A 62 year old female patient presents with progressive right-sided weakness and speech dificulty since one-month.
Fundus examination showed the condition as represented in the picture below.
Two months ago, she had a history of fall in her bathroom and struck her head against a wall. The most likely clinical diagnosis is?
A. Alzheimer’s disease.
B. Left parietal glioma.
C. Left MCA territory stroke.
D. Left chronic subdural haematoma.
Ans:D. Left chronic subdural haematoma.
Fundus Examination shows Papilloedema.
The presence of progressive hemiparesis and aphasias together with signs of raised ICT (papilloedema) as shown in the picture above in an elderly patient, developing weeks after sustaining a mild head injury is characteristic of chronic subdural hematoma.
- It is optic disc swelling that is caused by increased intracranial pressure.
- The swelling is usually bilateral and can occur over a period of hours to weeks.
- Unilateral papilledema can suggest a disease in the eye itself, such as an optic nerve glioma.
- It may be asymptomatic or present with headache in the early stages.
- It may progress to enlargement of the blind spot, blurring of vision, visual obscurations (inability to see in a particular part of the visual field for a period of time) and ultimately total loss of vision may occur.
Signs of papilledema that are seen using an ophthalmoscope include:
- venous engorgement (usually the first signs)
- loss of venous pulsation
- hemorrhages over and / or adjacent to the optic disc
- blurring of optic margins
- elevation of optic disc
- Paton’s lines or radial retinal lines cascading from the optic disc.
- When papilledema is found on fundoscopy, further evaluation with a CT or MRI of the brain and/or spine is warranted as vision loss can result if the underlying condition is not treated.
- It is a collection of blood below the inner layer of the dura but external to the brain and arachnoid membrane .
- Generally, acute subdural hematomas are less than 72 hours old and are hyperdense compared with the brain on computed tomography scans.
- The subacute phase begins 3-7 days after acute injury.
- Chronic subdural hematomas develop over the course of weeks and are hypodense compared with the brain. It can occur in the elderly after apparently insignificant head trauma.
- Symptoms and signs of raised ICP including headache, vomiting without nausea, ocular palsies, altered level of consciousness, back pain and Papilledema.
- Other symptoms include Aphasia, Hemiparesis,Difficulty with gait or balance,Cognitive dysfunction or memory loss , Personality change ,etc