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Amaresh Deginal, Siddling Changty

hospital stay. On follow up after eight weeks, there was thirty percent improvement in behavioural attitude and other KBS symptoms. Thereafter, he was lost to followup.

REFERENCES
1. Klver H, Bucy PC. Priliminary analysis of functions of the temporal lobes in monkeys. Arch Neurol Psychiatry 1939; 42:979-1000. Klver H, Bucy PC. Psychic blindness and other symptoms following bilateral temporal lobectomy in rhesus monkeys. Am J Physiol 1937; 119:352-3. Marlowe WB, Mancall EL,Thomas JJ. Complete Klver-Bucy syndrome in man. Cortex 1975; 11;53-9. Schraberg D, Welberg L. Klver-Bucy syndrome in man. J Nerv Ment Dis 1978; 166:130-4. Terzian H,Dalle-ore PC. Syndrome of Klver and Bucy reproduced in man by bilateral removal of the temporal lobes. Neurology 1995; 5:373-80. Jha S, Patel R. Klver-Bucy syndrome- an experience with six cases. Neurol India 2004; 52:369-71. Pradhan S, Singh MN, Pandey N. Klver-Bucy syndrome in young children. Clin Neurol Neurosurg 1998; 100:254-8. Misra UK, Phadke RV, Seth PK. Klver-Bucy syndrome: Sequelae of tubercular meningitis. Neurol India 1994; 42:29-31. Duggal HS, Jain R, Sinha VK, Haque NS. Post encephalitic Klver-Bucy syndrome. Ind J Pediatrics 2000; 62:74-6.

DISCUSSION
KBS was documented among humans after temporal lobectomy by H Terzian and G D ore in19555 and later by Marlowe WB and etal in 19753. Anatomical basis of KBS is due to damage that occurs when both the right and left medial temporal lobe of the brain malfunction. The amygdala has been a particularly implicated brain region in the pathogenesis of this syndrome 4,5,6,9. KBS also results from disruption of pathways connecting the dorsomedial thalami with pre frontal cortices and other limbic areas which essential for memory and regulation of impulses and emotions3,6. Single photon emission CT[SPECT] study by Ozawa etal 10 clearly showed hypoperfusion in the bilateral frontal, parietal and most remarkably, in temporal regions. In our case, patient had bilateral temporal lobe contusions that resolved with conservative treatment. Interestingly appearance of KBS in deeply unconscious patient is considered as good prognostic feature 11. Asensio and Juan have described a case of KBS after a minor head injury whose CT brain was normal but MRI brain showed few demyelinating plaques in frontal, temporal lobes12. The natural history of KBS is not known, but evidence suggests that in trauma,its course is temporary, ranging from seven days to one year12. There is no specific treatment except oral Carbamazepine(CBZ)13. CBZ and leuprolides have been found to decrease the sexual behavioral abnormality in individuals with KBS. Other medications such as haloperidol and anti-cholinergics may also be useful in treating behavioural abnormalities associated with KBS6.

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10. Ozawa H, Sasaki M, Sugai K, et al. Single-Photon Emission CT and MR findings in Klver-Bucy syndrome after Reye syndrome. Am J Neuroradiology AJNR; 1997; 18:540-42. 11. Saltuari FR, Gerstenbrand F. Presence of Klver-Bucy syndrome as positive prognostic feature for the remission of traumatic prolonged disturbances of consciousness. Acta Neurol Scand 1995; 91:54-7. 12. Salim A, Kim KA, Kimbrell BJ, Petrone P, Roldan G, Asensio Juan A. Klver-Bucy syndrome as a result of minor head trauma. Southern Med J 2002; [1] August, 2002. 13. Stewart JT. Carbamazepine treatment of patient with KlverBucy syndrome. J Clin Psychiatry 1985; 46:496-7.

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Case report

Indian Journal of Neurotrauma (IJNT) 43 2011, Vol. 8, No. 1, pp. 43-44

Unilateral multi-compartmental chronic subdural hematoma in a kabaddi player

Amit Agrawal M Ch
MM Institute of Medical Sciences & Research, Maharishi Markandeshwar University, Mullana, Ambala, Haryana

Kabaddi is a game widely played in India and in many other countries; which combines the actions of wrestling, judo, rugby and gymnastics and the important body movements in this game involve catching, holding, locking and jumping1. Inspite of the wide popularity of this game only few reports address the issue of injuries associated with game2,3. A 24 year male patient presented with the history of headache of 10 days duration. Headache was associated with blurring of vision, neck stiffness and vomiting. There was no history of focal weakness, fever or seizures. He had head-on collision with a fellow player while playing kabaddi two months earlier, and at that time he had transient loss of consciousness followed by recovery. Clinical examination was unremarkable, and funduscopy revealed papilloedema. Coagulation profile was normal. CT brain showed right-sided isodense biconvex temporal collection and a separate right sided fronto-parietal isodense concavo-convex collection with mass effect and midline shift (Figures 1 and 2). He was diagnosed as having right sided multi-compartmental chronic subdural hematoma, and taken for surgery. The sub-dural hematoma was evacuated though a high temporal burr-hole and through a small low temporal craniectomy. After surgery his headache was relieved and he is doing well. Chronic subdural hematoma (CSDH) is one of the most common types of traumatic intracranial hematoma encountered in daily neurosurgical practice, and often occurs in the elderly4-8. CSDH may be precipitated by minor trauma 9 and sports related CSDH have been reported in many sports including boxing10-13, basketball14, race walking9 and snowboard head injury15. An extensive search of the literature revealed that a CSDH in kabaddi player have not been reported in the literature. Based on the timing age of the CSDH, timing of imaging based
Address for correspondence: Professor of Neurosurgery MM Institute of Medical Sciences & Research Maharishi Markandeshwar University Mullana, Ambala, 133-207 (Haryana). Mobile: +91-7206423180 E-mail: dramitagrawal@gmail.com / dramit_in@yahoo.com

Fig 1: CT scan brain axial images showing crescentic hypoisodense fronto-parietal and biconvex temporal-sub temporal collections of chronic subdural hematoma

Fig 2: CT scan brain sagittal images showing crescentic hypo- & isodense fronto-parietal and biconvex temporal-sub temporal collections of chronic subdural hematoma

and patterns observed on the conventional views a classification regarding the shape of CSDH has been proposed and it describes the lesions as Type 1 (band), Type 2 (biconvex), Type 3 (diffuse) and Type 4 combined16. CSDH usually spreads out over the cerebral convexity, and appears as a crescent-shaped lesion17,18 and on imaging
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Amit Agrawal
9. Carmont MR, Mahattanakul W, Pigott T. Acquisition of a chronic subdural haematoma during training for competitive race walking?

rarely it can be of globular shape17, albeit subtemporal location of the subdural hemorrhage is not very common19,20. Evaluation of an athlete with a history of head injury, albeit mild, who complains of headaches should include CT and/or MRI if available to allow quick identification of acute or delayed intracranial pathology15.

Br J Sports Med 2002; 36:306-7.

10. Ross RT, Ochsner MG, Jr. Acute intracranial boxing-related injuries in U.S. Marine Corps recruits: report of two cases. Mil Med 1999; 164:68-70. 11. Sawauchi S, Murakami S, Tani S, Ogawa T, Suzuki T, Abe T. [Acute subdural hematoma caused by professional boxing]. No Shinkei Geka 1996; 24:905-11. 12. Cruikshank JK, Higgens CS, Gray JR. Two cases of acute intracranial haemorrhage in young amateur boxers. Lancet 1980; 1(8169):626-7. 13. Pothe H. [Chronic subdural hematoma in prize fighters]. Beitr Neurochir 1964; 8:232-7. 14. Keller TM, Holland MC. Chronic subdural haematoma, an unusual injury from playing basketball. Br J Sports Med 1998;32:338-9. 15. Uzura M, Taguchi Y, Matsuzawa M, Watanabe H, Chiba S. Chronic subdural haematoma after snowboard head injury. Br J Sports Med 2003; 37:82-3. 16. Sy WM, Weinberger G, Ngo N, Sackler JP. Imaging patterns of subdural hematoma a proposed classification. J Nucl Med 1974;15:693-8. 17. Murata T, Shigeta H, Horiuchi T, Sakai K, Hongo K. Globular subdural hematoma in a shunt-treated infant: case report. J Neurosurg Pediatr 2010; 5(2):210-2. 18. Calvo-Romero JM. Bilateral subacute-chronic subdural hematomas. CJEM 2008; 10:5. 19. Grinnell V, Mehringer CM, Hieshima GB, Pribram H. Radiology of acute subtemporal subdural hematomas. Surg Neurol 1983; 19:438-41. 20. Glickman MG, McNamara TO, Margolis MT. Arteriographic diagnosis of subtemporal subdural hematoma. Radiology 1973; 109:607-15.

REFERENCES
1. Dey SK, Khanna GL, Batra M. Morphological and physiological studies on Indian national kabaddi players. Br J Sports Med 1993; 27:237-42. Ganorkar SW, Vaidya VA. Injury incidence among kabaddi players during the two all-India level tournaments. J Indian Med Assoc 1973; 60:240-3. Sangwan SS, Aditya A, Siwach RC. Isolated traumatic rupture of the adductor longus muscle. Indian J Med Sci 1994; 48:186-7. Ernestus RI, Beldzinski P, Lanfermann H, Klug N. Chronic subdural hematoma: surgical treatment and outcome in 104 patients. Surg Neurol 1997; 48:220-5. Stanisic M, Lund-Johansen M, Mahesparan R. Treatment of chronic subdural hematoma by burr-hole craniostomy in adults: influence of some factors on postoperative recurrence. Acta Neurochir (Wien) 2005; 147:1249-56; discussion 56-7. Gelabert-Gonzalez M, Iglesias-Pais M, Garcia-Allut A, Martinez-Rumbo R. Chronic subdural haematoma: surgical treatment and outcome in 1000 cases. Clin Neurol Neurosurg 2005; 107:223-9. Muzii VF, Bistazzoni S, Zalaffi A, Carangelo B, Mariottini A, Palma L. Chronic subdural hematoma: comparison of two surgical techniques. Preliminary results of a prospective randomized study. J Neurosurg Sci 2005; 49:41-6; discussion 6-7. Lee JK, Choi JH, Kim CH, Lee HK, Moon JG. Chronic subdural hematomas : a comparative study of three types of operative procedures. J Korean Neurosurg Soc 2009; 46:210-4.

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Indian Journal of Neurotrauma (IJNT), Vol. 8, No. 1, 2011