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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

Correspondence Address:
Hiroshi Yokota
Department of Neurosurgery, Osaka Police Hospital, Kitayama-Cho 10-31, Tennouji-Ku, Osaka 543-0035
Japan




How to cite this article:
Yokota H, Miyamae S, Yonezawa T. Downward Migration of Cranial Acute Subdural Hematoma.Neurol India 2022;70:1764-1765


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 Nov 30 ];70:1764-1765
Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1764/355182


Full Text



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}{Figure 2}{Figure 3}

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

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2Reina 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.
3Singh K, Thakur RC, Khosla VK. Occipital lobe infarction caused by tentorial herniation in chronic subdural haematoma. Neurol India 1996;44:214-6.