title: A case report of rapid spontaneous redistribution of acute supratentorial subdural hematoma to the entire spinal subdural space presenting as a Pourfour du Petit syndrome and review of the literature.
abstract: OBJECTIVE
  This report illustrates the rare rapid spontaneous redistribution of an acute intracranial supratentorial subdural hematoma (AISSDH) to the entire spinal subdural space (SSS). The study is also unique in that the spinal subdural hematoma (SSH) manifested by the extremely rare Pourfour du Petit Syndrome (PPS).
  
  
  METHODS
  A 66-year-old man sustained blunt head trauma. On admission to the regional hospital, he scored 6 on GCS and his pupils were of equal size reacting to light. Initial computed tomography (CT) scan showed a unilateral AISSDH. The patient was referred to our department and arrived 16 h following the accident, at which time a repeat CT scan revealed almost complete resolution of the AISSDH without clinical improvement. On the 9th postinjury day transient anisocoria and tachycardia without spinal symptomatology developed. Since neither neurological examination nor follow-up CT scans showed intracranial pathology explaining the anisocoria, the patient was treated further conservatively. During the next 3 days circulatory instability developed and the patient succumbed to primary traumatic injury. Autopsy revealed a SSH occupying the entire SSS.
  
  
  CONCLUSIONS
  This case calls attention to the unique combination of the displacement of an AISSDH to the SSS and the presentation of this clinical entity by the PPS.
authors.affiliation: Department of Neurosurgery, Faculty Hospital Olomouc, I.P. Pavlova 6, 775 20 Olomouc, Czech Republic. balik.vladimir@gmail.com
authors.forename: Vladimir
authors.initials: V
authors.lastname: Balik
authors.forename: Petr
authors.initials: P
authors.lastname: Kolembus
authors.forename: Marian
authors.initials: M
authors.lastname: Svajdler
authors.forename: Igor
authors.initials: I
authors.lastname: Sulla
authors.forename: Miroslav
authors.initials: M
authors.lastname: Vaverka
authors.forename: Lumir
authors.initials: L
authors.lastname: Hrabalek
mesh_terms: D000059:Accidents; D000368:Aged; D015875:Anisocoria / Q000209:etiology; D006259:Craniocerebral Trauma / Q000150:complications / Q000473:pathology; D017809:Fatal Outcome; D020199:Hematoma, Subdural, Acute / Q000150:complications* / Q000175:diagnosis / Q000473:pathology*; D046649:Hematoma, Subdural, Spinal / Q000150:complications; D006801:Humans; D008297:Male; D012075:Remission, Spontaneous; D013355:Subdural Space / Q000473:pathology*; D013577:Syndrome; D013610:Tachycardia / Q000150:complications; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000473:pathology