When doom is vincible but imperceptible

Abstract

An eighty-year-old gentleman without any comorbidity or significant medical illness had presented with headache of recent onset. A detail clinical evaluation and imaging (MRI of brain) ruled out secondary cause of headache. A month later, he presented to emergency with altered sensorium and quadriparesis. Repeat brain imaging revealed bilateral subdural hemorrhage requiring emergent surgery. He was back to normalcy within few days postoperatively. A confession was obtained about his daily habit of induced vomiting after drinking large amount of water (kunjala kriya). The repeated habit of induced vomiting might have been responsible for the slowly evolving subdural hemorrhage. Interestingly, though he had significant clinical symptoms at the initial presentation, he had normal initial MRI of brain (the more sensitive imaging modality). Our case highlights the interesting neurophysiology of subdural hemorrhage and the importance of close monitoring of elderly patients of recent onset headache.