Tentorium cerebelli subdural haematoma

Case contributed by Dr Bruno Di Muzio

Presentation

Unwitnessed fall on the ward.

Patient Data

Age: 75-year-old
Gender: Female

There is an acute subdural haematoma observed along the superior portion of the tentorium on the right, measuring up to 3.2 mm in depth. No intra collection, mass or focal abnormality identified. Ventricles and remainder basal cisterns are unremarkable. Patchy white matter low attenuation is non-specific, but most likely represents a sequelae of chronic small vessel ischaemic change, and is of an amount commonly seen in this age group.

There has been progression of the right subdural haematoma tracking along the right tentorium now measuring 9 mm at its greatest depth ( previously 5 mm ) and extends to the level of the right anterior clinoid process. No new intra or extra-axial haemorrhage is identified. The ventricles and basal cisterns are unremarkable. Grey-white matter differentiation is preserved with no midline shift or mass effect. No abnormality of the posterior fossa is identified. Visualised paranasal sinuses and mastoid air cells are clear.​

Case Discussion

This case illustrates a typical incident that can happen with inpatients, especially among the elderly, and that is usually targeted by numerous institutional prevention campaigns. Unfortunately, even with all the prevention measures, it is not uncommon to receive requests for CT scans similar to this case. 

First CT scan demonstrated a right-sided subdural tentorial haematoma, haematomas like this one may sometimes be really thin and just identified by a subtle hyperattention of the tentorium. The follow-up scan performed one day later has demonstrated progression over the haematoma, but no further mass effect or other complications. 

 

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Case information

rID: 44509
Case created: 25th Apr 2016
Last edited: 3rd Jul 2016
Inclusion in quiz mode: Included

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