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How Does Surgery For Chronic Subdural Haematoma Work?
Question: My father-in-law is a very healthy and active 72 year old man. He slipped on some wet stairs in April 2014, and had a CT scan which did not show any areas of concern. He never loss consciousness. He walks several times a day. His mood is excellent. Appetite normal. His daily schedule of walking several miles a day has continued on. However, about 1 month after the fall, he began experiencing weakness in his left leg. It was making walking difficult. He still carried on with his routine. Over a 1 week period his left arm began to show signs of weakness, and walking became more difficult. Every other function remained absolutely normal. He has had no other degradation of any other function.
He just had a new CT scan and it was found he has a chronic subdural haematoma. He is scheduled for surgery in next week. He has been admitted to the hospital, but they are delaying the surgery by 1 week, because he has been on a blood thinner (ecospirin). So far he iis status quo and stable and has NO degradation.
Now that the surgery is planned, I have questions regarding the actual surgery and the post-care of the Chronic subdural haematoma to improve his care and outcome.
For a typical surgery for chronic subdural haematoma:
1. Is waiting 1 week long enough to build up the platelets? Or do we need to wait longer, if possible, to remove the blood thinner effects?
2. During surgery, do they intubate the patient? If yes, for how many days would he remain this way?
3. What is done after surgery to ensure the patient does not get pneumonia or any blood clots?
4. What are the steps taken to prevent post-surgery infection?
5. How to help him recover, without causing another haematoma by making him sit up too soon, etc. etc.
He just had a new CT scan and it was found he has a chronic subdural haematoma. He is scheduled for surgery in next week. He has been admitted to the hospital, but they are delaying the surgery by 1 week, because he has been on a blood thinner (ecospirin). So far he iis status quo and stable and has NO degradation.
Now that the surgery is planned, I have questions regarding the actual surgery and the post-care of the Chronic subdural haematoma to improve his care and outcome.
For a typical surgery for chronic subdural haematoma:
1. Is waiting 1 week long enough to build up the platelets? Or do we need to wait longer, if possible, to remove the blood thinner effects?
2. During surgery, do they intubate the patient? If yes, for how many days would he remain this way?
3. What is done after surgery to ensure the patient does not get pneumonia or any blood clots?
4. What are the steps taken to prevent post-surgery infection?
5. How to help him recover, without causing another haematoma by making him sit up too soon, etc. etc.
Brief Answer:
Waiting one week is fine.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the diagnosis and treatment plans of your father-in-law. Regarding your queries, my replies are below:
1. 5-7 days of time without Ecosprin is enough to build up the platelet functions.
2. Yes, during surgery, he would be intubated, and it would be removed within 1-2 days.
3. He would receive chest physiotherapy, good positioning in ICU bed, properly fed to prevent pneumonia. Antibiotics may be used if there is fever or raised WBC count.
To prevent blood clots in the legs, he would be given DVT stockings.
4. Proper wound dressing, and antibiotics are used to prevent infection.
5. We need to prevent any further falls.
I hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
Waiting one week is fine.
Detailed Answer:
Hi,
Thank you for posting your query.
I have noted the diagnosis and treatment plans of your father-in-law. Regarding your queries, my replies are below:
1. 5-7 days of time without Ecosprin is enough to build up the platelet functions.
2. Yes, during surgery, he would be intubated, and it would be removed within 1-2 days.
3. He would receive chest physiotherapy, good positioning in ICU bed, properly fed to prevent pneumonia. Antibiotics may be used if there is fever or raised WBC count.
To prevent blood clots in the legs, he would be given DVT stockings.
4. Proper wound dressing, and antibiotics are used to prevent infection.
5. We need to prevent any further falls.
I hope my reply has helped you.
I would be pleased to answer, if you have any follow up queries or if you require any further information.
Best wishes,
Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX
For DIRECT QUERY to me: http://bit.ly/Dr-Sudhir-kumar
My blog: http://bestneurodoctor.blogspot.com/
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. XXXXXXX
I thank you for your answers and it indeed provide me clarity. I do have a couple of further questions.
A brief update.
My father-in-law has been in the hospital 5 days, and in 5 more days they will perform the surgery.
He has not degraded. His mood, appetite, and socialization are all absolutely normal. He is however, pretty much just staying in bed - because it is easier. With assistance, he can walk.
1. Should we be making him walk? Our only concern is that we might cause stress to the site in the brain that had the original injury? Could you comment on whether we should be making him walk or not?
2. Regarding the actual surgery. It is my understanding that they will be drilling burr holes (draining) holes and also inserting catheters for the draining.
While this drains the build up blood etc., how is the original injury site fixed?
Or, how do we know that the area that original caused the blood to build up, has been stopped and is not continuing to leak into his brain?
3. Once he is released and brought home, should we be following-up with regular CT Scans to ensure there is no continued blood build up?
I thank you for your answers and it indeed provide me clarity. I do have a couple of further questions.
A brief update.
My father-in-law has been in the hospital 5 days, and in 5 more days they will perform the surgery.
He has not degraded. His mood, appetite, and socialization are all absolutely normal. He is however, pretty much just staying in bed - because it is easier. With assistance, he can walk.
1. Should we be making him walk? Our only concern is that we might cause stress to the site in the brain that had the original injury? Could you comment on whether we should be making him walk or not?
2. Regarding the actual surgery. It is my understanding that they will be drilling burr holes (draining) holes and also inserting catheters for the draining.
While this drains the build up blood etc., how is the original injury site fixed?
Or, how do we know that the area that original caused the blood to build up, has been stopped and is not continuing to leak into his brain?
3. Once he is released and brought home, should we be following-up with regular CT Scans to ensure there is no continued blood build up?
Brief Answer:
You can make him walk.
Detailed Answer:
Thank you for getting back with more information and asking more questions. My replies are below:
1. You can make him walk, and it would not increase the size of bleeding.
2. In this condition, there is no real injury to brain. There is injury to the blood vessel (located between brain and skull bone), which heals on own.
Patient's clinical condition, if stable, indicates that there is no further bleeding. When in doubt, we repeat the CT scan of brain.
3. Yes, follow up CT scans may be done to look for resolution of hematoma.
I hope it was helpful.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
You can make him walk.
Detailed Answer:
Thank you for getting back with more information and asking more questions. My replies are below:
1. You can make him walk, and it would not increase the size of bleeding.
2. In this condition, there is no real injury to brain. There is injury to the blood vessel (located between brain and skull bone), which heals on own.
Patient's clinical condition, if stable, indicates that there is no further bleeding. When in doubt, we repeat the CT scan of brain.
3. Yes, follow up CT scans may be done to look for resolution of hematoma.
I hope it was helpful.
Best wishes,
Dr Sudhir Kumar MD DM (Neurology) XXXXXXX Consultant Neurologist
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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