Chronic Subdural Hematoma
CHRONIC SUBDURAL HEMATOMA has been well described in the literature. Initial descriptions were published several centuries before 1857, when Virchow’s paper,1 now considered a classic, first presented a clear account of the histopathologic nature of the lesion and suggested an explanation of its origin. Putnam and Cushing2 in 1925 discussed the neurosurgical aspects, and Gardner3 in 1932 offered a plausible explanation of the delayed development of symptoms. The purpose of this report is to present a brief historical review together with an analysis of the cases of 60 patients seen and treated at the University Hospital in Copenhagen.
Trauma is believed generally to be the most important cause of a subdural hematoma. However, although demonstrable in nearly all acute cases,4,5 in a high percentage of chronic cases there is no traceable history of injury. Virchow1 recognized that the lesion sometimes was traumatic, but he believed that chronic subdural hematoma (which he called “pachymeningitis chronica hemorrhagica”) was most often caused by chronic inflammation of the dura with extravasation of blood into the subdural space and formation of a film of fibrin over the inner surface of the dura. Sperling6 in 1872 reported that whole blood injected into the subdural space resulted in formation of membranes that in many respects were similar to those of chronic subdural hematoma. Huegenin7 in 1877 reported that he frequently found fatty degeneration, sometimes thrombosis, and occasionally rupture of the veins of the pia. Barrett8 in 1902 stated that the pathologic findings did not appear. . .