He Sen, Xue Fang, Li Jing, Hao Jianqiang, Zhang Wenyan, Xie Fei
Department of Neurosurgery, The Ziyang Central Hospital, Ziyang, Sichuan, China.
Department of Pathology, The Ziyang Central Hospital, Ziyang, Sichuan, China.
Medicine (Baltimore). 2025 Jan 31;104(5):e41260. doi: 10.1097/MD.0000000000041260.
Organic chronic subdural hematoma is extremely rare in clinical practice, with unclear etiology and pathogenesis. Its clinical manifestations and treatment approaches are diverse, making diagnosis challenging and prone to misdiagnosis or mistreatment, adversely affecting patient care and quality of life.
The 58-year-old male patient exhibited cognitive impairment, characterized by memory deficits and delayed responses, over 1 month in the absence of notable medical comorbidities.
Initial neurological assessment upon admission showed cognitive deficits, with a Mini-Mental State Examination score of 18 and a Montreal Cognitive Assessment Scale score of 22. Imaging with a computed tomography scan revealed a subdural mass with low density. The preoperative diagnosis indicated a chronic subdural hematoma (may combined with intracranial hypertension) located at the apex of the right frontotemporal region, potentially with septation.
A bone flap craniotomy was proceeded under microscopic guidance for lesion resection. Postoperatively, the patient received targeted interventions, including fluid replacement, to promote brain tissue recovery and functional rehabilitation.
After treatment, the patient demonstrated improvement and was discharged from the hospital. Over the 1-year postoperative period, he reported mild recent memory decline but remained asymptomatic, continued his usual activities, and demonstrated improved cognitive function, as evidenced by Mini-Mental State Examination and Montreal Cognitive Assessment Scale scores of 28 and 29, respectively, along with normal muscle strength in all limbs.
Patients with mild or no significant symptoms, such as headaches and dizziness, are advised to undergo regular imaging follow-ups. Surgical intervention is recommended for patients presenting with intracranial hypertension and neurological impairment, with bone flap craniotomy and lesion resection under microscopic guidance being the preferred approach. It is imperative to conduct regular postoperative monitoring to promptly detect potential complications, such as hematoma recurrence.
在临床实践中，器质性慢性硬膜下血肿极为罕见，其病因和发病机制尚不明确。其临床表现和治疗方法多样，诊断具有挑战性，容易误诊或误治，对患者的治疗和生活质量产生不利影响。
这位58岁男性患者在无明显内科合并症的情况下，1个多月来出现认知障碍，表现为记忆缺陷和反应迟缓。
入院时的初步神经学评估显示存在认知缺陷，简易精神状态检查表评分为18分，蒙特利尔认知评估量表评分为22分。计算机断层扫描成像显示有一个低密度的硬膜下肿块。术前诊断为位于右额颞叶尖部的慢性硬膜下血肿（可能合并颅内高压），可能有分隔。
在显微镜引导下进行骨瓣开颅术以切除病变。术后，患者接受了针对性干预，包括补液，以促进脑组织恢复和功能康复。
治疗后，患者病情好转并出院。在术后1年期间，他报告近期有轻度记忆力下降，但仍无症状，继续其日常活动，并且认知功能有所改善，简易精神状态检查表和蒙特利尔认知评估量表评分分别为28分和29分，四肢肌力正常。
建议有轻度或无明显症状（如头痛和头晕）的患者定期进行影像学随访。对于出现颅内高压和神经功能损害的患者，建议进行手术干预，首选在显微镜引导下进行骨瓣开颅术和病变切除术。必须进行定期的术后监测，以便及时发现潜在并发症，如血肿复发。
