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Septum pellucidum hemorrhage

Case contributed by Dr Vijay Mistry

Presentation

Motor vehicle accident. No loss of consciousness. Scalp hematoma. Retrograde amnesia.

Patient Data

Age: 75 years
Gender: Female
CT

Non-contrast CT head performed on presentation

7 x 5 mm hyperdensity (64 HU) in the posterior aspect of the septum pellucidum, suspicious for focal hemorrhage in the setting of trauma.

Right parietal scalp hematoma.

CT

Non-contrast CT head performed 24 hours after presentation

Interval increase in the hyperdensity in the posterior aspect of the septum pellucidum, now measuring 17 x 14 mm (58 HU), in keeping with a septum pellucidum hemorrhage.

Stable right parietal scalp hematoma.

MRI

MR Brain performed 2 days after initial presentation

17 x 14 mm focus in the septum pellucidum demonstrates isointense T1 signal, hypointense T2 signal with signal loss on susceptibility weighted imaging (SWI) in keeping with hemorrhage. Subtle T2 and SWI hypointensities in the occipital horns of the lateral ventricles, in keeping with intraventricular extension of hemorrhage. Stable right parietal scalp hematoma.

CT

Non-contrast CT head performed 12 days after presentation

Known septum pellucidum hemorrhage remains stable in size, 18 x 16 mm, with interval evolution in density (42 HU). Resolution of the right-sided scalp hematoma.

CT

Follow-up imaging performed 41 days following initial presentation

Interval reduction in size of the septum pellucidum hemorrhage, now 13 x 7 mm (40 HU).

Case Discussion

This case demonstrates a traumatic septum pellucidum hemorrhage in the setting of a motor vehicle accident. The patient was a restrained driver in a vehicle that was t-boned. They were able to self-extricate and ambulate independently following the accident. She denied any loss of consciousness. The patient was not on any anti-coagulation medication. No prior imaging was available for comparison.

Initial imaging demonstrated the small hyperdensity in the posterior septum pellucidum. Repeat imaging was performed 24 hours following initial presentation which confirmed initial suspicions of a septum pellucidum hemorrhage with interval increase in the size of the hyperdensity. The patient was observed and apart from a headache, demonstrated no other neurological symptoms. MRI brain performed two days after initial presentation also demonstrated small-volume interventricular extension, however the patient remained asymptomatic. The patient was discharged home and remained asymptomatic with short-interval outpatient follow-up.

A potential pitfall considering the hyperdensity a thrombosis of the inferior sagittal sinus, which runs along the inferior (free) edge of the falx cerebri from anterior to posterior. In this case, it is easily distinguishable as hemorrhage by using the coronal and sagittal views.

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Case information

rID: 75591
Published: 5th Apr 2020
Last edited: 8th Apr 2020
Inclusion in quiz mode: Included
Institution: Princess Alexandra Hospital

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