Hypodense bubbles in acute extradural haematomas following venous sinus tear

Chee, C. P.; Habib, Zeina

doi:10.1007/bf00588255

Cited by 16 publications

(5 citation statements)

References 13 publications

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“…13,14 Mixeddensity hematoma has been observed in patients with epidural hemorrhage and is reported to correlate with active bleeding. 15 The hypointense area encapsulated within the hyperintense hematoma is termed the swirl sign and is found in a significant proportion of patients with epidural hematomas.…”

Section: Discussionmentioning

confidence: 99%

Blend Sign on Computed Tomography

Zhang

Huang

et al. 2015

Stroke

246

115

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Background and Purpose-Early hematoma growth is not uncommon in patients with intracerebral hemorrhage and is an independent predictor of poor functional outcome. The purpose of our study was to report and validate the use of our newly identified computed tomographic (CT) blend sign in predicting early hematoma growth. Methods-Patients with intracerebral hemorrhage who underwent baseline CT scan within 6 hours after onset of symptoms were included. The follow-up CT scan was performed within 24 hours after the baseline CT scan. Significant hematoma growth was defined as an increase in hematoma volume of >33% or an absolute increase of hematoma volume of >12.5 mL. The blend sign on admission nonenhanced CT was defined as blending of hypoattenuating area and hyperattenuating region with a well-defined margin. Univariate and multivariable logistic regression analyses were performed to assess the relationship between the presence of the blend sign on nonenhanced admission CT and early hematoma growth. Results-A total of 172 patients were included in our study. Blend sign was observed in 29 of 172 (16.9%) patients with intracerebral hemorrhage on baseline nonenhanced CT scan. Of the 61 patients with hematoma growth, 24 (39.3%) had blend sign on admission CT scan. Interobserver agreement for identifying blend sign was excellent between the 2 readers (κ=0.957). The multivariate logistic regression analysis demonstrated that the time to baseline CT scan, initial hematoma volume, and presence of blend sign on baseline CT scan to be independent predictors of early hematoma growth. The sensitivity, specificity, positive and negative predictive values of blend sign for predicting hematoma growth were 39.3%, 95.5%, 82.7%, and 74.1%, respectively. Conclusions-The CT blend sign could be easily identified on regular nonenhanced CT and is highly specific for predicting hematoma growth.

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Section: Discussionmentioning

confidence: 99%

Blend Sign on Computed Tomography

Zhang

Huang

et al. 2015

Stroke

246

115

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“…Several studies have reported the association of hematoma heterogeneity with acute hematoma growth. In the 1980s, hematoma heterogeneity was observed in patients with traumatic epidural hemorrhage 28,29 , and the mixed density of hematomas has been reported to correlate with active bleeding, which has been validated during the surgical exploration of patients with epidural hemorrhage 30,31 . Of note, similar to the multihematoma fuzzy sign, fukamachi A, et al described a characteristic salt and pepper or flecked patthern of mixed area of hypodensity and hyperdensity, which usually indicates delayed intracranial hematoma after head injury 32 .…”

Section: Discussionmentioning

confidence: 96%

Development and external validation of a novel multihematoma fuzzy sign on computed tomography for predicting traumatic intraparenchymal hematoma expansion

Sheng

Yang

Cai

et al. 2021

Sci Rep

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Acute traumatic intraparenchymal hematoma (tICH) expansion is a devastating neurological complication that is associated with poor outcome after cerebral contusion. This study aimed to develop and validate a novel noncontrast computed tomography (CT) (NCCT) multihematoma fuzzy sign to predict acute tICH expansion. In this multicenter, prospective cohort study, multihematoma fuzzy signs on baseline CT were found in 212 (43.89%) of total 482 patients. Patients with the multihematoma fuzzy sign had a higher frequency of tICH expansion than those without (90.79% (138) vs. 46.71% (71)). The presence of multihematoma fuzzy sign was associated with increased risk for acute tICH expansion in entire cohort (odds ratio [OR]: 16.15; 95% confidence interval (CI) 8.85–29.47; P < 0.001) and in the cohort after propensity-score matching (OR: 9.37; 95% CI 4.52–19.43; P < 0.001). Receiver operating characteristic analysis indicated a better discriminative ability of the presence of multihematoma fuzzy sign for acute tICH expansion (AUC = 0.79; 95% CI 0.76–0.83), as was also observed in an external validation cohort (AUC = 0.76; 95% CI 0.67–0.84). The novel NCCT marker of multihematoma fuzzy sign could be easily identified on baseline CT and is an easy-to-use predictive tool for tICH expansion in the early stage of cerebral contusion.

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“… 4 11) Other unusual preoperative CT findings indicate possible venous bleeding including bilateral EDHs, 7) and hypodense lesions within hematoma. 5) …”

Section: Discussionmentioning

confidence: 99%

Endovascular Treatment Following Gauze Packing for the Control of Massive Bleeding from Traumatic Transverse Sinus Lesion

Kim

et al. 2018

Korean J Neurotrauma

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Posterior fossa epidural hematoma (EDH) is uncommon, but the related clinical deterioration can occur suddenly. Accompanying venous sinus injury and lacerations are associated with 40% to 80% mortality. The authors present one clinical case of a patient with posterior fossa EDH from transverse sinus bleeding. A 57-year-old male was injured after falling while working. He was taken to the hospital, where computed tomography scans of his brain revealed a right posterior temporal and cerebellar EDH with a right temporo-occipital fracture. He underwent a right parieto-occipital craniotomy, incorporating the fracture line. Longitudinal laceration of the right transverse sinus extending to the sigmoid sinus with profuse bleeding was identified. Four gauzes were inserted in the epidural space for tamponade of the injured sinus. Conventional angiography and coil embolization for the injured sinus were immediately performed. Subsequently, the patient was transferred to the operating room, wherein staff members removed the gauzes and remnant hematoma. Based on this experience, the authors recommend that for posterior fossa EDH from transverse sinus bleeding, bleeding control should be performed by gauze packing and endovascular treatment.

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Hypodense bubbles in acute extradural haematomas following venous sinus tear

Cited by 16 publications

References 13 publications

Blend Sign on Computed Tomography

Blend Sign on Computed Tomography

Development and external validation of a novel multihematoma fuzzy sign on computed tomography for predicting traumatic intraparenchymal hematoma expansion

Endovascular Treatment Following Gauze Packing for the Control of Massive Bleeding from Traumatic Transverse Sinus Lesion

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