case_images: PMC11722198_01
case_images: A. Baseline plain brain CT demonstrated acute subdural hemorrhage (arrowheads) with a midline shift of 13 mm (measured). B. Post burr hole and evacuation of subdural hematoma plain CT demonstrated a pocket of air at the left frontal subdural space (bolded arrows). A midline shift of 6.6 mm was also observed (measured). C. Cerebral angiography demonstrated normal findings.
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case_images: PMC11722198_01_gr1.jpg
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case_images: A CT scan of the head revealed an acute left subdural hematoma with mass effect and a 13 mm midline shift as seen in Fig. 1A. Additionally, a pocket of air was noted in the left frontal subdural space as seen in Fig. 1B. Tomography Angiography (CTA) was performed to rule out other vascular causes of the subdural hematoma, as shown in Fig. 1C. Two weeks after discharge, the patient returned with a severe throbbing headache.
case_images: A. Plain CT of the brain, 2 weeks after initial treatment, demonstrated new mixed hyper and hypodense collections within the left subdural space (star) measuring 14.5 mm at the thickest point. It was causing a significant mass effect with a midline shift of about 9.2 mm. There was diffuse effacement of sulci at the left hemisphere.. B. Plain MRI of the brain, 2 weeks after initial treatment, demonstrated left frontoparietal-temporal-occipital and temporal subdural collection (star) measuring 13 mm at the thickest point, causing mass effect onto the adjacent sulci with significant midline shift(6 mm). There was Minimal subfalcine herniation.. C. Plain CT of the brain, 4 weeks after initial treatment, demonstrated a hyperdense subdural collection in the left subdural space (arrows) with a hypodensity in the non-dependent part measuring about 8.6 mm on the thickest part. There was a mass effect and an ipsilateral sulcal effacement with a mild midline shift of about 5 mm.
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case_images: Upon suspicion of a recurrent subdural hemorrhage, a repeat CT scan was performed, revealing a subacute on chronic left subdural hemorrhage with a mass effect and a midline shift of 9.2 mm, along with left-sided cerebral edema as seen in Fig. 2A.