We describe a case of acute subdural hematoma, successfully treated by burr-hole opening and subdural tapping. The patient was a 55-year-old man who fell from the third floor of his house and suffered a head injury. On admission, he was semicomatose, and a computed tomography (CT) scan showed a right acute subdural hematoma and brain contusion. During preparation for the craniotomy, the patient's neurological state deteriorated. Transcranial Doppler (TCD) examination showed a decrease in mean flow velocity (MFV) in the right middle cerebral artery (MCA) and an increase in the pulsatility index (PI), which means an increase in intracranial pressure and a decrease in cerebral perfusion pressure. The patient was therefore subjected to burr-hole opening and subdural tapping in the right parietal region on the spot, and about 100ml of semiliquid subdural hematoma was drained off. At this time, the both MFV and PI according to TCD had improved. A craniotomy was then performed, and the subdural hematoma was totally evacuated. A postoperative CT scan revealed a contralateral epidural hematoma. Therefore a second craniotomy was performed, and the epidural hematoma was totally evacuated. After surgery, the patient's neurological condition improved to a confused state. Our experience in this case suggests that assessment of intracranial pressure by TCD and subdural tapping in the emergency room prior to craniotomy in the operating room, are beneficial in emergency cases of acute subdural hematoma.
