Gyu Hwan An; Cheol Su Jwa

doi:10.13004/jknts.2011.7.1.39

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An and Jwa: "Contralateral" Acute Subdural and Intracerebral Hemorrhage Occurring Simultaneously after Evacuation of Huge Chronic Subdural Hematoma

Case Report

J Korean Neurotraumatol Soc 2011;7(1):39-42.

Published online: 30 April 2011

DOI: https://doi.org/10.13004/jknts.2011.7.1.39

"Contralateral" Acute Subdural and Intracerebral Hemorrhage Occurring Simultaneously after Evacuation of Huge Chronic Subdural Hematoma

Gyu Hwan An, Cheol Su Jwa

Department of Neurosurgery, National Medical Center, Seoul, Korea

Address for correspondence: Cheol Su Jwa, MD Department of Neurosurgery, National Medical Center, 243 Euljiro, Jung-gu, Seoul 100-799, Korea Tel: +82-2-2260-7279, Fax: +82-2-2262-4869 E-mail: chsjwa@hanmail.net

Received 14 March 2011 Revised 17 March 2011 Accepted 6 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report an uncommon case of "contralateral" acute subdural hematoma (SDH) and intracerebral hemorrhage (ICH) developing simultaneously after evacuation of a huge chronic SDH associated with previous ischemic stroke. An 80-year-old female admitted with bilateral chronic SDH with midline shift by the left-sided dominant huge hematoma. The patient underwent burr-hole evacuation for the bilateral hematoma. The left-sided huge hematoma was first evacuated and the right-sided small hematoma was drained later. Immediate computerized tomography (CT) scans after surgery revealed acute brain shift contrary to the initial scan and acute SDH and ICH developing contralaterally for the huge hematoma. The pathophysiological mechanisms were discussed.

Keywords: Acute subdural hematoma, Chronic subdural hematoma, Intracerebral hemorrhage, Complication

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FIGURE 1.

Preoperative computerized tomography (CT) scans show bilateral chronic subdural hematoma with the left-sided dominant huge hematoma, which causes mass effect and midline shift from left to right side.

FIGURE 2.

Postoperative computerized tomography (CT) scans just after surgery reveal acute brain shift from right to left side contrary to initial CT scans and acute subdural and intracerebral hemorrhage on the “contralateral” side of the huge subdural hematoma.

FIGURE 3.

Computerized tomography (CT) scan 2 months after surgery shows total hematoma resolution state and extensive cerebromalatic change in the territory of the left middle cerebral artery.

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