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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2019; 77(02): 140-141
DOI: 10.1590/0004-282X20190010
Images in Neurology

Swirl sign in epidural hematoma

Sinal do redemoinho no hematoma epidural
Marcos Rosa  Júnior
1   Universidade Federal do Espírito Santo, Empresa Brasileira de Serviços Hospitalares, Hospital Universitário Cassiano Antçnio de Moraes, Departamento de Neurorradiologia, Vitória ES, Brasil;
,
Larissa Aguiar Martins
2   Universidade Federal do Espírito Santo, Empresa Brasileira de Serviços Hospitalares, Hospital Universitário Cassiano Antçnio de Moraes, Departamento de Radiologia, Vitória ES, Brasil;
,
Laíza Alcure Dias Scussulin
3   Hospital Estadual Jayme Santos Neves, Departamento de Radiologia, Serra ES, Brasil
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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]).

Zoom Image
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 hematoma[1]. Recent studies indicate that the swirl signal is a direct sign of hematoma expansion, associated with high morbidity and mortality rates[1]. Unlike the spot sign, another predictor of epidural hematoma expansion[2] – [5], the swirl signal does not require the use of contrast.


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Conflict of interest:

There is no conflict of interest to declare.

  • References

  • 1 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
  • 2 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.20190010201900103290
  • 3 Rosa 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
  • 4 Rosa 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.20190010201900100182
  • 5 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

Address for correspondence

Marcos Rosa Júnior
Departamento de Neurorradiologia da UFES, Centro de Ciências da Saúde; Avenida Marechal Campos, 1355 - Maruípe; 29043-900 Vitória ES
Brasil   

Publikationsverlauf

Eingereicht: 14. September 2018

Angenommen: 12. November 2018

Artikel online veröffentlicht:
21. August 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 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
  • 2 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.20190010201900103290
  • 3 Rosa 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
  • 4 Rosa 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.20190010201900100182
  • 5 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

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Zoom Image
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).