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Updated: Jun 24, 2026
Advanced Diffusion Imaging in The Hippocampus of Rats with Mild Traumatic Brain Injury
Published on: August 14, 2019
[Case of infected subdural hematoma diagnosed by diffusion-weighted imaging]
Eriko Narita1, Jun Maruya, Keiichi Nishimaki
1Department of Neurosurgery, Akita Red Cross Hospital, 222-1 Nawashirosawa, Saruta, Kamikitate, Akita 010-1495, Japan.
Abstract:
An 80-year-old man who had undergone total gastrectomy and splenectomy for gastric cancer 13 years ago presented with headache, drowsiness, and high fever 1 month after a traffic accident. Brain CT scans revealed bilateral subdural fluid collections. Diffusion-weighted imaging (DWI) showed mixed high and low signal intensities in the left subdural fluid, and contrast-enhanced MR imaging revealed capsule enhancement of the left subdural fluid collection. The patient was diagnosed with left subdural empyema, and 2 burr-holes were drilled for drainage and irrigation. Operative findings revealed a neomembrane underneath the dura mater. Old hematoma and yellowish-white purulent fluid were present within the neomembrane. This confirmed the diagnosis of infected subdural hematoma (ISH). Abscess culture results were positive for Escherichia coli. The patient's symptoms resolved postoperatively with subsequent antibiotic therapy. However, 4 months after the operation, he suddenly died of severe sepsis and disseminated intravascular coagulation following cholecystitis, which was possibly associated with splenectomy. The clinical presentation, diagnosis, and treatment of an unusual case of ISH have been discussed. We emphasize that DWI and enhanced MR imaging may be useful for diagnosing ISH, and serial DWI evaluations may help in monitoring the therapeutic response in ISH.
Insights
This case study highlights an unusual infected subdural hematoma (ISH) in an elderly patient post-gastrectomy. Advanced MRI techniques like diffusion-weighted imaging (DWI) aided diagnosis and monitoring of this rare brain infection.
Area of Science:
- Neurology
- Infectious Diseases
- Radiology
Background:
- Elderly patients with a history of major surgery, such as total gastrectomy and splenectomy, may be at increased risk for complex infections.
- Subdural empyema and infected subdural hematoma (ISH) are rare but serious intracranial infections requiring prompt diagnosis and management.
Observation:
- An 80-year-old male, 13 years post-gastrectomy and splenectomy, presented with fever, headache, and drowsiness after a traffic accident.
- Brain imaging revealed bilateral subdural fluid collections; diffusion-weighted imaging (DWI) and contrast-enhanced MRI suggested a left subdural empyema.
- Surgical intervention and abscess cultures identified an infected subdural hematoma (ISH) caused by Escherichia coli.
Findings:
- The patient's acute symptoms resolved with surgical drainage, irrigation, and antibiotic therapy.
- Despite initial recovery, the patient later died from severe sepsis and disseminated intravascular coagulation, possibly linked to the prior splenectomy.
- The case underscores the diagnostic utility of DWI and enhanced MRI in identifying ISH.
Implications:
- Diffusion-weighted imaging (DWI) and enhanced MRI are valuable tools for the diagnosis of infected subdural hematoma (ISH).
- Serial DWI evaluations can assist in monitoring treatment response for ISH.
- Splenectomy may increase susceptibility to severe sepsis and associated complications, even years after the procedure.
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