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NEUROIMAGE
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1764-1765

Downward Migration of Cranial Acute Subdural Hematoma


Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka, Japan

Date of Submission07-Nov-2019
Date of Decision14-Nov-2019
Date of Acceptance05-Feb-2020
Date of Web Publication30-Aug-2022

Correspondence Address:
Hiroshi Yokota
Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka 543-0035
Japan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.355182

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How to cite this article:
Yokota H, Miyamae S, Yonezawa T. Downward Migration of Cranial Acute Subdural Hematoma. Neurol India 2022;70:1764-5

How to cite this URL:
Yokota H, Miyamae S, Yonezawa T. Downward Migration of Cranial Acute Subdural Hematoma. Neurol India [serial online] 2022 [cited 2022 Oct 7];70:1764-5. Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1764/355182




Sir,

An 82-year-old female came to us with a headache after suffering a head injury. Head computed tomography (CT) findings demonstrated an acute subdural hematoma (SDH) in the convexity extending to the falx cerebri and tentorium [Figure 1]a and [Figure 1]b. T2-weighted magnetic resonance imaging (MRI) showed the SDH to be located in both supra- and infratentorial subdural spaces [Figure 2]. T1-weighted spinal MRI indicated that this cranial SDH extended into spinal subdural space and reached the sacral region [[Figure 1]c, [Figure 1]d, [Figure 1]e, note arrows and arrowheads]. Following a period of conservative observation, the spinal SDH completely disappeared [Figure 3].
Figure 1: (a and b) Head CT images demonstrating an acute subdural hematoma (SDH) in the convexity, tentorium, and falx cerebri. (c-e) T1-weighted spinal MR images showing a continuous SDH as an isointense lesion extending from the posterior fossa into spinal subdural space. White arrows and black arrowheads indicated the SDH anterior and posterior margins, respectively

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Figure 2: T2-weighted coronal MRI showing the SDH as the high intensity in convexity, interhemispheric and supra- and infratentorial subdural spaces

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Figure 3: (a) T1-weighted craniocervical MRI obtained 9 days later demonstrating resolution of the SDH in the dorsal cerebellum and cervical canal, while a small residual SDH can be seen in the tentorium and falx cerebri. (b) Lumbar MRI obtained 3 months later demonstrating complete resolution of the spinal SDH

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Whether a cranial SDH can migrate into spinal subdural space is a controversial issue.[1] An electron microscopic study of human cadavers showed that the spinal subdural space includes a dura-arachnoid interface in a non-pathological condition and that space is filled with neurothelial cells with dura mater continuing to the arachnoid trabeculae.[2] Once an artificial subdural space is created under a pathological condition or because of surgical exposure, additional forces, such as increased intracranial pressure or gravity, can cause further dissection of the subdural space to provide a corridor for migration of an SDH. An anatomical variation of the tentorial hiatus,[3] atrophy associated with aging and coagulopathy can also be an important contributing factor. The present neuroimaging findings support the possibility of downward migration of a cranial acute SDH along with rapid resolution and redistribution, especially in cases with a posterior fossa location.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wong ST, Yuen MK, Fok KF, Yuen SC, Yam KY, Fong D. Redistribution of hematoma to spinal subdural space as a mechanism for the rapid spontaneous resolution of posttraumatic intracranial acute subdural hematoma: Case report. Surg Neurol 2009;71:99-102.  Back to cited text no. 1
    
2.
Reina MA, De Leon Casasola O, Lopez A, De Andres JA, Mora M, Fernandez A. The origin of the spinal subdural space: Ultrastructure findings. Anesth Analg 2002;94:991-5.  Back to cited text no. 2
    
3.
Singh K, Thakur RC, Khosla VK. Occipital lobe infarction caused by tentorial herniation in chronic subdural haematoma. Neurol India 1996;44:214-6.  Back to cited text no. 3
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