Chronic Subdural Hematoma after Eccentric Exercise Using a Vibrating Belt Machine
A 75-year-old man presented with a headache and intermittent left side numbness from 10 days ago. He had suffered from hypertension, diabetes mellitus, renal insufficiency and gout. On admission, he was in a relatively normal status without any significant neurological deficit. We suspected transient ischemic stroke, so we performed magnetic resonance imaging (MRI). On MRI, the T1-weighted IR images revealed bilateral subdural isointense collections (). On T2-weighted SE and T2-FLAIR images, bilateral subdural collections showed hypointensity (). We also performed gradient-echo T2-weighted MR imaging. The image of the right side collection was more prominently hypointense than the left side (). Bilateral hematomas were appeared as homogeneous lesion without multilayered or lobulated structure. Besides, arachnoid cyst was appeared on left temporal pole ().\nWe also obtained computed tomographic (CT) scans. The CT scan revealed thick crescent homogeneous isodensity lesions in both fronto-temporo-parietal regions without midline shift ().\nBased on the CT and MR findings, we could diagnose as bilateral CSDH. We tried to obtain any trauma history in detail again. However, the patient did not have even a minor trauma, except for using a vibration belt massage to his own head for 20 days.\nHe was treated by burr-holes in the both parietal regions. We could identify the subdural neomembrane on both sides. Dark red fluid was evacuated from both sides. We kept silastic drainage tubes for 24 hours, which were removed on the next day. Postoperatively, CT scan revealed removal of CSDH with subdural air. We could find an arachnoid cyst (AC) on the left temporal pole which was unnoticed on the preoperative CT scan ().\nThe patient discharged to home after release of symptoms. Follow-up CT scans obtained 2 months after surgery, revealed an asymptomatic recurred CSDH on the left fronto-temporo-parietal region (). An AC was remained on the left temporal pole.\nOn 5 months after surgery, the recurred CSDH was completely resolved spontaneously (). However, the AC was still found on the left temporal pole.