CLINICAL BACKGROUND

62-year-old Alcoholic Woman presented to Medical College Hospital, ER with decreased level of consciousness since 2 days with a chronic h/o of headache since 1 yrs back. Patient party denies any h/o seizure and vomiting, but the patient is complaining of Nausea since pt has developed this illness. She has h/o of fall 2 weeks back from Bed. She denies h/o DM but has h/o Controlled HTN under medication Tab Amlodipine 2.5mg. No other Past medical h/o and Surgical h/o.
Personal h/o : Alcoholic, Ex Smoker left 2 yrs back 4/5 cig /day in past

On Examination :
Patient was agitated, GCS : 12/15; E3 V4 M5 ;
Vitals : Bp : 150/90 mm Hg, Ps = 87/min, T= 98.9 F,RR = 22 /min
B/l pupils 3 mm sluggish reaction to light.
Chest / CVS / P/a = Reveals no abnormality

Laboratory Examination :
TC : 10,100/mm3 N 72 % L 28 % , Hb = 10.1 gm %, ESR = 18 ; Trop I -ve
Platelets : 1,75,000/mm3, PT : 14 sec , INR = 1
LFT, RFT, RBS, Na /K = WNL
ECG : LVH

Immediate nonenhanced computed tomography (CT) scan of the patient’s head done whichs shows : see images

What is the diagnosis, and what is the Mx in ER & further intervention is indicated ?

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"It's psychosomatic. You need a lobotomy. I'll get a saw." - Calvin in Calvin and Hobbes

hx of trauma and signs and symptoms of raised intracranial pressure like headache and nausea vomiting and mass close to frontal area with the cup shape margins epi dural haematoma burr hole or craniotomy can be done

she is on amlodipine which can cause headache

right frontal sapce occupying lesion. the lesion shown in CT is hypodense which is uncharcteristic of haemorrhage.....

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Most people are only alive because it is illegal to shoot them.

i think amlodipine is used in migraine so if it causes headache then y it is used ?

I Think So This Lesion Is That We Can Found In Epidural Haemotoma

Diagnosis
SubAcute with Chronic SDH

Management
Measures to decrease ICP.
Immediate Neurosurgical Consulation, Evaluation, Burr-Hole Evacuation of Haematoma.

Acute subdural hematoma

Small acute SDHs less than 5 mm thick on axial CT images, without sufficient mass effect to cause midline shift or neurological signs, can be followed clinically (see Image 1). Hematoma resolution should be documented by serial imaging because an acute SDH that is treated conservatively can evolve into a chronic hematoma.

Emergent medical treatment of an acute SDH causing impending transtentorial herniation is the bolus administration of mannitol (in the patient who is adequately fluid resuscitated with an adequate blood pressure). Surgical evacuation of the lesion is the definitive treatment and should not be delayed. Due to the risk of causing cerebral ischemia, hyperventilation as primary treatment is controversial and should be used only if other options do not exist.

The patient with an acute SDH should be transfused with fresh frozen plasma (FFP) and platelets to maintain the PT within the normal range and the platelet count above 100,000.

Chronic subdural hematoma

Without mass effect on imaging studies and no neurological symptoms or signs except mild headache, a chronic SDH can be followed with serial scans and may resolve. No medical therapy has been shown to be effective in expediting rapid resolution of acute or chronic SDHs.