The patient came to the clinic 12-August-2013 complaining of unstable gait for 40 days. He suffered RTA 5 months ago without loss of consciousness. He was seen by cardiologist, who confirmed the absence of cardiac causes. H has arterial hypertension for 2 years in Micardis 80 mg once daily and Concor 5 mg once daily. He stopped Baby aspiring the last month.

MRI brain done 31-July-2013 showing huge chronic subdural hematoma left convexity with minimal in the right with scattered old infarctions both cerebral hemispheres.

On examination: the patient limping, using crutches for one month. He has weak right upper limb muscles more the hand and the muscles of right lower limb.

Burr hole created at the left frontal region and left posterior aspect of the parietal region 15 cm off the midline. The hematoma was evacuated from both sides with irrigation of the hematoma cavity and checking for communication between them. Medtronic external drain was inserted to the most dependant point of the parietal burr hole.  Routine closure of the wounds.

Smooth postoperative recovery. The power of the right side became normal.

The patient has huge left convexity chronic subdural hematoma, requiring surgery. The minimal hematoma in the opposite side can resolve by the time. It could escalate. It must be kept in mind.