Health Performance Centre, University of Guelph, Guelph, Ontario, Canada; Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada.
World Neurosurg. 2013 Nov;80(5):654.e9-11. doi: 10.1016/j.wneu.2012.11.065. Epub 2012 Nov 24.
Chronic subdural hematoma is a common presentation to the neurosurgical practice that tends to occur among the elderly.
We identify a rare occurrence of a chronic subdural hematoma in a young and otherwise healthy female patient who denied a traumatic brain injury.
Upon reviewing the literature, we found only one reported case of a spontaneous nature in a young patient. The subtle presentation of headaches and absence of neurological deficit could be mistaken as migraine and result in a delay in obtaining imaging and necessary treatment. In this report, we present a 22-year-old patient who complained of persistent headaches and was neurologically intact on examination. Cranial computed tomography revealed the presence of a right-sided chronic subdural hematoma; this was followed by magnetic resonance imaging plus angiogram, which ruled out the presence of a vascular abnormality. A burr-hole craniostomy procedure was used that resulted in resolution of symptoms.
Without a heightened clinical suspicion, a similar presentation could be missed, resulting in delayed management.
慢性硬脑膜下血肿是神经外科常见的病症，多发生于老年人。
我们发现一例罕见的年轻且无其他健康问题的女性慢性硬脑膜下血肿患者否认有颅脑外伤史。
通过查阅文献，我们仅发现一例年轻患者自发性慢性硬脑膜下血肿的报道。头痛的隐匿性表现和无神经功能缺损可能被误诊为偏头痛，导致影像学检查和必要治疗的延误。在本报告中，我们介绍了一位 22 岁的患者，她主诉持续性头痛，神经系统检查完整。头颅 CT 显示右侧慢性硬脑膜下血肿；随后进行磁共振成像加血管造影，排除了血管异常的存在。采用颅骨钻孔引流术，症状得到缓解。
如果没有高度的临床怀疑，类似的表现可能会被忽视，导致治疗延误。
