Acute on chronic subdural hematoma causing mass effect

Case contributed by Subash Thapa
Diagnosis certain


Headache, disorientation followed by altered level of consciousness.

Patient Data

Age: 65 years
Gender: Male

Supratentorial crescent-shaped hypodense extra-axial collection with hyperdense area in the dependent portion and few internal septations involving the left fronto-temporo-parietal region. This causes mass effect by displacing the underlying brain parenchyma medially and effacing the adjacent cortical sulci, Sylvian fissure and left lateral ventricle with contralateral midline shift.

Case Discussion

The patient underwent surgical drainage with the evacuation of the chronic subdural hematoma with resection of its encapsulating membrane.

Rehemorrhage, either from vascularized encapsulating membrane or rupture of stretched cortical veins crossing the expanded subdural space result in “acute on chronic” subdural hematomas.

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