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

SAH

SDH

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.