62yr old suffering from Subdural Hematoma that caused his brain to shift to one side, treated successfully at SL Raheja Hospital, Mahim
~ The patient was previously mistaken to have had
Sinusitis and was undergoing treatment to correct it ~
~ Emergency Burr Hole Surgery was conducted to drain
out blood clots pressing against his brain ~
Mahim, Mumbai: A 62yr old male, an Accountant
by profession, had always been a fairly active person; however, he had been
complaining of mild Sinusitis, dull headache, and positional Vertigo. He was under
the treatment of a local ENT physician. He was diagnosed with Sinusitis and the
headaches were attributed to recent change in spectacles; although later when
the pain persisted, he was advised to undergo a CT scan of the brain.
After two days of enduring
subtle pain, the patients son got him to SL Raheja Hospita, Mahim for CT scan; as
the wait time was longer, the father-son duo were asked to wait at the
Emergency Room. While the Chief Medical Officer was on rounds, the relatives
decided to seek an opinion of the ER consultant.
Upon being examined aby Dr Amit Nabar, Consultant-Critical Care &
HOD-Accident and Emergency Medicine, S.L Raheja Hospital- A Fortis Associate,
at first, the symptoms were vague. The history revealed that he had minimal
imbalance since the past 15 days and brief positional Vertigo with minimal
headache for the past 5 days. The relatives further informed the doctor about
speech and functional impairment that particular morning, a few days ago, along
with disturbance in sleep patterns. His physical examination showed asymmetric
findings which did not correlate with the symptoms.
Initial impressions of the doctors were suggestive of Benign
Paroxysmal Positional Vertigo (BPPV) - a disorder of the inner ear or
Parkinson’s. Upon detailed examination however, there were asymmetric signs in
the form of Rhomberg’s Positive on the right side (while standing, the patient is
asked to close his eyes, loss of balance is interpreted as a Romberg's Positive),
squashing the diagnosis of BBPV or Parkinson’s. Dr Nabar consulted with Dr Kaustubh Mahajan, Neurologist at the
hospital; after evaluating the condition, Dr Mahajan recommended an MRI Angiogram
of the brain. The test revealed the presence of a large bleed (Subdural
Hematoma) which caused the brain to shift to one side. The patient was
immediately rushed into an emergency Burr Hole Surgery, to drain out the
chronic clots of blood that were pressing on the brain.
The patient
responded well to treatment, however, post-surgery , the doctors realized that the
patient had amnesia for the entire time and did not remember anything about the
surgery or that particular day and even the 15 days prior to that!
Timely management and expert intervention enabled right diagnosis, thus
saving the life of this patient. This kind of bleed can be caused due to a
spontaneous rupture or rise in blood pressure or because there are existing inherent
weaknesses in the blood vessels. If this wasn’t detected at the right time, the
patient would have ended up in coma or it could have led to paralysis.
Talking about this
particular surgery, Dr Amit Nabar, Consultant-Critical
Care & HOD-Accident and Emergency Medicine, S.L Raheja Hospital-A Fortis
Associate, said, “This was a classic
case of good clinical acumen, timely intervention, experts at hand, and team
work that helped to save a certain debilitating life. That one particular day
that forced him to slow down in his speech, walk etc. gave us an insight into his
concern. Importantly, people need to be aware that they need to seek medical
aid in a timely manner instead of ignoring the signs or self-diagnosing themselves.
The patient has had a speedy recovery and has been discharged, he is been
advised to follow-ups every 15 days. Nothing can replace thorough clinical
examination and specialized medical aid”.
Dr. Kaustubh Mahajan,
Consultant Neurologist, SL Raheja Hospital-A Fortis
Associate, added, “If it weren’t for the
timely intervention, the bleed would have gone unnoticed and the patient could
have slipped into Coma, or suffered Paralysis. Any new onset headaches even if
subtle should not be ignored”.
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