A Bilateral Subdural Hematoma, Case Report

Abstract

A 72 year-old male presented with deteriorating cognition and headache since 10 days. Two months earlier he fell on his head, after which an intracranial haemorrhage was excluded on CT. On physical examination, we found an impaired cognitive function and dysdiadochokinesia. A new CT-scan revealed an acute-on-chronic symmetrical bilateral subdural hematoma with active bleeding, compressing and balancing the brain in midline. CaseA 72 year-old male was brought to our Emergency Department by ambulance services because of a progressive deterioration of cognitive functions of 10 days duration and a headache since that morning. Moreover, a tendency to fall to the left was present. There were no complaints of nausea or vomiting. His medical history only included glaucoma for which he used Latanoprost eye drops (Xalatan).Two months earlier our patient fell on the back of his head after tripping over a lose tile. There were no neurologic symptoms at that time. A CT-scan of his skull and brain excluded an intracranial bleed or skull fracture and the patient was safely discharged home. His recovery was uneventfull until 10 days ago.Neurologic examination in our ED revealed a wide based gait, a tendency to fall to the left, an inadequate coordination response and a dysdiadochokinesia of the right hand. His Glascow Coma Scale was maximal and further neurologic and general examination were unremarkable.The CT-scan of skull and brain (Figure 1) revealed a relatively large bilateral subdural hematoma with possibly an small active haemorrhage in the rightsided frontolateral area. There was no midline shift because of the symmetry and there was no reduced patency of the basal cisterns.Because of the slow onset of symptoms and the overall clinical appearence, the neurosurgeon opted for semi-elective surgery and admitted the patient for close observation with Dexamethasone 4 mg twice daily. During surgery the next day a bilateral burr hole was made, the dura mater was incised and access to both hematomas was achieved. Two partially liquified, dark redcoloured hematomas were evacuated. Information on the findings during surgery were not available to us. The neurosurgeon irrigated untill clear liquids returned and thereby excluded an active bleed on the right side. The wounds were closed with passive drains in situ, which did not return serosanguinolent liquids up till their removal the next morning. The patient recovered uneventfully without any persisting neurologic deficit and was discharged home after two days.