Management of Bilateral Subacute Subdural Hematomas with Concomitant Subarachnoid Hemorrhage in a Diabetic Patient with HIV in Cameroon: A Case Report.

Bilateral subdural hematomas occurring simultaneously with subarachnoid hemorrhage in a traumatic context are rare and pose considerable diagnostic challenges. Comorbidities such as diabetes and HIV may further worsen prognosis and complicate management. This case underscores the vital importance of early diagnosis and multidisciplinary care in patients with subacute subdural hematomas and subarachnoid hemorrhage, particularly when compounded by comorbidities in resource‑limited settings. We report the case of a 44-year-old housewife who was diabetic and living with HIV. She presented with severe headaches followed by altered consciousness with severe coma, and Cushing's triad two weeks after a minor head trauma. Brain CT scan revealed a bilateral panhemispheric subacute subdural hematoma (SASDH) associated with subarachnoid hemorrhage. Management consisted of emergent bilateral burr hole craniotomy for drainage, combined with measures to reduce intracranial pressure and prevent secondary brain injury of systemic origin. Her course was complicated by infection and hypertensive crisis; both were successfully managed. Glycemic control was achieved and antiretroviral therapy optimized. Clinical and radiological outcomes were ultimately favorable. This case underscores the importance of early diagnosis and multidisciplinary management of subdural hematomas in patients with diabetes and HIV. Beyond timely surgical intervention with burr‑hole craniotomy, comprehensive intensive care - including vigilant monitoring, early detection, and prompt control of complications - can significantly improve survival and optimize neurological outcomes.