Year: 2024
Type: article
Study design: Case Report
Abstract: Subdural haematoma (SDH) is the accumulation of blood in the subdural space between the dura mater and the arachnoid mater surrounding the brain (1).Depending on the time elapsed from the onset of bleeding, SDH is classified as acute, subacute and chronic.Chronic SDH (CSDH) lasts longer than three weeks (2).Depressive disorders (3-5) and psychotic disorders (2,5,6) have been reported to develop secondary to CSDH.Rarely, psychiatric symptoms may be the sole clinical manifestation of CSDH.A case of an 82-year-old male (5), who had depressive symptoms and paranoid delusions unaccompanied by a neurological disorder, due to CSDH in the left frontoparietal region, was reported in the literature.There was another case with bilateral SDH and psychotic disorder without any neurological symptoms (2).It may be more difficult to diagnose cases without neurological symptoms, and clinicians should be aware of the fact that CSDH may present with isolated psychiatric symptoms (7).There is no treatment recommendation with a high level of evidence or indication criteria for surgery in cases of CSDH with isolated psychiatric symptoms.However, data can be provided to studies with a higher level of evidence thanks to the reporting of these rare cases.Thus, guidelines can be developed to determine the optimal management of these patients.In this article, we present a case of psychotic depression secondary to CSDH without neurological symptoms and unresponsive to pharmacotherapy. CASEA 77-year-old female patient presented to our outpatient clinic with complaints of depressive mood, suicidal thoughts, insomnia, and Chronic subdural hematomas (CSDH) with isolated psychiatric presentation are rare.In this paper, we report a case of 77-year-oldfemale patient who had psychotic depression after repetitive head trauma without any neurological symptoms.The brain magnetic resonance imaging revealed an 20 mm subdural hematoma in the right frontoparietal region and a 7 mm subdural hematoma in the left frontal region.The psychiatric symptoms improved within the first week after evacuation but relapsed with the occurrence of right sided pneumocephalus.In the follow up, with the disappearance of the pneumocephalus, the psychiatric symptoms improved.It should be kept in mind that isolated psychiatric symptoms can be seen due to subdural hematoma and evacuation of the hematoma has an important role in improving the psychiatric symptoms.
Source: Nöro Psikiyatri Arşivi
DOI: 10.29399/npa.28519
Authors: Anıl Alp, M. İrem Yıldız, Elçin Özçelik Eroğlu, İlkay Işıkay, Yavuz Ayhan, Aygün Ertuğrul
Institution: Hacettepe University
Language: English
Subfield: Clinical Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4391107561