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Lacunar Infarction Caused by Chronic Subdural Hematoma

Shoko Merrit Yamada1, Yusuke Tomita1, Yoshinori Takaya1

  • 1Department of Neurosurgery, Teikyo University Mizonokuchi Hospital.

Neurologia Medico-Chirurgica
|July 31, 2020
PubMed

Insights

Chronic subdural hematoma (CSDH) patients with rapid motor decline may have lacunar infarctions. Imaging can identify these, suggesting specific treatment approaches for better recovery.

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.

Keywords:
M1 portionchronic subdural hematomalacunar infarctionlenticulostriate arterymiddle cerebral artery

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