Subacute subdural hematoma

Case contributed by Dr Rania Adel Anan

Presentation

Dizziness and blurring of vision 2 weeks after fall on the ground.

Patient Data

Age: 65 years
Gender: Female
CT

An extra-axial relatively isodense collection with (small hyperdense area seen within its anterior portion) is seen contagious to the right frontal region with n associated significant mass effect, it measures about 14 mm in maximal thickness ... Mostly representing subacute subdural hematoma. 

There is age-appropriate mild brain atrophy with the ventricles, basal cisterns and cortical sulci are normal in size for the degree of brain atrophy.

The calvarium, base of the skull and facial bones appear intact. 

A well defined partially calcified scalp lesion is seen at the mid posterior parietal region with intact underlying bone & no intracranial extension, in keeping with proliferating trichilemmal cyst. 

Case Discussion

Subdural hematoma is a collection of blood between the inner layer of the dura mater and the arachnoid mater of the meninges in the brain. It is usually caused by tearing of the bridging veins in the subdural space. Classically, subdural hematomas are crescent-shaped on head CT.

It is most frequently caused by trauma in all age groups. In elderly, it usually happens after falls (however a definite history of trauma may be lacking).

Most patients (65-80%) present with a severely depressed conscious state and pupillary abnormalities are seen in ~40% (range 30-50%) of cases.

Clinical presentation of subacute/chronic subdural in the elderly is often vague and is one of the classic causes of pseudodementia. A history of head trauma is often absent or very minor.

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