Presentation
Found on floor; GCS 10; on warfarin.
Patient Data
Bilateral acute subdural hemorrhages are noted overlying both cerebral hemispheres. On the right is largely confined to the frontal region, and measures up to 8 mm in depth. On the left is far more extensive, surrounding the entire hemisphere, also seen layering over the tentorium and falx, but generally measures only up to 6 mm in depth. There is limited mass effect, with no midline shift and no transtentorial herniation. The posterior fossa is unremarkable.
Patchy white matter changes seen throughout the white matter of both hemispheres, non-specific but most likely representing the sequelae of chronic small vessel ischemic change. The ventricles are smaller than expected, no doubt compressed to a degree by the aforementioned subdural hemorrhages. Focal region of inflammation involves the left cerebellar hemisphere consistent with previous infarct. No acute infarction evident. No skull fracture evident.
Subdural window (Center 80HU, Width 200 HU) makes it much easier to see the bilateral subdural collections.
Case Discussion
Bilateral, thin acute subdurals can be difficult to spot, and the use of a wider 'subdural' window is very useful, and should be a routine part of assessing trauma CTB.
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