Chronic Subdural Hematoma


Step 1: View clinicals

A 68 year old lady presents with a worsening headache for 2 weeks, and mild disorientation for 2 days. There is no history of trauma. She was diagnosed with diabetes mellitus 10 years ago, which is uncomplicated and well controlled on metformin alone. She is not on any other drugs, and has an unremarkable family history.

Step 2: Order all relevant investigations

CT Brain

There is a large, hyperdense, right-sided subdural collection with signs of recent bleeding. A midline shift of 10 mm is noted.

Lumbar Puncture

You realize that performing a lumbar puncture might not be a good idea.

X-Ray Skull

The X-Ray of the skull appears completely normal.

Coagulation Profile

INR: 1.0 (0.9-1.2) APTT: 29 sec (25-35) TT: 12 sec (11-15)

Step 3: Select appropriate management

Burr Hole Craniotomy
Conservative Management

Score: ★★☆