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A 43-year-old man presented to the emergency department with a 2-day history of headache; he reported being otherwise healthy. Four weeks earlier, he had been an unrestrained driver involved in a motor vehicle accident in which he lost consciousness but did not present to a hospital. He reported having no history of coagulopathy, alcohol abuse, or use of antiplatelet or anticoagulant medication. In the emergency department, his clinical course deteriorated over a period of several hours, with worsening headache, nausea, vomiting, and lethargy. Computed tomography (CT) of the brain, performed without the administration of contrast material, revealed a loss of cortical sulci but failed to show a lesion clearly. Magnetic resonance imaging (MRI) (Panels A and B) revealed large bilateral subdural hematomas. The patient underwent successful evacuation of the hematomas through four burr holes (two on each side). He did well postoperatively and was discharged home, neurologically intact, on postoperative day 4. This case shows the occasional difficulty in visualizing subacute subdural hematomas on CT if they are isodense relative to the brain parenchyma. In such cases, MRI can be useful to better visualize the hematoma.
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