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Treatment of Herniating Subdural Hematoma

Charles L. Wiseman, MD; Charles Tiber, MD; George R. Blumenschein, MD
JAMA. 1980;244(24):2728-2729. doi:10.1001/jama.1980.03310240020010.
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To the Editor.—  Two letters (242:2844, 1979;241:2783,1979) appearing in The Journal discussed successful neurosurgical intervention for acute subdural hematoma associated with transtentorial herniation. We describe a case in which noninvasive medical measures alone were successfully employed.

Report of a Case.—  A 33-year-old woman under treatment for metastatic breast cancer had been hospitalized for evaluation of frontal headache and thrombocytopenia (<15,000/cu mm). No neurological findings were detected and a computerized tomographic (CT) brain scan was normal. On the 12th hospital day, the patient complained of a severe headache and abrupt loss of vision in the left eye. Previously normotensive, the blood pressure (BP) had acutely risen to 190/110 mm Hg. The patient was treated with diazoxide, and the BP fell to 160/75 mm Hg. Recurrent symptoms and hypertension required another dose of diazoxide 30 minutes later. The patient remained in satisfactory condition for approximately one hour, but the symptoms and


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