Acute and Critical Care

Case Reports

Neurosurgery
Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis: Chul Hee Lee; Korean J Crit Care Med. 2014;29(2):114-118. Published online May 31, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.2.114

Abstract PDF: A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

Inhospital Spontaneous Acute Subdural Hematoma (SADH) Patient with Antiplatelet Therapy due to Acute Cerebral Ischemia: A Case Report: Hyo Chang Kim, Chun Sik Choi, Jae Young Yang, Hyun Chul Shin, Yu Sam Won, Young Jun Kwon; Korean J Crit Care Med. 2011;26(2):94-97.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.94

Abstract PDF: A case of "spontaneous" acute subdural hematoma caused by aspirin and plavix therapy has not been described previously. As an isolated cerebrovascular event related to aspirin and plavix therapy, this is the first report described in the literature. It also represents a new differential diagnosis for nontraumatic acute subdural hematomas.

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