Subdural Hematoma

PATIENT PRESENTATION:
83 yr old female, K.W., with a past medical history significant for A-fib, (takes Coumadin®), presented to the ER with increased confusion, slightly slurred speech, 3/5 strength in her RUE/RLE, 5/5 strength in her LUE/LLE. Her daughter says that ever since she fell 3 weeks ago she seems to be getting worse.

DIFFERENTIAL LIST:
Ischemic Stroke, Subdural Hematoma, Epidural Hematoma

DIAGNOSIS:
Labs: Na+ 137, K+ 3.9, HCT 39, HGB 12, INR 1.8,
Vital Signs: HR: 87, BP: 145/77, SpO2: 98% on RA, RR: 16
Exam: K.W. is A&Ox2, pupils 3mm and brisk, PERRLA, c/o HA.

CT scan of the head shows a crescent shaped collection of blood in L frontal area in the subdural space. Based on the CT, a diagnosis of subdural hematoma was made.

TREATMENT:
Treatment included performing a L frontal craniotomy for evacuation of subdural hematoma. Once post op, pt will need to lie flat for 24 hrs to assist with brain re-expansion.

OUTCOME:
K.W. is expected to make a full recovery after going through some physical therapy.

Case created by Kelley Wicheta, 2011.