Description

An 84-year-old man who hit his head 2 months previously presented with indistinct consciousness, right-partial paralysis and aphasia. He had been in good health with no evidence of coagulopathy or haemorrhagic diathesis. CT showed a diffuse isodense lesion in the left frontoparietal region with brain shift (figure 1A). A diagnosis of chronic subdural haematoma (SDH) was made and he was treated with burr hole drainage four times.1 The initial drainage was applied to treat the SDH, and the others were required for treatment of bleeding after drainage. After 127 days, CT revealed gradual shrinkage of the haematoma, brain shift and a separate membrane around the SDH (figure 1B). The patient still showed the same clinical disturbances. The follow-up CT demonstrated the disappearance of brain shift after 189 days (figure 1C). At this time, he became alert and had no paresis and no difficulty in speech. CT after 520 days showed only a small area of haematoma (figure 1D) without treatment after the initial four rounds of neurosurgery.2 He recovered and is now able to drive a car safely.

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Figure 1

Recovery of brain damage. (A) Cerebral CT scan on admission. (B) Cerebral CT scan on day 127. (C) Cerebral CT scan on day 189. (D) Cerebral CT scan on day 520.