The predictive value of computed tomography and Haemophilus influenzae capsular antigen in subdural fluid collections

A study was made of 52 patients with Haemophilus influenzae type B meningitis complicated by subdural collections of fluid to determine which of these collections were sterile (effusions) and which infected (empyema). This differentiation is important for the treatment which differs in the two conditions. Cranial computed tomography (CT) alone was not as reliable as the combination of CT associated with detection of Haemophilus influenzae capsular antigen, in accurately predicting if a subdural fluid collection was infected, or had a high probability of becoming infected.     

Spinal subdural haematoma: a study of three cases.

AIMS: To define the clinical, computed tomography (CT) and magnetic resonance imaging (MRI) features and the role of MRI in the follow-up of spinal subdural haematoma (SSH), and to compare these findings with those of spinal epidural haematomas (SEH). METHODS: We report three cases of SSH (two women, one male, age: 50-74 years). Two patients were on anticoagulant therapy; in the other case the SSH was spontaneous. All the patients were examined 1-3 days after the onset of the symptoms. All of them had CT, two had MRI and one had angiography. Two patients underwent surgery. RESULTS: The haematoma was located in the thoracolumbar region (two) and in the thoracic region (one), extending from five (two) to 11 vertebral body levels (one). The haematomas were posteriorly located with lateral extension. The transverse shape differed with the level: biconvex, biloculated or circumferential. The haematomas were hyperdense on CT. On MRI, SSH yielded high signal on both T1 and T2. The integrity of the posterior fat pads, which was well shown on CT and MRI, and the visualization of the dura mater demonstrated the intradural location of these collections, making them easily distinguishable from spinal epidural haematoma. MRI provides better evaluation of the longitudinal extent. Our results are compared with those reported in the literature. CONCLUSION: MRI is superior to CT for diagnosis and follow-up of SSH. Our findings and those reported in the literature show that the MR features of SSH are quite specific and allow differentiation from SEH.     

Isodense subdural haematomas on CT: MRI findings

Summary MRI findings are described in two patients with subdural haematomas isodense on CT. In one patient, admitted 6 weeks after trauma, a chronic subdural haematoma showed extreme hypointensity on T2-weighted images, suggesting acute trauma, and therefore acute rebleeding. In the second patient with severe anaemia, an acute subdural haematoma was hyperintense on T2-weighted images, suggesting chronic trauma; this may be explained by the low haematocrit and a possible mixture of blood with cerebrospinal fluid. The MRI features of subdural haematomas and hygromas have to be kept in mind, in order not to misjudge the age of the haematoma.     

Leakage of contrast into a postmeningitic subdural effusion:

Summary The CT findings in a 6-month-old boy with hemophilus influenzae meningitis, complicated by the occurrence of bilateral subdural effusions, are described. The effusions were hypodense and the contents markedly enhanced (increase of 40 Hounsfield units) after contrast injection.     

血浆S-100B蛋白测定在外伤性颅内血肿诊疗中的临床意义

目的 探讨血浆S-100B蛋白在不同类型外伤性颅内血肿的诊断、分型、指导治疗中的临床价值.方法 颅内血肿116例,根据头颅CT分为硬膜外血肿(52例)、硬膜下血肿(32例)、脑内血肿(32例)三组,伤后早期(6小时内)抽取血浆测定S-100B蛋白含量,伤后每24小时送检1次,动态测定(3～7天).三组两两比较.结果 脑...     

创伤性颅脑损伤的CT征象与患者伤情及预后的相关性分析

目的探讨创伤性颅脑损伤各种CT征象与患者伤情及预后的相关性,并为其预后评价提供有价值的早期影像学信息。方法回顾性分析2008年1月～2010年11月我院收治的创伤性颅脑损伤患者的伤情及预后情况,收集患者的年龄、性别、入院时格拉斯哥昏迷评分(GCS)、GCS运动评分、血肿的位置及侧别、有无蛛网膜下腔出血、中线结构的偏移及程度、基底池的受压情况、6个月后的格拉斯哥预后评分(GOS)等数据,并进行统计学分析,采用统计描述、Logistic回归等统计方法对数据进行分析,评价各征象与伤情和临床预后的相关性。结果本组95例患者,平均年龄为(50.2±18.7)岁。GCS的中位数是10,43.2%的严重脑外伤患者在复苏后GCS评分≤9。根据入院患者死亡率,老年人明显高于年轻人,为20%∶2%,年龄在住院后死亡和存活患者的组间比较的差异有统计学意义(P=0.006);入院后死亡患者的GCS运动评分为1.4±0.7,入院后存活的患者GCS运动评分为3.9±1.4,两组之间的差异有统计学意义,P=0.001。在CT直接征象上,入院后死亡患者较存活患者有较高比例的硬膜下血肿、双侧血肿、颞叶血肿和蛛网膜下腔出血,通过Logistic回归得出,颞叶血肿在入院死亡和入院存活患者的组间差异有统计学意义,P=0.034。在CT间接征象上,基底池受压和中线结构移位情况在两组之间的差异有统计学意义(P<0.001)。对颅脑损伤患者6个月后的预后情况进行统计学分析,得出在预后较差组有较高比例的双侧血肿、蛛网膜下腔出血、硬膜下血肿和颞叶血肿,颞叶血肿和蛛网膜下腔出血在两组组间比较的差异有统计学意义,分别为P值=0.043,P值=0.027。结论 CT是急性脑外伤后判断颅内有无损伤及损伤程度的首选检查方法,双侧血肿、蛛网膜下腔出血、硬膜下血肿、颞叶血肿对患者入院死亡率和预后情况有重要的提示意义,可为临床治疗和患者后期恢复提供有效的参考依据。     

Chronic spinal subdural haematoma associated with intracranial subdural haematoma: CT and MRI

Chronic spinal subdural haematoma is a uncommon. We describe the CT and MRI appearances of chronic spinal and intracranial subdural haematomas following minor trauma. The aetiology, pathogenesis and differential diagnosis are discussed. Received: 7 January 1998 Accepted: 15 July 1998     

Role of brain perfusion single-photon emission tomography in traumatic head injury

This investigation examined the role of brain perfusion single-photon emission tomography (SPET) in traumatic head injury in 35 patients. The results were compared with those of X-ray computerized tomography (CT) and magnetic resonance imaging (MRI). CT and MRI detected brain contusions in seven patients, subarachnoid haemorrhage in one patient and both in nine patients. In 16 of the 17 subjects (94%), SPET with technetium-99m-hexamethylpropyleneamine oxime (Tc-HMPAO) revealed CT/MRI-negative abnormalities, such as hypoperfusion in the contre-coup region, frontal hypoperfusion related to personality change and cerebellar hypoperfusion associated with vertigo. In two patients presenting with diffuse axonal injury in the brainstem, hypoperfusion in the frontal cortex on the affected side was observed on SPET. SPET demonstrated hypoperfusion in the adjacent cortex, with no abnormality on either CT or MRI, in six of seven patients exhibiting acute epidural haematoma. SPET failed to provide additional information in two of five patients with acute subdural haematoma and in one of two patients displaying chronic subdural haematoma. In four of nine patients with post-traumatic amnesia, SPET detected hypoperfusion in the temporal lobe, with no abnormality on either CT or MRI. In five of eight patients with vertigo, SPET detected hypoperfusion in the morphologically normal cerebellum. In seven cases involving personality change, frontal hypoperfusion was observed in four; moreover, a markedly non-homogeneous pattern was evident in the remaining three. Overall, SPET afforded additional information in 26 patients (74%). CT possesses an advantage with respect to the detection of haemorrhagic lesions. MRI provides more precise information regarding contusions and axonal injury. Frequently, SPET may be the only examination to reveal perfusion abnormalities which are related to symptoms in the absence of other objective findings, such as post-traumatic amnesia, vertigo or personality change.     

Arachnoid cyst with complicating intracystic and subdural haemorrhage

Intracranial arachnoid cysts are usually non-symptomatic. Intracystic and subdural haematomas induced by even minor head injury may turn an asymptomatic AC into a symptomatic one, necessitating surgical treatment. We present a case of a previous asymptomatic AC, spontaneously complicated with subdural hygroma and development of intracystic and subdural haematoma. Clinical follow-up and control CT regime of patients with AC are recommended.     

Subdural and epidural empyemas: MR imaging

The MR images of six patients with extraaxial empyemas (five subdural and four epidural) were reviewed and compared with CT scans. MR demonstrated convexity and interhemispheric collections, which were mildly hyperintense relative to CSF and hypointense relative to white matter on short TR pulse sequences and hyperintense relative to CSF and white matter on long TR pulse sequences, allowing distinction from sterile effusions and most chronic hematomas. A hypointense rim, representing displaced dura, was depicted at the interface between the lesion and brain in epidural empyemas, a feature absent in subdural empyemas. Inflammation-induced parenchymal abnormalities, including edema, mass effect, and reversible cortical hyperintensity, were well depicted on MR imaging. MR was superior to CT in demonstrating the presence, nature, and extent of these lesions in all cases. Because early and accurate diagnosis will significantly improve the prognosis of these serious infections, MR is preferred to CT for patients in whom an acute intracranial infection is suspected.     

Computerized tomography in chronic subdural hematomas (effusions) of infancy

Summary During the past 2 years six infants were seen at University of Wisconsin Hospitals (UWH) with subdural hematomas (effusions). This communication describes the abnormalities found on computerized tomographic (CT) evaluation of the six infants.     

Spinal subdural haematoma mimicking tethered cord after posterior fossa open surgery

We report the MRI findings in a girl aged 3 years and 10 months who developed a spinal subdural haematoma after posterior fossa open surgery for cerebellar malignant rhabdoid tumour. Emergency surgery was performed immediately because of increased intracranial pressure. Control MRI 48 h after surgery showed a spinal subdural haematoma without clinical signs of paresis or bladder dysfunction. Spinal subdural haematoma is rare, and only few cases have been reported, especially in children. This report suggests that "silent" (without clinical symptoms) postoperative spinal acute subdural haemorrhage can occur after posterior fossa surgery.     

MRI demonstration of kernohan's notch: case report

Summary We report a left acute subdural haematoma caused by rupture of a left anterior cerebral artery aneurysm, which progressed to left hemiparesis. Coronal MRI was superior to CT for visualizing Kernohan's notch.     

Subdural haematoma associated with an arachnoid cyst after repetitive minor heading injury in ball games

We report the case of a chronic subdural haematoma caused by repetitive heading of a football which led to the diagnosis of a middle fossa arachnoid cyst. The association between arachnoid cysts and subdural haematoma is discussed as are safety implications in sporting injuries.     

CT evidence of intracranial contusion and haematoma in relation to the presence, site and type of skull fracture

The skull films and CT scans of 1383 patients with acute head injury transferred to a regional neurosurgical unit were reviewed. Of the 850 patients with a skull fracture, contusion and/or haematoma was found in 71%, compared with 46% of the 533 patients with no fracture. Thirty-nine per cent of patients had neither contusion nor haematoma, and 21% had neither skull fracture nor contusion/haematoma. Haematomas occurred more frequently in association with lateral and occipital fracture than with frontal fracture, but the incidence of contusion was similar for all fracture sites. Linear fractures were more often associated with extra- and subdural haematomas than were depressed fractures. Intracranial damage associated with depressed fractures was localized more frequently than with linear fractures. Frontal fractures were rarely associated with posterior damage alone, but with occipital fractures anterior contusion was more frequent than posterior. Damage associated with lateral fracture was solely contralateral in 26%. Skull fracture was present in 77% of patients with contusion, 87% of those with an extradural, 72% with a subdural, and 66% with an intracerebral haematoma (70% of all those with an intracranial haematoma).     

特殊部位硬膜下血肿的CT诊断

目的 探讨大脑镰,小脑幕硬膜下血肿的CT特点。资料与方法 回顾性分析32例大脑镰,小脑幕硬膜下血肿的CT和临床资料。结果 32例中大脑镰硬膜下血肿20例,CT表现为内缘平直,外缘弧形或波浪形的带状高密度影;小脑幕硬膜下血肿12例,CT表现为高密度片状影3例,新月状影3例,U形影2例,累及大脑镰后部4例,呈Y形或镰刀状。结论 大脑镰,小脑幕硬膜下血肿的CT表现具有特征性,CT复查对其诊断和鉴别诊断很有意义。     

Emission tomography: its contribution in the detection of subdural haematoma

The technique of emission computed tomography (ECT) was assessed with regards to its value in the detection of subdural haematoma. Results from an anthropomorphic head phantom and a short clinical trial both showed promising signs of better differentiation between normal and abnormal in equivocal results. A simple quantitative index was used to compare ECT with static imaging. The conclusion is that ECT is of value in those patients whose scan results are otherwise equivocal.     

Chronic subdural haematoma, an unusual injury from playing basketball

Although the literature records instances of acute epidural haematoma and acute subdural haematoma related to playing basketball, there has not been a report of chronic subdural haematoma as a basketball injury. With the burgeoning interest in this sport in the United Kingdom and Europe, the possibility of this particular neurotrauma increases. Such an injury, along with the diagnosis and management of this often insidious lesion, is documented in this case report.


     

Calcified convexity dura mater and acute epidural haematoma mimicking calcified chronic subdural haematoma

We report a patient with calcification of the convexity dura mater and an acute epidural haematoma. CT revealed a calcified layer between the haematoma and brain parenchyma, which mimicked acute bleeding into a calcified chronic subdural haematoma. The appearance of a calcified haematoma does not always mean a chronic lesion, and that emergency operation should not be foregone, when there is a history of acute head trauma and progressive impairment of consciousness.     

Dual-Energy CT in Enhancing Subdural Effusions that Masquerade as Subdural Hematomas: Diagnosis with Virtual High-Monochromatic (190-keV) Images

BACKGROUND AND PURPOSE:Extravasation of iodinated contrast into subdural space following contrast-enhanced radiographic studies results in hyperdense subdural effusions, which can be mistaken as acute subdural hematomas on follow-up noncontrast head CTs. Our aim was to identify the factors associated with contrast-enhancing subdural effusion, characterize diffusion and washout kinetics of iodine in enhancing subdural effusion, and assess the utility of dual-energy CT in differentiating enhancing subdural effusion from subdural hematoma.MATERIALS AND METHODS:We retrospectively analyzed follow-up head dual-energy CT studies in 423 patients with polytrauma who had undergone contrast-enhanced whole-body CT. Twenty-four patients with enhancing subdural effusion composed the study group, and 24 randomly selected patients with subdural hematoma were enrolled in the comparison group. Postprocessing with syngo.via was performed to determine the diffusion and washout kinetics of iodine. The sensitivity and specificity of dual-energy CT for the diagnosis of enhancing subdural effusion were determined with 120-kV, virtual monochromatic energy (190-keV) and virtual noncontrast images.RESULTS:Patients with enhancing subdural effusion were significantly older (mean, 69 years; 95% CI, 60–78 years; P < .001) and had a higher incidence of intracranial hemorrhage (P = .001). Peak iodine concentration in enhancing subdural effusions was reached within the first 8 hours of contrast administration with a mean of 0.98 mg/mL (95% CI, 0.81–1.13 mg/mL), and complete washout was achieved at 38 hours. For the presence of a hyperdense subdural collection on 120-kV images with a loss of hyperattenuation on 190-keV and virtual noncontrast images, when considered as a true-positive for enhancing subdural effusion, the sensitivity was 100% (95% CI, 85.75%–100%) and the specificity was 91.67% (95% CI, 73%–99%).CONCLUSIONS:Dual-energy CT has a high sensitivity and specificity in differentiating enhancing subdural effusion from subdural hematoma. Hence, dual-energy CT has a potential to obviate follow-up studies.

Diffusion of contrast material into the subdural space following intravascular contrast administration can result in hyperdense enhancing subdural effusions (ESDEs) on follow-up noncontrast head CTs.^1,2 These effusions can be mistaken for subdural hematomas (SDHs).^1,2 Three case reports have previously described ESDEs, all following intra-arterial contrast administration during conventional angiography with resolution documented on short-term follow-up CT examinations.^1,2We have frequently observed ESDEs in our busy level 1 trauma center, where patients usually undergo admission contrast-enhanced whole-body CT followed by serial noncontrast head CTs for documented or suspected traumatic brain injury. Because ESDEs can be mistaken for SDHs, lack of awareness of this entity can potentially result in needless delays in instituting thromboprophylaxis and trigger unnecessary follow-up CT studies. Patients with polytrauma usually require thromboprophylaxis to prevent deep vein thrombosis. A number of authors have posited a mandatory 24- to 72-hour period of documented stability of intracranial bleeds before beginning thromboprophylaxis.^3–6 Hence, early discrimination of SDHs from ESDEs has important clinical implications.On single-energy CT (SECT), the hyperattenuation caused by hemorrhage and contrast medium is difficult to distinguish due to overlapping Hounsfield units (HU).^1,2,7,8 Present recommendations for differentiating SDH from ESDE involve serial follow-up imaging.^1,2 ESDEs shows rapid washout of contrast, hence decreasing hyperattenuation, while SDH retains hyperattenuation from blood for 2–3 weeks.^1,2,9 Dual-energy CT (DECT) can potentially obviate follow-up scans by differentiating iodine from hemorrhage.^7,10,11 Iodine overlay maps and virtual noncontrast (VNC) images can discriminate contrast and hemorrhage with a high degree of accuracy.¹¹ If VNC images can be used to reliably identify hematoma, even in the presence of iodine, differentiation between ESDEs and SDHs can be a simple and straightforward task. The utility of DECT in diagnosing ESDE was recently demonstrated in a case in which a subdural hyperdense collection that developed after endovascular treatment of an intracranial aneurysm was hyperdense on iodine-overlay images and hypodense on VNC images.¹² This evidence suggests that DECT may play a vital role in providing an early definitive diagnosis without the need for follow-up CT studies to document resolution of ESDEs.The purpose of this study was to identify the factors associated with ESDE, characterize the diffusion and washout kinetics of iodine in ESDE, and assess the utility of DECT in differentiating ESDE from SDH.