Indentation sign in the sylvian sulcus and the arterial origin of an acute subdural hematoma. Contribution of computerized tomography
Candon, E.; Isnard, J.; Bousquet, C.; Choucair, Y.; Laporte, J.P.
Annales de Radiologie 36(4): 269-274
1993
ISSN/ISBN: 0003-4185 PMID: 8239466 Document Number: 416834
Thirty-two traumatic subdural haematomas were operated between 1984 and 1990. In 16 cases (50%), we encountered, after removal of the heamorrhage, a bleeding from a cortical artery at the lateral sulcus (middle cerebral artery). Four mechanisms of arterial bleeding have been reported: a) rupture of a cortico-dural bridging artery, b) "fire-hose" rupture, c) rupture at the level of an arachnoid attachment and d) rupture at the level of a dural adhesion. The characteristic finding of such haematomas on computerized tomography (CT-scan) was an indentation towards the lateral sulcus. This was called the "double brackets sign". In seventy-nine percent of subdural haematomas of arterial origin, the "double brackets sign" was demonstrated on CT-scan on at least two slices (9 mm). In 9% of subdural haematomas of non-arterial origin, this sign was absent or present in only one CT image. The characteristic "double brackets sign", when present on 3 or 4 CT-scan images, seems to have a very high specificity for an arterial origin of the haematoma.