Question

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. SAH
• B. EDH
• C. Normal Study
• D. Chronic SDH

Hint:

Elderly, on aspirin, minor fall weeks ago, now confused — look for a hypodense crescent that crosses sutures, not a bright lens shape.

Answer 1

The Correct Option is D

Step 1: Weigh the clinical clues. An elderly man (age causes brain atrophy and stretched bridging veins), on aspirin (bleeding tendency), with a MINOR fall 3 weeks ago and now confusion, is the textbook setting for a chronic subdural haematoma. The 3-week interval between trauma and symptoms is highly suggestive.

Step 2: Read the NCCT. The non-contrast CT shows a crescent-shaped (concave toward the brain) extra-axial collection over the cerebral convexity that crosses suture lines, with mass effect/midline shift. As the blood is old, it appears HYPODENSE (dark) or mixed density rather than bright - confirming a chronic subdural haematoma.

Step 3: Confirm the correct option. Crescentic, suture-crossing, hypodense convexity collection + elderly + remote minor trauma + anticoagulant/antiplatelet use = chronic subdural haematoma; option D is correct.

Step 4: Exclude the distractors. Subarachnoid haemorrhage (SAH) shows hyperdense blood within the sulci, basal cisterns and fissures (a 'starfish' pattern), usually with thunderclap headache, not a crescentic convexity collection 3 weeks after a fall; A is wrong. Extradural/epidural haematoma (EDH) is a biconvex (lens-shaped) hyperdense collection that does NOT cross suture lines, classically arterial (middle meningeal artery) after temporal trauma with a lucid interval - not this chronic, crescentic, hypodense picture; B is wrong. A normal study is excluded by the obvious extra-axial collection and mass effect; C is wrong.

Final answer: Option D - Chronic SDH.