Cortical spreading depression and multi-territorial cortical infarction following traumatic subdural hematoma: A case report and literature review.

BACKGROUND

Cortical spreading depression (CSD) has been recognized recently as a potential driver of secondary brain injury following traumatic brain injury and subdural hematoma (SDH). It can propagate in metabolically compromised cortical tissue, leading to the spread of ischemia and delayed infarction.

CASE DESCRIPTION: The case is an 87-year-old man with atrial fibrillation on long-term anticoagulation who sustained an unwitnessed fall at home and was only found a day later. On presentation, he was alert but suffering from a profound left-sided hemiparesis, as well as significant dysarthria and confusion. Brain computed tomography (CT) showed an acute SDH causing only mild local mass effect. CT-angiogram showed no evidence of cervical or intracranial occlusion or dissection. Brain magnetic resonance imaging revealed extensive cortical acute infarcts, including territories far from the SDH, and with white matter sparing.

CONCLUSION

This case highlights the potential contribution of CSD, inferred from characteristic imaging findings, and spreading ischemia to delayed, diffuse hemispheric infarction in the setting of traumatic SDH, emphasizing its pathophysiological mechanisms, diagnostic challenges, and therapeutic implications.