The patient came to the clinic 10-December-2012 complaining of weakness of the right leg for one moth with occipital headache. The patient is a known diabetic for 5 years with medication and hypertensive for 2 years without medication. The patient felt down one month ago.

On examination: the patient is limping as dragging his right lower limb with no synergistic movement of the right upper limb. There is flattening of the right naso-labial fold and all the muscles of the right side are weak 4/5 more pronounced in the legs.

MRI of the brain done 13-December-2012 showing very huge chronic subdural hematoma occupying the left hemisphere starting from the frontal down to the most posterior parts of the occipital lobe. MRI of the cervical spine showed small disci of no clinical significance.

2 burr holes were created with the most smallest size in the left frontal and occipital area 5 cm off the midline. The bone dust was kept. The dura was incised to allow insertion of the external drain in the occipital hole and to perform irrigation from the frontal one. Around 350 ml blood came out and irrigation was continued until the coming out fluid was crystal free.

Routine closure of the wounds. The external drain was fixed to the skin. Smooth postoperative recovery. The power of the right side became normal. The patient sent to the ICU and the external drain was adjusted to allow further evacuation of the fluids.

The patient suffered injury one month ago, which could be due to weak right side of the body which means that the hematoma was before, or it was the causative moment of the hematoma formation.