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Calcified chronic subdural hematoma with intracerebral rupture forming a subcortical hematoma. A case report
T Hirakawa1, A Tanaka, S Yoshinaga
1Department of Neurosurgery, Chikushi Hospital, Fukuoka, Japan.
Insights
A calcified chronic subdural hematoma ruptured into the brain, forming an acute subcortical hematoma. This rare event in a patient with liver cirrhosis suggests bleeding into granulation tissue caused the intracerebral hemorrhage.
Area of Science:
- Neurology
- Neurosurgery
- Hepatology
Background:
- Chronic subdural hematomas (CSDH) are collections of blood that can develop slowly.
- Liver cirrhosis is a risk factor for bleeding disorders.
Observation:
- A calcified CSDH was observed to have ruptured intracerebrally.
- The rupture formed an acute subcortical hematoma in the frontal lobe.
- Communication between the CSDH and subcortical hematoma was noted through a defect in the CSDH membrane.
Findings:
- Both hematomas contained identical clay-like clot material.
- The inner membrane of the CSDH was thick, vascular granulation tissue with hemosiderin deposits.
- Fresh bleeding into this granulation tissue likely caused the intracerebral rupture.
Implications:
- This case highlights an unusual mechanism for intracerebral hemorrhage originating from a CSDH.
- Disseminated intravascular coagulation may play a role in such complex bleeding events.
- Understanding this pathway is crucial for managing patients with CSDH and coagulopathy.
Abstract:
We report a calcified chronic subdural hematoma which ruptured intracerebrally forming an acute subcortical hematoma in the frontal lobe in a 59-year-old woman with long-standing liver cirrhosis. Both hematoma cavities communicated each other through a small defect within the inner membrane of the subdural hematoma. The content of both hematomas was identical and was of a clay-like clot. The inner membrane around this communication consisted of thick, very vascular granulation tissue with many hemosiderin deposits and was tightly adherent to the cortex. We speculated that a fresh bleeding into the granulation tissue resulted in formation of a subcortical hematoma through a rupture of the inner membrane. Disseminated intravascular coagulation likely played an important role in this unusual condition.