Gait disorder and cognitive impairment in an elderly patient
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* Vincenzo Sidoti
* Maria Dieli
* Lorenzo Lorusso
* Piercarlo Pelizzari

A 80-year-old man was evaluated in a neurologic department for a gait disorder and a progressive cognitive impairment dating back about 6 months earlier. His pathologic history was unremarkable, except for a minor head injury 6 months before. The neurologic examination revealed neuropsychologic impairment of frontal type, a bilateral Babinsky and an ataxic–apraxic gait with frequent freezings. He also complained about a new onset bladder incontinence. An electroencephalogram showed a slow bi-hemispheric activity. Cranial computed tomography (CT) scan revealed bilateral chronic subdural haematoma with a notable compression of the brain (figs 1 and 2). The patient was successfully treated with surgical drainage of the subdural haematomas, and recovered fully from the disturbances.

![Figure 1](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.06.2008.0130/F1.medium.gif)

[Figure 1](http://casereports.bmj.com/content/2009/bcr.06.2008.0130/F1)

Figure 1 
Coronal computed tomography (CT) scan of the brain showing a bilateral subdural chronic haematoma up to the convexity.

![Figure 2](http://casereports.bmj.com/https://casereports.bmj.com/content/casereports/2009/bcr.06.2008.0130/F2.medium.gif)

[Figure 2](http://casereports.bmj.com/content/2009/bcr.06.2008.0130/F2)

Figure 2 
Coronal CT scan of the brain showing a bilateral subdural chronic haematoma up to the convexity.

This case emphasises the importance of a detailed case history, follow-up of elderly patients after a cranial injury, and the use of CT scan to exclude reversible causes of gait disorder or cognitive impairment.1,2

## Footnotes

*   **Competing interests:** none.

*   **Patient consent:** Patient/guardian consent was obtained for publication

## REFERENCES

1.  McLachlan RS, Bolton CF, Coates RK, et al. Gait disturbance in chronic subdural hematoma. Can Med Assoc J 1981; 125: 865–8.
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=7306898&link_type=MED&atom=%2Fcasereports%2F2009%2Fbcr.06.2008.0130.atom) 

2.  Schebesch KM, Woertgen C, Rothoerl RD, et al. Cognitive decline as an important sign for an operable cause of dementia: chronic subdural haematoma. Zentralbl Neurochir 2008; 69: 61–4.
    
    [CrossRef](http://casereports.bmj.com/lookup/external-ref?access_num=10.1055/s-2007-1004582&link_type=DOI) 
    
    [PubMed](http://casereports.bmj.com/lookup/external-ref?access_num=18444216&link_type=MED&atom=%2Fcasereports%2F2009%2Fbcr.06.2008.0130.atom) 
    
    [Web of Science](http://casereports.bmj.com/lookup/external-ref?access_num=000256533300001&link_type=ISI)