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Results for “Subdural Effusion”

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PubMed1994

[The pathogenesis of chronic subdural hematomas and hydromas in children].

Although a chronic hygroma in most cases is residual of incompletely organized old subdural hematoma, both these chronic effusions may lay on different etiological factors and on pathogenetic mechanisms similar in the early stage, then different. The key event common to both the effusions is the neoformation of a subdural mesenchymal membrane (external capsule) with giant sinusoid capillaries. This membrane is due to fibroblastic proliferation of the dura-arachnoid interface layer cells, triggered by subdural bleeding (in cases of hematoma), by phlogistic transudate in meningitis or CSF escape in hydrocephalus or trauma (in cases of hygroma). The different physiopathological activity of the neoformed capsule produces either a hygroma or a hematoma: vascular transudation alone produces the former; hyperfibrinolysis, due to marked plasmin activity, sustaining repetitive microbleeding from the capillaries of the membrane, produces a hematoma. Most of the above data are obtained from adult cases; however, both the chemical composition of the fluid collections and the pathological features of the effusions in infancy are the same as in adulthood. It seems unlike that the enzymatic processes of reparative connective tissue, involving the hemostatic-fibrinolytic balance, be different in the early and late stages of life.

Child↗

PubMed1989

[Ultrasonic studies of craniocerebral injuries in infants].

This is a report on the sonographic diagnostic possibilities in 46 closed-head injured infants. Cerebral examination via the anterior fontanelle is completed by additional sections of the surface of the brain. The traumatic oedema is limited in most cases and - besides the increase in echogenicity - an increase of the arterial pulsation at the border of the oedema is seen in real-time scanning. The sonographic signs of the epidural and subdural haematomas are described and also the differentiation between both. Surgical treatment was necessary in three cases of subdural haematoma because of increasing ICP. Treatment of extradural and chronical subdural haematomas or effusions is discussed in connection with the sonographic follow-up. Alterations in symmetry and compression of the ventricular system is often caused by intracerebral haemorrhages and-or traumatic local oedema. Parenchymal cysts may occur after liquefaction of cerebral necrosis or clots. The advantage of the cerebral sonographic examination is the uncomplicated follow-up. In connection with the clinical state and with continuous registration of ICP, sonographic findings facilitate the decision if, where and when trepanation must be performed.

Brain↗

PubMed1996

[Promotive factors of chronic subdural hematoma in relation to age].

To reveal the pathogenesis of chronic subdural hematoma (CSDH), 256 patients with CSDH over 1 year of age were studied in relation to various traumatic or nontraumatic promotive factors of CSDH including arachnoid cyst, implantation of a cerebrospinal fluid shunt, secondary cerebral atrophy, coagulopathies and past history of acute subdural hematoma or effusion. All patients were grouped according to decade of age. The incidences of associated promotive factors were individually analyzed in each group. The incidences of associated promotive factors in the 1st, 2nd, 3rd, 4th, 5th, 6th, 7th, 8th, 9th decades of life were 71%, 89%, 56%, 33%, 9%, 11%, 8%, 8% and 5%, respectively. Thus, they were divided into two groups; youth (1st to 4th decade: n = 34) and elder (5th to 9th decade: n = 222). The incidences of associated promotive factors were 62% and 8%, respectively (P < 0.001). Severity of head injury received was also evaluated in these two groups. In the youth group, 15 out of 34 patients (44.1%) had received severe head injuries with loss of consciousness, while in the elder group, only 22 out of 222 patients (9.9%) had received severe head injuries (P < 0.001). The analysis was repeated after each group was divided into two subgroups regarding the coexistence of promotive factors. Among the youth group, 13 patients had no promotive factors and 21 had one or more promotive factors. In those without any promotive factor, 9 out of 13 had received severe head injuries with loss of consciousness, while in those with promotive factors, 6 out of 21 had received severe head injuries. On the other hand, majority of the elder group had not received severe head injuries irrespective of whether patients had promotive factors or not. The present study revealed that majority of young CSDH patient had some promotive factors or severe head injuries with loss of consciousness, and that majority of patients aged over 40 years had no promotive factors and did not receive severe head injuries.

Adolescent↗

PubMed1984

Computed tomographic findings in metastatic dural carcinomatosis.

A case is presented of metastatic dural carcinomatosis associated with a thickened subdural membrane similar to those found in association with posttraumatic chronic subdural hematomas. In this case burr-hole drainage was attempted as a result of findings on computed tomography scanning that suggested a right frontal chronic subdural hematoma. However, no chronic subdural hematoma or effusion was found. The pathology, radiographic findings, and clinical features of this phenomenon are discussed.

Aged↗

PubMedDate not supplied

Neuroimage in infants and children with mitochondrial disorders.

Neuroimage studies of thirty-eight infants and children with mitochondrial disorders were reviewed: 24 ultrasound (US), 21 computed tomography (CT), and 27 magnetic resonance image (MRI) examinations were analyzed. Patients included seventeen with Leigh syndrome, two with Kearns-Sayre syndrome (KSS), one with myoclonus, epilepsy, and ragged red fibers (MERRF), one with Alpers disease, five with Menkes disease, two with fatty acid metabolic defect, two with Rett syndrome, and eight with unspecified mitochondrial disorders. KSS and MERRF tended to occur in older children, whereas Leigh syndrome, Menkes disease, and Alpers disease occurred in infants and young children. The deep cerebral nuclei and the cerebral white matter were commonly involved in Leigh syndrome and KSS. Subdural hematomas or effusions with profound cerebral atrophy was found in Alpers disease and Menkes disease. Tortuosities of basilar, Willis circle, and cerebral vessels were also noted in Menkes disease. MRI and CT examinations of Rett syndrome, fatty acid metabolic defect, and most of the unspecified mitochondrial disorders were normal. Our results indicate that neuroimage studies have characteristic findings for specific mitochondrial syndromes.

Adolescent↗

PubMed1979

Benign subdural collections of infancy.

During the past two years we studied six infants with subdural collections of fluid. All patients had macrocrania and excessive transillumination of the head. Rapid head growth was common but five patients were otherwise asymptomatic. Subdural taps performed on five children confirmed the presence of abnormal fluid over the cerebral convexities. Subdural fluid in four patients was compatible with effusion and in another with a hematoma. Computerized tomographic evaluation of all infants showed ventricular enlargement, wide cerebral sulci, decreased density in the anterior temporal regions, large sylvian cisterns, prominent interhemispheric fissures, and decreased density over the cerebral convexities. The CT findings resembled cerebral atrophy but psychomotor development and neurologic examinations have been norma.

Child Development↗

PubMed1975

Local alterations of hemostatic-fibrinolytic mechanisms in reforming subdural hematomas.

Multiple chemical and coagulation determinations were undertaken on the subdural hematoma fluid from the reformed effusions of two patients. It was found that plasma or blood repeatedly reentered the subdural cavity. Coagulation studies compared the in vitro effects of subdural fluid with those of cerebrospinal fluid, serum, and a buffer control. Despite some chemical differences, the subdural fluids from both patients behaved similarly by (1) accelerating the intrinsic clotting system, (2) producing defective clot formation, and (3) accelerating the fibrinolytic system. It is presumed that these continuous hemostatic-fibrinolytic alterations, acting in the subdural sac, may have important implications in the growth and reformation of subdural hematomas, and a hypothesis of the mechanisms involved is presented.

Aged↗

PubMed2002

Subdural empyema complicating a concha bullosa pyocele.

Concha bullosa is the most common anatomic variant of the middle turbinate and remains usually asymptomatic. We report a case of concha bullosa pyocele with a subdural empyema in a 11-year-old girl presenting with a subcutaneous tumefaction without neurologic deficit. Computed tomography and magnetic resonance imaging confirmed a subdural empyema communicating with subcutaneous effusion and the presence of a concha bullosa pyocele being responsible for the obstruction of ostiomeatal complex leading to frontal sinusitis. Resection of the middle turbinate with a middle meatotomy and a frontal skin incision combined with an adequate antibiotic treatment allowed this child to recover within 6 weeks.

Child↗

PubMed1998

The pathogenesis and clinical significance of traumatic subdural hygroma.

Subdural hygroma (SDG) is a common post-traumatic lesion. Despite its common occurrence, the pathogenesis and clinical significance are uncertain. The author reviewed the literature to clarify the present knowledge on the pathogenic, diagnostic and therapeutic aspects of this controversial lesion. A trivial trauma can cause a separation of the dura-arachnoid interface, which is the basic requirement for the development of a SDG. If the brain shrinks due to brain atrophy, excessive dehydration or decreased intracranial pressure, fluid collection may develop by a passive effusion. Most SDGs resolve when the brain is well expanded. However, a few SDGs become chronic subdural haematomas, when the necessary conditions persist over several weeks. Since the majority of patients with a SDG do not show a mass effect, surgery is rarely required. Outcome is closely related to the primary head injury not to the SDG itself. The complexity of SDG depends on various factors including the dynamics of absorption and expansion, duration of observation, and indication and rate of surgery, besides variety of the primary head injury in types and severity. SDG is a common epiphenomenon of head injury.

Atrophy↗

PubMed1985

Subdural empyema in infant meningitis: diagnosis, therapy, and prognosis.

Collections of subdural fluid during the course of infant Hemophilus influenzae meningitis have been demonstrated in the past by routine subdural taps and, more recently, by computed tomography. While the fluid is usually a benign effusion, the clinical picture and CT pattern may suggest a subdural abscess (empyema) necessitating further subdural punctures. This is a review of nine infants with subdural empyema. As reported in the literature, a remarkably good prognosis is apparent following treatment with subdural taps and systemic antibiotics. Six of seven H. influenzae cases were ampicillin-resistant in this series.

Ampicillin↗

PubMed1992

Management of symptomatic chronic extra-axial fluid collections in pediatric patients.

The records of 103 pediatric patients having symptomatic chronic extra-axial fluid collections treated at Children's Hospital of Los Angeles from 1977 to 1988 were reviewed. Patients were treated with observation, serial percutaneous needle drainage, drainage through burr holes, drainage into a closed external drainage system, or subdural to peritoneal shunt. If the initial treatment was not effective, additional forms of treatment were instituted. Shunts, ultimately used in 73% of the patients, proved to be the most effective treatment. Of the group with shunts, the extra-axial fluid was unilateral in 20% and bilateral in 80%. In those patients with bilateral effusions, no difference in efficacy of shunts was seen in patients treated with bilateral versus unilateral shunts. Of the 75 patients with shunts, 12% required a shunt revision for progressive or recurrent symptoms. Shunt infections occurred in 3% of the patients, necessitating removal of the shunt and treatment with antibiotics. Eosinophilia in the subdural fluid was associated with shunt obstruction requiring revision. The shunt was never removed in 51% of patients with no untoward effects. This study demonstrates that the most efficacious treatment of symptomatic chronic extra-axial fluid collections in children is a unilateral subdural to peritoneal shunt. The shunt need not be removed after resolution of the fluid collections.

Adolescent↗

PubMed1987

[Intracranial pneumocephalus under pressure. A possible cause of postoperative deterioration in neurosurgery. 10 cases].

10 patients in whom an early post operative alteration of the level of consciousness or of the neurological status could be related to a tension pneumocephalus are reviewed. Four underwent a surgical procedure in the sitting position. Among these, 2 had been previously shunted for hydrocephalus. A 5th patient underwent a IIId ventriculocisternostomy for tumorous occlusion of the aqueduct. The other five patients were involved with supra-tentorial conditions (hemispheric glioma: 1 case, meningioma: 1 case, chronic subdural hematoma: 3 cases). The post-operative deterioration clinically suggested a post operative hematoma. CT showed a very low density effusion either located in the operative area or in the subdural space or both, with significant mass effect. 9 patients steadily improved after conservative therapy. In 1 case, reoperation was required. Pathogenesis of symptomatic pneumocephalus remains controversial. The role of the sitting position and of CSF drainage seem likely. Spontaneous or nitrous oxide induced expansion of post-operative residual intra cranial air plays a debatable role. It is postulated that tension pneumocephalus may result from a discrepancy between spontaneous reexpansion of the cerebral mass and a residual air collection. Such complications are regarded as serious enough to justify several preventive measures.

Adult↗

PubMed1993

Complications of anticoagulation for pulmonary embolism in low risk trauma patients.

Trauma patients are at significant risk for deep venous thrombosis (DVT) and pulmonary embolism (PE). Anticoagulation is standard therapy for DVT/PE, but may cause severe complications. We reviewed the course of 70 trauma ICU patients treated over a 28-month period. Thirty-six patients (51.4 percent) were treated by continuous IV heparin and/or oral warfarin. Of these, 13 patients (36 percent) developed complications requiring termination of anticoagulation. These included recurrent PE (four), subdural hematomas (three), hemothorax (two), heparin-induced thrombocytopenia (one), hemorrhagic pericardial effusion (one), retroperitoneal hematoma (one), and sudden unexplained drop in hemoglobin and shock (one). All patients with subdural hematomas had no prior evidence of head injury on brain computed tomography. All patients with recurrent PE received adequate anticoagulation therapy. Age > 55 was associated with increased risk of complications (8 of 13; p = .02:chi 2). Thirty-four other patients (48.6 percent) received inferior vena caval filters with no related complications or deaths. Anticoagulation for DVT/PE should be used selectively in trauma patients and avoided in elderly patients. Such patients should undergo early caval filter placement.

Adult↗

PubMed1987

Successful treatment of acute subdural haematoma associated with severe bleeding disorder.

A 76-year-old man suffering from myelofibrosis with thrombocytopenia sustained an acute subdural haematoma with severe neurological deficit. He was treated initially by bedrest and dexamethasone. Craniotomy was contraindicated because his bleeding time exceeded 20 min in spite of multiple infusions of platelet concentrate. After 3 weeks his condition deteriorated with increase of the fluid collection shown by CT. Partial drainage of the haematoma by subdural puncture with a 22-gauge spinal needle resulted in complete recovery from the neurological deficit and complete resorption of the effusion. The case shows that it is possible to avoid craniotomy in the acute phase of a subdural haematoma in patients with bleeding disorders and that it may be advantageous to use needle evacuation instead of burr-hole drainage in the chronic phase.

Aged↗

PubMed1988

The predictive value of computed tomography and Haemophilus influenzae capsular antigen in subdural fluid collections.

A study was made of 52 patients with Haemophilus influenzae type B meningitis complicated by subdural collections of fluid to determine which of these collections were sterile (effusions) and which infected (empyema). This differentiation is important for the treatment which differs in the two conditions. Cranial computed tomography (CT) alone was not as reliable as the combination of CT associated with detection of Haemophilus influenzae capsular antigen, in accurately predicting if a subdural fluid collection was infected, or had a high probability of becoming infected.

Bacterial Capsules↗

PubMed1977

[The role of the Scanner in traumatic cerebral pathology (author transl)].

The authors describe the tomodensitometric characteristics of various traumatic cerebral lesions: extradural haematoma, subdural haematoma, contusion. In the acute phase, traumatic lesions are characterised by the typical absorption pattern of the bloody effusion and perilesional oedema. In association with these specific densitometric signs there is naturally an alteration in normal cerebral anatomy. The course of traumatic lesions may be followed using the scanner. The signs alter with resorption of the haemorrhage and the regression of oedema, as well as with the secondary development of a focal atrophic process. The advantages of the scanner over oconventional neuroradiology are considerable, not only from a medical and technical standpoint, but also for ethical and medicolegal considerations.

Adolescent↗

PubMed1989

Subdural and epidural empyemas: MR imaging.

The MR images of six patients with extraaxial empyemas (five subdural and four epidural) were reviewed and compared with CT scans. MR demonstrated convexity and interhemispheric collections, which were mildly hyperintense relative to CSF and hypointense relative to white matter on short TR pulse sequences and hyperintense relative to CSF and white matter on long TR pulse sequences, allowing distinction from sterile effusions and most chronic hematomas. A hypointense rim, representing displaced dura, was depicted at the interface between the lesion and brain in epidural empyemas, a feature absent in subdural empyemas. Inflammation-induced parenchymal abnormalities, including edema, mass effect, and reversible cortical hyperintensity, were well depicted on MR imaging. MR was superior to CT in demonstrating the presence, nature, and extent of these lesions in all cases. Because early and accurate diagnosis will significantly improve the prognosis of these serious infections, MR is preferred to CT for patients in whom an acute intracranial infection is suspected.

Adolescent↗

PubMed1990

Pericerebral fluid collections and ultrasound.

The authors have studied 142 cases of pericerebral fluid collection, by ultrasound. Three echographic patterns are individualized: anechogenic single compartment (109); thin linear echogenic membrane dividing the pericerebral fluid collection (25); the third group (8) presented with a peripheric echogenic collection. The use of high frequency probes permits the detection of pericerebral effusions, and provides new information about the high incidence. Ultrasound can define the anatomical position and show the complications which are mainly acute subdural hematoma.

Acute Disease↗