Abstract
Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was “fatal in the ordinary course of nature”. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate “new incident” that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.
Highlights
Subdural space is a potential space and it is situated between dura and the arachnoid mater
Clinical features appear in 3 days in acute Subdural haemorrhage (SDH), in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH.[2]
The pre-op CT scan (Fig. 1) showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery
Summary
Subdural space is a potential space and it is situated between dura and the arachnoid mater. Case report A 42 years old female knocked down by a bus while walking along a road was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. Almost all symptoms were settled except headache and were discharged Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. The brain surface was flattened, hemisphere was not swollen, ventricles were not dilated and herniations were not found She was transferred back to the base hospital and according to the medico-legal examination performed likely post-surgical changes with no midline after 21 days of the incident, there were no apparent external head injuries. The category of hurt was fatal in the ordinary cause of nature (FIOCN) but it is not clear whether this is due to the fall from the bus or any other incident after that
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