Unsuspected subdural hematoma as a differential diagnosis in elderly patients

Subdural hematomas are among the most common forms of intracranial hemorrhage encountered in clinical practice and are a surgically remediable cause of dementia. When the symptom presentation is subtle or diffuse, a subdural hematoma can be overlooked. This is especially true among elderly people who may exhibit unrelated, preexisting dementia or delirium. Particularly confusing is that such declines in intellectual capacity can also result from subdural hematoma. It is therefore essential that a thorough physical and neurologic assessment be done on all patients with cognitive deficiencies. This always includes brain imaging. Early recognition of a subdural hematoma is important, given its treatability and potential reversibility. We describe an elderly woman with new-onset cognitive deficit and gait dyspraxia. There was no evidence of trauma. Physical examination was otherwise unremarkable. Initially, she refused evaluation, but once a subdural hematoma was identified by a tomographic scan, a satisfactory outcome followed surgical intervention.