Complete resolution of acute subdural hematoma in an elderly patient with the subdural evacuating port system

Abstract

A 79-year-old patient on an antiplatelet medication presented to the emergency department following a fall at home. She was found to have an enlarging mixed density acute subdural hematoma with significant mass effect and impaired neurologic status and was successfully treated with a subdural evacuating port system drain placement. The patient had rapid and complete radiographic resolution of the hematoma and return to her premorbid neurologic status. A craniotomy, and the associated risks, was avoided. Elderly patients are at particular risk for developing subdural hematomas given the high rates of receiving antiplatelet and anticoagulation therapies, risk for falls, and difficulties with safe ambulation and independent living. Twist drill craniostomy drainage through catheter or subdural evacuating port system placement has been used effectively in the treatment of liquefied older chronic or subacute subdural hematomas. However, acute subdural hematomas, when large or symptomatic enough to require evacuation have historically been treated by craniotomy. Craniotomy in elderly patients with a subdural hematoma has significant risks and typically requires several days of hospitalization and intensive care, which was avoided in this patient. Subdural evacuating port system drain placement can be an effective treatment option in some elderly patients with acute subdural hematomas, which have a significant hypodense component.