MR characteristics of subdural hematomas and hygromas at 1.5 T

Fobben, Edward S.; Grossman, Robert I.; Atlas, Scott W.; Hackney, David B.; Goldberg, Herbert I.; Zimmerman, Robert A.; Bilaniuk, Larissa T.

doi:10.2214/ajr.153.3.589

Cited by 89 publications

(53 citation statements)

References 8 publications

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“…Overall, the MRI appearances of acute and subacute SDH parallel those of intraparenchymal hematomas, but T2 hypointensity ("blooming") is both less frequent and less obvious in chronic SDH than in intraparenchymal hematomas, perhaps because hemosiderin is more readily absorbed from the subdural space, which lacks a blood-brain barrier. 10 Applying this algorithm to the present study, Pattern I represents an early subacute phase and Pattern II a late subacute phase (Table 4). It is apparent that both of these patterns occur much earlier than they do within intracerebral hematomas, with all Pattern I and many Pattern II SDH appearing on MR images obtained within 7 days of the reporting of injury.…”

Section: Findings On Mrimentioning

confidence: 99%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

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Object The appearance and evolution of neuroimaging abnormalities following abusive head trauma (AHT) is important for establishing the time frame over which these injuries might have occurred. From a legal perspective this frames the timing of the abuse and therefore identifies and excludes potential perpetrators. A previous pilot study involving 33 infants with AHT helped to refine the timing of these injuries but was limited by its small sample size. In the present study, the authors analyzed a larger group of 210 cases involving infants with AHT to chronicle the first appearance and evolution of radiological (CT, MRI) abnormalities. Methods All children younger than 24 months admitted to the Penn State Hershey Medical Center with AHT over a 10-year period were identified from a medical record review; the time of injury was determined through an evaluation of the clinical records. All imaging studies were analyzed, and the appearance and evolution of abnormalities were chronicled on serial neuroimaging studies obtained in the days and weeks after injury. Results One hundred five infants with specific injury dates and available imaging studies were identified; a subset of 43 children additionally had documented times of injury. In infants with homogeneously hyperdense subdural hematomas (SDHs) on initial CT scans, the first hypodense component appeared within the SDH between 0.3 and 16 days after injury, and the last hyperdense subdural component disappeared between 2 and 40 days after injury. In infants with mixed-density SDHs on initial scans, the last hyperdense component disappeared between 1 and 181 days. Parenchymal hypodensities appeared on CT scans performed as early as 1.2 hours, and all were visible within 27 hours after the injury. Rebleeding into SDHs was documented in 17 cases (16%) and was always asymptomatic. Magnetic resonance imaging of the brain was performed in 49 infants. Among those with SDH, 5 patterns were observed. Patterns I and II reflected homogeneous SDH; Pattern I (T1 hyperintensity and T2/FLAIR hypointensity, “early subacute”) more commonly appeared on scans performed earlier after injury compared with Pattern II (T1 hyperintensity and T2/FLAIR hyperintensity, “late subacute”), although there was considerable overlap. Patterns III and IV reflected heterogeneous SDH; Pattern III contained relatively equal mixtures having different intensities, whereas Pattern IV had fluid that was predominantly T1 hypointense and T2/FLAIR hyperintense. Again, Pattern III more commonly appeared on scans performed earlier after injury compared with Pattern IV, although there was significant overlap. Conclusions These data extend the preliminary data reported by Dias and colleagues and provide a framework upon which injuries in AHT can be timed as well as the limitations on such timing estimates.

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Section: Findings On Mrimentioning

confidence: 99%

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Bradford¹,

Choudhary²,

Dias

2013

PED

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“…Subdural hematomas tend to have a crescent shape and conform to dural attachments such as the falx cerebri (in contrast to epidural hematomas, which are biconvex in shape and can cross dural attachments but not calvarial sutures) [31]. The MR imaging characteristics of the different stages of SDH have been described [32]. CSDH are often hyperintense on T2W images and commonly have a layered appearance, as was appreciated in this case ( Figure 5(d)) due to the development of internal septations and membranes joining the inner and outer membranes of the hematoma [33].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

Hodshon

Narak

Craig

et al. 2015

Case Reports in Veterinary Medicine

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A 2-year-old female spayed Miniature Dachshund was presented for seizures and right prosencephalic signs. A multiloculated, ring-enhancing mass in the right cerebrum associated with dilation of the right lateral ventricle and brain herniation was seen on magnetic resonance imaging. An irregular calvarial defect with smoothly scalloped edges was seen overlying the mass on computed tomography. The mass was removed via craniectomy and was diagnosed as a chronic brain abscess caused by Peptostreptococcus anaerobius. The patient was maintained on antibiotics for 12 weeks. Follow-up MRI performed 14 weeks after surgery confirmed complete removal of the abscess as well as a contrast-enhancing collection of extra-axial material consistent with a chronic subdural hematoma. The neurologic abnormalities, including seizures, have improved in the 44 months since surgery. Brain abscesses in dogs can have an insidious clinical course prior to causing serious neurologic deterioration. Ventricular entrapment by an intracranial mass can contribute to acute neurologic decline. If surgically accessible, outcome following removal of a brain abscess can be excellent; aerobic and anaerobic bacterial culture should be performed in these cases. Subdural hematoma can occur following removal of a large intracranial mass. Growing skull fractures can occur in dogs but may not require specific surgical considerations.

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“…Chronic cerebral intraparenchymal hematomas appear hypodense on CT, and hypointense on T1- and T2-weighted MR images. However, the density and intensity patterns of chronic subdural hematomas differ from those of intraparenchymal hematomas owing to the absence of the blood-brain barrier in the subdural space and the tendency to recurrent bleeding [16]. Mixed intensity and T1 hyperintensity are commonly observed on MR imaging due to recurrent hemorrhage [17].…”

Section: Discussionmentioning

confidence: 99%

Factor X Deficiency Presenting with Bilateral Chronic Subdural Hematoma

Şentürk¹,

Güzel²,

Bayrak³

et al. 2010

Pediatr Neurosurg

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Factor X deficiency is a rare coagulation defect that can result in several hemorrhagic manifestations including central nervous system hematomas in infants and children. In this case report, we present computed tomography (CT) and magnetic resonance (MR) imaging findings of bilateral chronic subdural hematomas due to factor X deficiency. Cranial CT and MR imaging in a hypoactive 7-month-old male infant with right hemiparesis revealed bilateral chronic subdural hematomas at different stages. Laboratory findings showed a severe factor X deficiency, with a level of 0.7%. After fresh frozen plasma replacement, the patient was operated and the large hematoma on the left side evacuated. The patient recovered uneventfully and remained asymptomatic during the 1-year follow-up.

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MR characteristics of subdural hematomas and hygromas at 1.5 T

Cited by 89 publications

References 8 publications

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Serial neuroimaging in infants with abusive head trauma: timing abusive injuries

Surgical Treatment of a Chronic Brain Abscess and Growing Skull Fracture in a Dog

Factor X Deficiency Presenting with Bilateral Chronic Subdural Hematoma

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