[Calcified chronic subdural hematoma. A case report in an old patient]

Calcified chronic subdural hematoma is a well-known disease to many neurosurgeons as it is diagnosed with only a plain skull X-ray film. Although several reports on this condition are seen, many of them are dealing with those in children or young people, and those in the aged are only few. One case of calcified chronic subdural hematoma in an old man is described. An 86-year-old man with a sudden attack of left hemiparesis was admitted to the Kanto Rosai Hospital. Two years before, he had had a history of head injury on his right temporal area, which caused no neurological deficit before this attack. Neurological examination on admission revealed mild confusional state and severe left hemiparesis. A plain skull film of A-P projection showed a linear calcification in the right temporal area. CT scan revealed a right temporal chronic subdural hematoma with some calcification in the internal membrane, which caused moderate midline shift. Right temporal small craniotomy was performed. The hematoma contained no fluid as usual but paste-like substance, and was partially removed. Postoperatively, he showed an improvement in unstability, but the left hemiparesis remained. On the 23rd postoperative day, he expired of severe pneumonia. Autopsy showed 14.0 X 8.0 X 1.2cm sized subdural hematoma in the right temporal area. Microscopically, the internal layer of the dura markedly thickened, and the appearance of "pachymeningitis hemorrhagica interna" was clearly seen. The thicked internal layer was devided into two layers, and the hematoma was existed just between the two layers.(ABSTRACT TRUNCATED AT 250 WORDS)