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Suggest Treatment For Subdural Hematoma

Posted on Tue, 22 Jul 2014

Question: my father in law had a fall few days ago and he took a 2 hour flight to visit us. During his stay his left side kept becoming weak and was losing sensation in his hands and legs. An MRI was done which showed subacute subdural haematoma. We took him to an emergency of the local hospital and the doctor after doing another CT scan advised immediate surgery. We wanted him to fly back to his home country but the doctor advised against air travel. His initial surgery was not successful and a repeat was done where part of the skull bone was removed and parked in his abdomen. His recovery is very slow and is very disoriented and helucinates a lot. He is 81 years old. Should the surgery have been done? is it normal to be disoriented and helucinate?

Answered by Dr. Sudhir Kumar (5 hours later)

Brief Answer:
Surgery should have been done.

Detailed Answer:
Hi,

Thank you for posting your query.

I have noted your father-in-law's symptoms.

I agree with the decision to operate on the subdural hematoma (SDH), as he was becoming weak on the left side. If he had no symptoms (such as weakness and numbness), we could have waited for a few days.

However, the surgery was most probably not an emergency, as he was conscious and oriented prior to the surgery. SDH surgery becomes an emergency, if the patient becomes drowsy, disoriented or confused.

Disorientation and hallucinations do occur after SDH surgery, because of swelling in the brain. These would go away slowly over time and with treatment.

I hope my answer helps. Please get back if you have any follow up queries or if you require any additional information.

Wishing you good health,

Dr Sudhir Kumar MD (Internal Medicine), DM (Neurology) XXXXXXX Consultant Neurologist
Apollo Hospitals, XXXXXXX XXXXXXX
Click on this link to ask me a DIRECT QUERY: http://bit.ly/Dr-Sudhir-kumar
My BLOG: http://bestneurodoctor.blogspot.in

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (1 hour later)

Thank you for your answer. He is very agitated and has lot of anxiety and keeps pulling the tubes and removes clothes. is sedation advise able or will that impact or delay recovery

Answered by Dr. Sudhir Kumar (3 minutes later)

Brief Answer:
Low dose sedation can be given.

Detailed Answer:
Thank you for getting back with more information.

He can be given low dose sedation.

The best option would be quetiapine tablets. It can be used at a dose of 25 mg at bed time, and the dose can be increased as per the response.

Using physical restraints for hands are also a good option.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sudhir Kumar (13 hours later)

Thank you for your answer. you said that surgery was not an emergency but am I correct to assume that sooner or later surgery had to be done? also the doctors advised against air travel without surgery. would air travel on a 3 hour flight caused further damage? Thank you

Answered by Dr. Sudhir Kumar (7 minutes later)

Brief Answer:
Yes, surgery was needed.

Detailed Answer:
Thank you for getting back.

Yes, surgery was needed sooner or later.

Air travel could have been risky.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar