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Hyperdense Appearance in Active Epidural and Subdural Hematoma: Serial Case Report

Krisna Tsaniadi Prihastomo , Tedy Apriawan, Agus Turchan

Krisna Tsaniadi Prihastomo
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya. Email: Krisna_tsaniadi123@gmail.com

Tedy Apriawan
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya

Agus Turchan
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital Surabaya
Online First: January 08, 2019 | Cite this Article
Prihastomo, K., Apriawan, T., Turchan, A. 2019. Hyperdense Appearance in Active Epidural and Subdural Hematoma: Serial Case Report. Indonesian Journal of Neurosurgery 1(2). DOI:10.15562/ijn.v1i2.41


Many of traumatic brain injured patients come to the emergency department with active intracranial bleeding, either Epidural Hematoma (EDH) or Subdural Hematoma (SDH). The most common source of bleeding in EDH cases might be either from the oozed bleeding from fracture of adjacent bone or tear of medial meningeal vessel branches. The classic appearance usually found in non-contrast head CT, which formed a biconvex lesion. The active bleeding, usually from blood vessels tearing origin, could also be found in CT imaging. There is hypodense mixed within the hyperdense lesion, sometimes formed a whirlpool-like appearance, which later known as “Swirl Sign”3. The acute subdural hematoma, by its process, is different with EDH. It is usually caused by clot accumulation of adjacent cortical laceration or tearing of bridging veins. The crescent-like appearance is the classical CT image shown in acute SDH. However, up to now, the active bleeding in subdural hematoma is not widely explained. We report 12 cases of epidural and subdural hematoma which indicate active bleeding from imaging study.All of the cases revealed the active bleeding during the surgery.We suggest that hypodense lesion in acute TBI imaging should be considered as active bleeding not only for EDH but also for SDH cases. Thus, more attention must be taken carefully during the surgery.

 

Keyword: Swirl sign, Subdural Hematoma, SDH, active bleeding

References

Pouraghaei, M, Moharamzadeh, P, Dibazar, S, Taghizadieh, A, Ala, A, Maroufi, P,Ghiasi, RR. Hypodense area within epidural hematoma in brain CT scan; Prediction of active bleeding in epiduralhematoma. Life Science Journal, 2013; 10 (1).

Le, TH, Gean, AD. Imaging of Head Trauma. Seminars in Roentgenology. California: Elsevier, pp. 177-189

Al-Nakshabandi, NA. The Swirl Sign. Radiology, 2001; 218-413.

Kim, TA, Kalnins, AU, Prost, RW. Computed Tomography and Magnetic Resonance Imaging of The Brain. In: Winn, RH. Eds. Youmans Neurological Surgery. 6th Ed. Philadelphia: Elsevier. pp. 277-310.


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