• Kazufumi Suzuki, Eiko Ueno, and Hidetoshi Kasuya.
• Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University, Tokyo, Japan. Electronic address: kasuzuki-rad@umin.ac.jp.
• World Neurosurg. 2014 Dec 1;82(6):e747-51.

ObjectiveSylvian hematoma in subarachnoid hemorrhage (SAH) is associated with a poor prognosis. Although active bleeding can be detected by multiphase dynamic enhanced computed tomography (CT), bleeding from vessels in the Sylvian fissure has also been found in Sylvian hematoma. We investigated possible origins of Sylvian hematoma based on novel imaging findings of multiphase enhanced CT.MethodsWe investigated a series of SAH patients with or without Sylvian hematoma. The existence of active bleeding in a Sylvian hematoma was evaluated using multiphase dynamic enhancement CT perfusion scans. The location of the aneurysm as well as regional cerebral blood volume and flow were also recorded.ResultsAmong 71 SAH patients, 8 were found to have a Sylvian hematoma (11.3%), 3 of which showed multiple extravasations from small vessels apart from the ruptured aneurysms. No extravasations were found in the remaining patients in other cerebral artery territories, even those associated with Sylvian hematoma. No severe perfusion disturbance was observed in patients with extravasation in a Sylvian hematoma.ConclusionsSylvian hematomas may be caused secondarily by multiple bleeds from small vessels together with aneurysm rupture.Copyright © 2014 Elsevier Inc. All rights reserved.

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