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What are the possible causes of the fluid-fluid level?
1) Acute on chronic SDH (i.e. a re-bleed into a chronic subdural collection); 2) Deficient coagulation (e.g. warfarin).
How should this subdural hematoma be managed?
This collection requires urgent evacuation.
Hyperdense material (blood) can be seen layering on the tentorium and along the right side of the falx (blue arrows). A fluid-fluid level (yellow dotted line) separates it from a low density component anteriorly.
There is extensive midline shift (red) with dilatation of the left lateral ventricle (*) and compression of the right lateral ventricle.