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History:

67 year old woman was found unresponsive, in bed, by her daughter. She is taking Coumadin® (warfarin) for treatment of atrial fibrillation.

Exam:

• Decreased level on consciousness.
• No focal neurological injury noted.

Image Findings:

• CT shows "thickening" of the falx and the tentorium bilaterally
• MRI shows extensive bilateral extraaxial subdural fluid consistent with hematoma (SDH) overlying both cerebral hemispheres. The SDH is also seen layering in between the cerebral hemishperes and along the tentorial leaves - extending into posterior fossa.

Differential Diagnosis:

• Subdural empyema
• Subdural hematoma
• Subarachnoid hematoma
• Epidural hematoma

Actual Diagnosis:

Acute bilateral subdural hematomas, convexity, interhemispheric, tentorial

How Was Dx Confirmed:

MRI

Treatment and Outcome:

Vitamin K and supportive therapy

Patient Discussion:

Information on Coumadin® (warfarin) * View Link *

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