Chronic subdural hematoma infected by propionibacterium acnes: a case report

Abstract

We present a very rare case of a patient with an infected subdural hematoma due to Propionibacterium acnes. A 63-year-old male complained of dizziness and was admitted to our hospital. He had a history of left chronic subdural hematoma due to a traffic accident, which had been conservatively treated. Physical, neurological and laboratory examinations revealed no definite abnormality. Plain CT scan demonstrated a hypodense crescentic fluid collection over the surface of the left cerebral hemisphere. The patient was diagnosed with chronic subdural hematoma and underwent burr hole surgery three times and selective embolization of the middle meningeal artery, but the lesion easily recurred. Repeated culture examinations of white sedimentation detected P. acnes. Therefore, he underwent craniotomy surgery followed by intravenous administration of antibiotics. The infected subdural hematoma was covered with a thick, yellowish outer membrane, and the large volume of pus and hematoma was removed. However, the lesion recurred again and a low-density area developed in the left frontal lobe. Craniotomy surgery was performed a second time, and two Penrose drainages were put in both the epidural and subdural spaces. Subsequently, the lesions completely resolved and he was discharged without any neurological deficits. Infected subdural hematoma may be refractory to burr hole surgery or craniotomy alone, in which case aggressive treatment with craniotomy and continuous drainage should be indicated before the brain parenchyma suffers irreversible damage.

Keywords: Craniotomy; Infected subdural hematoma; Propionibacterium acnes.

Figures

Fig. 1

Plain CT scans on admission demonstrate that a hypodense crescentic fluid collection enlarged and extended over the surface of the left cerebral hemisphere. The fluid cavity was loculated, suggesting repeated hemorrhage in the subdural space. The midline structures of the brain were shifted to the right side.

Fig. 2

Plain CT scans show the recurrence of the left chronic subdural hematoma 1 month after the first burr hole surgery (a) and 1 week after the second burr hole surgery (b).

Fig. 3

a Plain CT scans demonstrate the recurrence of the left infected subdural hematoma 1 month after the embolization of the MMA. Note the low-density area in the left frontal lobe adjacent to the overlying hematoma. b Plain CT scans reveal that the volume of the left infected subdural hematoma increased again during 2 weeks after the third burr hole surgery.

Fig. 4

a Plain CT scans demonstrate that the left infected subdural hematoma recurred quickly 3 days after the first craniotomy surgery. b Plain CT scans show a complete disappearance of the infected subdural hematoma about 5 months after the second craniotomy surgery. Note the disappearance of the low-density area in the left frontal lobe.