[Clinical aspects and therapy of serous meningitis].
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The Authors present 70 cases of traumatic subdural hygromas, classified into acute, subacute and chronic, according to the interval between injury and the appearance of symptoms. The acute cases were 22.9% of our series. Criteria for surgical treatment were established by means of CT scan serial investigations. Pathogenesis, clinical aspects and results are discussed. Mortality rate was 17.1%.
Post-traumatic subdural hygromas, or hydromas, are collections of fluid most often caused by severe head injuries. They present from the onset as hypodense pictures on computerized axial tomography scan (CAT-scan). CAT-scan is the best way to diagnose and to follow the evolution of hygromas. Out of 3002 patients admitted for head injuries, the authors have collected 70 cases of hygromas. 24 of these 70 patients underwent burrhole evacuation of the hygroma. The other 46 had conservative treatment. In both groups, the clinical picture, at short or long-term follow up, was more influenced by the associated brain injuries (extra- or subdural hematomas, cerebral contusion) than by the evolution of the hygroma itself. The surgical treatment of the hygroma was seldom followed by a significant improvement in the patients' condition. As the size of hygromas usually diminishes spontaneously, it seems appropriate most of the time to treat them conservatively and to follow them by CAT-scan, according to the clinical picture.
Four asymptomatic infants with macrocrania, abnormal transillumination, and characteristic computed tomography scans are described. All had bilateral subdural collections, normal brain size, modest ventricular enlargement, and prominent cerebral sulci and interhemispheric fissures. Although these latter findings are often interpreted as atrophy, these infants had normal development and rapidly growing heads. No treatment beyond diagnostic subdural punctures was performed. After up to 13 months of follow-up, the size of the subdural collections was either stable or decreasing in all four infants.
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