Chronic Subdural Hematoma W/O Midline Shift, how to proceed?

My grandpa fell around June 2nd. At the time, the ER only scanned his lower back, since that’s where he hit. We didn’t realize his head might’ve also been affected. On July 8th, he returned to the ER for neck pain. More scans were done but again, none of his head. A week later, he began showing mental changes, unsteady walking, and hand tremors. On July 18th, we brought him to the ER again, where he was diagnosed with a chronic subdural hematoma.

The neurologist advised against surgery due to his age (88) and frailty, but I’m still waiting to speak with the neurosurgeon for a second opinion. I’m also seeking guidance on how to proceed. Just two weeks ago, he seemed to be recovering well from the fall and was mentally back to baseline.

I can’t accept the idea that this—what the neurologist called the “new normal”—is how he’s supposed to remain. Right now, he constantly calls out for his mother, wears a diaper, and struggles to urinate or defecate normally. He’s conscious and can somewhat recognize me and our family, but he can’t form complete sentences. None of this was happening one or two weeks ago. Something has clearly changed, and I need to understand all of our options before giving up hope.

• 88 years old
• Underweight
• Not on Aspirin for the last 1-2 months
• OK on heart, kidney, and liver function
• Type 2 Diabetic, Hypertension, Hypothyroidism

Exam: CT Head or Brain W/O Contrast 7/17/2025 8:17 PM CDT

CLINICAL INDICATION: ALTERED; Altered Mental Status

COMPARISON: Head CT APril 18, 2022

Technique: Axial CT images of the head are obtained from the skull base to the vertex without IV contrast. Axial, sagittal, and coronal images are interpreted.

This exam was performed according to our departmental dose-optimization protocal, which includesautomated exposure control, adjustment of the mA and/or kV according to patient size and/or use of iterative reconstruction technique.

Total DLF: 1494. CTDI: 39.53

Findings:

Cortex: There are large bilateral chronic subdural hematomas. Bilateral collections or homogeneous CSF Density. Both collections extend over the cerebral hemispheres. Left subdural hematoma thickness 1.9 cm. Right subdural hematoma thickness is 1.2 cm. There is No Midline shift. Mild bilateral sulcal effcement Gray-white interface maintaned. No parenchymal hemorrage.

White matter: Mild hypoattenuation compatible with chronic microvessel ischemic change

Basal Ganglia: Bilateral basal ganglia calcification. Bilateral chronic lacunar infarcts

Ventricles: Prominence of the ventricles compatible with volume loss

Posterior Fossa: The brain stem and cerebellum are within normal limits. No mass, mass effect, hemorrhage or recent cortical infarct is present. The foramen magnum is normal.

Skull: No acute skull abnormality is seen. No lytic or schlerotic lesions.

ORBITS, VISUALIZED PARANASAL SINUSES AND MASTOIDS: Visualized paranasal sinuses are clear. The mastoid air cells are clear. No orbital pathology.

Impression:

1. Large bilateral chronic subdural hematomas. No acute hemorrhage. No midline Shift

2. Generalized volume loss

3. Chronic microvessel ischemic changes.

Standardized Report: RPnrNSD_CT_brnwol