Please go through and advise. 'Acute on chronic subdural hemorrhage in bilateral cerebral convexities measuring 2 cm in the right side and 1.3 cm in the left side. The mass effect is noted in the form of effacement of adjacent sulcal spaces and compression of ventricles. Thin rim of subdural hematoma is seen along the lateral convexity of the left cerebellar hemisphere with maximal thickness measuring about 4 mm. The C.P. Angeles and posterior fossa contents are normal. The basal cisterns and Sylvian fissures are normal. The sella, parasellar and suprasellar regions are normal.'
Immediate surgery was recommended by the doctors. The cause suspected is the use of Ecosprin 150 for the last three months. It was prescribed when last admitted for high sugar level which caused stroke symptoms. But, the brain CT was normal at that time. The patient has been diabetic for the last 35 years on insulin. Please advise if surgery is needed or it can be cured with medications. How critical is this condition and is it risky to delay? Is this a major or minor surgery? How will it be done?
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Surgery is absolutely indicated in this case. This hematoma cannot be cured with medications. Surgery should not be delayed as there is a possibility of permanent brain damage if the mass effect is not relieved. This is usually a minor surgery.
Burr holes and drainage is the usual operation in most cases. In some cases, when there are membranes in the hematoma, craniotomy may be required to prevent recurrence.In addition to the surgery, Ecosprin (Aspirin) should be stopped immediately. It can be restarted at a later date depending upon its need.
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Sorry for the delayed reply. Thank you very much for the timely advise due to which we could take a decision to go ahead and get the surgery done. The patient has been discharged from hospital last Friday. The burr hole was done on one side and craniotomy on the other side as you anticipated. The CT report after surgery is attached herewith for your review. The questions on it are:
I would be grateful if you can let us know your opinion on the above. Ecospirin has been stopped for now until next review which is 10 days from discharge for stitches removal.
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It depends on the condition of the patient. If the patient is alright, we can wait. If the patient has residual symptoms, we may need to re-explore.
For further queries consult a neuro surgeon online --> https://www.icliniq.com/ask-a-doctor-online/neuro-surgeon
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