This patient has two main issues:

1. An acute interhemispheric subdural hematoma
2. Incidental lytic lesions consistent with multiple myeloma

While traumatic subdural hematomas are common, interhemispheric subdural hematomas are rare ¹. They are associated with traumatic venous tearing of the parasagittal bridging veins. In our patient, the hyperdense hematoma can best be visualized on the coronal and sagittal views. This is in contrast with typical subdural hematomas, which can be best appreciated on the axial views. Thus, it is important to image all three main views of the brain looking out for interhemispheric hematoma.
While there are clear management algorithms for the management of acute subdural hematoma. The management for interhemispheric subdural hematomas are less clear ². There is no clear benefit of surgical vs. conservative management in these uncommon hematomas.

Multiple myeloma is common neoplastic disorder of plasma B cells. It is most commonly associated with punched out lytic lesions ³. In this patient, note the numerous lytic lesions spread through the cervical vertebra. These are classic for multiple myeloma.

Case contributed by A/Prof. Pramit Phal.