Concurrent Computed Tomography Angiography Spot Signs in Cerebral Contusion and Subdural Hematoma Following Severe Traumatic Brain Injury: A Case Report

The spot sign is a well-established radiologic marker associated with hematoma expansion and poor clinical outcomes in spontaneous intracerebral hemorrhage. However, its role in traumatic intracranial hemorrhages remains insufficiently characterized. We report the case of a 67-year-old man who sustained a severe traumatic brain injury following a collision with a bicycle-driven cart. On presentation, his Glasgow Coma Scale score was 3T, with anisocoria (right pupil 1.5 mm; left pupil 4 mm). Computed tomography angiography revealed concurrent spot signs in a left-sided acute subdural hematoma (SDH) and a right temporal contusion. Emergent left decompressive craniectomy was performed for the SDH. Due to progressive hematoma expansion, a contralateral craniectomy was subsequently required for the temporal contusion. This case highlights the rare concurrence of spot signs in two distinct traumatic intracranial hemorrhages. Recognition of this imaging feature may enhance prognostication and guide urgent neurosurgical interventions in traumatic brain injury with multiple traumatic intracranial hemorrhages.