Clinical presentation of chronic subdural hematoma in adults
A big simulator
Abstract
Background: chronic subdural hematoma (CSDH-HSDC) is a relatively common disease in adults older than 60 years. The classic clinical presentation is a progressive focal neurologic syndrome with signs and symptoms of endocranial hypertension in patients that usually offer history of cranial traumatism (CT-TEC) of at least two or three weeks prior to consulting. However there are many forms of presentation of CSDH that difficult diagnosis.
Methods: in this study we analyzed clinical aspects of 63 patients carriers of CSDH at the Tacuarembó Hospital during 59 months.
Results: Patients were 30 to 88 years old, 73% were men. Cranial traumatism was present in 67% of the patients. The most frequent form of presentation was a progressive focal deficit or endocranial hypertension. In two cases deficit was sudden, simulating stroke. Three patients whose traumatic antecedents were not collected showed an tumoral expansive process. Eleven patients showed initial symptoms corresponding to neuropsychologic sphere simulating dementia. Haemorragic cerebrovascular or ischemic attack was diagnosed in 18 patients who showed depression in vigil (sudden in 5 patients).
The main symptom for 6 patients was permanent cefalea with no other signs or symptoms.
Conclusions: CSDH presentations have different ‘clinic masks’ that simulates tumoral expansive process, haemorragic cerebrovascular or ischemic attack or dementias. Suspicion of this disease in adults older than 60 years with a progressive and insidious presentation, even in absence of cranial traumatism, should be high.
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