Subdural hemorrhage

Case contributed by Dr Derek Smith

Presentation

Fall from standing. Head injury. On warfarin for AF.

Patient Data

Age: 90 years
Gender: Male
CT

Shallow subdural hemorrhage in the left anterior cranial fossa. This is barely visible against the skull on normal "brain" windowing and best seen with optimized windowing for blood products.

Moderate generalized volume loss with no mass effect from the bleed. No skull fracture.

Case Discussion

Remember to review CT heads with a slightly wider window (in this example C60 W150, instead of C35 W 70 for brain windowing) to help detect small bleeds and abnormalities close to the skull table, especially in the trauma setting.

Although an intracranial bleed, given the lack of significant mass effect and symptoms, the clinical decision was taken to slowly reverse the INR with oral vitamin K in this situation.

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Case information

rID: 74567
Published: 27th Feb 2020
Last edited: 25th Jul 2020
Inclusion in quiz mode: Included

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