Subdural Hematoma Presenting as Psychogenic Nausea

Abstract

Psychogenic nausea refers to nausea symptoms that are experienced outside of the context of obvious general medical pathology and presumably as a result of psychiatric etiology. Although this dichotomy between general medical and psychiatric pathology is somewhat dated according to the focus of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) Somatic Symptom Disorders, the psychogenic description of a medically unexplained symptom is still commonly used in the general medical vernacular. This case report involved a 74-year-old man who was presumed to have "psychogenic" nausea symptoms after a negative medical workup. New tremulous symptoms were presumed to be secondary to a benzodiazepine taper. However, the presence of additional focal neurological deficits prompted a computed tomography of the patient's head, which revealed a subdural hematoma. Emergent neurosurgical evacuation and drainage relieved the patient's symptoms and proved to be a life-saving measure. Subdural hematomas are most commonly the result of traumatic tearing of the cortical bridging veins that overlie this subdural space. Subsequent mass effect and ischemia from venous bleeding can cause multiple symptoms, including nausea. This case highlights the importance of ensuring a broad differential for medically unexplained symptoms and close monitoring of symptomatic changes.