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Neurology

Question
14 out of 21
 

A 62 year old diabetic female patient presented with history of progressive right-sided weakness of one month duration. The patient was also having speech difficulty. Fundus examination showed papilledema. Two months ago, she also had a fall in her bathroom and struck her head against a wall. The most likely clinical diagnosis is: (AIIMS Nov 2011)



A Alzheimer's disease

B Left parietal glioma

C Left MCA territory stroke

D Left chronic subdural hematoma

Ans. D

Left chronic subdural hematoma

B. Subdural hematoma (Ref. Hari-18th ed., pg- 3379)

Acute subdural hematoma (Ref. Hari-18th ed., pg- 3378)

1). A unilateral headache and slightly enlarged pupil on the side of the hematoma are frequently, present.

2). Stupor or coma, hemiparesis, and unilateral pupillary enlargement are signs of larger hematomas.

Chronic Subdural Hematoma

1). The presence of progressive hemiparesis and aphasias together with signs of raised ICT (papilledema) in an elderly patient, developing weeks after sustaining a mild head injury is characteristic of chronic subdural hematoma.

2). Gradual accumulation of blood in subdural space and classically presenting 3 weeks after the initial bleed. (Chronic)

Pathogenesis

1). Most commonly caused by rupture of superior cerebral veins (Bridging veins that connect the cerebral cortex to superior saggital sinus)

2). Repeated cycles of recurrent bleeding into subdural space and resorption of the resultant hematoma.

Etiology

1). Head Trauma (Usually trivial and unnoticed in upto 25% of cases) so It is very common in alcoholic patient.

2). Motor vehicle Accident

3). Repeated falls in elderly from syncope, ataxia, weakness or seizures

4). Patients with bleeding problems

- Anticoagulation

- Thrombocytopenia

- Liver failure

- Alcoholism

5). Dural lesions

- Sarcoma’s AV malformations and metastatic cancer

6). Low CSF volume

- CSF shunts, renal dialysis, excess diuretics

Clinical Features

Gradual onset of signs and symptoms over several weeks (characteristically >3 weeks for chronic subdural hematomas)

1). Headache: Constant and relatively mild & usually lateralized to the side of lesion

2). Deterioration of mental status with confusion lethargy and memory disturbance

3). Progressive contralateral hemiparesis and Aphasias (speech disturbance)

4). Papilledema

5). Others :

a. Cranial Nerve abnormalities

b. Hemianopsia

Neurology Flashcard List

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