Two common causes of infant macrocephaly are bess benign expansion of subarachnoid spaces and subdural hygroma. Management of chronic subdural haematoma c the puneet plaha. Arachnoid cyst of the brain is common in children but its association with spontaneous subdural hygroma is rare. Subdural hygroma shy is an accumulation of a csflike fluid in the subdural space. Mar 23, 2020 a chronic subdural hematoma is an old collection of blood and blood breakdown products between the surface of the brain and its outermost covering the dura. An acute subdural hygroma results from the acute accumulation of csf within the dural border cell layer. Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause lifethreatening subdural hematomas or cerebellar tonsillar herniation. Pdf subdural hygroma presenting as dementia with kluver. Epidural anesthesia complicated by subdural hygromas and a. All structured data from the file and property namespaces is available under the creative commons cc0 license.
The patient had bilateral leads placed and the stimulator was scheduled to be placed later in b6 2015. Manuel delgado garcia doctor in medicine and surgery ph. Csf contains prealbumin not present in subdural hematoma and may be under high pressure. Often, small hygromas which do not produce pressure symptoms are left untouched.
Mr imaging, with its unique ability to delineate the various phases of hemorrhage, is well suited to the evaluation of subdural. In this report, the authors present a diagnostic method for differentiating external hydrocephalus from simple subdural hygroma, based on their clinical experience in treating subdural fluid collection after mild head trauma. Subdural posttraumatic collections are called usually traumatic subdural hygroma tsh. Here you can read posts from all over the web from people who wrote about cerebral atrophy and subdural hygroma, and check the relations between cerebral atrophy and subdural hygroma. But the terms, subdural hematoma, hygroma, hydroma, effusion and fluid collection have been sometimes confusingly used to indicate the same or different conditions of an abnormal collection of fluid in the subdural space. However, as in other forms of epilepsy, investigations directed at the possi bility of uncovering organic. Pediatric neurology, 1 medical center blvd, winston. Subdural hematoma and hygroma as complications of spinal anesthesia are probably due to a decreased volume of csf. It is not possible to distinguish a subdural hygroma from a chronic sdh with ct because the two lesions may be identical in appearance. Enhanced density and heterogeneous appearance 53rd day signs of subdural bleeding into hygroma space. Up to 40 percent of sdhs among the elderly were misdiagnosed at the time of hospital admission, often as dementia.
Acute csf subdural hygromas had signal intensities identical to csf without mr evidence of blood products. What symptoms a person has with a general hygroma depends on the cause. Mr characteristics of subdural hematomas and hygromas at. Treatment options for craniosynostosis will be reserved for a later issue of neuro update. Complications infection bleeding airway compromise due to compression. A subdural hygroma, however, can be indistinguishable from a chronic subdural hematoma on imaging. Traumatic subdural hygroma sdg is an accumulation of cerebrospinal fluid csf in the subdural space that develops in 46% of patients with. Ct and mr imaging represent important tools for the diagnosis of abusive head trauma in living infants. The bleeding occurs within the layers of tissue that surround the brain. Full text is available as a scanned copy of the original print version. Management of hydrocephalus and subdural hygromas in pediatric. In many cases, it is considered an epiphenomenon of head. Subdural hygroma subdural hygromas refer to the accumulation of fluid in the subdural space. A case of a nineyearold boy, without any preceding history of trauma, is presented here who came to the emergency department of a tertiary care hospital with complaints of headache, nausea, and vomiting for the last two weeks but more for the last two days.
Higromas cerebrales pdf although the formation of traumatic subdural higroma is not fully understood, it has beeen reported. Foxit software is the reliable source for fast, affordable, and secure pdf solutions. They are commonly seen in elderly people after minor trauma but can also be seen in children after an infection. Clinical symptoms and ct findings in sd hygromas were studied. Petah tikva, israel epileptic seizures induced by flickering light, occurring either in natural circum stances or in the laboratory, are wellrecog nized. Acute traumatic subdural hygroma james peter murphy. It 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 cistioc fluid cisgico. Subdural hygroma associated with photogenic epilepsy h. Surgical treatment of chronic subdural hygromas in infants and children article pdf available in acta neurochirurgica 1446. This study reports a series of south american adult patients with traumatic subdural hygroma, with emphasis on the evolution of clinical and ct scan data. Congestion of bridging veins, in combination with traction by downward brain displacement, may cause tearing of the veins in the subdural space. Subdural hygromas are subdural fluid collections of clear xanthochromic or bloodtinged fluid.
Apr 17, 2012 pathophysiology unlike in epidural hematomas, sdh usually results from the tears in veins. Pdf surgical treatment of chronic subdural hygromas in. 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. These collections have also been called traumatic subdural effusion tse or external hydrocephalous ehp according to liquid composition, or image features. Chronic subdural hematoma csdh is an old collection of blood and blood breakdown product in the subdural space. Additionally, the mfhi reflects the nature of the subdural collection more accurately than. Are subdural hygromas the result of abusive head trauma.
Subdural hygroma associated with photogenic epilepsy. Subdural hygromas generally occur along the supratentorial cerebral convexities. But the terms, subdural hematoma, hygroma, hydroma, effusion and fluid collection have. This file contains additional information such as exif metadata which may have been added by the digital camera, scanner, or software program used to create or digitize it. Symptomatic subdural hygroma and temporal lobe edema after. Management of hydrocephalus and subdural hygromas in pediatric patients after decompression of chiari malformation type i. Traumatic subdural hygroma from the greek hygros, meaning wet. Although subdural hygromas have a fairly dramatic appearance on neuroimaging studies, unless they are very large and seem to be symptomatic, most will resolve spontaneously. Address all correspondence to scott rosenthal, wake forest university school of medicine.
Skull fractures were found in 39% of the cases, and subdural hygromas were associated with cerebral atrophy, cortical contusions, subdural hematomas, and. Subdural hematomas and hygromas are rare complications of spinal anesthesia. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural. The csf hypovolemia is probably due to a dural leak after dural puncture. Tsh is an accumulation of cerebrospinal fluid csf in the subdural space after head injury. On day 2 of hospitalization, the infant underwent a left sided subdural tap.
Its appearance can be due to several fisiopathoissn 22152741. A subdural hygroma, by contrast, is a csf collection in the subdural space caused by an arachnoid tear. Subdural hemorrhage definition of subdural hemorrhage by. Most reports do not distinguish between a tsh and a subdural effusion because protein content in the fluid is gener. Other differential diagnoses for pseudosubarachnoid hemorrhage findings in cts scan include diffuse cerebral edema, purulent meningitis, large parenchymal infarction with associated edema, mass effect from a subdural hemorrhage, contrast extravasation, status epilepticus, spontaneous intracranial hypotension, and after myelography 7. This procedure carries the risk of developing traumatic subdural hygroma tsh that can adversely affect the neurological status of the patient. If the file has been modified from its original state, some details such as the timestamp may not fully reflect those of the original file. Subdural hygroma is a collection of cerebrospinal fluid in the subdural space after head injury. A subdural hygroma is a hypodense extracerebral collection equal in density to csf fig.
As is well documented in the literature, the management of arachnoid cysts is varied and controversial. A subdural hygroma is a collection of cerebrospinal fluid csf, without blood, located under the dural membrane. The further expansion of the hygroma with conversion to a csdh is attributed to repeated minor haemorrhages into the subdural collection from. Permission is granted to copy, distribute andor modify this document under the terms of the gnu free documentation license, version 1. Several milliliters of bloody spinal fluid was removed. Infant with subdural hygroma and expanded subarachnoid.
Subdural hygroma sd hy is mostly asympto matic and has a regr essive course, but sometimes, it may cause mas s effect and become a life threatening condition. 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. 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. Decompressive craniectomy dc is performed to accommodate lifethreatening brain swelling when medical treatment fails. Csdhs were found at the site of sdhys with no history of further head injury at a mean interval of 56 days. Subdural hygroma presenting as dementia with kluverbucy symptoms article pdf available in indian journal of psychiatry 414. The chronic phase of a subdural hematoma begins several weeks after the first bleeding. Different treatment modalities and clinical outcome find, read and cite all the research you need on researchgate. A subdural hygroma will have no evidence of hemorrhage and no enhancing membranes. Treatments for subdural hygroma answers on healthtap. Files are available under licenses specified on their description page.
Apr 25, 2014 chronic subudural hygroma descompressive in patient with peritoneal shunt ventricle valve dr. Is typically an asymptomatic finding on ct studies, but in. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. Drainage and cranioplasty as a treatment for traumatic. This is called meningitis serosa traumatica, traumatic arachnoiditis, posttraumatic subdural cyst, circumscribed hydrocephalus or subdural hydroma. 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. Traumatic subdural hemorrhage with loss of consciousness of any duration with death due to other cause before regaining consciousness, initial encounter. Csf accumulation communicating freely with the subarachnoid spacesas 8, or an effusion. Thirteen of 145 patients with posttraumatic subdural hygroma sdhy developed chronic subdural haematoma csdh at the involved site over a period of 6 years.
Postpartum subdural hygroma after epidural analgesia. Although there are medications that decrease spinal fluid production, they do not do enough to treat true hydrocephalus. Pdf the pathogenesis and clinical significance of traumatic. Twenty patients with subdural fluid collection after mild head trauma were included in this study. Therefore, the current knowledge on subdural hygromas is. The main time for formation of hygroma was 18 days post traumatic. Subdural hygroma definition of subdural hygroma by medical. Surgical treatment of chronic subdural hygromas in infants and children. Some develop into a chronic subdural hematoma or subdural subdural hygroma pdf subdural hygromas refer to the accumulation of fluid in the subdural space. The role of surgical treatment in traumatic subdural. 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.
It may be a small opd procedure or an inpatient admission may be needed. 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. Analysis of risk factor for the development of chronic subdural. It is a common epiphenomenon after traumatic brain injury tbi however it may also occur. Subdural hygroma formation secondary to a traumatic tear of the cortical arachnoid membrane allowing egress of csf into the subdural space.
A subdural hygroma is a collection of cerebrospinal fluid csf, without blood, located under. Dec, 2011 a post trauma pt, 1st is on admission ct. A guide for patients and families 4 chronic subdural hematomas are sometimes hard to diagnose because their symptoms can resemble so many different conditions. Road traffic crashes were the main cause of head injury. Links to pubmed are also available for selected references. What links here related changes upload file special pages permanent link page. There are many surgical options, such as a shunt or a third ventriculostomy, but surgery is required for active hydrocephalus. A subdural hygroma is a collection of cerebrospinal fluid csfwithout blood, located under the dural membrane. Subdural hematoma sdh a guide for patients and families. On neuroimaging, sdhy was found to be frontoparietal in location in 60% of patients, frontal in 23. Posttraumatic subdural hygroma is common, but its natural history is not well defined because there are few reports of clinical and computed tomography scan ct evolution data. The treatment for persistence of tsh includes drainage and shunt placement or.
The technique of drainage depends on the location and size of the hygromas. Thirtyfour consecutive adult patients with subdural traumatic hygroma were. Spontaneous evolution of posttraumatic subdural hygroma. Subdural hematoma an overview sciencedirect topics. Neuroradiological findings in non accidental trauma. Subdural fluid collections sfcs may be either a hygroma i. In addition, indepth understanding of the pathogenesis of subdural hygromas is increasingly required by neuroradiologists, pediatricians, and forensic physicians. Head circumference hc was 33 cm with molding and bruising. Subdural hygroma may also develop in infants after infection where it may be misdiagnosed as subdural empyema 6. Subdural hygroma is the collection of cerebrospinal fluid in the subdural space. Most subdural hygromas are believed to be derived from chronic subdural hematomas. It collects under the brains tough outer wrapper known as the dura. It can result from prior acute subdural hematoma or from subdural hygroma with bleeding from micro capillaries. Traumatic subdural hygroma neurosurgery oxford academic.
Surgical treatment of subdural hygromas in infants and children. Five cases with changed density and spontaneous resolution. One of the complications which follow injury of the head is the accumulation of cerebrospinal fluid between the dura and the arachnoid. A subdural hygroma is the accumulation of clear or xanthochromic csf within the subdural space. In the majority of cases, if there has not been any acute trauma or severe neurologic symptoms, a small subdural hygroma on the head ct scan will be an incidental finding. The patients were 20 years old patient 129 years old patient 2 and 34 years old patient 3with mean age of 27 years, and underwent mri one week after us with, respectively 24, 35 and 33 gestational weeks mean in two cases of the present study, the lesions were hypointense on t1weighted sequences, and hyperintense on t2weighted sequences, with thin. The patient underwent burr hole evacuation of the collection and placement of a subdural drain, after which the edema in the temporal lobe and hygroma resolved. Differentiating subdural effusion from hygroma on mri.
This can result from an acute tear in both the arachnoid and the dural border cell layer, resulting in communication of these two spaces. Tshy are early lesions and can be detected in the first 24 hours after trauma, usually as small subdural effusion sseff. Late subdural hygromas from birth trauma neurology. Subdural hygroma definition, symptoms, causes, treatment. These collections have also been called traumatic subdural effusion. Despite its common occurrence, the pathogenesis and clinical significance are uncertain. Spontaneous arachnoid cyst rupture with subdural hygroma in a. A healthy term male baby was born vaginally after an uncomplicated pregnancy and very strong labor. Spontaneous evolution of posttraumatic subdural hygroma into. Get a printable copy pdf file of the complete article 1023k, or click on a page image below to browse page by page.
Hsd can develop sometimes after descompressive craniectomy and can be ipsilateral or contralateral. The term, subdural hydroma was first proposed by dandy 1940. Normal pressure subdural hygroma with mass effect as a. Monitoring subdural pressure may be a valuable tool for differentiating subdural hygroma from external hydrocephalus in patients with mild head trauma.
Diagnostic method for differentiating external hydrocephalus. Subdural hygromas have more than one cause, but the most common reason is traumatic. 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. Subdural hygroma was diagnosed by using ct scans in which a crescent shape hypodense area was detected. Answers from trusted physicians on treatments for subdural hygroma. A computed tomographic ct scan showed a large rightsided subdural hygroma and right temporal lobe edema. The decision to drain the subdural hygroma has to be taken by the neurosurgeon. Excess fluid in the subdural space may be clear, blood tinged, or xanthochromic and under variable pressure. Pdf subdural hygroma sdg is a common posttraumatic lesion. Traumatic subdural hygroma tsh is an accumulation of cerebrospinal fluid csf in the. Some authors have reported traumatic subdural hygroma presenting density modifications in the ct scan with change to chronic subdural hematoma 4,7,9,10,12,1518. It appeared that these patients did not have any distinguishing clinical features early on. A subdural collection of cerebrospinal fluid is usually referred to as a traumatic subdural hygroma tsh, which is also referred to as a traumatic subdural effusion tse or external hydrocephalus ehp 2022.
At that time, we suggested that it might be helpful to use a subarachnoid bolt for treatment to monitor intracranial pressure as the fluid was released. Crescentshaped extra axial collection with csf density on ct or signal intensity on mri. To determine if the position of the superficial cerebral cortical veins can be used to distinguish subdural hygroma from atrophy on mr brain scans. Postpartum subdural hygroma after epidural analgesia you will receive an email whenever this article is corrected, updated, or cited in the literature.
1117 804 1154 1322 1467 37 153 277 928 674 761 120 482 1048 499 1216 953 1447 1113 1449 661 665 822 550 1033 626 663 1436 998 810 1019 1280 634 1198 1180 49 1450