Tuesday, June 30, 2009

Traumatic Chronic Subdural Hematoma

Case: 67 years old Chinese gentleman, referred from HTAR on 27/6/09 with history of alleged fall at home 2 weeks and became disorientated and bed-ridden 3 days prior to admission.

He was admitted previously on 23/5/2009 when he was alleged fell at home on the same day with admission GCS of E4V2M5. CT scan done showed right frontal ICH. He underwent craniotomy and evacuation of clots and discharged home with full GCS.

On arrival his GCS was E3 V2 M5 with pupils 3+/3+.
BP 146/76,
HR 76
Afebrile
Spo2 100% on air
Lungs: clear
CVS: DRNM
P/a: soft, nontender
Able to move all 4 limbs but unable to assess proper power
CT brain
Mixed hyp & hyperdense lesion - SDH in left frontoparietal
Thickness 4cm
Local mass efeect on ipsolateral ventricle & contralateral MLS
BC still patent
Evidence of previous Rt frontoparietal craniectomy + encaphalomalacia Rt frontal lobe
Impression: chronic Lt frontoparietal SDH
He underwent left parietal burrhole and drainage on 27/6/09. Post-op he is remained ventilated and sedated.


Post-op CT scan on 28/6/09



Display Pacs ReportNON-ENHANCED CT SCAN OF BRAIN dated 28/6/09.

Written Clinical Comments: post Burrhole drainage

Findings:
***No previous image in the PACS for comparison.

Evidence of right frontal craniectomy and left parietal craniotomy.
Left fronto-parietal SDH with fluid level with mass effect to
adjacent lateral ventricle.
Midline shift of 1.8cm to the right with subfalcine herniation.
Right frontal contusion with perifocal oedema.
Basal cisterns are effaced but not obliterated.
No hydrocephalus.
Visualised paranasal sinuses are clear.

Impression:
ICB with midline shift.

He underwent left parietal mini-craniotomy and subdural drainage on 29/6/2009





Display Pacs ReportNON-ENHANCED CT SCAN OF BRAIN dated 28/6/09.

Written Clinical Comments: post Burrhole drainage

Findings:
***No previous image in the PACS for comparison.

Evidence of right frontal craniectomy and left parietal craniotomy.
Left fronto-parietal SDH with fluid level with mass effect to
adjacent lateral ventricle.
Midline shift of 1.8cm to the right with subfalcine herniation.
Right frontal contusion with perifocal oedema.
Basal cisterns are effaced but not obliterated.
No hydrocephalus.
Visualised paranasal sinuses are clear.

Impression:
ICB with midline shift.

On POD2, he was extubated. Pre-extubation GCS E4 VT M6.


2 comments:

prasad581 said...

what is sdh

Elizabeth said...

@prasad581 sdh = subdural hematoma

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001732/