[Acute interhemispheric subdural hematoma: a case report with good result by small craniotomy during the chronic...

A 88-year-old male slipped down and hit his head on the floor on the night of November 27, 1988. He was able to return to bed and fell asleep. Next morning, he noticed gait disturbance and was admitted to our clinic. Neurological examination revealed monoparesis (1/5) and hyperreflexia of the left lower extremity. Computed tomography (CT) demonstrated a semilunar high density area with the base toward the right side of the falx. General anesthesia for craniotomy was judged to be contra-indicated because serious ischemic heart disease was also present. Although his neurological condition proved to be not progressive, and the monoparesis recovered gradually under conservative treatment, he could not walk by himself one month after the accident. Since the hematoma was surmised to be liquidized and, hence, could be aspirated either through a burr hole or by small craniotomy, an operation was performed under local anesthesia on January 4th, 1989. The hematoma was successfully removed, and the muscle power of the extremities improved to the level of 4/5 - 5/5 just after operation. He was discharged on foot. Lately, there seems to be an increase in patients with traumatic intra-cranial hematomas who, because of systemic problems related to advanced age, are regarded as high-risk subjects for craniotomy under general anesthesia. Not a few of these patients have residual neurological deficits, even though they are in a chronic stage. The subject of this case reported here is typical of such patients.(ABSTRACT TRUNCATED AT 250 WORDS)