Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Subdural Hematoma


KEY FACTS

Terminology

  • Accumulation of blood between dura, arachnoid

Imaging

  • Intradural collection hyperintense on T1WI, predominantly hypointense on T2WI or gradient-echo imaging

  • Thoracolumbar > lumbar or lumbosacral > cervical

  • Clumped, loculated masses of hemorrhagic density/intensity

Top Differential Diagnoses

  • Epidural hematoma

  • Subdural abscess

  • Cerebrospinal fluid leakage syndrome

  • Spinal meningitis

  • Idiopathic hypertrophic spinal pachymeningitis

Pathology

  • Trauma

  • Bleeding diathesis: 54% of reported cases

  • Iatrogenic cause is factor in 2/3 of those with abnormal coagulation parameters

  • Neoplasm

  • Arteriovenous malformation

  • Postoperative complication

  • Spontaneous: 15%

Clinical Issues

  • Acute onset of neck or back pain

  • Radicular pain, bladder/bowel dysfunction

  • Much less common than spinal epidural hematoma

  • Treatment

    • May resolve spontaneously

    • Decompressive laminectomy with clot evacuation

      • –

        Indicated with severe and progressive deterioration of neurologic symptoms

Sagittal T1WI MR without fat saturation shows prominent hyperintense linear collections both ventral
and dorsal
within the bony spinal canal, with narrowing of the thecal cerebrospinal fluid (CSF) space.

Sagittal T1WI MR with fat saturation shows the hyperintense linear subdural blood collection to better advantage. There is marked narrowing of thecal CSF space
. Iatrogenic cause is a factor in 2/3 of those with abnormal coagulation parameters.

Axial T1WI FS MR in the same patient shows the typical appearance of a subdural hemorrhage, with a well-defined outer margin bounded by the dura
, and an inner lobulated margin, giving a Mercedes Benz sign
.

Sagittal T1WI MR in a patient with a subdural hematoma shows diffuse ventral
and dorsal
intraspinal hyperintense collections, with intracranial extension
.

TERMINOLOGY

Abbreviations

  • Spinal subdural hematoma (SSDH)

Definitions

  • Accumulation of blood between dura, arachnoid

IMAGING

General Features

  • Best diagnostic clue

    • Intradural collection hyperintense on T1WI, predominantly hypointense on T2WI or gradient-echo imaging

  • Location

    • Thoracolumbar > lumbar or lumbosacral > cervical

    • Ventral, dorsal, lateral, or circumferential

  • Size

    • Variable cranial-caudal extension

      • –

        Typically over multiple levels

  • Morphology

    • Clumped, loculated masses of hemorrhagic density/intensity

    • Conforms to dura

    • Distinct from epidural fat and adjacent osseous structures

You're Reading a Preview

Become a Clinical Tree membership for Full access and enjoy Unlimited articles

Become membership

If you are a member. Log in here

Related Posts