Question:hard
A 76-year-old elderly patient presents in a confused state. He is on antihypertensive medication and on aspirin due to a previous heart attack. There is a minor trauma due to a fall from a chair 3 weeks back. NCCT is done and shown below. Diagnosis?
A 76-year-old elderly patient presents in a confused state. He is on antihypertensive medication and on aspirin due to a previous heart attack. There is a minor trauma due to a fall from a chair 3 weeks back. NCCT is done and shown below. Diagnosis?
Show Hint
Elderly, on aspirin, minor fall weeks ago, now confused — look for a hypodense crescent that crosses sutures, not a bright lens shape.
Updated On: Jun 22, 2026
- SAH
- EDH
- Normal Study
- Chronic SDH
Show Solution
The Correct Option is D
Solution and Explanation
Build the risk profile first. Everything in the history points to a chronic subdural haematoma: advanced age (brain atrophy stretches the bridging veins so they tear easily), aspirin use (impaired haemostasis), a trivial fall, and a delay of several weeks before symptoms appear. Slow venous bleeding accumulates gradually, so confusion shows up weeks later.
Confirm it on the scan shape and density. A subdural collection follows the inner contour of the skull as a crescent (concave toward the brain) and freely crosses cranial sutures because it lies between dura and arachnoid. Because the blood is now weeks old, it is hypodense/isodense (dark or grey) rather than acutely bright, and there is mass effect with midline shift. That crescentic, suture-crossing, low-density appearance is diagnostic of chronic SDH.
Distinguish from the look-alikes.
- EDH: lens/biconvex, bright (acute arterial), and stops at sutures because the dura is firmly attached there - opposite shape and density.
- SAH: bright blood filling sulci, fissures and basal cisterns, with sudden severe headache - not a convexity crescent.
- Normal study: ruled out by the clear extra-axial collection and shift.
So the NCCT diagnosis is a Chronic Subdural Haematoma (Option D).
Confirm it on the scan shape and density. A subdural collection follows the inner contour of the skull as a crescent (concave toward the brain) and freely crosses cranial sutures because it lies between dura and arachnoid. Because the blood is now weeks old, it is hypodense/isodense (dark or grey) rather than acutely bright, and there is mass effect with midline shift. That crescentic, suture-crossing, low-density appearance is diagnostic of chronic SDH.
Distinguish from the look-alikes.
- EDH: lens/biconvex, bright (acute arterial), and stops at sutures because the dura is firmly attached there - opposite shape and density.
- SAH: bright blood filling sulci, fissures and basal cisterns, with sudden severe headache - not a convexity crescent.
- Normal study: ruled out by the clear extra-axial collection and shift.
So the NCCT diagnosis is a Chronic Subdural Haematoma (Option D).
Was this answer helpful?
0
