Simultaneous intracranial acute and chronic subdural hematoma on one side: A rare case report

Introduction: While acute and chronic subdural hematomas (SDH) are relatively common, co-occurrence is rare. Here, we report a case of unilateral simultaneous acute and chronic SDH. Case presentation: A 74-year-old man with comorbid diabetes mellitus and hypertension presented with decreased consciousness (Glasgow Coma Scale (GCS) 4; E1M2V1) with stable hemodynamics. Isochoric pupils and right motoric lateralization were found upon neurological examination. CT scan of the brain without contrast showed acute and chronic SDH in the left frontotemporoparietal area with a midline shift 2 cm to the right. An evacuation craniectomy of the SDH was performed. Postoperative care included mechanical ventilation, monitoring, fluid balance maintenance, and medication. The patient showed improvement during follow-up and was weaned off mechanical ventilation on the 5th day after surgery. Clinical discussion: SDH with a thickness of 10 mm or more and mass effect requires surgical management. Various techniques can be used for surgical evacuation. The prognosis of chronic SDH patients depends on their clinical condition when admitted, with early diagnosis and intervention resulting in improved prognosis. Conclusion: This rare case highlights the significance of promptly recognizing and addressing symptoms such as headache and decreased consciousness, especially in older patients with underlying health conditions. Good prognosis is dependent on prompt evaluation, including a head CT scan for recurrent headaches, and immediate treatment when necessary.