Role of Ayurveda multimodal therapy in the management of acute-on-chronic bilateral subdural hematoma with mass effect: A case report

Abstract INTRODUCTION: Subdural hematomas (SDH), can present with acute neurological deficits resembling hemiplegia. In Ayurveda, similar clinical features are described under Pakshaghata (hemiplegia). This case report highlights the management of an SDH with Ayurvedic interventions after conventional surgical options were declined. PATIENT INFORMATION: A 73-year-old male presented in a semi-conscious state, with inability to walk or stand, right-sided weakness, and inability to follow verbal commands for one month. His baseline Glasgow coma scale score was 11 (E3V4M4). Initial imaging revealed a large acute-on-chronic SDH with a significant midline shift. DIAGNOSIS: Based on clinical presentation and imaging findings, the patient was diagnosed with acute-on-chronic SDH with hemiparetic features. Though the neurological deficits mimicked stroke, the underlying cause was an extra-axial hemorrhage. INTERVENTION: The patient had undergone initial neurosurgical intervention but showed a recurrence of symptoms and fresh bleeding. Declining further surgery, he opted for Ayurvedic management, which included internal administration of polyherbo-mineral formulations and external therapies tailored according to Ayurvedic principles. The main interventions used were Yogendra Ras, Swarna Sameerpannag Ras, and Brihat Vatachintamani Rasa. OUTCOME: Within 10 days of Ayurvedic management, notable clinical improvements were observed. Over nine months of sustained therapy, complete radiological resolution of the hematoma was documented, and the patient achieved full functional recovery without residual neurological deficits. CONCLUSION: This case illustrates the potential role of Ayurveda-based multimodal management in facilitating recovery from complex neurological presentations such as SDH when surgical options are not always feasible. Further systematic studies are warranted to validate these outcomes.