Abstract

According to the Monro-Kellie hypothesis, the sum volumes of the brain, cerebrospinal fluid and blood inside the cranium should always be maintained constant. Any abnormality that may increase the intracranial pressure might lead to fatal brain herniation. Hence, this paper aims to present a case of chronic subdural hematoma eventually developing a left hemispheric cardioembolic infarct and how it was managed conservatively without developing the dreaded complications of increased intracranial pressure. This is a case of a 62-year old female patient, diagnosed with severe Valvular Heart Disease, Diabetes Mellitus and Toxic Goiter, who developed Chronic Subdural Hematoma from regular warfarin intake. However, she later developed a cardioembolic stroke after holding warfarin. She was managed medically with decompression, since surgical evacuation was deemed of very high risk for this patient. In a patient with multiple comorbidities presenting with concomitant chronic subdural hematoma and cardioembolic stroke, conservative management with an osmotic diuretic and corticosteroids, though still with scarce evidence in the literature, was found to be safe and may be beneficial in our patient. Keywords: Chronic subdural hematoma, warfarin use, cardioembolic stroke, conservative management.