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Suggest Treatment For Dizziness After Head Injury
Question: 65 year old male. Healthy overall but for last few weeks developed headache and few times fell down perhaps due to dizziness. He also fell from vehicle(scooter) a month ago and possibly head injury then on the backside of the head but was fine after the injury and hence we did not see a doctor then. After the symptoms of head ache showed up over last few weeks, we did a CT scan and it revealed a subdural haemotoma at 1.9 cm depth. The report also says there is compression of the left lateral ventrical midline shift to the right and mild dilation of the right lateral ventrical. Currently he is conscious and speaking and understanding well. Dr. says it maybe a quasi emergency state and needs to be operated. He says he will be using carietomy technique for operation and says 95% chance of recovery is there. Since he is taking aspirin, they want to wait till the effect of aspirin wears off as it causes blood thinning. Kindly provide your opinion on whether surgery is required and what are the chances of recovery?
Brief Answer:
Surgery is necessary.
Detailed Answer:
I read your question carefully and I understand your concern.
Subdural hematoma can be a life threatening condition. Fortunately in your husband's case it has been a case of chronic bleeding which makes his condition relatively good.
At times these hematomas can be simply watched, but that is in the case of small ones. In your husband's case it has a thickness of 1.9 cm which is considerale, usually over 1 cm they are intervened upon. Opinions may change at times between neurosurgeons, but I think even the more expectant ones would intervene in the case of a 1.9cm hematoma with ventricle compression and shift.
So I completely agree with your doctor's approach.
As for the method drill craniostomy is generally preferable, less operative risks involved. The alternative would be craniotomy (removing the bone as opposed to drilling a hole), which is reserved for cases when the hematoma has developed membranes and it is feared that there are compartments which may not be evacuated by a simple drill. However these are technical details to be considered by the neurosurgeon according to CT image, don't want to confuse you too much. Surgery is required though.
Surgery itself is a fairly easy routine procedure for the neurosurgeon. As for the recovery generally it depends on the condition of the patient before surgery, since in your husbands case you describe no neurological deficit, chances are recovery will be very good he could be out of the hospital in a couple of days.
I hope to have been of help.
Surgery is necessary.
Detailed Answer:
I read your question carefully and I understand your concern.
Subdural hematoma can be a life threatening condition. Fortunately in your husband's case it has been a case of chronic bleeding which makes his condition relatively good.
At times these hematomas can be simply watched, but that is in the case of small ones. In your husband's case it has a thickness of 1.9 cm which is considerale, usually over 1 cm they are intervened upon. Opinions may change at times between neurosurgeons, but I think even the more expectant ones would intervene in the case of a 1.9cm hematoma with ventricle compression and shift.
So I completely agree with your doctor's approach.
As for the method drill craniostomy is generally preferable, less operative risks involved. The alternative would be craniotomy (removing the bone as opposed to drilling a hole), which is reserved for cases when the hematoma has developed membranes and it is feared that there are compartments which may not be evacuated by a simple drill. However these are technical details to be considered by the neurosurgeon according to CT image, don't want to confuse you too much. Surgery is required though.
Surgery itself is a fairly easy routine procedure for the neurosurgeon. As for the recovery generally it depends on the condition of the patient before surgery, since in your husbands case you describe no neurological deficit, chances are recovery will be very good he could be out of the hospital in a couple of days.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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