Chronic Subdural Hematoma With Vasogenic Edema in the Cerebral Hemisphere. Case Report.

Abstract

An 80-year-old male with a history of hypertension presented with chronic subdural hematoma manifesting as progressive consciousness disturbance and left hemiparesis. T 1 -weighted and fluid attenuation inversion recovery (FLAIR) magnetic resonance imaging showed a fresh hematoma in the right subdural space with a midline shift of 15 mm. FLAIR and diffusion-weighted imaging showed a hyperintense area in the right paraventricular white matter compressed by the hematoma. Apparent diffusion coefficients (ADCs) corresponding to the hyperintense area in the central area of the affected cerebral hemisphere on FLAIR images were measured before and one month after the operation. The motion probing gradient was applied in the right-left direction to the body axis. Since the central area in the cerebrum includes nerve fibers perpendicular to the direction of the gradient, the measured ADC appeared to be anisotropic. Preoperative ADC in the right paraventricular white matter was anisotropic and greater than in age-matched normal subjects, so the edema was identified as the vasogenic type. The edema in the right paraventricular white matter resolved promptly with improvement of the midline shift and normalization of the ADC.

Diabetic ketoacidosis (DKA) induced cerebral edema complicating small chronic subdural hematoma/hygroma/ at Zewuditu memorial hospital: a case report

“…While it is established fact that both diabetic ketoacidosis and CSDH &/subdural hygroma/ can cause tight brain /cerebral edema/ alone, the mechanism how cerebral edema occurs is different. That is, the direct mass effect of the CSDH &/subdural hygroma/ & indirect mass effect from vasogenic edema tend to compress the adjacent sulci, ventricles & basal cisterns and causes cerebral edema if the thickness is significant and it appears to result a proportionate level of brain tightness for the amount of CSDH in majority of cases [ 2 ]; while cytotoxic & vasogenic brain edema mechanisms from direct metabolic effects of DKA, water re-distribution effect of DKA & treatment related changes seen in DKA (see Fig. 1 ) are responsible for cerebral edema from DKA [ 3 – 6 ].…”

Subdural Hyperintense Band on Diffusion-Weighted Imaging of Chronic Subdural Hematoma Indicates Bleeding From the Outer Membrane

“…2,14,19,22) We recently confirmed that diffusion-weighted imaging showed solid clots as high intensity areas in patients with traumatic subacute subdural hematoma 10) and organized subdural hematoma, 11) and measurement of the apparent diffusion coefficient (ADC) values was useful for differentiating solid from liquid components. 11) However, the diffusionweighted imaging appearance of chronic subdural hematomas has been rarely reported, 9) and the potential of diffusion-weighted imaging for the evaluation of chronic subdural hematoma has not yet been established.…”