Post-Subdural Hematoma Transient Ischemic Attacks
Hypoperfusion Mechanism Supported by Quantitative Electroencephalography and Transcranial Doppler Sonography
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An 81-year-old right-handed woman with hypertension developed mild left hemiparesis over 1 week. Computed tomography of the head showed a right acute on chronic subdural hematoma (SDH). She underwent burr hole evacuation, her weakness resolved, and she was discharged to home after 4 days.
One week later, she experienced transient left hemiplegia and confusion lasting a few hours. On arrival to the emergency department, her symptoms had resolved. Blood pressure was 140/90 mm Hg. Repeat head computed tomography showed a small residual SDH and mild right hemispheric edema; both hematoma volume and edema were stable compared with those of previous imaging. Magnetic resonance imaging showed no diffusion restriction underlying the SDH, and magnetic resonance angiography showed normal intra- and extracranial vasculature. Electroencephalography (EEG) showed no epileptiform activity; however, there was mild slowing in the right hemisphere. Quantitative EEG (qEEG) analysis showed reduced alpha/delta ratio within the right hemisphere (Figure 1). Levetiracetam was empirically started, and she was admitted for close observation.
On day 2 of admission, she developed left face, arm, and leg weakness, right gaze deviation, and left-sided neglect. Blood pressure at the time was 110/78 mm Hg. EEG …