The patient was admitted to Shmaisani hospital in the evening of 18-March-2012 complaining of inability to walk and right sided weakness with sensory dysphasia. The patient after falling down one month ago was admitted to other hospital and CT-scan done at that time showed fresh left sided huge subdural hematoma. The relatives claiming that she was deteriorating during this month. The patient has no diabetes mellitus, nor arterial hypertension.

CT-scan was repeated and showed enlargement of the hematoma with variable consistency of its texture. MRI of the brain showed

On examination, the patient is bedridden, with gross right sided weakness and not reacting properly to the verbal commands.

Burr holes inserted at the most prominent and dependent area of the left parietal region and in the left frontal just at the hair line. The dura was opened without violating the hematoma membranes. Incision of the hematoma membranes and insertion of the external drain from the hole located in the parietal region. Using saline, the hematoma cavity was irrigated several times and check for flow was all the time inspected.

Routine closure of the wound. Smooth postoperative recovery. The patient became well oriented and the hemiparesis disappeared.  The patient was sent to the ICU and the external drain system was setup for the following 72 hours.

The patient has progressing subdural hematoma with gradual clinical deterioration. Surgical evacuation is the only solution.

The patient was doing OK and the night of 20-March-2012 she complained, that she did not sleep the previous night. She was give 4 mg Valium tab. 30 minute after that, she progressed respiratory arrest, for what she was urgently put in ventilator. Control CT-scan was done 3.30 am the morning of 21-March-2012 and it was the same as the first postoperative check CT-scan done the morning of the first postoperative day.

The patient after completion of CT-scan regained consciousness and she was extubated. The drain was out during resuscitation.