Subdural hemorrhage - CTA spot sign

Case contributed by Assoc Prof Frank Gaillard


Head injury

CT of the brain demonstrates a large acute subdural hemorrhage with associated extensive cerebral contusions and a large scalp hematoma on the left, in keeping with a coup-contrecoup injury pattern. 

CTA demonstrates a globular blush of contrast (spot sign) representing active extravasation of blood into the subdural hemorrhage.

Case Discussion

It is always important to remember that CT is a snapshot of a potentially dynamic process, and the size of a hemorrhage at the time of the scan does not mean that it will not continue to enlarge. Presence of a spot sign in parenchymal hemorrhages has been well described, however, identical findings will be seen wherever active bleeding occurs. 

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