A Rare Case of Ossified Chronic Subdural Hematoma Complicated with Tension Pneumocephalus

Abstract

A 59-year-old man presented with epileptic seizures interpreted as episodic syncope in the past 3 years and the patient had a history of head trauma about 4 years ago. Computed tomography revealed an ossified chronic subdural hematoma involving the right frontotemporoparietal region, which was totally resected using microsurgical technique. Postoperatively, weakness developed in right arm and magnetic resonance imaging revealed a bilateral tension pneumocephalus, which was immediately treated by a left frontal burr hole trepanation, and the patient was discharged uneventfully.

A post-traumatic ossified subdural chronic hematoma successfully managed in a 34-year-old woman: a case report

“…In contrast with other types of SDHs, which are common in the practice of neurosurgery and more prevalent among elderly patients, OSCH typically occurs in children and young adults, as in this case, and is a much rarer entity 1 , 2 . It is reported that only 0.8–10% of CSDH patients develop OSCH 8 . As a consequence, there are no shared or consistent beliefs regarding the clinical approach or the pathophysiology 4 .…”

“…Clinically, OSCH patients are usually asymptomatic. However, when OSCH is symptomatic, complaints are not unique and are similar to those of nonossified or noncalcified SDH or any other space-occupying lesion 2 , 8 . Headache is reported as the most common symptom, followed by confusion, drowsiness, dementia, and convulsions.…”

“…Due to the possibility of cortical damage, ossified SDH is typically treated conservatively in elderly or asymptomatic patients. However, it is believed that surgical therapy is required for young or symptomatic patients 8 . So the surgery decision for this patient was not arguable because of the presence of symptoms that were not controlled by medical treatment, and there was no other explanation for them, as well as considering the young age of the patient.…”

“…In the event of dense adhesions to the brain parenchyma, partial resection may be the only choice. Partial resections restrict brain re-expansion, which increases the patient’s chance of developing a hematoma 3 , 5 , 8 . A clear plane between the ossified hematoma and the brain was noticed in our patient, which was used to achieve complete resection without damaging the brain (Fig.…”

“…One of the most frequently reported complications is recurrent hemorrhage, which should be differentiated from the residual fluid that may need months after surgery to be resolved 4 . One rare but fatal complication is the development of tension pneumocephalus, which needs urgent intervention in contrast with recurring hemorrhage or residual fluid that needs follow-up by control CT, with intervention only needed in clinically deteriorating cases 4 , 8 . Our patient’s follow-up CT was clear, clinical improvement was proven radiologically, and further follow-up was planned.…”