Neurology

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Disoriented 64-years-old female had severe headaches for 3 weeks prior to her current symptoms

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Findings:

  • Axial CT scans reveal a huge SDH along the right convexity of the skull. The crescentic shape, tapered peripheral margins, and extensive spread along the calvarium localize the lesion to the subdural space. The SDH is rather complex in CT appearance, containing several areas of differing CT density (hypo/iso/hyperdense , numerous septations), sedimentation level, and a thin irregular “subdural membrane” along the inner margin of the lesion

Dx:

  • A recent rehemorrhage into a preexisting chronic SDH.

A history of alcoholism is present in 50% of patients. Other patients with a predisposition to chronic SDHs are those with epilepsy, coagulopathy, and ventricular shunts. The vast majority of chronic SDHs arise in elderly of late middle age patients, with over 75% occurring after age 50.

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