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PubMed1994

Paediatric head trauma: influence of age and sex. II. Biomechanical and anatomo-clinical correlations.

A consecutive, unselected series of 1812 cases of head trauma in children less than 15 years of age and admitted hospital over a period of 8.5 years was studied. Data concerning the grade of energy involved, the ages of the victims, the types of pathologies caused and the clinical features noted were collected and statistically analysed. Babies and toddlers (0-3 years) were shown to sustain rather low-energy trauma and suffer more skull fractures, more subdural haematomas and more benign injuries. They lost consciousness less frequently and were less frequently in coma than the other children. By contrast, they had more frequent signs of lateralization, and early seizures were much more frequent in babies than in other children. Young children (3-9 years) had rather higher-energy accidents, frequently lost consciousness, were more frequently in coma and have more frequently had a free interval associated with the development of brain swelling. They did not suffer subdural effusion or contrecoup lesions. Schoolchildren (9-15 years) were statistically more or less like young adults: the clinical sequences of trauma were more severe than in the other children, mortality was a little bit higher, the risk of extradural haematoma was higher, and they rarely suffered subdural haematomas or contrecoup lesions. Traffic accidents, with higher energy involved, were more severe.

Accidents, Traffic↗
PubMed2003

High concentrations of procollagen propeptides in chronic subdural haematoma and effusion.

Procollagen propeptides increase in the CSF after subarachnoid haemorrhage, reflecting increased collagen synthesis in the arachnoid. We studied the induction of dural collagen synthesis after cerebral trauma by measuring the carboxyterminal propeptide of type I procollagen (PICP) and the aminoterminal propeptide of type III procollagen (PIIINP) in 17 subdural haematoma or effusion fluid samples obtained at operation on days 10-85 after head trauma. The concentration of PICP was 78-fold higher and that of PIIINP 156-fold higher, relative to that in the serum. These results indicate that meningeal trauma is followed by a long lasting increase in dural collagen synthesis, and suggest that enhanced synthesis of the various extracellular matrix components may have a role in the development of chronic subdural haematoma or effusion.

Adult↗
PubMed1998

[Rare intra-abdominal complications of a ventriculoperitoneal shunt: report of three cases].

Three cases of rare intra-abdominal complications of ventriculoperitoneal shunt (VPS) surgery are reported. Case 1 was a 32-year-old male who had undergone VPS surgery for hydrocephalus following meningitis on July 10, 1980. Two weeks later he developed fever and a cystic mass about 10 cm in diameter in the right hypochondrium. Shuntography and a barium enema study demonstrated a pseudocyst at the distal end of the shunt. The cyst wall was excised, the peritoneal tube removed, and VPS converted to a ventriculoatrial route following which the pseudocyst resolved. Case 2 was a 49-year-old female who developed hydrocephalus following subarachnoid hemorrhage, and VPS surgery was performed on March 10, 1989. Two weeks later, she developed fever and right upper abdominal pain. Abdominal x-ray and CT scan revealed a right subdiaphragmatic abscess. The abscess was drained and the shunt system was removed on April 4. VPS was placed again on April 21 without further complications. She was symptom free for the next 7 years. Case 3 was a 57-year-old female who presented in a semicomatose state after falling from bed on May 5, 1995. CT scan showed left-sided acute subdural hematoma (ASDH) for which surgery was performed. Her neurological status improved postoperatively. She eventually developed hydrocephalus and left-sided subdural effusion for which right VPS and left subduroperitoneal shunt (SPS) surgery was performed on January 25, 1996. The peritoneal end of the tube of the SPS protruded out of the anus one and a half year after shunt placement. The entire SPS system was removed as there was no more collection in the subdural space. We reviewed the literature and discussed the pathophysiology involved in the development of intraabdominal complications following VPS.

Abdominal Injuries↗
PubMed1985

Partial ventricular dilatation contralateral to chronic subdural haematoma.

In a series of 88 cases of chronic subdural haematoma, the occurrence of dilatation of the posterior portion of the contralateral ventricle was found to be unrelated to any major neurological variable. There was, however, a prevalence of recurrences of the subdural effusions in the patients with partial hydrocephalus, compared with patients without ventricular dilatation.

Adolescent↗
PubMed1980

[Neuropsychiatric follow-up of four- to eleven-year-old children with conspicuous skull diaphanoscopy (transillumination) findings in infancy].

Out of a group diaphanoscopically conspicuous infants a random test including 58 children was carried out in the form of psychological (HAWIK and SIT) and motometric (ROS) checkups and correlated with the findings obtained in babies and infants. In spite of a considerable delay in development (60 per cent of the children) in the first two years of life, the children showed on an average a normal intelligence in later years; in children at school age, however, a statistically significant fine-motor weakness was found. The incidence of convulsive fits was three to four times that of the normal. The subdural effusion (SDE) is considered as a factor of a disposition to the manifestation of an epilepsy although the high correlation of SDE and epilepsy mentioned in the literature could not be confirmed.

Child↗
PubMed1995

[Subacute subdural hematoma: findings in CT, MRI and operations and review of onset mechanism].

Subacute subdural hematoma was investigated in terms of findings in CT, MRI and operations and of onset mechanism. The subjects were 7 cases of subacute subdural hematoma in which CT and MRI were performed during the past 5 year period. Subacute subdural hematoma here was defined as a nonoperated case with acute subdural hematoma, accompanied by subacute exacerbation 1-3 weeks after head trauma. The time from the injury to the onset averaged 13.7 days. CT revealed mixed density in 4 cases, low density in 3 cases and cerebral atrophy in all cases, with increasing mass sign due to the enlarged low density area. MRI revealed mixed intensity in 5 cases and high intensity in 2 cases, with increasing mass sign due to the enlarged high intensity area. Operation disclosed the outer membrane of the hematoma only in 1 case, but the inner membrane could not be identified in any case. Analysis of the hematoma contents showed a low hemoglobin concentrations and a high level of methemoglobin. Lack of outer membrane in cases with subacute subdural hematoma suggests that this is a different disease entity from chronic subdural hematoma. It is surmised that subacute subdural hematoma is the result of subdural effusion in the subacute stage, because, judging from the findings of CT and MRI each performed over time, cerebrospinal fluid is considered accountable for the increase in the mass sign.

Aged↗
PubMed1997

[Natural course of non-operative cases of acute subdural hematoma: sequential computed tomographic study in the acute and subacute stages].

We have studied 20 non-operative cases of traumatic acute subdural hematoma in the acute and subacute stages by sequential computed tomography (CT). 20 patients were divided into three groups as is shown below; 8 patients with rapid complete resolution within 24 hours (rapid resolution group), 10 patients with slow resolution beyond 24 hours, mainly in the subacute stage (slow resolution group), and 2 patients worsening clinically due to the increase of subdural fluid collection in the subacute stage (subacute worsening group, what is called, "subacute subdural hematoma"). In the rapid resolution group, CT showed mixed density thin subdural hematoma in 6 patients; delayed subdural effusion in 3 patients; cerebral contusion in 2 patients; and diffuse brain swelling in 2 patients. We reviewed 8 of our cases and 13 reported cases. As a result, we consider that the main pathological mechanisms of rapid resolution types were, in the elderly, the washout of the hematoma by the leakage of cerebrospinal fluid (CSF) and, in the young, the compression of the hematoma by brain swelling. In the subacute worsening group, CT showed, in the acute stage, mixed density thick subdural hematoma with brain atrophy and no intraaxial lesions and, in the subacute stage, the increase of low density subdural fluid collection with marked mass effect. We reviewed 2 of our cases and 19 reported cases. As a result, we related the increase of subdural fluid collection in the subacute stage with the CSF leakage into the subdural space due to the tearing of arachnoid membrane. However, massive CSF leakage into the subdural space, producing marked mass effect, may be joined by other factors such as osmotic pressure gradient or oozing from the outer membrane of the hematoma.

Accidents, Traffic↗
PubMed1980

[Role of toxoplasmosis in the development of central nervous system lesions in children].

Because of the high degree of infestation in women capable of bearing children in Europe (70 to 80%) with Toxoplasma gondii the authors have studied all babies admitted for clinical treatment at the institute of Paediatrics in Lublin for clinical and serological indications of a connatal toxoplasmosis. In the period between January 1977 and December 1978, 133 babies showed positive findings. The most frequently occurring findings were lesions of the central nervous system (hydrocephalus 21 X, microcephaly 8 X, porencephaly 18 X, convulsions and psychomotor retardation 11 X, subdural hygroma and haematoma 34 X, encephalomeningitis 7 X). Intracranial calcifications within the classical triad were only found in two cases. Other internal lesions without cerebral deficiency symptoms were found in 18 children. The authors point out the possible connection between vascular lesions caused by toxoplasmosis and subdural effusions. One might think of both permeability disturbances and direct vascular lacerations. The treatment consisted in repeated punctures, trepanations and antibiotics (Spiramycin, Daraprim, Orisul). The serological proof of the presence of toxoplasmosis may well lag behind the clinical symptoms.

Brain Diseases↗
PubMed1990

[Clinical study of reaccumulation and persistence of chronic subdural hematoma; setting an Ommaya reservoir].

We treated 57 cases of chronic subdural hematoma by aspiration via the Ommaya reservoir following burr hole opening and irrigation of the hematoma in order to reduce the reaccumulation and persistence of the hematoma. An Ommaya reservoir was placed on the following patients: (1) the volume of hematoma was more than 100 ml and/or (2) expansion of the brain after evacuation of the hematoma was poor. However in spite of these techniques there were 6 cases (10.5%) of recurrence and 21 cases (36.8%) with persistence of the hematoma cavity for longer than 2 months after the first operation. The recurrence was due to occlusion of the Ommaya reservoir by massive rebleeding into the hematoma cavity in cases with a large subdural hematoma and/or an immature external membrane. Persistence of the hematoma cavity for longer than 2 months after the first operation was due to minor rebleeding and CSF inflow into the hematoma cavity through the damaged inner membrane in cases of acute onset and/or or coexisting intracranial disease (brain atrophy, cerebral infarction and subdural effusion). The most suitable cases for application of this technique were those with poor expansion of the brain after evacuation of the hematoma, or those with a mature external membrane and a medium-size hematoma.

Adult↗
PubMed1980

[Computerized tomography in ventral and lateral prone position in the differential diagnosis of subdural hematoma and cortical atrophy].

The differential diagnosis between brain atrophy versus subdural effusion in children has shown some difficulties in a few cases, mainly when the frontal subarachnoid space is very large on computed tomography. We think that a simple procedure, that is, CT scans in the lateral and prone position following the standard examination, may be worth to clarify those cases of doubtful diagnosis.

Atrophy↗
PubMed1978

[On the diagnostic efficiency of the body-coordination-test for children (KTK) (author's transl)].

The diagnostic efficiency of KTK was examined by evaluation of catamneses of children who mostly during their first year of life underwent neurosurgical treatment for subdural effusions. In addition, the influence of intelligence, side of hemispheric lesion, equivocal neurological signs and physical impairment, body height and weight as well as foot preference on the performance of motor tasks was examined. The results suggest sufficient practical advantages of KTK for the detection of brain damage in children.

Body Height↗
PubMed1980

Positron emission tomography in the evaluation of subdural hematomas.

Fifteen patients with 21 subdural effusions were investigated both with transmission computer assisted tomography (CAT) and positron emission tomography (PET). The tracer in the emission studies was 68Ga-EDTA. Twelve lesions were visualized both with CAT and PET. Five lesions that were negative or doubtful on CAT were visualized with PET, whereas four lesions negative or doubtful on PET were demonstrated by CAT. The two methods complement each other due to the fact that they are based on different mechanisms: CAT mainly on attenuation of the fluid collection. PET on isotope accumulation, particularly in the hematoma membranes.

Adolescent↗
PubMed1989

Nonacute subdural hematoma: fundamental interpretation of MR images based on biochemical and in vitro MR analysis.

Few reports have described the nature of the appearance of nonacute subdural hematoma on magnetic resonance (MR) images. The authors analyzed MR images in 39 cases of nonacute subdural hematoma and subdural effusion by measuring in vitro proton relaxation times and the biochemical variables of hematoma fluids. T1 became proportionally shorter than T2 with an increase in hematocrit but the direct cause of the variation in T1 and T2 was the amount of methemoglobin. The free iron content, not the bound iron content, was another main cause for shortened T1 and T2. Paradoxical findings in the correlation between the total protein or albumin concentration and relaxation times were noted. It is possible that as the protein level in the supernatant increased, more free iron was bound to the protein, decreasing the influence of the free iron on the relaxation times.

Adult↗
PubMed2004

Shaken baby syndrome manifesting as chronic subdural hematoma: importance of single photon emission computed tomography for treatment indications--case report.

A boy with shaken baby syndrome first presented at age 3 months with acute subdural hematoma (SDH) and was treated by subdural tapping at a local hospital. Chronic SDH was identified at a rehabilitation center at age 19 months. The chronic SDH appeared to have developed within the preceding 16 months. His physical and mental development was already delayed. Magnetic resonance (MR) imaging revealed a 20-mm thick right chronic SDH with midline shift and small bilateral subdural effusions. The chronic SDH had compressed the right cerebral hemisphere. MR imaging also disclosed bilateral cerebral atrophy. 99mTc-ethylcysteinate dimer single photon emission computed tomography (SPECT) revealed decreased cerebral blood flow (CBF) in the non-hematoma hemisphere, although CBF is said to decrease on the chronic SDH side, especially if midline shift is present. Burr hole craniotomy with external drainage was performed, but the patient showed no change in CBF postoperatively, although the volume of hematoma decreased. The patient was clinically unchanged immediately after the operation. In this case, SPECT measurement of CBF was important in evaluating the pathophysiology of the delays in physical and mental growth. Atrophy of the bilateral hemispheres was the major mechanism in the decreased CBF, not the compression by chronic SDH. MR imaging and SPECT can determine the surgical indications for chronic SDH in patients with cortical atrophy.

Atrophy↗
PubMed1993

Spectrum of complications during bacterial meningitis in adults. Results of a prospective clinical study.

OBJECTIVE: To determine systematically central nervous system and systemic complications during the acute phase of adult bacterial meningitis. DESIGN: Prospective clinical study. SETTING: University referral center, Department of Neurology. PATIENTS: A total of 86 consecutive patients between the ages of 15 and 87 years who had bacterial meningitis. MEASUREMENTS: Central nervous system complications, including brain swelling, hydrocephalus, brain abscess, subdural empyema, or subdural effusion (using computed tomography) and cerebrovascular involvement (using cerebral angiography), systemic complications, including septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome, or septic or reactive arthritis, and typical complications arising during intensive care therapy. RESULTS: Of the 86 adult patients with bacterial meningitis, complications developed in 43 patients. The major central nervous system complications included angiographically documented cerebrovascular involvement (15.1% of the patients [13/86 patients]), brain swelling (14.0% [12/86]), hydrocephalus (11.6% [10/86]), and intracerebral hemorrhage (2.3% [2/86]), while septic shock (11.6% [10/86]), adult respiratory distress syndrome (3.5% [3/86]), and disseminated intravascular coagulation (8.1% [7/86]) dominated among the patients with systemic complications. Seven patients had cerebral herniation, three with a lethal course. The overall mortality was 18.6% [16/86] and was 10 of 30 (3.33%) in pneumococcal meningitis. CONCLUSIONS: Clinical and autopsy studies showed that the major determinants for the lethal outcome were primarily central nervous system complications in six patients, systemic complications in five, and a combination of both in another five. The identification of the various complications and their time of expected occurrence may help to develop additional treatment regimens in bacterial meningitis in adults.

Adolescent↗
PubMed1982

Computed tomography in purulent meningitis.

Of 102 patients with bacterial meningitis admitted to the Children's Hospital of Buenos Aires, 25 were selected for computed tomographic (CT) scans on the basis of altered consciousness for more than 96 hours after admission, persistent or recurrent seizures after 72 hours of antibiotic therapy, development of focal neurologic signs, increased intracranial pressure or prolonged fever. Scan findings included hydrocephalus, cerebritis, vasculitis, subdural effusion, cerebral atrophy, abscess, and ependymitis. Serial CT scans demonstrated the progression or regression of some complications. The CT scan was very useful in indicating the need for neurosurgical procedures.

Brain Edema↗