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[Psychomotor recovery in an operated case of subdural hygroma of unusual dimensions].

A case of unusually large subdural chronic effusion is described in a child 3 years old with severe developmental retardation, without obvious symptoms of increased intra-cranial pressure. Diagnosis was made by angiography. The child underwent to a Pudenz-shunt. An intensive physical and educational care program is performed. Behavior improvement and partial integration in social structure are obtained.

Cerebral Angiography↗
PubMed1981

[Traumatic subdural hygromas (author's transl)].

Out of a group of 97 patients with intracranial haematomas, 12 were found to have a traumatic subdural hygroma. In four patients a small fluid effusion was demonstrated by CT scan just after the head injury. In the majority of cases the CT scan demonstrated a significant increase of volume and pressure of the subdural effusion during the second to third week. Half the patients simultaneously developed a moderate ventricular dilatation. The development of a subdural effusion was hard to recognize from the clinical course. Nevertheless the patients mostly had a good post-operative recovery. The hygromas disappeared by subdural peritoneal shunting. In two patients a ventriculoatrial shunt was necessary on account of the hydrocephalus. Based upon clinical and CT scan characteristics a multifactorial hypothetical model of the development of the traumatic subdural effusion is proposed.

Adolescent↗
PubMed1995

Disappearance of arachnoid cysts after head injury.

The mechanism of the disappearance of arachnoid cysts is not fully understood. This article discusses the spontaneous disappearance of these cysts after head injury. Five patients underwent computed tomography and were diagnosed as having a subdural hematoma or effusion associated with arachnoid cysts. In four of the five patients, the cyst decreased in size or disappeared. These cases suggest a possible mechanism by which this type of cyst associated with subdural hematoma or effusion might disappear. For the arachnoid cyst to disappear, the rupture of the cyst wall appears to be essential, and after rupture, subdural effusion must develop around the cyst. As this effusion is absorbed, the fluid in the cyst drains away, after which the cyst becomes smaller and gradually disappears. This hypothesis supports the possibility of a "natural cure" for arachnoid cysts without surgical intervention.

Adolescent↗
PubMed2000

Treatment of the subarachnoid-pleural fistula. Case report.

Subarachnoid-pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7-8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. Postoperatively he developed progressive respiratory distress and headache. A chest x-ray film revealed a pleural effusion, and computerized tomography (CT) myelography demonstrated a subarachnoidal-pleural fistula at the level at which the herniated disc had been removed. The patient had been managed via a CSF drainage system and a chest tube. He was discharged after relief of symptoms was attained. Subarachnoid-pleural fistulas can be secondary to traumatic injury and surgery, or they can be spontaneous. Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.

Aged↗
PubMed1995

[Magnetic resonance imaging of supratentorial and parafalcial empyema].

The authors report the MR imaging of two patients with multiple subdural empyemas, including one in the interhemispheric fissure. MRI demonstrated convexity and interhemispheric collections which were mild hyperintense relative to CSF, hypointense relative to gray and white matter on T1W1, and marked hyperintense relative to CSF, and brain on T2W1. On the basis of signal intensity differences, MRI can distinguish subdural empyemas from most sterile effusions and chronic subdural hematomas with similar CT appearances. MRI was found to be clearly more sensitive to subdural empyemas than CT, though such lesions missed on CT were considered to be relevant. MR was superior to CT in demonstrating the nature, presence, and extent of these lesions. In both cases, the capsule of the lesions demonstrated enhancement, and connection between each lesion was obvious on contrast-enhanced MRI. It seems that contrast-enhanced MR image may detect encapsulation of an abscess which can not be detected from contrast-enhanced CT. We emphasized that the most significant factor in the successful surgical management of multiple subdural empyema, particularly including interhemispheric collections is the accurate location of pus. This can be reliably achieved with MR imaging.

Adolescent↗
PubMed2002

Management of cerebrospinal fluid leakage complicating anterior procedures through thoracotomy: report of three cases.

Postoperative cerebrospinal fluid (CSF) leakage is a serious complication accompanying an anterior procedure through thoracotomy, and it is difficult to cure. In this report, we present three patients with CSF leakage in the thoracic spine complicating anterior decompression and fusion for ossification of posterior longitudinal ligament who were treated by surgical or nonsurgical methods. As a surgical method, direct closure by fixing substitute dura mater with fibrin adhesive sealant or cyanoacrylate adhesive was performed in two patients. This technique was effective but required another thoracotomy. As a nonsurgical method, intrapleural administration of OK-432 through chest drainage tubes was also effective to reduce intrapleural effusions in one patient, but with this method, care must be taken for neurotoxic reactions. Both techniques seem to be useful and effective for postoperative intrapleural CSF leakages complicating anterior procedures through thoracotomy.

Antineoplastic Agents↗
PubMed1983

[Postmeningitic pericerebral effusion in infants].

Agar-gel electrophoresis of the pericerebral fluid and more recent data obtained from CT-Scan examination suggest the presumably important role of external subarachnoid hydrocephalus in postmeningitic pericerebral effusions of infancy. Postmeningitic subarachnoid hydrocephalus results very likely from an impeded resorption at the level of the arachnoid villi and venous sinuses; in some cases, however, there could be a coincidental occurrence of meningitis and pericerebral effusion from a distinct origin. The presence of a pericerebral effusion correlates badly with the seriousness of the clinical condition, whilst its spontaneous tendency to resorption is obvious in many cases, leading to a more conservative attitude. Fontanometry seems helpful when discussing the indication to operate. If surgery is required, it will usually be limited to a minor procedure; we perform, in such cases, an external drainage that can be transformed, if necessary, into an internal shunt.

Diagnosis, Differential↗
PubMed1983

Intracranial complications of acute and chronic infectious ear disease: a problem still with us.

Among 334,884 admissions to the North Carolina Baptist Hospital from 1963 through 1982, 100 patients had central nervous system (CNS) complications of middle ear disease. The complications occurred predominantly in young patients, 85 of the 100 being less than 20 years of age. Meningitis occurred in 76 patients; the acute form was more prevalent (63 cases). The less common nonmeningitic complications included brain abscess (n = 6), effusion (n = 5), lateral sinus thrombosis (n = 5), otitic hydrocephalus (n = 5), and empyema (n = 3). Overall mortality was 10%. One patient with brain abscess died; 9 of the 76 patients with meningitis died (12%), with 4 of those deaths occurring among the 13 patients with chronic meningitis (31%). Because these complications have declined markedly since the advent of antibiotics, many contemporary otolaryngologists have been unexposed to these complications. However, as this series shows, they do still occur, their natural history remains the same, and the resulting mortality is still alarmingly high. A plea is made for otolaryngologists to maintain an awareness of these complications and to work with pediatricians and neurosurgeons for the best team care of patients with CNS complications of middle ear disease.

Adolescent↗
PubMed2004

Diagnostic relevance of beta2-transferrin for the detection of cerebrospinal fluid fistulas.

OBJECTIVE: The beta(2)-transferrin assay is a specific method to identify cerebrospinal fluid (CSF). Hitherto, this test has not been widely used for the routine screening of patients with suspected CSF leakage. The purpose of this study was to investigate the clinical relevance of the identification of beta(2)-transferrin by comparing the test results with other diagnostic measures and intraoperative findings. DESIGN: Case series. PATIENTS: Retrospective analysis of 182 patients tested once or multiple times for beta(2)-transferrin. MAIN OUTCOME MEASURES: Information was obtained regarding different diagnostic procedures applied to diagnose CSF leakage. The effectiveness of those diagnostic measures was compared. RESULTS: The main indication to test for beta(2)-transferrin was posttraumatic rhinorrhea (25%), followed by spontaneous (22%) and postsurgical (22%) rhinorrhea. In 35 of 205 cases, beta(2)-transferrin was detected in the tested specimens. Thirteen of these required surgical intervention for treatment of the CSF fistula, and the leakage site was identified in all of them. Taking all results into consideration, the highest correlation was observed between the beta(2)-transferrin assay, intrathecal fluorescein application, and surgical exploration. CONCLUSIONS: The beta(2)-transferrin assay is a reliable method for confirming suspected CSF and should be used as a primary screening method in all patients with suspected CSF leakage. Although less invasive, the beta(2)-transferrin assay almost matches the high sensitivity achieved by exploratory surgery and intrathecal application of fluorescein. However, the possibility of bias should be carefully considered, and in particular, negative results should be critically compared with clinical symptoms and with results from other diagnostic procedures.

Adolescent↗
PubMed2006

Spontaneous spinal cerebrospinal fluid leaks and intracranial hypotension.

CONTEXT: Spontaneous intracranial hypotension is caused by spontaneous spinal cerebrospinal fluid (CSF) leaks and is known for causing orthostatic headaches. It is an important cause of new headaches in young and middle-aged individuals, but initial misdiagnosis is common. OBJECTIVE: To summarize existing evidence regarding the epidemiology, pathophysiology, diagnosis, and management of spontaneous spinal CSF leaks and intracranial hypotension. EVIDENCE ACQUISITION: MEDLINE (1966-2005) and OLDMEDLINE (1950-1965) were searched using the terms intracranial hypotension, CSF leak, low pressure headache, and CSF hypovolemia. Reference lists of these articles and ongoing investigations in this area were used as well. EVIDENCE SYNTHESIS: Spontaneous intracranial hypotension is caused by single or multiple spinal CSF leaks. The incidence has been estimated at 5 per 100,000 per year, with a peak around age 40 years. Women are affected more commonly than men. Mechanical factors combine with an underlying connective tissue disorder to cause the CSF leaks. An orthostatic headache is the prototypical manifestation but other headache patterns occur as well, and associated symptoms are common. Typical magnetic resonance imaging findings include subdural fluid collections, enhancement of the pachymeninges, engorgement of venous structures, pituitary hyperemia, and sagging of the brain (mnemonic: SEEPS). Myelography is the study of choice to identify the spinal CSF leak. Treatments include bed rest, epidural blood patching, percutaneous placement of fibrin sealant, and surgical CSF leak repair, but outcomes have been poorly studied and no management strategies have been studied in properly controlled randomized trials. CONCLUSIONS: Spontaneous intracranial hypotension is not rare but it remains underdiagnosed. The spectrum of clinical and radiographic manifestations is varied, with diagnosis largely based on clinical suspicion, cranial magnetic resonance imaging, and myelography. Numerous treatment options are available, but much remains to be learned about this disorder.

Diagnostic Imaging↗
PubMed1993

Subarachnoid fluid collection in infants complicated by subdural hematoma.

In the natural history of infantile extracerebral fluid collections, subarachnoid fluid collection itself is regarded as a benign lesion, and surgical treatment is not indicated. As this condition is age-related and self-limiting, spontaneous resolution can be expected in most cases by 2-3 years of age. However, out of 20 cases of infantile subarachnoid fluid collection in an 8-year period, 3 infants developed subdural hematoma. Infantile subarachnoid fluid collection seems to be prone to complicate subdural hematoma. Surgical treatment should be considered when subarachnoid fluid collection is complicated by subdural hematoma due to arachnoid ruptures or tearing of the bridging veins. Therefore, all patients should be observed closely and measures should be taken to prevent head trauma since it may precipitate subdural hematoma.

Diagnosis, Differential↗
PubMed1995

Infantile subdural fluid collection: diagnosis and postoperative course.

The authors reviewed 47 cases of infantile subdural fluid collection with regard to diagnosis and postoperative course after placement of a subdural-peritoneal shunt. CT scan with contrast enhancement proved to be an important diagnostic modality, showing vessels in the subarachnoid space as high-density spots. Utilizing this technique, we were able to differentiate the following varieties of fluid collection: (1) subdural fluid collection, in which enhancing vessels were seen on the brain surface, (2) subarachnoid fluid collection, in which vessels were on the inner table of the cranium, and (3) coexistence of subdural and subarachnoid fluid collections, in which vessels were between the inner table of the cranium and the brain surface. The postoperative course of subdural fluid collection was characterized as follows: (1) the subdural fluid collection decreased first, with increased subarachnoid fluid collection; (2) the subarachnoid fluid collection remained after the disappearance of subdural fluid collection; and (3) the brain expanded again later. Subdural fluid collection disappeared about 1 month after the shunt operation, which could lead occlusion of the shunt system. Postoperative enlargement of the subarachnoid space was an early indicator of the efficacy of the subdural-peritoneal shunt.

Cerebral Angiography↗
PubMed1980

Gyriform calcification after purulent meningitis.

A 2-month-old baby developed bilateral frontoparietal gyriform calcification after purulent meningitis. Biopsy revealed severe cerebral cortical degeneration with many calcified foci. Another feature of interest was reabsorption of calcification over a period of 4.5 months.

Brain Diseases↗
PubMed1984

Computed tomographic evolution of post-traumatic subdural hygroma in young adults.

The authors report on two cases of post-traumatic subdural hygroma that were encountered in young adults. Serial computed tomograms were taken immediately following trauma and for more than 4 weeks thereafter. In the case of a 28-year-old man with a skull fracture, an initial CT scan revealed a thin crescentic subdural collection in the right frontal area. A successive CT scan on the 36th postoperative day revealed developed subdural hygroma, and the CSF-like fluid was surgically evacuated. In the second case, involving an 18-year-old man, a very thin bifrontal subdural collection was found on the initial CT scan, and on the 15th post-traumatic day CT scan demonstrated a bifrontal subdural hygroma. No surgical treatment was carried out, and the follow-up CT scan on the 29th post-traumatic day demonstrated no change in size. The two young patients were slightly symptomatic during the period involved, and the repeat unenhanced CT scans showed subdural lesions of less than brain density, even in the chronic stage.

Adolescent↗