From the Guidelines
A frontoparietal subdural hematoma (SDH) can cause right-hand weakness, and prompt medical attention is necessary to prevent further neurological deterioration. The symptoms of a frontoparietal SDH include progressive weakness in the right hand, headache that worsens over time, confusion, drowsiness, speech difficulties, and possibly seizures. The right-hand weakness occurs because the left frontoparietal region controls motor function for the right side of the body.
Diagnosis and Treatment
Treatment options depend on the size of the hematoma and symptom severity. Small hematomas with mild symptoms may be managed conservatively with close neurological monitoring, pain control with acetaminophen or mild opioids, and serial imaging 1. However, larger hematomas or those causing significant neurological deficits like hand weakness typically require surgical evacuation, usually through burr hole drainage or craniotomy 1. The neurosurgeon drills small holes in the skull or removes a bone flap to access and drain the blood collection.
Post-Surgery Care
Post-surgery, patients need close monitoring for recurrence, rehabilitation therapy to regain hand function, and management of underlying causes such as blood thinners (which may need temporary discontinuation) 1. Recovery time varies from weeks to months, with physical and occupational therapy playing crucial roles in restoring hand function. Prompt treatment is essential as delays can lead to permanent neurological damage.
Key Considerations
Some key considerations in the management of frontoparietal SDH include:
- The risk of hematoma expansion and early deterioration, which can be predicted by identifying patients at risk through CT angiography (CTA) and contrast-enhanced CT 1
- The importance of rapid reversal of anticoagulation in patients with elevated INR, which can be achieved through the use of clotting factors, vitamin K, and/or fresh frozen plasma 1
- The need for careful weighing of the risks and benefits of anticoagulation therapy after SDH, considering the risk of recurrent hemorrhage and ischemic stroke 1
From the Research
Symptoms of Frontoparietal Subdural Hematoma
- A frontoparietal subdural hematoma (SDH) can cause right-hand weakness, as seen in a case study where a right-handed man with trauma to the head was admitted with headache and seizures, and a severe right-sided weakness was noted after a blunt trauma to the right side of his head 2.
- The right-sided weakness in this patient was due to temporary transcallosal disconnection (diaschisis) of the minor hemisphere (left, in this case) from the excitatory signals arising from those structures of his major hemisphere devoted to movements occurring on the nondominant side.
- Other symptoms of SDH may include headache, seizures, and raised intracranial pressure.
Treatment Options for Frontoparietal Subdural Hematoma
- The management of recurrent subdural hematomas typically involves surgical evacuation, with a rate of recurrence ranging from 2% to 37% 3.
- Risk factors for recurrence include patient-related factors such as alcoholism, seizure disorders, coagulopathy, and history of ventriculoperitoneal shunt, as well as radiologic and surgical factors.
- Most recurrent hematomas are managed successfully with burr hole craniostomies with postoperative closed-system drainage, while refractory hematomas may require craniotomy or subdural-peritoneal shunt placement.
- Imaging of subdural hematomas is typically done using computed tomography (CT) and magnetic resonance imaging (MRI), with noncontrast CT being the accepted standard of care for initial evaluation 4.
Diagnosis and Imaging
- CT scans may not always detect subdural hematomas, and normal CT scans do not exclude the possibility of intracranial pathology 5.
- MRI scans can be used to determine potential secondary causes of subdural hematoma, such as dural-based neoplasms 4.
- Cardiac abnormalities are common in patients with acute subdural hemorrhage, but are not typically associated with SDH characteristics 6.