No abstract

IntrOductIOnSubdural Haemorrhage (SDH) is a form of brain haemorrhage in which there is a collection of blood between the dura and the arachnoid layers of the meninges. It is usually associated with mechanical brain injury [1]. The occurrence of subdural haemorrhage may or may not be associated with any visible injury to scalp, skull or brain. Hence, radio imaging tools remain the only method to diagnose subdural haemorrhage and its characteristics in surviving patients [2]. Computed Tomography (CT) is routinely utilized for the diagnosis of acute SDH [3].The CT scan finding of an SDH depends on the age of the haemorrhage. In the hyperacute phase, they appear relatively iso-dense to the adjacent cortex, with a swirled appearance due to a mixture of a clot, serum, and ongoing unclotted blood. In the acute phase, SDH appears as a hyper-attenuated crescent-shaped extra-axial collection. As the haematoma ages, it becomes more and more hypo dense. Sometimes areas of hyperdensities can be found within a hypodense area, indicating rebleeding as in cases of acute on chronic SDH [4]. The attenuation coefficient defines the extent to which the intensity of an energy beam is diminished as it passes through a particular material [5]. CT numbers/attenuation mainly depends on measurement technique, object composition, and beam energy [6].From the clinical point of view, classification of subdural haemorrhage into different ages or post-traumatic Intervals (PTI) based on its density on CT scan decides the further course of management of the patients. Though discussion on the management of subdural haemorrhage is out of the scope of this paper, few points can be noted. Hyperdense subdural haematomas are usually managed by craniotomy and at times by performing craniectomy. The surgical procedures like trephination and twist drill craniotomy are used in the management of hypodense subdural haemorrhage. Subdural Evacuating Port System (SEPS) are more efficient in draining Subdural Haematomas (SDHs) that are hypodense on CT scans than in evacuating mixed density SDHs [7-10].As far as Magnetic Resonance Imaging (MRI) is considered, it is more sensitive than CT in the detection of SDH because of its multi-planarity and superior tissue differentiation properties. More than 95% sensitivity has been reported with T2-weighted images of SDH because of the marked variation in signal intensity between blood products and adjoining structures [11]. Further with the passage of time, the variation in the MRI appearance of SDH can indicate the approximate stage of haemorrhage and even the age of the blood clot [12]. These observations have immense forensic applications where multiple traumatic events have occurred in the same case, in cases with the paucity of external injuries or in cases with repeated non-accidental trauma. Thus the radiological dating of SDH is of immense help, both from the forensic point of view as well as for the management of the patient.From the forensic perspective, the radiological tools have been valuable in the detec...

A 38-week-pregnant woman was brought to the emergency of PGIMER, Chandigarh with history of gunshot injury to abdomen with Intra-uterine fetal death. She underwent surgical intervention within two hours of the incident.

No abstract