Feng Qingping Joseph, Long Ian James, Lim Su Lone, Sun Ira Siyang, Low Shiong Wen, Goh Chun Peng
MBBS, MRCS, Department of Neurosurgery, Division of Neurosurgery, Department of General Surgery Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore. E-mail:
MBBch BAO, Division of Neurosurgery, Department of General Surgery Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore.
Malays Fam Physician. 2025 Jul 12;20:45. doi: 10.51866/cr.776. eCollection 2025.
Delayed chronic subdural haematoma (cSDH) is a common but potentially serious complication following traumatic brain injury (TBI). Mild TBIs are commonly managed by primary care providers (PCPs), particularly in large, resource-limited settings such as Malaysia, where access to tertiary neurosurgical services may be delayed. Early identification of red-flag signs and symptoms and timely referrals are crucial to prevent clinical deterioration. We describe the case of a 66-year-old man who sustained mild head injury following a vasovagal syncope. His initial brain CT revealed evidence of a small traumatic subarachnoid haemorrhage over the left precentral sulcus, with resolution on an interval scan 24 hours later. He was discharged home without follow-up. Eleven weeks later, he developed bilateral lower-limb weakness and unsteady gait, which prompted an urgent referral by his general practitioner. Repeat CT revealed bilateral acute-on-chronic subdural haematomas, with mass effect requiring emergency burr-hole drainage. The patient showed excellent post-operative improvement and was discharged home on day 4, with no clinical or radiological recurrence on subsequent follow-up. This case highlights the risk of delayed cSDH in patients following mild TBI, even in those discharged with a normal CT scan. PCPs play a pivotal role in recognising high-risk patients, ensuring structured follow-up and facilitating timely specialist referral. We advocate for updating the Malaysian head injury guidelines to incorporate routine follow-up protocols for at-risk patients, modelled after international standards.
迟发性慢性硬膜下血肿（cSDH）是创伤性脑损伤（TBI）后常见但可能严重的并发症。轻度TBI通常由初级保健提供者（PCP）处理，特别是在马来西亚等大型资源有限的环境中，那里获得三级神经外科服务可能会延迟。早期识别警示体征和症状并及时转诊对于预防临床恶化至关重要。我们描述了一名66岁男性的病例，他在血管迷走性晕厥后遭受轻度头部损伤。他最初的脑部CT显示左中央前沟有少量创伤性蛛网膜下腔出血的证据，24小时后的间隔扫描显示出血已消退。他出院回家，没有进行随访。十一周后，他出现双侧下肢无力和步态不稳，这促使他的全科医生紧急转诊。重复CT显示双侧急性慢性硬膜下血肿，有占位效应，需要紧急钻孔引流。患者术后恢复良好，于第4天出院，后续随访未出现临床或影像学复发。该病例强调了轻度TBI患者发生迟发性cSDH的风险，即使是那些CT扫描正常出院的患者。初级保健提供者在识别高危患者、确保结构化随访和促进及时专科转诊方面发挥着关键作用。我们主张更新马来西亚头部损伤指南，纳入针对高危患者的常规随访方案，以国际标准为蓝本。
