2019 Volume 24 Issue 2 Pages 218-223
Although the computed tomography (CT) findings of encapsulated acute subdural hematoma (EASDH) are similar to those of chronic subdural hematoma (CSDH), the treatment of EASDH differs from the treatment of CSDH. CSDHs are usually treated by burr‒hole irrigation and drainage, whereas a craniotomy is necessary for the radical cure of an EASDH. Here we report the case of a patient with EASDH, and we describe the difficulties in differentiating his EASDH from CSDH. At 1 week before his admission, a 92‒year‒old Japanese male was suffering from gait disturbance and somnolence. CT revealed a crescent‒shaped subdural hematoma which indicated high density within isodensity. We diagnosed CSDH and performed burr‒hole irrigation and drainage, but the post‒operative CT showed a residual hematoma. We then performed a craniotomy to evacuate the hematoma. The operative findings indicated a jellylike hematoma with a thick outer membrane, similar to a CSDH. His consciousness disturbance was improved, and the postoperative course was uneventful. The characteristics of an EASDH in operative findings would be a thick outer membrane similar to that observed in CSDHs and jellylike hematomas. In such cases, a craniotomy should be considered for the evacuation of the hematoma.
