Presentation
Headache, vomiting, left hemiparesis, and altered level of consciousness. The history of head trauma could not be ascertained. Suspicion of an intracranial space-occupying lesion or CVA was made.
Patient Data
A large subdural collection in the convexity of the right frontoparietal lobe. It appears hyperintense on T1 and hyperintense on T2/FLAIR sequences consistent with a late subacute subdural hematoma. There is a significant mass effect evidenced by effacement of the ipsilateral sulci and gyri, right lateral ventricle as well as midline shift to the left.
Case Discussion
Subdural hematoma is a collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater of the meninges around the brain. It occurs in any age group, head trauma being the major cause. Occasionally spontaneous acute subdural hematomas are seen in patients with an underlying bleeding disorder or structural abnormality such as dura arteriovenous fistula. They appear as crescentic collections on MRI. Subacute subdural hemorrhages may appear biconvex-shaped on the coronal plane rather than crescent-shaped which is a typical appearance on the axial plane, as demonstrated in this case.
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