Presentation
Confusion, head trauma 10 days prior to presentation.
Patient Data
There is left sided subdural collection that appears isodense to the gray matter compressing the ipsilateral sulci and lateral ventricle, seen in the frontoparietal area causing a shift of midline structures of about 15 mm as well as unilateral descending tentorial herniation, suggesting subacute subdural hematoma.
No evidence of space-occupying mass lesion.
No cerebellar tonsillar herniation.
No depressed skull fracture.
Complete opacification of the right maxillary sinus.
Case Discussion
In this patient there is significant amount of midline shift and compression of the ipsilateral ventricle, the presence of dilated ipsilateral CP angle cistern and medially displaced temporal horn of the ipsilateral lateral ventricle are important indirect signs of descending transtentorial herniation, this patient rapidly became unresponsive with dilated pupils bilaterally, indicating compression of both oculomotor nerves against the tentorial edge which is a poor prognostic sign.
Unable to process the form. Check for errors and try again.