Presentation
Sudden onset of unresponsiveness. GCS 5.
Patient Data
Large acute convexity subdural hematoma extending along the left cerebral hemisphere with significant mass effect over the brain parenchyma, which is characterized by sulcal effacement, significant rightward midline shift (2.5 cm), and subfalcine and uncal herniation. Third and lateral ventricles are compressed and distorted with dilatation of the right temporal horn in keeping with hydrocephalus. Small amount of intraventricular blood in the right temporal horn. There is a hemorrhagic focus on the right side of the pons/pontomesencephalic junction in keeping with a Duret hemorrhage. Grey-white matter differentiation is preserved. No evidence of acute infarct. Imaged orbits, paranasal sinuses, and calvarium are unremarkable.
Case Discussion
This case demonstrates an extensive subdural hematoma with cerebral herniations, midline shift, and Duret hemorrhage.