CONCENTRATION OF RADIOACTIVE CHLORMERODRIN IN THE FLUID OF CHRONIC SUBDURAL HEMATOMA.

Abstract

AT THE PRESENT time two radioactive compounds are in widespread use for the detection of intracranial lesions by brain scanning: radioiodinated serum albumin (RISA) and chlormerodrin Hg203 or Hg197. Three groups of workers, commenting on the concentration of RISA in chronic subdural fluid hematoma, are in agreement that it is highest in the membrane and is considerably less in the contents of the subdural fluid than in peripheral venous blood (2-4). Recently we have had occasion to measure the radioactivity of subdural fluid in a patient shortly after a chlormerodrin HgIUi scan. In contrast with the experience of other workers with RISA, the concentration of radioactivity in the subdural fluid was markedly higher than in the peripheral venous fluid. The purpose of this paper is to document this observation, which to our knowledge has not been reported previously. Case Report Because of increasing lethargy and occipital frontal headaches of two months duration, E. R. S., a 47-year-old white male, was first seen by a physician sometime in March 1!)(j4. No historv of head trauma could be elicited. A neurological examination resulted in normal findings except for a slightly more active ankle jerk on the left. Attempted lumbar puncture and pneumoencephalography were unsuccessful. The patient showed improvement in the hospital and was discharged with instructions to return in one week for a repeat lumbar puncture and pneumoencephalography. but failed to do so. Nine weeks later he returned because of increased severity of headaches, growing somnolence and anorexia, and frequent vomiting. He was then referred to the University of Florida Teaching Hospital. Physical examination at this time revealed questionable papilledema, motor weakness in both arms and legs, particularly the left, and instability of gait. A blocking dose of 1 cc of Mercuhydrin was given intramuscularly on the evening of May 24, 1964, and the next morning 700 microcuries of Hg197-labcled Neohydrin (Squibb) was injected intravenously. Right retrograde hrachial and left vertebral arteriography were then performed but were not diagnostic because of the poor filling of the anterior circulation. A brain scan about six hours after the injection showed an area of increased uptake peripherally on the left, suggesting subdural hematoma (Fig. 1). Left carotid arteriography on the morning of May 26 disclosed typical changes of a subdural hematoma (Fig. 2) with displacement of vessels from the calvaria corresponding to the area of increased uptake seen on the scan. At craniotomy several hours later, 75 cc of the fluid from the subdural hematoma was saved (by now about thirty hours from the time of the original isotope injection). Some smail clots were in the specimen. Samples of the peripheral blood were also obtained at this time. The clots were separated from the liquid blood in the specimen and homogenized.