Subacute subdural hematoma
Subdural hematoma evacuation 4 weeks prior. Re-admitted with altered GCS.
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Right frontal and parietal burr holes.
Large right sided frontoparietal, almost exclusively isodense, subdural hematoma with a minor amount of acute blood in the inferior aspect of the collection.
Marked sulcal effacement and compression and shift of the right lateral ventricle with subfalcine herniation.
Subacute subdural hematomas are the most difficult to identify especially when small, as the blood is isodense to the brain parenchyma.
Ancillary signs of sulcal effacement and use to of manual windowing ( second set of CT images ) assist in delineation.