Subdural empyema complicated after trepanation and drainage of chronic subdural hematoma

Abstract

Rationale: Chronic subdural hematoma (CSDH) is one of the most common neurosurgical diseases. However, complicated subdural empyema rarely occurs after trepanation and drainage of chronic subdural hematoma.Patient concerns: A male patient (77 years old) was admitted to the hospital on the 2nd day of fever after an undergoing a "trepanation and drainage of chronic subdural hematoma" operation at a local hospital. After admission, the patient was treated with an emergency operation in which a subdural abscess was diagnosed and then administered antibiotics after the operation.Diagnosis: According to the clinical manifestations, intraoperative findings of imaging examination and the results of pus culture, the diagnosis was subdural empyema.Intervention: We surgically removed the subdural empyema. Postoperative antibiotics were administered according to the results of bacterial culture.Outcomes: At 3 months after the operation, the patient returned to the hospital for reexamination and was found to have achieved a good recovery and good self-care.Lessons: Subdural empyema after trepanation and drainage of chronic subdural hematoma is a very rare and severe disease. Early diagnosis and operative intervention as well as the intravenous administration of antibiotics can improve the prognosis of patients and enhance their quality of life.Abbreviations: CSDH = chronic subdural hematoma, CT = computed tomography, MRI = magnetic resonance imaging.

Warning with chronic subdural hematomas in the elderly

“…10 One case was reported, an 82-year-old male patient was admitted to the hospital because of depression, paranoia, personality changes, was treated with sedatives for one week but did not improve, then a CT scan was indicated and discovered cSDH, which cause the midline shift to the left. 11 Older people often have brain atrophy, not only losing a large number of neurons, changing mood, memory, affecting cognition, but also when the brain parenchyma shrinks, it also increases the distance from the cerebral cortex to the dura, causing the bridging veins to stretch, long-term tearing and bleeding leading to cSDH. This condition and cSDH can both manifest with personality changes, depression, and anxiety.…”