Background Spontaneous Intracerebral hemorrhage is a rare and challenging condition to treat, especially in haemophiliacs. With their innate predilection to bleed following trivial trauma, surgical management of such cases have been individualised and no treatment protocols exist. Often they are managed with craniotomy and evacuation under cover of AHF. Discussion Here we discuss the nuances, clinical and treatment dilemma that one faces while treating a patient, diagnosed with haemophilia, with spontaneous subdural haematoma. While routine management strategy would be a craniotomy and evacuation of the haematoma, in our case, we chose to closely monitor the patient under cover of AHF, to convert the acute haematoma into a chronic subdural hematoma. We then managed it with a burr hole evacuation under cover of antihemophilic factor. Conclusion Treatment protocols are hard to formulate in such rare entities, however we would like to recommend the following; conservative management of an acute subdural to convert it into a chronic subdural when there are no financial constraints, there by obviating the complication of rebleed following craniotomy.
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