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Bilateral subdural hemorrhages (acute on chronic)

Case contributed by Ayush Goel
Diagnosis certain

Presentation

Altered consciousness and right side weakness

Patient Data

Age: 70 yrs
Gender: Female

Bilateral acute on chronic subdural hemorrhages with mild midline shift (5 mm) and subfalcine herniation to right and sulcal effacement. Maximum depth on right is 18 mm and on left is 30 mm.

Pansinusitis also noted.

Case Discussion

The shape of the extra-axial hemorrhages in this case is biconvex and not lentiform, but it crosses the sutures. This should not be confused with extra-dural hemorrhage which does not cross the suture. Usual teaching of differentiating SDH from EDH based on the shape does not hold true in many cases and SDH can take any shape practically.

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