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KMID : 0604020140290020114
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Korean Journal of Critical Care Medicine
2014 Volume.29 No. 2 p.114 ~ p.118
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Selection of Treatment for Large Non-Traumatic Subdural Hematoma Developed during Hemodialysis
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Lee Chul-Hee
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Abstract
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A 49-year-old man with end-stage renal disease was admitted to the hospital with a severe headache and vomiting. On neurologicalexamination the Glasgow Coma Scale (GCS) score was 15 and his brain CT showed acute subdural hematoma over the right cerebralconvexity with approximately 11-mm thickness and 9-mm midline shift. We chose a conservative treatment of scheduled neurologicalexamination, anticonvulsant medication, serial brain CT scanning, and scheduled hemodialysis (three times per week) without usingheparin. Ten days after admission, he complained of severe headache and a brain CT showed an increased amount of hemorrhage andmidline 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 increasedamount of subdural hematoma. Under the impression of persistent increased intracranial pressure, the patient was transferred tothe intensive care unit (ICU) in order to control intracranial pressure. Management at the ICU consisted of regular intravenous mannitolinfusion assisted with continuous renal replacement therapy. He stayed in the ICU for four days. Twenty days after the operation he wasdischarged without specific neurological deficits.
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KEYWORD
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acute subdural hematoma, end stage renal disease, hemodialysis, renal replacement therapy
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