What are you most suspicious for given imaging findings and clinical history?
Given interval change, imaging findings were suspicious for new subdural hemorrhage due to new intracranial hypotension. The ordering physician was notified of this, and we learned that the patient had spinal anesthesia at time of delivery and now endorses positional headaches. A follow-up brain and spine MRI was recommended for further evaluation.
What is the differential?
Differential may include a traumatic subdural hemorrhage; however, this would not explain new prominence of the extra-axial space or decreased size of ventricular system. Additionally, initial head CT at onset of headache was negative.
Axial non-contrast CT at presentation. There is a new left subdural hematoma overlying the left parietal convexity. Additionally, in comparison to the prior head CT, there is new increased prominence of the extra-axial spaces and the ventricular system is slightly decreased in prominence.