Chronic calcified subdural hematoma: Case report and review of the literature
We report a case of 73-year-old male, presenting with deterioration of motor function in his right limbs since 18 months, transferred from a foreign institution without access to neurosurgical care or evaluation. The patient was admitted to our emergency room, in Glasgow coma score (GCS) 14, right hemiparesis with motor strength grade 3. The computed tomography (CT) scans and magnetic resonance imaging (MRI) documented a large subdural collection of the left hemisphere, with calcified inner membrane []. The patient's surgery was delayed due to a pulmonary infection, and throughout this time, his clinical condition progressively deteriorated. When he finally had surgery on his subdural hematoma, the patient was in GCS 9, with no motor function to the right limbs. Left frontoparietal craniotomy was performed [], exposing an “armored dura”, with the mould of the underlying hematoma. The dura was opened in an arcuate manner, exposing the calcified capsule of the chronic subdural hematoma, which was tightly adherent to the inner surface of the dura. After dissecting it, the capsule was incised, exposing various stages of subacute hematoma. After total removal of these partially calcified gray mud-like materials, the thick partially calcified inner membrane was exposed overlying the parenchymal surface. However, the arachnoid membrane was intact and not adhered to the hematoma, allowing for its complete removal without injuring the underlying brain.\nThe postoperative period was uneventful, and at his 2 month follow-up, the patient was in GCS 15, maintaining some gate disturbances, with right hemiparesis more noticeable in his lower limb (grade 3 of 5). At his 3 month follow-up, he was able to deambulate with support of a clutch, only with slight monoparesis of the right lower limb (grade 4 of 5). His postoperative CT scans documented progressive reexpansion of the brain and resolution of subdural collection [].