Acute Subdural Haematoma

Non-contrast CT scan showing an acute epidural haematoma
(with overlying scalp swelling) (A) and acute subdural haematoma (B).

The first thing to recognize is that
the blood clot in each case is closely related to the skull. As a
matter of fact, it is separating the brain from the skull. You will
easily appreciate from further examination of the images that in
Fig the clot is biconvex (acute epidural haematoma, EDH)
whereas in Fig. the clot is crescent shaped like a new moon
draped over the surface of the brain (acute subdural haematoma,
ASDH).
‘In the majority of cases, this simple difference in shape
accurately distinguishes an epidural haematoma from a subdural
haematoma.’ We will come back to this in more detail
below. Your understanding of the conceptual (anatomic) basis for
the difference in the CT appearance of these two lesions is not
only important for your accurate use of the terms but ‘“epidural
haematoma patients” behave significantly differently from
patients with acute subdural haematoma, hence the distinction
is important’.

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