診断および治療に苦慮した慢性硬膜下血腫の１例

抄録

Complications of surgery for chronic subdural hematoma include such as acute subdural hematoma, pneumocephalus and subdural abscess. We report a case of chronic subdural hematoma that was difficult to diagnose and treat. The patient was an 87-year-old man who had fallen one day. Two months later, he devel­oped right hemiparesis, and was taken to our hospital by ambulance. The diagnosis was chronic subdural hematoma, and he underwent burr-hole irri­ga­tion. Right hemiparesis had improved after the opera­tion, but he became aware of clumsiness of the right hand on the third postoperative day. Subsequently, he addi­tional­ly developed aphasia, and head CT performed on the 6th postoperative day demonstrated a convex lens-shape­d hematoma. Therefore, he underwent cra­niotomy and hematoma evacuation with a diagnosis of acute epidural hematoma. However, no epidural hematoma was observed intraoperatively. When the dura mater was dissected, a chronic subdural hematoma was seen. Beneath the chronic subdural hematoma, there was a previous chronic subdural hematoma. We removed it as much as possible and the operation was finished. One month later, he developed right paresis and aphasia again so we performed burr-hole irrigation. The subsequent progress was good.

On the CT image, subdural hematoma that appeared outside the previous chronic subdural hematoma capsule should be carefully distinguished from acute epidural hematoma and acute subdural hematoma, which is a postoperative complication of chronic subdural hematoma.