Subdural hematoma

Case contributed by Dr Derek Smith

Presentation

Slipped on ice with head injury. Possible loss of consciousness at scene, with mild retrograde amnesia. On anticoagulant. ?stroke

Patient Data

Age: 80 years
Gender: Male
CT

Small right vertex soft tissue hematoma; no underlying fracture.

Thin right sided subdural hematoma, settling over the tentorium and floor of middle cranial fossa (better illustrated on the coronal windowed view). Maximal depth under cerebral convexity of 2 mm.

Minor effacement of the ambient cistern but no significant mass effect. Volume loss within age limits.

Mild periventricular small vessel change; no significant parenchymal abnormality.

This shallow traumatic SDH was managed conservatively, with cessation of the anticoagulant. Two weeks later while undergoing rehabilitation there was a deterioration in left sided mobility, strength and balance.

CT

Follow up CT

Progressive right sided subdural hematoma, with acute blood products encircling the cerebrum. Deep new parafalcine component. Maximal coronal depth now 10 mm from 2 mm.

Worsening mass effect with 8 mm midline shift to the left and ambient cistern effacement. No downward herniation or hydrocephalus.

Reduced cortical attenuation in the right temporal pole; possible reactive or infarct. Normal brainstem.

Case Discussion

Subdural hemorrhages occur when bridging veins in the subdural space are violated / torn. This typically occurs in patients with reduced brain volume and relatively minor trauma.

SDH should respect falcine boundaries as this case demonstrates with the blood products contained lateral to the falx cerebri and superior to the tentorium cerebelli.

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Case information

rID: 67949
Published: 2nd May 2019
Last edited: 2nd May 2019
Inclusion in quiz mode: Included

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