Massive subdural haematoma and dementia: a “yin and yang” paradigm

An 85-year-old man with a 2-year history of cognitive decline and falls, and signs of brain atrophy on previous computed tomography imaging, presented with severe drowsiness. Axial and coronal non-contrasted cerebral computed tomography images (Figure, A and B respectively) showed massive bi-hemispheric acute (hyperdense) and chronic (hypodense) subdural haematoma, with extensive parenchymal compression. Dementia is strongly associated with brain atrophy and frequent falling, both of which are risk factors for subdural bleeding1 caused by stretching and tearing of subdural veins2. The formation of a subdural haematoma can have further adverse effects in terms of cognitive decline. Surgical decompression of the subdural haematoma led to progressive improvement of the patient’s neurological status in the following weeks. The axial image resembles the black and white “yin and yang” symbol, which is conceptually relevant to the patient’s clinical history of subdural haematoma and dementia — two interdependent entities giving rise to each other.