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|Year : 2022 | Volume
| Issue : 4 | Page : 1764-1765
Downward Migration of Cranial Acute Subdural Hematoma
Hiroshi Yokota, Seisuke Miyamae, Taiji Yonezawa
Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka, Japan
|Date of Submission||07-Nov-2019|
|Date of Decision||14-Nov-2019|
|Date of Acceptance||05-Feb-2020|
|Date of Web Publication||30-Aug-2022|
Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka 543-0035
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Yokota H, Miyamae S, Yonezawa T. Downward Migration of Cranial Acute Subdural Hematoma. Neurol India 2022;70:1764-5
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. 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. 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, 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.
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| » References|| |
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[Figure 1], [Figure 2], [Figure 3]