Dwayne is a 79 year old gentleman who came to the emergency room with right sided weakness, confusion, and headaches. He has a history of a mechanical heart valve for which he has been on anticoagulants. On his head CT, Dwayne was found to have a large fluid collection pressing on the left side of his brain.
We gave Dwayne some medicine to reverse the effects of the anticoagulant and took him to surgery. At surgery, we noted membranes had formed in and around the surface of the brain. Also there was motor oil appearing fluid and clotted blood.
Dwayne had an acute on chronic subdural hematoma.
As the brain shrinks with age, there is more space between the brain and the skull. Veins traversing this space are prone to tear and bleed, even with relatively minor trauma. Compounding the problem in some patients is the use of anticoagulants. Multiple episodes of bleeding over time can lead to membrane formation. These membranes can be another source of bleeding.
Disclaimer: Although this is a real patient, I have used a different name for privacy protection and added a few details for educational purposes. This patient gave consent to have his case shared.