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Case #22

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Demographics: 76 years old, Female
Indication: Fall

Findings

  • Acute subdural hematomas layering along the bilateral cerebral convexities, right aspect of the falx near the vertex, and both aspects of the cerebellar tentorium with intermixed areas of hypoattenuation
  • Acute small volume subarachnoid hemorrhage layering in the left greater than right sylvian fissures, interpeduncular fossa, and prepontine cistern
  • Associated mass effect with bilateral cerebral sulcal effacement, partial effacement of the lateral ventricles and third ventricle, right to left midline shift, leftward subfalcine herniation, and mild downward transtentorial herniation with partial effacement of the basal cisterns
  • Soft tissue contusion/hematoma overlying the right zygomatic arch
  • Remote appearing left pontine infarct
  • Calcified intracranial atherosclerosis

Diagnosis

Hyperacute subdural hemorrhage

Sample Report

Acute subdural hematomas layering along the bilateral cerebral convexities (measuring up to 10 mm in thickness on the right and 15 mm on the left), right aspect of the falx near the vertex (measuring up to 10 mm in thickness), and both aspects of the cerebellar tentorium (measuring up to 8 mm in thickness) with intermixed areas of hypoattenuation concerning for hyperacute hemorrhage. Associated mass effect with bilateral cerebral sulcal effacement, partial effacement of the lateral ventricles and third ventricle, 5 mm right to left midline shift, leftward subfalcine herniation, and mild downward transtentorial herniation with partial effacement of the basal cisterns. No tonsillar herniation.

Acute small volume subarachnoid hemorrhage layering in the left greater than right sylvian fissures, interpeduncular fossa, and prepontine cistern. No hydrocephalus.

Soft tissue contusion/hematoma overlying the right zygomatic arch.

Remote appearing left pontine infarct, which is strictly age-indeterminate in the absence of prior studies for comparison.

Calcified intracranial atherosclerosis.

Discussion

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