PP 70 “I CAN’T RECALL EVER FALLING” SUBTLE PRESENTATION OF CHRONIC SUBDURAL HEMATOMA IN GERIATRIC PATIENT

Abstract

INTRODUCTION

In geriatric population, intracranial hemorrhage may not present in typical manner. We present a case in which a patient could not unable to recall any history of trauma but ended up having such pathology following investigation.

CASE DESCRIPTION

A 67 years old active gentleman complaints was complaining of intermittent mild headache for a month. He denied any recent history of trauma. Nevertheless, the wife noticed that recently he had intermittent history of short-term lapsed of memory. Apart from that, He had no nausea, can could walk normally and had no other problems. He was brought to our centre by his son who was also a physician at our centre. Upon arrival, his pupils were equal and reactive and he had a full GCS and no other remarkable examination finding. Nevertheless, it was noted intermittently he had short term amnesia. Her vitals were normal and he was afebrile. Decision was made to proceed with CT SCAN. CT SCAN showed large chronic subdural hematoma over left parietal area measuring 5X3 cm over 4 layers causing midline shift and obliterating left ventricle. Contusion was also noted over left cerebellum. Neurosurgical team was referred and patient subsequently underwent clot evacuation. Post surgical procedure, patient recalled that he had a fall about 4 weeks earlier during while jogging for which he denied any loss of consciousness. He also had history of going on long flights post fall about 2 weeks earlier. Patient had full recovery following the procedure. Patient likely had chronic subdural hematoma posttrauma complicated by history of flying.

LESSONS LEARNT AND CONCLUSION

This case illustrates the subtlety of chronic subdural hematoma in an elderly patient. Amnesia is a feature and in this case patient completely could not recall history of fall. Flying post intracranial bleeding provides decompression environment and increase risk of rebleeding. Apply high index of suspicion in such case and lower threshold for CT SCAN procedure so as not to miss such patients.