PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Subdural Effusion”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed1998

Serum protein exudation in chronic subdural haematomas: a mechanism for haematoma enlargement?

A study was conducted to investigate the role of serum protein exudation in the aetiology of chronic subdural haematoma (SDH). Scintigraphy after intravenous injection of 99mTc-labelled human serum albumin (HSA) was performed in three patients with chronic SDH and a patient with subdural effusion. In another 60 haematomas, the amounts of total protein and albumin as indices of serum exudation were measured, and then compared among low-density, iso-density and high-density haematomas. Accumulation of 99mTc-HSA in the haematoma cavity was seen 6 h after isotope injection and became more evident at 24 h. However, the protein concentrations and albumin ratios in the haematomas exhibited a reciprocal relationship, suggesting that not all the protein in the haematomas was derived from serum exudation. The higher the total protein concentration in the haematoma became, the higher the haematoma density which was observed on CT. The albumin concentration in low-density haematomas was lower than that in iso-density and high-density haematomas, whereas no significant difference was seen between the latter two haematoma types. These results provide morphological evidence for serum protein exudation into the haematoma cavity, and therefore it is possible that serum protein exudation plays a role in the progression of chronic SDH and is related to changes in haematoma density on CT.

Adult↗
PubMedDate not supplied

Diffusion-weighted MR imaging of subdural empyemas in children.

BACKGROUND AND PURPOSE: Subdural empyema (SDE), an infection of the subdural space, occurs most often in pediatric patients as a complication of meningitis, sinusitis, or otitis media. Diffusion-weighted imaging (DWI) has been used in the past to investigate intracerebral infections. The purpose of this study was to determine the signal intensity characteristics of SDE on DWIs as well as the corresponding apparent diffusion coefficient (ADC) maps. METHODS: MR studies of 10 patients with SDEs were retrospectively reviewed. Included were routine sequences and DWI, which consisted of an axial single-shot echo-planar spin-echo sequence (TR/TE, 4000/110) with b values of 0, 500, and 1000 s/mm(2). Signal-intensity characteristics on routine MR images and DWIs were evaluated. In seven patients, ADC values of the lesions were calculated by using two b values. Follow-up imaging study was performed in seven patients. RESULTS: In nine patients, the empyema was hyperintense on DWIs. In the remaining patient, the empyema showed mixed hyperintensity and hypointensity. ADC values were lower than those of normal cortical gray matter and much lower than those of reactive subdural effusions. In all seven patients with persistent clinical signs of infection, the empyemas were hyperintense on follow-up DWIs. CONCLUSION: SDE had high signal intensity on DWIs and low signal intensity on ADC maps, with an ADC value lower than that of the normal cortical gray matter. Diffusion MR imaging can be valuable in distinguishing SDE from effusion and in the follow-up of subdural collections.

Adolescent↗
PubMed1982

[Purulent meningitis in children. II. Treatment and prognosis].

In the years 1970 to 1979 312 patients with purulent meningitis were treated at the University of Innsbruck, Department of Pediatrics. The overall fatality rate was 16%, the majority of fatal cases were due to gram negative organisms before 1977. The mortality rate of meningococcal meningitis due to H. influenzae was 5.6 and 1.6%, respectively and compares very well to reports in the literature. 12% of children are severely handicapped. Hearing impairment is the most frequent cause of retardation with 6.8%. We compared therapeutic results of two different treatment regimen in our clinic with the therapeutic results in other centers reported in the literature. The combination of ampicillin and chloramphenicol was superior to other treatment modalities particularly ampicillin monotherapy in H. influenzae meningitis and meningitis due to unknown organisms. Theoretical reservations against this combination have been eliminated by the proof of the bactericidal action of chloramphenicol against the most common meningeal pathogens and the synergistic action with beta lactam antibiotics. In pneumococcal meningitis the administration of high doses of Na-Penicillin G as i. v. bolus proved to be connected with unexpected complications and fatalities. The administration of 25000-40000 E Na Penicillin G as an i. v. infusion over 1 hour 4--6 times daily was a less hazardous yet effective therapy. Unsatisfying results in the treatment of gram negative meningitis in neonates prompted the investigation of a new compound fosfomycin for this indication. In vitro investigation of the antimicrobial activity against 68 meningeal pathogens and investigation of this drug in a lapine model showed encouraging results. In the last years a limited clinical trial in severely affected newborn infants was done with promising therapeutic efficacy. A larger scale investigation of this drug is now proceeding in form of a National cooperative Study of gram negative meningitis in Austria. Besides an effective antimicrobial treatment particular attention has to be paid to an adequate fluid and electrolyte replacement. Symptomatic therapy of complications e. g. seizures as well as continuous close monitoring of all vital signs is mandatory for optimal therapeutic success. Subdural effusions have been observed infrequently and only diagnostic subdural punctures have been performed.

Ampicillin↗
PubMed1968

Subdural haematoma and effusion in infancy.

Analysis of 116 cases of subdural haematoma and effusion in infancy showed that in 40% trauma was involved and in 5% meningitis was an aetiological factor; in the remainder there was no known antecedent disease. Apart from retinal or subhyaloid haemorrhages there were no clinical features pathognomonic of the condition, though vomiting was the commonest presenting symptom and a tense fontanelle the commonest finding on examination. Treatment by subdural pleural shunt operation, which allows the fluid to drain into the chest, where it is absorbed, was found to be effective, and there is no longer any justification for the older method of removal of the subdural membrane by craniotomy.

Craniocerebral Trauma↗
PubMed1988

Marked cerebrospinal fluid collection associated with hepatic failure.

We report two cases with abnormal CSF accumulation in the cranium. One case had marked dilatation of the ventricular system, for which a ventriculoperitoneal shunt was carried out. The shunt was not beneficial and it turned out that the patient was suffering from ornithine transcarbamylase deficiency. The second case developed marked subdural effusion after fulminating hepatic failure and septicemia, for which drainage of the subdural space and subsequent insertion of Ommaya reservoirs were carried out. In spite of successful CSF control, the outcome was bad, both cases being incapacitated due to severe encephalopathy probably caused by hyperammonemia. The results of serial computed tomographic follow-up are presented.

Acute Kidney Injury↗
PubMed2004

Generalized chorea associated with bilateral chronic subdural hematoma.

A variety of acquired disorders cause chorea, such as hypoxia-ischemia injury, drugs, toxins, infections, autoimmune disorders, and endocrine and electrolyte abnormalities, but rarely subdural hematoma. We report the case of a 76-year-old woman who presented with sudden onset of generalized choreiform movements 1 day prior to admission. Computed tomography revealed a bilateral lateral convexity subdural effusion, which was later confirmed by magnetic resonance imaging as a chronic subdural hematoma. After surgical evacuation of the subdural hematoma, the choreoathetoid movements ceased completely. We propose that transient ischemia in the bilateral subcortical regions was from compression and distortion of the brain by the bilateral hematomas and resulted in generalized chorea.

Aged↗
PubMed1999

Acute subdural hematoma and pachymeningitis carcinomatosa: case report.

Subdural hematomas may affect 0.4-5 p. 100 of patients with cancer, because of predisposing risk factors or because of the cancer itself. The most likely association is with hematological cancer with coagulative disorders. An association with pachymeningitis carcinomatosa is less likely. In this instance the subdural hematoma is due to a neoplastic obstruction of dural vein with subdural engorgement and hemorrhage or subdural effusion. We report a case in which an acute neurological deterioration due to a subdural hematoma disclosed a dural metastasis from a breast cancer operated four years earlier and present a literature review.

Acute Disease↗
PubMed2005

Subdural haematoma and effusion in infancy: an epidemiological study.

AIM: To determine incidence, aetiology, and clinical features of subdural haematoma and effusion (SDH/E) in infancy throughout the British Isles. METHODS: Cases were notified to the British Paediatric Surveillance Unit over 12 months by paediatricians, neurosurgeons, and paediatric and forensic pathologists. RESULTS: A total of 186 infants (121 boys, 65 girls) aged 0-2 years were identified. Annual incidence of SDH/E for the UK and Republic of Ireland is 12.54/100,000 aged 0-2 (95% CI 10.3 to 14.62) and 24.1/100,000 aged 0-1 (95% CI 20.89 to 28.18). A total of 106 infants suffered non-accidental head injury (NAHI), 7 accidental head injury, 26 a perinatal cause, 7 a non-traumatic medical condition, 23 meningitis, and in 17 the cause was undetermined; 35 infants died. Significant differences were found in injury pattern, body weight, and Townsend score between NAHI and SDH/E from other cause. There were fewer diagnostic investigations in non-NAHI cases. Delay in diagnosis of greater than a week occurred in 48/181. CONCLUSION: SDH/E is a significant cause of morbidity and mortality in infancy. NAHI is the predominant cause of SDH/E. SDH/E can present in a non-specific and varied way and must be considered in any infant who is unwell. Determining the cause of the SDH/E in some cases continues to present a diagnostic challenge.

Child Abuse↗
PubMed1987

Infantile acute subdural hematoma.

A retrospective analysis of the infantile acute subdural hematoma was made with special reference to its pathogenesis. In 11 of 15 cases, the hematomas were bilateral or a contralateral subdural fluid collection was present. In 7 of 11 patients who underwent operation the collection was bloody fluid and/or clotted blood. In 3 patients, a subdural membrane, as seen in adult chronic subdural hematoma, was found. In only 1 patient with unilateral hematoma was clotted blood present without subdural membrane. The thickest collection of clotted blood was in the parasagittal region. It is postulated that in most cases hemorrhage occurs after minor head injury, from the bridging veins near the superior sagittal sinus, into a pre-existing subdural fluid collection such as chronic subdural hematoma or subdural effusion with cranio-cerebral disproportion, and that infants without intracranial disproportion are unlikely to have acute subdural hematoma caused by minor head injury.

Acute Disease↗
PubMed1995

Evolution of the cranial computed tomography scan in child abuse.

Computed tomography (CT) scans obtained at the time of clinical presentation have occasionally been reported to be normal in children with history and findings of significant abusive head injury. We have retrospectively observed abnormalities in "normal" scans of some similar children. We have also seen abnormalities develop on serial scanning. To determine how frequently these situations occur, we reviewed charts of 34 children with a final diagnosis of child abuse who also had cranial CT scans performed. Their CT scans were retrospectively reviewed by a pediatric radiologist. Eleven (11/34) CT scans had initially been interpreted as normal. Four (4/11) of these had been reinterpreted during the hospitalization as abnormal, affecting medical (1) and legal (3) outcome. Repeat scanning in three of the remaining seven resulted in surgical drainage of a subdural effusion (1) and affected legal outcome (2). Four of the seven initial scans felt normal throughout the hospitalizations were judged abnormal on retrospective review. This evaluation was confirmed in the two rescanned. Initial CT interpretation most often failed to appreciate changes in parenchymal density and small amounts of falcine or cortical subdural blood. Subsequent scans also showed evolving effusions and infarcts. Changes were noted in 1 1/2 to 5 days. The CT scan frequently shows subtle changes in the immediate posttrauma period. If the child does not recover promptly, subsequent scans frequently result in significant changes in clinical and legal management.

Brain Edema↗
PubMedDate not supplied

Salmonella meningitis in Thai infants: clinical case reports.

Between June 1988 and September 1996 12 of 65 infants (18%) admitted to the Department of Pediatrics, Ramathibodi Hospital, Bangkok, Thailand with purulent meningitis were infected with Salmonella spp. Their ages ranged from 1.5 to 6 months. Six of the infants had diarrhoea, 9 had seizures, and 11 had subdural effusion or empyema. Six infants required surgical treatment; 2 had brain abscesses. Salmonella was recovered from the cerebrospinal fluid of 11 infants and from the subdural fluid of 10. Eight infants were successfully treated with cefotaxime alone or in combination with co-trimoxazole, one with co-trimoxazole, and one with the combination of co-trimoxazole and ampicillin. The duration of treatment was 6 weeks, except for one patient who had a large brain abscess and was treated for 8 weeks. The last 2 patients, despite the fact that the organisms were susceptible to cefotaxime, failed to respond clinically to appropriate doses of it. Both were cured after ciprofloxacin was added to the therapy. Ciprofloxacin is probably the drug of choice to be used in addition to the previously used antibiotics for severe cases of Salmonella meningitis in infants.

Ampicillin↗
PubMed1993

[Subacute subdural hematoma--reexamination of mechanism by CT and MRI findings].

We have already reported about the importance of establishing the concept of subacute subdural hematoma. But the mechanism by which this disease develops has not as yet been elucidated fully. In one case of subacute subdural hematoma, we were able to perform CT and MRI over time and obtained findings which were of use in studying the mechanism of development. The case was a 56-year-old male. He developed with seizure. CT on admission revealed acute subdural hematoma and subarachnoid hemorrhage. But neurological deficits were absent. So he was treated conservatively. On the 16th hospital day there appeared seizure, anisocoria and an increase in the mass sign due to subdural hematoma was noted on CT, so a diagnosis of subacute subdural hematoma was made. Cerebrospinal fluid was considered accountable for the increase in the mass sign judging from the findings of CT and MRI each performed over time. It was surmised that subdural effusion developed concurrently in the subacute stage. Three conditions, namely, presence of (1) arachnoid tear, (2) clots, (3) no intracranial hypertension are considered important as the mechanism by which subacute subdural hematoma develops.

Acute Disease↗
PubMed1996

Subdural hemorrhage as an initial sign of glutaric aciduria type 1: a diagnostic pitfall.

The case of a 9-month-old girl with glutaric aciduria type 1 (GA 1) is reported. On initial presentation at 6 months of age, the patient demonstrated bilateral subdural hemorrhages and widening of the basal cisterns. After neurosurgical intervention the subdural effusions regressed; their etiology remained unclear. At the age of 9 months the patient presented again because of progressive loss of psychomotor abilities and a dystonic movement disorder. Cerebral MRI revealed regressive subdural hematoma, but marked frontotemporal atrophy as well. Because of a suspected metabolic disorder, urinary analysis of organic acids was performed. This repeatedly showed marked excretion of glutaric acid, 3-hydroxyglutaric acid and glutaconic acid, indicating a diagnosis of GA 1. Considering our patient's history, we recommend the inclusion of GA 1 in the differential diagnosis of patients with unexplained subdural hematoma and neurological deficits.

Amino Acid Metabolism, Inborn Errors↗
PubMed1989

[Clinical study of chronic subdural hematoma and hygroma in two hospitals for elderly patients with dementia].

The authors have investigated the incidence of chronic subdural hematoma and hygroma (CSH) in two hospitals for elderly patients with dementia syndrome over a period of three years and nine months. All observed patients had been in the hospital for 2 weeks or more and had had brain computed tomography (CT) on admission. The total of 613 patients included 212 males and 401 females. Based on the CT findings observed in patients on admission, the authors found 47 patients with CSH. This was equivalent to 7.7% of all patients observed. After admission, almost all patients had brain CT twice per year, with a mean of 2.2 CT examinations during the observation period. Sixteen patients who had no CSH on admission developed CSH. Thus a total of 63 (10.3%) demented patients demonstrated CSH during the observation period. It was assumed that the high incidence of CSH in this study may be due to the practice of performing routine CT examinations in hospitalized patients and the fact that demented patients are prone to fall and hit their heads. From the investigation of past history, tastes, and patterns of daily behavior, we found the risk factors for CSH development to be male sex, alcohol abuse and wandering as a symptom of dementia. We performed CT examinations on all patients who showed subjective or objective neuro-symptoms related to the central nervous system, but we could find only 2 patients with high-density lesions in the subdural space that indicated acute bleeding. This was only 3.1% (2/65) of all patients who developed subdural effusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1999

[Dural metastases mimicking meningioma. Report of a case].

We report a case of dural metastasis, detailing the neuroradiologic and therapeutic aspects. The clinical presentation was limited to a progressive left hemiparesis. Post-contrast CT scan revealed a heterogeneous high-density mass of the right fronto-parietal convexity. MRI demonstrated dural involvement mimicking meningioma. Chest X-ray showed a right lung opacity, suggesting the diagnosis of dural metastasis. Surgical resection was performed. Histology confirmed the diagnosis of dural metastasis from a poorly differentiated carcinoma. Treatment was completed with radiotherapy and chemotherapy. Dural metastases are rarely reported. A review of the literature revealed principally 2 radiological aspects: hemorrhagic effusion and tumor mass. The pathophysiology of dural metastases is still a subject of debate. Two mechanisms have been put forward involving venous and arterial dissemination. As radiological aspects are confusing, the diagnosis of dural metastasis should be evoked in patients with spontaneous hemorrhagic subdural effusion or a tumor mass involving the dura mater.

Diagnosis, Differential↗
PubMed1992

Cranial computed tomographic scans have little impact on management of bacterial meningitis.

OBJECTIVE: To assess which clinical features predict an increased likelihood of an abnormal computed tomographic (CT) scan and how frequently CT influences management of bacterial meningitis. DESIGN: Retrospective patient series. SETTING: University-affiliated hospitals in Dallas, Tex. PATIENTS: Three hundred thirty-seven children with bacterial meningitis, of whom 107 (32%) had undergone CT scans. RESULTS: One or more abnormalities were found in 52% of the initial scans. The most frequent indication for CT at our institution was persistent or secondary fever, and in 56% of these children, subdural effusion or empyema was noted. However, findings on CT rarely predicted a need for intervention. In contrast, children with focal seizures or focal neurologic signs were more likely to have brain parenchymal changes. Scans in 19 patients (12%) prompted surgical intervention, most commonly drainage of a subdural collection. The conditions of only nine children (8.4% of those who had undergone CT scans) improved following intervention that was initiated because of findings on CT. CONCLUSIONS: Although CT scans are frequently abnormal in children with meningitis, CT seldom reveals findings that require specific intervention.

Drainage↗