A 68-year-old man on warfarin presents to the emergency department two weeks after a minor fall. He reports progressive headache and drowsiness. CT head shows a crescent-shaped hyperdense collection crossing suture lines with significant midline shift. What is the most likely diagnosis?
- A Acute extradural hematoma
- B Acute subdural hematoma ✓
- C Chronic subdural hematoma
- D Traumatic subarachnoid hemorrhage
Correct answer: B. Acute subdural hematoma
Explanation
Acute subdural hematoma appears as a crescent-shaped (not biconconvex) hyperdense collection on CT that crosses suture lines, unlike extradural hematoma which is limited by sutures. It typically results from tearing of bridging veins and is common in elderly patients with cerebral atrophy or those on anticoagulation, even after minor trauma. The two-week history with progressive symptoms fits an acute rather than chronic presentation (which would be hypodense).
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.