醫學筆記匯整 ED Notes

  偉大的模仿者 Great neurologic imitator  

Symptoms often insidious and nonspecific, esp chronic SDH : 

 - Decreased level of consciousness 40%
 - Headache 常見,  mild to severe 都可能
 - Difficulty with gait or balance, Ataxia 
 - Cognitive dysfunction or memory loss, confusion 常見 

 - Personality change
 - Psychiatric symptoms : depression, paranoia, schizophreniform psychosis,
    manic-depressive psychosis, catatonia, and vague personality and intellectual changes

 - Motor deficit (eg, hemiparesis) 58%
 - Aphasia
 - Weakness, seizures, incontinence

 - Movement disorder : Hypokinetic
   May have a presentation similar to Parkinson disease 
 - Treatable demantia
 - TGA
 - Delirium 
 

這次遇到 Aphasia 表現的 SDH 真的是刻骨銘心
有任何 Conscious 相關的主訴都是要很高警覺 Brain CT 
SDH must be considered in any older person with an alteration in mental status
or acute changes in a patient's ADL 

老人, 抗凝血劑, 酗酒, substance abuse 都需要小心

 

In 75% of cases, the headache had at least one of the following characteristics :

   - Sudden onset
   - Severe pain
   - Accompanying nausea and vomiting
   - Exacerbation by coughing, straining, or exercise

Somnolence 嗜睡, confusion, and memory loss
 are significantly more common in elderly

Signs of IICP (headache and vomiting) 
are more likely to be seen in younger patients.

Fluctuating signs or symptoms occur in as many as 24% of cases.

Differential Diagnosis for SDH : 
 - Stroke/TIA
 - Normal pressure hydrocephalus
 - Parkinson's disease
 - Infection (meningitis, brain abscess)
 - Dementia
 - Psychiatric illness
 - CNS tumor
 - Adverse drug reactions