Spinal subdural hematoma

 We report the case of a 68-year-old patient with a traumatic spinal subdural hematoma. MRI demonstrated an area of abnormal intensity and a black line in the inner part of the intradural space. We anti-cipate that MRI will help to make one more confident in the preoper-ative diagnosis of spinal subdural hematoma. The symptoms complet-ely disappeared immediately after the operation. Spinal subdural he-matoma requires immediate surgical evacuation. The prognosis for func-tional recovery is good if the condi-tion is appropriately diagnosed and treated before development of irre-versible paralysis. We recom-mend MRI to make an early diagnos-is and early evacuation of spinal subdural hematoma.     

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.     

58例去骨瓣减压术后外伤性硬膜下积液的治疗

对58例去骨瓣减压术后并发外伤性硬膜下积液(TSH)患者,采取弹力绷带加压包扎结合腰椎穿刺+硬膜下积液穿刺抽吸,取得了较理想的效果.     

Spinal subdural metastasis A case report

Summary A case of metastasis to the thoracic spinal subdural space is reported. Metrizamide myelography showed narrowing of the upper thoracic subarachnoid space. A tumor in the spinal subdural space is unusual; only a few cases have been reported. The myelographic appearance is not specific; an epidural metastasis can produce the same myelographic picture.     

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.     

Gadolinium enhancement of spinal subdural collection on magnetic resonance imaging after lumbar puncture

We report a 35-year-old male with an unusual contrast-enhancing sterile spinal subdural collection on magnetic resonance imaging (MRI), apparently occurring as a complication of lumbar puncture. Follow-up MRI after 4 weeks demonstrated spontaneous resolution of the collection without intervening treatment.     

Giant cervical epidural veins after craniectomy for head trauma.

Markedly dilated cervical epidural veins and right upper extremity weakness developed in a 43-year-old man 4 months after contralateral craniectomy for head trauma. After cranioplasty, his symptoms improved markedly and the size of the veins returned to normal. These findings suggest that enlarged cervical epidural veins may occur without an underlying vascular lesion and that upper extremity weakness may occasionally be attributable to spinal cord venous stasis.     

改良大骨瓣开颅个体化外减压术治疗重型颅脑损伤伴急性硬膜下血肿

目的 分析改良大骨瓣开颅个体化减压术对重型颅脑损伤伴急性硬膜下血肿治疗效果和手术方法. 方法 回顾性分析2007年7月-2010年6月采用改良大骨瓣开颅个体化减压术治疗重型颅脑损伤伴急性硬膜下血肿患者81例(治疗组)与2004年7月-2007年6月采用标准外伤大骨瓣减压治疗同样的患者65例(对照组)的治疗效果. 结果 伤后6个月GOS评估法判定其疗效:治疗组良好(5分)21例,中残(4分)19例,重残(3分)24例,植物生存(2分)5例,死亡(1分)12例(P＜0.01),预后较好(良好/中残)占49%(P＜0.05),预后较差或差(重残/植物生存/死亡)占51%;对照组良好(5分)12例,中残(4分)9例,重残(3分)22例,植物生存(2分)3例,死亡(1分)19例,预后较好占32%,预后较差占68%.治疗组并发术后颅内血肿、硬膜下积液明显少于对照组(P＜0.05).结论 改良大骨瓣开颅个体化减压术治疗重型颅脑损伤伴急性硬膜下血肿有较好疗效,能有效降低大骨瓣减压术后并发症的发生.     

虐待性头部外伤硬脊膜下出血:回顾性研究

目的比较虐待性头部外伤患儿与意外创伤患儿硬脊膜下出血的相对发病率、分布及影像学特征。方法本研究得到了人类受试者保护办公室的事先批准。免除了知情同意。符合HIPAA要求。通过病例回顾收集到1997年—2009年间在     

Diffuse dural gadolinium MRI enhancement associated with bilateral chronic subdural hematomas

Chronic subdural hematomas (CSDHs) typically present with cognitive dysfunction and a history of trauma. Localized dural enhancement on postcontrast MRI scans associated with the surrounding membrane has been described in CSDH. We present an 83-year-old man with rapidly progressing cognitive dysfunction 4 weeks after head trauma related to a fall. MRI showed CSDHs, which in addition to localized dural gadolinium enhancement, showed a marked diffuse, symmetric, contiguous pachymeningeal enhancement of the supratentorial and infratentorial intracranial dural mater. Meningeal biopsy failed to disclose an infectious or neoplastic cause of the enhancement and instead showed fibrocollagenous change. We conclude that diffuse dural enhancement on MRI scans associated with CSDH cause does not necessarily indicate a superimposed process such as infection or malignancy. CSDH should be considered in the differential diagnosis of diffuse dural enhancement, especially when supported by appropriate clinical findings.     

Chronic subdural haematoma after snowboard head injury

Two cases of chronic subdural haematoma following a snowboard head injury are reported. Although such cases are rare in sport, the risk in snowboarders is higher than expected. Evaluation of a snowboarder with a history of head injury, albeit mild, who complains of headaches should include computed tomography or magnetic resonance imaging to allow rapid identification of any intracranial pathology.     

Spinal neuroarthropathy after traumatic paraplegia

Spinal neuroarthropathy is a little-known complication of traumatic paraplegia. Four cases of this syndrome are described, with emphasis on the characteristic radiographic findings of severe juxta-articular bone destruction, dense appositional new bone formation, large osteophytosis, and soft-tissue bony debris. The factors predisposing patients to develop a neuropathic joint are diminished pain and proprioceptive sensations with maintained mobility. When a paraplegic patient transfers in or out of a wheelchair or moves his upper torso, he exerts force on an insensate spine. Repeated trauma increases joint mobility beyond the normal limits, and this leads to further damage, with the process culminating in severe instability and bone destruction. The other causes of neuropathic joints in the spine--tertiary syphilis, syringomyelia, and diabetes--must be ruled out on clinical grounds. Neuropathic changes in the spine are often silent, delaying treatment, or may be mistaken for infection or degenerative disease. Their true prevalence is difficult to determine, but the possibility should be considered in paraplegic patients with the characteristic radiographic findings.     

The suboccipital carrefour: cervical and vertebral arterial anastomosis.

PURPOSEOur objective was to anatomically define the anastomoses between cervical and carotid arterial distributions (the carrefour) in the rabbit and to assess the contribution of these collaterals to cortical blood flow (CBF) during cerebral ischemia.METHODSAngiography was carried out in six rabbits with basilar artery occlusion using selective contrast injection into the right subclavian, external carotid, and internal carotid arteries. Anastomoses were corroborated with methacrylate vascular casts prepared in five additional rabbits. CBF was measured in eight rabbits by H2 clearance after basilar artery occlusion and again after bilateral common carotid artery occlusion. Cortical DC potential was measured during ischemia in these rabbits and in another 19 rabbits after additional occlusion of the cervical collateral arteries.RESULTSA network of anastomoses between superficial and ascending cervical, superior intercostal, vertebral, and occipital arteries was found by angiography and corrosion casts. Additional communications in the ophthalmic, ethmoidal, and cerebellar arterial distributions are described. These pathways were found to supply a mean of 15 +/- 7 mL/100 g per minute residual CBF during three-vessel ischemia, or 24% of the preischemic CBF. Ischemic depolarization of DC potential occurred in seven of the eight rabbits with collateral CBF at a mean latency of 2.64 +/- 0.59 minutes and at 1.71 +/- 0.09 minutes in those without.CONCLUSIONThe suboccipital collateral network of the rabbit resembles that of humans and can contribute significantly to CBF during ischemia. The results suggest that this model may be useful for evaluating methods of optimizing hemodynamic control of the anastomoses in situations such as those encountered during endovascular therapy.     

Reversal of abnormal ischemic vascular enhancement after intracerebral angioplasty.

We describe ischemia-related cerebral vascular enhancement on contrast-enhanced MR images that resolved after correction of a flow-limiting lesion. A brief literature review, highlighting some of the original work in this area, is included.