Cortical Spreading Depolarization in Chronic Subdural Hematoma: Bridging the Gap

Area of Science:

• Neuroscience
• Neurology
• Pathophysiology

Background:

• Cortical spreading depolarization (CSD) is a known cause of transient neurological symptoms (TNS) across various conditions.
• CSD is underrecognized in clinical practice, with limited literature specifically linking it to subdural hematoma (SDH).
• Transient neurological symptoms in SDH patients are often misattributed to seizures despite atypical presentations.

Purpose of the Study:

• To review the current literature on the pathophysiology of CSD.
• To focus on recent research concerning CSD in the context of subdural hematoma.
• To explore the potential role of CSD in Non-Epileptical Stereotypical Intermittent Symptoms (NESIS) associated with SDH.

Main Methods:

• Literature review of scientific articles and recent research.
• Analysis of existing data on CSD and its relation to neurological symptoms.
• Examination of the proposed pathophysiology of NESIS in SDH patients.

Main Results:

• Recent literature suggests a significant portion of TNS in SDH patients may be manifestations of CSD.
• The term Non-Epileptical Stereotypical Intermittent Symptoms (NESIS) has been proposed for TNS in SDH, potentially linked to CSD.
• Evidence indicates CSD pathophysiology may underlie NESIS.

Conclusions:

• CSD is a likely cause of TNS in subdural hematoma patients, often misdiagnosed as seizures.
• Understanding CSD in SDH has potential diagnostic, therapeutic, and prognostic implications.
• Further research is needed to fully elucidate the role of CSD in SDH and NESIS.