FINDINGS Figure 218-1. Axial NCCT through the level of the frontal horns at about 8 AM when she was brought into the emergency room. There are bilateral extraaxial crescentic collections larger and of mixed density (hypodense and hyperdense), on the left (arrows) and thinner iso- to hyperdense on the right (chevrons). There is a mild midline shift to the right (star). Figure 218-2. Axial NCCT through the same level as in Figure 218-1 about 3 hours later at about 11 AM when the patient’s condition deteriorated. There is now a larger mixed density (iso-hypo-hyperdense) crescentic extraaxial collection surrounding the right cerebral hemisphere (transverse arrows). The left extraaxial collection is now partially effaced. There is now a midline shift to the left (star). There is also dilatation (acute hydrocephalus) of the left trigone (vertical arrow) consistent with a trapped left lateral ventricle due to effacement and obstruction at the level of the foramen of Monro/third ventricle.
DIFFERENTIAL DIAGNOSIS Hyperacute subdural hematoma (HSDH), recurrent bleed into chronic subdural hematoma (CSDH).
DIAGNOSIS Hyperacute subdural hematoma (HSDH) with active bleed.
DISCUSSION
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