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Neurological Rehabilitation

Parafalcine Subdural Hemorrhage (SDH) and the Effectiveness of IV Magnesium Treatment: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks
Has Audio

    Poster Presenter(s)

  • Haris Shehzad, Other

    Medical Student
    Brody School of Medicine At East Carolina University
    Greenville, North Carolina

    • Primary Author(s)

  • Kevin Chin, MD

    Resident
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Co-Author(s)

  • Harrison Jordan, DO

    Resident
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

  • RL

    Robert Lombard, MD

    Assistant Clinical Professor
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Grimesland, North Carolina

Disclosure(s):
Kevin Chin, MD: No financial relationships to disclose
Harrison Jordan, DO: No financial relationships to disclose
Robert Lombard, MD: No financial relationships to disclose
Case Diagnosis: A 68-year-old man with traumatic left parafalcine SDH.

Case Description or Program Description: The patient with HTN, T2DM, and active ETOH use presented with right lower extremity (RLE) weakness after hitting his head on a ceiling beam. Imaging revealed a 20mm left parafalcine SDH without midline shift. Upon rehab admission, he had 4/5 RLE strength but demonstrated fluctuations in strength during his 21-day stay (around Day 11). STAT CT head showed decreased size and attenuation of the hematoma. These episodes were often accompanied by persistent headaches. He was trialed on multiple headache medications, including Depakote, propranolol, a Medrol dosePak, verapamil, and carbamazepine, with prn Compazine and Nurtec. Between headache management, he received IV magnesium sulfate four times, noting headache relief with possible motor recovery. By discharge, he transitioned to using a walker with supervision for balance and residual RLE weakness and reported improved headache frequency and intensity.

Setting: Tertiary care inpatient rehab hospital.

Assessment/Results: Headaches resolved after a final IV magnesium dose and carbamazepine initiation. Thirteen days post-discharge, he achieved full independence without assistive devices. Repeat imaging confirmed a stable 10mm left parafalcine SDH.

Discussion (relevance): Parafalcine SDHs, often nonoperative, account for 6% of SDHs. This case highlights IV magnesium’s potential role in management as its neuroprotective and hemostatic properties, including reducing cerebral edema and hematoma expansion, may have contributed to clinical improvement. However, literature on magnesium’s efficacy in traumatic brain injury remains mixed, underscoring the need for further research.

Moreover, antihypertensive medications for headache prevention presented notable concerns such as decreasing mean arterial pressure (MAP) that could have resulted in inadequate cerebral perfusion pressure (CPP). Conversely, IV magnesium may improve CPP through cerebral vasodilation. This highlights the balance required in managing headaches in parafalcine SDH.

Conclusions: IV magnesium sulfate may play a role in reducing cerebral edema and headaches and thus improve outcomes for parafalcine SDH management.