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Cerebral Hyperperfusion and Delayed Coma Recovery after Subdural Hematoma Evacuation
Ibrahim Migdady1, Patrick Chen1, Alejandra Márquez Loza1
1Department of Neurology, Brigham and Women's Hospital, Boston, MA; Department of Neurology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Summary
Delayed cerebral hyperperfusion can cause prolonged coma after acute subdural hematoma (SDH) evacuation. This condition may be reversible, highlighting the need for further investigation into this neurological complication.
Area of Science:
- Neurosurgery
- Neurology
- Radiology
Background:
- Acute subdural hematoma (SDH) is a severe brain injury associated with high mortality and morbidity.
- Large SDHs can cause brain compression, midline shift, and coma, necessitating emergent neurosurgical decompression.
- Persistent coma post-evacuation can stem from various factors, including midline shift, infarction, seizures, and metabolic/infectious causes.
Observation:
- An elderly patient remained comatose for weeks after SDH evacuation without a clear cause.
- Brain imaging revealed delayed cerebral hyperperfusion as a potential underlying etiology.
- Consciousness gradually improved, correlating with resolution of hyperperfusion on imaging.
Findings:
- Delayed cerebral hyperperfusion identified as a potential cause of unexplained persistent coma after SDH evacuation.
- The patient's neurological recovery coincided with the resolution of cerebral hyperperfusion.
- This case suggests cerebral hyperperfusion is a treatable cause of prolonged post-operative coma.
Implications:
- Cerebral hyperperfusion should be considered in the differential diagnosis of persistent coma following SDH evacuation.
- Further research is needed to understand the mechanisms and management of delayed cerebral hyperperfusion.
- Recognizing this entity may lead to improved patient outcomes and reduced long-term disability.
