Abstract
Subdural hematoma has been found in three of 143 dialysis patients (2.2%) in the past 15 years. One of them had a chronic subdural hematoma and, after the first operation, a subacute one was found on the opposite side which was removed at a second operation. Later, hydrocephalus developed which was healed by ventriculoperitoneal shunt. The other two cases had chronic and acute subdural hematomas, respectively. There was no worsening and both healing spontaneously. The characteristics of subdural hematoma occurring in dialysis patients to be noted are 1) bilateral and 2) the patients can be any age. Therefore, the main causes presumably are 1) lower coagulation due to heparinization and 2) intracranial pressure change due to dialysis. The syndrome includes intractable headache, mental disorder and light motor paralysis. These manifestations are vague and resemble those of dementia, hydrocephalus and disequilibrium syndrome. Thus, care must be taken at differential diagnosis. CT-scan has made it possible to diagnose early and treat appropriately. By observing the patient's progress through CT-scan one can determine whether operation is necessary or spontaneous healing can be expected. The most appropriate surgical procedure is burr hole, which carries a good prognosis. After operation, strict weight control should be observed during dialysis using Futhan which minimizes hemorrhage.
