Bilateral sub-acute subdural hematomas

Case contributed by Prashant Mudgal


elderly patient presented with unconsciousness. History of fall from stairs. Initially patient was conscious and free from any neurological deficit after the injury, and his CT brain showed small SDH in right frontoparietal region. But his general condition and level of consciousness were falling down gradually. He advised an MRI

Patient Data

Age: 80
Gender: Male

There are bilateral subdural hematomas seen in bilateral fronto-parietal, bilateral temporo-parietal and bilateral parieto-occipital regions. visualized SDHs are isointense on T1W and hyperintense on T2W and FLAIR suggestive of  late subacute SDH. Detachment of meninges is seen as hypointense thin line between SDH and brain parenchyma. Visualized venous sinuses show normal flow void. There is mild cerebellar atrophy present. No midline shift or mass effect is seen.

Case Discussion

Subacute or chronic subdural hematoma is predominantly a disease of the elderly. It usually follows a minor trauma. A history of direct trauma to the head is absent in up to half the cases. The common manifestations are altered mental state and focal neurological deficit. Neurological state at the time of diagnosis is the most important prognostic factor. Morbidity and mortality is higher in the elderly but outcome is good in patients who undergo neurosurgical intervention.

Large SDH may appear lentiform or biconvex like EDH on coronal plane. 

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