Objective: To describe a case of subdural hematoma caused by a tic-like head banging.

Background: Subdural hematoma is a medical condition that occurs when blood collects in the space between the brain and the dura mater, and can occur due to both traumatic and non-traumatic causes. A tic-like head-banging movements are repetitive, involuntary movements of the head that can result from neurological and developmental disorders. There have been rare cases reported where voluntary head-banging movements have resulted in hematomas or bleeding. We present a clinical case of subdural hematoma caused by an involuntary head banging.

Method: A 14-years-old LH has a history of difficulty integrating with peers and exhibiting mannerisms, stereotypies. At age 8, neuropsychiatric evaluations also showed difficulties with sustained attention, text comprehension, and logic-mathematics, leading to a diagnosis of ADHD with autistic traits. OCD symptoms emerged at age 10 and were treated with Fluvoxamine. Motor tics symptomatology developed at age 13 and were treated with Aripiprazole and Sertraline. However, at age 14, tic symptomatology worsened with head-banging movements, leading to diagnosis of Tourette Syndrome and OCD. Multiple medications were tried to manage tics and obsessive-compulsive symptomatology, but they did not provide any benefit (Clomipramine, Lurasidone and Tetrabenazine).

Results: A routine EEG revealed a right hemisphere asymmetry, and subsequent MRI identified a chronic subdural hematoma in the left hemisphere. A comprehensive physical examination, coupled with normal blood test results, revealed no signs of neurological deficits or intracranial hypertension and a craniotomy was performed. A follow-up head CT showed a significant reduction in mass effect. A month after the surgery, a recurrence of subacute subdural hematoma was observed, which necessitated evacuation through a double frontal and left temporal craniotomy. Two subsequent MRI scans showed nearly complete absorption of the hematoma. The final MRI scan conducted three months after the initial episode revealed complete absorption of the blood collection. An hematological evaluation resulted normal. There was no history of head or neck trauma, and a tic-like head banging movement probably caused the subdural hematoma.

Conclusion: This study presents a rare case of subdural hematoma caused by a tic-like head banging.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/a-clinical-case-of-subdural-hematoma-caused-by-a-tic-like-head-banging-in-a-patient-with-neurodevelopmental-disorder/