Surgical Neurology 64 (2005) S2:113 – S2:114
www.surgicalneurology-online.com

Acute interhemispheric subdural hematoma due to hemodialysis:
case report
Goksin Sengul, MDT, Yusuf Tuzun, MD, Associate PhD, Hakan Hadi Kadioglu, MD, PhD,
Ismail Hakki Aydin, MD, FCNS, FICA
Department of Neurosurgery, Ataturk University Medical School, Erzurum 25070, Turkey

Abstract

Background: Acute interhemispheric subdural hematoma (AISH) is an extremely limited
complication in patients on maintenance hemodialysis. Diagnostic difficulties result from a fact
that symptoms of acute hematoma such as headache, nausea, vomiting, apathy, sleepiness,
paresthesia and seizures may also suggest dysequilibrium syndrome, dialytic dementia as well as
hypertensive encephalopathy.
Case Description: A case of acute interhemispheric subdural hematoma during long-term dialysis
is presented.
Conclusion: AISH caused by hemodialysis is a very important complication. It is sometimes
difficult to differentiate from dysequilibrium or dialysis dementia. Clinicians must pay closer
attention on neurological examination of hemodialyzed patient. Surgical treatment must be as prompt
as possible because of the possible sudden worsening of the patient’s clinical condition.
D 2005 Elsevier Inc. All rights reserved.

Keywords:

Interhemispheric; Subdural; Hematoma; Hemodialysis

1. Case description
A 26-year-old woman had undergone hemodialysis
3 times weekly for 2 years. In July 2004, she had headache,
vomiting, right hemiparesis, and loss of consciousness
during hemodialysis. The patient was admitted to our clinic
within 1 hour from the onset of symptoms. On examination,
her Glasgow Coma Scale was 13 of 15 (opening eyes to
call, obeying commands, and confused). She had a right
hemiparesis with grade 2 power. Deep tendon reflexes were
exaggerated, and plantar reflex was up-going on the right
side. Computed tomography scan revealed interhemispheric
hyperdensity over the tentorium cerebelli and along the falx
and a 0.5 cm in thickness hyperdensity along the left parietal
region (Fig. 1). Her hematologic and biochemical studies
were not in normal range. After correcting them over
24 hours, the patient underwent paramedian twist drill
Abbreviations: AISH, acute interhemispheric subdural hematoma.
T Corresponding author. Department of Neurosurgery, Aziziye Research Hospital, Yenisehir, Erzurum 25070, Turkey. Tel.: +90 442 316 63
33-2085; fax: +90 442 316 63 40.
E-mail addresses: goksinsengul@hotmail.com, goksin73@atauni.edu.tr
(G. Sengul).
0090-3019/$ – see front matter D 2005 Elsevier Inc. All rights reserved.
doi:10.1016/j.surneu.2005.07.050

Fig. 1. Computed tomography scan demonstrating the hyperdensity
along the falx, left parietal region, and over the tentorium cerebelli. R
indicates right.

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G. Sengul et al. / Surgical Neurology 64 (2005) S2:113–S2:114

2. Conclusion

Fig. 2. Computed tomography scan demonstrating normal brain without
hematoma after surgery.

craniostomy, and the hematoma was removed. Left parietal
hematoma was treated nonsurgically. Postoperatively,
she gradually improved (Glasgow Coma Scale, 15) but
developed epileptic seizures. During the postoperative
period, hemodialysis sessions were performed without
heparin. After 15 days, the paresis recovered completely.
The computed tomography scan demonstrated normal brain
without hematoma (Fig. 2). The patient was discharged
without any neurological deficits.

In proportion to a rapid increase in dialysis patients,
neurological complications are increasing annually among
long-term hemodialyzed patients [2]. Acute interhemispheric subdural hematoma due to hemodialysis is very rare but
carries a bad prognosis. In most cases with AISH, focal
symptoms have been characterized by contralateral motor
palsy with crural dominance, as has been observed in the
bfalx syndrome.Q Other possible neurological manifestations
of AISH are disturbances of consciousness, focal or
generalized epileptic manifestations, gait ataxia, dementia,
language disorders, and oculomotor nerve palsies [1,3]. The
diagnosis of AISH is mainly based on computed tomography. Cerebral angiography is only used to identify the
source of bleeding [2,3].
Treatment strategies are based on the individual neurological response of each case and on the risk-benefit ratio to
decide on a medical or surgical approach. Prompt surgical
evacuation of hematoma is mandatory in the presence of a
worsening neurological condition.

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