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Acute subdural hematomas: atypical CT findings.

D Reed, W D Robertson, D A Graeb

    AJNR. American Journal of Neuroradiology
    |May 1, 1986
    PubMed
    Summary
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    Mixed-density subdural hematomas (MDSDH) present atypically on CT scans. These hematomas are larger, cause more midline shift, and have a higher mortality rate than typical subdural hematomas.

    Area of Science:

    • Neurosurgery
    • Radiology
    • Trauma Surgery

    Background:

    • Acute subdural hematomas (SDH) are commonly associated with severe head trauma.
    • Classical CT appearance of SDH is a homogeneous, high-density crescentic collection.
    • Variations in SDH presentation can complicate diagnosis and management.

    Purpose of the Study:

    • To characterize the CT appearance of acute subdural hematomas.
    • To investigate the prevalence and features of mixed-density subdural hematomas (MDSDH).
    • To compare clinical outcomes and CT findings between MDSDH and typical SDH.

    Main Methods:

    • CT scans of 71 patients with acute SDH within 72 hours of head injury were reviewed.
    • Hematomas were classified based on density (homogeneous vs. mixed).

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  • Clinical data, including mass effect, midline shift, and mortality, were analyzed.

    • Main Results:

    • 39% of patients (28/71) had MDSDH, featuring low-density areas within the hematoma.
    • MDSDH were larger (18.1 mm vs. 8.0 mm), had greater midline shift, and a higher mortality rate (50% vs. 26%) compared to homogeneous SDH.
    • A novel pattern of ventricular compression with CSF trapping was observed in four MDSDH patients.

    Conclusions:

    • MDSDH represent a significant subset of acute subdural hematomas with distinct CT characteristics.
    • The atypical appearance of MDSDH can mimic other intracranial pathologies, necessitating careful evaluation.
    • MDSDH are associated with worse outcomes and unique patterns of intracranial pressure effects.