ABSTRACT
The magnetic resonance (MR) features of spinal epidural hemorrhage depending with the passage of time have a meaning in veterinary medicine. The aim of this study is to propose the characteristic MR image of spinal epidural hemorrhage using a lower field permanent magnet scanner in dogs. A total of 8 clinically normal beagle dogs, weighing about 9 kg, were allocated. After a baseline MR examination, spinal epidural hemorrhage was created. MR scanning was executed on days 1, 2, 3, 4, 5, 10, 15, 20, 25, and 30 using 0.25 Tesla low field MR. Transverse MR images were attained for image examination. T2W, T1W, fluid-attenuated inversion recovery (FLAIR), short tau inversion recovery (STIR), and T2*-GRE sequences were used. Images were compared subjectively for signal transition assessment. Spinal epidural hemorrhage models were produced positively in 8 dogs at the T12 to L2 region. Initially, the spinal cord and epidural lesions were hyper-intense on T2W and T1W images. On T2W, FLAIR and STIR images, the spinal cord lesion was steadily hyperintense. No significant and consistent hypointense signal indicating hemorrhage was seen on T2*-GRE images. This study result suggests that relatively consistent hyperinstensity on T2 and FLAIR is observed for 30 days, meanwhile T2*-GRE imaging is less useful in hemorrhage detection.
Subject(s)
Animals , Dogs , Hematoma, Epidural, Spinal , Hemorrhage , Spinal Cord , Veterinary MedicineABSTRACT
OBJECTIVE: Repeated computed tomography (CT) follow up for traumatic brain injury (TBI) patients is often performed. But there is debate the indication for repeated CT scans, especially in pediatric patients. Purpose of our study is to find risk factors of progression on repeated CT and delayed surgical intervention based on the repeated head CT. METHODS: Between March, 2007 and December, 2013, 269 pediatric patients (age 0-18 years) had admitted to our hospital for head trauma. Patients were classified into 8 subgroups according to mechanisms of injury. Types, amount of hemorrhage and amount changes on repeated CT were analyzed as well as initial Glasgow Coma Scale (GCS) scores. RESULTS: Within our cohort of 269 patients, 174 patients received repeat CT. There were progression in the amount of hemorrhage in 48 (27.6%) patients. Among various hemorrhage types, epidural hemorrhage (EDH) more than 10 cc measured in initial CT was found to be at risk of delayed surgical intervention significantly after routine repeated CT with or without neurological deterioration than other types of hemorrhage. Based on initial GCS, severe head trauma group (GCS 3-8) was at risk of delayed surgical intervention after routine repeated CT without change of clinical neurologic status. CONCLUSION: We suggest that the patients with EDH more than 10 cc or GCS below 9 should receive repeated head CT even though absence of significant clinical deterioration.
Subject(s)
Humans , Brain Injuries , Cohort Studies , Craniocerebral Trauma , Follow-Up Studies , Glasgow Coma Scale , Head , Hematoma, Epidural, Cranial , Hemorrhage , Risk Factors , Tomography, X-Ray ComputedABSTRACT
A postoperative epidural hematoma (EDH) is a serious and embarrassing complication, which usually occurs at the site of operation after intracranial surgery. However, remote EDH is relatively rare. We report three cases of remote EDH after brain tumor surgery. All three cases seemed to have different causes of remote postoperative EDH; however, all patients were managed promptly and showed excellent outcomes. Although the exact mechanism of remote postoperative EDH is unknown, surgeons should be cautious of the speed of lowering intracranial pressure and implement basic procedures to prevent this hazardous complication of brain tumor surgery.
Subject(s)
Humans , Brain Neoplasms , Brain , Craniotomy , Hematoma , Intracranial Pressure , NeurosurgeryABSTRACT
Two infants with non-accidental inflicted neuro-trauma are reported. One presented with sudden onset lethargy, respiratory difficulty and unexplained seizures. There were bilateral retinal bleeds and extradural hemmorage. Other was a well thriving child who had 2 seizures and was noted to lack visual fixation. Retinal hemorrhages and chronic subdural and intraparenchymal hemorrhages were subsequently discovered. We highlight the importance of suspecting child abuse in infants with sudden unexplained unresponsiveness, seizures or respiratory difficulty and the unusual occurrence of extradual hemorrhage.
Subject(s)
Dyspnea/etiology , Hematoma, Epidural, Cranial/etiology , Hematoma, Epidural, Cranial/diagnostic imaging , Humans , Infant , Intracranial Hemorrhage, Traumatic/etiology , Lethargy/etiology , Male , Retinal Hemorrhage/etiology , Seizures/etiology , Shaken Baby Syndrome/diagnosisABSTRACT
Forty canine patients with a presumptive diagnosis of the intervertebral disc herniation at the thoracolumbar region were imaged. A neurological examination was performed and all patients were classified under four grades by the examination. The degrees of attenuation of the herniated disc material were measured in Housefield units (HU) in each image. The ratio of the area to herniated disc material and the height to disc material were measured. The clinical grade was correlated with the area ratio of the herniated disc material to the spinal cord, but not correlated with the height ratio of that. In the patients with epidural hemorrhage at surgery, HUs of the herniated disc material was lower than those with no epidural hemorrhage at surgery. Non-contrast computed tomography scans of the spine can be useful in diagnosing acute intervertebral disc disease in chondrodystrophoid breeds, evaluating patient status and identifying concurrent epidural hemorrhage.
Subject(s)
Animals , Dogs , Dog Diseases/pathology , Intervertebral Disc Displacement/diagnostic imaging , Lumbar Vertebrae/pathology , Retrospective Studies , Thoracic Vertebrae/pathology , Tomography, X-Ray Computed/methodsABSTRACT
A 61-year old woman without the history of unusual bleeding diasthesis underwent epidural blockade for the relief of lower back pain (LBP). One hour after the epidural block, patient complained of progressive lower back pain and developed depressed dorsiflexion (Grade 0) of great toe in both feet. Diagnosis utilizing magnetic resonance imaging, showed epidural hemorrhage extending from T6 to S1. A neurosurgery consult obtained, and emergent decompressive laminectomy with hematoma evacuation was performed. Operation was successful and patient recovered satisfactory without any sequelae.
Subject(s)
Female , Humans , Middle Aged , Diagnosis , Foot , Hematoma , Hemorrhage , Laminectomy , Low Back Pain , Magnetic Resonance Imaging , Neurosurgery , ToesABSTRACT
Spontaneous spinal epidural hemorrhage(SSEH) represent 0.3%~0.9% of spinal epidural-space-occupying lesions. The therapeutic outcome seems to be determined by the accuracy of the diagnosis and by the time interval between the onset of symptom and surgical decompression. Thus, SSEH is a rare spinal emergency and a diagnostic challenge. We experienced two such cases. In one case, the symptoms were confused with those for a ureter stone, aortic aneurysm, spinal cord infarction. That patient completely recovered spontaneously within 2 hours. In the other case, which was initially diagnosed incorrectly as a cerebral infarction, surgical decompression was performed. That patient recovered completely within 1 month.
Subject(s)
Humans , Aortic Aneurysm , Cerebral Infarction , Decompression, Surgical , Diagnosis , Emergencies , Hematoma, Epidural, Spinal , Infarction , Spinal Cord , UreterABSTRACT
A case of traumatic thoracolumbar epidural hemorrhage is presented in a 37-year-old man with ankylosing spondylitis. The patient complained neck and back pain right after the accident but paralegia and difficult urination followed 2 days later. Spine CT showed thoracolumbar epidural mass, which was confirmed to be hemorrhage associated with spine fracture and was solely responsible for paraplegia.