A case of neuromyelitis optica diagnosed with a chronic subdural hematoma

Abstract

Background: Chronic subdural hematoma (CSDH) is often found in the elderly owing to slight head trauma and is associated with several neurological disorders. Neurological deficits are cured by a simple surgical removal of the hematoma; however, these deficits persist if there is insufficient hematoma removal. It is rare for patients to continue having neurological disorders once the hematoma is removed. Case report: A 61-year-old woman presented with gait disturbance. She was diagnosed with a subdural hematoma through head computed tomography. After hematoma irrigation, her gait disturbance exacerbated, and she developed urinary tract dysfunction. Ubiquitous neurodegeneration in the midbrain and spinal cord was suspected owing to a hyperintense signal on fluid-attenuated inversion recovery of magnetic resonance imaging. The anti-aquaporin 4 antibody was detected in the patient's serum, and she was diagnosed with neuromyelitis optica (NMO). Conclusions: Progressive NMO caused gait dysfunction and triggered head trauma, followed by CSDH. Although NMO rarely causes CSDH, it should be considered in uncommon cases of CSDH.

Keywords: anti-aquaporin 4 antibody; chronic subdural hematoma; neuromyelitis optica.

Figure 1

Head computed tomography scan images at admission (A) and post irrigation (B).

Figure 2

Head magnetic resonance imaging of the neurological disorder worsening over time (A, B) and at remission (C). A shows diffusion weighted imaging findings of the axial plane on the medulla level. B and C show fluid-attenuated inversion recovery findings of the sagittal and coronal planes of the brain stem region.