The patient came to the clinic 17-October-2012 complaining of one episode of convulsion with secondary generalization, which happened yesterday for 15 min. The patient is a known diabetic for 8 years.

MRI done 16-October-2012 showing huge chronic subdural hematoma in the left convexity over the parietal area, but not causing shift of the midline structures due to brain atrophy.

On examination: the patient is alert, not complaining of headache with no meningeal signs. The patient has elements of Parkinson disease without treatment and a known case of rheumatoid for 5 years without treatment. The patient has weak distal muscles of the upper and lower limbs 4/5.

Using high speed drill, 2 tiny holes were created over the most anterior and posterior parts of the hematoma in the left fronto-parietal region. They were done oblique. The dura was opened in both sites and  external drain was inserted to the posterior one and irrigation of the hematoma was continued until the fluid coming from the lower one crystal water in color.

Routine closure of the wounds. Smooth postoperative recovery with normalization of the power of the right side of the body. The patient was sent to the ICU for proper observation.

The patient has chronic subdural hematoma causing epiactivity and paresis of the hand and foot.

The hematoma is not candidate for conservative treatment. Evacuation and drainage is the best solution.