Korean J Neurotrauma.  2018 Oct;14(2):142-145. 10.13004/kjnt.2018.14.2.142.

Burr Hole Drainage with Urokinase Irrigation for the Treatment of Acute Subdural Hematoma: A Case Report

• Cho SW
• Choi SW
• Lim J
• Kwon HJ
• Kim SH
• Koh HS
• Youm JY
• Song SH

• KMID: 2424328
• DOI: http://doi.org/10.13004/kjnt.2018.14.2.142

Abstract

We describe the case of a patient with an acute subdural hematoma (SDH) that was removed using urokinase irrigation after burr hole trephination in a limited situation where craniotomy was not possible. A 90-year-old woman was admitted to our hospital with a stuporous mental status. Computed tomography (CT) scans revealed a chronic SDH, and a burr hole procedure was performed. The patient's postoperative progression was good until the third day after surgery when we found that the acute SDH had increased on CT scans. The patient's guardian refused further surgery, and thus we drained the blood from the hematoma by injecting urokinase through a drainage catheter. We used urokinase for two days, and removed the catheter after confirming via CT scans that the hematoma was almost alleviated. The patient recovered gradually; she was discharged with few neurological deficits.

Keyword

Acute subdural hematoma; Drainage; Urokinase

MeSH Terms

Aged, 80 and over
Catheters
Craniotomy
Drainage*
Female
Hematoma
Hematoma, Subdural, Acute*
Humans
Stupor
Tomography, X-Ray Computed
Trephining
Urokinase-Type Plasminogen Activator*
Urokinase-Type Plasminogen Activator

Figure

• 

  FIGURE 1 (A) The initial computer tomography (CT) scan performed immediately after the trauma shows isodense subdural hematoma at the left frontotemporoparietal convexity. (B) At admission, CT scan shows low dense subdural hematoma at the left convexity.

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  FIGURE 2 (A) Computer tomography (CT) image on the day after the burr hole surgery shows that the chronic subdural hematoma (SDH) was partially drained. (B) Aggravation of symptoms occurred on postoperative day 3. The follow-up CT scan shows newly developed acute subdural hematoma over the chronic SDH.

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  FIGURE 3 Computer tomography scan shows partial removal of hematoma after urokinase irrigation.

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  FIGURE 4 Two-month follow-up computer tomography scan shows marked decrease of the subdural hematoma and excellent brain re-expansion.

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