title: Insular infarction in subdural hematoma: A case series and pathophysiologic review.
abstract: Subdural hematoma (SDH) is among the most common conditions managed by neurologists and neurosurgeons. As SDH incidence rates increase, a wider spectrum of SDH related complications have become evident. We prospectively identified a series of three patients with similar patterns of ipsilateral insular diffusion weighted imaging (DWI) hyperintensity associated with subdural hematoma. Detailed chart review was performed, and cases are described in relation to anatomy and proposed pathophysiology of venous hypertension and arterial vasospasm. The DWI changes were evident in all cases where clinical deficits following SDH evacuation were out of proportion to computed tomography findings. Therefore SDH-associated insular infarction may be a marker of greater disease severity, and further study of management and outcomes is needed.
authors.affiliation: Department of Neurology, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Sacchetti
authors.affiliation: Warren Alpert Medical School, Brown University, 222 Richmond St., Providence, RI 02903, USA.
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Yan
authors.affiliation: Department of Neurology, Rhode Island Hospital, 593 Eddy St., Providence, RI 02903, USA.
authors.forename: Bradford B
authors.initials: BB
authors.lastname: Thompson
authors.affiliation: Department of Neurology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: cfehnel@bidmc.harvard.edu.
authors.forename: Corey R
authors.initials: CR
authors.lastname: Fehnel
mesh_terms: D000328:Adult; D000368:Aged; D002540:Cerebral Cortex / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D002544:Cerebral Infarction / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006408:Hematoma, Subdural / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed
keywords: Cerebral blood flow; Cerebrovascular disease; MRI; Stroke; Subdural hematoma