Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. May 6, 2022; 10(13): 4288-4293
Published online May 6, 2022. doi: 10.12998/wjcc.v10.i13.4288
Enigmatic rapid organization of subdural hematoma in a patient with epilepsy: A case report
Hong-Tao Lv, Lin-Yun Zhang, Xiao-Tong Wang
Hong-Tao Lv, Lin-Yun Zhang, Xiao-Tong Wang, Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116000, Liaoning Province, China
Author contributions: Lv HT contributed to manuscript drafting and literature research; Zhang LY provided important intellectual content to the manuscript and processed the figures; Wang XT contributed to manuscript drafting and reviewed the literature; all authors issued final approval for the version to be submitted and participated in the surgical procedure as neurosurgeons.
Informed consent statement: Informed written consent was obtained from the patient’ husband for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Tong Wang, MD, Chief Doctor, Neurosurgeon, Research Fellow, Department of Neurosurgery, The First Affiliated Hospital of Dalian Medical University, No. 222 Zhongshan Road, Dalian 116000, Liaoning Province, China. evis@live.cn
Received: November 18, 2021
Peer-review started: November 18, 2021
First decision: December 27, 2021
Revised: December 31, 2021
Accepted: March 6, 2022
Article in press: March 6, 2022
Published online: May 6, 2022
Abstract
BACKGROUND

Determining a subdural hematoma (SDH) to be chronic by definition takes 3 wk, whereas organized chronic SDH (OCSDH) is an unusual condition that is believed to form over a much longer period of time, which generally demands large craniotomy. Therefore, it is a lengthy process from the initial head trauma, if any, to the formation of an OCSDH. Acute SDH (ASDH) with organization-like, membranaceous appearances has never been reported.

CASE SUMMARY

A 56-year-old woman presented to our hospital with a seizure, and computed tomography (CT) on admission was negative for signs of intracranial hemorrhage. She had clear consciousness and unimpaired motor functions on arrival and remained stable for the following week, during which she underwent necessary examinations. On the morning of day 10 of hospitalization, she accidentally hit her head hard against the wall in the bathroom and promptly lapsed into complete coma within 2 h. Therefore, we performed emergency CT and identified a left supratentorial SDH that was an absolute indication for surgery. However, the intraoperative findings were surprising, with no liquefaction observed. Instead, a solid hematoma covered with a thick membrane was noted that strongly resembled an organized hematoma. Evacuation was successful, but the family stopped treatment the next day due to financial problems, and the patient soon died.

CONCLUSION

Neurosurgeons should address SDHs, especially ASDHs, with discretion and individualization due to their highly diversified features.

Keywords: Organized chronic subdural hematoma, Acute subdural hematoma, Subacute subdural hematoma, Craniotomy, Encapsulation, Case report

Core Tip: Through unknown mechanisms, a minority of chronic subdural hematomas (SDHs) tend to be organized in the end with the prerequisite of being chronic. It takes a long time to form encapsulating membranes, as was traditionally thought. We report a rare case of enigmatic rapid encapsulation of an acute SDH, which, according to the definition, cannot be considered organized. Such a rapid formation of thick membranes around an acute SDH is rare and will certainly make the procedure, if needed, unpredictable. We may also need to review the natural history of SDH.