Intracerebral Hemorrhage Immediately Following Surgical Treatment of Chronic Subdural Hematoma

Abstract

Two rare cases of intracerebral hematoma which were encountered immediately after the surgical treatment of an intracranial chronic subdural hematoma were reported. In Case 1, a 70-year-old man deteriorated immediately following the irrigation of a chronic subdural hematoma. The carotid angiogram obtained two hours after the operation revealed a subcortical hemorrhage beneath the previously operated area, and this intracerebral hematoma was verified by the second operation four hours after the first. In Case 2, a 78-year-old woman immediately developed complete left hemiplegia and a drowsy state after removal of chronic subdural hematoma by craniotomy. About twenty hours after the operation, a follow-up CT scan revealed an intracerebral hematoma just beneath the previously removed hematoma in the right temporo-parietal lobe. Based on these experiences, although rare, the development of an intracerebral hemorrhage must be considered if a patient deteriorates immediately following surgical treatment of a chronic subdural hematoma. The possible reasons for the appearance of such intracerebral hematomas were also discussed.

Spontaneous intracerebral haemorrhage following evacuation of chronic subdural hematomas

“…Review of literature has documented only 25 cases that developed spontaneous intracerebral bleeding following drainage of CSDH. [2][3][4][5][6][7][8][9][10][11][12][13] Burr-hole evacuation of the haematomas with or without closed system drainage had been performed in all previously reported cases and the cases in this report.…”

Complications of burr-hole craniostomy and closed-system drainage for chronic subdural hematomas: a retrospective analysis of 376 patients

“…In most series, an intracerebral hematoma is the only or major cause of surgery-related mortality. Hemorrhage into previously undetected areas of contusion, damage to cerebral vasculature secondary to rapid perioperative parenchymal shift, and decompression-related increase of the cerebral blood flow in combination with a faulty autoregulation are considered to be the underlying pathomechanisms [31,32,33]. Recent data suggest that the latter are most likely responsible for formation of the hematoma.…”

Postoperative hematoma involving brainstem, peduncles, cerebellum, deep subcortical white matter, cerebral hemispheres following chronic subdural hematoma evacuation

“…This complication usually lead to the poor outcome in these patients[45101112] with a fatal outcome reported in one-third of the patients, with another third severely disabled. [45111415]…”