Case-Based Modules > Case 13 > Stage 1

Sorry, not quite. While this patient has a little cerebral edema, this isn't the underlying problem. The underlying problem here is the right > left SDH, the former of which is causing the most compression/subfalcine herniation (= midline shift). Hyperosmolar therapy is great for intracranial hypertension, but not so great for herniation, highlighting that these two entities have some overlap, but are not synonymous. Also, the fact that this patient is known to have had diffuse cerebral volume loss indicates that hyperosmolar therapy-- which would presumably work by reducing the parenchymal volume-- might actually exacerbate the midline shift that's already present. (This baseline atrophy probably predisposed him to having an SDH that was set off by his initial fall six weeks ago.) In terms of medical or surgical interventions available, there's another better option.

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