Combined Intracerebellar and Posterior Fossa Subdural Hematomas

This 48-year-old woman was admitted to one of the general surgical wards in this hospital on Christmas Day, 1967. Two days previously while standing on a stool she had overbalanced and fallen; she was found lying on the floor, having struck her head on the wail during the fall. She was unconscious for about 20 minutes and had total amnesia for the event. She was rather drowsy thereafter and stayed in bed at home. Her speech was slurred and, as she did not improve and appeared to have left-sided incoordination, the general practitioner referred her to hospital. Examination. On admission, myxoedematous stigmata were noted. There was no evidence of local injury to the head. The blood pressure and temperature were normal. The patient was drowsy but responsive to commands. There was slight neck stiffness and poor coordination of all limbs. A neurosurgical consultant noted nystagmus, a blurred left optic disc, and a right extensor plantar response. Her fight eye had been removed in 1963 after an injury, and she had had amenorrhea since the age of 18 years. Skull x-rays taken at this time revealed no definite abnormality. Bilateral carotid angiography was normal. A vertebral angiogram was not performed. Her condition remained unchanged for the next 2 days but definite papiUedema developed.