Acute on chronic subdural hematoma
Right sided weakness.
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Left frontoparietal extra-axial hemorrhage with horizontal sedimentation level. Although it has an elliptical shape, the finding is in keeping with acute on chronic subdural hematoma which are much more common in this age group. Mass effect in the form of effaced related sulci, as well as few millimeters of shifting of the midline, is demonstrated as well.
The absence of a history of trauma, the absence of a skull fracture, the advanced age of this patient and the fact that it crosses the coronal suture, make the possibility of this being an epidural hematoma very unlikely despite the biconvex appearance of the lesion in our case. Extradural hematomas in infants and geriatric may not manifest in a serious way due to the relatively small size of the brain and the prominent extra-axial CSF spaces.