Subdural hemorrhage with fluid-fluid levels

Case contributed by Dr Henry Knipe


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). 

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