Brain imaging course – Unknown case 4

This video is the 4th unknown case that goes with the brain imaging capstone course. If you want to follow along, you can find all the images for the case at the brain capstone page.

Introduction

65 year-old male with possible ground level fall found to be altered. On Coumadin for DVT.

Interactive review

This case features a CT showing a hyperdense hemorrhage in the extra-axial space. You first see it in the left middle cranial fossa and going along the temporal convexity all the way up to over both cerebral hemispheres. There is significant mass effect with uncal unherniation and complete effacement of the basal cisterns. There complete compression of the left lateral ventricle with entrapment of the right lateral ventricle.

Another finding that you can see is hypodensity in the left PCA distribution, which suggests that there is an infarction. This is from mass effect on or stretching of the PCA.

Interactive question 4a

What additional complications do you see on this case? From the explanation, you can see that you have all the complications, including midline shift, uncal herniation, infarct, and ventricular entrapment.

Interactive question 4b

What territory is the infarct in? The left PCA distribution

Diagnosis and Summary

This is a case of acute subdural hematoma. This can occur in patients who are older, who have falls, or who are on anticoagulation. There are a lot of potential complications that you can see in this case, such as ventricular entrapment and hernation.

You can tell the difference in subdural and epidural hematoma most of the time. Subdural hematomas are crescent shaped, cross sutures, and cross along dural reflections. Epidural hematomas are almost always associated with fractures and high energy traumas.

Thanks for tuning in to this case. There are a total of 7 cases you can review on your own at the website and explanations will be posted here.

See all of the brain course videos on the brain course playlist, or go back to the brain capstone course page. Be sure to check back in for additional videos in the future or check out the website at https://www.learnneuroradiology.com