Meningeal irritation, evaluate for infectious process, structural cause for subdural hematoma, evaluate for aneurysm or other vascular abnormality, evaluate for extracranial vascular abnormalities MRI brain: There are bilateral subdural hematomas left larger than right with mild diffuse prominence of the overlying dura. There is local mass effect and sulcal effacement and slight midline shift to the right of approximately 4 mm. There is no diffusion restriction or thick rim enhancement of the subdural collections. There is a nonspecific punctate focus of susceptibility effect in the left cerebellum, which may be from prior microhemorrhage. There is no evidence of acute cerebral infarction. The brain parenchyma appears grossly unremarkable. There is no evidence of intracranial mass lesions. There is no abnormal leptomeningeal enhancement. There is mild mucosal thickening in the paranasal sinuses. The orbits are unremarkable.MRA brain: The intracranial arteries appear intact without evidence of aneurysm, stenosis, or dissection. The left vertebral artery terminates in the PICA, which represents a normal variant.MRA neck: There is conventional origin of the arch vessels. The carotid and vertebral arteries appear intact without aneurysm, stenosis, or dissection.
1. Persistent bilateral subacute subdural hematomas with no change in the associated midline shift.2. Mild dural reaction overlying the subdural hematomas, but no evidence of abnormal leptomeningeal enhancement or cerebral abscess.3. No evidence of aneurysm, stenosis, or dissection of the intracranial and cervical arteries