Presentation
Confusion and shortness of breath in a patient with past medical history of alcohol abuse.
Patient Data
There is a large left frontoparietal extra-axial hemorrhage likely representing acute on chronic subdural hematoma. There is a small right frontoparietal subdural hematoma. There is mass effect with a midline shift of approximately 7 mm to the right.
There is age-appropriate brain atrophy. There is moderate periventricular and subcutaneous cortical white matter hypoattenuation most commonly seen in chronic small vessel ischemia.
The ventricles, basal cisterns and cortical sulci are normal in size for the degree of brain atrophy.
The calvarium, base of the skull and facial bones appear intact. The paranasal sinuses and mastoid air cells are patent.
Case Discussion
Subdural hematoma is a collection of blood between the inner layer of the dura mater and the arachnoid mater of the meninges in the brain. It is usually caused by tearing of the bridging veins in the subdural space. Classically, subdural hematomas are crescent-shaped on head CT.