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

  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]

  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]

  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]

  purulent discharge from any wounds), aspiration pneumonia (shortness of breath, pulmonary congestion, fever, productive cough), increased ICP Response to surgery and clot evacuation: Mental status changes, incisional healing, presence of complications [medical-dictionary.thefreedictionary.com]

• 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]

• 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]

  About 40% of patients with ASSDH have associated hypertension and alcohol abuse. [neurologyindia.com]

• Headache

  A 54-year-old man was admitted to our hospital with complaint of sudden headache. The patient had suffered two episodes of transient headache before admission. [ncbi.nlm.nih.gov]

  Very few other diseases can display posturodependent headache (cerebral thrombophlebitis, 6 incipient eclampsia, 7 meningitis, 8 and others), and, thus, position-related headache is almost synonymous with PDPH. [anesthesiology.pubs.asahq.org]

• 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]

  There will be changes in pulse and breathing rate along with possible seizures or unconsciousness. [sportsinjuryclinic.net]

• 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]

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

  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]

• Lethargy

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

  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]

  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]

• 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]

  Any abnormality of mental status that cannot be explained completely by alcohol intoxication or the presence of another mind-altering substance should increase suspicion of SDH in the patient with blunt head trauma. Obtain an urgent CT scan. [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]

This means that the results cannot be applied to patients with contusions or other intracranial injuries, whose treatment and prognosis are different." [news-medical.net]

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

This is one the most common etiologies because as the brain atrophies, which is more common in the elderly, the "bridging veins" that connect the cortex to the draining venous sinuses stretch, and are more easily torn from minor trauma, resulting in a [casemed.case.edu]

(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]

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]

"Pathophysiology of chronic subdural haematoma: inflammation, angiogenesis and implications for pharmacotherapy". Journal of Neuroinflammation. 14 (1): 108. doi : 10.1186/s12974-017-0881-y. PMC 5450087. [en.wikipedia.org]

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