The patient came to the Shmaisani hospital complaining of ataxic gait for 4 days with fainting attacks and headache the last 2 days. 3 months ago, he got fainting attack during praying and felt down and trivial head injury with cut wound at the right occipito-parietal region. The patient was treated by cardiologist and was in the ICU for 2 days and discharged with inderal 20 mg twice daily. 

The patient continued to complain of fainting with the escalation of the presented up complains.

CT-scan brain done 10-November-2013 showing huge chronic subdural hematoma over the right convexity. MRI done the same day confirming the pathology with shifting of mid-line structures.

On examination, the patient is alert. Cranial nerves are intact, but he has left sided hemiparesis. No sensory deficit.

Burr hole in the right frontal and most posterior aspect of the right parietal region. The external drain was put to the parietal region and meticulous cleaning and irrigation with saline done. The wounds closed and the drain fixed by nylon.

Smooth postoperative recovery. The power of the left side became normal.

The patient has huge hematoma, that evacuation is mandatory. Over 80% of case can be treated with insertion of external drain.

In case of failure of the external drain then craniotomy with removal of the thick hematoma must be done.