Korean J Crit Care Med.  2014 May;29(2):114-118. 10.4266/kjccm.2014.29.2.114.

Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis

• Lee CH

• KMID: 2227772
• DOI: http://doi.org/10.4266/kjccm.2014.29.2.114

Abstract

A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurological examination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebral convexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurological examination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without using heparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage and midline shift. Emergency burr hole trephination and removal of the hematoma were performed, after which symptoms improved. However, nine days after the operation a sudden onset of general tonic-clonic seizure developed and a brain CT demonstrated an increased amount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred to the intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitol infusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he was discharged without specific neurological deficits.

Keyword

acute subdural hematoma; end stage renal disease; hemodialysis; renal replacement therapy

MeSH Terms

Brain
Emergencies
Glasgow Coma Scale
Headache
Hematoma
Hematoma, Subdural*
Hematoma, Subdural, Acute
Hemorrhage
Heparin
Humans
Intensive Care Units
Intracranial Pressure
Kidney Failure, Chronic
Mannitol
Middle Aged
Neurologic Examination
Renal Dialysis*
Renal Replacement Therapy
Seizures
Tomography, X-Ray Computed
Trephining
Vomiting
Heparin
Mannitol