Subdural hematoma: a clinical approach.

Subdural hematoma (SDH) in the elderly often occurs following a relatively mild fall. Compared to the old person's high risk of falling, SDH is relatively uncommon and the diagnosis may be elusive. Five cases are presented, two in detail. In one, despite the acute onset within hours and manifestations of an ipsilateral neurologic deficit, operative removal of the SDH gave excellent results. The second patient represented a dementia assessment problem prior to admission to an institution. Inpatient observation eventually revealed a deteriorating neurologic state and led to the correct diagnosis of SDH. The patient returned home, fully recovered, two weeks after the appropriate surgical procedure. The pathogenesis of SDH is discussed. Clinical suspicion of its presence should prompt the performance of an echoencephalogram and a computerized axial tomogram of the brain.