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PubMed1982

[Suprasellar arachnoid cyst--report of a case (author's transl)].

A 4-year-old boy with suprasellar arachnoid cyst was reported. At the age of 30-month-old his aunt was aware of his squint. During the observation by ophthalmologists from the age of 1y. to 3y., enlargement of the head and impairment of the visual acuity were manifested. Cranial CT scan revealed the enlargement of the ventricular system and a round low density area located superior to the sella. Absorption coefficient of the lesion was similar to that of the cerebrospinal fluid. No abnormal contrast enhancement was seen. Examination revealed the head circumference of 53.3 cm larger than doubled standard deviation, the right external strabismus, impaired vision (R:0.03, L:0.3) and optic atrophy but no other neurological signs. Cerebral angiography showed suprasellar mass lesion. After the ventriculography with water-soluble contrast medium, V-P shunt operation was performed and then the patient was transferred to the CT room. CSF enhanced CT scan showed no communication between the ventricles and the cyst. By frontotemporal approach, microsurgical removal of the cystwall was performed and the histological diagnosis was arachnoid membrane. Several days after the operation, bilateral subdural effusion was seen on CT scan and was treated with bilateral S-P shunt and the removal of V-P shunt. Follow up CT scan disclosed the disappearance of the subdural effusion and the suprasellar cyst. The visual acuity was improved well and the endocrinological study was normal. Analysis of the 45 reported cases of suprasellar arachnoid cyst suggested that direct removal of the cyst wall is better than the V-P shunt operation and the cyst shunting is advisable for repeat recurrence of the cyst. Removal of the ventricular shunting system may be effective for the prevention of the subdural effusion as a complication after direct operation.

Arachnoid↗
PubMed1986

[Treatment of recurrent chronic subdural hematoma--setting an Ommaya tube].

The rate of postoperative recurrences of chronic subdural hematomas is high. Several methods have been advocated, but each one remains controversial. We proposed a simple method of setting an Ommaya tube after burr-hole evacuation. The reservoir was placed in the subcutaneous space, the tip of the tube was placed in the subdural space. The reservoir was punctured with a needle, thereby allowing aspiration of fluid from the subdural space. Sixty one cases of chronic subdural hematomas were operated by simple burr-hole evacuation. The Ommaya tube was used in 46 selected patients.: 1) the volume of hematoma was more than 100 ml and, or 2) older than 70 years of age. Reaccumulation of subdural effusion was detected in 10 cases. The subdural effusions were drained by percutaneously needling the reservoir of the Ommaya tube. This procedure was curative in 9 of the patients. However 1 patient required a small craniotomy. The patient had two outer membranes therefore inner hematoma could not be removed. The authors propose this technique and discuss about it.

Aged↗
PubMed1981

Megalocephaly and hypodense extracerebral fluid collections.

Computed tomographic (CT) scans were identified and reviewed for 25 pediatric patients with enlarged heads and extracerebral fluid collections that showed cerebrospinal fluid-like attenuation. Mild to moderate enlargement of the subarachnoid space over the convexity, interhemispheric fissure, and the lateral ventricles was observed in most of the cases. The CT findings are not specific, and it is not always possible to determine the nature of the extracerebral fluid, whether it lies in the subarachnoid space, the subdural space, or both. The differential diagnosis included subdural effusions, hygromas, preclinical or external hydrocephalus, hypodense subdural hematomas, megalocephaly, and possibly a normal variant. CT remains the method of choice for the initial study of these patients and for subsequent follow-up in selected cases.

Brain Neoplasms↗
PubMed1992

Subdural empyema complicating bacterial meningitis in a child: enhancement of membranes with gadolinium on magnetic resonance imaging in a patient without enhancement on computed tomography.

Subdural empyema is a known yet infrequent complication of bacterial meningitis. Subdural effusions occur frequently with meningitis in children and usually resolve spontaneously or with subdural taps. Subdural empyema should be suspected when a patient fails to respond to antibiotic therapy or worsens neurologically. Computed tomography (CT) scans with contrast often show enhancement of subdural collections when an empyema exists. However, this is not true all of the time. We present a case of subdural empyema complicating bacterial meningitis in a 4 month old in which CT enhancement was not present yet magnetic resonance imaging (MRI) scans with gadolinium demonstrated intense enhancement. For comparison, we present a second case of a child with sterile subdural effusions due to meningitis that demonstrates an absence of contrast enhancement on MRI studies. MRI scans with contrast may offer a more sensitive means of making an early diagnosis of subdural empyema.

Empyema, Subdural↗
PubMedDate not supplied

[Benign idiopathic external hydrocephalus (benign subdural collection) in 39 children: its natural history and relation to familial macrocephaly].

INTRODUCTION: Benign idiopathic external hydrocephalus (BIEH) is an age-dependent disorder that is self-limiting in time and has an uncertain aetiology. PATIENTS AND METHODS: A retrospective study was conducted involving 39 patients (16 girls and 23 boys) with BIEH. The following data were analysed for each patient: age, sex, family history, history concerning pregnancy, childbirth and neonatal period, postnatal history, data from clinical records and from physical examinations, progress of psychomotor development, findings from the first and successive neuroimaging studies, results of other complementary examinations, clinical and neuroimaging situation at the last check-up that was carried out, length of clinical control, age at which subdural effusion disappeared, and any other relevant associated facts. RESULTS: Age at diagnosis ranged from 1.33 and 25 months (mean: 8.4 months); in 38.46% of cases there was a history of macrocephalia in one of the progenitors; in four of them the presence of congenital macrocephalia was noted; in five, there was motor retardation and one of them displayed psychomotor retardation; in 15, there was an association with a slight dilatation of the lateral ventricles; the mean time of clinical control was 3.36 years; the process was seen to resolve in 14 cases; the minimum age for the disappearance of the subdural effusion was 9 months and the maximum was 8 years; macrocephalia persisted until the clinical control ended in 22 of the cases. We also noted the presence of two cases of mitochondrial encephalomyopathy, one craniosynostosis of the sagittal suture, one microdeletion 22q11.2, one a-1 antitrypsin deficiency, and one case of idiopathic bilateral congenital palpebral ptosis. CONCLUSIONS: The subdural effusion and/or macrocephalia persist in a high percentage of these patients and sometimes there is a close relationship between this condition and benign familial macrocephalia. Despite its benignity, it can influence psychomotor or motor retardation and behavioural disorders. On rare occasions it may be associated to mitochondrial encephalomyopathy and to the microdeletion 22q11.2.

Cephalometry↗
PubMed1983

[Neurological and cerebrospinal fluid evaluation in children with serogroup A meningococcal meningitis].

Our aim is to present the results obtained from the evaluation of the neurological examination as well as chemical and cytologic data from the CSF obtained at the admission and discharge of 255 children aged between zero and 12 years with a diagnosis of serogroup A meningococcal meningitis made at the Hospital Emilio Ribas in São Paulo, Brasil, in the years of 1976 and 1977. By the time of their admission, 27 patients (10,59%) showed positive neurologic findings besides meningeal signs. Seizures were the most common ones, with higher incidence in children under 13 months; ataxia, deafness, motor deficits, neuro-psychomotor involution, subdural effusions and disturbed behavior followed in that order. Subdural effusions were found only in those under 13 months. A fatal outcome was registered in eleven (4,31%) patients, of which nine died in the first 24 hours after admission. By the time of hospital discharge 14 patients (5,49%) had neurological abnormalities, deafness and ataxia being the most common ones, in the older patients. Under 13 months, developmental involution predominated. There is no need of CSF evaluation for antibiotic therapy interruption in patients with meningococcal meningitis.

Ataxia↗
PubMed2005

Very late onset of chronic subdural hematoma. Case report.

A 56-year-old man developed subdural effusion after mild head trauma, which remained unchanged in volume and density on computed tomography during a follow-up period of 7 months. However, typical chronic subdural hematoma (CSDH) had developed by 9 months after the head trauma. The CSDH was successfully treated by irrigation and drainage. This unusually delayed onset of CSDH suggests that we should be aware of the possibility of very late onset of CSDH in patients with persistent asymptomatic subdural effusion.

Craniocerebral Trauma↗
PubMed1982

Serial CT scans in Haemophilus influenzae meningitis of childhood.

Eleven children admitted to hospital with H. influenzae meningitis had computerized tomographic head scans during the acute stage of the illness. 10 of the 11 had at least one other scan between two weeks and 30 months later. This study evaluated the changes seen in the scans in relation to the evolution of the illness, especially with reference to subdural effusions and communicating hydrocephalus. The early scans were found to have no significance in predicting clinical outcome. However, a temporary developmental lag occurred in those children with subdural effusions, transient communicating hydrocephalus, and without permanent neurological deficit.

Brain↗
PubMed1984

[Computerized tomography findings of acute traumatic epidural hematoma].

During four year period from April, 1977 to March, 1981, 53 cases with acute traumatic epidural hematoma had been encountered out of 430 acute head injured patients examined by computerized tomography (CT) within 24 hours after incurring the trauma at the Department of Neurosurgery and Critical Care Medicine of Nippon Medical School, Sendagi, Tokyo, Japan. Besides the initial CT, the authors performed contrast enhanced CT (41 cases) and serial CT scanning (31 cases). There were 49 cases of epidural hematoma existing in the supratentorial region, Two cases infratentorial region and 2 cases in the both regions. Two cases of vertex epidural hematoma had been encountered, one of them required vertical scan technique. In 22 (41%) of the 53 patients, the initial CT showed evidence of other cerebral lesions. The most frequent lesion was pneumocephalus (11 cases), 3 cases of them existed in the epidural hematoma. There were also intracerebral hematoma (6 cases), subdural hematoma (4 cases), cerebral contusion (2 cases), intraventricular hemorrhage (2 cases) and 2 cases of them demonstrated "diffuse traumatic cerebral injury" (Zimmerman, 1979). During contrast enhanced CT, 11 cases out of 41 cases indicated several enhancement pattern. There were total enhancement of epidural hematoma (2 cases), partial enhancement of hematoma (2 cases) and enhancement of internal margin of hematoma (2 cases). Serial CT scans was performed in 36 out of the 53 patients. Common findings on the serial CT scans were decreased density collection in the subdural space such as subdural effusions or chronic subdural hematomas (8 cases) and enlargement of small epidural hematomas (3 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1996

[Arachnoid cysts of the middle cranial fossa in children. A review of 75 cases, 47 of which have been operated in a comparative study between membranectomy with opening of cisterns and cystoperitoneal shunt].

The authors report their experience concerning 75 cases of middle fossa arachnoid cysts observed in children during the period 1975-1993, 47 of which (62.6%) were operated upon. The aim of this study was to study the clinical presentation of these cysts, to discuss the surgical indications and to compare the results of the various techniques used to treat these malformations. Head injury was revealing in 17 cases (22.6%) and among these, 12 patients presented intracranial complications (subdural effusions; 6 cases, subdural hematomas: 4 cases and intracystic hematomas: 2 cases). The most usual signs and symptoms were: intracranial hypertension (25.3%), epilepsy (16%) and temporal bulging (24%). Twenty-one patients (44.7%) underwent a cystoperitoneal shunt; 20 patients (42.5%) were treated by membranectomy with opening of the basal cisterns and removal of intracystic (2 cases) or subdural hematoma (4 cases); 2 patients (4.3%) were treated using membranectomy, opening of the cisterns and cystoperitoneal shunt and 4 patients (8.4%) underwent a subduroperitoneal shunt. The long-term results were good regardless of the surgical procedure; nevertheless, only one patient among 20 cases treated by membranectomy and opening of the cisterns developped complications (5%), while multiple shunt revisions were necessary in 11 children (40.7%) out of 27 where a shunt was inserted. The authors conclude that membranectomy and opening of the basal cisterns is the procedure of choice to treat middle fossa arachnoid cysts in children.

Adolescent↗
PubMed1985

Clinicopathological classification of chronic subdural hematoma.

Clinicopathological classification of chronic subdural hematoma was made, based on a study of 135 cases; chronic subdural hematoma with a visible inner membrane (type I: 123 cases), acute subdural hematoma in chronic healing stage (type II: 8 cases), and chronic subdural effusion of hemorrhagic type (type III: 4 cases). Type I is an expanding lesion, due to repetitive hemorrhage from outer membrane. It is a traditional hematoma with a distinct inner membrane. Type II is a late healing stage of a previously unrecognized or unoperated acute subdural hematoma, and not an expanding lesion. It has a subdural granulation tissue of irregular thickness with little rebleeding tendency, but it lacks a visible inner membrane. Type III is a variant of chronic subdural effusion, in which a minimum amount of fresh blood is added to a maximum amount of xanthochromic fluids. The latter contains an extremely low level of LDH.

Adult↗
PubMed1983

Computed tomography for diagnosis and assessment of cerebral fat embolism.

A patient with cerebral fat embolism was followed by computed tomography (CT). For the first few days after injury, CT revealed no abnormality. About a week later, multiple low density areas appeared in the white matter of the frontal region. They disappeared within the subsequent 2 weeks while subdural effusions developed in the fronto-parieto-temporal regions. As neurologic recovery progressed, the subdural effusions gradually diminished and cerebral atrophy was seen.

Adolescent↗
PubMed1992

[A case of posttraumatic delayed cerebral arterial spasm; case report and review of the literature on the pathogenesis].

A case of posttraumatic delayed cerebral arterial spasm is presented. A 71-year-old man was admitted to our hospital with head injury. Neurological examination on admission only revealed consciousness disturbance (Japan Coma Scale 30). CT scan 19 hours after the injury demonstrated a contusional hematoma in the right frontal lobe, faint subarachnoid hemorrhage in the left sylvian fissure and subdural hematoma in the interhemispheric fissure. His consciousness was disturbed on the 14th day. CT scan demonstrated a left subdural effusion, which was surgically evacuated. However, from the next day the patient developed left hemiparesis. Right carotid angiogram on the 17th day after the injury revealed multiple segmental arterial narrowing in the right anterior cerebral artery (ACA) and middle cerebral artery (MCA). We diagnosed a posttraumatic delayed cerebral arterial spasm. CT scan revealed low density areas in the right ACA and MCA territory. The pathogenesis of posttraumatic delayed arterial spasm is not yet well known. Now, four theories have been suggested as follows: (1) Subarachnoid hemorrhage, (2) Direct mechanical injury to the arterial wall, (3) Hypothalamus dysfunction, and (4) Disturbed autoregulation. In our case, three important factors are suggested. The first is direct injury to the artery, the second is cerebral contusion, and the third is subdural effusion.

Aged↗
PubMed1992

Chronic subdural hematoma following bypass surgery--report of three cases.

Bypass surgery is a safe procedure with low mortality and morbidity, and few reported surgical complications. Three patients developed postoperative chronic subdural hematoma (CSDH): two with stroke after superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis and one with moyamoya disease after STA-MCA anastomosis combined with encephalomyosynangiosis. The factors inducing CSDH after revascularization in the seven reported and present cases included postoperative subdural effusion associated with brain atrophy, and postoperative anticoagulant therapy such as aspirin. CSDH may occur in patients with pre-existing brain atrophy and postoperative subdural effusion. Anticoagulant therapy should be avoided at the early postoperative stage after bypass surgery.

Brain↗
PubMed2001

[Surgical treatment for symptomatic arachnoid cysts].

During the period from 1983 to 1999, 12 patients with symptomatic arachnoid cyst were treated. The mean patient age was 20.6 years. The most common location was the middle fossa (10 cases). Initial CT scan revealed associated subdural hygroma in 7 patients and hydrocephalus in one. Clinical symptoms were related to increased intracranial pressure, cranio-megaly and seizure. One infant with a huge arachnoid cyst was treated, using a cystoperitoneal (CP) shunt. Four patients underwent membraectomy. Combination CP shunt and membraectomy was performed in 5 patients. The remaining 2 arachnoid cysts were complicated with subdural hygroma and, initially, they were observed conservatively, but hygroma gradually changed to hematoma. One was treated by irrigation and the other hematoma was spontaneously absorbed. Significant complications included extensive subdural effusion in one patient, contralateral chronic subdural hematoma in two, intracranial hypotension in two, and shunt dependency in one. There were no recurrences during the follow-up period (mean 3.6 years).

Adolescent↗
PubMed1981

[Subdural or sub-arachnoid pericerebral effusions in the infant with subdural or subarachnoid localisation (author's transl)].

Twenty-seven "subdural" effusions in infants were treated, according to our previously suggested method: a simple external drainage, followed ater one week by an internal peritoneal shunt, if the effusion did not dry up by this time. Daily electrophoresis of the fluid obtained by external drainage has been performed in 20 cases, either until the disappearance of the effusion or until the peritoneal shunting after 7 days. In 8 persistent and in 5 rapidly disappearing effusions, cerebro-spinal fluid was immediately present or appeared during the first week, simultaneously with a lowering of the total protein content. In the other 7 rapidly disappearing effusions, the protein content remained high and a conspicuous plasmatic transsudation was disclosed; the possibility that cerebro-spinal fluid could be present even in some of those last cases is discussed. The fact that some effusions display, from the onset, the characteristics of cerebro-spinal fluid, leads to the question of their subarachnoid rather than subdural localisation. For this reason, we prefer to use the less committed denomination of pericerebral effusions, in which we may distinguish subdural effusions, with or without cerebro-spinal fluid, and subarachnoid effusions. Nevertheless, it is not always easy to establish the pathogenic character of an effusion revealed by CT-scan. Pressure measurements by fontanometry appear to be a useful examination for that purpose.

Drainage↗
PubMed1977

Thiamphenicol in treatment of Haemophilus influenzae meningitis.

17 infants and children with pyogenic meningitis (14 Haemophilus influenzae, 2 Diplococcus pneumoniae, 1 Neisseria meningitidis) were treated with thiamphenicol, 100 mg/kg body weight/day in 4 doses i.v., as single drug. In the H. influenzae group 10 patients were cured, 4 had relapses of meningitis, 3 with documented subdural effusions. This group is compared with 14 children matched for age, initial leucocyte and CSF cell count treated with ampicillin: all of these were cured, 1 had a subdural effusion. Thiamphenicol concentrations were determined in the serum and CSF 2 h after administration. The mean serum levels were between 10-12 mcg/ml, the mean CSF levels varied from 5.4 mcg/ml at the beginning to 1-1.9 mcg/ml at the end of meningitis. The MIC of H. influenzae was 0.6-12 mcg/ml. A significant, acute, and dose related bone marrow toxicity of thiamphenicol could be documented, but was always rapidly fully reversible. We conclude that thiamphenicol cannot replace chloramphenicol in the treatment of pyogenic meningitis as single systemic antibiotic. Special indications for thiamphenicol in this disease are discussed.

Adolescent↗