A 95 year old woman is suffering a chronic (we believe) subdural hematoma.  It was diagnosed 12 days ago via CT scan.  A second CT scan showed some shrinkage.  However, 10 days ago her BP went from about 137/85 to 213/122.  Yesterday an MRI was done and showed an increase in size and an additional bleed.  Her mental function fluctuates between staring blankly to recognizing some family members and answering questions with one word.  What would be risk of surgery to relieve the pressure on the brain and what expectation would we have for some cognitive recovery?
Hi, Thank you for posting your query. Based on the symptoms, I would feel that surgery may be avoided for a 12-day-old subdural hematoma in a 95-year-old. This is because in an older person, there is brain shrinkage, which can accommodate brain swelling due to subdural hematoma, thereby, limiting the adverse effects of the brain swelling. Over a period of time, the blood gets re absorbed and would disappear. Also, cognitive changes may not completely reverse after surgery. So, we can avoid subjecting her to the risk and trauma of surgery. I hope it helps. Best wishes, Chat Doctor.