Subdural haematoma with acute and chronic components
Headache of two weeks duration. Diabetic and hypertensive. No definite history of trauma.
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A large extraaxial subdural blood collection with acute and chronic components is seen overlying the surface of the left cerebral hemisphere. The hematoma measures 16 mm in maximal thickness. It showed a concave inner margin and exerts a significant mass effect in the form of effacement of the underlying cortical sulci, compression of the left lateral ventricle and contralateral shift of the midline structures.
In this case of subdural haematoma, the patient is conscious complaining of headache for about two weeks duration. No history of trauma. He has type II DM and receives antihypertensive treatment.
CT was requested and it revealed a large left sided extraaxial crescentic shaped subdural collection of different densities denoting different blood ages, it covers the right cerebral hemispheres and exerts mass effect in form of effacement of the underlying cortial sulci, compression of the left lateral ventricle and contralateral shift of the midline.
Recent (acute) bleeding appears hyperdense and mainly presents at the dependent part of the collection.
Virtually there is no differential diagnosis for this case, but in chronic cases when blood becomes of CSF density subdural hygroma should be considered as a radiological differential diagnosis.