85 year old man had a subdural hematoma a year back and went un-operated (primarily as per wishes of the family, patient was suggested conservative management with dexamethasone for the acute phase on the basis of available case-series data:http://www.ncbi.nlm.nih.gov/pubmed/19688136, http://apps.elsevier.es/watermark/ctl_servlet?_f=10&pident_articulo=90138712&pident_usuario=0&pcontactid=&pident_revista=340&ty=166&accion=L&origen=neurocirugia&web=http://www.revistaneurocirugia.com&lan=en&fichero=340v20n04a90138712pdf001.pdf as well as case series data suggesting recurrence of subdural hematoma (which would be akin to this patient's current un-operated condition:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3053546/pdf/jkns-48-518.pdf

This patient currently complains of:

Chronic headache, Day time Hypersomnolence, Insomnia, dementia, nocturnal urinary incontinence as evidenced by reading the hand written letter of the patient's relative.

He is advised symptomatic medications for each of these symptoms (to be taken under supervision of and discussion with his local physician).

Tablet Paracetamol 500 mg SOS for headache.

Tablet Clonazepam (Clonofit MD) 0.25 mg at bedtime (one hour before dinner)

Tablet Amitryptiline 10 mg at bedtime (one hour before dinner).

Tablet Dexamethasone only when there is a further deterioration of sensorium ( to be started after discussion with local physician).

best wishes,
ArogyaUDHC team

PS: Rakesh Biswas is morally and legally responsible for this suggestion and ArogyaUDHC team is working under the hypothesis that informational support (such as this) for the patient and local physician is likely to be beneficial toward achieving better health outcomes."