Traumatic Chronic Subdural Hematoma: A Case Report in a Patient With Bilateral and Massive Compromise of the Frontal Lobes

TL;DR

A 24-year-old man with a rare traumatic chronic subdural hematoma and missing frontal lobes presented a complex diagnostic and treatment challenge.

Contribution

This case report highlights the diagnostic complexity of chronic subdural hematoma in patients with significant frontal lobe developmental alterations.

Findings

The patient had bilateral and massive compromise of the frontal lobes due to hemorrhagic arachnoid cysts.

Despite initial surgical drainage, rebleeding occurred, requiring further surgical intervention.

The case underscores the challenges in managing CSDH in the context of structural brain anomalies.

Abstract

Chronic subdural hematoma (CSDH) is a collection of blood in the subdural space that persists for more than three weeks. It is most commonly observed in the elderly, typically following mild to moderate cranial trauma; however, it is rare in young patients. We present the case of a 24-year-old male who presented mild cranial trauma secondary to a fall from his own height due to tonic-clonic seizures. Initially, he exhibited a transient loss of consciousness, followed by neurological improvement, with a Glasgow Coma Scale score of 15. Radiological imaging revealed extensive bilateral complicated arachnoid cysts (AC) in the frontal region, leading to craniotomy and drainage. Despite surgical intervention, follow-up imaging demonstrated rebleeding, necessitating further surgical reintervention. Surgical findings included bilateral CSDH secondary to hemorrhagic AC, as well as absence of the frontal lobes. This case represents an unprecedented source of insight into the diagnostic challenge posed by CSDH in the presence of significant developmental alterations of the frontal lobes, adding complexity to management due to potential cognitive and neurological implications.

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