Lacunar Infarction Caused by Chronic Subdural Hematoma

Area of Science:

• Neurology
• Radiology
• Neurosurgery

Background:

• Chronic subdural hematoma (CSDH) typically resolves with surgery, but some patients experience poor motor recovery.
• Investigating cerebral infarctions is crucial in CSDH patients with persistent hemiparesis post-surgery.

Observation:

• Among 284 CSDH patients with motor weakness, 82 underwent pre-operative MRI and MRA due to rapid hemiparesis progression.
• Small lacunar infarctions were found on the hematoma side in 5 elderly patients (all >80 years) with hypertension and/or diabetes.
• MRA revealed a characteristic shift of the middle cerebral artery (M1) in all 5 patients with lacunar infarction, compared to only 5.2% without infarction.

Findings:

• CSDH-associated lacunar infarctions may result from arterial distortion rather than typical risk factors like lipohyalinosis.
• These infarctions were small, associated with mild hemiparesis, and had a good prognosis with physical rehabilitation.
• Pre-operative MR imaging is recommended for CSDH patients presenting with sudden or rapidly worsening motor weakness.

Implications:

• Understanding the cause of lacunar infarction in CSDH can refine treatment strategies, potentially avoiding unnecessary anti-platelet therapy.
• Early detection via MRI/MRA can guide management and improve patient outcomes in complex CSDH cases.
• This study highlights the importance of neuroimaging in diagnosing specific causes of neurological deficits in CSDH patients.