Acute vs Chronic Subdural Hematoma

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Presentation transcript:

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

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

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

Initial CT w/out contrast SDH SDH SAH

Diagnosis Bilateral Acute SDH’s SAH Frontal Contusion vs IPH

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

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.

Follow-Up CT w/out contrast

References ACR: 13.43 References: Marx: Rosens Emergency Medicine: Concepts and Clinical Practice. 5th edition. Mosby 2002. pp. 309-310 Ferri: Ferri’s Clinical Advisor; Instant Diagnosis and Treatment. 2004 ed. Mosby 2004. p 813.