Dymecki J, Ostrowska D
Neurol Neurochir Pol. 1976 Jul-Aug;10(4):497-506.
The authors report clinical and morphological analysis of 31 autopsied cases of subdural haematomas unrecognized during life. The most frequent erroneous clinical diagnosis was cerebrovascular brain disease, psychiatric syndrome or brain tumour. The greatest diagnostic difficulties were encountered in cases of subdural haematoma developing in elderly subjects (in this material 24 patients were aged above 60 years). Brain atrophy delayed in them the appearance of intracranial raised pressure syndrome, coexistence of vascular changes masked the signs of subdural haematoma and frequent memory disturbances made history taking difficult. Brain atrophy in elderly subjects may be also a factor contributing to development of subdural haematoma. Widening of subdural space causes greater tension of bridging veins and their easier rupture when the brain is displaced during trauma. Absence of inflammatory changes in the neuropathological findings in cases of subdural haemorrhage suggests that the term "chronic subdural haematoma" is better than the older term "pachymeningitis haemorrhagic interna".
作者报告了31例生前未被识别的硬膜下血肿尸检病例的临床和形态学分析。最常见的错误临床诊断是脑血管性脑病、精神综合征或脑肿瘤。在老年患者发生硬膜下血肿的病例中遇到了最大的诊断困难（在该材料中，24例患者年龄在60岁以上）。脑萎缩使他们颅内压升高综合征的出现延迟，血管变化的共存掩盖了硬膜下血肿的体征，频繁的记忆障碍使病史采集变得困难。老年患者的脑萎缩也可能是导致硬膜下血肿发生的一个因素。硬膜下间隙增宽会使桥静脉张力增大，在创伤时脑移位时更容易破裂。硬膜下出血病例的神经病理学检查结果中无炎症变化表明，“慢性硬膜下血肿”这一术语比旧术语“硬脑膜内出血性硬脑膜炎”更好。
