6.2.4.3 Persistent headache attributed to past non-traumatic acute subdural haemorrhage

Identification: Male patient, 78 years old, on acetylsalicylic acid (100mg/day), with a history of spontaneous acute subdural hematoma (ASDH) treated conservatively 3 months ago. Current Illness History: Reports daily right frontotemporal headache since the ASDH episode. Characteristics: Intensity 5-7/10, pressure-like. Worsens with orthostatic position and Valsalva maneuvers. Partial improvement with rest and common analgesics. Associated Symptoms: Nonspecific dizziness. Difficulty concentrating. Chronic fatigue. No new focal neurological deficits. Current Neurological Examination: General state: GCS 15. Focal examination: Mild bradyphrenia. Slow gait, but without ataxia. No meningeal signs. BP: 150/85 mmHg. Complementary Exams: Follow-up cranial CT: Complete resolution of the subdural hematoma. Mild diffuse cortical atrophy. No residual fluid collections. Brain MRI with contrast: Gliosis in the right parietal cortex (sequela of previous bleeding). No expansive lesions. Signs of microangiopathic encephalopathy. Neuropsychological Assessment: Mild impairment of recent memory. Decreased processing speed.