A 32-year-old male was admitted to the emergency room due to traumatic brain injury. The computed tomography (CT), three hours after the trauma, showed an epidural hematoma with the swirl signal. After 24 hours the patient evolved with worsening of the condition and the CT was repeated (Figure).
(A, B and C) Non-contrast CT shows an epidural hematoma (arrow in A) with the swirl signal (arrow in C). After 24 hours, a new non-contrast CT showed an evident hematoma expansion (D and E).
The swirl signal is described as an area of low attenuation within an hyperattenuating hematoma11. Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management. Neurol Sci. 2017 Dec;38(12):2111–6. https://doi.org/10.1007/s10072-017-3121-4
https://doi.org/10.1007/s10072-017-3121-...
. Recent studies indicate that the swirl signal is a direct sign of hematoma expansion, associated with high morbidity and mortality rates11. Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management. Neurol Sci. 2017 Dec;38(12):2111–6. https://doi.org/10.1007/s10072-017-3121-4
https://doi.org/10.1007/s10072-017-3121-...
. Unlike the spot sign, another predictor of epidural hematoma expansion22. Wagemans BA, Klinkenberg S, Postma AA. Teaching neuroimages: swirl sign and spot sign in intraparenchymal hematoma. Neurology. 2016 Nov;87(18):e225-6. https://doi.org/10.1212/WNL.0000000000003290
https://doi.org/10.1212/WNL.000000000000...
–55. Rosa Júnior M, Rocha AJ, Maia Júnior AC, Saade N, Veiga JC, Romero JM. Contusion contrast extravasation depicted on multidetector computed tomography angiography predicts growth and mortality in traumatic brain contusion. J Neurotrauma. 2016 Jun;33(11):1015-22. https://doi.org/10.1089/neu.2015.4062
https://doi.org/10.1089/neu.2015.4062...
, the swirl signal does not require the use of contrast.
References
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1Guo C, Liu L, Wang B, Wang Z. Swirl sign in traumatic acute epidural hematoma: prognostic value and surgical management. Neurol Sci. 2017 Dec;38(12):2111–6. https://doi.org/10.1007/s10072-017-3121-4
» https://doi.org/10.1007/s10072-017-3121-4 -
2Wagemans BA, Klinkenberg S, Postma AA. Teaching neuroimages: swirl sign and spot sign in intraparenchymal hematoma. Neurology. 2016 Nov;87(18):e225-6. https://doi.org/10.1212/WNL.0000000000003290
» https://doi.org/10.1212/WNL.0000000000003290 -
3Rosa Júnior M, Rocha AJ, Saade N, Maia Júnior AC, Gagliardi RJ. Active extravasation of contrast within the hemorrhage (spot sign): a multidetector computed tomography finding that predicts growth and a worse prognosis in non-traumatic intracerebral hemorrhage. Arq Neuropsiquiatr. 2013 Oct;71(10):791-7. https://doi.org/10.1590/0004-282X20130124
» https://doi.org/10.1590/0004-282X20130124 -
4Rosa Júnior M, Rocha AJ, Maia Júnior AC, Saade N, Gagliardi RJ. The active extravasation of contrast (spot sign) depicted on multidetector computed tomography angiography might predict structural vascular etiology and mortality in secondary intracranial hemorrhage. J Comput Assist Tomogr. 2015 Mar-Apr;39(2):217-21. https://doi.org/10.1097/RCT.0000000000000182
» https://doi.org/10.1097/RCT.0000000000000182 -
5Rosa Júnior M, Rocha AJ, Maia Júnior AC, Saade N, Veiga JC, Romero JM. Contusion contrast extravasation depicted on multidetector computed tomography angiography predicts growth and mortality in traumatic brain contusion. J Neurotrauma. 2016 Jun;33(11):1015-22. https://doi.org/10.1089/neu.2015.4062
» https://doi.org/10.1089/neu.2015.4062
Publication Dates
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Publication in this collection
Feb 2019
History
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Received
14 Sept 2018 -
Reviewed
11 Oct 2018 -
Accepted
12 Nov 2018
