A case of chronic subdural haemorrhage and its medico-legal implications

Abstract

Subdural haemorrhage is almost always traumatic and rarely natural. Traumatic Subdural haemorrhage (SDH) occurs following break of the parasagittal bridging vessels due to shearing movement of the head. Clinical features appear in 3 days in acute SDH, in 3 days to 3 weeks in sub-acute SDH and after 3 weeks in chronic SDH. SDHs are aged macroscopically and histopathologically. A 42 years old female knocked down by a bus was admitted to a base hospital. She was unconscious on admission and had nausea, vomiting and headache. By the next day, almost all symptoms were settled except headache and was discharged. Fifteen days later, she developed sudden onset bilateral lower limb weakness and was re-admitted. She was transferred to a tertiary care hospital immediately. The pre-op CT scan showed left frontal chronic subdural hemorrhage (SDH) and the patient was subjected to a burr hole surgery. She was transferred back to the base hospital and according to the medico-legal examination performed 21 days after the incident, the category of hurt was ―fatal in the ordinary course of nature‖. In the remarks column, it was mentioned that it is not clear whether this SDH is due to the fall from the bus or any other incident after that. This chronic SDH also could be following a separate ―new incident‖ that took place after the traffic accident. Therefore, without dating the chronic SDH accurately, it is not safe to identify the real causative circumstance.