Review articleInsular infarction in subdural hematoma: A case series and pathophysiologic review

- Subdural hematoma (SDH) is among the most common diseases in the neurosciences.
- Mechanisms of ischemic stroke associated with SDH are not well delineated.
- Three cases of ipsilateral insular ischemic stroke and SDH are presented.
- Pathophysiological mechanisms of venous hypertension and vasospasm are proposed.
- Insular stroke may be a biomarker of SDH severity of great clinical importance.

Subdural hematoma (SDH) is among the most common conditions managed by neurologists and neurosurgeons. As SDH incidence rates increase, a wider spectrum of SDH related complications have become evident. We prospectively identified a series of three patients with similar patterns of ipsilateral insular diffusion weighted imaging (DWI) hyperintensity associated with subdural hematoma. Detailed chart review was performed, and cases are described in relation to anatomy and proposed pathophysiology of venous hypertension and arterial vasospasm. The DWI changes were evident in all cases where clinical deficits following SDH evacuation were out of proportion to computed tomography findings. Therefore SDH-associated insular infarction may be a marker of greater disease severity, and further study of management and outcomes is needed.