ABSTRACT
Introduction: The authors present a case of a delayed chronic subdural haematoma, a rare occurrence that manifested 3 years after a traumatic brain injury, accompanied by an unexpected symptom of urinary incontinence. Chronic subdural haematoma (CSDH) is a well-known condition characterised by the accumulation of old, liquefied blood under the dura mater, usually following minor head trauma. However, the atypical presentation of CSDH in a young patient without predisposing factors and the association with urinary incontinence challenge conventional understanding. This report explores the clinical manifestations, radiological findings, and management of this exceptional case, providing valuable insights into this unusual presentation. Case presentation: In this report, the authors present the case of a 23-year-old male with an unremarkable medical history, devoid of prior neurological deficits, who presented with persistent headaches, memory impairment, left-right disorientation, slurred speech, and urinary incontinence, troubling him for the past month. The patient had a history of a traumatic brain injury from a road traffic accident 3 years earlier, initially devoid of concerning symptoms. Imaging revealed a large heterogeneous mass lesion in the left fronto-parietal lobe consistent with a chronic subdural haematoma. The patient underwent surgical evacuation and excision of the haematoma, leading to the successful resolution of symptoms. Clinical discussion: Conventionally, chronic subdural haematoma is observed in elderly individuals following minor head trauma. However, this case challenges the traditional understanding by highlighting its delayed occurrence in a young patient without known predisposing factors. This case emphasises the need to consider delayed presentations even without immediate neurological deficits. The unexpected symptom of urinary incontinence underscores the necessity of comprehensive evaluations to understand the associated neurological effects of CSDH. A surgical approach was crucial for both diagnosis and treatment, underscoring the significance of prompt intervention in such atypical cases. Conclusion: This exceptional case sheds light on a delayed chronic subdural haematoma occurring years after traumatic brain injury in a young patient without known risk factors. The presence of urinary incontinence as a symptom further amplifies the uniqueness of this case. Understanding and recognising atypical presentations of CSDH is vital for accurate diagnosis and timely intervention. This report underscores the importance of vigilance and an integrated approach to managing patients with subdural haematomas, particularly in unexpected demographics and circumstances, to ensure optimal outcomes and patient well-being.
ABSTRACT
BACKGROUND: Penetrating trauma to the brain is a rare mode of self-harm in individuals with depressive psychosis. It may have variable presentations ranging from intact neurological status to non-survivable damage and the subjects may be surprisingly apathetic to pain. It is even unusual for such an injury to have an excellent prognosis despite coming late to clinical attention. CASE PRESENTATIONS: We report two cases of patients with psychotic depression who attempted suicide by hammering nails into their heads. On imaging, deep penetration within the brain parenchyma was noted; however, neither case had any neurological deficit or symptoms attributable to brain trauma. CONCLUSIONS: Self-inflicted penetrating brain injuries with peculiar objects such as nails are rarely encountered in practice. They need prompt management for their removal and addressing the underlying mental health illnesses.
