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Kuninaka H, Usumoto Y, Tanabe M, Ogawa N, Mukai M, Nasu A, Maeda K, Fuke C, Sawamura S, Yamashiro T, Utsunomiya D, Ihama Y. Distinguishing true from pseudo hematoma in the cervical spinal canal using postmortem computed tomography. Leg Med (Tokyo) 2024; 66:102358. [PMID: 38056179 DOI: 10.1016/j.legalmed.2023.102358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/08/2023]
Abstract
Spinal cord injury is difficult to detect directly on postmortem computed tomography (PMCT) and it is usually diagnosed by indirect findings such as a hematoma in the spinal canal. However, we have encountered cases where the hematoma-like high-attenuation area in the cervical spinal canal was visible on PMCT, while no hematoma was observed at autopsy; we called it a "pseudo hematoma in the cervical spinal canal (pseudo-HCSC)." In this retrospective study, we performed statistical analysis to distinguish true from pseudo-HCSC. The cervical spinal canal was dissected in 35 autopsy cases with a hematoma-like high-attenuation area (CT values 60-100 Hounsfield Unit (HU)) in the spinal canal from the first to the fourth cervical vertebrae in axial slices of PMCT images. Of these 22 had a hematoma and 13 did not (pseudo-HCSC). The location and length of the hematoma-like high-attenuation and spinal cord areas were assessed on reconstructed PMCT images, true HCSC cases had longer the posterior hematoma-like area and shorter the spinal cord area in the midline of the spinal canal (P < 0.05). Furthermore, we found that true HCSC cases were more likely to have fractures and gases on PMCT while pseudo-HCSC cases were more likely to have significant facial congestion (P < 0.05). We suggest that pseudo-HCSC on PMCT is related to congestion of the internal vertebral venous plexus. This study raises awareness about the importance of distinguishing true HCSC from pseudo-HCSC in PMCT diagnosis, and it also presents methods for differentiation between these two groups.
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Affiliation(s)
- Hikaru Kuninaka
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Yosuke Usumoto
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan; Department of Forensic Pathology and Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi, Fukuoka, Fukuoka 812-8582, Japan.
| | - Momoka Tanabe
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Noriko Ogawa
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan
| | - Moe Mukai
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Ayako Nasu
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Kazuho Maeda
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Chiaki Fuke
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Shungo Sawamura
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Tsuneo Yamashiro
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Daisuke Utsunomiya
- Department of Diagnostic Radiology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
| | - Yoko Ihama
- Department of Legal Medicine, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa, Yokohama, Kanagawa 236-0004, Japan.
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Namatame K, Igarashi Y, Nakae R, Suzuki G, Shiota K, Miyake N, Ishii H, Yokobori S. Cerebral edema associated with diabetic ketoacidosis: Two case reports. Acute Med Surg 2023; 10:e860. [PMID: 37346084 PMCID: PMC10280603 DOI: 10.1002/ams2.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/15/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Background Diabetic ketoacidosis (DKA) is associated with a high mortality rate, especially if cerebral edema develops during the disease course. It is rarer and more severe in adults than in children. We present cases of two patients with cerebral edema-related DKA. Case presentation The first patient was a 38-year-old man with diabetes mellitus who presented with DKA-related disturbed consciousness. Although glycemic correction was performed slowly, he showed pupil dilation 11 h later. He underwent emergency ventricular drainage, but died of cerebral herniation. The second patient was a 25-year-old woman who presented with impaired consciousness secondary to DKA. Head computed tomography showed subarachnoid hemorrhage and cerebral edema. No related intraoperative findings were observed; it was concluded that the first computed tomography scan revealed pseudo-subarachnoid hemorrhage. Conclusion Diabetic ketoacidosis-related cerebral edema develops despite treatment according to guidelines and is difficult to predict. Therefore, adult patients should be treated cautiously during DKA management.
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Affiliation(s)
- Kaoru Namatame
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Yutaka Igarashi
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Ryuta Nakae
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Go Suzuki
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
- Department of Emergency and Critical Care MedicineKawaguchi Municipal Medical CenterSaitamaJapan
| | - Kohei Shiota
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Nodoka Miyake
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Hirotomo Ishii
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
| | - Shoji Yokobori
- Department of Emergency and Critical Care MedicineNippon Medical SchoolTokyoJapan
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Fretwell ME, Mullaguri N, Sivakumar S, Knipfing M. Pseudo Subarachnoid Hemorrhage Sign in Bacterial Meningitis in a Patient Presenting With Acute Ischemic Stroke: A Novel Radiological Clue to Rapid Diagnosis. Cureus 2022; 14:e25283. [PMID: 35755497 PMCID: PMC9224982 DOI: 10.7759/cureus.25283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
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