Background <p>Chronic subdural haematoma (cSDH) is a significant neurological condition predominantly affecting the elderly, characterised by the accumulation of fluid, blood, and breakdown products in the subdural space. Given a global prevalence of roughly eight cases per 100,000 individuals, the incidence is anticipated to increase as a result of an ageing population and heightened use of anticoagulants. cSDH, however, is classically associated with minor head trauma, but the exact reason is still complex and remains unknown. The clinical presentation progresses unnoticed, therefore presenting a challenge in getting a cSDH diagnosis, but most patients suffering from cSDH can develop some sort of cognitive dysfunction and even unconsciousness.</p> Case presentation <p>This case study highlights a rare case of a 61-year-old female patient who presented with impaired sensorium and no history of trauma or anticoagulant use. She was diagnosed with bilateral infratentorial cSDH with obstructive hydrocephalus. After a bilateral suboccipital burr-hole craniostomy, the patient’s neurological condition significantly improved, and by the fifth postoperative day, the hydrocephalus had resolved.</p> Conclusion <p>The difficulty of related disorders like hydrocephalus, the rarity of infratentorial cSDH, and the necessity of prompt surgical intervention, especially in the absence of structured treatment protocols, are all highlighted in this instance. Further research is warranted to establish standardised treatment protocols for this uncommon neurosurgical challenge.</p>