0:01

I have to admit that dealing with hemorrhage in the

0:05

spinal canal is one of the more difficult

0:07

tasks that I feel I have to do,

0:11

because the thecal sac displacement is not as clear as it

0:16

is when you have a purely intradural

0:20

extramedullary lesion, for example.

0:22

So here we have scans with proton density-weighted,

0:27

T1-weighted, T2-weighted, and STIR imaging.

0:31

So on this T1-weighted scan,

0:33

we see that there is high signal intensity

0:35

in the lower thecal sac,

0:37

which on the T2-weighted scan also

0:40

shows high signal intensity.

0:42

And on the STIR image, has a little bit of a

0:45

heterogeneous signal intensity.

0:47

Frankly, from these three images,

0:50

I'm not really sure whether this is intrathecal or

0:53

extrathecal, that is intradural or extradural.

0:57

So we would have to rely on the T2-weighted scans.

1:00

Let's magnify the T2-weighted scans and

1:02

see whether we do any better with that.

1:04

So we're scanning from the conus medullaris downward,

1:07

and that all looks pretty good.

1:09

And then we start to hit some of this bright signal

1:12

intensity here. And continuing down into the L4-L5 level,

1:19

we see this collection here of abnormal signal intensity

1:24

within the thecal sac, corresponding to what

1:25

we're seeing on the STIR image.

1:27

To me, this looks like it is intradural.

1:32

So I would characterize this as a subdural hematoma

1:37

within the thecal sac. The leaves of

1:40

the thecal sac on the left side.

1:42

Down here, it's much more difficult to tell where

1:44

the blood products are. Most likely,

1:47

this is also in a subdural location.

1:49

Subdural hematomas of this thecal sac are considered

1:53

portions of the extradural component of the spine.