- Department of Neurosurgery, Shiga University of Medical Science, Setatsukinowacho, Otsu, 520-2192 Shiga, Japan
Department of Neurosurgery, Shiga University of Medical Science, Setatsukinowacho, Otsu, 520-2192 Shiga, Japan
DOI:10.4103/2152-7806.166777Copyright: © 2015 Surgical Neurology International This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Nitta N, Jito J, Nozaki K. Recurrent subdural hematoma secondary to headbanging: A case report. Surg Neurol Int 07-Oct-2015;6:
How to cite this URL: Nitta N, Jito J, Nozaki K. Recurrent subdural hematoma secondary to headbanging: A case report. Surg Neurol Int 07-Oct-2015;6:. Available from: http://surgicalneurologyint.com/surgicalint_articles/recurrent-subdural-hematoma-secondary-to-headbanging-a-case/
Background:"Headbanging" is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music extremely rarely causes a subdural hematoma.
Case Description:A 24-year-old female was admitted to our department because of right sided partial seizure and acute or subacute subdural hematoma over the left cerebral convexity. She had no history of recent head trauma but performed headbanging at a punk rock concert at 3 days before admission. Since, she had a previous acute subdural hematoma on the same side after an accidental fall from a baby buggy when she was 11 months old, the present was recurrent subdural hematoma probably due to headbanging.
Conclusions:Headbanging has the hazardous potential to cause a subdural hematoma.
Keywords: Headbanging, punk rock, recurrence, subdural hematoma
“Headbanging” is the slang term used to denote violent shaking of one's head in time with the music. This abrupt flexion-extension movement of the head to rock music has been recently reported to cause subdural hematoma in “The Lancet,” however, the number of such reports is very limited as compared with the number of “headbangers” in the world.[
A 24-year-old female was seen in our Neurosurgical Department because of partial seizures of right upper and lower limbs. On the morning of admission, episodes of partial seizures, motor weakness, and numbness of right upper and lower limbs occurred. She did not bruise her head during partial seizures.
On examination, she was awake, alert, and oriented. No head injury such as skin bruises was observed. Cranial nerves were intact. Motor examination showed mild right hemiparesis. Sensory examination showed right upper and lower limbs numbness. After simple partial seizures on the right upper and lower limbs were controlled with diazepam and phenytoin, the numbness disappeared. Cranial computed tomography (CT) scans showed left-sided acute or early subacute subdural hematoma with neither subcutaneous hematoma nor skull fracture [
She had no history of recent head trauma but reported headbanging at punk rock concerts at 17 and 3 days before admission. Her mother reported that she had been admitted to our department when she was 11 months old because of acute subdural hematoma on the same side after an accidental fall from a baby buggy. Although, she had an episode of generalized seizure when she was 20 years old, results of MRI and electroencephalography were normal at that time. Because she had no recent history of head trauma, we concluded that headbanging at 3 days before admission had caused a present subdural hematoma.
Carbamazepine was administered, and there were no episodes of seizure after the admission. On the second hospital day, her motor weakness improved, probably because of free of seizures. She was discharged home after 13 days. At 8-month follow-up, the patient remains free of seizures with the administration of carbamazepine. CT showed resolution of the subdural hematoma [
The headbanging story may begin when the front rows of the audience were banging their heads on the stage in time to the music at the Boston Tea Party during Led Zeppelin's first US tour in 1969.[
A previous study has reported that nothing need strike the head in order for the acute subdural hematoma to occur.[
Patton and McIntosh evaluated risks of brain and neck injury caused by headbanging using head injury criterion and neck injury criterion.[
Why did previous and our patients have the severe or fatal complication of headbanging? One reason is the cumulative effects of repetitive head movement, which no established injury criteria or risk assessment consider, in one session or multiple sessions of headbanging.[
Another reason is a predisposition. In six previous cases of subdural hematoma due to headbanging, two patients had an arachnoid cyst in the middle fossa, ipsilateral to the hematoma, suggesting that headbanging may cause subdural hematoma in patients with predisposing factors for subdural hematoma like an arachnoid cyst.[
Because our patient had no arachnoid cyst on images, but had a history of traumatic subdural hematoma on the same side in her infancy, we infer that she might have constitutionally structural vulnerability of BV which caused previous and present subdural hematoma, or acquire vulnerability of BV by the first subdural hematoma, e.g., reduction of play of BV by adhesion after first injury. We assume that angular acceleration of the head or relative displacement between the brain and skull during headbanging exceeded our patient's strain tolerance threshold of subdural BV, which might be much lower than normal.
We report a case of a 24-year-old woman with subdural hematoma after headbanging at punk rock concerts. In six previous cases of subdural hematoma due to headbanging, two patients had an arachnoid cyst in the ipsilateral middle fossa as predisposing factors for subdural hematoma, and our patients had a past history of acute subdural hematoma ipsilateral to the present subdural hematoma, suggesting that our patient also has vulnerability of BV to rapid movement of the head and should not perform headbanging.
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