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10-NOVEMBER-2022 AHMAD MUHAMED BARAKAT 80 YEARS
HUGE PROGRESSING BILATERAL SUBDURAL HYGROMA, MORE THE LEFT CONVEXITY WITH
SUBFALCINE HERNIATION LEFT FRONTAL LOBE.
Anamnesis
The patient a Yemeni citizen, came to the clinic
05-November-2022 telling that he felt down 2
weeks ago with left hemiparesis. MRI of the
brain done 31-October-2022 showing huge
biconvixital hygroma with infarction of the
right occipital lobe. The patient is
insulin-dependant for 30 years with arterial
hypertension for 10 years and underwent stinting
in Egypt. He has hearing loss right ear for 40
years. The son telling that he improved with
medication and coming for opinion.
On examination, the patient is alert and
neurologically free. He was advised to stop
anticoagulants and keep in other medications.
The patient was sent for investigations and MRI
done 6-November-2022 showing further enlargement
of the hygroma more the left side with
infarction of the left frontal lobe due to
subfalcine herniation, which was not present in
previous MRI. The patient was sent for cardio
evaluation.
The patient in right sided
position and 2 burr holes done in the left
frontal and left parietal areas. The subdural
end of the external drain was put to have
direction to most dependent area of the left
occipital area.
In the recovery room, the patient
removed the external drain, for what he was returned
to the operating room and another external drain was
inserted and fixed tightly at several points in the
skin. Smooth postoperative recovery and
the patient was sent to the ICU for 48 hours.
FOLLOW UP
The patient showed signs of full blown frontal
lobe syndrome, for what the third postoperative
day with the external drain still in place, MRI
done showing progression of the infarction of
the left frontal lobe with air fulfilling the
top of the frontal lobes and the callosal
arteries away from the falx cerebri. The
external drain was removed 13-November-2022 and
discharged 14-November-2022 with slight
improvement of his neurologic status.
Comments
The huge bilateral convexity hygroma is
progressing with the collection more in the left side with
subsequent frontal subfalcine herniation. External drain is
the only solution for his problem.
When the external drain was put at
5 cm level the third postoperative day, the patient showed
mild deterioration, for what the drain was put at 11 cm
level. The patient the next day improved with no CSF coming
out.
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Notice: Head injuries and very urgent surgeries are also
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