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Spinal subdural hematoma-Inverted Mercedes-Benz sign

Case contributed by Dr Mohamed Saber

Presentation

Low back pain and bilateral radiculopathy

Patient Data

Age: 35 years
Gender: Male

Lower lumbar & sacral region intraspinal extra-axial collection involving subdural space along the ventral and dorsal aspects, preserving epidural fat, and exerting a mass effect upon cauda equina roots. They elicit high signal in T1 and low signal in T2 (early subacute blood; intracellular methemoglobin).  "Inverted Mercedes-Benz sign' could be noted on axial T1WI.

The annotated image clarifies "Inverted Mercedes-Benz sign"

Case Discussion

The spinal subdural hematoma is a rare entity and it is much less common than the spinal epidural hematoma. On MRI, a preserved epidural fat is an important differentiating feature. The subdural blood collects in a special configuration known on imaging as "Inverted Mercedes-Benz sign"  with one anterior and two posterolateral collections limited by two lateral denticulate ligaments and a midline dorsal septum.

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Case information

rID: 84344
Published: 21st Nov 2020
Last edited: 24th Nov 2020
System: Spine
Inclusion in quiz mode: Included
Institution: Faculty of medicine Al-Azhar University

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