ACUTE SUBDURAL HEMATOMA IN AN ADULT PATIENT WITH PROGRESSIVE NEUROLOGICAL DETERIORATION AFTER MILD TRAUMATIC BRAIN INJURY: A CASE REPORT

Abstract

DOI: https://doi.org/10.46296/gt.v8i16.0325

Abstract

Introduction: Subdural hematoma (SDH) is a frequent intracranial hemorrhage, mainly related to trauma and predisposition factors such as ageing and antithrombotic therapy. Outcomes depend on early diagnosis, hematoma size, midline shift and prevention of secondary brain injury (1)(2). Case presentation: A 67-year-old man with atrial fibrillation on apixaban sustained a ground-level fall with head impact. He presented with headache and Glasgow Coma Scale (GCS) 15. Initial CT showed a right frontoparietal acute SDH (8 mm) with 3-mm midline shift. Six hours later, he developed progressive somnolence (GCS 11) and anisocoria; repeat CT revealed SDH expansion (13 mm) with 7-mm midline shift. Hemostatic reversal and emergent craniotomy were performed with favorable recovery (3)(4). Discussion: Reference surgical thresholds recommend evacuation when SDH thickness exceeds 10 mm or midline shift exceeds 5 mm regardless of GCS. In anticoagulated patients, timely reversal and close neurologic monitoring are critical. From a nursing standpoint, standardized neurologic assessment, early recognition of intracranial hypertension and effective interdisciplinary communication are essential to reduce complications (3)(4). Conclusions: This case underscores the value of close observation and timely repeat neuroimaging when clinical changes occur, as well as coordinated interdisciplinary care to enable safe and timely neurosurgical intervention.

Keywords: subdural hematoma; traumatic brain injury; anticoagulants; craniotomy; nursing care; case report.