Acute spinal epidural and subdural hematomas

Acute spinal epidural and subdural hematomas are rare entities. The clinical presentation is similar in both cases. MR imaging is the most appropriate imaging technique. On axial images, epidural hematoma has a biconvex shape. It is separated from the spinal cord by the hypointense dura on T2-weighted images. Conversely, subdural hematoma has a crescentic shape on axial images and is located medially to the dura. In the latter case, the epidural fat is not involved. There is no surgical indication for patients with early and rapid regressive symptoms. In other cases the surgical treatment consists of hematoma evacuation.     

Hyperacute spinal subdural haematoma as a complication of lumbar spinal anaesthesia: MRI

We report two cases of hyperacute spinal subdural haematoma secondary to lumbar spinal anaesthesia, identified with MRI. Prompt diagnosis of this infrequent, potentially serious complication of spinal anaesthesia is essential, as early surgical evacuation may be needed. Suggestive MRI findings in this early phase include diffuse occupation filling of the spinal canal with poor delineation of the spinal cord on T1-weighted images, and a poorly-defined high-signal lesion with a low-signal rim on T2-weighted images. Received: 10 November 1998 Accepted: 6 April 1999     

Spontaneous spinal subdural hematoma: MRI findings in two cases

Spontaneous spinal subdural hematoma is an uncommon finding. This report of two cases of spinal subdural hematoma (one hyperacute and one subacute) discusses the current theory of how it develops, the MRI findings, its differentiation from spinal epidural hematoma, and the value of MRI in monitoring patients undergoing conservative treatment. The most significant MRI findings in the hyperacute phase were isointense signal on T1-weighted sequences and hyperintense signal on T2-weighted sequences. Moreover, T2-weighted gradient-echo sequences showed a hypointense peripheral ring. In the subacute phase, a hyperintense signal was seen on T1-, T1-fat-suppression, and T2-weighted sequences.     

Uncommon magnetic resonance imaging observation of lumbar subdural hematoma with cranial origin

A patient with a history of pain, paresthesias, and weakness in both legs is reported. Magnetic resonance imaging (MRI) of the lumbar spine demonstrated subacute subdural hematoma. Brain MRI obtained 1 day later because of progressive headache showed hemorrhagic cortical metastasis and extensive subdural hematoma. It is hypothesized that the lumbar hematoma originated from the intracranial bleeding, which was substantiated by the observation of a thin hemorrhagic collection connecting cranial and lumbar hematomas on MRI. Cranial origin should be included in the differential diagnosis of spontaneous spinal subdural hematomas.     

Post-traumatic spinal hematoma in ankylosing spondylitis

Emergency Radiology - The purpose of this study is to examine the incidence, location, and magnetic resonance imaging (MRI) features of spinal epidural hematoma (SEH) and spinal subdural hematoma...     

自发性脊髓硬膜外血肿的MRI诊断(附4例报告)

目的：对自发性脊髓硬膜外血肿（ＳＳＥＨ）的ＭＲ和临床表现进行评价。材料与方法：本组包括１９９６年至１９９８年的３例ＳＳＥＨ患者,男３例,女１例,年龄３３～６１岁。４例患者均无外伤、血管损伤或凝血机制障碍等病史。均作ＭＲＩ检查并有手术病理证实。结果：在ＭＲ图像上,血肿分别位于硬膜外腔的左后、右后及正后方。其中１例为ＡＶＭ导致的有包膜的血肿,另１例的局部有椎间盘突出。Ｔ１加权能特征性地反映血肿随时间发生的信号变化而最有价值;１．５Ｔ高场强和轴位梯度回波的Ｔ２加权能很好地判断血肿的位置。结论：自发性脊髓硬膜外血肿是一少见病,ＭＲＩ是它的首选检查方法。应当注意的是,要获得理想的临床疗效,就必须做到诊断精确,并及时地手术治疗,解除脊髓压迫。     

Subdural hematoma in the setting of internal carotid artery occlusion: CT studies

A 72-year-old woman with previously symptomatic internal carotid artery occlusion subsequently presented with an acute hemispheric deficit. The patient was initially diagnosed as having an ischemic infarction but eventually was shown to have a subacute subdural hematoma with delay in surgical evacuation and a major permanent deficit. We speculate that internal carotid artery occlusion may predispose the patient to greater morbidity from subdural hematoma. Patchy hemispheric infarction may reflect greater vulnerability to extrinsic hemispheric compression in the setting of carotid occlusion. This case illustrates the necessity for vigorous pursuit of the diagnosis of subdural hematoma in patients presumed to have transient ischemic attacks or acute cerebral infarction.     

Delayed epidural hematoma after evacuation of a subdural hematoma

CT easily diagnoses epidural hematomas. The appearance of an epidural hematoma may be delayed by compression from a contralateral lesion. The possibility of a delayed epidural hematoma should be kept in mind in the presence of additional findings such as a skull fracture contralateral to the original lesion or decompression of the epidural hematoma into either the subgaleal or the subarachnoid space. We present a case in which an epidural hematoma declared itself after the evacuation of a contralateral subdural hematoma.     

急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像诊断

目的探讨急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像特征。方法回顾性分析17例急性大脑镰和小脑幕硬膜下血肿的CT及磁共振成像表现。结果 17例急性大脑镰和小脑幕硬膜下血肿中,大脑镰硬膜下血肿5例,小脑幕硬膜下血肿7例,大脑镰并小脑幕硬膜下血肿5例,6例伴有颅盖骨(大脑凸面)部位的硬膜下血肿或脑实质挫裂伤。结论急性大脑镰和小脑幕硬膜下血肿较少见,易误诊为蛛网膜下腔出血、大脑镰钙化,CT和磁共振成像征象具特征性,有助于鉴别。     

Spinales chronisches subdurales Hämatom

Compared with spinal epidural hematomas, spinal subdural hematomas are rare; chronic forms are even more uncommon. These hematomas are associated not only with lumbar puncture and spinal trauma, but also with coagulopathies, vascular malformations and tumors. Compression of the spinal cord and the cauda equina means that the patients develop increasing back or radicular pain, followed by paraparesis and bladder and bowel paralysis, so that in most cases surgical decompression is carried out. On magnetic resonance imaging these hematomas present as thoracic or lumbar subdural masses, their signal intensity varying with the age of the hematoma. We report the clinical course and the findings revealed by imaging that led to the diagnosis in three cases of chronic spinal subdural hematoma.     

A rare combination of complications of ruptured carotid artery aneurysm: A case report.

The giant aneurysm of the subclinoid portion of the internal carotid artery is a relatively rare disease that can present serious complications. We present the case of a 40-year-old guy who was suffering from a headache and had complete ophthalmoplegia in his right eye. A brain scan shows a right temporal subdural hematoma, associated with subarachnoid hemorrhage, and total Sylvian subacute ischemic stroke. CT angiography and MRI showed a ruptured and partially thrombosed aneurysm of the subclinoid portion of the right internal carotid artery complicated by subarachnoid hemorrhage, a right subdural temporal hematoma, and total Sylvian ischemic stroke. Our purpose is to recognize the possibility of an aneurysmal rupture when evaluating an acute subdural hematoma, alone or in combination with Ischemic stroke.     

Subdural enhancement on postoperative spinal MRI after resection of posterior cranial fossa tumours

In malignant brain tumours which may disseminate staging, usually by cranial and spinal MRI is necessary. If MRI is performed in the postoperative period pitfalls should be considered. Nonspecific subdural contrast enhancement on spinal staging MRI is rarely reported after resection of posterior fossa tumours, which may be mistaken for dissemination of malignancy. We investigated the frequency of spinal subdural enhancement after posterior cranial fossa neurosurgery in children. We reviewed 53 postoperative spinal MRI studies performed for staging of paediatric malignant brain tumours, mainly infratentorial primitive neuroectodermal tumours 2–40 days after surgery. There was contrast enhancement in the spinal subdural space in seven cases. This was not seen in any of eight patients who had been operated upon for a supratentorial tumour. After resection of 45 posterior cranial fossa tumours the frequency of subdural enhancement was 15.5%. MRI showing subdural enhancement was obtained up to 25 days postoperatively. No patient with subdural enhancement had cerebrospinal fluid (CSF) examinations positive for tumour cells or developed dissemination of disease in the CSF. Because the characteristic appearances of subdural contrast enhancement, appropriate interpretation is possible; diagnosis of neoplastic meningitis should rarely be impeded. Because of the striking similarity to that in patients with a low CSF-pressure syndrome and in view of the fact that only resection of tumours of the posterior cranial fossa, usually associated with obstructive hydrocephalus, was followed by this type of enhancement one might suggest that rapid changes in CSF pressure are implicated, rather the effects of blood introduced into the spinal canal at surgery.     

脊髓血管畸形的MRI诊断价值

目的 评价MRI对脊髓血管畸形的诊断价值。资料与方法 24例临床诊断为脊髓占位的患者行MR平扫、增强、3D-CISS和三维增强磁共振血管成像(3D-CE-MRA)。结果 24例中23例可显示畸形血管：髓内3例，髓外16例，髓内外4例。对供血动脉、引流静脉的显示MR平扫不及3D-CE-MRA。1例MRI显示硬膜下血肿，未见畸形血管。结论 MR平扫是脊髓血管畸形最敏感的首选检查方法，3D-CE-MRA有助于脊髓畸形血管的显示。     

MRI findings in spinal subdural and epidural hematomas

BACKGROUND: Spinal hematomas are rare entities that can be the cause of an acute spinal cord compression syndrome. Therefore, an early diagnosis is of great importance. PATIENTS AND METHODS: From 2001 to 2005 seven patients with intense back pain and/or acute progressive neurological deficit were studied via 1.5 T MRI (in axial and sagittal T1- and T2-weighted sequences). Follow-up MRI was obtained in six patients. RESULTS: Four patients showed the MRI features of a hyperacute spinal hematoma (two spinal subdural hematoma [SSH] and two spinal epidural hematoma [SEH]), isointense to the spinal cord on T1- and hyperintense on T2-weighted sequences. One patient had an early subacute SEH manifest as heterogeneous signal intensity with areas of high signal intensity on T1- and T2-weighted images. Another patient had a late subacute SSH with high signal intensity on T1- and T2-weighted sequences. The final patient had a SEH in the late chronic phase being hypointense on T1- and T2-weighted sequences. DISCUSSION: MRI is valuable in diagnosing the presence, location and extent of spinal hematomas. Hyperacute spinal hematoma and the differentiation between SSH and SEH are particular diagnostic challenges. In addition, MRI is an important tool in the follow-up in patients with conservative treatment.     

Middle fossa arachnoid cyst and subdural hematoma: CT studies

A patient with a history of previous head injury presented with an isodense subdural hematoma with extension into a preexisting middle fossa arachnoid cyst. The latter, suspected on the basis of findings pointing to chronic expansion of the middle fossa, was confirmed in a repeat CT study carried out after evacuation of the hematoma.     

Relapsing juvenile chronic subdural hematoma in adult life.

Two cases of relapsing juvenile chronic subdural hematoma with late relapse in adult life are presented and the literature reviewed. Both patients contracted subdural hematoma early in life; its persistence resulted in characteristic skull deformitites. The patients led an asymptomatic life until a second head trauma caused rebleeding into the old hematoma sac with recurring symptoms and signs. The source of rebleeding is the outer subdural membrane. Radiographic features vary, depending on the location and size of the subdural hematoma. The significance of localized thickening of the cranium is stressed in refining the differential diagnosis.     

椎管内血肿的影像学表现

目的探讨椎管内血肿的CT及MRI表现特点,提高椎管内血肿CT及MRI表现的认识。方法回顾分析18例经手术及临床治疗随访复查证实的椎管内血肿的CT及MRI表现。18例患者均常规CT、MR平扫,其中2例MR增强扫描。使用GE公司Lightspeed16CT扫描仪,及Phillip1．5TAcheive超导MR扫描仪,2例MR增强扫描采用钆喷酸葡甲胺（Gd—DTPA）对比剂经静脉团注,注射剂0．1mmol/kg。结果颈胸段3例,胸段5例,胸腰段6例,腰段4例;位于脊髓背侧方14例,脊髓两侧2例、腹侧2例。硬膜外血肿11例,硬膜下血肿6例,硬膜外血肿并蛛网膜下腔内积血1例。CT表现为高密度或等密度,MRI分别呈长T1长T2信号、长T-短Tz信号、等T1短T2信号及短T1长T2信号,其中2例MR增强扫描,1例边缘强化,1例未见强化。结论椎管内血肿的CT、MRI表现具有一定的特征性,对其定性定位诊断及鉴别诊断有着重要的价值。     

婴幼儿急性创伤性硬膜下血肿

目的 探讨婴幼儿急性创伤性硬膜下血肿临床特点及治疗方法.方法 回顾分析2002-2008年期间收治的年龄＜3岁的48例婴幼儿急性创伤性硬膜下血肿的临床特点.结果 婴儿31例,占65%;跌伤37例,占77%;12例(25%)有原发意识障碍,8例(17%)出现抽搐,8例(17%)合并颅骨骨折.18例行开颅血肿清除术(13例入院立即手术),7例行钻孔外引流,23例行保守治疗.1例因脑疝死亡,2例伴肢体运动功能减退,45例治愈.结论 婴幼儿急性创伤性硬膜下血肿发病率较高,尤其是婴儿,早期易被忽视,易转变为慢性硬膜下血肿或积液,早期诊断、积极外科治疗,预后良好.     

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.     

有占位效应的重型颅脑损伤术后再次手术去骨瓣减压41例分析

目的总结重型颅脑损伤患者因占位性损伤术后再次手术去骨瓣减压的治疗经验。方法回顾性调查2008年1月～2014年10月在四川大学华西医院住院的重型颅脑损伤患者病历,筛查第一次手术清除脑挫裂伤或硬膜下血肿等占位性损伤术后保留骨瓣但再次手术去骨瓣减压的患者,分析再次手术去骨瓣减压原因。结果 41例术后再次手术去骨瓣减压,其中术后局部脑水肿和进展性出血34例,术区新发血肿6例,远隔部位血肿1例。结论有占位效应的重型颅脑损伤患者术后有14.4%的患者再次手术去骨瓣减压,对大多数没有术中脑膨出的患者保留骨瓣是安全的,但对于硬膜下血肿伴脑挫裂伤、伤后早期低血压和初始颅内压35mm Hg的患者可能需要去骨瓣减压。