Postoperative hemispheric hyperperfusion and status epilepticus after chronic subdural hematoma evacuation: a case report

Cerebral hyperperfusion syndrome (CHS) is rarely reported after chronic subdural hematoma (CSDH) evacuation. We describe a 40-year-old man who developed right hemispheric swelling, neurological deterioration, generalized seizures, and ipsilateral hyperperfusion on computed tomography perfusion after burr-hole drainage of a right CSDH. The overall clinical and radiological course was most consistent with probable CHS complicated by refractory status epilepticus, although seizure-related ictal or postictal hyperperfusion could not be fully excluded. He required strict blood pressure control, antiseizure therapy, deep intravenous anesthesia, and continuous electroencephalographic monitoring. Serial perfusion imaging showed gradual resolution of the hyperperfusion. He was discharged without neurological deficits and had returned to work with a modified Rankin Scale score of 0 by postoperative day 45. At 1 year, he remained seizure-free after withdrawal of all antiseizure medications, and an outside-hospital 24-hour ambulatory electroencephalography report showed no epileptiform abnormalities.