A patient has lethargy, headache, and a hyperdense crescent-shaped lesion on CT scan. Diagnosis?

A patient has lethargy, headache, and a hyperdense crescent-shaped lesion on CT scan. Diagnosis?

• A. Subdural hematoma
• B. Epidural hematoma
• C. Intracerebral hemorrhage
• D. Concussion

Answer: (A)

A subdural hematoma is most likely. On CT, a hyperdense collection that forms a crescent shape along the surface of the brain and can cross the skull’s suture lines is classic for a subdural bleed. This happens when bridging veins between the brain and dura are torn, often after trauma, and the blood collects between the dura and arachnoid. The crescent shape differs from an epidural hematoma, which is typically lens-shaped (biconvex) and confined by suture lines because it sits between the skull and dura and is usually due to an arterial bleed from the middle meningeal artery. Intracerebral hemorrhage would be within the brain tissue itself, not a crescent along the brain surface, and concussion wouldn’t show a hyperdense lesion on CT at all. The clinical symptoms of lethargy and headache can accompany an expanding subdural hematoma due to increasing intracranial pressure.

A subdural hematoma is most likely. On CT, a hyperdense collection that forms a crescent shape along the surface of the brain and can cross the skull’s suture lines is classic for a subdural bleed. This happens when bridging veins between the brain and dura are torn, often after trauma, and the blood collects between the dura and arachnoid. The crescent shape differs from an epidural hematoma, which is typically lens-shaped (biconvex) and confined by suture lines because it sits between the skull and dura and is usually due to an arterial bleed from the middle meningeal artery. Intracerebral hemorrhage would be within the brain tissue itself, not a crescent along the brain surface, and concussion wouldn’t show a hyperdense lesion on CT at all. The clinical symptoms of lethargy and headache can accompany an expanding subdural hematoma due to increasing intracranial pressure.