Bilateral subdural hematomas exactly isodense to the subjacent gray matter

Abstract

A 47-year-old man presented with progressively worsening headache. Three weeks previously, the patient had bilateral subdural hematomas, which were secondary to trauma, evacuated via burr holes. On the current admission, a computed tomography (CT) scan demonstrated large subdural collections that were bilaterally symmetrical and exactly isodense to the underlying gray matter. This gave the appearance of bilaterally thickened cortical gray matter. The extra-axial collections were homogeneous and did not demonstrate fluid/fluid levels. Examination of regions of interest of the subdural collection and the gray matter showed them to be exactly isodense—within one Hounsfield unit of each other (Figure 1). The patient was brought to the operating room. The subdural hematomas were evacuated via prior burr holes. Brownish fluid, which was consistent with a subdural hematoma under moderate pressure, was noted. The patient had resolution of the headache and was discharged on postoperative day three.