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02-JUNE-2017 IBRAHEEM KHALEEL HAMDAN 78 YEARS
HUGE BILATERAL SUBACUTE CONVEXITAL SUBDURAL HEMATOMA MORE THE LEFT WITH RAPID
DETERIORATION AND ADVANCED CARDIAC FAILURE.
The patient was transferred from Islamic
hospital after staying there for 3 days. He was
admitted there walking and talking and CT-scan
of the brain done 30-May-2017 showed huge
bilateral convexital subacute subdural hematoma
more the left side. The patient underwent
stinting 6 months ago and was in Plavix. The
Plavix was stopped and as the family reporting
he was gradually deteriorating, for what he was
transferred to our department.
On examination, the patient has atrial
fibrillation with cardiomegaly and he was in
obtundation, with great effort to pronounce his
name with quadriplegia. He has vomiting attacks
and the relatives telling that at the morning he
was able to move his left hand. The patient was
urgently sent for another CT-scan of the brain,
confirming enlargement of the hematomas. The
relatives insisted to be seen only by his
cardiologist. His cardiologist sent his
assistant and reported that the cardiac
functions are in bad condition and the risk of
death even without surgery is very high. The
time was 6.30 p.m. and it was agreed to be under
strict observation by his cardiologist after
At 10.00 p.m. 2 bur holes
were created in each side with the anterior ones
locating at the frontal area and the posterior
ones in the postero-parietal location.
evacuation of the hematomas was stated until a
clear fluid start to come out with saline. It
was noticed that the both hematomas were
communicating with each other during irrigation.
External drains were inserted for each side.
recovery. The patient level of consciousness
improved and the left side regained full power,
but still having right sided plegia. The patient
was sent to the ICU at 1.00 a.m. the morning of
03-June-2017 for observation.
The patient one hour later
progressed myocardial infarction and Chain-Stokes
breathing. His level of consciousness was
fluctuating, with improvement with the rapid phase
of breathing and deterioration during the apnea
state. The cardiologist was consulted but he
did not come and several times was requested with
only verbal reaction by telephone, without seeing
what is happening in the stage.
The patient was put in ventilator
at 3.00 a.m. the morning of 03-June-2017. The
cardiac sounds were muffled and he was in
hypotension. CPR was done twice. During this time
the CSF in the external drain in the left side was
transmitting the cardio-pulmonary pulsation, and
with difficulty it was possible to feel the carotid
pulse. Dopamine mega doses did not help elevate his
BP which was all the time 80/50 mm Hg.
The patient died at 7.45 a.m.
The patient was severely critical and his
age with severe cardiac failure and the severe compression
of the hematomas with the rapid deterioration of his status
enforced us to perform surgery as soon as possible.
Even with Plavix, if the patient was operated
3 days ago the level of mortality could be less than with recent
A hard lesson, is to ask for a reliable
cardiologist, because the essential factor for his death is the
myocardial infarction. In the future if the relatives put there
terms of asking for foreign specialists, it better to tell them
to go to another hospital to avoid such situation.
What if you face the same situation in the
future. I will react the same, so as not to blame myself that
his death was due to the hematomas. At least I am feeling no
gilt when we face the God.