Presentation
A high speed motor vehicle accident. A CT brain was performed.
Patient Data
There is a trace right subdural hemorrhage over the lateral convexity, measuring 3 mm in depth. There is a linear hyperdensity in the right posterior frontal region may represent a small amount of subarachnoid blood or contusion.
Case Discussion
Subdural hemorrhage is a collection of blood in between the dura mater and the arachnoid mater of the brain. In young adults, subdural hemorrhage is typically caused by traumatic head injury associated with motor vehicle accidents. It is said to have an incidence of 12-29% of patients presenting with severe traumatic brain injury 1.
Patients with subdural hemorrhage can often present with neurological signs, such as a decreased conscious state or pupillary changes.
Treatment of subdural hematomas depends on the chronicity (acute vs chronic) as well as the degree of mass effect that is being produced. Surgical intervention in acute subdural hematoma can be dictated by the following guidelines 2:
SDH thickness greater than 10 mm
Midline shift greater than 5 mm
Neurological changes - GCS drop by 2 or more points; asymmetric pupils; intracranial pressure > 20mm Hg
In this case, this small subdural hemorrhage did not have any midline shift and was not associated with any neurological changes. The hemorrhage was managed conservatively.
Case contributed by A/Prof. Pramit Phal.
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