Determining the Cause

Chief Complaint: Headache

a. History: Disturbs sleep or presents immediately upon awakening

b. CT Scan Head (Non-Contrast):

Differential Diagnosis

Next Pivotal Assessment	Findings
CT Scan Head (Non-Contrast)*	1. Hyperdensity: The hematoma appears as a hyperdense (bright) area on the CT scan due to the presence of blood. The density can vary depending on the age of the hematoma (acute vs. chronic). 2. Crescent Shape: Subdural hematomas usually have a crescent-shaped appearance that conforms to the contours of the brain, often spreading over the surface. 3. Midline Shift: In larger hematomas, there may be a midline shift of the brain structures, indicating increased intracranial pressure. 4. Compression of Ventricles: The hematoma may compress adjacent brain tissue and ventricles. 5. Bony Changes: In cases of associated skull fractures, there may be bony abnormalities visible on the scan. 6. Chronic Hematoma: In older or chronic subdural hematomas, you might see a more heterogeneous appearance with possible encapsulation. These findings help distinguish subdural hematomas from other types of intracranial hemorrhages and guide treatment decisions.

Next Pivotal Assessment

Findings

CT Scan Head (Non-Contrast)*

1. **Hyperdensity**: The hematoma appears as a hyperdense (bright) area on the CT scan due to the presence of blood. The density can vary depending on the age of the hematoma (acute vs. chronic).

2. **Crescent Shape**: Subdural hematomas usually have a crescent-shaped appearance that conforms to the contours of the brain, often spreading over the surface.

3. **Midline Shift**: In larger hematomas, there may be a midline shift of the brain structures, indicating increased intracranial pressure.

4. **Compression of Ventricles**: The hematoma may compress adjacent brain tissue and ventricles.

5. **Bony Changes**: In cases of associated skull fractures, there may be bony abnormalities visible on the scan.

6. **Chronic Hematoma**: In older or chronic subdural hematomas, you might see a more heterogeneous appearance with possible encapsulation.

These findings help distinguish subdural hematomas from other types of intracranial hemorrhages and guide treatment decisions.

*Non-contrast imaging is sufficient to identify the presence of blood and assess the extent of the hematoma. Contrast is generally not necessary in acute cases, as the bleeding can be clearly visualized without it. In specific situations where more detail is needed—such as in chronic cases or to evaluate surrounding structures—contrast-enhanced imaging might be considered, but this is less common in the initial assessment.