Subdural haematoma presenting with transient neurological deficits

To stress that transient neurological deficits do not always imply transient cerebral ischaemia, and may be produced by subdural haematoma.

An 80-year-old man was seen for intermittent gait disturbance, with normal findings on initial examination. He was then admitted after the onset of a fixed neurological deficit which worsened. Subdural haematoma was diagnosed by computed tomography (CT). An 80-year-old woman was seen after she had experienced left hemisphere transient neurological deficits. A CT scan showed a left-sided subdural haematoma.

Both patients underwent successful surgery with complete resolution of their symptoms and signs.

Subdural haematoma is relatively common and must be considered in those with unexplained transient neurological deficits. Magnetic resonance imaging or CT are the diagnostic procedures of choice. Antiplatelet or anticoagulant therapy must not be instituted until subdural haematoma is excluded.