Concluded Case

Large SDH Lt Temporoparietal with acute SDH rt parietal

New case 44 yr ,F ,No known comorbidities,not taking any medicine ,Presented with left sided head ache since 1 week more while coughing. Dull aching type of head ache not associated with nausia/ vomiting/ vertigo.She is able to tolerate the head ache and able to do all house hold work.No definite history of trauma,but she is in doubt that her head hit on the window about 2 weeks ago. Examination failed to obtain any focal deficits. Optic fundi normal.On flexing the head she stated that she has headache on the left hemicranium,but no neck stiffness. Diagnosis & management ?

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Thanks Curofy and others for the answer. Discussion diagnosis and management. MRI shows Large acre on subacuteSDH left temporoparietl convexity with maximum thickness left parietal with midline shift and uncal herniation to rt .Ct shows mostly hypodense acute SDH left temporoparietal with midline shift brain edema . Small rt parietal acute SDH Temporoparietal burrhole evacuation done ,pt is better.
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Dear Dr Manorama Rajan, 1) This case seems to be a Left sided Sub Acute large SDH. 2) Small Right sided SDH, which is not a problem in this case Scenario. 3) No other symptoms of raised ICP. 4) We can wait and watch, bed rest is required. 5) Repeat CT after 2 weeks to assess the size of SDH. 6) Mean while cross Consultation with Neuro Surgeon is mandatory to decide whether Surgery is necessary or not. Regards and thanks, Dr Sepuri Krishna Mohan.
Dear Dr Mohan. You are correct in the diagnosis. There is midline shift to rt with uncal herniation this is an emergency .No body can wait. Emergency surgery done .I will update later.
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Thanks Curofy and others for the answer. Discussion diagnosis and management. MRI shows Large acre on subacuteSDH left temporoparietl convexity with maximum thickness left parietal with midline shift and uncal herniation to rt .Ct shows mostly hypodense acute SDH left temporoparietal with midline shift brain edema . Small rt parietal acute SDH Temporoparietal burrhole evacuation done ,pt is better.
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