Concluded Case

BILATERAL ACUTE ON CHRONIC SDH

83 years old female patient with history of sudden deterioration of loss of consciousness- sonce 2 days with E2 V1 M3 - GCS . O/Examination- pulse 60/ minute , B.P - 130 / 76 mm of Hg . Chest , CVS , Abdominal Examination- normal. A CT and MRI was done . There was a BILATERAL ACUTE ON CHRONIC SDH - Left >right with mass effect on left cerebral hemisphere, sulcal effacement , effacement of left lateral ventricle with sub Falcine herniation and midline shift of 14 mm towards right side Treatment Protocol and Prognosis if early surgery is done

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Concluded answer
Treatment protocol simultaneous evacuation of both side SDH.Left shows uncal herniation to Rt,is an emergency
All Answers
EVD . SAH. CONSERVATIVE TREATMENT. INJ MANNITOL 100ML IV TDS. INJ CEFTAM 500MG IV BD. INJ DEXANO 1 AMP IV BD. ANTIEPIEPILEPTICS SOS . REASSURANCE AND COUNCILING REQUIRED.
Thanks Dr Dinesh Gupta
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EVD should be placed . Prognosis is good. Start him on inj mannitol 100 ml Tds to reduce cereral edema Add antiepileptics and supporting treatment.
Treatment protocol simultaneous evacuation of both side SDH.Left shows uncal herniation to Rt,is an emergency
I agree
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Surgical drainage urgently is the only way forward. Should be operated bilaterally.
Thank you doctor
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Surgery is the treatment of choice in most of the CSDHs
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