We suggest that the performance of 201Tl dynamic SPECT for 15 min is useful for distinguishing malignant brain tumours from benign brain tumours and reduces the examination stress of patients.

BackgroundThe incidence of acute epidural hematoma not accompanied by fracture is low, and it mostly occurs right below the impact point in children. Acute epidural hematoma on the contralateral side of the impact point without fracture is very rare.Case presentationCase 1: a 52-year-old Japanese woman fell and was bruised in the left occipital region, and acute epidural hematoma developed in the right frontal region. No fracture line was observed in the right frontal region on head computed tomography or during surgery, and the source of bleeding was the middle meningeal artery. Case 2: a 56-year-old Japanese man fell down the stairs and was bruised in the right occipital region, and acute epidural hematoma developed in the right occipital supra- and infratentorial regions and left frontal region. Separation of the lambdoid suture was noted in the right occipital region, but no fracture line was present in the left frontal region on either head computed tomography or during surgery, and the source of bleeding was the middle meningeal artery.ConclusionsTwo rare cases of frontal contrecoup acute epidural hematoma without facture near the hematoma were reported. It is possible that the dura mater detaches from the inner surface of the skull due to cavitation theory-related negative pressure and blood vessels in the dura mater are damaged, causing contrecoup acute epidural hematoma even though no fracture occurs, for which careful course observation is necessary.

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A man in his 50s with no significant past medical history developed subarachnoid hemorrhage due to ruptured left middle cerebral artery aneurysm. 9th hospital day, he experienced a ruptured visceral aneurysm with segmental arterial mediolysis, and we successfully treated with transarterial embolization using metallic coils.