Rapid evacuation of chronic subdural hematoma - A possible traumatic brain injury (TBI)

The chronic subdural hematoma is an entity, which affects mainly the elderly patients. According to literature, the complication rate was up to 22,7%, including recurrence of hematoma, worsening of the neurological status, postoperative delirium, etc. Treating of a chronic subdural hematoma could be conservative and operative, including twist drill craniostomy, single or multiple burr hole drainage, and craniotomy. In the patients who underwent a decompression of the hematoma a postoperative hyperperfusion syndrome could be observed, according to literature up to 51,4%. This syndrome is associated risk of postoperative delirium and neurological deterioration. The hyperperfusion syndrome is also observed in traumatic brain injury. A rapid decompression of a subdural hematoma leads to a brain shifting to the skull bones and thus a traumatic brain injury due to decompression. The development of the hyperperfusion syndrome could be related to the decompression of the subdural hematoma in a rapid fashion.