Presentation
Male patient in late 60's on medical ward, who is 'out of sorts'. No neurological examination findings given. No prior CT head.
Patient Data
Large T1 hyperintense, T2 hypointense right sudural collection with marked effacement and displacement of the right lateral ventricle ( 'midline shift' ).
Case Discussion
Subdural hematoma is one form of extra-axial collection.
It is typically identified on CT head, which is the first line investigation for concerns over intracranial hemorrhage and unspecified CNS symptomatology.
This MRI illustrates the ability of aging blood on MRI, in this case the collection being subacute in nature.
In this case the subdural hematoma is causing severe mass effect, for which the patient proceeded promptly for surgical evacuation.
Imaging requesting after sound clinical assessment remains the most effective, satisfying and cost effective form of clinical medicine.
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