Bilateral Chronic Subdural Hematoma and Blindness: Bilateral Infarction to the Posterior Cerebral Artery following Evacuation of Bilateral Chronic Subdural Hematoma — A Rare Case Report and Review of Literature

Abstract

Objective The authors report a rare scenario in which evacuation of bilateral chronic subdural hematoma (CSDH) was followed by bilateral PCA infarction and blindness. A literature review was also conducted, which revealed only four cases of blindness after CSDH evacuation.

Methods A 45-year-old man was admitted with the chief complaint of holocranial headache for 2 months with past history of head trauma. Clinical examination was normal. CT and MRI scanning showed bilateral frontotemperoparietal CSDH without midline shift and parenchymal and vascular abnormality. Bilateral frontal and parietal burr holes and evacuation of CSDH was done.

Results The patient developed progressive blindness in both the eyes in the postoperative period. MRI revealed bilateral PCA infarction.

Discussion Bilateral PCA infarction following bilateral CSDH evacuation is an extremely rare entity. Only four case of blindness following CSDH evacuation have been reported so far, and all the patients suffered permanent visual loss. The exact etiopathogenesis and mechanism of this rare complication remain unknown.

Conclusion Bilateral CSDH is a separate entity with altered pathophysiology and deranged cerebral autoregulation. The authors conclude that Bilateral CSDH may be sentinel tags for bilateral PCA infarction secondary to altered hemodynamics in the posterior circulation, and hence, needs to be evaluated and treated with greater diligence.

Keywords

bilateral CSDH - bilateral PCA infarction - postoperative cortical blindness

Conference Presentation

This case was presented (as a flash paper presentation) by Dr. B. Sneha Chitra at NSICON (Neurological Society of India), 2014, Coimbatore, Tamil Nadu, India.

Funding

None.

Publication History

Received: 02 April 2017

Accepted: 29 May 2017

Publication Date:
24 July 2017 (online)

• References

• 1 Huang Y-H, Yang K-Y, Lee T-C, Liao C-C. Bilateral chronic subdural hematoma: what is the clinical significance?. Int J Surg 2013; 11 (07) 544-548
• 2 Galetović D, Karlica D, Bojić L, Znaor L. Bilateral cortical blindness—Anton syndrome: case report. Coll Antropol 2005; 29 (Suppl. 01) 145-147
• 3 Aldrich MS, Alessi AG, Beck RW, Gilman S. Cortical blindness: etiology, diagnosis, and prognosis. Ann Neurol 1987; 21 (02) 149-158
• 4 Keane JR. Blindness following tentorial herniation. Ann Neurol 1980; 8 (02) 186-190
• 5 Russegger L, Langmayr JJ, Twerdy K. [Chronic subdural hematoma as a cause for blindness] [in German]. Neurochirurgia (Stuttg) 1992; 35 (06) 207-209
• 6 Kudo K, Naraoka M, Shimamura N, Ohkuma H. [Chronic subdural hematoma (CSH) complicated by bilateral occipital lobe infarction: two case reports] [in Japanese]. No Shinkei Geka 2013; 41 (04) 319-322
• 7 Gelabert-González M, Arán-Echabe E, Bandín-Diéguez FJ. , et al. [Bilateral chronic subdural haematoma: analysis of a series of 190 patients] [in Spanish]. Neurocirugia (Astur) 2016; 27 (03) 103-111
• 8 Kurokawa Y, Ishizaki E, Inaba K. Bilateral chronic subdural hematoma cases showing rapid and progressive aggravation. Surg Neurol 2005; 64 (05) 444-449 , discussion 449
• 9 Tanaka A, Nakayama Y, Yoshinaga S. Cerebral blood flow and intracranial pressure in chronic subdural hematomas. Surg Neurol 1997; 47 (04) 346-351
• 10 Okuyama T, Saito K, Fukuyama K, Yamamoto K, Morimoto M, Aburano T. [Clinical study of cerebral blood flow in bilateral chronic subdural hematoma measured by 99mTc-HMPAO SPECT] [in Japanese]. No To Shinkei 2000; 52 (08) 709-714