UNSUSPECTED SUBDURAL-HEMATOMA AS A DIFFERENTIAL-DIAGNOSIS IN ELDERLY PATIENTS

Subdural hematomas are among the most common forms of intracranial hem orrhage encountered in clinical practice and are a surgically remediab le cause of dementia. When the symptom presentation is subtle or diffu se, a subdural hematoma can be overlooked. This is especially hue amon g elderly people who may exhibit unrelated, preexisting dementia or de lirium. Particularly confusing is that such declines in intellectual c apacity can also result from subdural hematoma. It is therefore essent ial that a thorough physical and neurologic assessment be done on all patients with cognitive deficiencies. This always includes brain imagi ng. Early recognition of a subdural hematoma is important, given its t reatability and potential reversibility. We describe an elderly woman with new-onset cognitive deficit and gait dyspraxia. There was no evid ence of trauma. Physical examination was otherwise unremarkable. Initi ally, she refused evaluation, but once a subdural hematoma was identif ied by a tomogaphic scan, a satisfactory outcome followed surgical int ervention.