We describe a case of a delayed subdural hemorrhage presenting in a young adult not on any antiplatelet or anticoagulation therapy. A 19-year-old male presented to the emergency department after being involved in a motor vehicle accident. [ncbi.nlm.nih.gov]

• Fever

  Case 1: A 54-year-old man presented with a 10-day history of headache, fever. At admission neurologic examination and Brain-CT were normal. Blood cultures showed Streptococcus bovis. [ncbi.nlm.nih.gov]

  A 58-year-old man, a shepherd, was admitted to Centre Hospitalier National (Nouakchott, Mauritania) on July 2, 2012, with fever and epistaxis. One week earlier, he had fever, nausea, and vomiting. [wwwnc.cdc.gov]

  However, the patient developed a fever of 37.6 C and 0.5 g paracetamol (Southwest Pharmaceutical Co., Ltd., Chongqing, China) was administered orally as an antipyretic. [spandidos-publications.com]

  Signs and symptoms [ edit ] Clinical manifestations of intraparenchymal hemorrhage are determined by the size and location of hemorrhage, but may include the following: [ citation needed ] Hypertension, fever, or cardiac arrhythmias Nuchal rigidity Subhyaloid [en.wikipedia.org]

• Acutely Ill Patient

  Even though MRI has advantages, computed tomography remains the procedure of choice in the acute setting because of shorter examination time, which is important in acutely ill patients, reliability in identifying other parenchymal lesions, no magnetic [pmj.bmj.com]

• Hypersomnia

  An 18-month-old male infant with moderate hemophilia A was admitted with fever, vomiting, and hypersomnia. There was no history of trauma or seizure. [ncbi.nlm.nih.gov]

• Pathologist

  Although most subdural hematomas (SDH) are caused by extrinsic factors, forensic pathologists should consider the possibility of intrinsic SDH. In addition, postmortem angiography can be useful for identifying vascular lesions in such cases. [ncbi.nlm.nih.gov]

• Hunting

  Favorable outcome was achieved in 68% of patients with good-grade clinical presentation on admission (Hunt and Hess Grades I-III) versus 23% of the patients with poor-grade presentation (Hunt and Hess Grades IV and V, p 0.0001). [ncbi.nlm.nih.gov]

• Regurgitation

  Mitral regurgitation was evidenced. A methicillin-sensitive staphylococcus aureus left-sided IE was diagnosed. Pre- and post-contrast Brain-CT were normal. He presented 15 days later a secondarily generalized status epilepticus. [ncbi.nlm.nih.gov]

• Hypertension

  Seizures, intracranial hypertension signs, neurological deficits, macrocrania, developmental delay and bulging of the skull are the main signs and symptoms of the lesion. [ncbi.nlm.nih.gov]

  At any time during this clinical sequence, the patient may demonstrate the Cushing reflex—systemic arterial hypertension and bradycardia—which is also a secondary sign of severe intracranial hypertension. [alpfmedical.info]

• Headache

  Neurosurgeons should be aware that SIH patients do not always present with orthostatic headache. [ncbi.nlm.nih.gov]

• Seizure

  Ninety percent of patients with preoperative seizures were seizure free after operation for 3 months. Independent predictors of seizures were GCS CONCLUSION: Occurrence of seizures affected severity and outcomes after surgical treatment of aSDH. [ncbi.nlm.nih.gov]

• Confusion

  METHODS (CASE PRESENTATIONS): Identical twin brothers presented 1 year and 10 days apart to an academic medical center after incurring confusion, decreased mental functioning, and a subsequent comatose state. [ncbi.nlm.nih.gov]

  The patient may have loss of memory and confusion. Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures. [sportsinjuryclinic.net]

  The patient was discharged with mild confusion 40 days after the admission. [jmedicalcasereports.biomedcentral.com]

  Deterioration in consciousness, including increasing confusion, sleepiness, and a deep coma, can quickly follow. [merckmanuals.com]

• Lethargy

  Main clinical presentations were with depressed sensorium, coma, stupor, drowsiness, headache, motor weakness, lethargy, and seizure. [ncbi.nlm.nih.gov]

  Other symptoms include lethargy, nausea, vomiting, and behavioral changes as well as weakness, impaired vision or even seizures. Causes Chronic subdural intracranial hematomas usually occur in those over the age of 60. [sportsinjuryclinic.net]

  Symptoms of subdural hematomas include confusion, headache, movement difficulties, loss of sensation, visual changes, speech difficulties, seizures, lethargy, vomiting, and loss of consciousness. [healthgrades.com]

  Symptoms often include headache, hemiparesis or alteration of consciousness like agitation, lethargy, or coma. If the acute subdural is small, it can be managed non-surgically. Antiplatelet drugs are stopped, and coagulation is corrected. [neurosurgerybasics.com]

• Altered Mental Status

  We report a case of plasmacytoma that presented as altered mental status after head trauma, located in the subdural area. We also describe its differential diagnosis and treatment by total removal and adjuvant radiotherapy. [ncbi.nlm.nih.gov]

  Altered mental status may be from an SDH, not ethanol. Consult a neurosurgeon as soon as the diagnosis is suspected and initiate transfer if a another facility is required for diagnosis or management. Media file 1: Acute subdural hematoma. [oncare.blogspot.com]

  Gastrointestinal or Nutrition Issues Nutritional status must be closely monitored in SDH patients, especially those with altered mental status or coma. Supplemental nutrition may be required. [clinicaladvisor.com]

She was admitted for workup. The next day, she neurologically deteriorated to a GCS score of 6. CT of the head was reobtained and showed acute, left-sided subdural hematoma with shift and herniation. [ncbi.nlm.nih.gov]

Intubation and imaging Consider endotracheal intubation when Glasgow Coma Score (GCS; see the Glasgow Coma Scale calculator) score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup. [emedicine.medscape.com]

TREATMENT Emergency Department Care Consider endotracheal intubation when GCS score is less than 12 or other indications are present; this guarantees airway protection during the diagnostic workup. [oncare.blogspot.com]

• Epileptiform Activity

  Twenty-four patients who underwent evacuation for acute or acute-on-chronic SDH and with epileptiform activity on EEG were identified retrospectively. [ncbi.nlm.nih.gov]

• Periodic Lateralized Epileptiform Discharges

  Twenty-one patients (87%) had epileptiform discharges on EEG; 13 of them (62%) had midline epileptiform discharges and 9 of them (43%) had periodic lateralized epileptiform discharges (PLEDs). [ncbi.nlm.nih.gov]

• Multifocal Discharges

  Poor early outcomes were associated with the presence of bilateral (P 0.03), midline (P 0.04), and bilateral independent multifocal discharges (P 0.09) on EEG. The EEG findings in this group of patients were complex. [ncbi.nlm.nih.gov]

• Staphylococcus Aureus

  A methicillin-sensitive staphylococcus aureus left-sided IE was diagnosed. Pre- and post-contrast Brain-CT were normal. He presented 15 days later a secondarily generalized status epilepticus. [ncbi.nlm.nih.gov]

• Streptococcus Pneumoniae

  Streptococcus pneumoniae was identified from bacterial cultures. Despite improvement in postoperative CT findings, she fell into septic shock and died 3 days after the drainage. [ncbi.nlm.nih.gov]

• Streptococcus Bovis

  Blood cultures showed Streptococcus bovis. MRI 5 days later revealed ischemic spots and minime ASDH over the right convexity. [ncbi.nlm.nih.gov]

Yet, the benefit of surgical treatment for aSDH and the subsequent functional outcome in elderly patients (age 80 years) remain unclear. [ncbi.nlm.nih.gov]

Associated aSDH does not appear to indicate a poorer long-term functional prognosis in SAH patients presenting with coma. [ncbi.nlm.nih.gov]

Keywords: Meningioma; Intracranial; Subdural hematoma; Surgery; Etiology Introduction Meningioma usually manifests as a gradual onset of symptoms. [austinpublishinggroup.com]

(Etiology) Acute Subdural Hematoma generally occurs due to a severe blow or injury to the head Research has demonstrated Acute Subdural Hematoma to be rated as one of the most serious conditions in comparison to the other head trauma associated conditions [dovemed.com]

The etiological possibilities of spontaneous subdural hematoma are discussed. Patients and methods We analyzed 8 cases of acute spontaneous subdural hematoma among a total number of 321 patients with subdural hematoma is presented. [revistaneurocirugia.com]

Coma/diagnosis* Coma/epidemiology Coma/surgery Female Follow-Up Studies Hematoma, Subdural, Acute/diagnosis* Hematoma, Subdural, Acute/epidemiology Hematoma, Subdural, Acute/surgery Humans Intracranial Aneurysm/diagnosis* Intracranial Aneurysm/epidemiology [ncbi.nlm.nih.gov]

Tallon JM, Ackroyd-Stolarz S, Karim SA, et al ; The epidemiology of surgically treated acute subdural and epidural hematomas in Can J Surg. 2008 Oct51(5):339-45. [patient.info]

Practical considerations for sensitivity analysis after multiple imputation applied to epidemiological studies with incomplete data. BMC Med Res Methodol 2012; 12:73. 26. D’Agostino RB. [journals.lww.com]

In future studies, epidemiological changes as population ages, management of delayed pathophysiology, superiority of each surgical procedures, and salvage ability should be addressed. [ncbi.nlm.nih.gov]

The possible pathophysiological mechanisms are discussed. [hoajonline.com]

Decompression with a burr-hole craniotomy promptly followed by a decompressive craniectomy was performed to prevent contralateral ASDH. [ncbi.nlm.nih.gov]