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PubMed1993

Early and delayed SPECT images of extracerebral fluid collection in infants using 123I-N-isopropyl-p-iodoamphetamine.

Cerebral blood flow in seven infants with extracerebral fluid collections was investigated using single photon emission computed tomography (SPECT) with 123I-N-isopropyl-p-iodoamphetamine. Early and delayed SPECT imaging was carried out. Areas of hypoperfusion were observed in five cases. The watershed zone of the major cerebral arteries or the territory of the anterior cerebral arteries were common areas of low perfusion. The hypoperfusion area was redistributed in two cases with intracranial hypertension. Subduroperitoneal shunts produced improvement of clinical symptoms in these cases. Hypoperfusion without redistribution was observed in three patients. In these areas, permanent tissue damage caused by a primary disease existed. Normal circulation patterns were observed in two patients. They showed normal development and follow-up CT revealed a decrease in the size of the extracerebral fluid collection. Measurement of regional cerebral blood flow may be helpful in considering surgical indications and in following up extracerebral fluid collection in infants.

Asphyxia Neonatorum↗
PubMed1984

Ultrasonic detection of subdural collections.

Subdural collections in infants are common complications of meningitis, trauma and post surgical procedures. Careful ultrasonic examination via the anterior fontanelle is a reliable method of demonstrating these collections. It has an accuracy comparable to computed tomography and is our first line of investigation.

Female↗
PubMed1991

Percutaneous twist-drill craniostomy for the treatment of chronic subdural haematoma.

A consecutive series of 65 adult patients with chronic subdural haematoma was reviewed to ascertain the efficacy of twist-drill craniostomy and closed-system catheter drainage. In all patients but two the percutaneous evacuation of the haematoma alone was enough to bring about their recovery. Infections or neurological complications were never observed. Pneumocephalus was likewise absent in all patients. Therefore this technique should be recommended as the "first intention" management of the disease, particularly in elderly patients.

Aged↗
PubMed1989

Subdural fluid collections following transcortical approach to intra- or paraventricular tumours.

Subdural fluid collections appeared in 15 cases (39%) after removal of 38 intra- and paraventricular tumours in the third or lateral ventricle through 18 frontal and 20 parietal transcortical approaches. Transient fluid collections which disappeared within 2 weeks occurred in 6 cases (16%) and persistent ones in 9 cases (24%). Four of the 9 cases (11%) of collections required surgical treatment because of positive clinical signs and symptoms. Two cases had expansive fluid collections and the other two contained subdural haematomas at surgery. The risk factors likely to contribute to a persistent collection were preoperative ventriculomegaly (frontal horn index greater than 0.38) and a frontal transcortical approach. A symptomatic collection should be considered as a potential complication of the transcortical approach to intraventricular tumours and some methods should be devised to prevent it when intra- or paraventricular tumours with ventriculomegaly are removed.

Adolescent↗
PubMed1996

Management of subarachnoid fluid collection in infants based on a long-term follow-up study.

We report the natural history and management of subarachnoid fluid collections in infants and their management based on a longterm follow-up study in 20 cases. These subarachnoid fluid collections were resolved spontaneously in 17 of 20 patients and only 3 by surgical intervention at the age of 2. In our 20 patients the natural history of subarachnoid fluid collection in infants was benign unless the patients sustained head trauma. Surgical treatment was performed in the cases where a subarachnoid fluid collection developed into a subdural haematoma. Head trauma may precipitate subdural haematoma in patients with subarachnoid fluid collection. All patients except one who underwent the placement of subdural-peritoneal shunt, attained normal psychomotor development in time. During the follow-up period of 3 to 10 years after resolution of the fluid collection, no patient has had a recurrence once it resolved.

Cerebrospinal Fluid Shunts↗
PubMed1985

Supratentorial space occupying lesions following infratentorial surgery early diagnosis and treatment.

Supratentorial complications of infratentorial surgery are rare. In the last 3 years we have operated on 187 patients with infratentorial lesions and have observed an incidence of 3.7% of supratentorial haemorrhages. Postoperative intracranial air, as shown by early postoperative CT control, was encountered mainly in a subdural frontal location and within the interhemispheric fissure. We performed no surgical decompression of the air accumulation because of the lack of clinical symptoms. Predisposing factors for the development of supratentorial complications remote from the surgical area are hypertonia, female sex, brain atrophy and preoperative shunting procedures. Measures to avoid these complications are discussed.

Adult↗
PubMed1994

Spontaneous evolution of posttraumatic subdural hygroma into chronic subdural haematoma.

Thirteen of 145 patients with post-traumatic subdural hygroma (SDHy) developed chronic subdural haematoma (CSDH) at the involved site over a period of 6 years. CSDHs were found at the site of SDHys with no history of further head injury at a mean interval of 56 days. It appeared that these 13 patients did not have any distinguishing clinical features early on. Old age and brain atrophy on CT scans do not seem to be reasonable causative factors in the evolution of SDHy into CSDH. Initial enlargement of subdural accumulations at an early stage of SDHy and a subsequent increase in density at a later stage may point to the development of CSDH from SDHy in some instances. Ten of these 13 CSDH cases underwent surgical drainage, and the remaining 3 cases received no specific management. All resolved completely. The prognosis was good in all patients. The possible mechanism for the evolution of SDHy into CSDH is discussed.

Adult↗
PubMed1995

Subdural fluid collections: an unusual manifestation of CNS disease in a connective tissue disorder.

We describe a case of autoimmune cerebritis/meningitis presenting as altered mental status that was associated with subdural fluid collections in a connective tissue disorder patient. The fluid collections cleared following high dose corticosteroid therapy and the patient's clinical status improved promptly. Subdural fluid collections have not been previously reported as a manifestation of autoimmune CNS disease.

Adult↗
PubMed2005

Detection of cerebrospinal fluid leakage in intracranial hypotension with radionuclide cisternography and blood activity monitoring.

UNLABELLED: Radionuclide cisternography is an indispensable examination to detect cerebrospinal fluid (CSF) leakage in patients suspected of having spontaneous intracranial hypotension (SIH). However, it sometimes fails to demonstrate the site of CSF leakage, and in such cases, early bladder visualization is utilized for the diagnosis of SIH as an indirect finding. The aim of this work is to improve the diagnostic ability of radionuclide cisternography and to reevaluate the reliability of early bladder visualization as an indirect finding of CSF leakage. METHODS: We obtained serial images during the first hour after injection as well as the following time points in 4 patients with SIH and 5 with normal pressure hydrocephalus (NPH) as a control. We also performed blood sampling over time to measure blood radioactivity concentrations. RESULTS: All 4 patients with SIH demonstrated leakage, 2 of 4 within one hour after injection. Bladder visualization was observed falsely in 4 of 5 patients with NPH, considered to be the result of a lumbar puncture complication. In this false bladder visualization, blood radioactivity showed a more rapid raise and fall than in CSF leakage of SIH. CONCLUSIONS: The combination of radionuclide cisternography, including early time points and blood sampling, may enable accurate diagnosis of SIH.

Adult↗
PubMed2006

Unsuccessful tracer injection in radionuclide cisternography revisited.

Since cerebrospinal fluid (CSF) leakage is highlighted as a cause of persistent headache, radionuclide cisternography has been increasingly performed in Japan to confirm the disorder, although the limited ability of the examination should be recognized. We present 3 cases in which failure of a tracer injection was strongly suspected. In 2 cases with chronic symptoms, the tracer appeared to be injected into the epidural space, because of irregular initial accumulation of the tracer and lack of diffusion along the CSF cavity. Another is a case with spontaneous CSF leakage confirmed by MRI, and the tracer was thought to be injected into the leaked fluid accumulated in the spinal epidural space. Tracer in the CSF space rapidly disappeared within several hours in all cases. As such cisternographic images may be misdiagnosed as severe CSF leakage, careful interpretation of images in patients especially with no typical MR findings of CSF leakage is necessary. Excessive tracer clearance from the body suggests such technical failure.

Adult↗
PubMed2002

Radionuclide cisternography in intracranial hypotension syndrome.

A 44-year-old male patient complaining of severe headache right after twisting his body during aerobic exercises in a swimming pool underwent In-111 DTPA radionuclide cisternography. Leakage of cerebrospinal fluid (CSF) was proved on the right side of T2 and T3 vertebrae. Cisternography after bed and conservative treatments demonstrated the disappearance of abnormal tracer accumulations. Radionuclide cisternography is of great value in diagnosing cerebral-spinal fluid leak and in evaluating the therapeutic effect.

Adult↗
PubMed2005

Intracranial hypotension due to leakage of cerebrospinal fluid: could myelography be a therapeutic option?

Spontaneous intracranial hypotension (SIH) is an uncommon condition caused by cerebrospinal fluid leakage. We report of a 29-year-old woman with typical symptoms in whom initial cranial MRI and CT were normal . A clinical diagnosis of SIH, but the symptoms did not resolve with conservative therapy or a lumbar epidural blood patch. Repeat MRI revealed (indirect) findings consistent with SIH but failed to directly demonstrate a cerebrospinal fluid fistula. Subsequent CT myelography revealed leakage of contrast medium into the epidural space bilaterally along the nerve roots at C3-7. Following the myelography the patient reported dramatic clinical improvement with complete resolution of symptoms. The adhesive quality of the myelographic contrast medium might have precipitated closure of the meningeal tears. Myelography may be not only of diagnostic value but also therapeutic in SIH.

Adult↗
PubMed2001

Discrepant time course of cranial and spinal subdural collections in a case of SIH treated by EBP.

The MR monitoring of a patient with acute spontaneous intracranial hypotension successfully treated by epidural blood patch revealed strikingly different time course of the initially concomitant cranial and spinal subdural fluid collections. This undescribed feature suggested different pathophysiological mechanisms for the disorder in the two locations and should be kept in mind when imaging patients with the condition.

Blood Patch, Epidural↗
PubMed2002

A case of schizencephaly with subdural fluid collection in a neonate.

CASE REPORT: A neonate who had schizencephaly associated with ipsilateral chronic subdural fluid collection in the neonatal period is described. A boy was born to a healthy Japanese woman. After birth, the boy presented with rapid expansion of head circumference. Computed tomography (CT) and magnetic resonance images (MRI) of the head demonstrated left schizencephaly combined with a midline shift attributable to hydrocephalus. Thereafter, the patient gradually presented other symptoms caused by increased intracranial pressure. Ultrasonography and MRI of the head showed the presence of a subdural fluid collection overlaid on the schizencephaly. We identified the outer membrane by burr-hole craniotomy. CONCLUSION: This was a rare case of schizencephaly associated with hydrocephalus and the formation of ipsilateral chronic subdural fluid collection.

Brain↗
PubMed2002

Managing subdural fluid collection in infants.

INTRODUCTION: The authors classify infantile subdural fluid collection (SFC) into four chronological stages: (I) SFC with arachnoid tear, (II) SFC with inner membrane, (III) SFC with inner and outer membrane, and (IV) subdural hematoma, and discuss the appropriate treatment for each stage. CONCLUSIONS: Fontanel tapping can be used for every stage of SFC, but it is best indicated for stage II. Massive bleeding seldom occurs with punctures made with a small needle. Continuous external drainage is indicated for stages II and III. Although the risk of bleeding decreases even in stage III, this method involves a risk of infection. Burr hole irrigation is usually indicated for stage IV. Implantation of an Ommaya reservoir and endoscopic observation of the SFC cavity along with burr hole irrigation are very useful. A subduroperitoneal shunt cannot be recommended for the treatment of SFC in most cases.

Catheters, Indwelling↗