"Contralateral" Acute Subdural and Intracerebral Hemorrhage Occurring Simultaneously after Evacuation of Huge Chronic Subdural Hematoma

We report an uncommon case of “contralateral” acute subdural hematoma (SDH) and intracerebral hemorrhage (ICH) developing simultaneously after evacuation of a huge chronic SDH associated with previous ischemic stroke. An 80-year-old female admitted with bilateral chronic SDH with midline shift by the left-sided dominant huge hematoma. The patient underwent burr-hole evacuation for the bilateral hematoma. The left-sided huge hematoma was first evacuated and the rightsided small hematoma was drained later. Immediate computerized tomography (CT) scans after surgery revealed acute brain shift contrary to the initial scan and acute SDH and ICH developing contralaterally for the huge hematoma. The pathophysiological mechanisms were discussed. (J Kor Neurotraumatol Soc 2011;7:39-42)