Background:Subacute subdural hematoma (SASDH) is an entity which is yet to capture the popular imagination among the neurosurgeons. Its management is often equated clinically to that of the chronic subdural hematoma (CSDH). However, their neurological deterioration is usually rapid, which seems to align them with acute subdural hematoma (ASDH). We proceed for their epidemiological evaluation. The advantages of a novel “double barrel technique (DbT)” over the conventional burrhole drainage are also presented.Methods:This retrospective study was conducted on all the patients having clinical and radiological evidence of SASDH, admitted to a tertiary care referral institute, during the period August 2013 to December 2015. Postoperatively, patients were followed-up for 3–24 months.Results:46.87% of the patients belonged to the 35–54 year age group with a male predominance (3.6:1); 68.7% had a history of alcohol abuse, whereas aspirin users were 25%. 87.5% cases were unilateral, 18.75% were hemispheric, and 46.87% were present on the left side. Altered consciousness (100%) followed by headache (37.5%) were the most common presenting clinical features.Conclusion:SASDH is an uncommon neurosurgical entity (0.89% of traumatic brain injury cases in our study) and mimics both CSDH as well as ASDH. The true incidence of SASDH may have been underestimated due to its clinical imitation with CSDH. This study in a South Asian nation also provides the epidemiological data of this rare neurosurgical entity. Outcome of surgery is good; our retrospective study confirms that “DbT” is an adequate and safe treatment. However, a better designed, randomized control trial will be needed to reinforce our findings.

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Traumatic Brain Injury (TBI) constitutes a wide spectrum of clinic-radiological events, ranging from EDH (Extra dural hematoma), ASDH (Acute Subdural Hematoma), contusion or DAI (Diffuse Axonal Injury). TBI present to Emergency Department (ED) either due to RTA (Road Traffic Accident), an assault or a fall from height. They result in closed type or open type of head injury. Brain stem is the part of brain more over injured by severe collisional impact to the skull causing alteration in microstructural organization inside the brain. Patients usually present with altered sensorium. The impact of trauma may be either localized or distributed all over. Here we present an uncommon case of traumatic "Brain Stem Contusion" (BSC), its presentation & management in an acute setting. Case Description Here we present a case of a 35 year male (Figure 1b) presenting to our E.D. (Emergency department) with altered sensorium, vomiting, bleeding from nose and two episode of convulsions, due to fall from bike under the influence of alcohol, with Glasgow coma scale (GCS)-E1V1M5 (7/15). There was left sided hemiparesis (MRC-Medical research council, Grade-2/5). Pulse rate was 62 per min, blood pressure 140/80 mm of Hg. Respiration was abdominothoracic type, 18 per minute; left pupil dilated but sluggishly reacting to light, right side normally reacting to light. There was right side weakness (Figure 1a) of both the limbs. Noncontrast CT scan of the brain revealed brain stem contusion (BSC), in the midbrain area on the right side with DAI (Figure 2).

Posttraumatic ipsilateral basal ganglia infarction with contralateral hemorrhage (IBGICH) is an extremely rare neuropathologic entity. Hematomas or infarction of the basal ganglia in head injury have long been recognized but their mechanism has not been revealed clearly. It is presumed to be secondary to rupture and/or vasospasm, followed by thrombosis of the lenticulostriate and/or anterior choroidal artery. This happens by shearing stress as a result of acceleration or deceleration torques. Outcome of traumatic basal ganglia hemorrhage (TBGH) appears favorable unless it is large, associated with coagulation disorders or other intracranial injuries such as diffuse axonal injury, cerebral contusion etc. We present a rare case of a 32-year-old man with traumatic IBGICH (mirror-image). Patient was managed conservatively and discharged with residual paresis and aphasia. Mechanism of trauma, clinical features, management, and most importantly the medicolegal aspect of the TBGH is discussed.