Spontaneous Chronic Subdural Hematoma in an Adolescent Girl
A previously healthy 14-year-old girl was admitted to our emergency room with a 2-week history of severe headache following blurring of vision, which resolved after a few minutes. She was a music student majoring in flute at middle school. There was no history of any trivial head injury. She had no previous history of anticoagulant therapy or hematological coagulopathy, and was in good health before this episode. On neurological examination, she was alert and fully oriented. No neurologic abnormalities were found in cranial nerves or the cerebellar system. Pupils were isocoric and reacted to light. However, a fundoscopic examination revealed bilateral papilledema on fundoscopic examination. A motor examination revealed slight hemiparesis (Grade IV+/Grade V) on the right side. The patient's coagulation profiles including platelet count, prothrombin time, and partial thromboplastin time were all within normal ranges. Brain computed tomography (CT) and magnetic resonance imaging (MRI) identified left-sided mixed density and high signal intensity suggesting chronic subdural hematoma (). She underwent burr hole evacuation of the chronic SDH; the evacuated hematoma had the typical dark appearance of chronic SDH with high pressure. She made an uneventful post-operative recovery (). Postoperative cerebral angiography was performed to exclude vascular risk factors for subdural hematoma, such as arteriovenous malformation, aneurysm and other vascular abnormality. However, angiographic findings were unremarkable. At her six-month follow-up, the symptoms had completely resolved. A follow-up MRI and MR angiography taken at 3 months after surgery was also unremarkable.