[Organized chronic subdural hematoma; report of two cases]

Two cases of organized chronic subdural hematoma were presented. The first case had a one-year history of disorientation and right hemiparesis. CT scan revealed a low density area with linear high density in its medial margin, suggesting chronic subdural hematoma on the left frontal convexity. Surgery was performed expecting to remove the hematoma. There was, however, only a little fluid inside with thick membranous tissue. The second case, who has Crouzon disease, presented a one-year history of pseudobulbar palsy and tetraparesis after surgery for chronic subdural hematoma and hydrocephalus. The diagnosis of organized subdural hematoma was made at the time of reoperation which was performed expecting to remove the recurrent chronic subdural hematoma. Plain CT, done after admission to our hospital, showed homogeneous low density area remaining in the bilateral frontal convexity. Infusion scan revealed marked enhancement of the medial margin of the low density area. The lesion was demonstrated as a low intensity area by T1-weighted magnetic resonance images (MRI). Marked enhancement was noted around the low intensity area after the infusion of Gd-DTPA. Although it is very hard to make a diagnosis of organized chronic subdural hematoma using only the CT scan preoperatively, combination of the CT scan and MRI with Gd-DTPA enhancement seemed to be very useful for this purpose.