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.