J Korean Neurotraumatol Soc.  2011 Apr;7(1):39-42. 10.13004/jknts.2011.7.1.39.

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

• An GH
• Jwa CS

• KMID: 1427652
• DOI: http://doi.org/10.13004/jknts.2011.7.1.39

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.

Keyword

Acute subdural hematoma; Chronic subdural hematoma; Intracerebral hemorrhage; Complication

MeSH Terms

Brain
Cerebral Hemorrhage
Female
Hematoma
Hematoma, Subdural, Acute
Hematoma, Subdural, Chronic
Humans
Stroke

Figure

• 

  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.

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  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.

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  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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