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This was a 62-year-old alcoholic individual who

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deteriorated while being evaluated in the emergency room.

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This is the initial CT scan from 12:30 in the afternoon.

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For a 62-year-old person,

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this is a lot of volume loss.

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You see sulcal enlargement, ventricular enlargement.

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And an addition,

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you see that the patient has low-density collections

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bilaterally, so-called chronic subdural hematomas.

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Remember that as the hematomas age,

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they get less and less dense,

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and therefore,

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these low-density collections that can be seen

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here are likely weeks to months old.

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There was a single section in which there appeared to be

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a small area of hemorrhage associated with

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the sylvian fissure on the left side.

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But this would have been read as bilateral chronic

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subdural hematomas in a patient demonstrating marked

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volume loss and a small focus of blood products in the

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subarachnoid space around the left sylvian fissure.

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The patient deteriorated while in the emergency room.

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I'd like to show the follow-up study.

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As you can see by the scout image,

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the patient is now being monitored with EEG

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monitors because of the deterioration.

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And on the CT scan, we can see that those low-density

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subdural hematomas, bilaterally,

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are now isodense.

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Now,

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we know that these are not subacute hematomas.

1:45

This is isodense subdural hemorrhage,

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secondary to dilution of the low-density chronic subdural

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hematomas with new acute blood.

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So, we take low-density blood in the chronic subdural.

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We add an acute higher-density blood from the acute subdural.

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We mix them together and what do you get?

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An isodense subdural, bilaterally, in this patient.

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As I mentioned, this patient had alcoholic history

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and the patient may have had a coagulopathy,

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secondary to the hepatic degeneration in,

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for example, the blood clotting factors.

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So, this is an example of acute hemorrhage into a chronic

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collection, going from low density to isodensity and

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creating bilateral isodense subdural hematomas.

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You'll notice that that minimal amount of blood that was in

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the sylvian fissure on the left side previously

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has now resolved 8 hours later.