Chronic subdural haematoma secondary to headbanging

Abstract

A 50-year-old man presented to our neurosurgical department in January, 2013, with a 2 week history of constant worsening headache aff ecting the whole head. He had no history of head trauma, but reported headbanging at a Motorhead concert 4 weeks previously. His medical history was unremarkable and he denied substance misuse. Neurological examination and laboratory studies, including coagulation screening, were normal. Cranial CT showed right-sided chronic subdural haematoma with pronounced midline shift (fi gure). He underwent burr hole evacuation of the haematoma and closed system subdural drainage for 6 days after surgery. His headache resolved and he was discharged home after 8 days. At 2 month follow-up he was free of neurological symptoms. The repeat cranial CT showed complete resolution of the subdural fl uid collection, and an arachnoidal cyst in the right middle cranial fossa (Galassi grade I), which had initially been interpreted as haematoma at the tip of the temporal lobe in extension of the subdural haemotoma (fi gure). Headbanging is a contemporary dance form consisting of abrupt fl exion–extension movements of the head to the rhythm of rock music, most commonly seen in the heavy metal genre. Although generally considered harmless, health complications attributed to this practice include carotid artery dissection, mediastinal em physema, whip lash injury, and odontoid fracture. Headbanging was intro duced in the early 1970s. The number of avid afi cionados is unknown. Its association with the hard rock genre was popular ised by bands such as Motorhead, which was also seminal in the creation of the speed metal sub genre, where tempos greater than 200 bpm are aspired to. While such shows are enjoyable and stimulating for the audience, some fans might be endangered by indulging in excessive headbanging. A review of the literature showed three cases of subdural haematoma secondary to headbanging. Two were classifi ed as subacute haematomas and one was an acute haematoma leading to the patient’s sudden death. As in our case, one patient had an arachnoidal cyst in the middle cranial fossa, ipsilateral to the haematoma. Arachnoidal cysts are usually asymptomatic and are found incidentally. These cysts sometimes cause symptoms either because of progressive enlarg ement and mass eff ect on adjacent neural structures, or traumatic intracystic or subdural haemorrhage from rupture of bridging veins or veins surrounding the cyst. The annual risk of haemorrhage is estimated to be less than 0·1%. Our patient had no history of head trauma, so we assume that headbanging, with its brisk forward and backward acceleration and deceleration forces, led to rupturing of bridging veins causing haemorrhage into the subdural space. The existence of an arachnoidal cyst in the middle cranial fossa must be regarded as a predisposing factor, rendering the brain susceptible to haemorrhage into the subdural space. This case serves as evidence in support of Motorhead’s reputation as one of the most hardcore rock’n’roll acts on earth, if nothing else because of their contagious speed drive and the hazardous potential for headbanging fans to suff er brain injury.