Subdural haemorrhage - acute on chronic
Presentation:
Decreased level of consciousness following a minor head strike.
Patient Data:
Non-contrast CT of the brain demonstrates an extra-axial collection overlying the right cerebral hemisphere and layering on the right side of the falx and tentorium. There is a prominent haematocrit level. Extensive midline shift is present with dilatation of the left lateral ventricle in keeping with outflow obstruction.
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Hyperdense material (blood) can be seen layering on the tentorium and along the right side of the falx (blue arrows). A fluid-fluid level (yellow dotted line) separates it from a low density component anteriorly.
There is extensive midline shift (red) with dilatation of the left lateral ventricle (*) and compression of the right lateral ventricle.
Case Discussion:
Presence of haematological disorders, including anti-coagulation (this patient was on warfarin) can alter the way blood clots and thus change the appearances of a subdural hematoma (although this depends on numerous factors including degree of coagulation impairment, timing of imaging etc..). This same appearance can be seen in acute on chronic haematomas, and as not previous imaging is available, it is possible that this in fact represent a re-bleed in a patient who is also anti-coagulated.
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