Subdural hygroma with secondary hemorrhage

Case contributed by Frank Gaillard
Diagnosis certain


Head trauma

Patient Data

Age: 65 years

CT 5 months before trauma


Single CT image demonstrating a normal, albeit volume depleted, brain. 

CT day of trauma


CT acquired within 24 hours of head trauma demonstrates a CSF intensity collection over the left hemisphere. A small amount of traumatic subarachnoid blood was also present on the right (not shown). 

CT day 1 post trauma


The left sided subdural collection is enlarging but remains CSF density. A smaller right sided hygroma is also developing. 

CT day 5 post trauma


There has been further enlargement of the subdural hygromas. A small amount of intraventricular blood (redistribution of the subarachnoid blood) is also seen. 

CT day 23 post trauma


The right sided hygroma has resolved and the left hygroma has reduced in size. 

CT day 62 post trauma


The patient is readmitted with decreased conscious state. An acute hemorrhage is now seen admixed with the hygroma on the left. Note how the CSF in the sulci is not involved (this blood is subdural not subarachnoid). 

Case Discussion

This case illustrates the development of subdural hygromas (CSF) post trauma, later complicated by a subdural hemorrhage. Often these hemorrhages are referred to as 'acute on chronic' although no prior hemorrhage was ever present. 

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