Intracerebral hemorrhage immediately after evacuation of a chronic subdural hematoma-Report of two cases-

Abstract

Two rare cases of intracerebral hemorrhage occurring immediately after evacuation of a chronic subdural hematoma via burr hole were encountered. In Case 1, a 64-year-old man was aggravated immediately after evacuation of a chronic subdural hematoma and a CT scan revealed the presence of a large subcortical hemorrhage subjacent to the subdural hematoma. In Case 2, an 85-year-old woman who had bilateral chronic subdural hematomas progressively deteriorated in coma about 25 hours after unilateral evacuation of a chronic subdural hematoma and a CT scan revealed the presence of a large subcortical hemorrhage in the temporal lobe contralateral to the burr hole.
Eleven similar cases, nine of which had been reported in other papers and two of which were the present ones, were summarized and the features of this complication were stated based on them. The etiopathogenesis of this complication is not clearly known but rapid surgical decompression of the chronically compressed brain or a sudden increase in the systemic blood pressure which disturbs an autoregulation may cause an increase in the local cerebral blood flow in the area which has damage to parenchymal vessels and in part be responsible for the postoperative intracerebral hemorrhage as encountered in the present cases. Thus, this devasting complication can be avoided if a chronic subdural hematoma is slowly removed with keeping normotension during and after the surgery.