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| NEUROIMAGE |
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| Year : 2022 | Volume
: 70
| 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 |
Correspondence Address:
Hiroshi Yokota
Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka 543-0035
Japan
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0028-3886.355182
How to cite this article:
Yokota H, Miyamae S, Yonezawa T. Downward Migration of Cranial Acute Subdural Hematoma. Neurol India 2022;70:1764-5 |
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 | |  |
| 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.  |
| 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. |
| 3. | Singh K, Thakur RC, Khosla VK. Occipital lobe infarction caused by tentorial herniation in chronic subdural haematoma. Neurol India 1996;44:214-6. [ PUBMED] |
[Figure 1], [Figure 2], [Figure 3]
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