ORIGINAL
Introdução: Hematoma subdural crônico (HSDC) é uma doença comum na pratica neurocirúrgica e em especial em idosos. Geralmente ocorre após um trauma craniano leve. Sua ocorrência é unilateral na maioria dos casos, entre 3,5% a 25% dos casos é bilateral. Objetivo: Analisar sexo, idade, fator de predisposição, quadro clínico, achados de imagem, tratamento e complicações em prognóstico de HSDC bilateral. Métodos: Trata-se de uma série retrospectiva de 26 casos de HSDC bilateral, estudados no serviço de neurocirurgia do Hospital de Urgência (Aracaju-Sergipe), durante o período de janeiro de 2009 a dezembro de 2012. Resultados: Predomínio do sexo masculino e a média das idades foi de 72 anos. Traumatismo craniano ocorreu em 50% dos casos. Tomografia computadorizada (TC) foi realizada em todos casos. Todos pacientes foram submetidos a procedimento cirúrgico. Houve oito complicações e cinco óbitos. Conclusão: O HSDC bilateral ocorre em idosos com história prévia de trauma craniano. Tem sido considerado uma emergência cirúrgica. O prognóstico é péssimo em relação ao HSDC unilateral.
Introduction: Chronic subdural hematoma (CSDH) is a common disease in neurosurgical practice and especially in the elderly. It usually occurs after mild head trauma. Its occurrence is unilateral in most cases; between 3.5% to 25% of cases are bilateral. Objective: To analyze sex, age, predisposing factors, clinical picture, imaging findings, treatment and complications in prognosis of bilateral CSHD. Methods: This is a retrospective series of 26 cases of bilateral CSDH, studied in the neurosurgery service of the Hospital de Urgência (Aracaju-Sergipe, Brazil), from January 2009 to December 2012. Results: Predominance of males; average age of 72 years. Head trauma occurred in 50% of cases. Computed tomography (CT) was performed in all cases. All patients underwent a surgical procedure. There were eight complications and five deaths. Conclusion: Bilateral HSDC occurs in the elderly with a previous history of head trauma. It has been considered a surgical emergency. The prognosis is poor in relation to unilateral HSDC.
Med. 2006;99(2):91-2. http://doi.org/10.1177/014107680609900223. PMid:16449784.
3. Hima-Maiga A, Sakho Y, Ndoye N, et al. Les hematomes sous-duraux chronique bilateraux, à propôs de 20 cas. Mali Med. 2012;XXVII(2):29-33. PMid:30049077.
4. Min X, Bo Y, Cunzu W, et al. Minimally invasive approach in bilateral chronic subdural hematomas: surgical selection and outcome in 74 cases. Turk Neurosurg. 2017;27(3):380-5. PMid:27593800.
5. Lee J, Park JH. Clinical characteristic of bilateral versus unilateral chronic subdural hematoma. Korean J Neurotrauma. 2014;10(2):49-54. http://doi.org/10.13004/kjnt.2014.10.2.49. PMid:27169033.
6. Hsieh CT, Su JC, Hsu SK, Huang CT, Lian FI, Chang CI. Chronic subdural hematoma difference between unilateral and bilateral occurence. J Clin Neurosci. 2016;34:252-8. http://doi.org/10.1016/j.jocn.2016.09.015. PMid:27742369.
7. Robinson RG. Chronic subdural hematoma: surgical management in 133 patients. J Neurosurg. 1984;61(2):263-8. http://doi.org/10.3171/ jns.1984.61.2.0263. PMid:6737050.
8. Choudhury AR. Avoidable factors that contribute to complications in the surgical treatment of chronic subdural hematoma. Acta Neurochir. 1994;129(1-2):15-9. http://doi.org/10.1007/BF01400867. PMid:7998490.
9. Agawa Y, Mineharu Y, Tani S, Adachi H, Imamura H, Sakai N. Bilateral chronic subdural hematoma is associated with rapid progression and poor clinical outcome. Neurol Med Chir. 2016;56(4):198-203. http:// doi.org/10.2176/nmc.oa.2015-0256. PMid:26923835.
10. Penchet G, Loiseau H, Castel JP. Chronic bilateral subdural hematoma. Neurochirurgie. 1998;44(4):247-52. PMid:9864695.
11. De Jesús O, Pacheco H, Negron B. Chronic and subacute subdural hematoma in the adult population. The Puerto Rico experience. P R Health Sci J. 1998;17(3):227-33. PMid:9883468.
12. Huang YH, Yang KY, Lee TC, Liao CC. Bilateral chronic subdural hematoma: what is the clinical significance. Int J Surg. 2013;11(7):5448. http://doi.org/10.1016/j.ijsu.2013.05.007. PMid:23707986.
13. Mersha A, Abat S, Temesgen T, Nebyon A. Outcome of chronic subdural hematoma treated with single burr hole under local anestesia. Ethiop J Health Sci. 2020;30(1):101-6. http://doi.org/10.4314/EJHS. v30il.13. PMid:32116438.
14. Yang AIL, Balser OS, Mikheev A, et al. Cerebral atrophy is associated with development of chronic subdural hematoma. Brain Inj. 2012;26(13-14):1731-6. http://doi.org/10.3109/02699052.2012.698364. PMid:22759238.
15. Kotwica Z, Saracen A, Dziuba I. Chronic subdural hematoma is still na importante clinical problem. Analysis of 700 consecutive patients. Transl Neurosci. 2019;10(1):260-3. http://doi.org/10.1515/ tnsci-2019-0042. PMid:31737353.
16. Liu W, Bakker NA, Groen RJ. Chronic subdural hematoma: a systematic review and meta-analysis of surgical procedures. J Neurosurg. 2014;121(3):665-73. http://doi.org/10.3171/2014.5.JNS132715.
PMid:24995782.
17. Kawamata T, Takeshita M, Kubo O, Izawa M, Kagawa M, Takakura K. Management of intracranial hemorrhage associated with anticoagulante therapy. Surg Neurol. 1995;44(5):438-42. http:// doi.org/10.1016/0090-3019(95)00249-9. PMid:8629228.
18. Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural hematoma in the elderly. Postgrad Med J. 2002;78(916):71-5. http://doi.org/10.1136/pmj.78.916.71. PMid:11807186.
19. Tsai TH, Lieu AS, Hwang SL, Huang TY, Hwang YF. A comparative study of the patients with bilateral or unilateral chronic subdural hematoma: precipitanting factors and posoperative outcomes. J Trauma. 2010;68(3):571-5. http://doi.org/10.1097/TA.0b013e3181a5f31c. PMid:20065879.
20. Srimanee D, Pasutharnchat N, Phanthumchinda K. Bilateral subdural hematoma and hearing disturbances caused by spontaneous intracranial hypotension. J Med Assoc Thai. 2009;92(11):1538-43. PMid:19938748.
21. Chotai S, Kim JH, Kim JP, Kwon TH. Brain herniation induced by drainage of subdural hematoma in spontaneuos intracranyal hypotension. Asian J Neurosurg. 2013;8(2):112-5. http://doi.org/10.4103/17935482.116390. PMid:24049555.
22. Chen HH, Huang CI, Hseu SS, Lirng JF. Bilateral subdural hematomas caused by spontaneous intracranial hypotension. J Chin Med Assoc. 2008;71(3):147-51. http://doi.org/10.1016/S1726-4901(08)70007-8. PMid:18364267.
23. Ahmed SV, Bonny S, Chandra S. “Idiopathic” chronic bilateral subdural hematoma: a separate entity or a missed cause? BMJ Case Rep. 2011;2011:bcr0920114771. http://doi.org/10.1136/bcr.09.2011.4771. PMid:22674597.
24. Takemoto Y, Matsumoto J, Ohta K, Hasegawa S, Miura M, Kuratsu JJ. Bilateral posterior fossa chronic subdural hematoma treated with craniectomy. Case report. Surg Neurol Int. 2016;7(11, Suppl 10):S255-8. http://doi.org/10.4103/2152-7806.181979. PMid:27213111.
25. Stendel R, Schulte P, Pietilä TA, Suess O, Brock M. Spontaneous bilateral chronic subdural hematoma of the posterior fossa. Case report and review of the literatrure. Acta Neurochir. 2002;144(5):497-500. http://doi.org/10.1007/s007010200072. PMid:12111507.
26. Mori K, Maeda H. Surgical treatment of chronic subdural hematoma in 500 consecutive cases. Clinical characteristics, surgical outcome, complications, and recurrence rate. Neurol Med Chir. 2001;41(8):37181. http://doi.org/10.2176/nmc.41.371. PMid:11561347.
27. Herath HMMTB, Matthias AT, Kulatinga A. Acute on chronic bilateral subdural hematoma presenting with acute complete flaccid paraplegia and urinary retention mimicking an acute spinal cord injury: a case report. BMC Res Notes. 2017;10(1):627. http://doi.org/10.1186/ s13104-017-2969-y. PMid:29183359.
28. Okudera H, Saito J, Matsuo T. A case of divergence palsy associated with bilateral chronic subdural hematoma. No To Shinkei. 1991;43(2):183-6. PMid:1873087.
29. Matsuda R, Hironaka Y, Kawai H, Park YS, Taoka T, Nakase H. Unilateral oculomotor nerve palsy as an initial presentation of bilateral chronic subdural hematoma. Case report. Neurol Med Chir. 2013;53(9):616-9. http://doi.org/10.2176/nmc.cr2012-0339. PMid:24067774.
30. Phookan G, Cameron M. Bilateral chronic subdural hematoma: an unusual presentation with isolated oculomotor nerve palsy. J Neurol Neurosurg Psychiatry. 1994;57(9):1146. http://doi.org/10.1136/ jnnp.57.9.1146. PMid:8089699.
31. Nagatomo J, Ueyama K, Fukuzako H, Matsumoto K. Three cases of chronic subdural hematoma with depressive state. Jpn J Psychiatry Neurol. 1990;44(4):703-7. http://doi.org/10.1111/j.1440-1819.1990. tb01647.x. PMid:2096240.
32. Suman S, Meenakshisundaram S, Woodhouse P. Bilateral chronic subdural hematoma: a reversible cause of parkisonism. J R Soc Med. 2006;99(2):91-2. http://doi.org/10.1177/014107680609900223. PMid:16449784.
33. Tokuno T, Sato S, Kawakami Y, Yamamoto T. Bilateral chronic subdural hematoma presented with subarachnoid hemorrhage: reporto f two cases. No Shinkei Geka. 1996;24(6):573-6. PMid:8677008.
34. Rabinstein AA, Pittock SJ, Miller GM, Schindler JJ, Wijdicks EFM. Pseudosubarachnoid haemorrhage in subdural hematoma. J Neurol Neurosurg Psychiatry. 2003;74(8):1131-2. http://doi.org/10.1136/ jnnp.74.8.1131. PMid:12876252.
35. Schaller B, Radziwill AJ, Wasner M, Gratzl O, Stick AJ. Intermitent paraparesis as manifestations of a bilateral chronic subdural hematoma. Schweiz Med Wochenschr. 1999;129(29-30):1067-72. PMid:10464909.
36. Sangondimath G, Chhabra HS, Venkatesh R, Nanda A, Tandon V. A rare case of chronic subdural hematoma presenting with paraparesis: a case report and review of literature. J Clin Orthop Trauma. 2015;6(4):2658. http://doi.org/10.1016/j.jcot.2015.05.005. PMid:26566341.
37. Agrawal A. Bilateral biconvex frontal chronic subdural hematoma mimicking extradural hematoma. J Surg Tech Case Rep. 2010;2(2):90-1. http://doi.org/10.4103/2006-8808.73625. PMid:22091345.
38. Marcu H, Becker H. Computed-tomography of bilateral isodense chronic subdural hematoma. Neuroradiology. 1977;14(2):81-3. http:// doi.org/10.1007/BF00339964. PMid:909632.
39. Yadav YR, Parihar V, Namdev H, Bajaj J. Chronic subdural hematoma. Asian J Neurosurg. 2016;11(4):330-42. http://doi.org/10.4103/17935482.145102. PMid:27695533.
40. Hosoda K, Tamaki N, Masumura M, Matsumoto S, Maeda F. Magnetic resonance images of chronic subdural hematoma. J Neurosurg. 1987;67(5):677-83. http://doi.org/10.3171/jns.1987.67.5.0677. PMid:3668635.
41. Kurokawa Y, Ishizaki E, Inaba K. Bilateral chronic subdural hematoma cases showing rapid and progression aggravation. Surg Neurol. 2005;64(5):444-9. http://doi.org/10.1016/j.surneu.2004.12.030. PMid:16253697.
42. Camel M, Grubb RL Jr. Treatment of chronic subdural hematoma by twist-drill craniotomy with continuous catheter drainage. J Neurosurg. 1986;65(2):183-7. http://doi.org/10.3171/jns.1986.65.2.0183. PMid:3723175.
43. Markwalder JM, Seiler RW. Chronic subdural hematoma: to drain or not drain? Neurosurgery. 1985;16(2):185-8. http:// doi.org/10.1227/00006123-198502000-00010. PMid:3974829.
44. Hamilton MG, Frizzell JB, Tranmer B. Chronic subdural hematoma: the role for craniotomy reevaluated. Neurosurgery. 1993;33(1):67-72. http://doi.org/10.1227/00006123-19930700000010. PMid:8355849.
45. Rodziewicz GS, Chuang WC. Endoscopic removal of organized chronic subdural hematoma. Surg Neurol. 1995;43(6):569-72. http:// doi.org/10.1016/0090-3019(95)00005-4. PMid:7482236.
46. Yilmaz H, Bayali O, Atci IB, Kocaman U. Spontaneous resolution of post-traumatic chronic subdural hematoma. Case report. Pan Afr Med J. 2017;28:167. http://doi.org/10.11604/pamj.2017.28.167.13944. PMid:29541313.
47. Baldawa SS, Nayak N. Spontaneous resolution of bilateral chronic subdural hematoma. Turk Neurosurg. 2015;25(5):835-6. PMid:26442560.
48. Plaha P, Malhotra NR, Hener GG, Whitfield P. Management of chronic subdural hematoma. ACNR. 2008;8(1):12-5.
49. Lee SC, Kang JK, Jung HT, Dho JO. Factors affecting brain reexpansion after simple burr hole drainage in chronic subdural hematoma. J Korean Neurosurg Soc. 1998;27:757-62.
50. Chon KH, Lee JM, Koh EJ, Choi HY. Independent predictors for recurrence of chronic subdural hematoma. Acta Neurochir. 2012;154(9):1541-8. http://doi.org/10.1007/s00701-012-1399-9. PMid:22653496.
51. Leroy HA, Aboukais R, Reyns N, et al. Predictors of functional outcomes and recurrence of chronic subduralhematomas. J Clin Neurosci. 2015;22(12):1895-900. http://doi.org/10.1016/j.jocn.2015.03.064. PMid:26260114.
52. Rust T, Kiemer N, Erasmus A. Chronic subdural hematomas and anticoagulation or anti-thrombotic therapy. J Clin Neurosci. 2006;13(8):823-7. http://doi.org/10.1016/j.jocn.2004.12.013. PMid:16997707.
53. Andersen-Ranberg NC, Poulsen FR, Bergholt B, Hundsholt T, Fugleholm K. Bilateral chronic subdural hematoma: unilateral or bilateral drainage? J Neurosurg. 2017;126(6):1905-11. http:// doi.org/10.3171/2016.4.JNS152642. PMid:27392267.
54. Park KJ, Kang SH, Lee HK, Chung YG. Brain stem hemorrhage following burr hole drainage in chronic subdural hematoma. Case report. Neurol Med Chir. 2009;49(12):594-7. http://doi.org/10.2176/ nmc.49.594. PMid:20035135.
55. Okuchi K, Fujioka M, Maeda Y, Kagoshima T, Sakaki T. Bilateral chronic subdural hematoma resulting in unilateral oculomotor nerve paresis and brain stem symptoms after operation. Case report. Neurol Med Chir. 1999;39(5):367-71. http://doi.org/10.2176/nmc.39.367. PMid:10481440.
56. Jaiswal M, Gandhi A, Purohit D, Mittal RS. Tiger hide appearance: impaction and prolapse of brain parenchyma through burr holes after evacuation of bilateral chronic subdural hematoma. A case rare report. Asian J Neurosurg. 2016;11(3):321. http://doi.org/10.4103/17935482.145094. PMid:27366284.
57. Weigel R, Schmiedek P, Krauss JK. Outcome of contemporary surgery for chronic subdural hematoma: evidence based review. J Neurol Neurosurg Psychiatry. 2003;74(7):937-43. http://doi.org/10.1136/ jnnp.74.7.937. PMid:12810784.
1Neurosurgery Service, Hospital Governador João Alves Filho, Aracaju, SE, Brazil.
2Universidade Tiradentes, Aracaju, SE, Brazil.
3Associação Brasileira de Enfermagem em Neurologia e Neurocirurgia (ABENEURO), Aracaju, SE, Brazil.
Received Feb 24, 2025
Accepted Mar 17, 2025
