Abstract
We report a rate case of multiple intracerebral hematomas which immediately followed the evacuation of chronic subdural hematoma. A 81-year-old woman with a 5 year-history of multiple cerebral infarction was referred to our clinic with a disturbance of consciousness. A CT scan of head show large bilateral subdural layering hematomas with remarkable bilateral brain compression. The bilateral subdural collections were evacuated through a burr hole and subdural dranage respectively. Postoperatively she remained lethargic, with mild left hemiparesis. A CT scan revealed multiple intracerebral hematomas in the frontal lobe and deep in the bilateral hemisphere. The patient was treated conservatively and discharged with a slight left hemiparesis. Possible pathogenic mechanisms included hemorrhage into a previously undetected area of contusion, damege to the cerebral vasculature secondary to the rapid perioperative parenchymal shift, and sudden increase in cerebral blood flow combined with focal disruption of autoregulation. We think that the present postoperative multiple intracerebral hematomas occurred as a result of diapedesis through the increased permeability of parencymal blood vessels due to the sudden increase in cerebral blood flow following the rapid surgical decompression of the initial lesion. This devastating comlication could be avoided if closed-system dranage is used for the slow decompression of chronic subdural hematoma.
