hematoma as a differential diagnosis in patients with diagnosed asymptomatic AC showing signs of increased intracranial pressure even after minor head affection. Conversely, the importance of a thorough investigation for small ACs in young patients with subdural hematoma is emphasized.