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01-DECEMBER-2008  ALI SALEM AL-HIYASAT  80 YEARS  CHRONIC SUBDURAL HEMATOMA LEFT CEREBRAL HEMISPHERE.

Anamnesis:

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The patient was admitted to the Shmaisani hospital 29-November-2008 with clinical history of minor trauma 2 months ago and ataxic gait for 10 days.

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The patient has esophageal diverticulum for long time and cardiomegaly, but not under treatment.

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CT-scan of the brain done 3 days ago at Issra hospital and the day of admission, confirming the presence of huge chronic subdural hematoma over the left convexity.

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On examination: the patient  has right sided hemiparesis more in the distal muscles and some elements of frontal lobe syndrome. Otherwise he was neurologically free except for ataxic gait due to paresis.

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Burr hole in the left parietal region was performed and washing of the hematoma was performed. It was more resembling hygroma in consistency and insertion of external drain was performed.

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Smooth postoperative recovery and the patient was sent to the ICU with the external drain kept at low level and the patient was asked to keep in the left sided position to allow further draining of the remaining collection.


Comments

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Chronic subdural hematomas or hygromas usually occur at the old age and they are all the time associated with minor trauma and manifest themselves clinically after 1-4 month after the insult.

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Most of the time creation of one burr hole with insertion of the drain to the most inferior point of the hematoma cavity resolve the problem.

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Usually a little amount of collection remains and it resolves over the time within several weeks. It happens that reaccumulation take place, then double burr holes are used or craniotomy depending upon the thickness of the hematoma wall. This last scenario have place in around 10% of cases.

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Washing during surgery of the hematoma cavity helps in breaking the osmotic mechanism, which trigger the hematoma formation, for what washing is considered an integral part of the operation.

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