Subdural hematoma - isodense bilateral

Case contributed by Dr Sajoscha Sorrentino

Presentation

Headaches and some confusion over past week or two.

Patient Data

Age: 70 years
Gender: Male

ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with Radiopaedia.org. 

There is generalized fullness to the brain with little if any sulcal CSF visible over the convexities. There cortex is poorly visualized and appears thickened in parts. 

Contrast opacifies the intracranial arteries and veins. The cortex can now be distinguished from the overlying previously iso-dense subdural collections. Cortical vessels can be seen in contact with the cortex confirming the location of the collections. 

Annotated image

Non-contrast CT demonstrates a wide isodense region peripherally (*) with medial displacement of the grey-white matter junction (blue dotted line). 

Following administration of contrast the cortex can now be seen slightly hyperdense to the collections and cortical vessels can bee seen adjacent to the brain (red arrows). 

Case Discussion

This case illustrates the typical appearance of a large bilateral iso-dense subdural hematoma, and demonstrates the utility of giving contrast if the diagnosis is suspected. 

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