A 70-year-old patient on anticoagulants falls and presents with gradually worsening headache, confusion, and ipsilateral pupillary dilation over 3 weeks. A crescent-shaped hypodense collection is seen on CT over the cerebral convexity. This is consistent with:

• A Extradural hematoma from middle meningeal artery injury
• B Subarachnoid hemorrhage from berry aneurysm rupture
• C Chronic subdural hematoma from bridging vein rupture ✓
• D Intracerebral contusion from cortical injury

Explanation

Chronic subdural hematoma results from rupture of bridging veins (cortical veins that traverse the subdural space to drain into dural venous sinuses). These veins are vulnerable to minor trauma, especially in elderly patients with cerebral atrophy (greater bridging vein length). Initial hemorrhage is a small amount; the hematoma expands slowly over days to weeks due to osmotic mechanisms. CT shows a crescent-shaped collection (following brain surface) that is hypodense in chronic phase. Extradural hematoma is biconvex (lenticular), hyperdense, and associated with middle meningeal artery injury.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.