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Acute vs Chronic Subdural Hematoma

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

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Acute vs Chronic Subdural Hematoma

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  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 SDH SDH SAH

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

  6. 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 Acute vs Chronic SDH

  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 2002. pp. 309-310 • Ferri: Ferri’s Clinical Advisor; Instant Diagnosis and Treatment. 2004 ed. Mosby 2004. p 813.

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