A 31-year-old woman with history of antiphospholipid syndrome treated with warfarin reported two days after a roller-coaster ride, sudden onset of paresthesias in the right side of the face and in the right hand, followed by headache. Neuroimaging results are shown in Figures 1 and 2.
The “blood/fluid level” represented by the interface between plasma and
sedimented blood (Figure 1) can be seen in
hemorrhages related to bleeding disorders, among other causes11 Mittal MK, Burkholder DB, Wijdicks EF. Blood-fluid level on computed
tomography head: a sign of warfarin-associated intraparenchymal hemorrhage. Am J
Emerg Med. 2012;30(9):2079.e1-2.
http://dx.doi.org/10.1016/j.ajem.2011.10.015
https://doi.org/10.1016/j.ajem.2011.10.0...
. We suspect that the sudden head and neck movements
during the roller-coaster ride contributed to the remarkably unusual combination of
subdural hematoma and carotid artery dissection (Figure
2) in this patient.
(A) Initial head CT shows subdural hematomas in the left temporal region (arrowhead) and in the left tentorium (arrow), where a blood-fluid level can be observed; (B) Follow-up brain MR: axial FLAIR; and (C) SWI and sagittal postcontrast T1-weighted images demonstrate more clearly the same findings, the blood-fluid level (arrows in B to D) and the temporal subdural hematoma (arrowheads, B and C).
Reference
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1Mittal MK, Burkholder DB, Wijdicks EF. Blood-fluid level on computed tomography head: a sign of warfarin-associated intraparenchymal hemorrhage. Am J Emerg Med. 2012;30(9):2079.e1-2. http://dx.doi.org/10.1016/j.ajem.2011.10.015
» https://doi.org/10.1016/j.ajem.2011.10.015
Publication Dates
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Publication in this collection
Dec 2014
History
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Received
02 Aug 2014 -
Reviewed
21 Aug 2014 -
Accepted
09 Sept 2014