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Contralateral Acute Subdural Hematoma Developing Intraoperatively following Evacuation of an Ipsilateral Spontaneous Acute Subdural Hematoma in an Elderly Patient
A 73-year-old male patient presented in an unconscious state with weakness of the right side of the body, 8 hours after a fall. On examination, he had no eye opening, no verbal response, and on pain was localizing with the left hand. He was flexing weakly with the right upper limb on pain. There was no history of antiplatelet or anticoagulant intake and he had no other preexisting medical illnesses. Computed tomography (CT) scan showed a left-sided acute subdural hematoma (SDH) with significant mass effect, effacement of cisterns, and midline shift ([Fig. 1A-C]). There was no contralateral intracranial bleed or injury. He underwent left-sided temporoparietal craniotomy, durotomy, and clot evacuation. Intraoperatively, an arterial bleeding point was noted in the left frontal lobe and was cauterized. The brain was extremely lax and hence after duraplasty, the bone flap was replaced. Postoperatively, he was reversed from anesthesia but not extubated and was noted to have left-sided focal seizures. A CT scan was done that showed contralateral acute SDH with a small interhemispheric SDH with no parenchymal contusion ([Fig. 2A–E]). However, as this was not causing any significant midline shift or cisternal effacement conservative treatment was continued. A magnetic resonance imaging (MRI) study was done later too that showed only an acute subdural hematoma on the right side with no cerebral injury ([Fig. 3A–D]). His seizures were managed with anticonvulsants and serial CT scans showed resolution of the contralateral SDH over time ([Fig. 3E–H]). He was discharged uneventfully after 3 weeks with a full recovery.
Article published online:
29 July 2021
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