Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 2, 2011, pp. 308-309

Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 308-309

Letter to Editor

Incidental aneurysmal rupture during burrhole drainage for chronic subdural hematoma

Shyam K Mishra, Mukund Prasad, Indranil Ghosh, Rabindra N Bhattacharya

Department of Neurosurgery, AMRI Hospitals, Dhakuria, Kolkata, India

Correspondence Address: Shyam K Mishra, Department of Neurosurgery, AMRI Hospitals, Dhakuria, Kolkata, India, rnb@gmail.com

Date of Submission: 11-Dec-2010
Date of Decision: 11-Dec-2010
Date of Acceptance: 25-Jan-2011

Code Number: ni11089

PMID: 21483148

DOI: 10.4103/0028-3886.79167

Sir,

Chronic subdural hematoma (SDH) classically occurs in the elderly and burrhole drainage is effective in more than 85% of patients. ^[1] The complications of burrhole evacuation include recollection, inadequate drainage, underlying intracerebral hemorrhage (ICH), ^[2],[3] and contralateral hematoma. ^[4] We present a case of burrhole evacuation of chronic SDH, during which an incidental aneurysm ruptured.

A 63-year-old gentleman presented with headache of 4 days duration with few episodes of transient loss of consciousness and vomiting. Computed tomography (CT) scan of brain [Figure - 1] showed left fronto-temporo-parietal SDH with mass effect. Burrhole drainage of SDH was done. During the procedure, there was sudden deterioration in the clinical status of the patient with brain swelling. Repeat CT scan of the brain [Figure - 2] showed massive subarachnoid hemorrhage (SAH). He was kept on ventilator, and after his condition stabilized, cerebral digital subtraction angiography was done [Figure - 3], which revealed a large anterior communicating artery (Acom) aneurysm with vasospasm involving A1 segment of anterior cerebral artery and Acom. Craniotomy and clipping of Acom aneurysm was done. As there was gradual neurological deterioration, CT scan was repeated which revealed hydrocephalus. Continuous external ventricular drain was installed. But the patient continued to deteriorate and expired.

To best of our knowledge, there is no similar published report. We assume that such cases might have happened but not reported. Unexplained brain swelling after chronic SDH evacuation should give a suspicion of SAH other than underlying ICH and contralateral SDH.

References

Copyright 2011 - Neurology India

The following images related to this document are available:

Photo images