Interhemispheric subdural hemorrhage

Case contributed by Dr Yesid Cardozo Vélez

Presentation

Fall on level ground. There was no history of hemiparesis, altered sensorium, seizures or vomiting.

Patient Data

Age: 85 years
Gender: Male

There is an acute interhemispheric subdural hemorrhage, 7 mm thick and with an inside density of 55 HU The brain parenchyma adjacent to the hemorrhage shows no alterations. There is no displacement of adjacent anatomical structures. A left parieto-occipital subgaleal hematoma was also identified, which did not associate with alterations in the underlying bone structures.

Case Discussion

Interhemispheric subdural hemorrhage, first described by Aring and Evans in 1940, is an uncommon subtype of subdural hemorrhage due to its location. Up to 1997, only 100 cases had been reported 1. It represents 6% of all subdural hemorrhages and 0.8% of diagnoses in patients hospitalized for traumatic brain injury 2. This type of hemorrhage is associated with trauma in 83% of cases 3. Interhemispheric subdural hemorrhages have also been reported in child abuse patients with shaking, labor dystocia using forceps, hemodialysis, anticoagulation, bleeding from aneurysms, and penetrating wounds. The trauma that generates this type of hemorrhage is generally of low speed and energy. The rupture of the veins that serve as a bridge in the interhemispheric fissure is postulated as the cause 4. Treatment depends on the severity of the injury, opting for surgical treatment in patients with symptoms and conservative treatment for asymptomatic ones 2.

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