Remote acute subarachnoid hemorrhage after drainage of chronic subdural hematoma: A case report and review of the literature

Abstract

Introduction: Chronic subdural hematoma(CSDH) can be treated by a relatively simple burr hole surgery. Acute subarachnoid hemorrhage (SAH) occurring after surgery for CSDH has been reported as a rare but severe complication.

Case report: An 88-year-old female complained of progressive headache and dizziness for one month. A right fronto-temporo-parietal CSDH with a shift in the midline structures and lateral ventricle compression was shown by computed tomography (CT) scans. Closed-system drainage of the hematoma was performed via one burr hole under general anesthesia. Two hours after we began draining the hematoma at the patient's bedside, the patient complained of headache and exhibited impaired consciousness that progressively degenerated. The drainage bag collected 200 ml of bloody liquid overa short time. A subsequent CT scan revealed SAH and an acute subdural hematoma. A CT angiogram excluded the presence of intracranial aneurysms. The patient died of hypostatic pneumonia after 15 days despite conservative medical management.

Discussion: Relevant literature was reviewed, and we believe that the occurrence of a hematoma in the opposite hemisphere and the hyperperfusion resulted from the rapid drainage of the hematoma, which caused the rupture of weak bridging veins during drainage.

Conclusion: Slow decompression with closed-system drainage is recommended to avoid rapid dynamic intracranial changes during drainage of a subdural hematoma, including brain shift or restoration of normal perfusion,to prevent devastating complications.

Keywords: Chronic subdural hematoma; Drainage; Subarachnoid hemorrhage.

Fig. 1

Preoperative images, CT scans and MRI showed a CSDH in the right hemisphere with a shift of the midline structures and lateral ventricle compression. A–B: brain CT images; C–D: brain T2-weighted MRI.

Fig. 2

Closed-system drainage for CSDH after a burrhole craniostomy.

Fig. 3

Postoperative CT images, A–C: CT scans revealed an SAH focused on the tentorium cerebella, a parasagittal acute subdural hematoma and a contralateral acute subdural hematoma. The right lateral ventricle compression was markedly reduced, and the midline structure shad generally returned to their original positions. D: The drainage catheter can be seen in the hematoma cavity.

Fig. 4

Postoperative CT angiography images, A–D: A CT angiogram showed normal arteries and excluded the presence of intracranial aneurysms.