Presentation
Left hemiparesis. No history of head trauma.
Patient Data
Large right-sided frontoparietal subdural collection (maximum thickness = 28 mm), isodense to the cortical grey matter in keeping with a subacute subdural hematoma. There is effacement of the cortical sulci with mass effect on the midline structures and subfalcine herniation.
Another small left parietal hyperdense subdural collection (maximum thickness = 10 mm, mean density = 58 HU) in keeping with acute subdural hematoma.
No cranial vault fracture was seen on the bone window (not shown).
Case Discussion
CT features of bilateral subdural hematoma subacute on the right and acute on the left.
Subdural hematomas are difficult to identify in the subacute phase because the collection of blood appears isodense to the adjacent cortical grey matter, however, some indirect signs will help to identify the presence of subdural collection such as:
- CSF-filled sulci do not reach the skull but rather fade out into the subdural
- mass-effect including sulcal effacement (distortion) and midline shift
- apparent thickening of the cortex
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