Bilateral Subdural Hematomas Without Midline Shift: A Case Report.

Area of Science:

• Neurosurgery
• Neurology

Background:

• Subdural hematomas (SDH) are collections of blood between the dura mater and arachnoid mater, posing a significant risk for neurological compromise.
• Commonly associated with elderly individuals and alcohol abuse, SDH can lead to midline shift and brain herniation, often requiring surgical intervention.
• Treatment modalities for SDH include craniotomy or burr hole trephination, with outcomes influenced by factors like the Glasgow Coma Scale (GCS) score and radiological findings.

Observation:

• A 93-year-old male presented with acute-on-chronic bilateral subdural hematomas following a home fall.
• The patient was neurologically intact, hemodynamically stable, and notably lacked a midline shift on imaging.
• Despite the bilateral nature of the hematomas, conservative management was not pursued due to the acute-on-chronic presentation.

Findings:

• Bilateral burr hole trephination was performed to evacuate the subdural hematomas.
• The patient experienced an uncomplicated postoperative recovery.
• Discharge was uneventful, with no immediate complications noted.

Implications:

• This case demonstrates the successful surgical management of bilateral subdural hematomas in an elderly patient with preserved neurological status and no midline shift.
• It suggests that bilateral burr hole evacuation can be a safe and effective treatment option in carefully selected cases of SDH, even in the absence of significant mass effect.
• Further research may explore criteria for surgical intervention in neurologically intact patients with bilateral SDH.