Intraparenchymal haemorrhage after evacuation of chronic subdural haematoma. Report of three cases and review of the literature

Abstract

Three cases of intracerebral haemorrhage following removal of a chronic subdural haematoma are reported and the literature on this topic reviewed. The possibility of an increase in cerebral blood flow following removal of CSH, makes slow, gradual decompression mandatory in all patients submitted to cranial trapanation.

Spontaneous intracerebral haemorrhage following evacuation of chronic subdural hematomas

“…Review of literature has documented only 25 cases that developed spontaneous intracerebral bleeding following drainage of CSDH. [2][3][4][5][6][7][8][9][10][11][12][13] Burr-hole evacuation of the haematomas with or without closed system drainage had been performed in all previously reported cases and the cases in this report.…”

Intracerebral haemorrhage during surgery for chronic subdural haematoma

“…ICH also occurred in such atypical locations as occipital, 12 parietal, 6,9,11 parieto-occipital, 10 frontal, 1,4,6,12-14 temporal, 6,11 frontotemporal, 7,14 temporoparietal, 7-9,13 diffuse cortical or deep intracerebral locations. 1,4,7,13,15 Complications were usually debilitating in nature and were invariably responsible for the poor outcomes in these patients, with a fatal outcome reported in a fifth of patients, 1,6,7,9,12 and another quarter being severely disabled. 1,[7][8][9]12 At present, the most likely explanation for the onset of haematoma formation is a sudden variation in cerebral blood flow as a consequence of cerebral decompression.…”

“…Symptoms due to haematoma formation appeared immediately after surgery, 1,6-9,12-14 within 1 day, 4,9,[11][12][13][14] or several days after surgery. [5][6][7]10 Characteristically, haematomas always developed on the ipsilateral side to the subdural haematoma if unilateral. ICH also occurred in such atypical locations as occipital, 12 parietal, 6,9,11 parieto-occipital, 10 frontal, 1,4,6,12-14 temporal, 6,11 frontotemporal, 7,14 temporoparietal, 7-9,13 diffuse cortical or deep intracerebral locations.…”

“…1,[7][8][9]12 At present, the most likely explanation for the onset of haematoma formation is a sudden variation in cerebral blood flow as a consequence of cerebral decompression. 1,2,[4][5][6][7][8][9][10][11][12][13][14][15] Xenon-enhanced CT studies have demonstrated that cerebral blood flow in patients with CSDH is diminished, particularly in the ipsilateral frontal cortex, 16 rolandic cortical region, 17 putamen and thalamus. 16,18 This is followed postoperatively by a progressive normalization of blood flow in these areas.…”

“…[5][6][7]10 Characteristically, haematomas always developed on the ipsilateral side to the subdural haematoma if unilateral. ICH also occurred in such atypical locations as occipital, 12 parietal, 6,9,11 parieto-occipital, 10 frontal, 1,4,6,12-14 temporal, 6,11 frontotemporal, 7,14 temporoparietal, 7-9,13 diffuse cortical or deep intracerebral locations. 1,4,7,13,15 Complications were usually debilitating in nature and were invariably responsible for the poor outcomes in these patients, with a fatal outcome reported in a fifth of patients, 1,6,7,9,12 and another quarter being severely disabled.…”