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Bilateral subdural hematoma

Altered sensorium following traumatic brain injury.

Patient Data
AGE: 40 years

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Coronal T2

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Axial T2

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Coronal T1

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Axial T1

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Axial Gradient Echo

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Axial DWI

There are crescentic collections in the convexity of bilateral frontal, temporal and parietal bones which appears hyperintense on T1, T2 and FLAIR sequences consistent with bilateral late subacute subdural hematoma. The subdural collections demonstrate fluid-fluid levels anteriorly. There is mass effect evidenced by effacement of the sulci and gyri. No midline shift. The ventricles are within normal limits.

Case Discussion
Subdural hematoma is a collection of blood in the potential space between the dura and arachnoid mater of the meninges of the brain. it occurs in all age groups, most frequently due to trauma.

MRI findings are in keeping with bilateral late subacute subdural hematoma following traumatic brain injury. The MRI was performed 10 days post injury.

Subdural hemorrhage (SDH) (also commonly called a subdural hematoma) is a collection of blood accumulating in the subdural space, the potential space between the dura and arachnoid mater of the meninges around the brain. SDH can happen in any age group, is mainly due to head trauma and CT scans are usually sufficient to make the diagnosis. Prognosis varies widely depending on the size and chronicity of the hemorrhage. 

Subdural hematomas, most frequently due to trauma, are seen in all age-groups although etiology will vary :

infants: non-accidental injury
young adults: motor vehicle accidents, vascular lesions
elderly: falls (although a definite history of trauma may be lacking)
They are present in ~15% (range 10-20%) of all head trauma cases and occur in up to 30% of fatal injuries.

In addition to trauma, there are numerous other far less common causes: 

glutaric aciduria type 1  (infants and children, rare)
vascular malformations (all ages)
Intracranial hypotension

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