Bilateral Subdural Hematomas Without Midline Shift: A Case Report

Subdural hematomas are blood collections between the dura mater and the arachnoid mater of the meninges that can rapidly progress into surgical emergencies. Commonly seen in the elderly and alcoholic demographics, the accumulation of blood can cause midline shifts and brain herniation. The standard practice of treatment may include either a craniotomy or burr hole trephination. Subdural hematomas may be acute or chronic and be unilateral or bilateral; predicting mortality rate can be done based on the Glasgow Coma Scale (GCS) score, age of the patient, hemodynamic stability, neurological deficits, and radiological findings such as location of the bleed and measurement of midline shift. We present a 93-year-old male patient who was found to have acute-on-chronic bilateral subdural hematomas without a midline shift a week after he had a fall at home. The patient was neurologically intact and not in respiratory distress. Bilateral burr hole trephination was used to evacuate the hematomas, and the patient was closely followed up postoperatively and did not have any complications and was discharged. This case provides an interesting look at managing bilateral subdural hematomas without midline shift or neurological deficits and stable hemodynamics.