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Images in Neurology |

Cerebral and Spinal Cord Subdural Hematomas

Alexandra LaMela, MS; Karen M. Lynch, MD, MRCPI; Mary Anne Muriello, MD; Doreen T. Ho, MD
Arch Neurol. 2012;69(4):543. doi:10.1001/archneurol.2011.2220.
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A 58-year-old man came to us from another hospital with severe back pain radiating to the knees, lower extremity weakness, and mild headache over 3 weeks. Because of inconsistent monitoring, the patient was supratherapeutic while taking warfarin, which he took for atrial fibrillation (international normalized ratio, 6.2). Magnetic resonance imaging revealed 2 subdural hematomas—1 acute and 1 chronic—along the left cerebral hemisphere and in the spinal cord from T5 to T12 as well as in the lumbosacral canal (Figure 1 and Figure 2).1The only trauma he reported was periodically hitting his head on a shelf in his home. He underwent frontotemporal craniotomy and hematoma evacuation when his international normalized ratio was 1.4. His lower extremity deficits improved with conservative treatment. He did well postoperatively, having only minor headaches at follow-up.

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Figure 1. Brain magnetic resonance image without contrast. Axial T1 image of the brain revealed 2 left-sided subdural hematomas of differing ages with associated mass effect.

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Figure 2. Thoracic and lumbar magnetic resonance images without contrast. A, Sagittal T1 image of the thoracic spine showed a hyperintense signal in the posterior aspect of the spinal canal from T5 to T12. B, A prone axial T2 view revealed layering of blood consistent with subdural hematomas. C, Pooling of blood in the lumbosacral canal was noted in the sagittal T1 image.




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