Intracerebral Hematoma after Evacuation of Chronic Subdural Fluid Collection

Report of Three Cases

Abstract

The authors encountered three cases of intracerebral hematoma (ICH) occurring early after surgery for chronic subdural fluid collection. A 54-year-old male complained of speech disturbance and facial weakness 22 hours after irrigation of a chronic subdural hematoma (CSH). Computed tomography scan showed an ICH beneath the previously removed CSH. His neurological deficit disappeared with conservative treatment. A 73-year-old male developed expressive aphasia 14 hours after surgery for chronic subdural hygroma. The patient was treated conservatively and the aphasia was still present 1 year after the ictus. A 3-month-old boy developed a left ICH and had a generalized convulsion 60 hours after irrigation of bilateral CSH. With conservative treatment there was no neurological deficit 1.5 months after the episode. Almost all of the reported ICH appeared in the subcortex just beneath a previously evacuated collection of subdural fluid. The symptoms were rapid deterioration of consciousness and focal neurological deficits developing soon after surgery. One possible mechanism of ICH is diapedesis through increased permeability of parenchymal blood vessels due to the sudden increase in cerebral blood flow after longstanding extracerebral fluid collection. The prognosis of this complication is poor. Therefore, subdural fluid should be removed slowly to avoid sudden decompression.