Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain Case

Chronic subdural hematoma (SDH)

This is a 70 year old male presents to ER after seizure. He has no history of seizure. The seizure occurred at dinner table. He had generalized shaking with loss of consciousness, witnessed by wife. The patient is without memory of the event. He complains of headache. He has no history of trauma. The patient has history of cardiac stents placed 3 years prior and takes aspirin, 81mg daily, and clopidogrel (Plavix) 75 mg daily.

Description

This is a 70 year old male presents to ER after seizure. He has no history of seizure. The seizure occurred at dinner table. He had generalized shaking with loss of consciousness, witnessed by wife. The patient is without memory of the event. He complains of headache. He has no history of trauma. The patient has history of cardiac stents placed 3 years prior and takes aspirin, 81mg daily, and clopidogrel (Plavix) 75 mg daily.

Gallery

Images

Figure 1CT head performed more than 2 years prior to his presentation to ER. This is a relatively normal image.
Figure 2CT head performed on his day of presentation. It shows a thin layer of acute (fresh) blood on the left side of the head between the brain and the overlying cranium (red arrow). It is hemorrhage in the subdural space (aka a subdural hematoma (SDH)).
Figure 3CT head performed 9 days later. It shows a much smaller subdural collection of acute subdural hematoma (white in shade, red arrow) and shows the development of a subacute collection more anteriorly (grey in shade, violet arrow).
Figure 4CT head performed an additional week later. It now shows a large collection of chronic (old) blood in the subdural space; a chronic SDH (violet arrow). Not that it is causing significant pressure on and deforming the underlying brain.
Figure 5Photo taken in the OR showing the planned incision for craniotomy to evacuate the left-sided chronic SDH.
Figure 6Video taken in the OR. The craniotomy has been performed and the dura has been opened. An electro-cautery is used to perforate the exposed subdural membrane. The chronic subdural hematoma then is spontaneously expressed under some pressure. The underlying brain is then seen.
Figure 7Photo taken showing the surface of the brain after much f the chronic SDH has been evacuated.
Figure 8CT head performed within a few hours of the craniotomy. It shows reduction in the size of the subdural collection and its effect on the underlying brain. Air and a surgical drain (violet arrow) can be seen in the subdural space.
Figure 9CT head using bone windowing to demonstrate the craniotomy.
Figure 10CT head performed 1 week postop. It shows continued resolution of the chronic SDH and effect on the brain.
Figure 11CT head performed about 1 months after the surgery. It shows complete resolution of the chronic SDH and normal appearance of the underlying brain.

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