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Subdural hematomas and isolated transient aphasia
1Internal Medicine Dept., Memorial Health University Medical Center, PO Box 23089, Savannah, GA 31403-3089, USA.
Insights
Chronic subdural hematoma (CSDH) often affects older adults with subtle symptoms like intermittent aphasia. Early diagnosis of this insidious condition is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Neurology
- Neurosurgery
Background:
- Chronic subdural hematoma (CSDH) is a common condition in elderly patients.
- CSDH often presents with atypical and insidious neurological manifestations, making diagnosis challenging.
Purpose of the Study:
- To highlight the diverse and unusual presentations of CSDH.
- To emphasize the importance of a high index of suspicion for early diagnosis and management.
Main Methods:
- Case report of a CSDH patient presenting with isolated intermittent aphasia.
- Review of literature on CSDH clinical presentations.
Main Results:
- The patient's CSDH manifested solely as intermittent aphasia, without other neurological deficits.
- CSDH typically involves insidious onset with symptoms such as headache, altered mental status, or hemiparesis.
Conclusions:
- CSDH can present with highly unusual symptoms like isolated aphasia, necessitating a broad differential diagnosis.
- Prompt diagnosis and treatment of CSDH are vital to prevent significant morbidity and mortality.
Abstract:
Chronic subdural hematoma (CSDH) is particularly common in the older patient. Chronic subdural hematoma can present with atypical, and sometimes unusual, manifestations. It has an insidious onset and can, at times, be very difficult to diagnose. The most frequent presenting symptoms are headache, changes in mental status, and hemiparesis. Chronic subdural hematoma might also present as a transient ischemic attack. Here we report a case of CSDH that presented with intermittent aphasia and no other neurological deficit. Chronic subdural hematoma usually begins with a hemorrhage into the subdural space, which then becomes encapsulated by a membrane with abundant abnormal vessels in the outer portion of the membrane. Chronic subdural hematoma is a distinct and interesting clinical entity with diverse and insidious onset. A high index of suspicions is needed to make the early diagnosis and to start appropriate treatment to avoid morbidity and mortality.