Male, 64 years old, with aphasia and subdural hemorrhage, Brain:Bilateral cerebral convexity subdural collections are redemonstrated showing no significant interval change. They continue to measure up to 10 mm in thickness.No significant parenchymal signal abnormality is detected. No edema or mass effect is observed. No findings to suggest parenchymal hemorrhage are seen. The ventricular system is stable and normal in size.Spine:Extra-thecal fluid collections are evident along the ventral aspect of the thecal sac at L5 and S1 showing signal characteristics compatible with hemorrhage. By virtue of their morphology, these collections are favored to be subdural rather than epidural in location. They measure up to 8 mm in thickness at the S1 level with moderate associated thecal sac narrowing. Trace blood product is also evident along the dorsal thecal sac more distally at S2.No other epidural, subdural or intrathecal blood product is seen in the spine. The visualized spinal cord, conus and cauda equina demonstrate normal signal intensity and morphology.Spinal alignment is anatomic. Vertebral body heights are preserved. Although marrow signal is mildly heterogeneous in some places, no definite evidence of any pathologic marrow replacement is seen to suggest the presence of tumor.In the cervical spine, only mild disc osteophyte formation is seen without significant spinal canal narrowing. Moderately severe foraminal narrowing is seen on the left at C3-4, largely due to facet hypertrophy.In the thoracic spine, no significant disc bulge or disc herniation is seen. The spinal canal and neural foramina are patent.In the lumbar spine, loss of disc height and T2 signal is seen at L3-4, L4-5 and L5-S1. Additional level specific findings are as follows:L3-4: Mild facet hypertrophy. Disc bulge with a left foraminal protrusion. No significant generalized spinal canal stenosis. Mild left foraminal narrowing.L4-5: Facet hypertrophy, worse on the right. Disc bulging. Effacement of the right subarticular recess. Moderate right foraminal narrowing.L5-S1: Facet hypertrophy. Disc bulging asymmetric to the left. Mild effacement of the left lateral recess. Narrowing of the thecal sac due primarily to the extrathecal collection. Severe right and moderate left foraminal narrowing.Incidental note is made of scattered pleural fluid and pleural thickening on the left. At least two fractured left-sided ribs are demonstrated.
1.No significant change in the size or distribution of bilateral convexity subdural hematomas. No significant brain parenchymal abnormalities are seen.2.Extra-thecal hemorrhage, likely subdural, is seen along the ventral thecal sac at L5 and S1. These collections do result in moderate narrowing of the thecal sac, most notably at S1. The etiology for this hemorrhage is not certain. It could represent the same process that induced intracranial subdural bleeding, or it could potentially represent dependent redistribution of intracranial blood product.