Email via MedLink Neurology: Sat, Dec 14, 2013 at 7:51 PM
87 male who had a fall and CT of the brain showed a right curvilinear acute SDH about 2 mm in width. Is there is any data about the risks of expansion that would require surgical intervention. He has been on ASA 81 mg. Also he had a femur fracture that needed surgical correction. Repeat CT in 4 hours and 8 hours later showed no changes.
Email via Medlink from Neurosurgeon, Berkeley, California: Sat, Dec 14, 2013 at 11:56 PM
I think that it could be carefully watched. If any neurological signs develop, or if the hematoma enlarges, I would consider intervention. Avoid anticoagulants.
Email to Medlink from caregiver7careseeker on Sun, Dec 15, 2013 at 2:03 PM:
We reviewed some of the literature around this (non systematically)
for a similar patient (who continues to live with a non surgically
managed subdural hematoma 2 years since he first became acutely
symptomatic with it). Online patient record after 'informed
de-identification' available here: http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=265
The link below is a non systematic review with experience based
guidelines that recommend conservative management for those without
overt focal deficits: https://ssl-w03dnn0374.websiteseguro.com/sbn-neurocirurgia/site/download/artigos/article.pdf
For more Chronic instances, UK surgeons employ conservative management
in less than one-quarter of such cases and 55% of these surgeons
prescribe steroids to those managed conservatively. http://www.ncbi.nlm.nih.gov/pubmed/18686063
87 male who had a fall and CT of the brain showed a right curvilinear acute SDH about 2 mm in width. Is there is any data about the risks of expansion that would require surgical intervention. He has been on ASA 81 mg. Also he had a femur fracture that needed surgical correction. Repeat CT in 4 hours and 8 hours later showed no changes.
Email via Medlink from Neurosurgeon, Berkeley, California: Sat, Dec 14, 2013 at 11:56 PM
I think that it could be carefully watched. If any neurological signs develop, or if the hematoma enlarges, I would consider intervention. Avoid anticoagulants.
Email to Medlink from caregiver7careseeker on Sun, Dec 15, 2013 at 2:03 PM:
We reviewed some of the literature around this (non systematically)
for a similar patient (who continues to live with a non surgically
managed subdural hematoma 2 years since he first became acutely
symptomatic with it). Online patient record after 'informed
de-identification' available here: http://www.udhc.co.in/INPUT/displayIssueGraphically.jsp?topic_id=265
The link below is a non systematic review with experience based
guidelines that recommend conservative management for those without
overt focal deficits: https://ssl-w03dnn0374.websiteseguro.com/sbn-neurocirurgia/site/download/artigos/article.pdf
For more Chronic instances, UK surgeons employ conservative management
in less than one-quarter of such cases and 55% of these surgeons
prescribe steroids to those managed conservatively. http://www.ncbi.nlm.nih.gov/pubmed/18686063
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