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Acute vs Chronic Subdural Hematoma

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Presentation on theme: "Acute vs Chronic Subdural Hematoma"— Presentation transcript:

1 Acute vs Chronic Subdural Hematoma
Matt Leonard MS-IV UVA School of Medicine February 2004

2 Clinical Data An 88 yo WM with confusion and R facial droop found down on front steps of assisted living home HPI: h/o ground level falls PMH: HTN, CABG, GERD, Arthritis SH, FH, Allergies: Noncontributory Meds: HCTZ, ASA, Terazosin, Ambien, Pepcid

3 Physical Exam VS: 180/80, 79, afebrile, 94%
Neuro: Awake, alert, oriented x 3, Pupils irregular, but reactive, R facial asymmetry, bilateral symmetric motor function

4 Initial CT w/out contrast

5 Diagnosis Bilateral Acute SDH’s SAH Frontal Contusion vs IPH

6 Acute vs Chronic SDH Within 24 hours
Decreased LOC, Pupil inequality, motor deficit Hyperdense on CT Tx: Surgical Evacuation Greater than 2 weeks Subtle signs, weakness or hemiparesis Isodense or hypodense to brain parenchyma Tx: Symptomatic= Surgical Evacuation, Otherwise= Observation

7 Hospital Course Pt. 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.

8 Follow-Up CT w/out contrast

9 References ACR: 13.43 References:
Marx: Rosens Emergency Medicine: Concepts and Clinical Practice. 5th edition. Mosby pp Ferri: Ferri’s Clinical Advisor; Instant Diagnosis and Treatment ed. Mosby p 813.

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