Concluded Case

Bilateral Acute on Chronic SDH

New Case Todays 1st OPD case. 60 yr ,M, DM and Systemic hypertension detected 1 yr ago, on rsgular med and follow up. History of alleged RTA 11 Jan 2020,fell down from Two wheeler. Sustained multiple aberrations with out head injury. Treated in our hospital. CT brain was done on 11 jan ( last set of films in the posted images). He was doing fine till 3 days ago.He went out for buying some house hold items and on the way back developed left parietal head ache ,moderately severe,lasted for an hr only subsided spontaneously. He skipped his dinner and slept. The next day morning is yesterday the wife noted Rt hand weakness and he was unable to hold the tooth brush. The whole day he was dull,not asking or doing anything & wife noted spontaneous laugh with using inappropriate answers and missing words. Today morning onwards he has difficulty in walking . On eam BP was 150/90 mmhg.Asking anything he has a tendency to laugh with missing the words while answering and using inappropriate words.Rt sided hemiparesis with gr 3/ 5 power. Urgent CT brain wa done and ref the case to our Neurosurgeon for further management. Diagnosis and Management.

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Concluded answer
Thanks to all answeres. Discussion: Diagnosis & Management. Diagnosis.BILATERAL ACUTE ON CHRONIC SDH. Extra- axial SDH noted in bilateral frontoparietal convexities with CSF - BLOOD densities. Management: Emergency bilateral burrhole evacuation of SDH done under GA. Patient became better and discharged
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Thanks to all answeres. Discussion: Diagnosis & Management. Diagnosis.BILATERAL ACUTE ON CHRONIC SDH. Extra- axial SDH noted in bilateral frontoparietal convexities with CSF - BLOOD densities. Management: Emergency bilateral burrhole evacuation of SDH done under GA. Patient became better and discharged
Again, i see so many answers mentioning mannitol and steroids etc....PLEASE PLEASE, take this message strongly.. these are contraindicated here. MANNITOL AND STEROIDS SHOULD NEVER BE USED LOOSELY FOR EACH AND EVERY CNS CASE LIKE PCM OR MULTIVITAMINS
B/l chronic SDH.. burr holes evacuation .. very good result.. bilateral collection is quite commonly seen and single stage surgery is needed..Otherwise opp side will expand
BURR HOLE SURGERY CAN B DONE UNDER LOCAL ANAESTHESIA IN MOST SUCH PATIENTS.THE SURGERY UNDER MONITORED ANAESTHESIA USING CONSCIOUS SEDATION HAS BEEN FOUND TO BE SAFE AND EFFECTIVE.
Nees Radiological opinion of case
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B/l Chronic SDH,the usual treatment is to remove the chronic SDH one or two Burr holes with irrigation and aspiration of the clotted blood.
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Chronic SDH and craniotomy and evacuation might require. 1. Ventilation 2. Levipil 3. Mannitol 3. May require steroids .
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Bilateral subacute subdural heamatomas with mass effect. Gliosis right parietal region
Chronic SDH Required anti oedema mannitol Anti epileptics And urgent surgical decompression
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Chronic Sub Dural haematoma on Lt side Neurosurgeon consultantion needed
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A CASE OF RT SIDED HEMIPARESIS
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