# Navigating the Challenges of Delayed Subdural Hemorrhage and COVID-19: A Case Report

## TL;DR

A 61-year-old woman developed delayed subdural hemorrhage three weeks after a fall and recovered after surgery, highlighting the need for close monitoring in such cases.

## Contribution

This case report highlights the challenges of delayed subdural hemorrhage diagnosis and management in patients with comorbidities like COVID-19.

## Key findings

- The patient showed no initial signs of hemorrhage but developed symptoms three weeks post-injury.
- Bilateral burr holes and subdural drains led to full recovery of cognitive function.
- The case emphasizes the importance of vigilance in diagnosing delayed SDH in high-risk patients.

## Abstract

The delayed onset of posttraumatic subdural hemorrhage (SDH) represents non-specific clinical features, complicating the diagnostic process, especially in individuals predisposed due to pre-existing risk factors and comorbidities. This case report delineates the medical trajectory of a 61-year-old female patient who sustained a traumatic fall, initially displaying neither clinical nor radiological signs indicative of hemorrhage. However, three weeks post-injury, she developed altered mental status, cephalgia, and emesis. Diagnostic imaging unveiled a significant bilateral acute-on-chronic subdural hemorrhage exerting pronounced mass effect and leading to obliteration of the basal cisterns. Complicating her clinical picture was a concurrent SARS-CoV-2 infection and a medical history of hypertension. Emergent neurosurgical intervention was undertaken, encompassing the creation of bilateral burr holes for drainage and the placement of subdural drains. The patient was managed with the requisite medical therapies. Post-operatively, the patient regained consciousness and exhibited significant neurological improvement. Follow-up imaging demonstrated complete resolution of the subdural hemorrhage, and the patient achieved a full recovery of cognitive function. This case underscores the critical necessity for vigilant surveillance for delayed SDH in patients lacking initial radiographic findings and advocates for individualized therapeutic approaches in patients with concurrent pathologies. Prompt recognition, timely neurosurgical management, and care are pivotal to optimizing outcomes in delayed posttraumatic SDH cases.