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Gamma-encephalography in the diagnosis of subdural effusions in infancy and childhood.
The results of the use of gamma-encephalography (GEG) as a diagnostic tool in a group of 28 patients with subdural effusions and 46 membranes confirmed at surgery are presented. 27 patients were submitted to bilateral surgical expolorations and 1 was unilaterally explored. Positive GEG: membranes were present in 34, in 8 the test was nonconclusive and there were 4 false-negatives. Negative GEG: membranes were absent in 6, 1 case was nonconclusive and 2 were false-positive tests. Therefore, from 28 patients with 46 membranes the GEG was correct in two thirds of the cases, it was nonconclusive in 9 cases and the image did not confirm the surgical findings in 6 cases (false-positive or false-negative). The results suggest that the presence of a medium or thick membrane almost always results in a positive image, whereas the presence of a thin membrane leads to a nonconclusive result or in some cases a false-negative one. The general data from the literature correlates well with the present series.
Bilateral subdural effusion (hygromas) in non-immune hydrops fetalis.
In addition to body edema fluid accumulation in serous cavities is a component of non-immune hydrops fetalis. A case with bilateral symmetrical subdural effusion is reported. Fluid accumulation in this space appears to be a part of this entity.
[Subdural effusion during bacterial meningitis].
Twelve children of age ranged from 4 to 34 months with Haemophilus influenzae type b meningitis treated at Meyer Hospital of Florence, were retrospectively reviewed. Eight patients had subdural effusion demonstrated with TC, RM and transfontanellar ultrasonography. All patients are cured without sequelae.
[Extra-cerebral intracranial fluid collections in childhood: differentiation between benign subarachnoid space enlargement and subdural effusion using color-coded duplex ultrasound].
BACKGROUND: Extracerebral fluid collections in infancy are a common diagnostic problem, because by noninvasive imaging studies (including cranial ultrasonography, CT and NMR), no definite differentiation between two distinct pathological conditions can be found until today: An enlargement of the subarachnoid spaces in children with macrocephaly is a frequent observation of mostly unknown etiology but is known to be associated with a good prognosis. If surgery is necessary in these patients, ventricular shunting is required. On the other hand subdural effusions are often of traumatic origin and require frequently neurosurgical intervention (subdural shunting). Most reports on extracerebral fluid collections in infancy have not differentiated between both pathological conditions and therefore reveal confusing results. Recent studies using magnetic resonance imaging have shown that vascular flow phenomena in the arachnoid space can be used to a reliable diagnosis, whereas previous noninvasive neuroimaging attempts including high resolution computerized tomography (CT) have been useless. PATIENTS AND METHODS: We investigated a cohort of 20 patients aged 4 mths to 30 mths (mean 10.5 +/- 6.6 months) 16 with the history of macrocephaly and normal neurological development and 4 patients after head trauma and symptoms of an elevated intracranial pressure. RESULTS: In all 16 patients with the clinical diagnosis of benign subarachnoid space enlargement colour coded Doppler sonography detected archnoid vessels within the fluid collection, furthermore high resolution ultrasound demonstrated the dural border of of the arachnoidea as an echogenic membrane, an observation useful as a further sign of the subarachnoid location of the fluid collection. In the 4 patients with subdural hematoma the fluid collection showed an increased echogenity, no vascular structures and no surrounding border. CONCLUSION: Out of these observations we conclude that high resolution ultrasound and colour-Doppler sonography are able to reliably differentiate between a subdural and a subarachnoid fluid collection. An NMR investigation with its higher risks (sedation, anesthesia) focused on this target only seems therefore to be not necessary in these patients.
Bilateral subdural effusion and subcutaneous swelling with normally functioning csf shunt.
We report a child with hydrocephalus due to tuberculous meningitis who developed a subcutaneous fluid collection around the ventriculoperitoneal shunt tube entry point, after one month of shunting. On investigation, he had decompressed ventricles with bilateral fronto parietal subdural hygroma. Bifrontal burr hole drainage helped resolution of both subdural effusion and subcutaneous scalp swelling. This complication is unique and its pathogenesis has been postulated.
Benign subdural effusion in infants.
Twenty cases of infants with computed tomographic low density areas over the frontal lobes that mimicked cortical atrophy are reported. Almost all cases presented with a slight increase in intracranial pressure associated with delayed developmental milestones. Peripheral hypodensity over the frontal lobes disappeared, and the infants' development was essentially normal, in many cases without surgery. The lesion might be called "infantile benign subdural effusion" and should be treated conservatively.
[Anesthetic procedure in trepanation in infants for subdural effusion].
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Intracranial complications of ear disease in a pediatric population with special emphasis on subdural effusion and empyema.
Between the years 1963 to 1982, 84 consecutive cases of intracranial complications of ear disease in pediatric patients were diagnosed and treated at the North Carolina Baptist Hospital. This group consisted of 65 patients with otitic meningitis, four with otitic brain abscess, four with otitic hydrocephalus, three with lateral sinus thrombosis, three with otitic subdural empyemas, and five with an otitic subdural effusion of fluid. The advent of antibiotics has drastically altered the natural history of middle ear infections. We present these 84 cases to review diagnostic problems and therapeutic options, and to offer a plea for continued awareness of the middle ear as a potential source of central nervous system complications.
Haemophilus influenzae type b meningitis with subdural effusion: a case report.
Haemophilus influenzae type b causes invasive infection in children under 2 years of age. The disease may be complicated with hearing impairment, lowered learning ability, and other neurologic sequelae. The incidence of invasive H. influenzae type b has declined dramatically after the introduction of routine administration of protein-conjugated H. influenzae type b vaccine in the United States and some other countries. Because of its low incidence in Taiwan, many clinicians are not familiar with the initial symptoms and management of H. influenzae type b. This case report describes a 7-month-old H. influenzae type b meningitis patient who had initial presentations of prolonged intermittent fever and vague neurologic signs. Left peripheral facial palsy with hearing loss in left ear and bilateral frontal subdural effusion developed during the first 5 days of cefotaxime therapy. Betamethasone was then given for 4 days to relieve the severe inflammation. Drug-induced fever was observed after 11 days of antibiotic use and subsided with prednisolone treatment. Left ear hearing impairment persisted during the follow-up period, but the children did not experience other significant development delay.
[Differential diagnosis of subdural effusions].
Although x-ray computerized tomography facilitates the diagnosis of intracranial disorders, differentiation of the lesions like extracerebral effusions is often unsatisfactory. Epidural and acute subdural haematoma shown as hyperdensity in CT requires an emergency neurosurgical operation, so that differentiation of these hyperdense effusions may not be required. But the discrimination of the effusions shown as hypodensity in CT (chronic subdural haematoma, subdural hygroma, subdural empyema as well as arachnoid cysts) is urgent because of the different treatment of these effusions. The clinical differentiation is hampered by unspecific neurologic symptoms and the lack of adequate laboratory tests. Some aspects facilitating the diagnostic decision are presented. Recent magnetic resonance (MR) studies promise further progress in differentiating between subdural effusions.
[SUBDURAL EFFUSIONS IN INFANTS. ETIOPATHOGENETIC DISCUSSION APROPOS OF 59 CASES].
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Delayed onset of acute posttraumatic subdural effusion.
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Bilateral encapsulated subdural effusion complicating bacterial meningitis in infancy; report of a case with review of literature.
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The nature of postmeningitic subdural effusions.
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Brain shrinkage and subdural effusion associated with ACTH administration.
Sequential computed tomographic (CT) studies of 11 patients (aged five months to seven years) with intractable epilepsy treated with synthetic ACTH-Z showed brain shrinkage in all cases. Brain shrinkage started to appear on daily ACTH injections for seven days, reached the maximum within four weeks of administration (14 injections every day and then 7 injections every other day), and almost returned to the original status in seven out of nine cases which were followed up for one to three months after the therapy. The subjects aged less than two years showed more remarkable brain shrinkage than did those aged more than five years. Furthermore, two other cases were complicated by subdural effusion after ACTH therapy. It is the authors' assumption that both of these phenomena are caused by the high concentration of corticosteroid through a change of the water and electrolyte contents in the brain.
Treatment of hydrocephalus and bilateral subdural effusions in a patient with closed sutures. Case report.
For management of bilateral subdural hematomas in a hydrocephalic child with fused sutures, a simple technique is described that involves minimal cranial procedures for modification of an already installed ventriculoperitoneal shunt system.