Extensive #Subdural-hematoma (Orange) in a patient with prev | Figure 1

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Extensive #Subdural-hematoma

Orange in a patient with previous burr hole for hematoma (Blue). Treatment included two burr holes to evacuate #Hematoma

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#Pseudomeningocele Post burr hole for what was initially thought to be a chronic subdural hematoma. Turned out to be a subdural hygroma. Presented with a history of involvement in a motor vehicle 1 month prior. Had headaches and left-sided weakness. CT scan shows a left hypodense subdural collection. Post burr holes, recovered fully and was discharged. Now presents with the mass as above. What would you do?

These CT images are typical of a chronic subdural hematoma. The 1st image is normal with no compromise of subarachnoid spaces surrounding the brainstem. Higher cuts show the subdural with mass effect on the midline (shift) and collapse of ventricle. Chronic subdural hematoma looks hypointense (dark) whereas an acute subdural looks hyperintense (white) on CT, having to do with the way the blood and hemoglobin breakdown over time. Chronic SDH can be evacuated with a burr hole because the blood is liquefied. An acute SDH requires a craniotomy because the blood is clotted and cannot drain through a burr hole. Chronic SDH patients are generally older and many are on antiplatelet medications and blood thinners. This complicates the timing of surgery.

bilateral subacute #Subdural-hematomas in an 82F. Went to OR for bilateral burr hole drainage.

Massive acute subdural hematoma on top of a chronic subdural hematoma. The patient is still alive.

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