This patient has two main issues:
- An acute interhemispheric subdural haematoma
- Incidental lytic lesions consistent with multiple myeloma
While traumatic subdural haematomas are common, interhemispheric subdural haematomas are rare 1. They are associated with traumatic venous tearing of the parasagittal bridging veins. In our patient, the hyperdense haematoma can best be visualised on the coronal and sagittal views. This is in contrast with typical subdural haematomas, which can be best appreciated on the axial views. Thus, it is important to image all three main views of the brain looking out for interhemispheric haematoma.
While there are clear management algorithms for the management of acute subdural haematoma. The management for interhemispheric subdural haematomas are less clear 2. There is no clear benefit of surgical vs. conservative management in these uncommon haematomas.
Multiple myeloma is common neoplastic disorder of plasma B cells. It is most commonly associated with punched out lytic lesions 3. In this patient, note the numerous lytic lesions spread through the cervical vertebra. These are classic for multiple myeloma.
Case contributed by A/Prof. Pramit Phal.