Q: What imaging are you likely to do based on this history? show answer
Chronic subdural haemorrhage (teaching)
Confusion and headache. History of high alcohol intake. Patient denies any head injury or trauma. No focal neurological signs on examination.
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There is a cresentic, concave collection surrounding the left cerebral lobes. It is uniformly hypodense.
There is also evidence of mass effect with compression of the left lateral ventricle and a few millimeters of midline shift to the opposite side.
From other imaging, no evidence of bony injury.
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This case is a good illustration of a chronic subdural haemorrhage.
In confused patients, particularly the elderly or inebriated, you may struggle to get a consistent history and due to the delay in presentation, there may be little to no external evidence of trauma. This is one of the reasons why CT head is part of the "confusion screen".
Thanks to Dr Jeremy Jones for contributing this case (original entry here).