Armoured brain

Calcified chronic subdural hematoma is a rare but known entity, estimated to represent 0.3-2.7% of chronic subdural hematomas. Although surgical treatment is unanimous for chronic subdural hematomas, therein lies some debate on surgical evacuation of calcified chronic subdural hematomas. We report a case of an 18-year-old male presenting after 17 years of VP shunt with calcified chronic SDH. He presented with only mental retardation and no other neurological deficit and as such he was managed conservatively and discharged with close follow-up. We believe that surgical treatment should only be used in circumstances when it is symptomatic, essential, and viable, and will eventually lead to the patient's neurological improvement based on the cases mentioned in the literature. Our personal experience with this case is that the non-surgical procedure sometimes is able to provide good outcomes, especially when the extracranial problems are managed carefully and the patient doesn’t complain of any neurological deficit.