These CT images re typical of a chronic subdural hematoma. | Figure 1

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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 with 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 thru a burr hole. Chronic SDH patients are generally older and many are on antiplatelet medications and blood thinners. This complicates the timing of surgery.

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