Presentation
Fall from standing. Head injury. On warfarin for AF.
Patient Data
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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