The fate of traumatic subdural hygroma in serial computed tomographic scans

We reviewed serial computed tomographic (CT) scans of 58 patients with traumatic subdural hygroma (SDG) to investigate its natural history. All were re-evaluated with a special reference to the size and density of SDG. Thirty-four patients (58.6%) were managed conservatively and 24 patients (41.4%) underwent surgery. The lesion was described as remained, reduced, resolved, enlarged and changed. Means of interval from injury to diagnosis and any changes in CT were calculated. SDGs were resolved in 12 (20.7%), reduced in 15 (25.9%), remained in 10 (17.2%), enlarged in 2 (3.4%), and changed into chronic subdural hematoma (CSDH) in 19 patients (32.8%). SDG was diagnosed at 11.6 days after the injury. It was enlarged at 25.5 days, remained at 46.0 days, reduced at 59.3 days, resolved at 107.5 days, and changed into CSDH at 101.5 days in average. SDGs were developed as delayed lesions, and changed sequentially. They enlarged for a while, then reduced in size. The final path of a SDG was either resolution or CSDH formation. Nearly half of SDGs was resolved or reduced within three months, however, 61.3% of unresolved or unreduced SDG became iso- or hyperdense CSDH. These results suggest that the unresolved SDG is the precursor of CSDH.

Evaluation by MRI of Disc Injury in Fractures of the Thoracic and Lumbar Spine

Injury to a lumbar disc is rare, and is seldom mentioned in the literature describing spinal fracture; even in patients with such fractures, disc herniation is infrequent and is often considered to be a sequella of trauma. Using magnetic resonance imaging(MRI) we investigated the incidence and pattern of disc injuries by an in 37 patients with fractures of the lumbar and thoracic spines. Discs adjacent to the fracture site were found to be normal in 19 patients(51.4%), but in ten(27.0%), the end plate was disrupted. The disc was ruptured in six patients(16.2%), and had degenerated in two patients(5.4%). Injured discs were found in the three patients with fracture-dislocation and three of the seven(42.9%) with burst fracture, but in none of the 27 with compression fracture. The three lower lumbar discs(L3-4, L4-5, and L5-S1) were found to be normal in 26 patients(70.3%), but had degenerated in seven(18.9%). Incidental asymptomatic disc herniation was found in four patients(10.8%), including one with degenerative spondylolisthesis. There was no traumatic disc herniation in the lower lumbar region. These results suggest that traumatic lumbar disc herniation is quite uncommon, even in the unstable thoracolumbar spinal injuries.

Differentiation Between Acute and Old Fractures in The Thoracic and Lumbar Spine: Observer Agreement

Differentiation between acute and old fractures in the thoracic and lumbar spine is often difficult. We have evaluated the intraobserver agreement and interobserver variability of interpretations. We have prepared 50 cases from 40 patients with thoracic or lumbar spine fracture for evaluation. At first, two radiologist interpreted each of the 50 cases, Only by using plain roentgenograms. Then, they interpreted the cases again using also spine CT, MRI, bone scintigrams and follow-up roentgenograms. Intraobserver agreement was found to be 78% in Doctor A, and 76% in Doctor B. Interobserver agreement was only 62% at first. It was 88%, when they used CT, MRI, bone scintigrams and follow-up roentgenograms. It was not easy to differentiate the old fractures from acute one only by plain roentgenograms. Differentiation was more difficult, when the patient was female or over 55 years old. Plain roentgenography in hyperextension posture seems to be a simple but useful method for the diagnosis of the acute fracture. MRI was more valuable than CT or bone scintigraphy to differentiate the old fractures from the acute ones.

Brain abscess from a ganglionic hemorrhage: a case report

We present a unique case of a brain abscess that occurred secondary to a ganglionic hemorrhage in a 64-year-old man. This abscess appeared to be metastatic after septicemia. Aspiration with antibiotics eliminated this infection.

Intracerebral Hemorrhage from a Traumatic Carotid Cavernous Fistula: Case Report

No abstract available.