Brain haematoma can often elude a junior doctor at the busy Manchester Royal Infirmary Accident and Emergency Department. Here we described an unusual presentation of brain haematoma—a sub acute on chronic subdural haematoma. Radiologic findings of this 82-year-old gentleman on head CT includes the classic mass effect (ipsilateral effacement and contralateral dilatation) and a layered appearance of different densities—a mixture of biconcave isodense (multiple known causes), hypodense (indicative of >21 days bleed), and hyperdense (indicative of 72 h bleed) collection! Here we discussed the type and duration of bleed with multiple CT evidence, also supporting the clinical finding of Hutchinson pupil in our case—a worrying sign of early tentorial herniation! A brief review on thrombolysis is also discussed.
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