title: Subpial Hematoma and Extravasation in the Interhemispheric Fissure with Subarachnoid Hemorrhage.
abstract: A recent report on computed tomography (CT) findings of contrast extravasation in subarachnoid hemorrhage (SAH) with Sylvian hematoma suggests that the occurrence of the hematoma is secondary to bleeding in the subpial space. Our patient was in his sixties and was admitted to the hospital because of loss of consciousness (Glasgow Coma Scale E4V1M4). SAH was diagnosed in plain head CT, and growing hematomas were observed in the Sylvian and interhemispheric fissures following a subarachnoid hemorrhage. CT angiography (CTA) using a dual-phase scan protocol revealed contrast extravasation in both the fissures in the latter phase, and hematoma in the interhemispheric fissure contained multiple bleeding points. This case indicates that the occurrence of subpial hematoma such as Sylvian hematoma can be a secondary event following subpial bleeding from damaged small vessels elsewhere in the cranium. Instead of four-dimensional (4D) CT, the dual-phase CTA technique may help detect minor extravasations with usual helical CT scanner.
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine kasuzuki-rad@umin.ac.jp.
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Suzuki
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University; Tokyo, Japan.
authors.forename: Go
authors.initials: G
authors.lastname: Matsuoka
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine.
authors.forename: Kayoko
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Neurosurgery, Tokyo Women's Medical University; Tokyo, Japan.
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Okada
authors.affiliation: Department of Diagnostic Imaging and Nuclear Medicine.
authors.forename: Shuji
authors.initials: S
authors.lastname: Sakai
mesh_terms: D002533:Cerebral Angiography; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010841:Pia Mater / Q000000981:diagnostic imaging*; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging*; D036542:Tomography, Spiral Computed; D014057:Tomography, X-Ray Computed
keywords: Sylvian hematoma; computed tomography; subarachnoid hemorrhage; subpial hematoma