Fatal Subependymal Hemorrhage Following Drainage of Intracranial Chronic Subdural Hematoma

Introduction: Intracranial chronic subdural hematomas are frequently encountered in neurosurgical practice. Surgical drainage of this type of hematoma has been used for many years with good results. Nevertheless, with chronic subdural hematomas draining, unexpected neurological complications may occasionally happen. An intracerebral or intraventricular hemorrhage following such an evacuation is very rarely observed. We report a rare case of fulminant subependymal hemorrhage after the evacuation of intracranial chronic subdural hematomas. Case Report: We report the findings regarding 75-year-old male presented with complaints of severe headache for 5 days, with mental confusion, disorientation, and slight right hemiparesis. Past history revealed a road accident with head and pelvis trauma three months ago. Computed tomography of the head showed a left acute on chronic subdural hematomas with mass effect and midline shift. We proceeded with the surgical evacuation of the left subdural hematoma via two burr-hole craniotomy, complicated later with subependymal intraventricular hemorrhage, subsequently operated on for external ventricular drainage. Unfortunately, the patient died one week later of a pulmonary infection. Discussion and Conclusion: Our case demonstrated a subependymal bleed following surgical drainage. We hypothesize that the sudden decompression of the brain could lead to mechanical stress at the interface between the solid (brain) and liquid (cerebrospinal fluid) components within the cranium. This stress might cause rupture of the engorged subependymal veins, which were likely swollen due to prolonged compression. This mechanism could account for the post-operative CT findings in our case. This postoperative complication could be avoided if slow and gradual decompression is performed during surgical drainage.