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PubMed1978

Neuroradiologic evaluation of the subdural pathogenesis in infants with small heads.

A marginal low density area is often revealed by CT scan in infants with microcephalia. However, it is difficult to assess precisely the main pathologic state of the marginal low density area and also whether such a lesion exists in the subdural-epiarachnoid space or in the subarachnoid space. A carotid angiographic evaluation of cortical vessels in the marginal avascular area was made and suggestive results were obtained. When there is acute subdural effusion or subdural hematoma, cortical arteries in the marginal avascular area will have a straightened and attenuated figure. But when such a pathologic state persists for a long period, it induces secondary cortical atrophy and the subarachnoid space becomes enlarged. The cortical artery appears as if it is flying in the enlarged subarachnoid space because it is detached from the gyrus and the sulcus following the cortical atrophy. This is why we named it the 'flying artery.' Angiographic findings allow more precise interpretation of the marginal low density area in the CT scan.

Age Factors↗
PubMed1998

The pathogenesis and clinical significance of traumatic subdural hygroma.

Subdural hygroma (SDG) is a common post-traumatic lesion. Despite its common occurrence, the pathogenesis and clinical significance are uncertain. The author reviewed the literature to clarify the present knowledge on the pathogenic, diagnostic and therapeutic aspects of this controversial lesion. A trivial trauma can cause a separation of the dura-arachnoid interface, which is the basic requirement for the development of a SDG. If the brain shrinks due to brain atrophy, excessive dehydration or decreased intracranial pressure, fluid collection may develop by a passive effusion. Most SDGs resolve when the brain is well expanded. However, a few SDGs become chronic subdural haematomas, when the necessary conditions persist over several weeks. Since the majority of patients with a SDG do not show a mass effect, surgery is rarely required. Outcome is closely related to the primary head injury not to the SDG itself. The complexity of SDG depends on various factors including the dynamics of absorption and expansion, duration of observation, and indication and rate of surgery, besides variety of the primary head injury in types and severity. SDG is a common epiphenomenon of head injury.

Atrophy↗
PubMed2002

Significance of computed tomography mixed density in traumatic extra-axial hemorrhage.

Computed tomography (CT) mixed density of traumatic extra-axial hemorrhages (TEH) or the 'swirl sign' has been reported to correlate with active bleeding found at craniotomy and poor outcome. This study was done to test the hypothesis that mixed density of TEH detected by third or fourth generation CT correlated with the type of bleeding or clinical outcome. All cases of TEH operated at Detroit Receiving Hospital from 1991-1997 were reviewed for type of bleeding (active vs. not active; arterial vs. venous); Glasgow Coma Scale (severe 1-8, not severe 9-15); and Glasgow Outcome Score (1-3 poor; 4,5 good). CT density (CTD) of 51 cases with specific written documentation of bleeding type were then independently reviewed (SKS and MHR) and classified into TEH with mixed or high density. Data was analyzed using corrected Chi Square analysis, Fischer's Exact Test and Pearson's Correlation (SPSS 6.0). The Pearson Chi Square probability for correlation follows: CTD vs. active bleeding, 0.21; CTD vs. arterial, 0.41; CTD vs. severity, 0.57; and CTD vs. outcome, 0.81. No other statistical analysis identified a significant correlation, thus the null hypothesis could not be rejected. CT mixed density was not found to be correlated by more than chance with bleeding type, injury severity or outcome. Surgeon inaccuracy in documentation of bleeding type and use of later generation CT may account for the discrepancy between this and previous studies. Nevertheless, we conclude clinical exam and other published CT criteria are better indicators of injury severity and outcome.

Brain↗
PubMedDate not supplied

RADIOLOGICAL NOTES.

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Dermoid Cyst↗