Case 2

This is a CT study of the brain, showing crescentic bilateral intracranial, extra-axial collections – these cross suture lines but do not cross dural reflections, and are characteristic of subdural haematomas. The larger collection on the left is exerting mass effect on the brain, causing left sided sulcal effacement and midline shift to the right. Both collections exhibit a gradient of density with layering of denser content to a dependent position – this is due to the fresh, denser blood layering and displacing the older, liquefied collection. There is also hyperdense blood along the septations, which represents hyperacute bleeding.

There are incidental basal ganglia calcifications.

The features are characteristic of acute-on-subacute subdural haemorrhages. This constitutes a neurosurgical emergency. In the first instance, I would contact the referring physician and recommend urgent neurosurgical referral. A craniotomy may be warranted in this case.