Computed tomography of spinal epidural hematoma

Three cases of spinal epidural hematoma are presented. Computed tomography (CT) was the first diagnostic method used in two patients and demonstrated a surgically confirmed spinal epidural hematoma in both patients. In a third patient who presented with a complete block on myelography, CT was helpful in assessment of the extent of the lesion and suggested a vertebral hemangioma as the cause of the hematoma. CT is a very useful tool in the diagnosis of spinal epidural hematomas.     

Computed tomographic artifact simulating acute subdural hematoma

Radiologists are alerted to the need to distinguish subdural hematoma from an artifact of computed tomography.     

Computed tomography of acute spinal epidural hematoma associated with cervical root avulsion

A case of acute spinal epidural hematoma associated with post-traumatic cervical root avulsion is described. Surgical management of this condition depends to a large extent on its early recognition as well as accurate information about its site and extent. Computed tomography is the investigative procedure of choice to evaluate this entity.     

Computed tomography of spontaneous acute cervical epidural hematoma

Cervical spinal epidural hematoma is a rare cause of acute neurologic syndromes including paralysis of various types. Although devastating, it can be successfully treated surgically if recognized early. We report two cases of spontaneous cervical epidural hematoma diagnosed by computed tomography, the first with a plain scan and the second with a scan after intrathecal injection of metrizamide. In both patients the diagnosis was not clinically suspected. Surgery resulted in a dramatic improvement of the neurologic deficit in both cases.     

Computed tomography of duodenal hematoma

As the initial study in cases of abdominal trauma, computed tomography may demonstrate intramural duodenal hematoma as an inhomogeneous, high-attenuation mass associated with obstructive changes. Representative cases show the manifestations of this injury as presented by this technique.     

Computed tomographic diagnosis of traumatic fetal subdural hematoma

Intrauterine subdural hematoma (SDH) is a rare event; maternal trauma, especially during the last trimester of pregnancy, is the best documented cause of fetal SDH. We report an extremely rare case of fetal SDH due to maternal trauma diagnosed by multidetector computed tomography. We also discuss the clinical and imaging features of fetal SDH which can be used to assist in diagnosis with emphasis on CT criteria.     

Computed tomography of isodense subdural hematomas.

Eight cases of isodense subdural hematomas were evaluated by computed tomography (CT). CT demonstrated varying degrees of compression of a lateral ventricle, shift of the midline structures and, in some cases, obliteration of the subarachnoid sulci on the side of the lesion. Contrast enhancement was helpful in one case and demonstrated medial displacement of enhanced cortical margins away from the inner table of the skull. Two of the eight patients had no clear history of trauma.     

Computed tomography of isoattenuating subdural hematomas.

CT scans of 87 patients with subdural hematoma were compared to those of 393 patients with midline shift caused by other intracranial lesions with regard to attenuation changes in the lesion and the character of the ventricular deformity. Isoattenuating was exhibited by 25% of the subdural hematomas and 5% of the other lesions. In 70 to 80% of the isoattenuating hematomas, the diagnosis could be made on the basis of the characteristic ventricular deformity. Other diagnostic procedures are not necessary in these cases.     

Computed tomography of spinal injuries

Computed tomography images are free of superpositional effects. Therefore, today CT represents the most effective method of evaluating spinal fractures. Clear imaging of the vertebral elements provides a sufficient analysis of stability in most cases. Moreover, in the polytraumatized patient, every region of the body can be evaluated without new positioning. Thus, the sequence of therapy may become obvious within a reasonable amount of time. The 3-column theory has proved to be very effective for evaluation of the remaining stability in spinal fractures.     

Computed tomography of spinal tuberculosis

The computed tomographic (CT) features of nine documented cases of spinal tuberculosis are analyzed. The mechanisms of vertebral involvement are reviewed. The ability of CT to facilitate the diagnosis as well as to delineate the extent of soft tissue involvement is emphasized. The need for increased alertness to the diagnosis of tuberculosis is stressed.     

Computed tomography of spinal chordomas

Computed tomography of 16 spinal chordomas revealed lytic lesions, or lytic and blastic lesions, of 2 or more adjacent vertebrae and a fairly well-delineated soft tissue mass in 16 patients. Intravenous contrast enhancement revealed multiple zones of hypodensity in 5 tumors pathologically proved to contain areas of cystic degeneration. Invasion of the epidural space was noted on computed tomography in 2 vertebral and 7 sacral lesions, and on myelography in 7 vertebral lesions. Computed tomography is ideal for delineation of the soft tissue component of these lesions, detection of sacral lesions at an early stage, planning of surgical excision or irradiation treatment, and detection of recurrence.     

Limitations of computerized tomography in diagnosis of subdural hematoma

Summary CT findings in 51 patients with subdural hematomas are studied. Direct signs (hyperdensity, hypodensity) and indirect signs (any form of mass lesion) are distinguished. CT is limited with regard to determining correlations between time and the attenuation values. The factors which influence density of the hematoma are discussed. For a rational approach with subdural hematomas, which present diagnostic problems and reveal the limitations of CT diagnosis, a diagnostic scheme is proposed.     

Computed tomography in spinal trauma

In a retrospective study of 65 patients with spinal trauma, computed tomography was found to add to plain radiography clinically relevant information in 47 patients. It was most helpful in identifying unsuspected neural arch fractures and in assessing spinal canal narrowing. Computed tomography is of great value in pretreatment evaluation and in follow-up of the patient with significant spinal trauma.     

Computed tomography in spinal tuberculosis

Exhaustive ciinicoradiologic and computed tomographic (CT) analysis of 114 cases of spinal tuberculosis seen between January 1983 and January 1989 is presented. The mechanisms of the spinal involvement are reviewed. CT helped to diagnose cases of spinal tuberculosis in their initial stages. Inaccessible fixed areas of spine were seen with ease on axial sections of CT. The extent and anatomic depiction of soft-tissue involvement as depicted on CT helps surgeons choose the appropriate surgical approach, which may affect future spinal stability.     

Computed tomography in the evaluation of subdural hematomas.

Computed tomographic (CT) scans used in the diagnosis and management of subdural hematomas were analyzed with respect to their contribution to angiography and surgery. There has been a progressive increase in the use of CT in evaluating post-traumatic and postoperative subdural hematomas at the Mayo Clinic. At present, 40% of all patients undergo operation on the basis of the CT findings alone. False-positive diagnoses revealed at surgery have decreased to less than 4%. Erroneous negative interpretations have involved 10% of all patients whose diagnosis was subdural hematoma. Criteria for the interpretation of scans have been established.