Rapid-High-Dose Contrast Computed Tomography of Isodense Subdural Hematoma and Cerebral Swelling

Abstract

Ten patients were studied in whom precontrast computed tomography (CT) revealed an isodense mass which obliterated cerebral sulci and deformed the ventricle(s). Upon rapid-high-dose (RHD) contrast enhancement, the cerebral hemispheric surface was so well demonstrated, that in 4 patients the possibility of an isodense subdural hematoma was exluded, while in the other 6 it was correctly diagnosed. Preoperative angiography was not necessary.

White matter buckling: CT sign of extraaxial intracranial mass

“…Th ey conc luded th at " if th e patient with acute head trauma has a negative plain CT scan, nothing is to be gain ed by using co ntrast " [ 5]. On the other hand , rece nt reports have stressed th e usefuln ess of c ontrast sca ns [7] , delayed contrast scans [2 0], and coronal vi ews [10] in th e id entificati on of isod ense subd ural hematoma. We agree with Hayman et al [ 7] th at double-dose co ntrast scans are ve ry helpful in doubtful cases.…”

“…On the other hand , rece nt reports have stressed th e usefuln ess of c ontrast sca ns [7] , delayed contrast scans [2 0], and coronal vi ews [10] in th e id entificati on of isod ense subd ural hematoma. We agree with Hayman et al [ 7] th at double-dose co ntrast scans are ve ry helpful in doubtful cases. Furth erm ore, c ontrast scans and espec iall y double-dose co ntrast scans offer optim al gray white differenti ati on and, th erefore, fac ilitate the demonstrati on of white matter bucklin g. Th e appea rance of ede ma assoc iated with extraax ial lesions may be a so urce of confu sion .…”

“…The typical appearance on computed tomography (CT) of extraaxial intracran ial masses, notably meningiomas [1,2] and extracerebral hematomas [3][4][5][6][7][8][9][10][11], has been extensively reported. The specific effects on adjacent gray and white matter have not been adequately defined.…”