Delayed brain reexpansion in schizophrenic patient affected by trabecular type chronic subdural hematoma

Chronic subdural hematoma (cSDH) represents a complex and unpredictable disease, characterized by high morbidity and mortality, especially in elderly patients. Factors affecting the postoperative brain reexpansion along to cSDH recurrence have not been yet adequately investigated. The authors presented the case of a schizophrenic patient affected by trabecular type cSDH that presented a delayed brain reexpansion despite a craniotomy and membranotomy.

A 51-year-old female patient with diagnosis of schizophrenia was admitted to the emergency department with GCS score of 5/15 and right anisocoria. An urgent brain CT revealed a trabecular right cSDH (35 mm in maximum diameter) with recent bleeding. After surgery, a brain CT scan showed a markedly reduced brain reexpansion and pneumocephalus. Nevertheless, postoperative 7-day brain CT documented a progressive brain reexpansion with reduced midline shift.

According to our opinion, anatomopathological alterations in schizophrenia reduce normal brain compliance and increasing elastance, thus modifying the normal timing of reexpansion after cSDH drainage, also after craniotomy and membranotomy. Although postoperative pneumocephalus is a well-known cause of hindered reexpansion, this could be due to anatomical alterations in schizophrenia. Such factors must be considered in the preoperative planning but mostly in the postoperative management.