Rev Esp Med Nucl Imagen Mol. 2012;31(2):110

Interesting images

Incidental finding of bilateral subdural hematoma on brain perfusion SPECT
Hallazgo casual de un hematoma subdural bilateral mediante SPECT de perfusión cerebral
A.M. Álvarez, A. Serena ∗ , J.M. Nogueiras, J. Barandela, O. Rivas, L. Campos
Servicio de Medicina Nuclear, Hospital do Meixoeiro (CHUVI), Vigo, Spain

a r t i c l e

i n f o

Article history:
Received 28 August 2011
Accepted 30 August 2011
Available online 26 November 2011

A brain perfusion SPECT was performed in a 58-year-old male
with mild cognitive impairment. He suffered behavioral disorders
and memory loss and had a first-degree family history of dementia, so the neurologist requested neuroimaging and a genetic study.
Two months prior to Nuclear Medicine appointment the patient
presented a seizure and fell down, but immediate post-ictal CT
scan only revealed cortico-subcortical atrophy and no subsequent
clinical changes happened.

99mTc-ECD (Neurolite® ) SPECT showed an atypical morphology of anterior cerebral pole due to bilateral disappearance of
the frontal convexity (large arrows) and parenchymal medial
displacement that produced an elongated brain shape. Subtle crescent photopenic areas and a slight decrease of cortical perfusion
in the dorsolateral surface of frontal lobes were also observed
on both sides (small arrows). These findings pointed out to an
extra-axial compression and were suggestive of chronic subdural hematomas.1,2 A new CT scan evidenced an extensive bilateral
fronto-temporal subdural collection with bleeding areas and mass
effect (Fig. 1).The patient underwent surgery with excellent clinical
and image evolution. On the other hand the genetic study identified changing of an alanine to a threonine at 152 position of the
protein encoded by the gene MAPT (NP005901.2: p.A152T), a mutation described on the literature as linked to Alzheimer disease,
but currently the patient is clinically stable.CT diagnosis of subdural hematoma is straightforward, but clinical suspicion sometimes
can be challenging. Brain perfusion SPECT provides highly relevant
information for diagnosis and monitoring of cognitive disorders.3
However, a proper assessment of emission tomography should not
only include cortical and subcortical perfusion but also be aware of
indirect signs of bone and soft tissue disease so that extracerebral
pathology will not be overlooked.
References

Fig. 1. 99mTc-ECD (Neurolite® ) SPECT.

1. Wilson M, Lazzaro N, Thierry A, Abghari R. Bilateral subdural hematomas
detected on brain SPECT. Clin Nucl Med. 2007;32:559–61.
2. Toyama H, Ichise M, Schacter BI, Kirsh JC. Reverse crescent pattern on SPECT brain
perfusion scan in chronic subdural hematoma. Clin Nucl Med. 1992;17:473–6.
3. Banzo I, Quirce R, Martínez-Rodriguez I, Jimenez-Bonilla J, PortillaQuattrocciochi H, Medina-Quiroz P, et al. Molecular neuroimaging in the
study of cognitive impairment: contribution of the cerebral blood flow
SPECT with (99m)Tc-HMPAO and (18)F-FDG PET/CT scan. Rev Esp Med Nucl.
2011;30:301–6.

∗ Corresponding author.
E-mail addresses: aserena58@hotmail.com, andres.serena.puig@sergas.es (A. Serena).
2253-654X/$ – see front matter © 2011 Elsevier España, S.L. and SEMNIM. All rights reserved.
doi:10.1016/j.remn.2011.08.003