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. 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.