Spontaneous bilateral supra-and infratentorial chronic subdural hematoma in human immunodeficiency virus-infected patient: A case report and literature review

Infratentorial chronic subdural hematomas are rare. Simultaneous supra- and infratentorial chronic subdural hematoma is extremely rare. Commonly caused by head trauma in a predisposed brain; coagulopathy, cerebral atrophy secondary to alcohol, old age, or human immunodeficiency virus infection. Only a few cases have been reported, and this is the first report from our setup. 50 years old human immunodeficiency virus-positive woman presented to our hospital with headache, decreased mentation and left side body weakness of two days. Brain magnetic resonant imaging showed bilateral supra-and infratentorial chronic subdural collection. Under local anesthesia and light sedation, bilateral burr hole and evacuation of supratentorial hematoma were done and the infratentorial hematoma was managed conservatively as it is thought asymptomatic. Postoperatively consciousness and weakness improved but the patient complained of severe global headache and computed tomography scan showed significant residual right side supratentorial chronic subdural hematoma. Thus under local anesthesia and light sedation right parietal burr hole was done and the hematoma was removed. Postoperatively patient was conscious, the headache disappeared. This experience demonstrates conservative management of asymptomatic infratentorial chronic subdural hematoma is a viable treatment option in patients presenting with both supra- and infratentorial chronic subdural hematoma. We suggest burr hole evacuation, irrigation and placement of closed drainage system should be considered as a first choice surgical treatment for symptomatic infratentorial chronic subdural hematoma.