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TITLE:

CHRONIC SUBDURAL HEMATOMA WITH UNEXPLAINED WHITE COLORED SEDIMENT: A CASE REPORT

AUTHORS:

Dr. Hani Talal Aljohani , Subhi M.K. Zino Alarki

ABSTRACT:

Introduction. Chronic subdural hematoma is characterized by the abnormal collection of blood products in the subdural space with a relatively indolent course of disease progression. Patients with this condition can develop signs of infection as a consequence of hematoma infection. Case presentation. An 83 years old male patient, Came to the hospital complaining of 2-week right-sided hemiparesis. The patient was conscious with GCS of 15. Power of right upper and lower extremities was one out of five. No signs of infection were noticed. An enhanced brain CT scan showed left hypodense crescentic fluid collection. Diagnosis of chronic subdural hematoma was made. Management and Outcome. Primarily, Hematoma was aspirated using a burr-hole under local anesthesia. Upon aspiration, the hematoma cavity was filled with a white-colored fluid which raised the suspicion of subdural abscess. The evacuated fluid was cultured and turned negative. Subsequently, a 2nd operation with craniotomy was done and the evacuated fluid turned negative as well. Thus, diagnosis of a subdural abscess was excluded with the negative culture results. Postoperatively, the patient was free of hemiparesis and discharged after reporting a generalized well-being. Discussion Infected subdural hematoma is a rare condition. After the literature reviews, almost only 28 cases have been reported in the same condition with variable clinical presentations and causative agents. In our patient, this finding was not expected as the patient did not show any systemic signs of infection. Interestingly, with the aforementioned finings, observation was considered unique. Key words: Chronic subdural hematoma, infected subdural hematoma, burr-hole evacuation, craniotomy, subdural abscess, computed tomography

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