Ophthalmologic aspects of subdural hematoma
Hiroshi Mitsumoto, M.D.
Department of Neuropathology
John P. Conomy, M.D.
Department of Neurology
Gary Regula, Ph.D.
Jonathan Hutchinson,1 in 1867, described ipsilateral fixed and dilated pupil in a patient with subdural hematoma (SDH). At that time SDH was called “arachnoid hematoma.” Since then, numerous ophthalmologic abnormalities in patients with SDH have been reported. The pathogenesis of ophthalmologic signs in an expanding lesion in a hemisphere was more clearly understood in 1920 when Adolph Meyer2 reported on the importance of pathologic findings in cerebral herniation. There is, however, no complete agreement among authors concerning the reliability of opthalmologic signs in predicting the laterality of unilateral SDH. In 1960 Pevehouse et al3 studied the ophthalmologic aspects of SDH based upon a large number of patients. These authors concluded that pupillary dilatation, abducens palsy, and homonymous hemianopsia (HHA), if present, assisted in lateralizing SDH more than 90% of the time. HHA was noted in only 3% of patients in that study.
In this retrospective study of SDH, the ophthalmologic signs were often observed.4 It was also found that many confusing elements in diagnosing and lateralizing SDH were often based upon the interpretation of ophthalmologic findings. Because of this, it was decided to analyze the data derived from the neuroophthalmologic examination in 115 consecutive patients with SDH. This was done in an effort to clarify the diagnostic reliability, prognostic worth, and pathologic correlation of abnormal findings related to vision, pupillary function, lid posture, and ocular motility in patients with SDH.
Seventy-one patients in this series had abnormal ophthalmologic signs at the time of hospital admission. Additional oculovisual signs subsequently developed . . .