Abstract
Pediatric chronic subdural hematoma (CSDH) is a relatively common disorder. Treatment often requires burr hole drainage or subduroperitoneal shunt placement; some patients are managed conservatively. However, the long-term outcome of untreated pediatric CSDH is unknown. The authors report a case of a huge, progressively enlarging subdural granuloma that was surgically treated 26 years after the initial diagnosis of CSDH. This 30-year-old male patient presented with worsening intermittent atonic seizure-like movements, which had been noted since he was 4 years old. At that time, the patient was diagnosed with CSDH at an outside hospital, but an operation was refused by the parents. Magnetic resonance imaging (MRI) performed at 23 years of age showed a huge subdural mass on the right frontoparietal region and a smaller mass on the left side with a significant midline shift. Upon presentation at the age of 30, MRI revealed worsening of the right subdural mass and midline shift. Subsequently, the patient underwent craniotomy and subtotal removal of the mass and capsule. The volume of the content was approximately 430 cc. Untreated pediatric CSDH can grow progressively, even over several decades. Patients with CSDH, especially those managed conservatively, should be closely monitored for worsening symptoms over a long-term follow-up period.
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References
D'Abbondanza JA, Loch Macdonald R (2014) Experimental models of chronic subdural hematoma. Neurol Res 36:176–188
Goyal PK, Singh D, Singh H, Dubey J, Tandon M (2013) Armoured brain of unknown etiology. Asian J Neurosurg 8:165
Hwang SK, Kim SL (2000) Infantile head injury, with special reference to the development of chronic subdural hematoma. Childs Nerv Syst 16:590–594
Ide M, Jimbo M, Yamamoto M, Umebara Y, Hagiwara S (1993) Asymptomatic calcified chronic subdural hematoma—report of three cases. Neurol Med Chir (Tokyo) 33:559–563
Imaizumi S, Onuma T, Kameyama M, Naganuma H (2001) Organized chronic subdural hematoma requiring craniotomy—five case reports. Neurol Med Chir (Tokyo) 41:19–24
Kwak YS, Hwang SK, Park SH, Park JY (2013) Chronic subdural hematoma associated with the middle fossa arachnoid cyst: pathogenesis and review of its management. Childs Nerv Syst 29:77–82
Mori N, Nagao T, Nakahara A, Izawa M, Amano K, Kitamura K (1982) A case of huge calcified chronic subdural hematoma. No Shinkei Geka 10:1203–1209
Papanikolaou PG, Paleologos TS, Triantafyllou TM, Chatzidakis EM (2008) Shunt revision after 33 years in a patient with bilateral calcified chronic subdural hematomas. Case illustration. J Neurosurg 108:401
Petraglia AL, Moravan MJ, Jahromi BS (2011) Armored brain: a case report and review of the literature. Surg Neurol Int 2:120. doi. https://doi.org/10.4103/2152-7806.84391
Shimizu Y, Nagamine Y, Onuma T (1988) Calcified chronic subdural hematoma in a young child. Neurol Med Chir (Tokyo) 28:190–194
Taha MM (2012) Armored brain in patients with hydrocephalus after shunt surgery: review of the literatures. Turk Neurosurg 22:407–410
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Yoon, SY., Park, K., Park, SH. et al. Progressively enlarging childhood chronic subdural hematoma surgically treated 26 years after diagnosis. Childs Nerv Syst 35, 2431–2434 (2019). https://doi.org/10.1007/s00381-019-04350-6
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DOI: https://doi.org/10.1007/s00381-019-04350-6