Case Report: Subdural evacuating port system for the management of acute on-chronic subdural hemorrhage.
6 affiliations
- 1College of Medicine, University of Arizona College of Medicine, Phoenix, Arizona, United States.
- 2School of Medicine, University of Colorado Anschutz School of Medicine, Aurora, Colorado, United States.
- 3Department of Neurocritical Care, Neurocritical Care and Stroke of Arizona, Phoenix, Arizona, United States.
- 4Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, United States.
- 5Department of Neurology, Midwestern University College of Osteopathic Medicine, Glendale, Arizona, United States.
- 6Department of Neurology, A.T. Still University School of Osteopathic Medicine, Mesa, Arizona, United States.
Abstract
Background
Traumatic subdural hematomas (SDHs) carry high morbidity and mortality without timely decompression, posing major challenges in settings lacking immediate neurosurgical support.Case description
A 75-year-old man with hypertension and hyperlipidemia on aspirin fell from a 3-foot ladder sustaining brief loss of consciousness. He presented with amnesia, headache, and nausea with Glasgow Coma Scale (GCS) 15. Computed tomography of the head (CTH) showed subarachnoid hemorrhage and bilateral SDH with acute and chronic components (left: 9 mm, right: 7 mm). Four hours later, GCS declined to 10 (E2V3M5) with the motor examination notable for localization to pain on the right and absent response on the left. Anisocoria also developed, with a fixed, non-reactive right pupil (4.6 mm, NPi 0) and a reactive left pupil (3.2 mm, NPi 2.9). Repeat CTH demonstrated SDH expansion (left: 17mm, right: 11mm). The patient was intubated and underwent right-sided subdural evacuating port system (SEPS) drainage (674 cc cumulative output over 2 days). Follow-up CTH showed reduction of the right SDH to 5 mm and left to 14 mm. His examination improved to GCS 11T; he was extubated the next day. He subsequently underwent middle meningeal artery embolization 4 weeks later. CTH 7 months post-injury demonstrated near-complete resolution of bilateral SDHs.Conclusion
SEPS is well established for the management of chronic SDHs. This case illustrates its use as an emergent, temporizing bridge in a patient with a mixed acute-on-chronic collection and rapidly evolving intracranial hypertension, followed by adjunctive middle meningeal artery embolization to promote durable resolution. This combined approach may be considered in select patients with elevated intracranial pressure when definitive neurosurgical care is unavailable or delayed.
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BibTeX
@article{zach2026case,
title = {{Case Report: Subdural evacuating port system for the management of acute on-chronic subdural hemorrhage.}},
author = {Rose V Zach and Daniel A Oesterle and Sean V Cleymaet and Udaya Kakarla and Victor Zach},
journal = {Surgical neurology international},
year = {2026},
month = oct,
doi = {10.25259/sni_965_2026},
url = {https://europepmc.org/article/MED/42974559},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Case Report: Subdural evacuating port system for the management of acute on-chronic subdural hemorrhage.
AU - Rose V Zach
AU - Daniel A Oesterle
AU - Sean V Cleymaet
AU - Udaya Kakarla
AU - Victor Zach
PY - 2026
DA - 2026/10/30
JO - Surgical neurology international
DO - 10.25259/sni_965_2026
UR - https://europepmc.org/article/MED/42974559
AB - Background Traumatic subdural hematomas (SDHs) carry high morbidity and mortality without timely decompression, posing major challenges in settings lacking immediate neurosurgical support.Case description A 75-year-old man with hypertension and hyperlipidemia on aspirin fell from a 3-foot ladder sustaining brief loss of consciousness. He presented with amnesia, headache, and nausea with Glasgow Coma Scale (GCS) 15. Computed tomography of the head (CTH) showed subarachnoid hemorrhage and bilateral SDH with acute and chronic components (left: 9 mm, right: 7 mm). Four hours later, GCS declined to 10 (E2V3M5) with the motor examination notable for localization to pain on the right and absent response on the left. Anisocoria also developed, with a fixed, non-reactive right pupil (4.6 mm, NPi 0) and a reactive left pupil (3.2 mm, NPi 2.9). Repeat CTH demonstrated SDH expansion (left: 17mm, right: 11mm). The patient was intubated and underwent right-sided subdural evacuating port system (SEPS) drainage (674 cc cumulative output over 2 days). Follow-up CTH showed reduction of the right SDH to 5 mm and left to 14 mm. His examination improved to GCS 11T; he was extubated the next day. He subsequently underwent middle meningeal artery embolization 4 weeks later. CTH 7 months post-injury demonstrated near-complete resolution of bilateral SDHs.Conclusion SEPS is well established for the management of chronic SDHs. This case illustrates its use as an emergent, temporizing bridge in a patient with a mixed acute-on-chronic collection and rapidly evolving intracranial hypertension, followed by adjunctive middle meningeal artery embolization to promote durable resolution. This combined approach may be considered in select patients with elevated intracranial pressure when definitive neurosurgical care is unavailable or delayed.
SN - 2229-5097
SN - 2152-7806
ER -