Intracerebral hematoma following evacuation of chronic subdural hematomas. Report of two cases.

Two cases of intracerebral hemorrhage occurring after evacuation of bilateral chronic subdural hematomas are reported. Possible pathogenic mechanisms included hemorrhage into previously undetected areas of contusion, damage to cerebral vasculature secondary to rapid perioperative parenchymal shift, and sudden increase in cerebral blood flow combined with focal disruption of autoregulation; of these, the latter mechanism seemed most likely to be responsible for the hematoma formation. The need for clinical awareness of this nearly uniformly devastating complication, as well as prompt use of computerized tomography scanning in assessing the postoperative course, are stressed.