Presentation on theme: "Acute vs Chronic Subdural Hematoma"— Presentation transcript:
1Acute vs Chronic Subdural Hematoma Matt Leonard MS-IVUVA School of MedicineFebruary 2004
2Clinical DataAn 88 yo WM with confusion and R facial droop found down on front steps of assisted living homeHPI: h/o ground level fallsPMH: HTN, CABG, GERD, ArthritisSH, FH, Allergies: NoncontributoryMeds: HCTZ, ASA, Terazosin, Ambien, Pepcid
3Physical Exam VS: 180/80, 79, afebrile, 94% Neuro: Awake, alert, oriented x 3, Pupils irregular, but reactive, R facial asymmetry, bilateral symmetric motor function
5DiagnosisBilateral Acute SDH’sSAHFrontal Contusion vs IPH
6Acute vs Chronic SDH Within 24 hours Decreased LOC, Pupil inequality, motor deficitHyperdense on CTTx: Surgical EvacuationGreater than 2 weeksSubtle signs, weakness or hemiparesisIsodense or hypodense to brain parenchymaTx: Symptomatic= Surgical Evacuation, Otherwise= Observation
7Hospital CoursePt. was admitted to ICU. Bilateral SDH’s were allowed to liquefy before attempted drainage. Three bore holes drilled, 2 left/1 right. Due to post-op coagulopathy, pt. was given multiple FFP doses. Pt’s coagulopathy recovered and he was discharged with neurologic deficit attributed to long inpatient stay.