Organized chronic subdural hematoma in which its development was observed chronologically in CT scan: Case report

Abstract

The case was 80 year old male. The patient presented gait disturbance, disorientation and dysarthria. CT scan revealed chronic subdural hematoma on the left side and he was treated with trepanation operation. Ordinary thin outer membrane was found on operation. Thereafter, the remaining hematoma was frequently tapped through the burr hole.

High density area was found on the lateral side of the hematoma cavity 7 weeks after operation. 14 weeks after operation, motor aphasia and behavior abnormality happened. CT revealed marked rebleeding, so the second operation (trepanation and drainage) was performed. On operation, ordinary outer mem­brane was found. Even after the operation, the hematoma still remained with the high density area on the lateral side of hematoma cavity. So the recurrence of hematoma was treated by the repeated tap through the burr hole. Even 2 weeks after the second operation, the air bubble remained to be trapped along septum of the hematoma cavity.

The disorientation happened 22 weeks after the first opera­tion (8 weeks after the second operation). The eighth tap was tried, but the hematoma could not aspirated adequately. So the third trepanation and drainage operation was performed. The hematoma was organized. After operation, the size of hematoma decreased to some degree, but the symptom did not change. The hematoma was cultured and Propionibacterium sp was found to exist in hematoma cavity.

Gait disturbance and aphasia happened 24 weeks after the first operation (2 weeks after the third operation). Ultimately, the hematoma was removed by craniotomy. Organized hematoma was found in the subdural space. Although the cultured hematoma showed Propionibacterium sp, the bacteria could not found on Gram stain. The symptom improved after the craniotomy operation. The compression of the brain almosy completely disappeared 26 weeks after the first operation (2 weeks after the cranioto­my operation). No recurrence of chronic subdural hematoma was found 35 weeks after the first operation (11 weeks after the craniotomy).