Calcified Chronic Subdural Hematoma: Case Report And Review Of Literature

Abstract

Calcified chronic subdural hematomas or ‘armoured brain’ are a rare variant of chronic subdural hematomas accounting for 0.3-2.7% of all chronic subdural hematomas. They are common in children and young adults than in adults. The spectrum of presentation varies and ranges from being asymptomatic to presenting with neurologic deficit, convulsions or raised intracranial pressure. Despite the paucity of data with regards to its pathophysiology, the pathogenesis of calcification is thought to be multifactorial with contribution of both metabolic and vascular factors. Although surgery is the optimal treatment option for chronic subdural hematoma, management of a calcified chronic subdural hematoma should be individualized. This is attributable to the inherent risk of neurological injury in excisions of an adherent inner membrane to the cortical surface or leptomeninges; or risk of recurrence of hematoma from a chronic compressed brain that fails to reexpand following evacuation or in presence of brain atrophy especially in elderly. However, surgery is recommended in acute or progressive neurological deterioration and in presence of unadherent arachnoid membranes. I report an elderly man, 96 years, who presented to our facility with a month history of global, progressive headache that was accompanied with left-sided weakness. On examination, he was alert and oriented with a left hemiparesis. Imaging revealed a right frontoparietal hemispheric chronic subdural collection with calcification. Patient underwent craniotomy with complete and successful removal of the hematoma with impressive clinical improvement postoperatively.