transmedТрансляционная медицинаTranslational Medicine2311-44952410-5155Almazov National Medical Research Centre, Saint Petersburg, Russia10.18705/2311-4495-2025-12-4-387-396KYXBGAtransmed-1016Research ArticleНЕВРОЛОГИЯ И НЕЙРОХИРУРГИЯNEUROLOGY AND NEUROSURGERYПроблемы диагностики и тактики ведения пациентов с нетравматическими субдуральными гематомамиChallenges in the diagnosis and management of patients with non-traumatic subdural hematomasШнякинП. Г.ShnyakinP. G.

Шнякин Павел Геннадьевич — доктор медицинских наук, профессор 

Красноярск 

Pavel G. Shnyakin, MD, PhD, DSc, Professor 

Krasnoyarsk 

КазадаеваИ. А.KazadaevaI. A.

Казадаева Инна Александровна — врач-невролог 

Красноярск 

Inna A. Kazadaeva, MD, neurologist 

Krasnoyarsk 

ШульженкоП. Д.ShulzhenkoP. D.

Шульженко Полина Дмитриевна — студент VI курса лечебного факультета 

ул. Партизана Железняка, д. 1, Красноярск, 660022 

Polina D. Shulzhenko, 6th year Student at the Faculty of Medicine  

Partizana Zheleznyaka str., 1, Krasnoyarsk, 660022 

polina.shulzhenko.00@mail.ruФедеральное государственное бюджетное образовательное учреждение высшего образования «Красноярский государственный медицинский университет имени профессора В. Ф. Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияKrasnoyarsk State Medical University named after Professor V. F. Voino-YasenetskyRussian FederationКраевое государственное бюджетное учреждение здравоохранения «Краевая клиническая больница»РоссияRegional state budgetary healthcare institution “Regional Clinical Hospital”Russian Federation202504112025124387396Copyright © Шнякин П.Г., Казадаева И.А., Шульженко П.Д., 20252025Шнякин П.Г., Казадаева И.А., Шульженко П.Д.Shnyakin P.G., Kazadaeva I.A., Shulzhenko P.D.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://transmed.almazovcentre.ru/jour/article/view/1016

Нетравматические субдуральные гематомы (НСГ) представляют собой редкую, но клинически значимую патологию в практике неврологов и нейрохирургов. Установление их нетравматического генеза зачастую представляет сложность, особенно при отсутствии явных факторов риска, среди которых ведущими являются прием антитромботической терапии и пожилой возраст пациентов. Более редкими этиологическими факторами выступают разрывы аневризм, артериовенозных мальформаций и фистул, а также тромбоз венозных синусов. В настоящее время отсутствуют крупные серии наблюдений, посвященные тактике ведения пациентов с НСГ, в связи с чем отбор на оперативное лечение основывается на рекомендациях для травматических субдуральных гематом. В данной статье представлен обзор литературы за период 2000– 2024 гг. по базам Elibrary и PubMed, посвященный случаям НСГ; из просмотренных 119 публикаций критериям включения (строго нетравматический генез) соответствовали 36. Проведенный анализ позволил систематизировать современные данные об этиологии, диагностике и подходах к лечению НСГ, подчеркнув важность тщательного ангиографического обследования для выявления сосудистых аномалий, особенно у молодых пациентов, и необходимость коррекции нарушений гемостаза в периоперационном периоде. Кроме того, на примере трех собственных клинических наблюдений демонстрируются особенности течения и исходы данного состояния у лиц, получавших двойную антитромботическую терапию, где, несмотря на успешное удаление гематом, отмечался высокий риск соматических осложнений. Таким образом, статья обобщает современные представления о сложной проблеме НСГ, что имеет важное практическое значение для совершенствования диагностики и лечения этой патологии.

Non-traumatic subdural hematomas (NSDH) represent a rare but clinically significant pathology in the practice of neurologists and neurosurgeons. Establishing their non-traumatic origin often poses a challenge, especially in the absence of obvious risk factors, among which the leading ones are the use of antithrombotic therapy and advanced age of patients. Less common etiological factors include rupture of aneurysms, arteriovenous malformations and fistulas, as well as dural venous sinus thrombosis. Currently, there are no large case series dedicated to the management strategies of NSDH patients; therefore, indications for surgical treatment are based on recommendations for traumatic subdural hematomas. This article presents a literature review covering the period from 2000 to 2024, based on the Elibrary and PubMed databases, focusing on NSDH cases. Of the 119 publications screened, 36 met the inclusion criteria (strictly non-traumatic origin). The analysis allowed for the systematization of current data on the etiology, diagnosis, and treatment approaches for NSDH, emphasizing the importance of thorough angiographic examination to detect vascular anomalies, especially in young patients, and the necessity of correcting hemostatic disorders in the perioperative period. Furthermore, three original clinical cases are presented illustrating the course and outcomes of this condition in patients receiving dual antithrombotic therapy, where despite successful hematoma evacuation, a high risk of somatic complications was observed. Thus, the article summarizes contemporary understanding of the complex issue of NSDH, which holds significant practical value for improving diagnosis and treatment of this pathology.

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The authors declare that there are no conflicts of interest present.