Subacute Subdural Hematoma Following Ventriculoperitoneal Shunt Procedure: A Case Report

The ventriculoperitoneal shunt (VPS) procedure is known to be a risk factor for subdural hematoma (SDH), although it is uncommon. The development after possible cerebrospinal fluid overdrainage and stretching of bridging veins facilitates the further expansion of the hematoma, thus provoking intracranial symptoms and often necessitates surgical treatment. However, in the case of complications, the incidence of SDH post-VPS insertion is not well documented, especially in Indonesia. We reported a case of a 59-year-old previously healthy Indonesian male with sudden right-side extremity weakness and dysarthria 2 months post-VPS procedure as the treatment for long-standing overt ventriculomegaly in adults. History of head trauma and oral anticoagulant consumption was denied. As his mental state deteriorated, he also presented with a high fever; therefore, suspicion of cerebritis was raised and was later confirmed to be subacute SDH after a second radiology scan, prompting further surgical intervention. Burr-hole drainage was done, and the patient was discharged from the hospital with a favorable outcome. This case demonstrated that subdural accumulation of the blood may occur following VPS insertion, most likely caused by a sudden pressure release following the procedure. The near-misdiagnosis of subacute SDH proves a challenging diagnosis in such an underreported case.