[Indentation sign in the sylvian sulcus and the arterial origin of an acute subdural hematoma. Contribution of computerized tomography].
Thirty-two traumatic subdural haematomas were operated between 1984 and 1990. In 16 cases (50%), we encountered, after removal of the heamorrhage, a bleeding from a cortical artery at the lateral sulcus (middle cerebral artery). Four mechanisms of arterial bleeding have been reported: a) rupture of a cortico-dural bridging artery, b) "fire-hose" rupture, c) rupture at the level of an arachnoid attachment and d) rupture at the level of a dural adhesion. The characteristic finding of such haematomas on computerized tomography (CT-scan) was an indentation towards the lateral sulcus. This was called the "double brackets sign". In seventy-nine percent of subdural haematomas of arterial origin, the "double brackets sign" was demonstrated on CT-scan on at least two slices (9 mm). In 9% of subdural haematomas of non-arterial origin, this sign was absent or present in only one CT image. The characteristic "double brackets sign", when present on 3 or 4 CT-scan images, seems to have a very high specificity for an arterial origin of the haematoma.
Candon
E
E
Service de Neurochirurgie, CHG de Saint-Pierre-le-Tampon.
Isnard
J
J
Bousquet
C
C
Choucair
Y
Y
Laporte
J P
JP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications*; D002533:Cerebral Angiography; D005260:Female; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011300:Preoperative Care; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
Le signe de l'indentation dans la vallée sylvienne et l'origine artérielle d'un hématome sous-dural aigu. Apport du diagnostic tomodensitométrique.