The patient came from Palestine urgently with MRI lumbar spine done 2 years ago showing extruded disc L4-5 with right foraminal occlusion for disc surgery. He had at that time right sciatica, but improved. The patient the last three months started to complain of weak right left with ataxic gait with dramatic deterioration the last 3 days with inability to walk.

On examination; the patient is alert, complaining of headache with fever. Cranial nerves were intact and no neck rigidity. The patient has quadriparesis more pronounced in the right side with plegia of the right leg.

The patient was sent for MRI of the brain and whole spine, which showed very huge chronic subdural hematoma left convexity with falcine conning and impaction of the midbrain.

Osteoplastic craniotomy over the left fronto-parietal region. The dura was opened and a huge amount of old blood was evacuated. he thick capsule in the left frontal pole was reached and removed. Water-tight closure of the wound after inserting Medtronic external drain.

Smooth postoperative recovery. The patient sent to the ICU. The power of the right leg improved dramatically after 90 min after recovering from anaesthesia.

The patient has signs of pending impaction and subfalcine herniation. Urgent surgery is the only solution.