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Updated: Oct 20, 2025

3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
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Subdural Hematoma Presenting as Psychogenic Nausea.

David C Fipps, Elisabet Rainey

    Journal of Psychiatric Practice
    |September 16, 2021
    PubMed
    Summary

    Medically unexplained nausea in an elderly man was initially misattributed to psychogenic causes. A subdural hematoma was discovered, emphasizing the need for broad differentials in diagnosing unexplained symptoms.

    Area of Science:

    • Neurology
    • Geriatrics
    • Medical Diagnostics

    Background:

    • Psychogenic nausea is a term for nausea without clear medical pathology, often linked to psychiatric factors, though this distinction is evolving with DSM-5 criteria.
    • The concept of psychogenic symptoms persists in clinical practice, particularly for medically unexplained conditions.

    Observation:

    • A 74-year-old man presented with nausea initially presumed to be psychogenic following a negative medical evaluation.
    • New tremors were attributed to a benzodiazepine taper.
    • The development of focal neurological deficits prompted further investigation.

    Findings:

    • A computed tomography scan revealed a subdural hematoma.
    • Neurosurgical intervention (evacuation and drainage) successfully resolved the patient's symptoms.

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  • Subdural hematomas, often caused by venous tearing, can lead to mass effect and ischemia, presenting with various symptoms including nausea.
  • Implications:

    • This case underscores the critical importance of maintaining a comprehensive differential diagnosis for all medically unexplained symptoms.
    • Close monitoring for evolving symptoms is essential, even when initial assessments suggest a psychiatric or benign etiology.
    • Prompt neurosurgical evaluation can be life-saving in cases of subdural hematoma presenting with neurological deficits.