Subdural Hematoma

Figure 1. A 76-year-old man with hypertension and a history of stroke reported headache, difficulty walking, and loss of appetite. He denied using alcohol, having a recent fall, or being assaulted. The initial neurologic examination demonstrated slowed speech, disorientation, somnolence with right homonymous hemianopia, right-sided facial droop, right-sided paresis with marked spasticity, and a flexion contracture of his right arm. Within hours, he became obtunded and his blood pressure rose. Unenhanced computed tomography showed a subdural hematoma with a blood–fluid level (A). The right lateral ventricle was markedly compressed and shifted across the midline (B). There was diffuse edema throughout . . .