Recurrent Subacute Subdural Hematoma in a 67-Year-Old Female with Late Alzheimer’s Disease: A Case Report

Abstract

Background: Chronic Subdural Hematoma (CSDH) is becoming an urgent public health issue due to an increase of incidence in aging populations like Taiwan. Though trauma still stands as the primary mechanism of CSDH, it is often overlooked in the elderly, especially those with mid-to-late stage Alzheimer’s Disease (AD). Coincidentally, the clinical presentation of mid-to-late stage AD shares significant overlap with CSDH. AD creates an immense challenge for physicians and family members to identify early signs of CSDH.
 The Case: We report a peculiar case of a 67-year-old female with a history of AD who presents to the Emergency room in Belmopan City, Belize, with recurrent CSDH. On admission her consciousness was disturbed and late stage dementia presented an enormous challenge for logical and meaningful history taking. Axial non-contrast computed tomography showed a crescent-shaped isodense subdural hematoma in the left hemisphere of the parietal lobe. She was stabilized and treated conservatively with corticosteroids, beta blockers, angiotensin-converting enzyme (ACE) inhibitors and diuretics.
 Conclusion: It is important for physicians to recognize and develop protocols to identify early signs of CSDH in patients with late stage AD. Early management is a key factor in minimizing more serious complications like recurrence, seizures, and tension pneumocephalus.