Radiologic Findings of Acute Spontaneous Subdural Hematomas

PURPOSE: To evaluate the characteristic CT and cerebral angiographic findings in patients with acutespontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome. MATERIALS AND METHODS: Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presentingduring the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determinethe cause of bleeding, CT and angiographic findings were retrospectively analysed. Clinical history, laboratoryand operative findings, and final clinical outcome were reviewed. RESULTS: The 21 cases of acute spontaneoussubdural hematomas were caused by cerebral vascular abnormalities(n=10), infantile hemorrhagic disease(n=5), orwere of unknown origin(n=6). All ten cases of cerebral vascular abnormality were confirmed angiographically; sixwere aneurysms, three were arteriovenous malformations, and one was moyamoya disease. On CT, subarachnoidhemorrhage was seen to be associated with aneurysms, intracerebral hemorrhage with arteriovenous malformations,and intraventricular hemorrhage with moyamoya disease. All five patients with hemorrhagic disease were infantsaged 1-17 months ; characteristic diffuse distribution of subdural hematoma in both temporoparietal-occipitalregions is typical. The average overall mortality rate was 52.4%(11/21). In patients with cerebral vascularabnormalities, mortality was as low as 20%(2/10), but in hemorrhagic disease was high (60%). In cases of unknownorigin it was 100%. CONCLUSION: Acute spontaneous subdural hematoma is a rare condition, and the mortality rateis high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid orintracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm andarteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus morkedlyreduce mortality, the causes of bleeding should be prompty determined by means of cerebral angiography.

CT and MR Findings in Patients with Mild Head Injury

PURPOSE: To assess the prevalence, lesion sites and characteristics of MR findings in patients with mild head injury and the relationship between MR findings and the postconcussion syndrome. MATERIALS AND METHODS: Our study involved 26 patients with mild head injury (Glasgow Coma Scale, 13 to 15 ; no subsequent deterioration ; loss ofconsciousness < 30 minutes). Prospective CT and MR Imaging was performed and the prevalence rate of abnormalities, sites and characteristics of lesions were evaluated, as well as the relationship between MR findings and the postconcussion syndrome. RESULTS: In 17 of 26 patients(65%) there were abnormal findings on MR, and in 8 of the 26(31%), abnormal findings were seen on CT. Abnormalities consisted of cerebral contusion in nine patients, diffuse axonal injury in six and small thin extracerebral hematomas in nine. MR is more sensitive than CT, especially when the lesion is non-hemorrhagic and is closer to the cranial vault. In 16 patients who wereclinically followed up, the prevalence rate of postconcussion syndrome was higher in those with abnormal MR than in those with normal MRI. CONCLUSION: The greater sensitivity of MR makes it a better indicator than CT for the presence and extent of injuries and thus potentially a better predictor of outcome, even in patients with mildhead injuries. Positive MR findings are an objective predictors for the evaluation of patients with postconcussion syndrome after mild head injury.

Retroperitoneal duodenal rupture: role of the plain abdomen

Retroperitoneal duodenal rupture is rare and is often difficult to diagnose on the plain abdominal x-ray. From a review of the plain abdomen films of 21 cases with retroperitoneal duodenal rupture, confirmed by operation, pneumoretroperitoneum was revealed in 16 cases; Air in the peritoneum was manifested as a bubbly shadow in 12 cases, a renal halo in 9 cases, air shadow along the right psoas margin in 2 cases, air along the diaphragmatic crus in 2 cases and air in the right properitoneal fat in 2 cases, US and CT also revealed air bubbles and fluid collection around the right kidney. We recommend the plain abdomen as a useful diagnostic method for detection of pneumoretroperitoneum.