Presentation
Confusion and vague neurological change on the last 10 days that started after a fall from her own height.
Patient Data
CT scan demonstrates mild mass effect with a slight midline shift to the right, associated with an asymmetry between the hemispheres, due to an unilateral frontoparietal extra-axial haemorrhage, which is a subdural haematoma in the left cerebral convexity, with a crescent distribution around the periphery of the cranium.
This CT scan shows that the patient had already undergone a surgical drainage procedure, with no evident signs of complication.
As additional findings, it is possible to identify some normal intracranial calcifications, such as of the: falx cerebri, tentorium cerebelli, basal ganglial, pineal gland, and habenula. Furthermore, the is still atherosclerosis of the internal carotid arteries. Smal tentorial lipoma is also noted.
It is possible to notice a faint increase of density of the haematoma, which is probably due to the metabolisation of haemoglobin when progressing and transitioning to chronic haematoma.
Case Discussion
Usually the elderly tend to tolerate larger haematomas than younger patients, due to cerebral atrophy. Interestingly, when there is a midline shift, older patients seem to be more vulnerable to mental deterioration than younger patients.
Contributed by Dr. Guilherme Pioli Resende MD.
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