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Year : 2013  |  Volume : 16  |  Issue : 4  |  Page : 178

Bifrontal acute subdural hematoma

Consultant Neurosurgeon, Neurospine Clinic, Satpathy Nagar, Mughalsarai, Uttar Pradesh, India

Date of Web Publication21-Jan-2014

Correspondence Address:
Pankaj Kapoor
Consultant Neurosurgeon, Neurospine Clinic, Satpathy Nagar, Mughalsarai - 230 101, Uttar Pradesh
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DOI: 10.4103/1118-8561.125584

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How to cite this article:
Kapoor P. Bifrontal acute subdural hematoma. Sahel Med J 2013;16:178

How to cite this URL:
Kapoor P. Bifrontal acute subdural hematoma. Sahel Med J [serial online] 2013 [cited 2020 Mar 28];16:178. Available from: http://www.smjonline.org/text.asp?2013/16/4/178/125584


The article "Bifrontal acute subdural hematoma" published in the Sahel Medical Journal vol 16(2) (April-June 2013) makes an interesting reading. [1] In the article, the authors report the clinical, radiological findings, and successful management of a rare case of traumatic acute bilateral bifrontal subdural hematoma. [1] While we appreciate the efforts of the authors in describing the patient, there were some inconsistencies in the manuscript. The image quality of [Figure 1], [Figure 3], and [Figure 4] was poor. Although the authors claim that the lesion was bilateral, but it was largely unilateral as evident on computed tomogram (CT) just extending to the left of the midline [Figure 1]. [1] It is supported by the obliteration of the frontal horn of the right lateral ventricle; the left frontal horn was partly visible. [2],[3],[4],[5],[6],[7],[8] If there were a large bifrontal lesion it would have led to medial compression of frontal horn of the lateral ventricles resulting in a narrow, slit-like elongated ventricles ("squeezed ventricle," "hare's ears sign," or "rabbit's ears"). [6],[7],[8],[9] There was an inconsistency between intra-operative and post-operative images. The intra-operative bone cuts on the left side was much more lateral [Figure 2]; [1] however, on the CT scan it was just away from the midline. In addition, [Figure 2] did not show the exact location of the hematoma as there was a gauze piece covering the area hiding the underlying brain and its view. For such a large lesion that was only on the right a right frontal craniotomy would have been sufficient. There was no indication for a bicoronal frontal craniotomy. On the follow-up CT scan, there was large infarct involving the whole of the right frontal lobe, part of the right basal ganglion, extending into the left medial frontal lobe through corpus callosum [Figure 4]. [1] This finding was neither described in the case report nor discussed. It would be difficult for a the patient described by the author [1] to recover without deficits in immediate post-operative period. Finally, most of the references were not related to acute subdural hematoma but chronic subdural hematoma which has different pathology and outcome.

  References Top

1.Singh S, Mohammad A, Bedi S. Bifrontal acute subdural hematoma. Sahel Med J 2013;16:77-9.  Back to cited text no. 1
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2.Baechli H, Nordmann A, Bucher HC, Gratzl O. Demographics and prevalent risk factors of chronic subdural haematoma: Results of a large single-center cohort study. Neurosurg Rev 2004;27:263-6.  Back to cited text no. 2
3.de Noronha RJ, Sharrack B, Hadjivassiliou M, Romanowski CA. Subdural haematoma: A potentially serious consequence of spontaneous intracranial hypotension. J Neurol Neurosurg Psychiatry 2003;74:752-5.  Back to cited text no. 3
4.Adhiyaman V, Asghar M, Ganeshram KN, Bhowmick BK. Chronic subdural haematoma in the elderly. Postgrad Med J 2002;78:71-5.  Back to cited text no. 4
5.Gelabert-González M, Iglesias-Pais M, García-Allut A, Martínez-Rumbo R. Chronic subdural haematoma: Surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005;107:223-9.  Back to cited text no. 5
6.Ellis GL. Subdural hematoma in the elderly. Emerg Med Clin North Am 1990;8:281-94.  Back to cited text no. 6
7.Karasawa H, Tomita S, Suzuki S. Chronic subdural hematomas. Time-density curve and iodine concentration in enhanced CT. Neuroradiology 1987;29:36-9.  Back to cited text no. 7
8.Kim KS, Hemmati M, Weinberg PE. Computed tomography in isodense subdural hematoma. Radiology 1978;128:71-4.  Back to cited text no. 8
9.Marcu H, Becker H. Computed-tomography of bilateral isodense chronic subdural hematomas. Neuroradiology 1977;14:81-3.  Back to cited text no. 9


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