Subdural hemorrhage with fluid-fluid levels

Case contributed by Dr Henry Knipe

Presentation

PEA arrest - unresponsive and unequal pupils.

Patient Data

Age: 75
Gender: Male

Massive left-sided subdural hematoma 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 hemorrhage, probably secondary to infarct, in the right cerebellar hemisphere. 

Case Discussion

Fluid-fluid levels and the lobulated appearance can occur with anticoagulation with the hematoma unable to clot properly. In this case the INR was 2.2 (warfarinised). 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.