Concurrent intracranial and spinal subdural hematoma in a teenage athlete: a case report of this rare entity.

A 15-year-old male high school football player presented with episodes of headache and complete body stiffness, especially in the arms, lower back, and thighs, immediately following a football game. This was accompanied by severe nausea and vomiting for several days. Viral meningitis was suspected by the primary clinician, and treatment with corticosteroids was initiated. Over the next several weeks, there was gradual symptom improvement and the patient returned to his baseline clinical status. The patient experienced a severe recurrence of the previous myriad of symptoms following a subsequent football game, without an obvious isolated traumatic episode. In addition, he experienced a new left sided headache, fatigue, and difficulty ambulating. He was admitted and an extensive workup was performed. CT and MRI of the head revealed concurrent intracranial and spinal subdural hematomas (SDH). Clinical workup did not reveal any evidence of coagulopathy or predisposing vascular lesions. Spinal SDH is an uncommon condition whose concurrence with intracranial SDH is an even greater clinical rarity. We suggest that our case represents an acute on chronic intracranial SDH with rebleeding, membrane rupture, and symptomatic redistribution of hematoma to the spinal subdural space.

Multimodal magnetic resonance imaging evaluation of primary brain tumors.

Gliomas comprise 80% of primary brain neoplasms, with glioblastoma multiforme being the most commonly diagnosed glioma. The annual incidence is 5.26 per 100,000, or 17,000 newly diagnosed cases per year in the United States. The incidence increases with age, peaking between the 6th and 8th decades. Gliomas are more common among Caucasians and occur more often in men. They can be associated with certain rare hereditary syndromes including Cowden, Turcot, Li-Fraumeni, neurofibromatosis type 1 and type 2, tuberous sclerosis, and familial schwannomatosis. Known risk factors include a history of ionizing radiation, family history of glioma, and certain genetic susceptibility variants that are weakly associated with glioma. Preventative measures have not been shown to decrease the risk of later development. In addition, screening tests are unwarranted since early diagnosis and treatment have not been shown to improve outcome.