Delayed Extensive White Matter Injury Caused by a Subdural Hemorrhage and Role of Corticospinal Tract Integrity
- Author:
Kyoung Bo LEE
1
;
Sang Cheol YOON
;
Joon Sung KIM
;
Bo Young HONG
;
Jung Geun PARK
;
Won Jin SUNG
;
Hye Jung PARK
;
Seong Hoon LIM
Author Information
- Publication Type:Case Report
- Keywords: Subdural hemorrhage; Corticospinal tracts; Diffusion tensor imaging; Leukomalacia; White matter injury
- MeSH: Diffusion Tensor Imaging; Follow-Up Studies; Hematoma; Hematoma, Subdural; Hemorrhage; Humans; Inpatients; Magnetic Resonance Imaging; Middle Aged; Muscle Strength; Prognosis; Pyramidal Tracts; Rehabilitation; Trephining; White Matter
- From:Brain & Neurorehabilitation 2019;12(2):e15-
- CountryRepublic of Korea
- Language:English
- Abstract: A subdural hemorrhage (SDH) is a common disorder with usually good prognosis. Most SDHs resolve with or without with minimal sequelae. We present a case report of a patient with SDH, who had delayed extensive white matter injury with disruptions of corticospinal tracts (CSTs) by diffusion tensor imaging (DTI) and showed abysmal prognosis, despite long-term rehabilitation. A 62-year-old man with an SDH underwent burr hole trephination for hematoma removal. Within 7 days, the hemorrhage diminished. At 12 weeks after the onset, the patient's weakness did not improve, and a follow-up magnetic resonance imaging revealed extensive leukomalacia, especially in the white matter. The DTI for CST revealed severe injury of CST integrity. He did not re-gain muscle strength and functional independence, despite 3 months of inpatient rehabilitation. This case describes SDH with delayed extensive white matter injury and exceptional poor prognosis and urges caution in that the SDH may induce very variable functional recovery. Besides, DTI for CST would be useful in predicting the long-term functional prognosis in extensive white matter injury.
