Acute subdural hemorrhage

Clinical presentation

Worsening headache in a mid 70s gentleman. History of mild head trauma couple of days ago.

CT Brain

Findings

Bilateral frontoparietotemporal convexity extra axial hemorrhage with dependent varying density within is seen, more on the left side, causing compression of bilateral supratentorial neuroparenchyma, mild midline shift to right, effacement of cortical sulci and lateral ventricles. Incidental midline calcified lesion in the region of anterior falx cerebri, could represent a chronic benign calcified meningioma.

Learning points

  • Look for the shape of the bleed to determine if it is subdural or extradural. A concavoconvex appearance traversing suture lines is typical of a subdural bleed which is what is commonly encountered in old age with blunt head trauma.
  • A convexoconvex extra  axial bleed limited by suture lines and often associated with a calvarial fracture is typical of extra dural hemorrhage.
  • The varying density of blood within demonstrated by dependent hyperdensity shows that there is blood of varying ages within, suggesting of ongoing nature.
  • Look for the different types of herniation that could happen when a supratentorial extra axial bleed occurs.
  • Inform the referring doctor at the earliest and the patient needs a neurosurgical consult.

Read more

  1. Extradural hematoma vs subdural hematoma – Radiopaedia.

 

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