Loculated acute subdural haematoma masquerading as an extradural

Case contributed by Dr Chris O'Donnell

Presentation

Fall at home. Laceration to right eyebrow. Unable to recall event.

Patient Data

Age: 90
Gender: Male

Biconvex blood collection overlying the right temporal lobe in the expected position of an extradural.  Note, however, the absence of a fracrture (usually always present leading to rupture of a middle meningeal arterial branch), the patient's age (very unusual in an elderly person), presence of a more chronic right convexity subdural collection and the "tail" of more tyical acute subdural haematoma anteriorly (arrow).

Case Discussion

In patients with chronic subdural haematoma, adhesions can develop as part of the "membrane" producing process pathologically associated with these subdurals.  The space therefore becomes loculated or walled-off, allowing venous bleeding to accumulate producing an appearance that is similar to an extradural haematoma.  The point is that are under low (venous) not high (arterial) pressure exerting relatively minor pressure effect on the underlying brain unlike an extradural bleed.

 

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Case information

rID: 27945
Case created: 27th Feb 2014
Last edited: 5th Oct 2015
Inclusion in quiz mode: Included

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