Case history
Case history #1
A young man is brought to the emergency room after being involved in a high-speed motor vehicle accident. He was an unrestrained driver, and no airbags were deployed. He has multiple areas of abrasions, lacerations, and ecchymosis on his scalp and face. On neurologic exam, he does not open his eyes to painful stimuli; he is intubated, and he withdraws his left side to pain. His right side is plegic. His right pupil is 3 mm and reactive to light and his left pupil is 8 mm and nonreactive.
Case history #2
A 75-year-old man with a longstanding history of atrial fibrillation on anticoagulation with warfarin is brought into the emergency room by his caregiver, who states his concern about the patient's confusion at home. The caregiver describes frequent falls over the last several months and says that the patient is dropping utensils from his right hand. On neurologic exam, his pupils are equal, round, and reactive to light. He has a right-sided pronator drift and is weaker on his right side than on his left. His mental status testing reveals poor concentration and attention, and impaired short- and long-term recall and registration.
Other presentations
The presentation of subdural hematoma (SDH) occurs on a spectrum, ranging from asymptomatic, mild headaches, or subtle cognitive decline to seizures and neurologic extremis/herniation syndromes.[2][3] This variable presentation reflects the size of the hematoma and the amount of time over which it develops. Neurologic presentation (along with signs of increased intracranial pressure) has been correlated to patient age and degree of premorbid brain atrophy.[3]
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