Acute on Chronic Subdural Haematoma

Contributor:

Dr. Chris Ekong

Case 3

Age: 61

Sex: Male

History: An alcoholic for over 30 years. Presented with one week of headaches. Has been confused and ataxic for three days.

Examination

Showed him to be alert but dysphasic. He had a slight drift of the right arm.

Treatment

Burr hole and evacuation of subdural haematoma was done on an emergency basis.

• Alcoholism is a predisposing factor for development of subdural haematoma partly from frequent falls and partly from bleeding disorders related to liver malfunction.
• If he was not having evidence of brain compression, he might have been treated with observation only. The chronic subdural can often be treated with burr holes alone. Acute subdural haematoma usually requires a craniotomy. A combination can often be removed with burr holes alone but we usually prepare for craniotomy as well.
• Some patients with chronic subdural haematoma may have reaccumulation of blood and may ultimately require subduro-peritoneal shunt. This is more common in elderly people with some degree of crtical atrophy.

A Project of The Emmanuel Charitable Foundation