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16-OCTOBER-2019 ZAKI YOUSEF ASAAD 75 YEARS
HUGE SUBACUTE SUBDURAL HEMATOMA LEFT CEREBRAL HEMISPHERE WITH
PROGRESSIVE RIGHT HEMIPARESIS.
Anamnesis
The patient came to the Emergency of Shmaisani
hospital the morning of 16-October-2019 with
right sided severe paresis and motor and sensory
dysphasia. The patient 45 days ago after RTA
suffered fracture right tibia and screw fixation
was applied. CT-scan at that time showed tiny
subdural hematoma left parietal convexity. The
patient condition started to deteriorate the
last 2 days. CT-scan performed showed very huge
subdural hematoma left cerebral convexity with
slipping to the other hemisphere and shifting of
the brain to the right side. The patient is
diabetic with cardiomegaly with irregular pulse,
in medication.
On examination: The patient is bedridden with
right sided paresis, motor and sensory
dysphasia. Considering that he has cardiac
problems, cardiologist was consulted.
The patient before surgery was sent for MRI of
the brain to rule out presence of vascular
anomalies. The patient could not cooperate for
investigation for what it was performed under
general anesthesia. After induction and during
the investigation, the patient showed severe
hypotension, for what the investigation was
halted for resuscitation. MRI of the brain was
achieved before that and no vascular
abnormalities of the brain were detected and the
huge hematoma was more clearly seen. It was
decided so as not to loose the patient to
perform surgery.
Through 2 burrs at the left
frontal and posterior parietal region, the hematoma
was evacuated and external drain was inserted. The
patient was sent to the MRI after performing surgery
and the hematoma disappeared, but the brain still
shifting and TWIST ruled out the suspicion of
aneurysm of the aorta.
The patient was sent to the ICU
after extubating him and after 4 hours, he started
to regain consciousness and the start to improve.
Follow Up
The patient next day talking walking and
understand the speech and eating. The patient
will be kept in ICU for 72 hours after surgery.
Comments
The patient was during MRI under G.A in
critical condition. Some told me to leave him, but
considering that the evacuation of the hematoma is the only
hope to jump him through this catastrophic event, it was
decided to perform surgery.
The hypotension attack after starting the
G.A. could be due to cold environment of the MRI suite, or
sensitively to certain drugs.
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