Unusual Clinical And Imaging Presentation Of Chronic Subdural Hematoma

Various clinical and radiologic presentations of chronic subdural hematoma (SDH) are reported in the literature. Therefore, sometimes the presentation of a patient with chronic SDH often creates confusion regarding decision making. Here, the authors present three cases of chronic SDH, in which the clinical presentation, radiology, and operative findings were unusual. In the first case, the patient presented with acute extradural hematoma like clinical as well as radiologic presentation but intraoperatively found to have chronic calcified SDH, whereas another case with history of bilateral ventriculoperitoneal (VP) shunting at childhood presented with large head with discharging sinus at the forehead. Radiologic and operative findings were very much unusual. Intraoperatively, the bilateral subdural collection was found to have fungus-like projections with subdural space communicating with the forehead sinus. In another case, a 10-year-old girl with history of VP shunting at age of 6 months presented with left hemiparesis of subacute onset. Computed tomographic (CT) scan revealed biconvex lesion at the right parietal region intraoperatively. The authors found the shell-like lesion with inner and outer membrane calcified, within which the subdural collection was present. In these three cases, they observed the very unusual mode of presentation of chronic SDH, and in the literature such mode of presentation and operative findings of such type are very rare.