EURORAD ESR

Case 14582

Irrelevant stroke code protocol? Hidden spontaneous acute spinal subdural haematoma.

Author(s)
PESQUERA MUÑOZ, A.S.; DUALDE BELTRÁN, D.; LEÓN GUIJARRO, J.L.; ALIAGA MÉNDEZ, R.; FLORES CASAPERALTA, S.; PIÑANA PLAZA, C; RUBIO, MAICAS, C.

Hospital Clínico Universitario de Valencia, Department of Radiology; Avenida Blasco Ibañez 17

46010 Valencia, Spain;
Email:aspm.sasao@gmail.com
 
Patient
male, 85 year(s)
 
 
  • Figure 1
    Cranial non enhanced CT

    Cranial non enhanced CT is normal for age, without acute hemorrhage or early ischaemic signs.

     
    Area of Interest: Head and neck; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Haemorrhage;
     
     
  • Figure 2
    Stroke code protocol

    Stroke code protocol: Brain and neck CT-angiography. It is normal for age too. No occlusion, no dissection, no significative stenosis.

     
    Area of Interest: Head and neck; Imaging Technique: CT-Angiography; Procedure: Contrast agent-intravenous; Special Focus: Embolism / Thrombosis; Obstruction / Occlusion;
     
     
  • Figure 3
    Cervical MRI sequences
     

    Axial T2-WI Echo-gradient RM image shows extramedular collection at C2-C4 level which displaces spinal cord to the right spinal recess and presents peripheral hypointense ring of hemosiderin.

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Blood; Haemorrhage;

    Axial T1-WI+Gd FAT SAT: Collection appears hypointense and has no enhancement. It is located within thecal sac (black thin line, blue arrows). Epidural enhanced fat is not compressed at this level (yellow arrowheads).

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Contrast agent-intravenous; Special Focus: Blood; Haemorrhage;

    Sagittal T1-WI non enhanced (left) and sagittal T1-WI+Gd (right): Isodense collection respect to spinal cord is hardly identified at C2-C4 level (yellow arrowheads). It does not present any enhancement.

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Comparative studies; Contrast agent-intravenous; Special Focus: Blood; Haemorrhage;

    Axial T2-WI shows that collection is predominantly hypointense compared with spinal cord , as well as on T1-WI (black thin line, blue arrows)

     
    Area of Interest: Head and neck; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Blood; Haemorrhage;
     
     
  • Figure 4
    Stroke code protocol. "Take home" image

    Stroke code protocol: Brain and neck CT-angiography, sagittal plane. Reviewing images, a hyperdense collection into spinal canal is detected which was not identified initially (yellow arrowheads).

     
    Area of Interest: Head and neck; Imaging Technique: CT-Angiography; Procedure: Diagnostic procedure; Special Focus: Embolism / Thrombosis; Obstruction / Occlusion;
     
     
Cranial non enhanced CT is normal for age, without acute hemorrhage or early ischaemic signs.
 
Stroke code protocol: Brain and neck CT-angiography. It is normal for age too. No occlusion, no dissection, no significative stenosis.
 
Axial T2-WI Echo-gradient RM image shows extramedular collection at C2-C4 level which displaces spinal cord to the right spinal recess and presents peripheral hypointense ring of hemosiderin.
 
Axial T1-WI+Gd FAT SAT: Collection appears hypointense and has no enhancement. It is located within thecal sac (black thin line, blue arrows). Epidural enhanced fat is not compressed at this level (yellow arrowheads).
 
Sagittal T1-WI non enhanced (left) and sagittal T1-WI+Gd (right): Isodense collection respect to spinal cord is hardly identified at C2-C4 level (yellow arrowheads). It does not present any enhancement.
 
Axial T2-WI shows that collection is predominantly hypointense compared with spinal cord , as well as on T1-WI (black thin line, blue arrows)
 
Stroke code protocol: Brain and neck CT-angiography, sagittal plane. Reviewing images, a hyperdense collection into spinal canal is detected which was not identified initially (yellow arrowheads).
 
 
 
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