Simultaneous cranioplasty and subduralperitoneal shunting. They are commonly seen in elderly people after minor trauma but can also be seen in children after an infection. The pathogenesis and clinical significance of traumatic subdural hygroma. Bilateral refractory subdural hygromas following intrathecal. Tsh was infrequent among the intracranial mass lesions following head injury. Descriptions in literature of evolving trau matic subdural hygroma have presented ct scan density modifications changing into chronic subdural hematoma. Hepatic arteriography in patients with hepatocellular carcinoma under balloon occlusion of a hepatic vein draining the tumorbearing liver parenchyma. Subdural hygroma consists of a cerebrospinal fluidlike subdural fluid collection with a low oncotic pressure in comparison with venous blood. Epidural anesthesia complicated by subdural hygromas and a. Subdural hygroma definition, symptoms, causes, treatment. Subdural fluid collections sfcs may be either a hygroma i. Traumatic subdural hygroma neurosurgery oxford academic.
In this instance no gas has passed over the convexity. Mayo 1 reported a typical case of subdural hydroma but classified the lesion as a cerebral cyst. Mr characteristics of subdural hematomas and hygromas at 1. Subdural effusion with hydrocephalus sdeh is a rare complication of traumatic brain injury, especially following decompressive craniectomy dc for posttraumatic cerebral infarction. Changes in mental status without focal signs of brain damage were noted in over 50% of the cases. Is typically an asymptomatic finding on ct studies, but in some cases may increase in size flapvalve mechanism or bleeding and cause mass effect similar to. Distinguishing between subdural hygroma and hematoma is difficult and may be artificial, because hygromas often progress to hematomas. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia. The hygroma exerted mass effect on the ipsilateral hemisphere and was noted to be under significant pressure at the time of surgical intervention in each case.
This can result from an acute tear in both the arachnoid and the dural border cell layer, resulting in communication of these two spaces. Subdural hematomas and hygromas are rare complications of spinal anesthesia. On imaging, spinal subdural fluid collection typically demonstrates outer convex and inner concave margins with fluid between the. One of the common causes of subdural hygroma is a sudden decrease in pressure as a. Lifethreatening physical abuse of infants and toddlers is frequently correlated with head injuries.
Road traffic crashes were the main cause of head injury. The patient had bilateral leads placed and the stimulator was scheduled to. Ct scans showed a large subdural hygroma on the right with midline shift to the left. Postoperative subdural hygroma and chronic subdural. Skull fractures were found in 39% of the cases, and subdural hygromas were associated with cerebral atrophy, cortical contusions, subdural hematomas, and. Normal pressure subdural hygroma with mass effect as a. The clot was evacuated and the bone flap was left out. A subdural hygroma is a collection of cerebrospinal fluid csf, without blood, located under the dural membrane.
A possible misconception among radiologists is that chronic subdural hemorrhage should show some degree of blooming on t2gradient recalledecho or susceptibilityweighted sequences such as swi and susceptibilityweighted angiography, which is not necessarily true. Possible sih with spinal subdural hygroma, what next. What symptoms a person has with a general hygroma depends on the cause. Shms usually resolve spontaneously but a number of these may become a hygroma, a type of external hydrocephalus and precursor of chronic subdural hematoma cshm 7. Management of subdural hygromas associated with arachnoid cysts. Mr characteristics of subdural hematomas and hygromas at.
Investigating the possibility and probability of perinatal. Csf contains prealbumin not present in subdural hematoma and may be under high pressure. A guide for patients and families 3 subacute subdural hematomas are ones found within 37 days of an injury. Association of antithrombotic drug use with subdural. Roentgendiagnosis of subdural hygroma in infants pdf. Traumatic subdural hygroma tshy is an accumulation of cerebrospinal fluid csf in the. Subdural hygromas refer to the accumulation of fluid in the subdural space. Subdural hygroma following endoscopic third ventriculostomy. Subdural hygroma development appears to be a rare occurrence.
Therefore, the current knowledge on subdural hygromas is. Nov 06, 2019 subdural hygroma development appears to be a rare occurrence. The cause of the complication is thought to be leakage of the cerebrospinal fluid. Ruptured intracranial arachnoid cysts in the subdural. In this study, the authors evaluated the clinical and radiological evolution of patients treated by a subduroperitoneal shunt for. Only a few case reports of subdural hygroma developed after known durotomy 4, 5 making this complication uncommon. The demographics will depend on the underlying cause which. It is usually asymptomatic but may alter consciousness. Management is still a matter of controversy conservative vssurgical especially when consciousness is a concern. Arachnoid cyst rupture producing subdural hygroma and. A subdural hygroma radiographically appears as a crescentic nearcsf densitysignal accumulation in the subdural space that does not extend into the sulci and rarely exerts significant masseffect 5. This file is licensed under the creative commons attributionshare alike 3.
Are subdural hygromas the result of abusive head trauma. Mr imaging, with its unique ability to delineate the various phases of hemorrhage, is well suited to the evaluation of subdural hemorrhage. During two and a half years since the introduction of a ct scanner in february, 1977, 38 patients with traumatic subdural hygroma sd hygroma and 42 patients with chronic subdural hematoma chronic sdh were experienced. A case of dementia with kluverbucy symptoms secondary to subdural hygroma is described and implications of kluverbucy symptoms in dementia are discussed. The authors report a series of 80 cases of traumatic subdural hygroma and discuss the clinical and radiological features, management, surgical results, and pathogenesis. Differentiating external hydrocephalus from simple subdural hygroma may be difficult, but the former appears to be a distinct clinical entity separate from the latter. Clinical symptoms and ct findings in sd hygromas were studied. In one, a coexisting quadrigeminal cyst ruptured, producing a subdural hygroma ipsilateral to the mfac and dilating the basal cisterns. Massive intracerebral hemorrhage following drainage of subdural. Subdural hygroma may also develop in infants after infection where it may be misdiagnosed as subdural empyema 6. Dementia is not an uncommon presentation in psychiatric practice. Widening of subdural space filled with a csf density collection.
Five male patients ranging in age from 6 to 25 years sustained the rupture of arachnoid cysts, which produced acute subdural hygromas. Simple evacuation of the hygroma and cranioplasty was done. The total number of charts included cases from all adult clinical services as well as from the pathology department. Although its pathogenic mechanism is uncertain, it develops by the. Subdural hygromas generally occur along the supratentorial cerebral convexities. The fate of traumatic subdural hygroma in serial computed tomographic scans. Pdf surgical treatment of chronic subdural hygromas in. We present 5 cases of chronic subdural hemorrhages in infants, demonstrating intensity near or greater than that of. Trauma may be absent or very minor and does not explain the progressive, chronic course of the condition. Subdural hygroma definition of subdural hygroma by medical. This procedure carries the risk of developing traumatic subdural hygroma tsh that can adversely affect the neurological status of the patient.
Drainage and cranioplasty as a treatment for traumatic. You may do so in any reasonable manner, but not in. Limitations of t2gradient recalledecho and susceptibility. Postpartum subdural hygroma after epidural analgesia. Enhanced density and heterogeneous appearance 53rd day signs of subdural bleeding into hygroma space. A 45yearold man developed traumatic cerebral infarction after traumatic brain injury and underwent dc because of the. Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter. Of the various causes of reversible dementia, subdural hygroma is a lesserknown potentially reversible cause. A subdural hygroma is a subdural body of cerebrospinal fluid csf, without blood. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural. In many cases, it is considered an epiphenomenon of head injury when it is called a traumatic subdural hygroma. Traumatic subdural hygroma neurosurgery oxford academic dois.
In the cranium it is also commonly referred to as extraaxial space space outside the brain tissue among many other terms listed in table 1 below. The surgical management and diagnostic methods used are assessed. Spinal subdural hygroma as a postoperative complication in. An acute subdural hygroma results from the acute accumulation of csf within the dural border cell layer. Roentgendiagnosis of subdural hygroma in infants 63. Management of hydrocephalus and subdural hygromas in. Roentgendiagnosis of subdural hygroma in infants pdf document. After showing initial improvement, 10 weeks after the initial surgery the patient progressively worsened and became unresponsive. Subdural hygromas are encountered in all agegroups but are overall most common in the elderly 7. Spinal subdural hygroma as a postoperative complication. In addition, indepth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Lumbar puncture is a procedure used commonly for intrathecal chemotherapy for patients with bcell acute lymphocytic leukemia ball though subdural hygroma is a very rare complication.
Diagnostic method for differentiating external hydrocephalus. Subdural hygromas are characterized by a subdural collection of cerebrospinal fluid csf. In 1942 scott reported 3 cases of prolonged stupor associated with subdural hygromas and in the following year he described a case of acute subdural hygroma. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. Subdural hygroma sdg is an important complication after intrathecal injections of medications. Special attention was paid to frequency of occurrence, angiographic features, and the relationship between subdural fluid appearance and clinical course, since these have been seldom reported previously. Csf accumulation communicating freely with the subarachnoid spacesas 8, or an effusion. The different mechanisms have been proposed to explain the pathogenesis of sdg, include an arachnoid flap, bloodbrain barrier bbb failure, arachnoid rupture, and brain atrophy 2. Subdural hygroma definition of subdural hygroma by.
Subdural hygromas sdg are different from acute and chronic subdural hematomas in clinical features and pathogenic mechanism. Pdf subdural hygroma presenting as dementia with kluver. Dear sir, my fathers mri report gives the following impression the non contrast mri findings of brain are suggestive of small old lacunar infractions at right basal ganglia and adjoining paraventricular white matter with features of mild diffuse celebral atrophy. A subdural hygroma is an accumulation of cerebrospinal fluid in the subdural space that may occur secondary to trauma and surgery, or for iatrogenic reasons, such as a lumbar puncture. Mar 23, 2015 contralateral subdural hygroma caused by decompressive craniectomy tends to combine with external cerebral herniation, causing neurological deficits. The diagnosis and treatment are still difficult and controversial for neurosurgeons. In this report, the authors present a diagnostic method for differentiating external hydrocephalus from simple subdural hygroma, based on their clinical experience in treating.
Chronic subdural haematoma csdh is an encapsulated collection of blood and fluid on the surface of the brain. Upper cervical subdural hygroma contiguous with posterior fossa subdural hygroma also noted. Nine patients who underwent onestage, simultaneous cranioplasty and contralateral subdural peritoneal shunting were included in this study. A subdural hygroma is the accumulation of clear or xanthochromic csf within the subdural space.
The formation of cranial subdural hematomas after lumbar puncture is a wellknown complication of spinal anesthesia, although rare in young patients. The latter does not communicate freely with the sas and is encapsulated by a neomembrane bearing capillaries. The space that forms around the brain and the fluid within the hygroma space is distinct from the subdural fluid. Because they differ by their location in relationship to the meningeal membranes and. Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of chiari malformation type i. A common variant of the abusive head trauma is the shaken baby syndrome. Sdg develops because of a cerebrospinal fluid leak into subdural space. Spontaneous resolution of idiopathic lumbar subdural. Ct and mr imaging represent important tools for the diagnosis of abusive head trauma in living infants. The ct scans taken 69 weeks postoperatively were used to measure the volume of. Differentiating subdural effusion from hygroma on mri. Higromxs has been proposed that subdural hygromas, at least sometimes, represent prominent subdural effusions in which there is a separation of the dural border cell layer with an accumulation of fluid 7. Cerebrovascular accident or subdural fluid collection. Hygroma is a generic term for any abnormal fluid filled space.
Other causes of subdural hygroma include, spontaneous subdural hygroma that may occur due to rupture of arachnoid cyst, and postoperative that develops after decompressive craniectomy, cranioplasty or shunt installation 4 8. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. Surgical treatment of chronic subdural hygromas in infants and children. Question are changes in subdural hematoma incidence related to antithrombotic drug use findings in this observational study with 10 010 subdural hematoma cases and 400 380 controls, subdural hematoma risk was significantly associated with antithrombotic drug use, in particular use of a vitamin k antagonist adjusted odds ratio, 3. Subdural hygroma published on jul 1945 by journal of neurosurgery publishing group. Subdural hygroma sdhy is a collection of cerebrospinal fluid csf under the dural membrane. Abnormalities in csf absorption are common and typically manifest as subdural hygromas or effusions78 as well as. Subdural hygroma shy is an accumulation of a csflike fluid in the subdural space. Subdural hygroma in head trauma patients admitted to a hospital. A total of 248 patients who underwent etv between 2014 and 2016 were included in this study. Subdural hygromas are subdural fluid collections of clear xanthochromic or bloodtinged fluid. If the inline pdf is not rendering correctly, you can download the pdf file here.
Arachnoid tears and arachnoid dura separations which commonly occur near sylvian fissure appears to be the possible mechanism which results in csf escape into subdural space. Subdural hematoma sdh a guide for patients and families. To assess the different treatment modalities of sdhy regarding the patients characteristics and clinical. A subdural hygroma, which is the accumulation of csf in the subdural space, was identified based on a ct finding of a density similar to that of csf in the unilateral or bilateral frontoparietal region. Chronic subdural hematomas may take weeks to months to appear. Thirty patients with subdural hygroma were included in this study, 24 were men 80% and 6 were wo men 20%, their ages ranged from one month to 78 ye ars old mean age 25. Historically considered a result of head trauma, recent evidence suggests there are more complex processes involved. Aha coding clinic for icd10cmpcs, second quarter 2018, page 4. Acute csf subdural hygromas had signal intensities identical to csf without mr evidence of blood products. The treatment for persistence of tsh includes drainage and shunt placement or drainage and membranectomy. Among neurotraumatologists it is generally known that sdhys usually derive from head injuries and represent rare posttraumatic complications that may coexist with epidural or subdural hematomas. Spinal subdural hygroma has previously been associated with intracranial hypotension or as a complication of spinal procedures. Reported in approximately 10% of head injuries, provided it is moderate to.
Spinal hematomas are a frequent indication for radiologic evaluation and can be a diagnostic dilemma for many radiologists and surgeons. Rupture of arachnoid cysts ac in the subdural space after trauma may cause a subacutechronic subdural hematoma or a hygroma. Lack of gas passage to the convexity may occur in normal cases a. When a subdural hygroma is seen in infants and children it is often after they have had an infection but it could also be from a minor head injury from falling, hitting their head, or even child abuse. Tshy are early lesions and can be detected in the first 24 hours after trauma, usually as small subdural effusion sseff.
In this study, we investigated the clinical characteristics of subdural hygroma in patients with traumatic brain injury. This case report describes a postoperative complication of cauda equine syndrome with a subdural hygroma that developed cephalad to the site of the spine fusion. Most subdural hygromas are believed to be derived from chronic subdural hematomas. Understanding subdural collections in pediatric abusive head. Two of the five cases are unique in the literature. Decompressive craniectomy dc is performed to accommodate lifethreatening brain swelling when medical treatment fails. Treatment of this complication still remains controversial, and no consensual strategy is to date clearly proposed. Definition and pathophysiology of subdural hygroma. Bilateral subdural hygroma also noted at the celebral frontal and fronto parietal regions. Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause lifethreatening subdural hematomas or cerebellar tonsillar herniation. Subdural hygroma presenting as dementia with kluverbucy symptoms article pdf available in indian journal of psychiatry 414. Only cases proved at operation or on autopsy to have subdural fluid collections were considered.
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