Two cases of subdural hematoma associated with dural metastasis are reported. The computed tomographic and angiographic features are presented. The possible pathogenetic mechanism is discussed. Our cases support the idea of obstruction of dural capillaries by neoplastic cells and subsequent subdural bleeding.

Bilateral approximately symmetrical hypodense areas located in the thalamus were encountered in two patients who recovered clinically. Regression of the lesions could be observed on CT. The clinical symptoms corresponded to the thalamic location. Since these two patients recovered, no autopsy material is available to prove the nature of the causative lesion, although the etiology is most probably inflammatory.

While unilateral chronic isodense subdural hematomas as a result of indirect signs of a space-occupying lesion are easily recognizable on computed tomography (CT) and clearly diagnosed on the angiogram, bilateral chronic isodense subdural hematomas may cause considerable difficulty. In two cases with CT false negative findings we observed, retrospectively, significant small cellae mediae and also the main part of the anterior horns sharply pointed and approaching one another. Three further cases showed the same ventricular configuration, which we called "hare's ears sign". This sign together with clinical data is always suspicious of chronic bilateral isodense subdural hematomas and carotid angiography is indicated. Other possible signs are: subtle midline shift if the size of the hematoma varies, changed formation of density of brain tissue, non-appearance of cerebral sulci especially in elderly patients, and eventually the visualization of a membrane after intrevenous injection of contrast material.

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Apesar do desenvolvimento de novas medidas diagnosticas e terapêuticas, a mortalidade após um traumatismo crânio-encefálico severo continua alta. Vários fatores contribuem para essa alta mortalidade. O rápido reconhecimento e pronto tratamento de complicações como hematomas intracranianos, está diretamente relacionado com o prognóstico desses pacientes. Hemorragia intracerebral traumática de aparecimento tardio foi inicialmente descrita em 1891 4 . O advento da tomografia axial computorizada (CT-scan) facilitou o diagnóstico e o acompanhamento evolutivo desses casos.Recentemente tivemos a oportunidade de observar cinco pacientes que apresentaram hemorragia intracerebral algum tempo após um traumatismo crânio-encefálico.

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