Postoperative Subarachnoid Hemorrhage and Multipunctate Intracerebral Hemorrhages Following Evacuation of Bilateral Chronic Subdural Hematomas

Abstract

Chronic subdural hematoma (CSDH) can be easily treated by burr hole surgery. However, several complications including intracerebral hemorrhage (ICH), subarachnoid hemorrhage (SAH), and acute subdural hematoma are rare after evacuation of a CSDH. A 77-year-old man was admitted with right hemiparesis and dysarthria. A brain computed tomography (CT) scan revealed a bilateral CSDH with midline shifting toward the right side. The patient got the burr hole trephination with the catheters insertion in the both sides of parietal area under the local anesthesia. After burr hole surgery immediately, he developed left side weakness and decreased level of consciousness. Repeat CT scans detected a diffuse SAH and multiple small ICHs. He was treated conservatively and fully recovered at discharge after 1 month. To avoid these complications, slow and gradual drainage of the CSDH is needed. The authors report a rare case of SAH and multipunctate ICHs in both cerebral hemispheres after evacuation of a bilateral CSDH.

Keywords: Chronic subdural hematoma; Drainage; Intracerebral hemorrhage; Subarachnoid hemorrhage.

FIGURE 1. (A) Preoperative computed tomographic scan showing bilateral chronic subdural hematomas with a severe shift of the midline structures. (B) Diffusion-weighted image showing an absence of acute ischemic lesions. (C) Gradient-echo image showing no evidence of cortical and intraparenchymal hemorrhagic contusions.

FIGURE 2. Computed tomography scans after evacuation of the bilateral chronic subdural hematomas showing (A) multipunctate small intracerebral hemorrhages on the left, (B) bilateral cortical subarachnoid hemorrhage, and (C) hyperemic condition at bilateral cortices.