Delayed Acute Subdural Haematoma: A Trivial Fall Causing a Rare, Life Threatening Complication

A 65-year-old man presented to us with giddiness and fall. His examination including a detailed neurological assessment was normal. CT brain revealed only age related cerebral atrophy and the patient was discharged after observation for 24 hours. 34 days later, he was brought to the emergency room in altered sensorium and a repeat CT revealed a large acute and subacute subdural haematoma with intracranial cerebral herniation needing emergency drainage by burrhole craniotomy. The patient recovered well following the procedure. Delayed acute post traumatic subdural haematoma is a rare condition that may occur following even the most trivial of falls and is often associated with poor outcome. It brings to light that a CT brain done immediately after the trauma is insufficient to predict delayed deterioration and calls for high level of vigilance in cases of mild head trauma and a low threshold for repeating a CT brain.