Characteristics of symptomatic chronic subdural haematomas on high-field MRI

We studied the frequency of various features of the appearances on high-field MRI in symptomatic patients with chronic subdural haematomas (CSDH). The ability to predict recurrence after treatment with one burr-hole procedure using MRI was evaluated. A total of 40 patients with symptomatic CSDH underwent MRI at 1.5 T. All haematomas were evacuated within a few days of the MRI examination. Symptomatic CSDH were divided into five groups according to the MRI findings: group A (11 cases), isointense or low signal on T1- and low signal on T2-weighted images; group B (18 cases), high signal on T1- and low signal on T2-weighted images; group C (5 cases), high signal on both T1- and T2-weighting; group D (1 case), low signal on T1- and high signal on T2-weighted images; group E (5 cases), heterogeneous intensity on T1- and T2-weighting throughout the haematoma cavity. The mean interval between onset of symptoms and MRI for group A was 5.0 ± 4.1 days, which was significantly shorter than that for group B (9.4 ± 4.4 days, P < 0.02), group C (27.8 ± 20 days, P < 0.005) or group E (17.8 ± 12.2 days, P < 0.01). Recurrence was seen in three haematomas of group A and one of group B. Reoperation was most closely correlated with diffuse low signal on T2-weighted images but not with a multiloculated appearance. Low signal on T2 weighting was surprisingly high (72.5 %) and the age of the haematomas as estimated on the MRI correlated well with the interval between the onset of symptoms and MRI. Our findings support the causative role of recurrent bleeding in the enlargement of CSDH. Received: 24 March 1998 Accepted: 15 July 1998     

不同年龄慢性硬膜下血肿的临床特点

目的分析慢性硬膜下血肿（CSDH）患者各不同年龄组之间的临床特点。方法把2000～2009年间诊断为CSDH并经手术治疗的病例116例分成三组：即55岁以下组、55～75岁组和75岁以上组。对患者的一般资料、临床症状、影像学表现、治疗及预后等进行比较分析。结果①75岁以上组较前两组血小板计数数值小（P〈0.01）;②前两组患者与75岁以上组相比,出现头痛/头昏的比率高,出现精神异常/智力障碍及大小便失禁的比率低,后两组出现肢体瘫痪的比率高于55岁以下组（P〈0.01）;③55岁以下组患者头CT扫描以（稍）高或混杂密度和低密度为主,55～75岁组多为等密度,75岁以上多为低密度;55岁以下组患者血肿量要少于后两组（P〈0.05）;④术后绝大多数症状完全或部分缓解（93.10%）;75岁以上组6例（18.75%）效果不佳,其中2例（6.25%）死于心/肺功能衰竭。结论正确认识不同年龄组CSDH的临床特点,有利于提高该病的诊疗水平。     

Bilateral occipital condylar fracture with associated haematomas

Occipital condylar fractures (OCFs) seem to be rare. The exact incidence is unknown, but a few studies reported a 3–4% incidence of OCFs in patients with severe head injury and altered Glasgow Coma Scale score. The low incidence of OCFs and missed diagnoses in these patients may result in late neurological deficits. We report the history of a patient with bilateral OCFs, a combined fracture of the anterior arcus of the atlas and associated retropharyngeal and epidural cervical haematomas, who presented without life-threatening symptoms or neurological deficits.     

Spontaneous bilateral subdural haematomas in the posterior cranial fossa revealed by MRI

A 52-year-old woman treated for acute myeloproliferative disease developed progressive stupor. CT showed obstructive hydrocephalus resulting from unexplained mass effect on the fourth ventricle. MRI revealed bilateral extra-axial collections in the posterior cranial fossa, giving high signal on T1- and T2-weighted images, suggesting subacute subdural haematomas. Subdural haematomas can be suspected on CT when there is unexplained mass effect. MRI may be essential to confirm the diagnosis and plan appropriate treatment.     

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.     

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     

开颅术后顽固性脑膨出脑室-腹腔分流术的时机探讨

探讨开颅术后顽固性脑膨出脑室-腹腔(V-P)分流术时机及手术方式。认为早期V-P分流,对控制顽固性膨出所导致的继发性脑组织的损伤有重要意义。     

Calcified encapsulating peritoneal sclerosis associated with peritoneal dialysis: A case report

Encapsulating peritoneal sclerosis (EPS) is a rare, but sometimes fatal, complication of peritoneal dialysis characterized by diffuse thickening and encapsulation of the bowel and peritoneum. In more advanced cases, the peritoneum will gradually calcify. EPS usually presents as partial small bowel obstruction and diagnosed on imaging studies. We present a case of a 19-year-old female on long-term peritoneal dialysis with EPS and diffuse peritoneal calcifications.     

Spontaneous thrombosis of congenital cerebral arteriovenous malformation complicated by subdural collection: in utero detection with disappearance in infancy

We report a case of congenital left temporal lobe arteriovenous malformation (AVM) detected by cranial ultrasound in utero and confirmed immediately after birth by cranial Doppler ultrasound and cranial MRI. The AVM disappeared on follow-up cranial MRI 4 months later. A small left frontal subdural collection was present on these follow-up MR images, which subsequently resolved by the 7 month MRI study. The cause of the spontaneous thrombosis of the AVM is uncertain. The frontal subdural collection may be secondary to volume loss. This case documents the perinatal presence of AVM. The baby was neurologically intact before, during and after the thrombosis of the AVM.     

Pericerebellar fluid collections in infancy,sequelae of birth injury? A retrospective CT study

Summary Retrospective analysis of axial CT scans from 600 consecutive pediatric patients revealed 37 patients (6%) with abnormal low density pericerebellar spaces. Fourteen of these 37 patients (38%) were diagnosed as cerebellar atrophy, whereas 23 of the 37 patients (62%) were diagnosed as mass-like pericerebellar fluid collections. Detailed analysis of the morphology of these spaces suggests that the CT criteria proposed in this paper distinguish between (a) those low attenuation pericerebellar spaces that represent cisternal dilatation caused by cerebellar atrophy (Group I — Atrophy) and (b) those low attenuation pericerebellar spaces that represent low density mass-like collections of fluid which distort a relatively normal cerebellum (Group II — Collections). Analysis of the medical records of the patients in Group II — Collections reveal a high incidence of prematurity, developmental delay, difficult birth and head trauma, possibly indicating that such collections represent sequelae of birth.     

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.     

Intrahepatic portosystemic venous shunt associated with a large abdominal tumour

Intrahepatic portosystemic venous shunt (IPSVS) is relatively uncommon, and is usually associated with chronic hepatitis or cirrhosis. We present a case of IPSVS that was considered to be caused by increased blood flow from a large abdominal tumour. The characteristic intrahepatic haemodynamics were demonstrated by CT angiography.