Subdural haemorrhage with fluid-fluid levels
PEA arrest - unresponsive and unequal pupils.
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Massive left-sided subdural haematoma with lobulated appearance with fluid-fluid levels may relate to anti-coagulation; extends along the falx cerebri and tentorium cerebelli. Severe left-to-right midline shift with subfalcine, transtentorial and cerebellar tonsilar herniation. Complete effacement of the third ventricle and basal cisterns. Loss of grey-white differentiation in the left temporal lobe. There is also a intra-parenchymal haemorrhage, probably secondary to infarct, in the right cerebellar hemisphere.
Fluid-fluid levels and the lobulated appearance can occur with anticoagulation with the haematoma unable to clot properly. In this case the INR was 2.2 (warfarinised).