Not Everything Requires a Psychiatry Consult: Subdural Hematoma as a Cause of Transient Acute Quadriplegia

While subdural hematoma (SDH) is a commonly encountered emergent pathology that is often in the setting of trauma, its ability to present with a wide variety of symptoms, or no symptoms at all, may delay diagnosis. SDH symptoms progress in a stepwise manner, potentially resulting in rapid neurological degeneration and can result in irreversible damage. Here we describe a case of an elderly woman with bilateral chronic SDH with mass effect who initially presented with severe headaches and a mild altered mental status, notably without a history of head trauma. Diagnosis was achieved through radiographic imaging. Within 24 hours, the patient suddenly became quadriplegic. Emergent bilateral evacuation of SDH was performed. Full neurological recovery of both arms and legs was achieved without delay, demonstrating the ability of this approach to reverse the development of acute quadriplegia attributed to SDH in such patients. Comprehensive and timely medical screening on initial presentation accompanied by radiographic studies, especially of patients presenting with altered mental status is crucial for identifying any underlying pathology, such as SDH. Altered mental status without head trauma is not always psychologic in nature and a psychiatric consult is insufficient in identifying lesions of the central nervous system (CNS). Altered mental status encompasses a broad differential diagnosis that seeks to find organic causes of altered state. While mortality from symptomatic chronic SDH is high, especially in the geriatric patient population, our findings support the position that rapid diagnosis and intervention to reverse neurological deterioration is an essential component of improving patient outcomes.