J Korean Radiol Soc.  1998 Mar;38(3):391-396. 10.3348/jkrs.1998.38.3.391.

Radiologic Findings of Acute Spontaneous Subdural Hematomas

• Kim HJ
• Bae WK
• Cha JG
• Kim GW
• Cho WS
• Kim IY
• Lee KS

• KMID: 2201391
• DOI: http://doi.org/10.3348/jkrs.1998.38.3.391

Abstract

PURPOSE: To evaluate the characteristic CT and cerebral angiographic findings in patients with acutespontaneous subdural hematomas and correlate these imaging findings with causes of bleeding and clinical outcome.
MATERIALS AND METHODS
Twenty-one patients with nontraumatic acute spontaneous subdural hematoma presentingduring the last five years underwent CT scanning and cerebral angiography was performed in twelve. To determinethe cause of bleeding, CT and angiographic findings were retrospectively analysed. Clinical history, laboratoryand operative findings, and final clinical outcome were reviewed.
RESULTS
The 21 cases of acute spontaneoussubdural hematomas were caused by cerebral vascular abnormalities(n=10), infantile hemorrhagic disease(n=5), orwere of unknown origin(n=6). All ten cases of cerebral vascular abnormality were confirmed angiographically; sixwere aneurysms, three were arteriovenous malformations, and one was moyamoya disease. On CT, subarachnoidhemorrhage was seen to be associated with aneurysms, intracerebral hemorrhage with arteriovenous malformations,and intraventricular hemorrhage with moyamoya disease. All five patients with hemorrhagic disease were infantsaged 1-17 months ; characteristic diffuse distribution of subdural hematoma in both temporoparietal-occipitalregions is typical. The average overall mortality rate was 52.4%(11/21). In patients with cerebral vascularabnormalities, mortality was as low as 20%(2/10), but in hemorrhagic disease was high (60%). In cases of unknownorigin it was 100%.
CONCLUSION
Acute spontaneous subdural hematoma is a rare condition, and the mortality rateis high. In patients with acute spontaneous subdural hematoma, as seen on CT, associated subarachnoid orintracerebral hemorrhage is strongly indicative of intracerebral vascular abnormalities such as aneurysm andarteriovenous malformation, and cerebral angiography is necessary. To ensure proper treatment and thus morkedlyreduce mortality, the causes of bleeding should be prompty determined by means of cerebral angiography.

Keyword

Aneurysm, cerebral; Brain, hemorrhage; Brain, CT; Brain, angiography

MeSH Terms

Aneurysm
Arteriovenous Malformations
Cerebral Angiography
Cerebral Hemorrhage
Hematoma
Hematoma, Subdural*
Hemorrhage
Humans
Intracranial Aneurysm
Mortality
Moyamoya Disease
Retrospective Studies
Tomography, X-Ray Computed

Figure

• 

  Fig. 1. 56 year-old female (Case No. 2) with the aneurysm. A. Noncontrast CT scan shows diffuse subarachnoid hemorrhage and thin subdural hematoma in both frontal repions. B. Left internal carotid angiogram shows small round aneurysm (arrowheads) on the bifurcation of left miadle cerebral artery.

• 

  Fig. 2. 24 year-old female (Case No. 8) with the arteriovenous malformation. A. Noncontrast CT scan shows thick subdural hematoma on the left frontotemporal region and some intracerebral hematoma in adjacent cortical region. Mild midline shifting is seen to the right side. B. Left internal carotid angiogram shows the nidus of small arteriovenous malformation feeding from precentral branch of the left middle cerebral artery.

• 

  Fig. 3. 59 year-old female (Case No. 10) with moyamoya disease. A. Noncontrast CT scan shows thin acute subdural hematoma on left frontotemporal region with intraventricular hemorrhage and subarac- hmoid hemorrhage. Ventricular shunt catheter was inserted. B. Left internal carotid angiogram shows occlusion of distal internal cerebral artery with some moyamoy- a vessels. Right cartoid angiogram (not shown) shows similar findings as left.

• 

  Fig. 4. 1.7 month-old female (Case No. 15) with hemorrhagic disease. Axial (A) and sagittal (B) Tl- weighted spin echo images show diffuse subdural hematoma in both occipitotemporoparietal region.

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