Cerebral Vasospasm After Burr Hole Evacuation of Chronic Subdural Hematoma

TL;DR

A 74-year-old woman developed cerebral vasospasm after a procedure to remove a chronic subdural hematoma, highlighting a rare but important complication.

Contribution

This case report demonstrates that cerebral vasospasm can occur following burr hole evacuation of chronic subdural hematoma.

Findings

The patient developed neurological symptoms and imaging showed cerebral vasospasm after burr hole evacuation.

Conservative treatment led to recovery and follow-up imaging showed improvement in arterial narrowing.

Magnetic resonance angiography helped identify vasospasm as the cause of postoperative neurological decline.

Abstract

Cerebral vasospasm is a frequent complication of subarachnoid hemorrhage. We report a case of chronic subdural hematoma complicated by cerebral vasospasm after burr hole evacuation. A 74-year-old woman underwent burr hole evacuation of a chronic subdural hematoma. She developed left hemiparesis and disturbance of consciousness on postoperative day 3. Magnetic resonance imaging showed a right parietal infarct and decreased cerebral blood flow signal in the right middle cerebral artery territory. Digital subtraction angiography showed multiple segmental narrowings of the right middle cerebral artery. Her neurological symptoms recovered with conservative treatment. Follow-up angiography showed improvement in the arterial narrowing, which finally led to a diagnosis of cerebral vasospasm. Cerebral vasospasm can occur after burr hole evacuation of chronic subdural hematoma. Magnetic resonance angiography is useful for determining the cause of postoperative neurological worsening in chronic subdural hematoma patients.

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