Presentation
Fall from standing height, minor head injury. Reducing GCS.
Patient Data
Large right acute subdural hematoma demonstrates mixed density and is causing significant mass effect. The right lateral ventricle is effaced and the left lateral ventricle entrapped and dilated, with posterior periventricular CSF seepage causing hypodensity. Midline shift measures 20mm. The cingulate gyrus is herniating under the anterior falx and there is obliteration and asymmetry of the ambient cisterns in keeping with transtentorial herniation. No tonsillar herniation identified in the posterior fossa however. Grey/white matter differentiation is preserved.
No skull fracture. Diffuse sclerosis of the cranium in keeping with myelofibrosis.
Conclusion
Large right acute subdural hematoma causing significant mass effect and midline shift. Left lateral ventricle is entrapped and there is descending transtentorial and cingulate herniation. No tonsillar herniation identified.
Case Discussion
The patient had a very low platelet count from myelofibrosis and a history of previous leukemia.
The patient was taken to neurosurgery for urgent evacuation of the subdural hematoma. Despite standard neurosurgical and ICU care, the patient not unexpectedly failed to recover and died 2 days later.
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