Case of the Month

July/August 2009, Background

10 month-old boy with increasing head circumference.

Coronal		Coronal		Sagittal

Coronal and sagittal head ultrasound images through the anterior fontanelle demonstrate bilateral enlargement of the extra-axial spaces, which show hypoechoic layers of slightly different echogenicities. The lateral ventricles are prominent.

Color Doppler images show bridging veins not reaching the superior sagittal sinus but, rather, displaced against the brain surface. Appearances are suspicious for bilateral subdural hematomas.

Coronal FLAIR	Axial T2
Sagittal and Cornonal	T1 post contrast

Selected images from a brain MRI performed the next day – coronal FLAIR, axial T2, sagittal and coronal contrast-enhanced T1 – demonstrate bilateral parafalcine subdural hematomas, with blood layers of different signal intensities, possibly due to repeated bleeds. Additionally, the ventricular system and the subarachnoid spaces are generally increased.

What is your best guess at the diagnosis?

Archived Case of the Month.